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 summarize the surgical strategy of reoperative aortic root replacement after prior aortic valve replacement (AVR), and analyze the early and mid-term outcomes. Methods    From April 2013 to January 2020, 75 patients with prior AVR underwent reoperative aortic root replacement in Fuwai Hospital. There were 54 males and 21 females with a mean age of 56.4±12.7 years. An emergent operation was performed in 14 patients and an elective operation in 61 patients. The indications were aortic root aneurysm in 38 patients, aortic dissection involving aortic root in 30 patients, root false aneurysm in 2 patients, prosthesis valve endocarditis with root abscess in 2 patients, and Behçet's disease with root destruction in 3 patients. The survival and freedom from aortic events during the follow-up were evaluated with the Kaplan-Meier survival curve and the log-rank test. Results    The operative procedures included prosthesis-sparing root replacement in 45 patients, Bentall procedure in 26 patients, and Cabrol procedure in 4 patients. Operative mortality was 1.3% (1/75). A composite of adverse events occurred in 5 patients, including operative death (n=1), stroke (n=1), and acute renal injury necessitating hemodialysis (n=3). The follow-up was available for all 74 survivors, with the mean follow-up time of 0.5-92.0 (30.3±25.0) months. Four late deaths occurred during the follow-up. The survival rate at 1 year, 3 years and 6 years was 97.2%, 91.4% and 84.4%, respectively. Aortic events developed in 2 patients. The rate of freedom from aortic events at 1 year, 3 years, and 6 years was 98.7%, 95.0% and 87.7%, respectively. There was no difference in rate of survival or freedom from aortic events between the elective patients and the emergent patients. Conclusion    Reoperative aortic root replacement after prior AVR can be performed to treat the root pathologies after AVR, with acceptable early and mid-term outcomes.

Objective:To compare the expression levels of candidate genes before and after Shuganjieyu capsule treatment, to analyze their correlation with depression symptoms and cognitive function, and to find and clarify the biomarkers related to the efficacy of Shuganjieyu capsule.Methods:Among 27 patients with mild to moderate depression (MMD), 24 items Hamilton depression rating scale (HAMD-24) was used to assess the severity of depression, Chinese revised Wechsler adult intelligence scale(WAIS-RC) and Chinese revised Wechsler memory scale(WMS) were used to assess cognitive function, and qRT-PCR was used to detect the expression levels of candidate genes in peripheral blood of patients with depression before and after treatment with Shuganjieyu capsule.SPSS 25.0 software was used for statistical analysis, paired t-test, non-parametric test, Spearman correlation analysis and receiver operating characteristic curve were used for data statistics. Results:The symptoms of MMD patients were relieved after Shuganjieyu capsule treatment(HAMD scores: baseline 14.00(9.75, 18.25), 8-week 4.00(2.00, 7.25), Z=-4.462, P<0.01), and the verbal intelligence quotient(VIQ) of WMS was puomoved (VIQ scores: baseline (123.00±10.24), 8-week (128.00±6.77), t=4.372, P<0.01). The level of gene expression brain derived neurotrophic factor(BDNF) (baseline 1.68(0.92, 2.63), 8-week 2.30(1.47, 4.34), Z=-2.781, P=0.005), glial cell derived neurotrophic factor(GDNF) (baseline 0.74(0.31, 1.15), 8-week 0.97(0.50, 1.71), Z=-2.159, P=0.031), 5-hydroxytryptamine receptor 2A(HTR2A) (baseline 0.60(0.39, 1.60), 8-week 0.98(0.44, 2.29), Z=-1.994, P=0.046) and glutamate ionotropic receptor AMPA type subunit 1(GRIA1) (baseline 1.19(0.66, 2.40), 8-week 1.76(0.86, 4.13), Z=-2.756, P=0.006) was up-regulated after treatment.The change rate of BDNF expression were correlated with the score of HAMD-24 ( r=-0.35, P=0.038) and performance intelligence quotient of WMS ( r=0.40, P=0.022). Conclusions:BDNF may be used as a therapeutic marker of Shuganjieyu capsule in the treatment of clinical symptoms and cognitive function of MMD patients, which is used to evaluate the efficacy of antidepressants.

Objective To evaluate the health-related quality of life (HRQOL) for prostate cancer patients receiving androgen deprivation therapy (ADT).Methods We studied 200 patients with prostate cancer who were treated with primary ADT in Peking University People's Hospital from June 2014 to June 2015.The patients'average age was 73.9 years.The mean PSA level was 21.57 ng/ml when they were diagnosed with prostate cancer.Of these 200 patients,79％ (158/200) were localized and seclected ADT therapy due to age,body condition,basic diseases or individual will.21％ (42/200) were locally advanced or metastasic,which accord with the indication of ADT therapy.The scales,including the MOS item short from health survey (SF-36),Functional Assessment of Cancer Therapy-General module (FACT-G),Functional Assessment of Cancer Therapy-Prostate instrument (FACT-P),Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) were used to evaluate their HRQOL.Results According to results of SF36,the physical health component score and mental health component score was 67.41 ± 16.39 and 64.81 ± 17.51,respectively.They indicated that the overall quality of life of these patients was at an acceptable level.And the average score of all domains exceeded 60 except general health domain,which the score was only 40.03 ± 21.89.When it comes to FACT-P,the sum score,emotional well-being score and prostate cancer component score were 8.15 ± 3.72,12.30 ± 4.04 and 77.41 ± 9.95,respectively,which were less than half of their respective top score.However the physical well-being score was 20.41 ±4.29,which was a relatively satisfactory value.In addition,61％ (121/200) patient selected not at all in item I am able to have and keep an erection.The score of SDS and SAS was 46.76 ± 8.29 and 43.25 ±9.69,respectively.And there were 23.0％ (46/200) and 21.5％ (43/200) patiens exhibited depression and anxiety,respectively.Conclusion In the present study,the prostate cancer patients receiving ADT showed acceptable HRQOL,but some patients sufferd from depression,anxiety and erectile dysfunction.

Objective To study the roles of miR-20a in lipopolysaccharide induced inflammation of A549 cells and the possible mechanisms.Method The miR-20a mimic/inhibitor were transfected into A549 cells, and the cells were stimulated using lipopolysaccharide for 24 h.Interleukin-6 ( IL-6) and IL-8 were detected at mRNA level and protein level using real-time PCR and ELISA method , respectively.Protein expression of apoptosis signal regulating kinase 1 (ASK1)、P38、P-P38、JNK and P-JNK were detected using Western blot. Result Compared to mimic negative control group , the levels of mRNA and protein expression of IL-6 and IL-8 in the mimic group were all significantly decreased ( P<0.05).Compared to inhibitor negative control group , the levels of mRNA and protein expression of IL-6 and IL-8 in the inhibitor group were all significantly increased (P<0.05).The levels of ASK1, P-P38 and P-JNK protein in the mimic group were significantly lower than the mimic negative control group (P<0.05);the level of protein expression of ASK1, P-P38 and P-JNK in the inhibitor group were all higher than the inhibitor negative control group (P<0.05).Conclusion The regulation of ASK1 by miR-20a may play an important role in the inflammation process of acute respiratory distress syndrome .

Objective To explore the role of miR-20a on pulmonary surfactant synthesis of alveolar epithelial cells A549 and its potential mechanism.Methods Lentivirus miR-20a overexpression vector(miR-20a group) or lentivirus no-load vector(no-load group) was transfected into A549 cells,and the expression of green fluorescent protein(GFP) was observed to determinate the transfection effficiency;cell proliferation was detected by using 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT);the bioinformatics software and database were applied to predict and analyze the target genes of miR-20a about lung development;expressions of miR-20a,pulmonary surfactant-associated protein A(SP-A),pulmonary surfactant-associated protein B(SP-B),pulmonary surfactant-associated protein C(SP-C) and pulmonary surfactant-associated protein D(SP-D) mRNA were detected by using quantitative real-time PCR(qPCR);the expressions of SP-A protein,SP-B protein,SP-C protein,SP-D protein and protein signal transducers and activators of transcription 3 (STAT3) were detected by using Western blot.Results Observation of GFP expression under a fluorescent microscope indicated similar transfection efficiency,and real time-PCR showed that the expression of miR-20a increased after being transfected with lentivirus miR-20a overexpression vector(3.85 ± 0.18)compared with the normal group (0.99 ± 0.04)and the no-load group (1.21 ± 0.12),and the differences were significant(t =10.85,9.64,all P ＜0.001).As a result,lentivirus miR-20a overexpression vector was constructed successfully.Online software predicted that STAT3 gene was likely to be the target gene of miR-20a.Compared with the normal group (24 h,48 h,72 h:0.23 ± 0.01,0.39 ± 0.01,0.56 ± 0.03) and the no-load group (24 h,48 h,72 h:0.25 ± 0.01,0.44 ± 0.05,0.59 ± 0.01),miR-20a did not change the cell proliferation at different time points(24 h,48 h,72 h:0.26 ± 0.01,0.41 ± 0.02,0.58 ± 0.02) (all P ＞ 0.05).Compared with the normal group (1.00 ± 0.05,1.24 ± 0.20,1.31 ± 0.09,0.89 ± 0.12) and the no-load group (0.76 ± 0.10,1.31 ± 0.13,1.50 ± 0.11,1.01 ± 0.11),miR-20a up-regulated the mRNA expressions of SP-A,SP-B,SP-C and SP-D (2.05 ± 0.17,2.14 ± 0.10,2.84 ± 0.09,1.66 ± 0.08),and the differences were significant (all P ＜ 0.05).Compared with the normal group (0.46 ± 0.01,0.27 ± 0.03,0.69 ± 0.01,0.43 ± 0.01) and no-load group (0.43 ± 0.01,0.21 ± 0.01,0.79 ± 0.02,0.44 ± 0.02),miR-20a also increased the protein expressions of SP-A,SP-B,SP-C and SP-D (0.55 ±0.01,0.47 ±0.05,0.96 ±0.02,0.59 ±0.03),the diffe-rences were statistically significant (all P ＜0.05).The expression of STAT3 in miR-20a group(0.37 ±0.05) was significantly lower than that in the normal group(0.60 ±0.04) and the no-load group (0.68 ±0.06),and the differences were statstically significant (all P ＜ 0.05) in A549.Conclusions STAT3 is a downstream target gene of miR-20a.miR-20a can promote pulmonary surfactant synthesis of alveolar epithelial cells A549 by inhibiting STAT3.

Objective To explore the effect of mental nursing intervention on gastric cancer with liver metastasis patients treated with TACE sequential chemotherapy.Methods Sixty four gastric cancer patients with liver metastasis,no hopes of accepting operations,were included.All patients were divided into control group (32 cases) and observation group (32 cases).The former received routine nursing care and the later received extra mental nursing intervention.The anxiety,depression and quality of life in both groups were evaluated and compared.Results After extra mental nursing intervention,the SDS and SAS scores of the observation group [(41.6 ± 1.8) points and (41.6 ± 2.3) points] were significantly lower than those of the control group [(50.9 ± 1.9) points and (53.0 ± 3.5) points,P =0.040,P =0.036,respectively].The quality of life scores,including the physiological function,body pain,general self rating,vitality,social function,emotional function and mental health score were (45.26 ± 38.26)points vs (35.17 ± 33.65) points (P =0.044),(71.98 ± 17.36) points vs (63.01 ± 18.41) points (P =0.039),(55.59 ± 12.78) points vs (49.67 ± 12.43) points (P =0.048),(74.82 ± 14.23) points vs (55.61 ± 10.58) points (P =0.027),(75.47 ± 12.15) points vs (57.22 ± 14.78) points (P =0.031),(70.24 ± 22.00) points vs (45.92 ± 34.76) points (P =0.004),(78.31 ± 19.11) points vs (67.23 ± 11.96) points (P =0.037),respectively,the scores in the observation group were significantly higher than those in the control group (all P ＜ 0.05).Conclusion The extra mental nursing intervention on gastric cancer with liver metastasis patients,treated with TACE sequential chemotherapy,can not reduce the patients'negative mood,improve the patients'compliance with chemotherapy and the confidence to treatment,but improve the quality of patients'life effectively.

Objective:To investigate the association between metabolic factors,such as obesity,blood pressure,blood glucose,serum lipid profile,and the histopathological characteristics of renal cell carci-noma.Methods:The medical records of 382 consecutive renal cell carcinoma patients who underwent radical or partial nephrectomy at Peking University People’s Hospital from January 2009 to January 2015 were retrospectively reviewed.Metabolic factors were collected from the records,including weight,body mass index,waist circumstance,blood pressure,fasting blood glucose,serum total triglyceride,serum total cholesterol,serum low-density lipoprotein-cholesterol and serum high-density lipoprotein-cholesterol. The patients were divided into different groups according to tumor grade,stage and diameter.Statistics analysis,such as t test,Mann-Whitney U test and Logistic analysis,were performed to investigate the as-sociation between metabolic factors and grade,stage and tumor diameter of renal cell carcinoma.Re-sults:A total of 80 (20.94%)of the tumors were classified as high grade disease,63 (16.49%)were classified as advanced disease and 153 (40.05%)tumor diameter more than 4 cm.The patients in high grade group were found to have lower high-density lipoprotein-cholesterol level than in low grade group (P =0.015),body mass index,total cholesterol and high-density lipoprotein-cholesterol were found to be lower in advanced disease than in localized disease (P =0.022,P =0.005 and P =0.006,respec-tively),and low-density lipoprotein-cholesterol was found to be lower in larger tumors (P =0.030). Other factors were comparable between the different groups.The results of Logistic analyses showed that, body mass index (OR =0.906,95%CI:0.852 -0.986,P =0.023)and total cholesterol (OR =0.660,95%CI:0.492 -0.884,P =0.005)were associated with the tumor stage,high-density lipopro-tein-cholesterol level was significantly associated with tumor grade (OR =0.293,95% CI:0.108 -0.797,P =0.016)and stage (OR =0.204,95%CI:0.065 -0.635,P =0.006),and low-density lipoprotein-cholesterol level was significantly associated with tumor diameter (OR =0.756,95% CI:0.586 -0.975,P =0.031).Conclusion:The results of our study indicate that metabolic factors,espe-cially obesity and serum lipid profile,are closely related with the histopathological characteristics of renal cell carcinoma.

Objective To investigate the effect on blood coagulation function and immune function in patients with gas-tric cancer by laparoscopic radical gastrectomy and open operation. Methods In our hospital from June 2011 to June 2014,selected hospitalized patients with gastric cancer 30 cases as the research object,15 cases were undergone tradi-tional open operation in patients with the establishment of the control group, the remaining 15 cases received laparo-scopic radical resection of gastric cancer,set up the observation group,the changes of the TT,APTT,INR,FIB,D-D of blood coagulation indexes of two groups were compared,and changes in two groups of patients with immune function indexes of CD3+,CD4+,CD8+,CD4+/CD8+,and the operation time,bleeding amount of two groups of operation,ambula-tion time, hospital stay, postoperative complications were compared between two groups. Results In the observation group and the control group after 24 h,the FIB,D-D was significantly higher than the preoperative,and the observa-tion group patients after operation significantly were higher than the control group (P<0.05). After operation 1 weeks,CD3+,CD4+, CD8+, CD4+/CD8+of observation group showed no significant changes (P>0.05). CD3+, CD4+, CD4+/CD8+of control group after 1 weeks significantly changed compared with the preoperative, and CD3+, CD4+, CD4+/CD8+ of observation group compared with the control group,the difference was statistically significant(P<0.05). But CD8+of the control group had no obvious change before and after surgery(P>0.05). The observation group patients' out of bed activity time, postoperative hospitalization time was significantly shorter than that in the control group,the amount of bleeding observation group was significantly less than that the control group(P<0.05). Conclusion Laparoscopic radical gastrectomy for gastric cancer curative has good effect, compared with open radical gastrectomy for gastric cancer with less bleed-ing, fewer complications, patients recovered quickly, the advantages of immune function in patients with small inter-ference, but the effects of laparoscopic operation on blood coagulation in patients with more significant, corresponding measures should be taken to prevent the formation of thrombus coagulation abnormalities caused by postoperative.

Objective To explore the effect of psychological nursing intervention on the pain, sleep quality and life quality of patients with gastric cancer. Methods A total of 84 cases of gastric cancer patients from January 2013 to January 2014 were randomly divided into intervention group and control group, 42 cases in each group, the control group was received conventional care, while the intervention group focused on the implementation of psychologicalnurs-ing intervention, SAS, SDS scores, VAS scores and PSQI scores before and after the intervention, and the general health, physiological function, physiological function, body pain, vitality, social function, emotional function, mental health quality of life scores were compared before and after intervention between two groups. Results After intervention, the SAS scores, SDS scores, VAS scores decreased significantly than before intervention and intervention group were lower than control group(P<0.05),the PSQI scores were significantly lower than before the intervention and intervention group were lower than the control group (P<0.05), after the intervention,the physical function, physical function, bodily pain, vitality, social functioning, role emotional, mental health scores were significantly higher than before intervention and intervention group were higher than the control group(P<0.05). Conclusion Positive psychological nursing interven-tion for gastric cancer helps to alleviate patients anxiety, depression and other negative psychological, reduce pain and improve sleep quality in patients, to further improve the quality of life of patients.