Aim To explore the effect of age on myocardial remodeling after percutaneous coronary intervention(PCI)in patients with acute anterior myocardial infarction.Methods This study was a cross-sectional study analyzing clinical data of regular follow-up at 1,3,6 and 12 months after PCI for acute anterior myocardial infarction.According to the age of the patients,they were divided into a low age group(＜65 years old)and a high age group(≥65 years old).The differences in baseline data,biochemical indexes,coronary angiography,inflammatory factor levels,and cardiac ultrasound indexes between the two groups were analyzed,and the correlation analysis between age and inflammatory factors and the multivariate linear regression analysis of diastolic function were performed.Results A to-tal of 87 patients with acute anterior myocardial infarction were selected,aged(62±13)years,including 67 males(77.0％),43 in the low age group and 44 in the high age group.Compared with the low age group,the levels of inflam-matory factors such as C-reactive protein,interleukin-1β(IL-1β),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)increased in the high age group,while ultrasound indicators such as mitral valve annulus septal e',mitral valve flow velocity E/A,and mitral valve annulus sidewall e'decreased(P＜0.05).Older age was an independent risk factor for a decrease in mitral valve flow velocity E/A,mitral valve annulus sidewall e'and mitral valve annulus septal e'in patients with acute anterior myocardial infarction 6 months after PCI(P＜0.05).Conclusion Age is an independent risk factor for reduced diastolic function after PCI in acute anterior myocardial infarction,inflammatory factor such as IL-1β,IL-6 and TNF-α may play a role in the impaired diastolic function after PCI in age-related acute anterior myocardial infarction.

Poly-(adenosine diphosphate-ribose)-polymerase(PARP)inhibitors are a novel group of small molecule targeted therapeutic drugs.It has become an effective treatment for ovarian cancer,prostate cancer and breast cancer carrying BRCA1/2 mutations.Studies have demonstrated that PARP inhibitors(PARPi)can improve treatment outcomes by targeting genetic defects in tumors with syner-gistic effects with standard therapies for glioma treatment,such as increasing radiation sensitivity and overcoming temozolomide resistance.Howev-er,the limited blood-brain barrier permeability,the adverse reactions of drug combination and the oc-currence of drug resistance are the key factors af-fecting the therapeutic effect.This article reviews the mechanism of action and research progress of PARP inhibitors involved in the treatment of brain glioma,and analyzes the challenges to be faced in clinical practice,in order to provide references for future research in this field.

Aim To explore the effect of age on myocardial remodeling after percutaneous coronary intervention(PCI)in patients with acute anterior myocardial infarction.Methods This study was a cross-sectional study analyzing clinical data of regular follow-up at 1,3,6 and 12 months after PCI for acute anterior myocardial infarction.According to the age of the patients,they were divided into a low age group(＜65 years old)and a high age group(≥65 years old).The differences in baseline data,biochemical indexes,coronary angiography,inflammatory factor levels,and cardiac ultrasound indexes between the two groups were analyzed,and the correlation analysis between age and inflammatory factors and the multivariate linear regression analysis of diastolic function were performed.Results A to-tal of 87 patients with acute anterior myocardial infarction were selected,aged(62±13)years,including 67 males(77.0％),43 in the low age group and 44 in the high age group.Compared with the low age group,the levels of inflam-matory factors such as C-reactive protein,interleukin-1β(IL-1β),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)increased in the high age group,while ultrasound indicators such as mitral valve annulus septal e',mitral valve flow velocity E/A,and mitral valve annulus sidewall e'decreased(P＜0.05).Older age was an independent risk factor for a decrease in mitral valve flow velocity E/A,mitral valve annulus sidewall e'and mitral valve annulus septal e'in patients with acute anterior myocardial infarction 6 months after PCI(P＜0.05).Conclusion Age is an independent risk factor for reduced diastolic function after PCI in acute anterior myocardial infarction,inflammatory factor such as IL-1β,IL-6 and TNF-α may play a role in the impaired diastolic function after PCI in age-related acute anterior myocardial infarction.

Poly-(adenosine diphosphate-ribose)-polymerase(PARP)inhibitors are a novel group of small molecule targeted therapeutic drugs.It has become an effective treatment for ovarian cancer,prostate cancer and breast cancer carrying BRCA1/2 mutations.Studies have demonstrated that PARP inhibitors(PARPi)can improve treatment outcomes by targeting genetic defects in tumors with syner-gistic effects with standard therapies for glioma treatment,such as increasing radiation sensitivity and overcoming temozolomide resistance.Howev-er,the limited blood-brain barrier permeability,the adverse reactions of drug combination and the oc-currence of drug resistance are the key factors af-fecting the therapeutic effect.This article reviews the mechanism of action and research progress of PARP inhibitors involved in the treatment of brain glioma,and analyzes the challenges to be faced in clinical practice,in order to provide references for future research in this field.

OBJECTIVE To provide reference for strengthening the standardized management of off-label drug use in cancer hospitals. METHODS The evaluation system for off-label drug use was established to standardize the application， approval， and filing process for off-label drug use in our hospital. The changes in off-label drug application quantity， proportion， disease category and drug category in our hospital were compared before （October 1st， 2021-September 30th， 2022） and after （October 1st， 2022- September 30th， 2023） the establishment of the evaluation system； drug items supported by high-level evidence screened by pharmacy department were analyzed statistically. RESULTS The number of off-label drug use applications in our hospital had gradually increased， from 306 pieces in the fourth quarter of 2021 to 3 828 pieces in the third quarter of 2023. In the year before the construction of the evaluation system， there were a total of 4 482 applications for off-label drug use， and in the year after the construction of the evaluation system， there were 11 840 applications for off-label drug use. After the construction of the evaluation system， the proportion of unregistered off-label drug use significantly decreased， compared to the same period last year （P＜0.05）. Among them， there were no unregistered applications for off-label drug use for digestive system tumors， head and neck tumors， and radioactive drugs； lymphoma， breast tumors，urogenital system tumors， cytotoxic drugs and new anti-tumor drugs all had a decrease of over 70% in unregistered off-label drug applications. Twenty-seven off-label drug use items related to 19 drugs supported by high-level evidence were screened by the pharmacy department of our hospital， among which 25 items were drug use beyond indication. CONCLUSIONS The establishment of off-label drug use evaluation system in cancer hospital is helpful to the rational use and refined management of clinical anti-tumor drugs.

Objective    To explore the safety and effectiveness of different interventional approaches for the treatment of patent ductus arteriosus (PDA) in children. Methods    The children (≤7 years) who underwent interventional treatment for PDA from 2019 to 2020 in our hospital were retrospectively included. The patients were divided into 3 groups according to the procedures: a conventional arteriovenous approach group, a simple venous approach group, and a retrograde femoral artery approach group. The clinical efficacy of the patients was compared. Results     A total of 220 patients were included. There were 78 males and 142 females, with an average age of 3.21±1.73 years, weight of 14.99±5.35 kg, and height of 96.19±15.77 cm. The average diameter of the PDA was 3.35±1.34 mm. A total of 85 patients received a conventional arteriovenous approach, 104 patients received a simple venous approach, and 31 patients received a retrograde femoral artery approach. The diameter of PDA in the retrograde femoral artery group was smaller than that in the other two groups (3.44±1.43 mm vs. 1.99±0.55 mm; 3.69±1.17 mm vs. 1.99±0.55 mm, P<0.001); the contrast medium usage [40 (30, 50) mL vs. 20 (20, 30) mL; 35 (25, 50) mL vs. 20 (20, 30) mL, P≤0.001] and operation time [32 (26, 44) min vs. 25 (23, 30) min; 29 (25, 38) min vs. 25 (23, 30) min, P<0.05] in the simple venous approach group were significantly less or shorter than those in the other two groups; the length of hospital stay of the conventional arteriovenous group was longer than that in the other two groups [3 (3, 5) d vs. 4 (3, 6) d; 4 (3, 5) d vs. 4 (3, 6) d, P<0.05]. There was no significant difference in postoperative complications. Conclusion    It is safe and effective to close PDA through simple venous approach. The retrograde femoral artery approach has the advantage of simplifying the surgical procedure for PDA with small diameters.

Objective:To explore the feasibility of three-dimensional CT axial sequence assisted volumetric measurement (CTAS) in evaluating atrial septal defect (ASD).Methods:The patients with single secundum ASD who successfully underwent interventional therapy in Fuwai Hospital from January 2016 to December 2019 were retrospectively collected. The patients underwent coronary CT angiography (CTA) before and on the second day after closures, and DSA examinations during operation. A total of 52 cases met the inclusion conditions, among them, there were 37 patients with large defects which had deficient inferior rims ≤3 mm, and 15 patients with severe pulmonary arterial hypertension that occluded with fenestrated ASD occluder. The CT data of patients before and after operation were reconstructed by CTAS. Then the anatomical structure of ASD before the operation was evaluated, including the long diameter and short diameter of ASD, and the CT three-dimensional volume diameter of ASD was calculated by using the equivalent circle conversion formula of ellipse. The waist diameter of occluder and rims of the ASD were measured after occlusion on postoperative CT three-dimensional volume reconstruction images. Meanwhile, the deployed occluder waist dimension was measured in DSA examination during the operation by simulating the balloon measurement of ASD. Lastly, paired t-test and consistency analysis were carried out among the values of parameters. Results:Before operation, the equivalent circle diameter of ASD was (32.3±5.4) mm measured by CTAS. After ASD occlusion, the size of the waist dimension measured by DSA and CTAS were (32.5±4.9) mm and (32.6±4.9) mm. There were no significant differences between them ( P>0.05). There were also no significant differences for each rims of the ASD pre and post operation on CTAS except for the inferior rims and the total length of atrial septum in superior-inferior direction ( P>0.05). Conclusion:As an alternative to balloon sizing, CTAS can be used as a reference standard to conduct ASD interventional treatment.

OBJECTIVE：To study the abnormal use of anti-tumor dr ugs i n the clinic in order to provide reference for rational use of drugs in the clinic. METHODS ：Referring to foreign and domestic anti-tumor drug use guidelines and literatures ，Guidelines for Clinical Use of New Anti-tumor Drugs （2018 edition），Off-label Drug Use List （2019 edition），Practical Oncology （secondary edition），anti-tumor drug package inserts approved by FDA and package inserts of anti-tumor drug listed in China ，abnormal use of antitumor drugs （including instructions ，special indications ，and the order of administration of new anti-tumor drugs ） was summarized and analyzed. RESULTS & CONCLUSIONS ：The off-label use of anti-tumor drugs were summarized in this paper ， including 11 drug varieties and 4 kinds of off-label drug items ，such as off-label drug use plan （recombinant human endostatin ， rituximab），off-label administration route （pemetrexed disodium ，bortezomib，bevacizumab），off-label administration lines （erlotinib，gefitinib），off-label drug dosage （actinomycin D ，gemcitabine，ifosfamide，etoposide）. They should be carefully selected and strictly monitored in clinical use ，and treatment plan should be adjusted according to needs. Among the special indications，cyclophosphamide，cytarabine，methotrexate and cisplatin were used in large doses ，which were 2 000-2 400 mg/m2， 2 000 mg/m2，12 g/m2 and 80-120 mg/m2，respectively；individual differences should be paid attention to and therapeutic drug monitoring should be carried out if necessary. In the scheme of combination of new anti-tumor drugs or traditional chemotherapy drugs，there were 5 categories and 11 items in total ，such as combination of molecular targeted anti-tumor drugs with traditional chemotherapy drugs （such as docetaxel at first ，gefitinib at the same time or later ），combination of target immunocheckpoint drugs with traditional chemotherapy drugs （such as platinum at first ，then nivolumab ），and molecular targeted anti-tumor drugs combination（such as pertuzumab and trastuzumab should be given in sequence ，in either order ）. In clinical use ，histopathological diagnosis should be made clear ， and drugs with specific targets should be used after gene detection and strictly follow the indications.

Objective To investigate the effects of subthreshold micropulse yellow laser (577 nm) on vascular endothelial growth factor (VEGF),nerve growth factor (NGF) and Chemerin expressions in retina of early stage diabetic rats.Methods A total of 40 Brown Norway rats were treated with streptozocin (65 mg · kg-1) to establish the diabetic model.20 diabetic BN rats' right eyes were received subthreshold micropulse yellow laser (577 run) therapy after 2 weeks.The left eyes were used as control group.At 3 days,7 days,14 days,28 days after laser therapy,5 BN rats were randomly chosen to perform RT-PCR and Weston-blot.The expressions of mRNA and protein of VEGF,NGF and Chemerin were analyzed.Results The expression of VEGF mRNA and protein increased in control group at 3 days,7 days,14 days and 28 days (all P ＜ 0.05).Compared with the control group,VEGF mRNA and protein decreased in the subthreshold micropulse yellow laser (577 nm) group (all P ＜ 0.05).The expression of NGF mRNA and protein decreased in the control group at 3 days,7 days,14 days and 28 days (all P ＜ 0.05),however,the difference was not statistically significant between 3 days and 7 days(P ＞0.05).Compared with control group,NGF mRNA and protein increased in the subthreshold micropulse yellow laser (577 nm) group (all P ＜ 0.05),with maximum expression at 14 days.The expression of chemerin mRNA and protein increased at 3 days,7 days,14 days and 28 days in the control group (all P ＜0.05).Compared with the control group,chemerin mRNA and protein decreased in the subthreshold micropulse yellow laser (577 urn) group (all P ＜ 0.05).Conclusion Subthreshold micropulse yellow laser (577 urn) can suppress VEGF,Chemerin expression and upregulate NGF expression in early stage diabetic rats.

Objective To explore the cognition ,attitude and intention of seeking doctor on hierarchical diagnosis and treat-ment among the patients suffering from chronic diseases in Chongqing City .Methods A multistage stratified sampling method was adopted to investigate 1125 patients with chronic diseases extracted from 9 public hospitals as well as basic medical and health in-stitutions in 9 districts and counties of Chongqing City .Meanwhile ,the differences of intentions of seeking doctor and cognition situ-ation of hierarchical diagnosis and treatment were analyzed .Results The patients with chronic diseases in basic medical and health institutions were more likely to choose the basic medical and health institutions for seeking doctor than the patients treated in public hospitals ,the difference was statistically significant (χ2 = 190 .051 ,P<0 .01);31 .2% of the patients with chronic diseases never contacted the hierarchical diagnosis and treatment .The technical capabilities of basic medical and health institutions meeting treat-ment needs ,gradual improvement of medical condition and service level and trending to seeking doctor in basic medical and health institutions had statistical difference between the patients in public hospitals and patients in basic medical and health institutions (P<0 .01) .The aspects of understanding the current referral system between medical institutions and downward referral conducing the disease to obtain continuous long tern treatment had statistical difference between the patients in public hospitals and patients in basic medical and health institutions (P< 0 .01) .Conclusion In order to better carry out hierarchical diagnosis and treatment in Chongqing City ,it is necessary to perfect the supporting polices of hierarchical diagnosis and treatment for guiding the primary diag-nosis in the patients with chronic disease ,meanwhile establish an efficient dual referral mechanism and enlarge the propaganda of hi-erarchical diagnosis and treatment policy .