BACKGROUND: The FAVOR (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease) III China trial demonstrated that percutaneous coronary intervention (PCI) lesion selection using quantitative flow ratio (QFR) measurement, a novel angiography-based approach for estimating fractional flow reserve, improved two-year clinical outcomes compared with standard angiography guidance. This study aimed to assess the cost-effectiveness of QFR-guided PCI from the perspective of the current Chinese healthcare system. METHODS: This study is a pre-specified analysis of the FAVOR III China trial, which included 3825 patients randomized between December 25, 2018, and January 19, 2020, from 26 centers in China. Patients with stable or unstable angina pectoris or those ≥72 hours post-myocardial infarction who had at least one lesion with a diameter stenosis between 50% and 90% in a coronary artery with a ≥2.5 mm reference vessel diameter by visual assessment were randomized to a QFR-guided strategy or an angiography-guided strategy with 1:1 ratio. During the two-year follow-up, data were collected on clinical outcomes, quality-adjusted life-years (QALYs), estimated costs of index procedure hospitalization, outpatient cardiovascular medication use, and rehospitalization due to major adverse cardiac and cerebrovascular events (MACCE). The primary analysis calculated the incremental cost-effectiveness ratio (ICER) as the cost per MACCE avoided. An ICER of ¥10,000/MACCE event avoided was considered economically attractive in China. RESULTS: At two years, the QFR-guided group demonstrated a reduced rate of MACCE compared to the angiography-guided group (10.8% vs . 14.7%, P <0.01). Total two-year costs were similar between the groups (¥50,803 ± 21,121 vs . ¥50,685 ± 23,495, P = 0.87). The ICER for the QFR-guided strategy was ¥3055 per MACCE avoided, and the probability of QFR being economically attractive was 64% at a willingness-to-pay threshold of ¥10,000/MACCE avoided. Sensitivity analysis showed that QFR-guided PCI would become cost-saving if the cost of QFR were below ¥3682 (current cost: ¥3800). Cost-utility analysis yielded an ICER of ¥56,163 per QALY gained, with a 53% probability of being cost-effective at a willingness-to-pay threshold of ¥85,000 per QALY gained. CONCLUSION: In patients undergoing PCI, a QFR-guided strategy appears economically attractive compared to angiographic guidance from the perspective of the Chinese healthcare system. TRIAL REGISTRATION ClinicalTrials.gov , NCT03656848.
Humans ; Cost-Benefit Analysis ; Percutaneous Coronary Intervention/methods* ; Male ; Female ; Coronary Angiography/methods* ; Middle Aged ; Aged ; Coronary Artery Disease/surgery* ; Quality-Adjusted Life Years ; Fractional Flow Reserve, Myocardial/physiology*

Objective To establish a quality evaluation method for Shengmai injection with antioxidant and anti-inflammatory effects as indicators. Methods Using water-soluble vitamin E (Trolox) and N-nitro-L-arginine methyl ester (L-NAME) as control drugs, using trinitrophenyl-hydrazine (DPPH) method and nitric oxide (NO) detection kit, the anti-oxidation effect and the inhibition ability of lipopolysaccharide (LPS)-induced NO release from mononuclear macrophage RAW264.7 were measured. The sample was converted into the corresponding concentration of the control drug to control and evaluate its methodological and biological effects. Results Each batch of samples had good anti-inflammatory and anti-oxidation effects with high precision and good repeatability. There was no significant difference in the anti-inflammation capacity among batches of. Samples 2 and 8 were significant differences from other samples in anti-inflammatory ability. Conclusion The established method can accurately evaluate the anti-oxidant and anti- inflammatory effects of Shengmai injection.

Objective: To evaluate the clinical and radiological outcomes,and the complications of staged minimally invasive surgery for adult degenerative scoliosis, comparing with that of the conventional open surgery. Methods: From Jun 2013 to Jun 2017, a total of 42 cases of degenerative scoliosis underwent surgical treatment. Among which, 23 cases underwent staged minimally invasive surgery(MIS group) and 19 cases underwent posterior open surgery(open group). The intra-operative bleeding, and operation time were recorded.The clinical outcomes were assessed using the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) for low back pain and leg pain.The radiological outcome was evaluated with Cobb angles and sagittal balance parameters (Sagittal Vertical Axis (SVA), Pelvic Incidence (PI)-Lumbar Lordosis (LL), Pelvic Tilt (PT)). The occurrence of complications was recorded. Results: The baseline demographic features of both groups (gender, age, medical comorbidity, etc.) were similar.The mean follow-up period for both groups was more than 2 years.The intraoperative bleeding in the MIS group 405.7±144.8 ml was significantly lower than that in the open group (2 005.3±728.4 ml, t=10.31, P<0.001); The total operation time 414.3±63.0 min of MIS group was significantly longer than that of the open group (304.2±51.8 min, t=6.10, P<0.001), but the operating time of each stage was shorter than the open group. The VAS score for back pain and leg pain,the ODI scores were significantly improved after surgery for both group, there was no significant difference between the two groups, but the low back pain and function in MIS group were better than the open group. The parameters of the coronal and sagittal deformity were significantly improved in both groups, correction of coronal deformity in MIS groupwassignificantly superior to the open group (F=12.02, P=0.001), there was no significant difference in sagittal balance correction between the two groups. The overall complication rate (63.2%) was slightly higher in the open group than in the MIS group (34.8%) without significant difference(χ²=3.36, P=0.07). The incidence of major complications in the open group was significantly higher than that in the MIS group (P=0.014). Conclusion Staged minimally invasive surgery can significantly relieve the patient's pain, improve functionand the coronal and sagittal balance of the patient, the early clinical and radiological outcomes were comparable to the open surgery; Minimally invasive surgery may significantly reduce the amount of bleeding and major complications. Minimally invasive surgery is safe and effective for carefully selected patients with degenerative scoliosis.However, the long-term outcomes of minimally invasive surgery remains to be followed up.

Objective To investigate the analgesic and anti-inflammatory effects of Shui ethnic medicine Maguangwa .Methods Acetic acid-provoked writhing and hot plate provocation of pain were adopted to observe the analgesic effect of Shui ethnic medicine Maguangwa ,and xylene-induced ear swelling was used to observe the anti-inflammatory effect of Shui ethnic medicine Maguangwa There were five experimental groups ,i .e .,the blank control group ,the aspirin group(positive control) ,the 0 .84 g/kg Shui ethnic medicine Maguangwa group(group Ⅰ) ,the 0 .42 g/kg Shui ethnic medicine Maguangwa group(group Ⅱ ) ,and the 0 .21 g/kg Shui ethnic medicine Maguangwa group(group Ⅲ) .Results The writhing latency increased significantly and the writhing frequency de-creased significantly in the positive control group ,group Ⅰ and group Ⅱ ,when compared with the blank control group(P<0 .05) . The writhing latency and frequency differed insignificantly between group Ⅲ and the blank control group(P>0 .05) .Before medica-tion the pain threshold of mice in each group differed insignificantly (P>0 .05) .At 30 min ,60 min ,90 min and 120 min after medi-cation ,the pain threshold increased significantly in the positive control group ,group Ⅰ ,and group Ⅱ ,when compared to the blank control group(P<0 .05) .Meanwhile ,the pain threshold differed insignificantly between group Ⅰ and the positive control group(P>0 .05) ,or between group Ⅲ and the blank control group(P>0 .05) .When compared with the blank control group ,the right ear mass and degree of swelling decreased significantly in the positive control group ,group I and group Ⅱ (P<0 .05) .However ,the right ear mass and degree of swelling differed insignificantly between group Ⅰ and the positive control group(P>0 .05) ,or between group Ⅲ and the blank control group(P>0 .05) .Conclusion Shui ethnic medicine Maguangwa exhibits potent analgesic and anti-inflammatory effects in a dose-dependent manner .

ObjectiveTo investigate the value of ultrasound in diagnosis and differential diagnosis of uterine arteriovenous fistula (UAF).MethodsUltrasound results of 12 patients with UAF were analyzed retrospectively,and were compared with uterine artery angiography.ResultsUAF showed uneven echo signals of uterine muscle wall near endometrium or cesarean section incision and irregular echo-free zone on ultrasonographies,the typical case of which displayed “honeycomblike” change.Color Doppler ultrasound showed rich blood flow in local area and lake-like or multicolored mosaic change.Spectral Doppler waveform shape was characterized as high-speed low resistance.The ultrasonographic results of UAF were consistent with those of uterine artery angiography.ConclusionUltrasonography combined with uterine artery angiography contributes to the diagnosis of UAF.

It was well known that the damage of skeletal muscle occurred and exercise performance declined after one prolonged eccentric exercise.But there were few studies on the adaptation to the continuous eccentric exercise in skeletal muscle.The purpose of this study was to investigate the effects of downhill running once(group B) and for one week(group C ) on α-actin gene expression of rat gastrocnemius muscle.Serum CK and LDH were determined, too.The results showed that the training had obvious effects on α-actin gene expression of rat gastrocnemius muscle in group B and C.In group B, serum CK and LDH recovered obviously 7 days after training, but not to the normal value.In group C, it recovered to the normal.These results suggest that the recovery of the damage after first training had been accelerated by the continuous eccentric exercise, the subjects gradually adapted to exercise.

group C,CORT value in group I was significant higher than in the other two.In group I+S,the CORT and ACTH concentrations were lower than that in group I,but higher than that in group C and C+S.Conclusion Chronic psychological stress could induce stress-related hormone excretion and action alteration.Exercise to some degree could mitigate the psychological stress reactions.