Diagnostic and Clinical Value of FFRCT in Stable Chest Pain Patients With Extensive Coronary Calcification: The FACC Study

BackgroundThe influence of extensive coronary calcifications on the diagnostic and prognostic value of coronary computed tomography angiography–derived fractional flow reserve (FFRCT) has been scantily investigated.ObjectivesThe purpose of this study was to investigate the diagnostic and short-term role of FFR_CT in chest pain patients with Agatston score (AS) >399.MethodsThis was a prospective multicenter study of 260 stable patients with suspected coronary artery disease (CAD) and AS >399. FFR_CT was measured blinded by an independent core laboratory. All patients underwent invasive coronary angiography (ICA) and FFR if indicated. The agreement of FFR_CT ≤0.80 with hemodynamically significant CAD on ICA/FFR (≥50% left main or ≥70% epicardial artery stenosis and/or FFR ≤0.80) was assessed. Patients undergoing FFR had colocation FFR_CT measured, and the lowest per-patient FFR_CT was registered in all patients. The association among per-patient FFR_CT, coronary revascularization, and major clinical events (all-cause mortality, myocardial infarction, or unstable angina hospitalization) at 90-day follow-up was evaluated.ResultsMedian age and AS were 68.5 years (IQR: 63-74 years) and 895 (IQR: 587-1,513), respectively. FFR_CT was ≤0.80 in 204 patients (78%). Colocation FFR_CT (n = 112) showed diagnostic accuracy, sensitivity, and specificity to identify hemodynamically significant CAD of 71%, 87%, and 54%. The area under the receiver-operating characteristics curve (AUC) was 0.75. When using the lowest FFR_CT (n = 260), per-patient accuracy, sensitivity, and specificity were 57%, 95%, and 32%, respectively. The AUC was 0.84. A total of 85 patients underwent revascularization, and FFR_CT was ≤0.80 in 96% of these. During follow-up, major clinical events occurred in 3 patients (1.2%), all with FFR_CT ≤0.80.ConclusionsMost patients with AS >399 had FFR_CT ≤0.80. Using ICA/FFR as the reference revealed a moderate diagnostic accuracy of colocation FFR_CT. Compared with the lowest per-patient FFR_CT, colocation FFR_CT measurement improved diagnostic accuracy and specificity. The 90-day follow-up was favorable with few coronary revascularizations and no major clinical events occurring in patients with FFR_CT >0.80. (Use of FFR-CT in Stable Intermediate Chest Pain Patients With Severe Coronary Calcium Score [FACC]; NCT03548753)     

Efficacy of proportional versus high condylectomy in active condylar hyperplasia — A systematic review

ObjectiveTo perform a systematic literature review to test the efficacy of proportional condylectomy versus high condylectomy in patients with active condylar hyperplasia, in terms of avoiding secondary surgeries.MethodFollowing a search of Medline (Pubmed), Embase, Scopus, Web of Science and Cochrane databases, ten studies were included for qualitative analysis, and two studies were included for meta-analysis. Quality assessment was performed using the Newcastle–Ottawa scale for cohort studies and the 18-item modified Delphi technique for case series.Results259 patients were included in the qualitative analysis, with a weighted arithmetic mean age of 20.4 years, and a female:male ratio of 2:1. Meta-analysis was carried out for 52 patients, and it was found that proportional condylectomy reduced the need for secondary surgery (p = 0.0003). Although this evidence had limitations, excised bone on proportional condylectomy was superior when compared with excised bone on high condylectomy, re-establishing the occlusal plane, resulting in fewer asymmetries, and therefore reducing the need for further surgery.ConclusionsThis systematic review showed a tendency for proportional condylectomies to avoid additional surgeries; however, more comparative studies are necessary.     

Chinese adults′ cognition of respiratory diseases in Healthy China Initiative (2019—2030)CSCD

Objective To investigate the cognition of Chinese adults on respiratory health in the Healthy China Initiative (2019—2030). Methods From January 2022 to February 2022, the electronic questionnaire was distributed by using the two‑dimensional code on the Wechat platform. The questionnaire involving the respiratory health part of the Healthy China Initiative (2019—2030) was conducted among people aged ≥18 years (except pregnant and postpartum women) in 32 provincial administrative regions in China. A total of 5 892 questionnaires were distributed, 4 754 valid questionnaires were recovered. Chi square test was used to analyze the basic situation of the survey subjects, the cognition of people in different regions to the content, the correlation between physical activity and age stratification, the correlation between smoking cessation and disease, and the common cognitive misunderstanding of chronic obstructive pulmonary disease. Results Of the 4 754 subjects in this study, 3 462 were from urban area and 1 292 were from rural area. In terms of active participation in lung cancer screening, regular physical examination, no awareness of reducing risk factors exposure, isolation of pulmonary tuberculosis patients, reduction of travel of pulmonary tuberculosis patients, wearing masks when contact with pulmonary tuberculosis patients, active learning of medical and health care knowledge, and timely medical treatment in case of health problems, the cognition status of people in the city was better than people in the rural areas (all P< 0.05). The compliance rates of moderate intensity physical activity and high intensity physical activity were 72.7% and 83.8%, respectively, among the population aged 18—64 years old; the compliance rates of moderate intensity physical activity and high intensity physical activity were 82.3% and 85.7%, respectively, among the population aged≥65 years old; the proportions of light intensity physical activity in people aged 18—64 and ≥65 years old were 65.2% and 87.6%, respectively. There was a correlation between whether the patients had respiratory diseases and whether they were troubled by respiratory diseases for a long time and their determination to quit smoking (all P<0.05); the rate of common misconceptions about chronic obstructive pulmonary disease among Chinese adults was between 13.0% and 38.0%, and the rate of misconceptions among people with college education or above who believed that even if the cognition of chronic obstructive pulmonary disease was improved and the diagnosis and treatment were standardized, the treatment of the disease was still ineffective was as high as 30.3%; in addition, the rate of two cognitive misunderstandings (when the symptoms of chronic obstructive pulmonary disease were mild, no intervention was needed; the medication can be discontinued when the symptoms were relieved) of people with college education or above were 24.2% and 25.8%, respectively, which were higher than those with primary school education and junior high school education (all P<0.05). Conclusions The cognition of Chinese adults on early screening of respiratory diseases, reduction of exposure to risk factors, prevention and control of tuberculosis, and acquisition of scientific knowledge in the Healthy China Initiative (2019—2030) is generally poor. The participation of people <65 years old in high‑intensity physical activities is insufficient, and the cognition of people with high education level does not show advantages. © 2021 Journal of Clinical Otorhinolaryngology Head and Neck Surgery. All rights reserved.     

YY 0336-2020《一次性使用无菌阴道扩张器》标准解析

介绍了YY0336-2020《一次性使用无菌阴道扩张器》的制定背景,对比了YY0336新、旧标准的主要内容变化,分析了YY0336-2020中外观、尺寸、抗变形能力、结构强度、环氧乙烷残留量等重要条款,总结了YY 0336-2020的改进及优势.指出了YY 0336-2020的发布实施,对于生产该类产品的生产商稳步提高...     

64层螺旋CT对冠状动脉支架术后再狭窄的评价

目的评价64层螺旋CT诊断冠状动脉支架内再狭窄（ISR）的临床应用价值。方法采用64层螺旋CT对32例冠状动脉支架置入术后的患者（共计54枚支架）进行CT冠状动脉成像（CTA）。在CTA上,通过肉眼观察方法诊断ISR。结果 39枚支架中,CCA检出ISR（≥50%）11枚,正常（包括ISR〈50%）28枚。与CCA对照,CTA肉眼观察法正确诊断ISR8枚,无狭窄24枚。以冠状动脉造影（ISR≥50%）为标准,分析ISR的敏感性、特异性、阳性预测值和阴性预测值分别为72.7%、85.7%、66.7%、88.9%。结论 64层螺旋CT诊断支架腔内ISR有一定的限度,但能较准确地区分支架通畅和闭塞;对支架边缘型ISR显示了较好的准确性。     

卡马西平口腔速崩片处方筛选和制备工艺研究

目的为了方便老人、儿童和吞咽困难的患者服药,提高卡马西平的生物利用度,优化处方制备卡马西平口腔速崩片（CBZ—ODT）。方法筛选恰当的崩解时间测定方法,以崩解时间和口感为主要评价指标,通过实验选择最佳制备工艺及配方,并通过单因素试验选取对崩解时间影响大的成分的含量为变量进行三因素四水平的L16（43）正交试验设计,确定最优处方。结果采用全粉末直接压片法,用乳糖作为填充剂,硬脂酸镁做为润滑剂,交联羧甲基纤维素钠（CCNa）作为崩解剂,以崩解时间、硬度和口感为评价指标筛选出最佳处方组合压制三批卡马西平口腔速崩片,片面光洁圆整,无斑点,经测试,崩解时间在（21±3）s。结论采用全粉末直接压片法压片,工艺简单且能满足要求。采用崩解仪改良法测量崩解时间更为接近于人体口腔内的测定结果,所制备的卡马西平口腔崩解片崩解时间短,硬度适中,口感好,具备临床应用价值。     

卡马西平临床合并用药及不良反应

本文通过研究、总结、提高卡马西平临床合并用药合理性,使人们对卡马西平治疗作用有进一步了解;同时让人们认识到如果合并用药不当,将会产生一系列毒副作用。因此要重视卡马西平药物相互作用,促进合理用药。     

卡马西平治疗癫血药浓度监测及合理用药

目的探讨卡马西平抗癫作用与血药浓度的关系,以指导临床合理用药。方法采用萤光偏振免疫法(FPIA)测定128例癫患者卡马西平的血药浓度。结果血药浓度在有效治疗范围且癫发作得以基本控制的占82.56%,25.00%的患者血药浓度低于有效治疗范围而癫发作仍得到有效控制,其中联合用药中42.86%的患者癫发作得以控制。结论血药浓度监测有利于提高癫治疗药物的安全性、有效性及合理性,减少毒副作用,但需考虑一些影响因素,如卡马西平肝药酶诱导作用,代谢物卡马西平10,11-环氧化物对临床疗效的影响,药物相互作用,以及给药方案等。     

Isobolographic characterization of interactions of retigabine with carbamazepine, lamotrigine, and valproate in the mouse maximal electroshock-induced seizure model

The aim of this study was to characterize the pharmacodynamic, pharmacokinetic, and adverse-effect profiles of retigabine (RTG) in combination with carbamazepine (CBZ), lamotrigine (LTG), and valproate (VPA). The isobolographic analysis for parallel and nonparallel dose–response effects was used in the mouse maximal electroshock seizure (MES) model for evaluation of pharmacodynamic interaction. Potential adverse-effect profiles of interactions of RTG with CBZ, LTG, and VPA at the fixed ratio of 1:1 in the MES test were evaluated in the chimney (motor performance), passive avoidance (long-term memory), and grip strength (muscular strength) tests. Free plasma and total brain concentrations of CBZ, LTG, and VPA were determined by immunofluorescence and chromatography to assess pharmacokinetic interaction. In the MES model, RTG administered singly had its dose–response relationship curve (DRRC) parallel to that for VPA and nonparallel to that for CBZ and LTG. With isobolography for parallel DRRCs, the combination of RTG with VPA at fixed ratios of 1:3, 1:1, and 3:1 exerted supraadditive (synergistic) interaction. Isobolography for nonparallel DRRCs revealed that the combinations of RTG with CBZ and LTG at the fixed ratio of 1:1 produced additive interaction. In all combinations, neither motor coordination, long-term memory, nor muscular strength were affected. Only the combination of RTG with VPA at the fixed ratio of 3:1 was complicated by a pharmacokinetic increase in both free plasma and total brain VPA concentrations. All remaining combinations of RTG with VPA, CBZ, and LTG were pharmacodynamic in nature. RTG synergistically interacted with VPA and exerted additive interaction with CBZ and LTG in the mouse MES model.