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 explore the effect of KIAA0753 on glucose and energy metabolism in mouse embryonic osteoblast precursor cell line MC3T3-E1.Methods The GSE182286 datasets of patients with Joubert syndrome acquired from the Gene Expression Comprehensive database were analyzed for the levels of gene expression.After the cells with KIAA0753 overexpression were constructed and the experiment were divided into the control group,the high glucose group and the high glucose+overexpression KIAA0753 group,Western blotting was used to determine the effect of KIAA0753 on MC3T3-E1 cells under high glucose condition by detecting the expression of the glucose metabolism-related proteins,such as glycogen synthase 1 (GYS1 ),glycogen phosphorylase L (PYGL ),glucose transporter type 4 (GluT4 ),phosphofructokinase muscle (PFKM),pyruvate dehydrogenase phosphatase 1 (PDP1 ),and acetyl-CoA carboxylase α(ACACA ),as well as the mitochondria function-associated proteins,including peroxisome proliferator-activated receptor-γcoactivator-1α(PGC-1α),nuclear respiratory factor 1 (NRF1 ),and mitochondrial transcription factor A (TFAM).The effect of KIAA0753 on the intermediates of glucose metabolism was analyzed by determining the contents of glycogen,glucose and lactic acid in the cell culture medium.Cellular immunofluorescence assay and adenosine triphosphate (ATP ) assay were employed to measure the mitochondrial activity and function impacted by KIAA0753 in the cells under high glucose condition.The effect of KIAA0753 on the proliferation of MC3T3-E1 cells under high glucose was detected by EdU staining. Results The expression of KIAA0753 protein was downregulated in patients with Joubert syndrome and in MC3T3-E1 cells under high glucose conditions (P<0.05).High glucose resulted in inhibited protein expression of GYS1,ACACA,PFKM,GluT4,PGC-1α,TFAM and NRF1,enhanced protein levels of PDP1 and PYGL,reduced glycogen generation and consumption of extracellular glucose,and promoted production of lactic acid (P<0.05 ).While,overexpression of KIAA0753 could attenuate the effect of high glucose,that is,up-regulating the protein expression levels of GYS1,ACACA,PFKM,GluT4,PGC-1α,TFAM and NRF1,suppressing those of PDP1 and PYGL,enhancing glycogen generation and consumption of extracellular glucose,and inhibiting production of lactic acid (P<0.05 ). What's more,the overexpression also could elevate the activity and membrane potential of mitochondria,and promote the ATP synthesis (P<0.05 )and cell proliferation (P<0.05)in MC3T3-E1 cells under high glucose.Conclusion KIAA0753 can promote glucose metabolism and improve mitochondrial activity and function in osteoblasts,consequently providing more energy to the body.

Objective:To investigate the effect of anterior or posterior debridement on infections of the lumbar vertebral fusion with cage and pedical screw system.Methods:A total of 10 cases (3 males and 7 females, age 49.80±13.29 years) with infections in the lumbar fusion device were admitted from January 2013 to December 2019. The cases were diagnosed with deep infections after the preview surgery at 10.80±13.24 months, including 10 cases with 12 cages infections and 8 cases with screw system infections. 7 cases were done with debridement and removal of the cages via the anterior approach. And another 3 cases underwent posterior debridement and removal of lumbar fusion cages. The changes in laboratory examination such as WBC count, ESR, CRP, visual analogue scale (VAS) and Oswestry Disability Index (ODI) score were compared preoperatively, 2 months and 6 months postoperatively.Results:No patients were lost in the follow-up. The average follow-up time periods is 16.30±5.10 months (range 9-24 months). There was no significant difference in WBC count between 2 and 6 months after surgery compared with preoperation ( F=0.855, P=0.436). The ESR, CRP, VAS and ODI scores decreased in 2 months and 6 months after sugery, which has significant differences compared preoperation ( P<0.05). The abnormal signals in the lambar vertebral showed a gradual fading trend in the postoperative MRI. The completely fading time was 5.00±1.33 months (range 3-7 months). One-stage bone grafting was performed in 6 cases with 8 spaces via anterior approach, 5 cases with 7 spaces showed the intervertebral fusion after postoperative with 6.80±2.28 months (range 4-10 months), 1 case wirh 1 space was not fused. One-stage bone grafting was performed in 2 cases via posterior approach: 1 case was fused after postoperative and the other patient was not, which due to bone graft area infection. Postoperative bone graft displacement occurred with 1 case and 1 case with L 5 nerve root pulling injury during the operation. Conclusion:The fusion cage can be removed by debridement via posterior approach, but it is difficult to done the completely debridement, which the main reason is the obstruction of the posterior nerve and bone structure. Posterior approach also have risks of infection recurrence and nerve root injury. Cage removal via anterior approach was relatively easy and debridement was thoroughly, which has the risk of injury of important adjacent vessels.

Objective:To evaluate the operation effect of remote imaging network platform in a regional medical center.Methods:The workload data of remote imaging network in a regional medical center from 2017 to 2019 were analyzed.Results:137 medical institutions were connected to the remote imaging diagnosis network platform, and the number of imaging examinations in grass-roots medical institutions increased significantly. Part of the imaging examination in the superior medical center was gradually diverted to the subordinate medical institutions. However, limited by the ability of image diagnosis, grass-roots medical institutions relied on remote diagnosis of higher-level hospitals.Conclusions:Remote image diagnosis network is an important platform support for Internet plus medical health service, which can rapidly and effectively enhance the ability and level of imaging diagnosis in primary medical institutions.

Objective: To explore the effect of post-abortion care service based on Wechat follow-up on contraceptive compliance of multiple induced abortion patients, and to evaluate the satisfaction with PAC service. Methods: A quasi-experimental method was adopted. A total of 300 cases of induced abortion were selected in Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University from March 2018 to March 2019, with 150 cases from eastern branch in the experimental group and 150 cases from western branch in the control group. The control group received routine nursing care and post-abortion care service based on telephone follow-up, while the experimental group received routine nursing care and post-abortion care service based on Wechat follow-up. The missing rate of follow-up, the contraceptive method and the occurrence of unexpected pregnancy within one year after operation were collected in the two groups. Patients′ follow-up compliance and nursing satisfaction were evaluated. Results: The awareness of the risk of induced abortion in the experimental group was 90.4% (120/135) higher than that in the control group 77.5% (88/111), and the difference was statistically significant (χ² value was 9.128, P=0.010). The contraceptive consciousness of the two groups was 99.3% (134/135) and 94.6% (105/135), respectively, and the difference was not statistically significant (χ² value was 3.256, P=0.071). There was a statistically significant difference in the missing rate of follow-up between the two groups in January, March, June, and December (χ² value was 13.664, P=0.003). Compared with 19.8% (22/111) in the control group, 73.3% (99/135) patients in the study group chose high-efficiency contraception, the difference was statistically significant (χ² value was 69.795, P<0.01).There were no recurring pregnancies in the experimental group within one year, compared with 6.3% (7/111) in the control group, the difference was statistically significant (χ² value was 6.630, P=0.003). In the experimental group, the participation rate of the follow-up were (95.37±12.29)%, which were higher than that in the control group (90.77±16.49)%. The difference was statistically significant (t value was 2.438, P<0.05). The overall satisfaction score of the experimental group was 26.55 ± 2.80, which was higher than that of the control group (23.66 ± 3.32). The difference was statistically significant (t value was 7.285, P <0.01). Conclusion Post-abortion care service based on Wechat follow-up could enhance patients′ compliance and satisfaction, guide patients to choose the right contraceptive methods, reduce the rate of repeated abortion and promote female reproductive health.

Objective: To investigate the prognostic value of SYNTAX score on 1 year outcome in coronary heart disease patients underwent percutaneous coronary intervention(PCI). Methods: The present study (PANDA Ⅲ trial) was a perspective, multi-center, randomized controlled trial. Between December 2013 and August 2014, 2 348 patients who underwent PCI from 46 centers were enrolled. SYNTAX score was calculated from all patients. Patients were divided into 3 groups based on SYNTAX score: lower risk group (SYNTAX score≤22, 1 777 patients), intermediate risk group (SYNTAX score 23-32, 412 patients), and higher risk group (SYNTAX score≥33, 159 patients). The patients were followed up after the procedure for one year.Primary endpoint was target lesion failure (TLF), including cardiac death, target vessel myocardial infarction,and ischemia driven target lesion revascularization. Secondary endpoints included stent thrombosis and major adverse cardiac events were defined as a composite of all-cause death, myocardial infarction and any revascularization. Results: (1) A total of 1 766 (99.2%), 411 (99.8%),and 159 (100%) patients in the lower risk group, intermediate risk and higher risk group completed the 1 year follow up. (2) Incidence of TLF were 5.6%(99/1 763) in lower risk group, 8.8%(36/411) in intermediate risk group,and 8.8%(14/159) in higher risk group(P=0.03). The incidence of target vessel myocardial infarction in lower risk group was 3.9%(68/1 763), 6.6%(27/411) in intermediate risk group,and 7.5% (12/159) in higher risk group(P=0.01).Prevalence of cardiac death and ischemia driven target lesion revascularization was similar among the 3 groups(P>0.05).(3) The probable stent thrombosis events rate was 0.1% (1/1 763), 0.7% (3/411), and 0.6% (1/159) in the lower, intermediate,and higher risk groups respectively (P=0.02). The incidence of major adverse cardiac events was 8.1% (142/1 763) in lower-risk group, 11.7% (48/411) in intermediate risk group, and 14.5% (23/159) in higher risk group (P<0.01). The incidence of all-cause death was 1.7%(30/1 763) in lower-risk group, 1.7%(7/411) in intermediate risk group, and 6.3%(10/159)in higher risk group (P<0.01). The incidence of myocardial infarction was 4.2% (74/1 763) in lower-risk group, 6.6% (27/411) in intermediate risk group, and 8.2% (13/159) in higher risk group(P=0.02).Incidence of any revascularization was similar among groups(P=0.59). (4) The multivariable Cox analysis showed that age (HR=1.04, 95%CI 1.02-1.06, P<0.01), total implanted stent length (HR=1.01, 95%CI 1.00-1.02, P=0.03), and baseline SYNTAX score (HR=1.02, 95%CI 1.02-1.04, P=0.02) were independent risk factors of TLF after PCI in this patient cohort. Conclusion The SYNTAX score is a valuable tool for predicting prognosis on 1 year in coronary heart disease patients underwent PCI. Trial Registration www.clinicaltrials.gov, NCT02017275.

Objective: To investigate the effect of knee-chest position on exhaust and defecation of gynecologic diseases patients after laparoscopic surgery. Methods: This quasi-experiment trail was conducted between July 2016 to May 2017, in a birth control ward at an obstetrics and gynecology hospital in Beijing, China. The study included a total of 258 patients who had gynecological benign diseases and received gynecological laparoscopic surgery. Participants were recruited in the trail by using a convenient sampling method with 130 patients who received gynecological laparoscopic surgery from July 2016 to December 2016 in the experimental group (on the basis of routine care, patients preformed a knee-chest position intervention after 6 hours of the surgery) and 128 patients who received gynecologic laparoscopic surgery between January 2017 and May 2017 in the control group (patients received a routine care). The primary end point was the postoperative anal exhaust. Results: The ambulation rate before post-operative ventilation of the experimental group was 21.5% (28/130) less than that of the control group (91.4%, 117/128). The difference was statistically significant (χ²=127.903, P<0.01). The incidence of abdominal distension after operation was 0, lower than that of the control group 7.0% (9/128), the difference was statistically significant (χ²=9.471, P<0.01). The postoperative exhaust time and defecation time of the experimental group was (8.17 ± 2.88) h,(27.86 ± 4.29) h, earlier than that of the control group, (21.24 ± 5.90) h,(38.69 ± 7.73) h, and the differences were statistically significant (t=22.580, 13.885, P<0.01). Conclusions Postoperative knee-chest position significantly improved the exhaust and defecation of patients with gynecological benign disease after laparoscopic surgery.

Objective To investigate the clinical effects of Dexmedetomidine on analgesia and postoperative cognitive function in elderly patients with lumbar spine surgery.Methods The patients were randomly divided into the control group (n=88) and the study group (n=100).The patients in the study group were treated with Dexmedetomidine at a loading dose of 1.0 μg/kg for 15 min,and 0.3 μg · kg-1 · h 1 was continuously pumped.The anesthetic mode and drugs in the control group were similar to those in study group,except that Dexmedetomidine in the study group was replaced with physiological saline in the control group.Intraoperatively used dose of analgesic drugs,and pain and cognitive function changes were compared between the two groups.Results The intraoperatively used doses of Remifentanil,Fentanyl and propofol were significantly lower in the study group than in the control group (P＜0.05).The VAS scores were markedly lower in the study group than in the control group (2.6±0.5 vs.4.5± 1.2,t=4.9398,P=0.0000).The MMSE scores were higher in the study group than in the control group (28.0 ± 1.3 vs.26.0 ± 2.5,t =-6.6484,P=0.0000).Conclusions Intraoperative use of Dexmedetomidine for treatment of the elderly patients with lumbar surgery will not only reduce the perioperatively used dose of analgesic and sedative drug,but also reduce postoperative pain and improve postoperative cognitive function.

Objective To study on the evaluation of haemodynamics in the normal and pulmonary hypertensive mouse hearts using pressure volume loops measured by electric catheter.Methods Compared the difference in haemodynamics between mice exposed to chronic hypoxia for 10 days,which causes hypoxia-induced pulmonary hypertension (experimental group,n =8),and mice raised under normal atmospheric pressure (control group,n =8).The right carotid artery was cannulated with a 1.2 F catheter and advanced into the ascending aorta,then punctured towards the right ventricular apex.A 1.2 F admittance pressure-volume catheter was introduced using a 20-gauge needle to obtain the pressure-volume measurements and calculate hemodynamic parameters.Results There were no significant differences in average by weight,ratio of right atrial weight to body weight,left atrial weight/body weight,left ventricular free wall and septum weight/body weight between the 2 groups(all P ＞ 0.05).The ratio of right rentricle/left rentricle and septum weight as well as right rentricular weight/body weight was increased in the experimental group and of significant difference when compared to the control.The mice in in the experimental group had a 61％ mean decrease in cardiac output,a 55％ decrease in ejection fraction,and a 63％ decrease in ventricular compliance(P ＜0.05).The increase in dP/dtmax-EDVand PRSWfound in the experimental group reflected significant increase in myocardial contractility.Increase in Ees was observed but without significant difference as compared to the control.Ea significantly increased in the experimental group resulting in significant decrease in Ees/Ea from (0.71 ±0.27) to (0.35 ±0.17) (P＜ 0.005).Conclusion This study demonstrates the feasibility of obtaining RV pressure-volume measurements in mice using electric catheter.These measurements provide insight into right ventricular-pulmonary artery interactions in healthy and diseased conditions.

Objective To study pulmonary wedge angiography ( PWA ) with hemodynamic the evaluation of children with congenital heart disease and pulmonary artery hypertension ( PAH) . Methods Hemodynamic measurement and pulmonary wedge angiography were performed in 50 children with congenital heart disease. Comparison and analysis were made from the data obtained from PWA and catheterization. Results After PWA, the patients were categorized into 3 groups according to the measured hemodynamics parameters:group A [ n=15, patients with normal mean pulmonary artery pressure ( mPAP≤25 mmHg) and normal pulmonary vessel resistance (PVR﹤300 dyne?s?cm5)], group B [n=24, patients with PAH (mPAP﹥25 mmHg) but normal PVR] and group C (n=11, patients with PAH and elevated PVR (PVR≥300 dyne?s?cm5). Rote of tapering (ROT) was significant lower in group C than in group A and B (F=42. 559,P﹤0. 05). Pulmonary circulation time (PCT) was higher in group C than in group A and B (F=6. 037,P﹤0. 05). ROT correlated negatively with PVR (r = -0. 606, P ﹤0. 05). PCT index correlated positively with PVR (r=0. 783,P=0. 01). There was no significant correlation between PCT and mean pulmonary artery hypertension (mPAP). Conclusions PWA may help to make quantitative analysis of the pulmonary vascular status in patients with congenital heart disease.