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*

Dendritic cells (DCs) serve as the primary antigen-presenting cells in autoimmune diseases, like rheumatoid arthritis (RA), and exhibit distinct signaling profiles due to antigenic diversity. Type II collagen (CII) has been recognized as an RA-specific antigen; however, little is known about CII-stimulated DCs, limiting the development of RA-specific therapeutic interventions. In this study, we show that CII-stimulated DCs display a preferential gene expression profile associated with migration, offering a new perspective for targeting DC migration in RA treatment. Then, saikosaponin D (SSD) was identified as a compound capable of blocking CII-induced DC migration and effectively ameliorating arthritis. Optineurin (OPTN) is further revealed as a potential SSD target, with Optn deletion impairing CII-pulsed DC migration without affecting maturation. Function analyses uncover that OPTN prevents the proteasomal transport and ubiquitin-dependent degradation of C-C chemokine receptor 7 (CCR7), a pivotal chemokine receptor in DC migration. Optn-deficient DCs exhibit reduced CCR7 expression, leading to slower migration in CII-surrounded environment, thus alleviating arthritis progression. Our findings underscore the significance of antigen-specific DC activation in RA and suggest OPTN is a crucial regulator of CII-specific DC migration. OPTN emerges as a promising drug target for RA, potentially offering significant value for the therapeutic management of RA.

Objective:To explore and analyze the characteristics and influencing factors of language development in children with attention deficit hyperactivity disorder (ADHD).Methods:A case-control study was used, from May 2021 to August 2023, patients diagnosed with attention deficit hyperactivity disorder (ADHD) were enrolled in the mental health clinic of the Children′s Hospital Affiliated to the Capital Institute of Pediatrics. The language ability of 272 children with ADHD and 117 healthy children who underwent physical examination in children′s health center during the same period were tested by Diagnostic Receptive and Expressive Assessment of Mandarin-Comprehensive (DREAM-C), and the development levels of total language, receptive, expressive, semantics and syntax of the two groups were compared by independent sample t-test. The influential factors of language lag in children with ADHD were analyzed by univariate χ2 analysis and multiple logistic regression. Results:There were 272 children with ADHD, including 206 males and 66 females, with an age range of 6-8 (7.29±1.17) years. While in the control group, there were 117 healthy children, including 91 males and 26 females, with an age range of 6-8 (7.02±0.82) years. The average scores of total language, expressive and syntax of ADHD children were lower than those of healthy children [(92.73±12.47/96.36±11.04), t=-2.857, P<0.05; (84.49±13.24/87.78±15.25), t=-2.029, P<0.05; (87.93±10.26/90.27±11.05), t=2.022, P<0.05]. Univariate χ2 analysis showed that disharmonious family relationship ( χ2=4.183, P<0.05), the main caregivers were non-parents ( χ2=9.121, P<0.05), early screen exposure ( χ2=3.889, P<0.05), ADHD family history ( χ2=5.423, P<0.05) were influential factors of language development lag in ADHD children. The results of multivariate logistic regression model analysis showed that cesarean section ( OR=2.137, 95% CI: 1.078-4.379, P=0.030), disharmonious family relationship ( OR=2.659, 95% CI: 1.178-5.999, P=0.019), early screen exposure ( OR=3.556, 95% CI: 1.127-11.213, P=0.030), ADHD family history ( OR=1.959, 95% CI: 1.058-3.630, P=0.033) were risk factors for comorbidities of language development in children with ADHD. Conclusion:The total language ability, expressive and syntax scores of ADHD children lag behind those of healthy children. The delayed language development of ADHD children is related to delivery mode, family relationship, the main caregivers, early screen exposure, family history of ADHD.

Objective:To analyze the trend of dementia mortality rate among individuals aged 60 to 94 years in China from 1982 to 2021.Methods:Utilizing data from the Global Burden of Disease Study 2021, the Joinpoint regression model was employed to analyze the trend in the dementia mortality rate among Chinese older adults from 1982 to 2021. The age-period-cohort analysis method was used to decompose the age effect, period effect and cohort effect of dementia mortality data in Chinese elderly people.Results:From 1982 to 2021, the crude mortality rate of dementia in elderly women aged 60-94 in China (133.67/100 000-214.02/100 000) was higher than that in men (70.92/100 000-119.70/100 000), and the age-standardized mortality rate of dementia in women (230.74/100 000-246.87/100 000) was also higher than that in men (132.88/100 000-140.19/100 000). The age-standardized mortality rate of dementia in both genders showed an N-shaped fluctuation trend. The average annual percent change (AAPC) of dementia mortality rate in elderly males aged 60-94 was 0.07% (95% CI: 0.01%-0.13%), and the AAPC of dementia mortality rate in elderly females was -0.01% (95% CI:-0.08%-0.07%). Age effect analysis showed that from the age of 60, the risk of dementia death in males and females increased with age, especially among elderly people aged 75-94 who experienced a rapid increase in dementia mortality rate. The period effect analysis showed that the overall risk of dementia death in elderly men and women aged 60-94 was decreasing, but it had increased from 2017 to 2021. The cohort effect analysis showed that the risk of dementia death was lower in later birth cohorts. Conclusion:From 1982 to 2021, the dementia mortality rate among Chinese older adults aged 60 to 94 years exhibited fluctuations. Particularly, there has been a notable rebound in recent years. Special attention should be directed towards female seniors and those aged 75 to 94 years.

Objective:To investigate the features and influencing factors of language in children with various types of speech disorders.Methods:A case-control study was carried out, 262 children with speech disorder had been diagnosed at the language-speech clinic of the Center of Children′s Healthcare, Children′s Hospital, Capital Institute of Pediatrics from January 2021 to November 2023, the children with speech sound disorder as the speech sound disorder group, the children with developmental stuttering as the stuttering group. There were 100 typically-developed children who underwent physical checkups at the Center of Healthcare during the same period as the healthy group. All children experienced a standardized evaluation of language with diagnostic receptive and expressive assessment of mandarin‐comprehensive(DREAM-C) and questionnaire, One-way ANOVA and LSD test were conducted to compare the differences in overall language, receptive language, expressive language, semantics, and syntax scores among 3 groups of children. According to the results of DREAM-C, the children with speech disorder were divided into language normal group and language delay group. Chi‐square test and multivariate Logistic regression were implemented to analyze the association between the linguistic development of children with speech disorder and potential influential factors.Results:There were 145 children in the speech sound disorder group, including 110 males and 35 females respectively, with an age of (5.9±1.0) years; 117 children in the stuttering group, including 91 males and 26 females, with an age of (5.8±1.0) years; 100 children in the healthy group, including 75 males and 25 females, with an age of (5.7±1.2) years. The variations in overall language, expressive language, and syntax scores among 3 groups of children were statistically significant (92±18 vs.96±11 vs. 98±11, 81±18 vs. 84±14 vs. 88±13, 87±16 vs. 89±11 vs. 91±10, F=5.46, 4.69, 3.68, all P<0.05). Pairwise comparison revealed that the speech sound disorder group had lower scores in overall language, expressive language, and syntactic compared to the healthy group, and the differences were statistically significant (all P<0.01) and the overall language score was lower than that of children with stuttering ( P<0.05). In terms of overall language and expressive language, there was a statistically significant difference in the incidence of language delay among the three groups of children (15.9% (23/145) vs. 20.5% (24/117) vs. 7.0% (7/100), 46.2% (67/145) vs. 39.3% (46/117) vs. 26.0% (26/100); χ2=7.93, 10.28; both P<0.05). In terms of overall language, the stuttering group took up the highest proportion. In terms of expressive language, the speech sound disorder group accounted for the highest amount. The incidence of language delay in children with speech disorder was 44.3% (116/262). Non-parent-child reading, daily screen time ≥1 hour and screen exposure before 1.5 years of age are risk factors for the development of language in children with speech disorder ( OR=1.87, 2.18, 2.01; 95% CI 1.07-3.27, 1.23-3.86, 1.17-3.45; all P<0.01). Negative family history are protective factors for the progress of language ability ( OR=0.37, 95% CI 0.17-0.81, P<0.05). Conclusions:Children with speech disorder tend to have easy access to language delay, especially in expressive language and syntax. The occurrence of language delay in children with speech disorder is tightly connected with factors such as the family medical history, parent-child reading, screen time, etc. Attention should be paid to the development of language in children who suffer from speech disorder.

Objective To investigate the efficacy and safety of intravenous thrombolysis with low-dose and standard-dose recombinant tissue plasminogen activator(rt-PA)in the elderly patients(aged over 80 years)with acute ischemic stroke(AIS).Methods A total of 201 elderly patients with AIS treated at Tianjin Fourth Central Hospital from February 2019 to February 2023 were prospectively included and randomly assigned to the rt-PA low-dose group(n=93,0.6 mg/kg)and rt-PA standard-dose group(n=108,0.9 mg/kg).The incidence of intra-cranial hemorrhage,symptomatic intracranial hemorrhage,fatal intracranial hemorrhage,neurologic deterioration within 7 days and mortality within 90 days were observed to evaluate the safety.The neurologic improvement rate and good prognosis rate at 90 days were used to evaluate the effectiveness.A stratified analysis of 90-day outcomes was performed based on stroke severity and age.Results The incidence of intracranial hemorrhage,symptomatic intracranial hemorrhage and fatal intracranial hemorrhage within 7 days in rt-PA low-dose group was lower than that in rt-PA standard-dose group(P＜0.05).There were no statistically significant differences between the two groups concerning the residual safety index and the effectiveness index.The 90-day good prognosis rate of moderate stroke sub-group and of≥90 years of age sub-group in rt-PA low-dose group were both higher than that of rt-PA standard-dose group(P＜0.05).Conclusions For AIS patients with moderate stroke and aged over 90 years,intravenous thrombolytic therapy with rt-PA 0.6 mg/kg is recommended.

Lumbar interbody fusion is a surgical method for treating lumbar degenerative diseases. By establishing the stability of the lumbar segment, it solves the related symptoms caused by lumbar degenerative diseases. Minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) is a mature technology for treating lumbar degenerative diseases and improving the stability of the lumbar segment. In recent years, the emergence of lumbar interbody fusion under the small-channel working tube has made it have more minimally invasive characteristics compared to MIS-TLIF, with smaller incisions, less bleeding, and shorter recovery time. However, due to its long operation time, low efficiency of endplate treatment, and high complications incidence rate, it has not been widely popularized. At present, the large-channel endoscopic system, because of its larger field of view under the endoscope and more efficient endoscopic operation tools, reduces the operation time, improves the efficiency of endplate treatment, and reduces the postoperative related complications incidence rate. According to the surgical approach, it can be divided into transforaminal approach, posterior approach, oblique anterior approach, etc. According to the channel mode, it can also be divided into uniaxial endoscopy and unilateral dual-channel endoscopy, and each has its own advantages and disadvantages. Nowadays, the safety and effectiveness of spinal endoscopic posterior lumbar interbody fusion(Endo-PLIF) under the large-channel have achieved satisfactory results. This article reviews the research progress of Endo-PLIF under the large-channel, including surgical indications and contraindications, anatomical basis, surgical techniques, the choice of cages, the choice of fixation methods, safety and effectiveness, advantages and disadvantages, and explores its clinical application and prospects.

Objective:To explore and analyze the characteristics and influencing factors of language development in children with attention deficit hyperactivity disorder (ADHD).Methods:A case-control study was used, from May 2021 to August 2023, patients diagnosed with attention deficit hyperactivity disorder (ADHD) were enrolled in the mental health clinic of the Children′s Hospital Affiliated to the Capital Institute of Pediatrics. The language ability of 272 children with ADHD and 117 healthy children who underwent physical examination in children′s health center during the same period were tested by Diagnostic Receptive and Expressive Assessment of Mandarin-Comprehensive (DREAM-C), and the development levels of total language, receptive, expressive, semantics and syntax of the two groups were compared by independent sample t-test. The influential factors of language lag in children with ADHD were analyzed by univariate χ2 analysis and multiple logistic regression. Results:There were 272 children with ADHD, including 206 males and 66 females, with an age range of 6-8 (7.29±1.17) years. While in the control group, there were 117 healthy children, including 91 males and 26 females, with an age range of 6-8 (7.02±0.82) years. The average scores of total language, expressive and syntax of ADHD children were lower than those of healthy children [(92.73±12.47/96.36±11.04), t=-2.857, P<0.05; (84.49±13.24/87.78±15.25), t=-2.029, P<0.05; (87.93±10.26/90.27±11.05), t=2.022, P<0.05]. Univariate χ2 analysis showed that disharmonious family relationship ( χ2=4.183, P<0.05), the main caregivers were non-parents ( χ2=9.121, P<0.05), early screen exposure ( χ2=3.889, P<0.05), ADHD family history ( χ2=5.423, P<0.05) were influential factors of language development lag in ADHD children. The results of multivariate logistic regression model analysis showed that cesarean section ( OR=2.137, 95% CI: 1.078-4.379, P=0.030), disharmonious family relationship ( OR=2.659, 95% CI: 1.178-5.999, P=0.019), early screen exposure ( OR=3.556, 95% CI: 1.127-11.213, P=0.030), ADHD family history ( OR=1.959, 95% CI: 1.058-3.630, P=0.033) were risk factors for comorbidities of language development in children with ADHD. Conclusion:The total language ability, expressive and syntax scores of ADHD children lag behind those of healthy children. The delayed language development of ADHD children is related to delivery mode, family relationship, the main caregivers, early screen exposure, family history of ADHD.

Objective:To analyze the trend of dementia mortality rate among individuals aged 60 to 94 years in China from 1982 to 2021.Methods:Utilizing data from the Global Burden of Disease Study 2021, the Joinpoint regression model was employed to analyze the trend in the dementia mortality rate among Chinese older adults from 1982 to 2021. The age-period-cohort analysis method was used to decompose the age effect, period effect and cohort effect of dementia mortality data in Chinese elderly people.Results:From 1982 to 2021, the crude mortality rate of dementia in elderly women aged 60-94 in China (133.67/100 000-214.02/100 000) was higher than that in men (70.92/100 000-119.70/100 000), and the age-standardized mortality rate of dementia in women (230.74/100 000-246.87/100 000) was also higher than that in men (132.88/100 000-140.19/100 000). The age-standardized mortality rate of dementia in both genders showed an N-shaped fluctuation trend. The average annual percent change (AAPC) of dementia mortality rate in elderly males aged 60-94 was 0.07% (95% CI: 0.01%-0.13%), and the AAPC of dementia mortality rate in elderly females was -0.01% (95% CI:-0.08%-0.07%). Age effect analysis showed that from the age of 60, the risk of dementia death in males and females increased with age, especially among elderly people aged 75-94 who experienced a rapid increase in dementia mortality rate. The period effect analysis showed that the overall risk of dementia death in elderly men and women aged 60-94 was decreasing, but it had increased from 2017 to 2021. The cohort effect analysis showed that the risk of dementia death was lower in later birth cohorts. Conclusion:From 1982 to 2021, the dementia mortality rate among Chinese older adults aged 60 to 94 years exhibited fluctuations. Particularly, there has been a notable rebound in recent years. Special attention should be directed towards female seniors and those aged 75 to 94 years.

Humans ; Aged ; Lung Diseases ; Pneumonia/drug therapy* ; Adrenal Cortex Hormones/therapeutic use* ; Pulmonary Disease, Chronic Obstructive/drug therapy* ; Administration, Inhalation ; Community-Acquired Infections/drug therapy*