Objectives:This study aimed to investigate the impact of quantitative flow ratio(QFR)-guided revascularization on outcome of elderly patients with coronary artery disease(CAD)undergoing valve surgery.Methods:We retrospectively analyzed 750 consecutive patients with angiographically confirmed CAD(≥50%stenosis)who underwent valve surgery at Zhongshan Hospital,Fudan University,between January 2016 and December 2021.According to the patients'ages,they were divided into the younger group(age<70 years old,n=532)and the elderly group(age≥70 years old,n=218).Revascularization strategies were evaluated using anatomical(angiography-based)and functional(QFR-based)criteria.Anatomical complete revascularization(CR)was defined as bypass grafting for all lesions with≥70%diameter stenosis in major coronary arteries or≥50%stenosis in the left main coronary artery.Functional CR referred bypass grafting for all lesions with QFR≤0.80.Incomplete revascularization(ICR)was defined as failure to meet CR criteria.According to the anatomical and functional definitions,the younger group and the elderly group were further divided into the incomplete revascularization subgroup and the complete revascularization subgroup respectively.Major adverse cardiovascular events(MACE),including death,myocardial infarction,repeat revascularization,and stroke,were assessed as the composite endpoint.Results:Over a follow-up of(3.7±1.8)years,the overall MACE rate was 13.3%.The younger group exhibited significantly lower MACE rates than the elderly group(10.7%vs.19.7%,P=0.001).In the younger group,anatomical ICR did not increase MACE risk(HR=1.46,95%CI:0.81-2.62,P=0.164),whereas functional ICR significantly increased MACE risk(HR=2.27,95%CI:1.24-4.15,P=0.001).In the elderly group,neither anatomical ICR(HR=1.22,95%CI:0.62-2.41,P=0.540)nor functional ICR(HR=1.52,95%CI:0.78-2.96,P=0.172)was associated with increased MACE risk.Conclusions:In patients undergoing valve surgery with CAD,functional ICR correlated with adverse outcomes in the younger group,whereas neither anatomical nor functional ICR significantly affected prognosis in elderly patients.These findings suggest that a moderately conservative revascularization strategy may be more appropriate for elderly populations.

Objectives:This study aimed to investigate the impact of quantitative flow ratio(QFR)-guided revascularization on outcome of elderly patients with coronary artery disease(CAD)undergoing valve surgery.Methods:We retrospectively analyzed 750 consecutive patients with angiographically confirmed CAD(≥50%stenosis)who underwent valve surgery at Zhongshan Hospital,Fudan University,between January 2016 and December 2021.According to the patients'ages,they were divided into the younger group(age<70 years old,n=532)and the elderly group(age≥70 years old,n=218).Revascularization strategies were evaluated using anatomical(angiography-based)and functional(QFR-based)criteria.Anatomical complete revascularization(CR)was defined as bypass grafting for all lesions with≥70%diameter stenosis in major coronary arteries or≥50%stenosis in the left main coronary artery.Functional CR referred bypass grafting for all lesions with QFR≤0.80.Incomplete revascularization(ICR)was defined as failure to meet CR criteria.According to the anatomical and functional definitions,the younger group and the elderly group were further divided into the incomplete revascularization subgroup and the complete revascularization subgroup respectively.Major adverse cardiovascular events(MACE),including death,myocardial infarction,repeat revascularization,and stroke,were assessed as the composite endpoint.Results:Over a follow-up of(3.7±1.8)years,the overall MACE rate was 13.3%.The younger group exhibited significantly lower MACE rates than the elderly group(10.7%vs.19.7%,P=0.001).In the younger group,anatomical ICR did not increase MACE risk(HR=1.46,95%CI:0.81-2.62,P=0.164),whereas functional ICR significantly increased MACE risk(HR=2.27,95%CI:1.24-4.15,P=0.001).In the elderly group,neither anatomical ICR(HR=1.22,95%CI:0.62-2.41,P=0.540)nor functional ICR(HR=1.52,95%CI:0.78-2.96,P=0.172)was associated with increased MACE risk.Conclusions:In patients undergoing valve surgery with CAD,functional ICR correlated with adverse outcomes in the younger group,whereas neither anatomical nor functional ICR significantly affected prognosis in elderly patients.These findings suggest that a moderately conservative revascularization strategy may be more appropriate for elderly populations.

Objectives: The survivors of first-ever stroke are at a high risk of recurrent stroke. The time interval between first-ever stroke and first recurrence of stroke, however, have not been well studied. The aim of the present study was to evaluate the time interval between first-ever and first recurrence of stroke and the risk factors of stroke that were related to the length of time interval. Methods: Patients admitted in our hospitals during 2014 with first recurrence of stroke were included in the study. A total of 377 patients were enrolled and a standardized questionnaire was used to collect data in this retrospective study. Results: The mean time interval among all the subjects was 58.42 months (median, 36.01 months; range 0.16months to 455.98months). The mean time interval was shorter in hemorrhagic stroke group (56.78 months) than in ischemic stroke group (58.75 months), but the difference was not significant (p=0.819). The median of time interval was similar in the two groups. The associated risk factors to the length of time interval were age over 60 years, subtype of first-ever stroke, the length of history of hypertension. Age was the only associated risk factor to the time interval among patients with first recurrence of hemorrhagic stroke. Conclusion: Factors associated with the time interval are different among different types of recurrent stroke. This provides the basis for preventive treatment for recurrent stroke after their first-ever stroke
Stroke

A 65-year-old female patient was given treatment scheme of bevacizumab(0. 386 g,the first day),oxaliplatin(150 mg,the first day)and capecitabine(1 g,twice daily,the first day to the 14th day)for colon cancer with liver metastasis. Twenty-three days after administration,the patient developed upper abdominal pain. She was diagnosed of gastrointestinal perforation and diffuse peritonitis by abdominal X-ray and CT scan. Emergency exploratory laparotomy was performed and a perforation with a size about 5 cm × 2 cm was found at the location of ascending colon 5 cm away from ileocecus. Then an ascending colon and terminal ileum fistula operation was performed. After the patientˊs condition was stable,she was given oxaliplatin and capecitabine to continue treatment.

A 65-year-old female patient was given treatment scheme of bevacizumab(0. 386 g,the first day),oxaliplatin(150 mg,the first day)and capecitabine(1 g,twice daily,the first day to the 14th day)for colon cancer with liver metastasis. Twenty-three days after administration,the patient developed upper abdominal pain. She was diagnosed of gastrointestinal perforation and diffuse peritonitis by abdominal X-ray and CT scan. Emergency exploratory laparotomy was performed and a perforation with a size about 5 cm × 2 cm was found at the location of ascending colon 5 cm away from ileocecus. Then an ascending colon and terminal ileum fistula operation was performed. After the patientˊs condition was stable,she was given oxaliplatin and capecitabine to continue treatment.

Objective To analyze the economic effects of different rehabilitation patterns for children suffering from cerebral palsy. Methods A total of 153 cerebral palsy patients were divided into a hospital-community-family rehabilitation group(n = 52), a hospital rehabilitation group (n = 50) and a non-intervention control group (n = 51). Those in the first group were provided with a hospital-community-family rehabilitation therapy pattern, those in the sec-ond only hospital rehabilitation and the third no intervention. All the patients were evaluated using the Gross Motor Function Measure-88 (GMFM-88) Scale and the Cost Measure Scale at admission, and at the end of the 3rd and 6th months of treatment. Results There were no significant differences in gross motor function among the three groups at admission. At the end of the 3rd month and the 6th month there were significant differences between the children in the hospital-community-family rehabilitation program and those in the hospital rehabilitation program in terms of gross motor function. Their general percentage, monthly percentage and monthly relative percentage results were all significantly different. But there was no significant difference in the non-interventian control group since admission. Every unit of improvement in gross motor function cost $101.87±97.59, $75.11±45.75 in the hospital-community-family reha-bilitation program and $387.21±54.76, $170.31±123.16 in the hospital rehabilitation program at the end of the 3rd and the 6th month respectively. So the cost of the former was only about 30% of the latter. Conclusion Hospital rehabilitation is suitable for the early rehabilitation of cerebral palsy children. Hospital-community-family rehabilitation is better for long-term rehabilitation of cerebral palsy children, and what is more, it can decrease the rehabilitation ther-apy cost substantially. So a hospital-community-family rehabilitation pattern is more compatible with China's national situation.

OBJECTIVETo study the immunogenicity and safety of recombinant yeast-derived hepatitis B vaccine (YDV) in adults.

METHODSOne hundred and twenty-four healthy teachers aged 22 approximately 58 years with serum negative HBsAg, anti-HBs, anti-HBc and with normal temperature were randomly selected from Beipiao city, Liaoning province. All the subjects were immunized with 5 microg/0.5 ml of YDV made by Beijing Institute of Biologic Products, for three doses at an interval of one and six months, respectively.

RESULTSThe positivity of serum anti-HBs was 35.0%, 83.3%, 65.5% and 32.7% with a geometric mean titre (GMT) of 12.6 mIU/ml, 402.0 mIU/ml, 70.3 mIU/ml and 20.3 mIU/ml, respectively, three, seven, 12 and 24 months after immunization. The positivity and GMT of serum anti-HBs appeared the highest seven months after immunization, then began to decrease sharply. The positivity and GMT of serum anti-HBs in women was higher than that in men either three, or seven, or 12, or 24 months after immunization. The positivity of serum anti-HBs in those of 35 years or over was lower than that less than 35 years, seven months after immunization, but no age difference could be found 12 months after immunization. No local or systematic adverse reactions were found in all the subjects within three days after immunization.

CONCLUSIONThe recombinant yeast-derived hepatitis B vaccine (YDV) is immunogenic and safe for adults, but the persistency of serum anti-HBs in after immunization should be followed-up further.

Adult ; Age Factors ; Hepatitis B Antibodies ; blood ; Hepatitis B Vaccines ; immunology ; Humans ; Immunization ; Middle Aged ; Sex Factors ; Vaccines, Synthetic ; immunology ; Yeasts ; genetics

Objective: To study the synthesis and antibacterial activity of 7 substituted 1 (2 fluoroethyl) 6,8 difluoro 1, 4 dihydro 4 oxo 3 quinolone carboxylic acid compounds. Methods: The title compounds were synthesized by condensation,cyclization, nucleophilic substitution. Antibacterial activity in vitro was determined with 6 kinds of common pathogenic bacteria. Results: Eleven compounds of 7 substituted 1 (2 fluoroethyl) 6,8 difluoro 1,4 dihydro 4 oxo 3 quinolone carboxylic acid were designed and synthesized. These compounds were firstly reported. The chemical structures of all compounds were determined by IR, 1HNMR and elementary analysis. CompoundⅠ 1,Ⅰ 2,Ⅱ 4 showed better antibacterial activities than that of fleroxacin. Conclusion: Some of the title compounds show potent antibacterial activities and should be further studied. [