Objective:To investigate the clinical efficacy and safety of fruquintinib in elderly patients with advanced metastatic colorectal cancer who failed chemotherapy.Methods:Ninety-nine elderly patients with advanced metastatic colorectal cancer who failed chemotherapy in No. 904 Hospital of Joint Logistics Support Force from September 2018 to July 2020 were selected. All patients were given furquintinib capsules, 1 time/d, 5 mg/time, and 28 days was 1 cycle. All patients were treated continuously for 2 cycles and the effect was observed. The patient's recent anti-tumor efficacy was counted. The serum levels of carbohydrate antigen 125 (CA125), carcinoembryonic antigen (CEA) and carbohydrate antigen 199 (CA199) in patients before and after treatment were compared. The safety of the medication during the patient's treatment was recorded, and the Kaplan-Meier method was used for survival analysis.Results:A total of 99 elderly patients with advanced metastatic colorectal cancer who failed chemotherapy were treated for 2 cycles, with an objective response rate (ORR) of 22.22% (22/99) and a clinical control rate (CCR) of 75.76% (75/99). The serum levels of CA125, CA199 and CEA after treatment were lower than those before treatment (all P<0.05). The drug adverse reactions in 99 patients during the treatment were mostly grade Ⅰ-Ⅱ, and grade Ⅲ-Ⅳ were rare. The most common gradeⅠ-Ⅱ adverse reactions were hypertension (45.45%, 45/99), hand-foot syndrome (40.40%, 40/99), and elevated aspartate transferase (36.36%, 36/99). Followed up for 12 months, 5 cases were lost to follow-up, the follow-up rate was 94.95%, the median progression-free survival time of the remaining 94 patients was 5.62 months (95% CI 3.57-8.75 months), and the median overall survival time was 8.41 months (95% CI 4.85-11.14 months). Conclusions:Fruquintinib has good efficacy in the treatment of elderly patients with advanced metastatic colorectal cancer who failed chemotherapy. It can reduce the levels of tumor markers, the survival status of patients is good, and the adverse reactions are controllable.

Lateral ankle avulsion fracture is a common sports injury that can lead to chronic lateral ankle instability and substantial deterioration of the joint function. Currently, problems such as misdiagnosis, inappropriate treatment, disparate outcomes and lack of standardization are usually met in the diagnosis and treatment of lateral ankle avulsion fracture. The Foot and Ankle Committee of Chinese Association of Sports Medicine Physicians thus organized a working group of experts in the field of sports medicine and ankle surgery from China to develop "An evidence-based clinical guideline for the diagnosis and treatment of lateral ankle avulsion fractures (2022 version)" in accordance with the principle of evidence-based medicine and scientificity and practicability. The guideline covered the topics of imaging diagnosis, indications and methods of non-operative and operative treatment as well as postoperative rehabilitation, in order to provide guidance for the diagnosis and treatment of lateral ankle avulsion fracture.

The rapid development of point-of-care testing (POCT) in clinical laboratories has brought challenges to the unified management in the hospital. There are many problems, such as how to ensure the ability and qualification of POCT operators, how to improve the quality management awareness of human, machines, materials, methods and environment in the process of POCT in clinical laboratories, how to help the clinical laboratories in the hospital to carry out POCT comparison, and how to strengthen the information construction of POCT in the hospital. Thus, this article reviews the practice and experience of POCT management in our hospital on POCT quality assurance and the problems existing in POCT in clinical departments, proposes suggestions and solutions to strengthen the unified management of POCT in clinical laboratories and establish POCT quality management documents and to improve quality awareness. We hope to provide references for hospital administrators, medical departments, nursing departments, quality control departments and other functional departments on the quality management of POCT in the hospital, and find helpful answers to the puzzles of clinical laboratory in POCT, so as to make joint efforts to standardize the quality management of POCT in the hospital to ensure the accuracy of testing results.

Objective To explore the safety and feasibility of guiding catheter passing through spasmodic vessels in patients undergoing percutaneous coronary intervention (PCI) via radial artery access by the aid of PCI guiding wire and balloon .Methods The clinical data of 33 coronary artery disease (CAD) patients undergoing PCI via radial artery access with radial artery or (and) brachial artery spasm ( group A ) were retrospectively analyzed .Among all these patients , guiding catheters were delivered through the spasmodic vessels successfully by the aid of PCI guiding wires and balloons .The clinical data of other 38 CAD patients having PCI during the same period performed by other operators via radial artery or ( and ) brachial artery approach and experienced vessel spasm were anlysed as the control ( group B ) .All patients in group B received conventional anti-spasm management during PCI .All vessel spasm was identified by angiography.For patients in group A , a diameter of 0.014 inch guiding wire was chosen to pass through the spasmodic vessel segment carefully and gently .The diameter of balloon should be chosen according to the diameter of guiding catheter .A balloon diameter of 2.0 mm and 2.5 mm was corresponded to 6F and 7F guiding catheter respectively .The balloon was advanced to the tip of guiding catheter , keeping a half in catheter and a half in vessel followed by inflating the balloon with a pressure of 8 atm.The balloon was kept inflated the guiding catheter was pushed in vitro carefully and slowly until the catheter passed through the spasmodic vessel segment .Then the balloon was deflated and pulled out together with PCI guiding wire . Exchanged a diameter of 0.035 inch wire and completed the positioning of guiding catheter .After finishing the PCI, radial or ( and) brachial angiography was performed again to observe if spasm disappeared and to determine if there any contrast medium exudation .For patients in group B , routine approach was applied including administration of nitroglycerine , diltiazem or nitroprusside etc . to relieve vessel spasm. Results The location of vessel spasm was similar in group A and group B ( P=0.150 ) , and the incidence rate of spasm in brachial artery was higher than that in radial artery in both groups .The chance of guiding catheter crossing the spasmodic vessel segment was significantly higher in group A than in group B ( 100%vs.39.5%, P=0.00).In patients whose guiding catheter could pass through the spasmodic vessel segment successfully , time spent in group A was shorter than in group B ( P=0.000 ) .The patient number which time spent was less than five minutes , five to 15 minutes and more than 15 minutes was 30 and 2 ( 90.1%vs.13.3%) , 3 and 7 ( 9.9% vs.46.7%) and 0 and 6 ( 0% vs.40.0%) in group A and in group B respectively.The incidence of forearm hematoma was lower in group A than in group B without statistical difference [6.1%(2/33) vs.18.4%(7/38), P =0.113].Conclusions It is safe and feasible for passing guiding catheter through spasmodic vessels during PCI via radial artery access by the aid of PCI guiding wire and balloon .

Objective: To study the clinical outcomes of stent-thrombosis (ST) at different times in patients after drug-eluting stent (DES) implantation.
Methods: A total of 131 coronary angiography conifrmed ST patients in our hospital from 2005-01 to 2015-04 were studied. According to the time of ST occurrence, the patients were divided into 2 groups: Early ST group, ST occurred ≤30 days,n=42 and Late ST group, ST occurred >30 days,n=89. The in-hospital and follow-up information was collected; clinical outcomes were compared between 2 groups.
Results: The in-hospital MACE occurrence rate in Early ST group was higher than that in Late ST group (16.7% vs 4.5%),P=0.04. There were 123 patients survived to discharge and they were followed-up for the median of 38.00 (15.00, 62.00) months. Kaplan-Meier analysis estimated that the MACE-free survival was similar between 2 groups (41.9% vs 36.3%), P=0.43.
Conclusion: In-hospital MACE occurrence was higher in early ST patients, while the long term prognosis was similar between the early and late ST patients for whom with DES implantation.

Objective:To evaluate the change in hamstring ( H ):quadriceps ( Q ) ratio following anterior cruciate ligament ( ACL) rupture during isokinetic knee extension and flexion at 30 degrees of flexion which is important for knee dynamic function .Methods:A study was performed in 25 male com-plete unilateral ACL ruptures .Isokinetic concentric and eccentric quadriceps and hamstring muscle tests in both the deficient knees and intact knees were performed at 60°/s, respectively.At 30 degrees of flexion, the average torque of quadriceps and hamstring , Qe∶Qc ratios ( ratios of eccentric quadriceps to concentric quadriceps muscle torque ) , He∶Hc ratios ( eccentric hamstring to concentric hamstring ) , Hc∶Qc ratios ( concentric hamstring to concentric quadriceps ) , He∶Qc ratios ( eccentric hamstring to con-centric quadriceps ) , and Hc∶Qe ratios ( concentric hamstring to eccentric quadriceps ) were calculated . Wilcoxon matched-pairs signed-ranks test was used .Results:At 30 degrees of knee flexion , a significant reduction ( P<0.05) in the average torque of quadriceps was observed at concentric and eccentric 60°/s produced by the deficient-side compared with the intact side .In addition, Hc∶Qc, He∶Qc, and Qe∶Qc significantly increased on the ACL-deficient side .Conclusion:The change in H ∶Q ratio in the mode of isokinetic 60 °/s at 30 degrees of knee flexion might therefore be a new tool to objectively document muscle function in ACL-deficient knee .

BACKGROUNDLarge-scale clinical trials have shown that routine monitoring of the platelet function in patients after percutanous coronary intervention (PCI) is not necessary. However, it is still unclear whether patients received high-risk PCI would benefit from a therapy which is guided by a selective platelet function monitoring. This explanatory study sought to assess the benefit of a therapy guided by platelet function monitoring for these patients.

METHODSAcute coronary syndrome (ACS) patients (n = 384) who received high-risk, complex PCI were randomized into two groups. PCI in the two types of lesions described below was defined as high-risk, complex PCI: lesions that could result in severe clinical outcomes if stent thrombosis occurred or lesions at high risk for stent thrombosis. The patients in the conventionally treated group received standard dual antiplatelet therapy. The patients in the platelet function monitoring guided group received an antiplated therapy guided by a modified thromboelastography (TEG) platelet mapping: If inhibition of platelet aggregation (IPA) induced by arachidonic acid (AA) was less than 50% the aspirin dosage was raised to 200 mg/d; if IPA induced by adenosine diphosphate (ADP) was less than 30% the clopidogrel dosage was raised to 150 mg/d, for three months. The primary efficacy endpoint was a composite of myocardial infarction, emergency target vessel revascularization (eTVR), stent thrombosis, and death in six months.

RESULTSThis study included 384 patients; 191 and 193 in the conventionally treated group and platelet function monitoring guided group, respectively. No significant differences were observed in the baseline clinical characteristics and interventional data between the two groups. In the platelet function monitoring guided group, the mean IPA induced by AA and ADP were (69.2 ± 24.5)% (range, 4.8% to 100.0%) and (51.4 ± 29.8)% (range, 0.2% to 100.0%), respectively. The AA-induced IPA of forty-three (22.2%) patients was less than 50% and the ADP-induced IPA of fifty-seven (29.5%) patients was less than 30%; therefore, their drug dosages were adjusted. The TEG was rechecked one to four weeks after PCI, and the results indicated that the IPAs had significantly improved (P < 0.01). However, no significant differences were found in the rates of the primary efficacy endpoint. Rates in the conventionally treated group and platelet function monitoring guided group were 4.7% and 5.2%, respectively (hazard ratio: 1.13; P = 0.79).

CONCLUSIONAn antiplatelet therapy guided by TEG monitored platelet function could not improve clinical efficacy even in ACS patients treated with high-risk complex PCI.

Acute Coronary Syndrome ; drug therapy ; Aged ; Arachidonic Acid ; therapeutic use ; Aspirin ; therapeutic use ; Blood Platelets ; drug effects ; Female ; Humans ; Male ; Middle Aged ; Platelet Aggregation ; drug effects ; Platelet Aggregation Inhibitors ; therapeutic use

Objective: To evaluate the efficacy and safety of overlapping biodegradable polymer sirolimus-eluting stents (EXCEL) in treating the patients with diffuse long coronary lesions (total stent length for per lesion>60 mm).
Methods: A total of 71 patients with diffuse long coronary lesions with overlapped EXcellstents implantation in our hospital from 2010-08 to 2012-05 were retrospectively studied. The average age of patients was (62.85 ± 10.26) years and 74.56%with male gender. The clinical endpoints were the major adverse cardiac events (MACE) at in-hospital time and at 2-year follow-up period.
Results: The average target lesion was implanted (2.61 ± 0.52) stents, the mean stent diameter was (3.21 ± 0.35) mm and the length was (73.34 ± 13.11) mm. The in-hospital MACE rate was 4.23%, the 2-year target vessel revascularization and MACE rates were 9.86%and 18.31%respectively. Cox regression analysis indicated that smoking (HR 12.102, 95%CI 1.460-100.309, P=0.021), previous history of MI (HR 11.948, 95%CI 1.144-124.726, P=0.038) and previous history of PCI (HR 0.097, 95%CI 0.010-0.990, P=0.049) were the independent risk factors of out of hospital MACE occurrence.
Conclusion: EXcellstent implantation was safe and effective for treating the patients with diffuse long coronary lesions, the long term follow-up study revealed that there was the increased risk for MACE and target vessel revascularization.

Objective To investigate the ultrasonic characteristics of angiographical normal left main (LM) branch of coronary artery observing with intravaseular ultrasound(IVUS). Methods Seventy-six patients whose coronary angiogram showed the lesions restricted only in left anterior descending (LAD) branch or left cireumflex(LCX) branch and no lesion was found in LM branch were enrolled and IVUS was performed. The plaque burden was measured and the quality of atherosclerosis was identified in lesion site of LAD or LCX by IVUS. Meanwhile,the absence or existence of lesions in LM was identified,and the quality of lesions was analyzed if it showing those existed lesions. The diameter and area of lumen in left main were measured and diameter and area of vessel were also measured. The plaque burden were measured for those who atheroselerosis existed in LM. Results IVUS showed 28 cases completely normal, 12 cases with intimal membrance hyperplesia,36 cases with plaque and 2 cases with intimal membrance flap in patients which LM was angiographically normal. Among those there were 30 eccentric plaques and 6 concentric plaques. For 36 patients whose lesions existed in LM observed by IVUS,there were 25 cases (69.4%) with soft plaque,4 eases (11.1%) with fibrous plaque,2 cases (5.6%) with calcific plaque,5 cases (13.9%)with mixed plaque. IVUS showed lumen diameter was (5.32±0.68)mm and lumen area was (23.34±5.27)mm2 for female patients; and lumen diameter was (5.90±0.50)mm and lumen area was (27.75±4.47)mm2 for male patients. The difference had significane when comparing lumen diameter and lumen area between male and female patients (P=0.042 and P=0.048, respectively). Vessel diameter was (5.90±0.47)mm and vessel area was (27.58±4.21)mm2 in patients with intimal membrance hyperplesia; lumen diameter was (4.39±0.54)mm and lumen area was (17.45±5.23)mm2,vessel diameter was (5.99±0.67)mm and vessel area was(26.61±6.27)mm2 n patients with atherosclerotic plaque.Diameter stenosis percentage was(26.17±7.87)%and plaque burden was(34.79±9.37)%in LM.Conclusions IVUS can find those lesions in LM which CAG cannot detect and identify the quality and severity of lesion precisely.

Objective To observe the effect of reperfusion therapy on the prognosis of acute myocardial infarction (AMI) complicated by eardiogenic shock(CS)in reperfusion era.Methods 89 cases of AMI with CS were included with 57 male and 32 female.50 cases received conservative therapy and 39 cases reperfusion therapy.28 of the 39 cases had suecessflll reperfusion and 11 eases failed.18 patients had intra-aortic balloon pump (IABP) within 1 hour of CS,they constituted an early group;35 patients treated with IABP 1 hour after CS were of a late group.A group of 36 cases were not treated with IABP (no IABP group).Results The mortality of the early group with IABP Was significantly lower than that of the late and no IABP group(33.3% vs.74.2% vs.86.1%,P＜0.01).The mortality of the group with sucessful reperfusion was significantly lower than that of unsuccessful reperfusion and conservative no IABP group (42.8% vs.81.8% vs.84.0%,P＜0.01).logistic regression analysis showed that successful reperfusion therapy (OR 4.232,95% CI 1.407～12.730,P=0.01) and THE TIME of using IABP(OR 0.22.95% CI 0.063～0.764,P=0.017)were independent risk factors for death.Conclusion Early successful reperfusion and early institution of IABP were the most important therapeutic measures for reducing mortaliIv of AMI complicated by CS.