Background and Objectives: The Fractional Flow Reserve and Intravascular UltrasoundGuided Intervention Strategy for Clinical Outcomes in Patients with Intermediate Stenosis (FLAVOUR) trial demonstrated non-inferiority of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) compared with intravascular ultrasound (IVUS)-guided PCI. We sought to investigate the cost-effectiveness of FFR-guided PCI compared to IVUS-guided PCI in Korea. Methods: A 2-part cost-effectiveness model, composed of a short-term decision tree model and a long-term Markov model, was developed for patients who underwent PCI to treat intermediate stenosis (40% to 70% stenosis by visual estimation on coronary angiography).The lifetime healthcare costs and quality-adjusted life-years (QALYs) were estimated from the healthcare system perspective. Transition probabilities were mainly referred from the FLAVOUR trial, and healthcare costs were mainly obtained through analysis of Korean National Health Insurance claims data. Health utilities were mainly obtained from the Seattle Angina Questionnaire responses of FLAVOUR trial participants mapped to EQ-5D. Results: From the Korean healthcare system perspective, the base-case analysis showed that FFR-guided PCI was 2,451 U.S. dollar lower in lifetime healthcare costs and 0.178 higher in QALYs compared to IVUS-guided PCI. FFR-guided PCI remained more likely to be cost-effective over a wide range of willingness-to-pay thresholds in the probabilistic sensitivity analysis. Conclusions Based on the results from the FLAVOUR trial, FFR-guided PCI is projected to decrease lifetime healthcare costs and increase QALYs compared with IVUS-guided PCI in intermediate coronary lesion, and it is a dominant strategy in Korea.

Background and Objectives: The Fractional Flow Reserve and Intravascular UltrasoundGuided Intervention Strategy for Clinical Outcomes in Patients with Intermediate Stenosis (FLAVOUR) trial demonstrated non-inferiority of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) compared with intravascular ultrasound (IVUS)-guided PCI. We sought to investigate the cost-effectiveness of FFR-guided PCI compared to IVUS-guided PCI in Korea. Methods: A 2-part cost-effectiveness model, composed of a short-term decision tree model and a long-term Markov model, was developed for patients who underwent PCI to treat intermediate stenosis (40% to 70% stenosis by visual estimation on coronary angiography).The lifetime healthcare costs and quality-adjusted life-years (QALYs) were estimated from the healthcare system perspective. Transition probabilities were mainly referred from the FLAVOUR trial, and healthcare costs were mainly obtained through analysis of Korean National Health Insurance claims data. Health utilities were mainly obtained from the Seattle Angina Questionnaire responses of FLAVOUR trial participants mapped to EQ-5D. Results: From the Korean healthcare system perspective, the base-case analysis showed that FFR-guided PCI was 2,451 U.S. dollar lower in lifetime healthcare costs and 0.178 higher in QALYs compared to IVUS-guided PCI. FFR-guided PCI remained more likely to be cost-effective over a wide range of willingness-to-pay thresholds in the probabilistic sensitivity analysis. Conclusions Based on the results from the FLAVOUR trial, FFR-guided PCI is projected to decrease lifetime healthcare costs and increase QALYs compared with IVUS-guided PCI in intermediate coronary lesion, and it is a dominant strategy in Korea.

Background and Objectives: The Fractional Flow Reserve and Intravascular UltrasoundGuided Intervention Strategy for Clinical Outcomes in Patients with Intermediate Stenosis (FLAVOUR) trial demonstrated non-inferiority of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) compared with intravascular ultrasound (IVUS)-guided PCI. We sought to investigate the cost-effectiveness of FFR-guided PCI compared to IVUS-guided PCI in Korea. Methods: A 2-part cost-effectiveness model, composed of a short-term decision tree model and a long-term Markov model, was developed for patients who underwent PCI to treat intermediate stenosis (40% to 70% stenosis by visual estimation on coronary angiography).The lifetime healthcare costs and quality-adjusted life-years (QALYs) were estimated from the healthcare system perspective. Transition probabilities were mainly referred from the FLAVOUR trial, and healthcare costs were mainly obtained through analysis of Korean National Health Insurance claims data. Health utilities were mainly obtained from the Seattle Angina Questionnaire responses of FLAVOUR trial participants mapped to EQ-5D. Results: From the Korean healthcare system perspective, the base-case analysis showed that FFR-guided PCI was 2,451 U.S. dollar lower in lifetime healthcare costs and 0.178 higher in QALYs compared to IVUS-guided PCI. FFR-guided PCI remained more likely to be cost-effective over a wide range of willingness-to-pay thresholds in the probabilistic sensitivity analysis. Conclusions Based on the results from the FLAVOUR trial, FFR-guided PCI is projected to decrease lifetime healthcare costs and increase QALYs compared with IVUS-guided PCI in intermediate coronary lesion, and it is a dominant strategy in Korea.

Background and Objectives: The Fractional Flow Reserve and Intravascular UltrasoundGuided Intervention Strategy for Clinical Outcomes in Patients with Intermediate Stenosis (FLAVOUR) trial demonstrated non-inferiority of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) compared with intravascular ultrasound (IVUS)-guided PCI. We sought to investigate the cost-effectiveness of FFR-guided PCI compared to IVUS-guided PCI in Korea. Methods: A 2-part cost-effectiveness model, composed of a short-term decision tree model and a long-term Markov model, was developed for patients who underwent PCI to treat intermediate stenosis (40% to 70% stenosis by visual estimation on coronary angiography).The lifetime healthcare costs and quality-adjusted life-years (QALYs) were estimated from the healthcare system perspective. Transition probabilities were mainly referred from the FLAVOUR trial, and healthcare costs were mainly obtained through analysis of Korean National Health Insurance claims data. Health utilities were mainly obtained from the Seattle Angina Questionnaire responses of FLAVOUR trial participants mapped to EQ-5D. Results: From the Korean healthcare system perspective, the base-case analysis showed that FFR-guided PCI was 2,451 U.S. dollar lower in lifetime healthcare costs and 0.178 higher in QALYs compared to IVUS-guided PCI. FFR-guided PCI remained more likely to be cost-effective over a wide range of willingness-to-pay thresholds in the probabilistic sensitivity analysis. Conclusions Based on the results from the FLAVOUR trial, FFR-guided PCI is projected to decrease lifetime healthcare costs and increase QALYs compared with IVUS-guided PCI in intermediate coronary lesion, and it is a dominant strategy in Korea.

Objective:The aim of this study was to explore whether hydroxysafflor yellow A (HSYA) combined with hyaluronidase (HAase) can enhance the therapeutic effect of arterial embolism caused by hyaluronic acid (HA) .Methods:Thirty-two white male rabbits were randomly divided into four groups, with 8 rabbits in each group, of which group A, B and C were experimental groups and group D was group control. An axial rectangular composite tissue flap sized 2.0 cm × 5.0 cm, with 1.0 cm pedicle width, and 4.0 cm from the root, was designed with the central auricular artery as the long axis on the dorsal side of the ear. The depth of incision reached the ventral perichondrium of the ear, and the flap was sutured continuously in situ and divided into three equal parts (area Ⅰ, Ⅱ, Ⅲ) from the proximal area to the distal area. The proximal end 1 cm to the flap and the central artery was the intersection point, into which 50 μl HA was injected, by which the model of HA arterial embolism was established. Each group was treated after 60 min. Group A: 20 ml solution HSYA was injected slowly into the thigh saphenous vein (the dosage of HSYA is calculated at 10 mg/kg) . Group B: 0.5 ml solution HAase was injected into the central auricular artery (400 U/ml) . Group C: 0.5 ml solution HAase with the same dosage of group B was injected into the central auricular artery and 20 ml solution HSYA with the same dosage of group A was injected slowly into the thigh saphenous vein. Group D and other parts of group A and B were injected with the same dosage of normal saline (NS) . The thigh saphenous veins of all groups were injected with the same dosage of solution once a day for 14 days. Flaps were observed immediately, 1, 7 and 14 days after establishment of hyaluronic acid arterial embolism models of tissue flaps, and dorsal and backlight auricular photographs were taken. On the postoperative 14th day, percentages of survival areas of the flaps were calculated, and samples were taken from areas II of tissue flaps, which were stained by hematoxylin-eosin (HE) and Masson, and were detected the activity of superoxide dismutase (SOD) and the content of malondialdehyde (MDA) . The measurement data conformed to normal distribution was represented as Mean ± SD. Single factor analysis of variance (ANOVA) was used to compare the differences among groups, and head-to-head comparison by LSD test. P <0.05 was considered statistically significant. Results:Tissue flaps of all groups were pale immediately after operation. On the first day after operation, the dark ischemic area appeared at the distal end of each group. On the postoperative 7th day, the ischemic area of each group was necrotic and blackened to varying degrees, and the non-necrotic area swelled obviously. On the postoperative 14th day, the ischemic area of each group was further necrotic, blackened, curled and the boundary was clear. Group C was the best, group D was the worst, and both group A and B were between the two. The swelling of non-necrotic areas in group A and C were basically reduced. HE staining showed that numerous thrombi and inflammatory cells infiltration were formed in group D, and group B was behind it, and thrombi were rare in group A and C. Masson staining showed that collagen fibers were arranged regularly in group C, and abundant collagen fibers were disintegrated and disordered in group D, and both group A and B were between the two. The percentages of survival areas of the flaps in group A, B, C and D were as follows: (69.87 ± 5.04) %, (85.03 ± 6.58) %, (93.93 ± 4.25) % and (49.22±9.64) %. There were statistical differences in pairwise comparison between groups (all P <0.05) . SOD activity of group A, B, C and D were as follows: (49.83±8.08) , (36.65±5.49) , (55.61±7.93) and (22.45 ± 5.47) U/mg prot. Except that group A vs. C, there were statistical differences between groups (all P <0.05) . MDA content of group A, B, C and D were as follows: (0.77±0.17) , (1.03±0.16) , (0.68±0.12) , and (0.41±0.09) nmol/mg prot. Except that group A vs. C, there were statistical differences between groups (all P <0.05) . Conclusions:Under the condition of animal experiment, compared with HAase, HSYA combined with HAase can significantly enhance the therapeutic effect of HA arterial embolism and increase the proportion of survival area of tissue flap.

Objective:To explore the therapeutic effect of hydroxysafflor yellow A (HSYA) combined with hyaluronidase (HAase) for arterial embolism caused by hyaluronic acid (HA).Methods:Thirty-two white male rabbits were randomly divided into four groups, with 8 rabbits in each group. Groups A, B and C were experimental groups, while group D served as the control group. An axial rectangular composite tissue flap sized 2.0 cm × 5.0 cm, with a pedicle width of 1.0 cm, and located 4.0 cm from the root, was designed with the central auricular artery as the long axis on the dorsal side of the ear. The incision depth reached the ventral perichondrium of the ear, and the flap was sutured continuously in place and divided into three equal parts (areas Ⅰ, Ⅱ, Ⅲ) from the proximal to the distal area. The proximal end, located 1 cm from the flap, and the central artery was the intersection point, where 50 μl of HA was injected to establish the model of HA arterial embolism. Each group was treated after 60 minutes. Group A: 20 ml of HSYA solution was slowly injected into the saphenous vein of the thigh (the dosage of HSYA was calculated at 10 mg/kg). Group B: 0.5 ml of HAase solution was injected into the central auricular artery (400 U/ml). Group C: 0.5 ml of HAase solution with the same dosage as in group B was injected into the central auricular artery, while 20 ml of HSYA solution with the same dosage as in group A was slowly injected into the saphenous vein. Group D and other parts of groups A and B were injected with the same dosage of normal saline (NS). The thigh saphenous veins of all groups were injected with the same dosage of solution once daily for 14 days. Flaps were observed immediately, 1, 7 and 14 days after establishing hyaluronic acid arterial embolism models of tissue flaps. Dorsal and backlight auricular photographs were taken. On the 14th day postoperatively, the survival areas of the flaps were calculated. Samples were taken from areas Ⅱof tissue flaps, stained with hematoxylin-eosin (HE) and Masson, to detected the activity of superoxide dismutase (SOD) and the content of malondialdehyde (MDA). The measurement data that conformed to a normal distribution was represented as Mean ± SD. Single-factor analysis of variance (ANOVA) was used to compare the differences among groups, followed by head-to-head comparison using the LSD test. P<0.05 was considered statistically significant. Results:Tissue flaps from all groups appeared pale immediately after the operation. On the first day after the operation, a dark ischemic area appeared at the distal end of each group. On the 7th day postoperatively, the ischemic area of each group showed varying degrees of necrosis and blackening, while the non-necrotic area exhibited significant swelling. On the 14th day post-operation, the ischemic area in each group showed further necrosis, blackening, and curling, with clear boundaries. Group C was the best, group D was the worst, and both group A and B were in between the two. The swelling of non-necrotic areas in groups A and C was reduced. HE staining revealed numerous thrombi and infiltration of inflammatory cells in group D, with group B following closely behind. Thrombi were rare in groups A and C. Masson staining showed that collagen fibers were organized regularly in group C, while abundant collagen fibers were disintegrated and disordered in group D. Groups A and B exhibited characteristics that fell between the other two groups. The percentages of survival areas of the flaps in groups A, B, C and D were as follows: (69.87±5.04)%, (85.03±6.58)%, (93.93±4.25)% and (49.22±9.64)%. There were statistical differences in pairwise comparisons between groups (all P<0.05). SOD activity of groups A, B, C, and D were as follows: (49.83±8.08), (36.65±5.49), (55.61±7.93) and (22.45±5.47) U/mg prot. Except for the group A vs. C, there were statistical differences between the groups (all P<0.01). The MDA content of groups A, B, C and D were as follows: (0.77±0.17), (1.03±0.16), (0.68±0.12), and (0.41±0.09) nmol/mg prot. Except that group A vs. C, there were statistical differences between groups (all P<0.01). Conclusion:In animal experiments, it was found that compared to HAase alone, the combination of HSYA with HAase significantly improves the therapeutic outcomes of HA arterial embolism and increases the proportion of tissue flap survival area.

Objective:To observe the clinical effect of lower eyelid blepharoplasty combined with micro-autologous fat transplantation (MAFT) in the rejuvenation of the infraorbital regions.Method:A retrospective analysis was conducted on the clinical data of patients with lower eyelid pouch and tear trough treated with lower eyelid blepharoplasty combined with MAFT in the Department of Plastic Surgery of Affiliated Hospital of Nanjing University of Chinese Medicine from March 2020 to March 2022. Patients seeked medical attention due to lower eyelid pouch and tear trough, with or without skin laxity, and some patients had varying degrees of midface depression. After preoperative examination and evaluation of the patient’s infraorbital area and midfacial depression, appropriate individualized plans were developed.The patient underwent lower eyelid blepharoplasty by transconjunctival approach combined with tear trough MAFT. For patients with low or depressed midface, midface MAFT was also performed, and for patients with skin laxity, skin removal surgery was performed simultaneously. Complications were recorded after the operation. Preoperative and postoperative photos of more than 6 months were taken with the same postion and delivered to the same doctor to grade the patient’s Barton classification (0-3 grades, with higher grade indicating more obvious tear trough deformity). The improvement of tear trough deformity after surgery was assessed, and the global aesthetic improvement scale (GAIS) score was also assessed. The patients evaluated their improvement using the patients aesthetic improvement scale (PAIS) score (GAIS and PAIS are both 1-5 points, with higher scores indicating more significant postoperative improvement). Normal distribution metric data was represented by Mean±SD, and count data was represented by frequency and/or percentage; skewed distribution metric data was represented by M ( Q1, Q3), and compared by rank sum test. Results:A total of 69 patients were enrolled, including 9 males and 60 females, aged 25-45 years, with an average age of 36.7 years. Among them, 35 patients had midfacial depression, and 11 patients had skin laxity. (0.37±0.07) ml (0.2-0.6 ml) of micro-autologous fat was injected into the orbicularis oculi muscle on each side; (0.18±0.06) ml (0.1-0.2 ml) of micro-autologous fat was injected into the subcutaneous layer on each side; (3.80±0.98) ml (3-5 ml) of micro-autologous fat was injected into the deep medial cheek fat compartment and pyriform aperture fat compartment on each side. No serious complications occurred after the surgery. Postoperative follow-up lasted for 6-13 months, with an average of 8.7 months. The patient’s lower eyelid pouch, tear trough deformity, and depression in the midface have all improved, presenting a youthful and smooth appearance from the infraorbital area to the midface. The skin texture in the lower eyelid area had also improved. At the last follow-up, the Barton classification of the lacrimal groove decreased compared with that before surgery, and the difference was statistically significant [grade 0 (0, 1) vs. grade 2 (1, 2), Z=-7.62, P<0.001]. At the last follow-up, the PAIS score of 69 patients was 5 points in 49 cases (71%) and 4 points in 20 cases (29%); doctor’s GAIS score was 5 points in 38 cases (55%), 4 points in 27 cases (39%), and 3 points in 4 cases (6%) . Conclusion:For those patients with aging status of infraorbital region, like lower eyelid pouch and tear trough deformities, the combination of lower eyelid blepharoplasty through the transconjunctival approach and MAFT can achieve good therapeutic effects. This method is safe with a short recovery time.

Background and Objectives: Angiographic assessment of coronary stenosis severity using quantitative coronary angiography (QCA) is often inconsistent with that based on fractional flow reserve (FFR) or intravascular ultrasound (IVUS). We investigated the incidence of discrepancies between QCA and FFR or IVUS, and the outcomes of FFR- and IVUS-guided strategies in discordant coronary lesions. Methods: This study was a post-hoc analysis of the FLAVOUR study. We used a QCA-derived diameter stenosis (DS) of 60% or greater, the highest tertile, to classify coronary lesions as concordant or discordant with FFR or IVUS criteria for percutaneous coronary intervention (PCI). The patient-oriented composite outcome (POCO) was defined as a composite of death, myocardial infarction, or revascularization at 24 months. Results: The discordance rate between QCA and FFR or IVUS was 30.2% (n=551). The QCAFFR discordance rate was numerically lower than the QCA-IVUS discordance rate (28.2% vs. 32.4%, p=0.050). In 200 patients with ≥60% DS, PCI was deferred according to negative FFR (n=141) and negative IVUS (n=59) (15.3% vs. 6.5%, p<0.001). The POCO incidence was comparable between the FFR- and IVUS-guided deferral strategies (5.9% vs. 3.4%, p=0.479).Conversely, 351 patients with DS <60% underwent PCI according to positive FFR (n=118) and positive IVUS (n=233) (12.8% vs. 25.9%, p<0.001). FFR- and IVUS-guided PCI did not differ in the incidence of POCO (9.5% vs. 6.5%, p=0.294). Conclusions The proportion of QCA-FFR or IVUS discordance was approximately one third for intermediate coronary lesions. FFR- or IVUS-guided strategies for these lesions were comparable with respect to POCO at 24 months.

Background and Objectives: Angiographic assessment of coronary stenosis severity using quantitative coronary angiography (QCA) is often inconsistent with that based on fractional flow reserve (FFR) or intravascular ultrasound (IVUS). We investigated the incidence of discrepancies between QCA and FFR or IVUS, and the outcomes of FFR- and IVUS-guided strategies in discordant coronary lesions. Methods: This study was a post-hoc analysis of the FLAVOUR study. We used a QCA-derived diameter stenosis (DS) of 60% or greater, the highest tertile, to classify coronary lesions as concordant or discordant with FFR or IVUS criteria for percutaneous coronary intervention (PCI). The patient-oriented composite outcome (POCO) was defined as a composite of death, myocardial infarction, or revascularization at 24 months. Results: The discordance rate between QCA and FFR or IVUS was 30.2% (n=551). The QCAFFR discordance rate was numerically lower than the QCA-IVUS discordance rate (28.2% vs. 32.4%, p=0.050). In 200 patients with ≥60% DS, PCI was deferred according to negative FFR (n=141) and negative IVUS (n=59) (15.3% vs. 6.5%, p<0.001). The POCO incidence was comparable between the FFR- and IVUS-guided deferral strategies (5.9% vs. 3.4%, p=0.479).Conversely, 351 patients with DS <60% underwent PCI according to positive FFR (n=118) and positive IVUS (n=233) (12.8% vs. 25.9%, p<0.001). FFR- and IVUS-guided PCI did not differ in the incidence of POCO (9.5% vs. 6.5%, p=0.294). Conclusions The proportion of QCA-FFR or IVUS discordance was approximately one third for intermediate coronary lesions. FFR- or IVUS-guided strategies for these lesions were comparable with respect to POCO at 24 months.

Objective:To observe the clinical effect of lower eyelid blepharoplasty combined with micro-autologous fat transplantation (MAFT) in the rejuvenation of the infraorbital regions.Method:A retrospective analysis was conducted on the clinical data of patients with lower eyelid pouch and tear trough treated with lower eyelid blepharoplasty combined with MAFT in the Department of Plastic Surgery of Affiliated Hospital of Nanjing University of Chinese Medicine from March 2020 to March 2022. Patients seeked medical attention due to lower eyelid pouch and tear trough, with or without skin laxity, and some patients had varying degrees of midface depression. After preoperative examination and evaluation of the patient’s infraorbital area and midfacial depression, appropriate individualized plans were developed.The patient underwent lower eyelid blepharoplasty by transconjunctival approach combined with tear trough MAFT. For patients with low or depressed midface, midface MAFT was also performed, and for patients with skin laxity, skin removal surgery was performed simultaneously. Complications were recorded after the operation. Preoperative and postoperative photos of more than 6 months were taken with the same postion and delivered to the same doctor to grade the patient’s Barton classification (0-3 grades, with higher grade indicating more obvious tear trough deformity). The improvement of tear trough deformity after surgery was assessed, and the global aesthetic improvement scale (GAIS) score was also assessed. The patients evaluated their improvement using the patients aesthetic improvement scale (PAIS) score (GAIS and PAIS are both 1-5 points, with higher scores indicating more significant postoperative improvement). Normal distribution metric data was represented by Mean±SD, and count data was represented by frequency and/or percentage; skewed distribution metric data was represented by M ( Q1, Q3), and compared by rank sum test. Results:A total of 69 patients were enrolled, including 9 males and 60 females, aged 25-45 years, with an average age of 36.7 years. Among them, 35 patients had midfacial depression, and 11 patients had skin laxity. (0.37±0.07) ml (0.2-0.6 ml) of micro-autologous fat was injected into the orbicularis oculi muscle on each side; (0.18±0.06) ml (0.1-0.2 ml) of micro-autologous fat was injected into the subcutaneous layer on each side; (3.80±0.98) ml (3-5 ml) of micro-autologous fat was injected into the deep medial cheek fat compartment and pyriform aperture fat compartment on each side. No serious complications occurred after the surgery. Postoperative follow-up lasted for 6-13 months, with an average of 8.7 months. The patient’s lower eyelid pouch, tear trough deformity, and depression in the midface have all improved, presenting a youthful and smooth appearance from the infraorbital area to the midface. The skin texture in the lower eyelid area had also improved. At the last follow-up, the Barton classification of the lacrimal groove decreased compared with that before surgery, and the difference was statistically significant [grade 0 (0, 1) vs. grade 2 (1, 2), Z=-7.62, P<0.001]. At the last follow-up, the PAIS score of 69 patients was 5 points in 49 cases (71%) and 4 points in 20 cases (29%); doctor’s GAIS score was 5 points in 38 cases (55%), 4 points in 27 cases (39%), and 3 points in 4 cases (6%) . Conclusion:For those patients with aging status of infraorbital region, like lower eyelid pouch and tear trough deformities, the combination of lower eyelid blepharoplasty through the transconjunctival approach and MAFT can achieve good therapeutic effects. This method is safe with a short recovery time.