Objectives:To explore the predictive value of residual Murray's law-based quantitative flow ratio(μQFR)on long-term vessel-oriented composite endpoints(VoCE).Methods:This retrospective study included 3 510 patients from the FAVOR Ⅲ China trial.Offline residual μQFR analysis was performed on all vessels(diameter≥2.5 mm)with 50%-90%stenotic lesions.Patients were stratified into high-,intermediate-,and low-risk groups based on residual μQFR tertiles.The primary endpoint was 3-year VoCE,defined as a composite of cardiac death related to the target vessel,target vessel-related spontaneous myocardial infarction,and ischemia-driven target vessel revascularization.Results:Offline analysis was performed on 5 256 vessels from 3 510 patients.The mean residual μQFR was 0.92±0.75.The high-risk group(residual μQFR≤0.91)with 1 554 patients(1 958 vessels);the intermediate-risk group(residual μQFR 0.92-0.96)with 1 211 patients(1 906 vessels);and the low-risk group(residual μQFR>0.96)with 745 patients(1 392 vessels).Over 3-year follow-up,VoCE occurred in 227 vessels(4.3%).The 3-year VoCE incidence was significantly higher in the high-risk group compared to the intermediate-and low-risk groups(6.2%vs.4.1%vs.2.5%,log-rank P<0.001),primarily driven by ischemia-driven target vessel revascularization(5.0%vs.3.0%vs.1.6%,log-rank P<0.001).Hypertension(OR=0.83,95%CI:0.72-0.96),hypercholesterolemia(OR=0.84,95%CI:0.73-0.97),bifurcation lesions(OR=0.72,95%CI:0.63-0.83),moderate/severe calcification(OR=0.70,95%CI:0.57-0.84),and tandem lesions(OR=0.59,95%CI:0.47-0.75)were independent predictors of lower residual μQFR values.Conclusions:Lower residual μQFR is significantly associated with increased VoCE risk during the 3-year follow up period.

Objectives:To explore the predictive value of residual Murray's law-based quantitative flow ratio(μQFR)on long-term vessel-oriented composite endpoints(VoCE).Methods:This retrospective study included 3 510 patients from the FAVOR Ⅲ China trial.Offline residual μQFR analysis was performed on all vessels(diameter≥2.5 mm)with 50%-90%stenotic lesions.Patients were stratified into high-,intermediate-,and low-risk groups based on residual μQFR tertiles.The primary endpoint was 3-year VoCE,defined as a composite of cardiac death related to the target vessel,target vessel-related spontaneous myocardial infarction,and ischemia-driven target vessel revascularization.Results:Offline analysis was performed on 5 256 vessels from 3 510 patients.The mean residual μQFR was 0.92±0.75.The high-risk group(residual μQFR≤0.91)with 1 554 patients(1 958 vessels);the intermediate-risk group(residual μQFR 0.92-0.96)with 1 211 patients(1 906 vessels);and the low-risk group(residual μQFR>0.96)with 745 patients(1 392 vessels).Over 3-year follow-up,VoCE occurred in 227 vessels(4.3%).The 3-year VoCE incidence was significantly higher in the high-risk group compared to the intermediate-and low-risk groups(6.2%vs.4.1%vs.2.5%,log-rank P<0.001),primarily driven by ischemia-driven target vessel revascularization(5.0%vs.3.0%vs.1.6%,log-rank P<0.001).Hypertension(OR=0.83,95%CI:0.72-0.96),hypercholesterolemia(OR=0.84,95%CI:0.73-0.97),bifurcation lesions(OR=0.72,95%CI:0.63-0.83),moderate/severe calcification(OR=0.70,95%CI:0.57-0.84),and tandem lesions(OR=0.59,95%CI:0.47-0.75)were independent predictors of lower residual μQFR values.Conclusions:Lower residual μQFR is significantly associated with increased VoCE risk during the 3-year follow up period.

As a sub-discipline of field surgery,trauma surgery of naval warfare focuses on the treatment of marine casualties,which is the extension and application of field surgical theories and techniques in the context of naval warfare.Informatization and 3-dimension have been the basic features of modern naval warfare.With the extensive use of high-tech weapons,maritime combat styles and security needs have undergone profound changes.The complexity and diversity of marine trauma injuries have created new opportunities and challenges for the development of trauma surgery.This paper analyzes the marine trauma under the conditions of modern warfare,the characteristics of marine trauma surgical care,and the medical evacuation system of casualty care in naval battle,aiming to promote the research of naval medical support and the development of field surgery.

Objective:To evaluate the long-term outcomes and predictors of coronary atherosclerotic lesions deemed functionally non-ischemic (quantitative flow ratio(QFR)>0.80) and deferred from intervention.Methods:This study is a post-hoc analysis of the FAVOR Ⅲ China trial, which enrolled 3 825 patients with stable or unstable angina pectoris or with myocardial infarction occurring at least 72 hours prior to screening, between December 5, 2018 and January 9, 2020 from 26 research centers in China. Coronary vessels with QFR>0.80 and without interventional treatment were analyzed in this study. The primary endpoint was 3-year target vessel revascularization. Vessels with revascularization (revascularized group) during follow-up were matched 1∶1 using propensity score matching to comparable vessels without revascularization (non-revascularized group). Multivariate Cox regression analysis was used to identify the risk factors for target vessel revascularization (TVR).Results:A total of 6 212 functionally negative vessels with deferred intervention were included in the final analysis, among which 153 vessels (2.5%) underwent TVR during a 3-year follow-up. Prior to propensity score matching, 6 059 vessels comprised the non-revascularized group. At the vessel level, compared to the non-revascularized group, the revascularized group exhibited a significantly higher proportion of males (79.1% (121/153) vs. 70.2% (4 253/6 059), P=0.018), higher body mass index ((25.6±4.0) kg/m2 vs. (24.3±5.2) kg/m2, P=0.003), and a higher prevalence of hypertension (73.9% (113/153) vs. 65.1% (3 944/6 059), P=0.025). And 152 pairs of vessels were successfully matched. Multivariate Cox regression analysis identified in-stent restenosis lesions ( HR=2.59, 95% CI 1.28-5.23, P=0.008) as an independent risk factor for target vessel revascularization. Conclusions:Coronary lesions classified as functionally non-ischemic at baseline are not entirely stable and may progress to lesions that requiring revascularization over time. In-stent restenosis emerges as a critical independent predictor of revascularization.

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 correlation between cardiac remodeling and the occurrence of contrast-associated acute kidney injury(CA-AKI)assessed by echocardiography.Methods A retrospective analysis was conducted on the clinical data of 100 patients with coronary artery disease(CAD)who underwent coronary angiography(CAG)and percutaneous coronary intervention(PCI)from March 2021 to March 2024.The patients were divided into CA-AKI group and non-CA-AKI group according to whether CA-AKI occurred.Baseline data and echocardiographic parameters,inclu-ding left ventricular end-diastolic internal diameter index(LVIDDI),left ventricular end-systolic in-ternal diameter index(LVIDSI),and left ventricular mass index(LVMI),were collected and com-pared between the two groups.Logistic regression analysis was used to screen for independent influen-cing factors of CA-AKI occurrence.Results The level of N-terminal pro-B-type natriuretic peptide(NT-proBNP)in the CA-AKI group was higher than that in the non-CA-AKI group,and the difference was statistically significant(P＜0.001).Compared with the non-CA-AKI group,the CA-AKI group had higher levels of C-reactive protein and glycosylated hemoglobin(HbA1c),as well as a higher proportion of patients with diabetes and anemia,and the differences were statistically significant(P＜0.05).Echocardiographic data showed that LVMI,LVIDDI,and LVIDSI in the CA-AKI group were all higher than those in the non-CA-AKI group,and the differences were statistically sig-nificant(t=2.057,3.429,2.975;P＜0.05).The left ventricular ejection fraction(LVEF)level in the CA-AKI group was lower than that in the non-CA-AKI group,and the difference was statisti-cally significant(t=3.005,P=0.003).Univariate Logistic regression analysis showed that diabe-tes,anemia,inflammation,NT-proBNP,HbA1c,LVMI,LVIDDI,LVIDSI,LVEF,ventricular hy-pertrophy,and ventricular dilation were significantly associated with the occurrence of CA-AKI(P＜0.05).Multivariate Logistic regression analysis results showed that LVMI(OR=3.81;95％CI,1.04 to 8.50;P=0.045),LVIDDI(OR=4.21;95％CI,2.02 to 6.08;P＜0.001),LVIDSI(OR=1.61;95％CI,1.27 to 2.03;P=0.024),ventricular hypertrophy(OR=3.42;95％CI,1.83 to 4.44;P=0.001),and ventricular dilation(OR=2.93;95％CI,1.43 to 3.74;P=0.033)were independent influencing factors for the occurrence of CA-AKI.Conclusion Cardiac remodeling is significantly correlated with the risk of CA-AKI in CAD patients.Clinicians should take protective measures timely for patients with abnormal cardiac structure to prevent the occurrence of CA-AKI.

Objective:To evaluate the long-term outcomes and predictors of coronary atherosclerotic lesions deemed functionally non-ischemic (quantitative flow ratio(QFR)>0.80) and deferred from intervention.Methods:This study is a post-hoc analysis of the FAVOR Ⅲ China trial, which enrolled 3 825 patients with stable or unstable angina pectoris or with myocardial infarction occurring at least 72 hours prior to screening, between December 5, 2018 and January 9, 2020 from 26 research centers in China. Coronary vessels with QFR>0.80 and without interventional treatment were analyzed in this study. The primary endpoint was 3-year target vessel revascularization. Vessels with revascularization (revascularized group) during follow-up were matched 1∶1 using propensity score matching to comparable vessels without revascularization (non-revascularized group). Multivariate Cox regression analysis was used to identify the risk factors for target vessel revascularization (TVR).Results:A total of 6 212 functionally negative vessels with deferred intervention were included in the final analysis, among which 153 vessels (2.5%) underwent TVR during a 3-year follow-up. Prior to propensity score matching, 6 059 vessels comprised the non-revascularized group. At the vessel level, compared to the non-revascularized group, the revascularized group exhibited a significantly higher proportion of males (79.1% (121/153) vs. 70.2% (4 253/6 059), P=0.018), higher body mass index ((25.6±4.0) kg/m2 vs. (24.3±5.2) kg/m2, P=0.003), and a higher prevalence of hypertension (73.9% (113/153) vs. 65.1% (3 944/6 059), P=0.025). And 152 pairs of vessels were successfully matched. Multivariate Cox regression analysis identified in-stent restenosis lesions ( HR=2.59, 95% CI 1.28-5.23, P=0.008) as an independent risk factor for target vessel revascularization. Conclusions:Coronary lesions classified as functionally non-ischemic at baseline are not entirely stable and may progress to lesions that requiring revascularization over time. In-stent restenosis emerges as a critical independent predictor of revascularization.

This study aimed to preliminarily evaluate the efficacy of posterior debridement and corpectomy via the spinal canal’s lateral wall approach (PDC-SCLWA) for spinal infection after vertebral augmentation (SIAVA). The procedure is characterized as “lateral wall resection for access, anterior lesion removal for debridement, and posterior wall preservation for bone graft fusion.” This distinguishes it from conventional 360° decompression that involves extensive lamina and facet joint resection. Eight patients who underwent PDC-SCLWA were included. The mean surgical duration was 290.6±59.2 minutes, with an average intraoperative blood loss of 775.0±389.7 mL. Intraoperative dural laceration occurred in two patients. All patients’ symptoms were alleviated, and no recurrent infection was observed during follow-up. Seven patients received double titanium meshes, and one received an iliac bone graft. At 3 months postoperatively, the fusion rates of intervertebral bodies and posterolateral laminae were 93.8% (15/16) and 100% (7/7), respectively. SIAVA is a severe postoperative complication, especially in elderly patients with multiple comorbidities. PDC-SCLWA is a safe and effective surgical technique. It provides advantages through posterior wall preservation that minimize spinal cord disruption, maintains mechanical stability, and optimizes the bone graft bed for fusion.

The difficulty in the treatment of diabetic foot lies in the high rate of recurrence and difficulty in eradicating the disease, and the results of both systemic basic treatment and local surgical treatment are not ideal. In recent years, domestic scholars have applied tibial transverse transport for the treatment of diabetic foot. Tibial transverse transport is suitable for the treatment of severe diabetic foot with a good blood supply of the large and middle arteries. It has the advantages of high healing rate and low recurrence rate, and can effectively reduce the mortality and amputation rate of patients. However, postoperative complications such as tibial osteotomy fracture, pin tract infection, skin necrosis at osteotomy area, tibial deformity and osteomyelitis should be paid attention to. Domestic scholars have improved the operation of tibial transverse bone transport in terms of reducing the surgical incision, osteotomy area, and preserving the blood supply of the osteotomy site. The modified double bone flap transverse tibial bone transport and "door" shaped window technique have been derived, and related surgical instruments have also been improved in the direction of precision. At present, the research on the mechanism of tibial transverse transport in the treatment of diabetic foot mainly focuses on promoting the reconstruction of macrophage polarization balance, stem cell mobilization and angiogenesis. After tibial transverse transport, the polarization of macrophages to classical activated type was decreased, and the polarization of selective activated type was increased. The two mechanisms promoted each other to reconstruct the polarization balance of macrophages. Bone transport activated SDF-1/CXCR4/PI3K/AKT and Wnt signaling pathways to induce stem cell mobilization. At the same time, it stimulates the release of angiogenic factors, activation of endothelial progenitor cells and Ras/Raf/MEK/ERK signaling pathways to promote angiogenesis and ultimately promote the healing of diabetic foot ulcers.

Objective To construct a diagnostic model based on the information of the TCM four diagnoses in hyperactive liver yang syndrome in patients with essential hypertension.Methods Syndromic investigation was carried out in patients with essential hypertension in some hospitals in Fujian and Beijing,and diagnostic information such as age,gender,symptoms,tongue and pulse were collected.On the basis of statistical analysis,this study adopted C5.0,CRT,CHAID and QUEST decision tree models respectively.After evaluating the stability and performance consistency of the models,the accuracy of the models was measured by diagnostic rate,and the optimal model of hyperactivity of liver yang in essential hypertension was selected.Results Totally 533 patients with essential hypertension were included,including 198 patients with hyperactive liver yang syndrome and 335 patients without hyperactive liver yang syndrome.The diagnostic rates of the four models were 75.2%,66.2%,67.7%and 65.0%,respectively.The diagnostic efficiency of C5.0 was better than that of CRT,CHAID and QUEST models."Aggravation after emotional excitement,poor complexion,string-like pulse,irritability,head swelling pain,bitter mouth,heavy pulse,fatigue,dark tongue,irritability,dizziness,thin pulse,yellow fur"could be regarded as the specific items of the syndrome model of hyperactive liver yang in essential hypertension.Conclusion The C5.0 decision tree model can clearly and intuitively identify the hyperactive liver yang syndrome in essential hypertension patients based on clinical TCM four diagnostic information data,and summarize diagnostic rules.