BACKGROUND: The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China. METHODS: This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences. RESULTS: Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [ n  = 278] vs . 43.7% [ n  = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45-0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs . 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82-2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses. CONCLUSION This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.
Humans ; Percutaneous Coronary Intervention/methods* ; Male ; Female ; Coronary Artery Disease/drug therapy* ; Retrospective Studies ; Renal Dialysis/methods* ; Middle Aged ; Aged ; China ; Proportional Hazards Models ; Treatment Outcome

Elemene is widely recognized as an effective anti-cancer compound and is routinely administered in Chinese clinical settings for the management of several solid tumors, including non-small cell lung cancer (NSCLC). However, its detailed molecular mechanism has not been adequately demonstrated. In this research, it was demonstrated that elemene effectively curtailed NSCLC growth in the patient-derived xenograft (PDX) model. Mechanistically, employing high-throughput screening techniques and subsequent biochemical validations such as microscale thermophoresis (MST), microRNA-145-5p (miR-145-5p) was pinpointed as a critical target through which elemene exerts its anti-tumor effects. Interestingly, elemene serves as a binding stabilizer for miR-145-5p, demonstrating a strong binding affinity (dissociation constant (K _D) = 0.39 ± 0.17 μg/mL) and preventing its degradation both in vitro and in vivo, while not interfering with the synthesis of the primary microRNA transcripts (pri-miRNAs) and precursor miRNAs (pre-miRNAs). The stabilization of miR-145-5p by elemene resulted in an increased level of this miRNA, subsequently suppressing NSCLC progression through the miR-145-5p/mitogen-activated protein kinase kinase kinase 3 (MAP3K3)/nuclear factor kappaB (NF-κB) pathway. Our findings provide a new perspective on revealing the interaction patterns between clinical anti-tumor drugs and miRNAs.

Objectives:To establish a comprehensive system of Cardiovascular Academic Performance Evaluation(CAPE)and rank global TOP100 medical institutions in the fields of cardiovascular diseases(CVD). Methods:CVD-related terms were extracted from Medical Subject Headings(MeSH),Embase thesaurus(EMtrees)and International Classification of Diseases(ICD)by CVD-related professionals,as well as by librarians and information professionals.Terminology databases(named as Fuwai Subject Headings)were established,and nine sub-disciplines were proposed,including ischemic heart diseases,hypertension,vascular diseases,arrhythmia,pulmonary vascular diseases,heart failure,congenital heart diseases,cardiomyopathy,and valvular heart diseases.The mapping patterns of sub-discipline,cardiovascular terminology and entry terms were pre-defined.The CVD-related research literature published from January 1,2016 to December 31,2022 were retrieved from Web of Science,PubMed and Scopus.Based on this,metadata were fused and duplicates were excluded.Fuwai Subject Headings were searched and matched into four respects for each literature,including subject words,titles,keywords,and abstracts,which was used to generate an information table of"Position—CVD terminology—Frequency",and to calculate CVD correlation scores and sub-discipline scores.We standardized the names of medical institutions and scholars,and make a ranking system for CAPE based on original articles with strong cardiovascular correlation(correlation score≥4).When evaluating the science and technological performance for Chinese hospitals in cardiovascular diseases,National Natural Science Foundation Projects,authorized invention patents,prize achievements,research platforms,and registered data of drug clinical trials in Center for Drug Evaluation(CDE)were considered besides research papers. Results:During 2016 and 2022,1 545 103 CVD research literatures were found worldwide.After excluding meeting abstracts,books,biographies,news,videos,audio texts,retracted publications,and corrections,1 178 019 CVD research literatures were further evaluated.518 058 literatures were indexed as"strongly correlated to CVD"using Fuwai Subject Headings.Besides papers,other data sources were also collected,including 11 143 CVD-related Natural Science Foundation Projects,19 382 CVD-related effective authorized invention patents,103 CVD-related national prize achievements,24 CVD-related national research platforms,and 2 084 CDE registered data of CVD-related drug clinical trials.Research teams from nine sub-disciplines reviewed and validated research literature in respective fields,and classification rules of corresponding sub-disciplines were created and improved based on their opinions.Finally,eleven individual indexes were chosen to construct CAPE system for ranking global TOP100 medical institutions in overall CVD field and TOP30 in nine sub-disciplines.From 2016 to 2022,the number of cardiovascular disease research papers published by Chinese institutes has increased by 123.5%,with a total of approximately 76.8 thousands papers published(about 30 papers per day on average),ranked the second under the United States(approximately 114.1 thousands papers).However,the proportion of papers published by the Chinese Journal Citation Reports(JCR)and the Chinese Academy of Sciences only ranked eighth in the world.In the comprehensive academic performance of original cardiovascular research papers in global hospitals from 2020 to 2022,only two Chinese medical institutions ranked in the TOP20 as evaluated by CAPE system. Conclusions:Based on multi-source data from 2016 to 2022,CAPE initiated to establish a cardiovascular academic performance evaluation system.

Objectives:To compare the patent protection and application status of cardiovascular technology innovation in ten major countries worldwide from 2016 to 2023,and to analyze and evaluate the relative competitiveness and innovation ability of technology achievements in the cardiovascular fields in China,providing reference for improving the transfer and transformation rate of scientific and technological achievements in this field. Methods:Based on the HimmPat,IncoPat,and Wisdom Seed patent databases,using the Fuwai Subject Headings,we searched patent application data in the cardiovascular fields from ten major countries worldwide from January 1,2016 to December 31,2023 by adopting the method of the International Patent Classification(IPC)-Title-Claims-Abstract.We compared and analyzed specific indicators from the three dimensions of the patent,including technology value,legal value,and economic value. Results:Over the past eight years,the total number of patent applications in the cardiovascular fields was counted from the perspective of patent applicant addresses to analyze the technological innovation capabilities in cardiovascular field of each country.The results showed that China ranked the second in the world in terms of the total number of patent applications in the cardiovascular fields,with approximately 46 536,followed the United States with 75 382.Although the number of patent family applications in China is higher than that in the United States(32 879 vs.19 587),overseas applications for family patent in China only account for 25.4%of its total patent application volume,which is only higher than that in Russia(15.5%),while much lower than that in the other eight countries.In terms of the average number of patent applicants,there are only 2.61 applicants per patent in China,compared with 10.02 in the United States and 12.69 in Germany.In terms of citation frequency of simple patent family,the United States has 9.76 citations per patent,while China has only 2.64 citations per patent.Besides,the patent transfer rate in China is also relatively low with a proportion of only 7.3%. Conclusions:The economic development,government policy support and technological advancement jointly contribute to the continuously increased number of cardiovascular patent applications in China.However,the patents are associated with poor quality,insufficient overseas layout,and insufficient horizontal cooperation in technological innovation,which may also be the main reasons for the insufficient momentum and efficiency of patent achievement transformation.

Objective:To explore the impact of coronary CT angiography (CCTA) image quality and related factors on the diagnostic performance of CT-derived fractional flow reserve (CT-FFR).Methods:Based on the CT-FFR CHINA trial, the prospective multicenter trial enrolled patients with suspected coronary artery disease who underwent CCTA, CT-FFR and FFR measurement. The subjective and objective assessments of CCTA image were performed on a per-vessel level. The objective assessments included the enhancement degree of coronary artery, the signal-to-noise ratio (SNR) of the aortic root. We used χ 2 test and DeLong test to compare the diagnostic performance of CT-FFR with FFR as the reference standard in different subjective groups (non-artifact vs. artifact), enhancement degree of coronary artery groups (≤400 vs. 401-500 vs.>500 HU), SNR of the aortic root groups (≤16.9 vs.>16.9), body mass index (BMI) groups (<25 kg/m 2 vs.≥25 kg/m 2) and heart rate groups (<75 bpm vs.≥75 bpm). FFR and CT-FFR values≤0.80 was identified as myocardial ischemia. Results:The study enrolled 317 patients with 366 vessels. All target vessels in CCTA images were successfully analyzed by CT-FFR. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and AUC of the non-artifact group were 90.45%, 86.75%, 93.10%, 90.00%, 90.76% and 0.928, respectively, and those of the artifact group were 83.23%, 87.21%, 79.01%, 81.52%, 85.33% and 0.869, respectively. The differences in accuracy and specificity were statistically significant (χ 2=4.23, P=0.040; χ 2=8.55, P=0.003). The diagnostic efficacy of CT-FFR had no statistically significant differences among different objective groups (all P>0.05). Conclusions:The artifact of CCTA image has an effect on CT-FFR in the diagnosis of myocardial ischemia. The degree of vascular enhancement, SNR, BMI, and heart rate have no significant effect on the diagnostic performance of CT-FFR.

Objective:To explore the role and mechanism of nuclear receptor subfamily 4 group A member 1 ( NR4A1) in suppressing cisplatin nephrotoxicity. Methods:The expression of NR4A1 gene in renal cell subpopulations was analyzed using the "Tabula-muris" single cell transcriptome sequencing database. NR4A1 gene was over-expressed by lentivirus infection in HK-2 cell line and primary renal proximal tubular epithelial cells. Cell counting kit-8 was used to detect the cytotoxicity of cisplatin. The cell death ratio was analyzed using propidium iodide (PI) staining by flow cytometry. The expression of NR4A1 and nuclear factor erythroid 2-related factor 2 ( NRF2) was detected by real-time fluorescent quantitative PCR and Western blotting. Ferroptosis was analyzed by detecting the contents of malondialdehyde (MDA), oxidized glutathione (GSSG) and lipid reactive oxygen species (ROS). Results:The single cell transcriptome sequencing database showed that NR4A1 gene was the lowest expression in renal proximal tubular epithelial cell subsets. Cisplatin (50 μmol/L or 100 μmol/L) could significantly induce MDA, GSSG and lipid ROS production in renal proximal tubular epithelial cells (all P<0.01), and higher cisplatin concentration accompanied with a more increase of MDA, GSSG and lipid ROS. Compared with the control HK-2 cells, the lipid ROS content and iron ion content of HK-2 cells over-expressing NR4A1 were significantly lower (all P<0.01), and the over-expression of NR4A1 inhibited cisplatin-induced cytotoxicity and ferroptosis in renal proximal tubular epithelial cells. Mechanistically, NR4A1 up-regulated the expression of anti-ferroptosis gene NRF2 in proximal renal tubular epithelial cells ( P<0.01). Furthermore, single cell data analysis showed that, similar to the expression of NR4A1 in renal tissue subsets, NRF2 was also the lowest in renal proximal tubular epithelial cells. Conclusions:Cisplatin can induce ferroptosis of renal proximal tubular epithelial cells in a dose-dependent manner. NR4A1 can inhibit cisplatin-induced ferroptosis by up-regulating NRF2 in renal proximal tubular epithelial cells, thereby alleviating the cytotoxicity of cisplatin.

Objective:To investigate the effect of cathodic transcranial direct current stimulation (ctDCS) combined with upper limb robot therapy (RT) on the rehabilitation of upper limb motor function in stroke patients.Methods:Forty patients with stroke hemiplegia who met the enrollment criteria were randomly divided into a pseudo-stimulation group ( n = 20) and a stimulation group ( n = 20). In addition to conventional treatment in both groups, ctDCS + RT was used in the stimulation group, and sham stimulation + RT was used in the sham-stimulation group. Treatment was performed 10 times, 5 times per week, for 30 minutes each time. Patients in both groups were evaluated before, during, and after treatment using the Brunnstrom Staging Scale, the Modified Barthel Index (MBI) scale, and the Modified Ashworth Scale (MAS), respectively. Results:Compared with the same group before treatment, there were statistically significant differences in Brunnstrom’s rating grade Ⅳ for upper limbs and hands in both groups during and after treatment (all P < 0.05). Compared with the same group during treatment, there were statistically significant differences in Brunnstrom’s rating grade Ⅳ for upper limbs and hands in both groups after treatment (all P < 0.05). MBI scores were higher in two groups during and after treatment compared to the same group before treatment (all P < 0.05). MBI scores were higher in two groups after treatment compared to the same group during treatment (all P < 0.05). The MBI scores after treatment in the stimulation group were higher than those in the pseudo-stimulation group ( P < 0.05). The MAS scores of elbow flexion grade 2 and extension grade 4 and shoulder flexion grade 2, extension grade 2, adduction grade 2, and abduction grade 2 were lower in both groups after treatment compared with the same group before treatment (all P < 0.05). Conclusions:Cathodic transcranial direct current stimulation combined with robotic therapy can effectively promote upper limb motor function rehabilitation in stroke patients and is superior to upper limb robotic therapy alone.

Objective:To evaluate the postoperative symmetry of soft and hard tissues in patients with unilateral old zygomatic fractures.Methods:A retrospective analysis of patients who underwent computer-assisted open reduction and internal fixation for unilateral old zygomatic complex fractures. The spiral CT data of the patient before and 1 year after operation was imported into ProPlan CMF 3.0 software to segment the skin and bone STL models. Eleven sets of soft tissue landmarks and 10 sets of hard tissue landmarks in the middle of the face were marked, with a coordinated system for measurement established. The asymmetry index (AI) between each mark point was calculated. The data were expressed by Mean±SD. Paired t-test was used to compare whether there was a statistical difference in the AI of each landmark before and after operation. P<0.05 was considered the difference to be statistically significant. At the same time, the study subjects were selected from the Chinese craniomaxillofacial three-dimensional morphological database. Microsoft Excel 2017 software was used to draw the AI baseline data map of common people. The patients’ soft and hard tissue landmarks AI (before and 1 year after surgery) were included in the AI baseline map of common people, and the patient’s soft and hard tissue symmetry was evaluated. Results:A total of 30 patients were included in the study, including 17 males and 13 females, age range from 18 to 55 years old, with an average age of 25.2 years. The preoperative hard tissue AI was 4.5±4.1, and the hard tissue AI was 2.0±1.7 one year after surgery, and the difference in the AI of each hard tissue landmark before and 1 year after operation was statistically significant( P<0.01 or <0.05). The preoperative soft tissue AI was 4.5±4.0, and the soft tissue AI was 2.3±1.9 one year after surgery, and the difference in the AI of each soft tissue landmark before and 1 year after operation was statistically significant( P<0.01 or <0.05). 50 common people were selected from the total database, including 25 men and 25 women, aged from 18 to 57 years old, with an average of 23.8 years old. The hard tissue landmark AI was 2.1±2.0, and the soft tissue landmark AI was 2.0±1.9. The hard tissue landmarks AI of patients 1 year after operation were all within the symmetrical baseline value, with good symmetry. The AI values of some soft tissue landmarks were higher than the symmetrical baseline value, indicating poor symmetry. Conclusion:The three-dimensional symmetry of the soft and hard tissues of patients with unilateral old zygomatic complex fractures after surgery was significantly improved compared with that before surgery. Compared with the normal range of the database, the postoperative hard tissue has better symmetry, but the postoperative soft tissue has poor symmetry.

Objective:To evaluate the postoperative symmetry of soft and hard tissues in patients with unilateral old zygomatic fractures.Methods:A retrospective analysis of patients who underwent computer-assisted open reduction and internal fixation for unilateral old zygomatic complex fractures. The spiral CT data of the patient before and 1 year after operation was imported into ProPlan CMF 3.0 software to segment the skin and bone STL models. Eleven sets of soft tissue landmarks and 10 sets of hard tissue landmarks in the middle of the face were marked, with a coordinated system for measurement established. The asymmetry index (AI) between each mark point was calculated. The data were expressed by Mean±SD. Paired t-test was used to compare whether there was a statistical difference in the AI of each landmark before and after operation. P<0.05 was considered the difference to be statistically significant. At the same time, the study subjects were selected from the Chinese craniomaxillofacial three-dimensional morphological database. Microsoft Excel 2017 software was used to draw the AI baseline data map of common people. The patients’ soft and hard tissue landmarks AI (before and 1 year after surgery) were included in the AI baseline map of common people, and the patient’s soft and hard tissue symmetry was evaluated. Results:A total of 30 patients were included in the study, including 17 males and 13 females, age range from 18 to 55 years old, with an average age of 25.2 years. The preoperative hard tissue AI was 4.5±4.1, and the hard tissue AI was 2.0±1.7 one year after surgery, and the difference in the AI of each hard tissue landmark before and 1 year after operation was statistically significant( P<0.01 or <0.05). The preoperative soft tissue AI was 4.5±4.0, and the soft tissue AI was 2.3±1.9 one year after surgery, and the difference in the AI of each soft tissue landmark before and 1 year after operation was statistically significant( P<0.01 or <0.05). 50 common people were selected from the total database, including 25 men and 25 women, aged from 18 to 57 years old, with an average of 23.8 years old. The hard tissue landmark AI was 2.1±2.0, and the soft tissue landmark AI was 2.0±1.9. The hard tissue landmarks AI of patients 1 year after operation were all within the symmetrical baseline value, with good symmetry. The AI values of some soft tissue landmarks were higher than the symmetrical baseline value, indicating poor symmetry. Conclusion:The three-dimensional symmetry of the soft and hard tissues of patients with unilateral old zygomatic complex fractures after surgery was significantly improved compared with that before surgery. Compared with the normal range of the database, the postoperative hard tissue has better symmetry, but the postoperative soft tissue has poor symmetry.

Objectives:To investigate the clinical impacts of chronic total occlusion (CTO) in acute non-ST segment elevation myocardial infarction (NSTEMI) patients underwent primary percutaneous coronary intervention (PCI).Methods:A total of 2 271 acute NSTEMI patients underwent primary PCI from China Acute Myocardial Infarction Registry were enrolled in this study and divided into the CTO group and the non-CTO group according to the angiography. The primary endpoint was in-hospital mortality and mortality during a 2-year follow-up. The secondary endpoint was major adverse cardiovascular events (MACE) including revascularization, death, re-myocardial infarction, heart failure readmission, stroke and major bleeding.Results:Thirteen-point four percent of the total acute NSTEMI patients had concurrent CTO. In-hospital mortality (3.6% vs. 1.4%, P<0.01) and 2-year mortality (9.0% vs. 5.1%, P<0.01) were significantly higher in the CTO group than those in the non-CTO group, respectively. Multiple regression analyses showed that chronic obstructive pulmonary disease ( HR 7.28, 95% CI 1.50-35.35, P=0.01) was an independent risk factor of in-hospital mortality, and advanced age ( HR 1.04, 95% CI 1.01-1.07, P<0.01), and low levels of ejection fraction ( HR 0.95, 95% CI 0.93-0.98, P<0.01) were independent risk factors of 2-year mortality. CTO ( HR1.67, 95% CI 1.10-2.54, P=0.02) was an independent risk factor of revascularization, but not a risk factor of mortality. Conclusions:Although acute NSTEMI patients concurrent with CTO had higher mortality, CTO was only an independent risk factor of revascularization, but not of mortality. Advanced age and low levels of ejection fraction were independent risk factors of long-term death among acute NSTEMI patients.