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

Objective:To explore the genetic etiology of a fetus with cryptophthalmos detected by prenatal ultrasonography.Methods:A fetus undergoing induced labor at 32nd gestational week due to absence of bilateral eye fissures detected by prenatal ultrasonography in January 2017 was selected as the study subject. Umbilical cord blood sample from the fetus and peripheral blood samples from its parents were collected for the extraction of genomic DNA. Pathogenic variants were screened through whole exome sequencing (WES) and verified by Sanger sequencing. Pathogenicity of candidate variants was verified by bioinformatic analysis and protein structure simulation. Based on the results of genetic testing, prenatal diagnosis was provided to the couple upon their subsequent pregnancy.Results:The couple had four adverse pregnancies previously. The aborted fetus was the fifth, with fused bilateral upper and lower eyelids, poorly developed eyeballs, adhesion of the cornea with the upper eyelid, low-set ears, and abnormal plantar creases, and was diagnosed with cryptophthalmos. WES and Sanger sequencing revealed that the fetus has harbored compound heterozygous variants of the FREM2 gene, namely c. 4537G>A (p.D1513N) and c.7292C>T (p.T2431M). Both variants were unreported associated with cryptophthalmos previously. Protein structure simulation showed that they may lead to loss of hydrogen bonds in the protein product. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), both variants were predicted to be likely pathogenic (PM1_Supporting+ PM2_Supporting+ PM5+ PP3+ PP4; PM2_Supporting+ PM3+ PP3+ PP4). The mother was performed prenatal diagnosis in her sixth pregnancy based on the variants detected in this family, and delivered a daughter with normal phenotype. Conclusion:The FREM2: c. 4537G>A and c. 7292C>T compound heterozygous variants probably underlay the pathogenesis of cryptophthalmos in this fetus. Above finding has enriched the mutational spectrum of the FREM2 gene.

【Objective】 To analyze the genetic variation characteristics and clinical phenotypes of a family with primary microcephaly (MCPH) caused by RTTN gene variation, and to provide reference for genetic counseling and prenatal diagnosis. 【Methods】 Clinical data of the three patients (including 2 fetuses and 2-year-old proband,and one fetus with clinical diagnosis) and their parents were collected and analyzed. Two of the children and their parents were tested by trio whole exome sequencing (trio-WES), sanger sequencing validation sites, and the hazard of their compound heterozygous variants was predicted. Literature review was conducted through domestic and international databases to collect reported RTTN gene mutation cases. 【Results】 Three patients in this family had anomalies of the septum pellucidum, hypoplasia of the corpus callosum and other brain malformations during fetal period. The proband (G2) and fetus (G3) showed intrauterine growth retardation and MCPH in late pregnancy; besides, G2 was born with global developmental delay. Trio-WES detected a c.2101(exon16)C>T(p.Arg701Ter,1526) nonsense and a c.2863(exon22)G>A(p.Glu955Lys)missense in the RTTN gene of G2 and G3, which were inherited from their father and mother, forming a compound heterozygous variant. According to the American College of Medical Genetics and Genomics (ACMG) variant classification guidelines, two variants were likely to be pathogenic (LP) and uncertain significance (VUS). Among them, c.2863(exon22)G>A was a newly discovered missense, which was predicted by the software to be harmful to the gene product. 【Conclusions】 Complex heterozygous variations of RTTN gene (c.2101C>T and c.2863G>A) are the genetic cause of MCPH in this family. This report has enriched the variation spectrum of RTTN gene, provided guidance for prenatal diagnosis and reproduction of this family, as well as material and reference for further understanding of the diseases caused by this gene mutation.

Objective:To investigate the correlation between iodine nutrition level and thyroid function in women in early pregnancy and to analyze the risk factors associated with adverse pregnancy outcomes.Meth-ods:A retrospective analysis of 566 early pregnant women who underwent routine prenatal examinations from Oc-tober 2020 to May 2022 in Peking Union Medical College Hospital.Their general clinical information,urinary iodine concentration and thyroid function were collected to determine the iodine nutritional status of pregnant women in early pregnancy.According to different iodine nutrient levels,they were divided into the iodine deficiency group(UIC＜150 μg/g),iodine beyond appropriate group(250 μg/g ≤ UIC＜500 μg/g),iodine excess group(UIC ≥500 μg/g),iodine appropriate group(150 μg/g≤UIC＜250 μg/g)and iodine nutrition abnormality group(inclu-ding iodine deficiency,iodine beyond appropriate,and iodine excess).The incidence of thyroid disease was com-pared and analyzed.Logistic regression analysis was used to analyze the risk factors of the adverse pregnancy outcomes(including hypertensive disorders in pregnancy,gestational diabetes mellitus,preterm delivery,miscar-riage,and low birth weight infants).Results:①The median urinary iodine/creatinine ratio of the 566 pregnant women in early pregnancy was 99 μg/g,indicating an overall iodine deficiency level.The abnormal rate of iodine nutrition was 82.9％(including 73.0％in iodine deficiency group,7.4％in iodine beyond appropriate group and 2.5％in iodine excess group),but only 17.1％in appropriate group.②There was no significant difference in the incidence of thyroid dysfunction(including hypothyroidism,subclinical hypothyroidism,and simple positive TPO-Ab)among groups with different levels of iodine nutrition(P＞0.05).However,the incidence of thyroid dys-function in pregnant women with iodine nutrition abnormalitieswas higher than that in pregnant women with moder-ate iodine and the difference was statistically significant(20.3％vs.11.3％,x2=4.198,P=0.04).③Multivariate Logistic regression analysis showed that age(≥35 years),body mass index(≥24 kg/m2)and abnormal iodine nutrition were independent risk factors of the adverse pregnancy outcomes(OR＞1,P＜0.05).Conclusions:The rate of abnormal iodine nutrition in early pregnancy is more than 80％,indicating an overall iodine deficiency state Abnormal iodine nutrition is a risk factor of adverse pregnancy outcomes.It is recommended to monitor the iodine nutrition level of pregnant women in early pregnancy,provide iodine supplementation or low iodine diet according to different iodine nutrition levels,correct abnormal iodine nutrition during pregnancy,and strengthen health educa-tion intervention to improve pregnancy outcomes.

Objective:To investigate the correlation between iodine nutrition level and thyroid function in women in early pregnancy and to analyze the risk factors associated with adverse pregnancy outcomes.Meth-ods:A retrospective analysis of 566 early pregnant women who underwent routine prenatal examinations from Oc-tober 2020 to May 2022 in Peking Union Medical College Hospital.Their general clinical information,urinary iodine concentration and thyroid function were collected to determine the iodine nutritional status of pregnant women in early pregnancy.According to different iodine nutrient levels,they were divided into the iodine deficiency group(UIC＜150 μg/g),iodine beyond appropriate group(250 μg/g ≤ UIC＜500 μg/g),iodine excess group(UIC ≥500 μg/g),iodine appropriate group(150 μg/g≤UIC＜250 μg/g)and iodine nutrition abnormality group(inclu-ding iodine deficiency,iodine beyond appropriate,and iodine excess).The incidence of thyroid disease was com-pared and analyzed.Logistic regression analysis was used to analyze the risk factors of the adverse pregnancy outcomes(including hypertensive disorders in pregnancy,gestational diabetes mellitus,preterm delivery,miscar-riage,and low birth weight infants).Results:①The median urinary iodine/creatinine ratio of the 566 pregnant women in early pregnancy was 99 μg/g,indicating an overall iodine deficiency level.The abnormal rate of iodine nutrition was 82.9％(including 73.0％in iodine deficiency group,7.4％in iodine beyond appropriate group and 2.5％in iodine excess group),but only 17.1％in appropriate group.②There was no significant difference in the incidence of thyroid dysfunction(including hypothyroidism,subclinical hypothyroidism,and simple positive TPO-Ab)among groups with different levels of iodine nutrition(P＞0.05).However,the incidence of thyroid dys-function in pregnant women with iodine nutrition abnormalitieswas higher than that in pregnant women with moder-ate iodine and the difference was statistically significant(20.3％vs.11.3％,x2=4.198,P=0.04).③Multivariate Logistic regression analysis showed that age(≥35 years),body mass index(≥24 kg/m2)and abnormal iodine nutrition were independent risk factors of the adverse pregnancy outcomes(OR＞1,P＜0.05).Conclusions:The rate of abnormal iodine nutrition in early pregnancy is more than 80％,indicating an overall iodine deficiency state Abnormal iodine nutrition is a risk factor of adverse pregnancy outcomes.It is recommended to monitor the iodine nutrition level of pregnant women in early pregnancy,provide iodine supplementation or low iodine diet according to different iodine nutrition levels,correct abnormal iodine nutrition during pregnancy,and strengthen health educa-tion intervention to improve pregnancy outcomes.

Objective:To investigate the correlation between iodine nutrition level and thyroid function in women in early pregnancy and to analyze the risk factors associated with adverse pregnancy outcomes.Meth-ods:A retrospective analysis of 566 early pregnant women who underwent routine prenatal examinations from Oc-tober 2020 to May 2022 in Peking Union Medical College Hospital.Their general clinical information,urinary iodine concentration and thyroid function were collected to determine the iodine nutritional status of pregnant women in early pregnancy.According to different iodine nutrient levels,they were divided into the iodine deficiency group(UIC＜150 μg/g),iodine beyond appropriate group(250 μg/g ≤ UIC＜500 μg/g),iodine excess group(UIC ≥500 μg/g),iodine appropriate group(150 μg/g≤UIC＜250 μg/g)and iodine nutrition abnormality group(inclu-ding iodine deficiency,iodine beyond appropriate,and iodine excess).The incidence of thyroid disease was com-pared and analyzed.Logistic regression analysis was used to analyze the risk factors of the adverse pregnancy outcomes(including hypertensive disorders in pregnancy,gestational diabetes mellitus,preterm delivery,miscar-riage,and low birth weight infants).Results:①The median urinary iodine/creatinine ratio of the 566 pregnant women in early pregnancy was 99 μg/g,indicating an overall iodine deficiency level.The abnormal rate of iodine nutrition was 82.9％(including 73.0％in iodine deficiency group,7.4％in iodine beyond appropriate group and 2.5％in iodine excess group),but only 17.1％in appropriate group.②There was no significant difference in the incidence of thyroid dysfunction(including hypothyroidism,subclinical hypothyroidism,and simple positive TPO-Ab)among groups with different levels of iodine nutrition(P＞0.05).However,the incidence of thyroid dys-function in pregnant women with iodine nutrition abnormalitieswas higher than that in pregnant women with moder-ate iodine and the difference was statistically significant(20.3％vs.11.3％,x2=4.198,P=0.04).③Multivariate Logistic regression analysis showed that age(≥35 years),body mass index(≥24 kg/m2)and abnormal iodine nutrition were independent risk factors of the adverse pregnancy outcomes(OR＞1,P＜0.05).Conclusions:The rate of abnormal iodine nutrition in early pregnancy is more than 80％,indicating an overall iodine deficiency state Abnormal iodine nutrition is a risk factor of adverse pregnancy outcomes.It is recommended to monitor the iodine nutrition level of pregnant women in early pregnancy,provide iodine supplementation or low iodine diet according to different iodine nutrition levels,correct abnormal iodine nutrition during pregnancy,and strengthen health educa-tion intervention to improve pregnancy outcomes.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Objective:To investigate the correlation between iodine nutrition level and thyroid function in women in early pregnancy and to analyze the risk factors associated with adverse pregnancy outcomes.Meth-ods:A retrospective analysis of 566 early pregnant women who underwent routine prenatal examinations from Oc-tober 2020 to May 2022 in Peking Union Medical College Hospital.Their general clinical information,urinary iodine concentration and thyroid function were collected to determine the iodine nutritional status of pregnant women in early pregnancy.According to different iodine nutrient levels,they were divided into the iodine deficiency group(UIC＜150 μg/g),iodine beyond appropriate group(250 μg/g ≤ UIC＜500 μg/g),iodine excess group(UIC ≥500 μg/g),iodine appropriate group(150 μg/g≤UIC＜250 μg/g)and iodine nutrition abnormality group(inclu-ding iodine deficiency,iodine beyond appropriate,and iodine excess).The incidence of thyroid disease was com-pared and analyzed.Logistic regression analysis was used to analyze the risk factors of the adverse pregnancy outcomes(including hypertensive disorders in pregnancy,gestational diabetes mellitus,preterm delivery,miscar-riage,and low birth weight infants).Results:①The median urinary iodine/creatinine ratio of the 566 pregnant women in early pregnancy was 99 μg/g,indicating an overall iodine deficiency level.The abnormal rate of iodine nutrition was 82.9％(including 73.0％in iodine deficiency group,7.4％in iodine beyond appropriate group and 2.5％in iodine excess group),but only 17.1％in appropriate group.②There was no significant difference in the incidence of thyroid dysfunction(including hypothyroidism,subclinical hypothyroidism,and simple positive TPO-Ab)among groups with different levels of iodine nutrition(P＞0.05).However,the incidence of thyroid dys-function in pregnant women with iodine nutrition abnormalitieswas higher than that in pregnant women with moder-ate iodine and the difference was statistically significant(20.3％vs.11.3％,x2=4.198,P=0.04).③Multivariate Logistic regression analysis showed that age(≥35 years),body mass index(≥24 kg/m2)and abnormal iodine nutrition were independent risk factors of the adverse pregnancy outcomes(OR＞1,P＜0.05).Conclusions:The rate of abnormal iodine nutrition in early pregnancy is more than 80％,indicating an overall iodine deficiency state Abnormal iodine nutrition is a risk factor of adverse pregnancy outcomes.It is recommended to monitor the iodine nutrition level of pregnant women in early pregnancy,provide iodine supplementation or low iodine diet according to different iodine nutrition levels,correct abnormal iodine nutrition during pregnancy,and strengthen health educa-tion intervention to improve pregnancy outcomes.

Objective:To investigate the correlation between iodine nutrition level and thyroid function in women in early pregnancy and to analyze the risk factors associated with adverse pregnancy outcomes.Meth-ods:A retrospective analysis of 566 early pregnant women who underwent routine prenatal examinations from Oc-tober 2020 to May 2022 in Peking Union Medical College Hospital.Their general clinical information,urinary iodine concentration and thyroid function were collected to determine the iodine nutritional status of pregnant women in early pregnancy.According to different iodine nutrient levels,they were divided into the iodine deficiency group(UIC＜150 μg/g),iodine beyond appropriate group(250 μg/g ≤ UIC＜500 μg/g),iodine excess group(UIC ≥500 μg/g),iodine appropriate group(150 μg/g≤UIC＜250 μg/g)and iodine nutrition abnormality group(inclu-ding iodine deficiency,iodine beyond appropriate,and iodine excess).The incidence of thyroid disease was com-pared and analyzed.Logistic regression analysis was used to analyze the risk factors of the adverse pregnancy outcomes(including hypertensive disorders in pregnancy,gestational diabetes mellitus,preterm delivery,miscar-riage,and low birth weight infants).Results:①The median urinary iodine/creatinine ratio of the 566 pregnant women in early pregnancy was 99 μg/g,indicating an overall iodine deficiency level.The abnormal rate of iodine nutrition was 82.9％(including 73.0％in iodine deficiency group,7.4％in iodine beyond appropriate group and 2.5％in iodine excess group),but only 17.1％in appropriate group.②There was no significant difference in the incidence of thyroid dysfunction(including hypothyroidism,subclinical hypothyroidism,and simple positive TPO-Ab)among groups with different levels of iodine nutrition(P＞0.05).However,the incidence of thyroid dys-function in pregnant women with iodine nutrition abnormalitieswas higher than that in pregnant women with moder-ate iodine and the difference was statistically significant(20.3％vs.11.3％,x2=4.198,P=0.04).③Multivariate Logistic regression analysis showed that age(≥35 years),body mass index(≥24 kg/m2)and abnormal iodine nutrition were independent risk factors of the adverse pregnancy outcomes(OR＞1,P＜0.05).Conclusions:The rate of abnormal iodine nutrition in early pregnancy is more than 80％,indicating an overall iodine deficiency state Abnormal iodine nutrition is a risk factor of adverse pregnancy outcomes.It is recommended to monitor the iodine nutrition level of pregnant women in early pregnancy,provide iodine supplementation or low iodine diet according to different iodine nutrition levels,correct abnormal iodine nutrition during pregnancy,and strengthen health educa-tion intervention to improve pregnancy outcomes.

Objective:To investigate the correlation between iodine nutrition level and thyroid function in women in early pregnancy and to analyze the risk factors associated with adverse pregnancy outcomes.Meth-ods:A retrospective analysis of 566 early pregnant women who underwent routine prenatal examinations from Oc-tober 2020 to May 2022 in Peking Union Medical College Hospital.Their general clinical information,urinary iodine concentration and thyroid function were collected to determine the iodine nutritional status of pregnant women in early pregnancy.According to different iodine nutrient levels,they were divided into the iodine deficiency group(UIC＜150 μg/g),iodine beyond appropriate group(250 μg/g ≤ UIC＜500 μg/g),iodine excess group(UIC ≥500 μg/g),iodine appropriate group(150 μg/g≤UIC＜250 μg/g)and iodine nutrition abnormality group(inclu-ding iodine deficiency,iodine beyond appropriate,and iodine excess).The incidence of thyroid disease was com-pared and analyzed.Logistic regression analysis was used to analyze the risk factors of the adverse pregnancy outcomes(including hypertensive disorders in pregnancy,gestational diabetes mellitus,preterm delivery,miscar-riage,and low birth weight infants).Results:①The median urinary iodine/creatinine ratio of the 566 pregnant women in early pregnancy was 99 μg/g,indicating an overall iodine deficiency level.The abnormal rate of iodine nutrition was 82.9％(including 73.0％in iodine deficiency group,7.4％in iodine beyond appropriate group and 2.5％in iodine excess group),but only 17.1％in appropriate group.②There was no significant difference in the incidence of thyroid dysfunction(including hypothyroidism,subclinical hypothyroidism,and simple positive TPO-Ab)among groups with different levels of iodine nutrition(P＞0.05).However,the incidence of thyroid dys-function in pregnant women with iodine nutrition abnormalitieswas higher than that in pregnant women with moder-ate iodine and the difference was statistically significant(20.3％vs.11.3％,x2=4.198,P=0.04).③Multivariate Logistic regression analysis showed that age(≥35 years),body mass index(≥24 kg/m2)and abnormal iodine nutrition were independent risk factors of the adverse pregnancy outcomes(OR＞1,P＜0.05).Conclusions:The rate of abnormal iodine nutrition in early pregnancy is more than 80％,indicating an overall iodine deficiency state Abnormal iodine nutrition is a risk factor of adverse pregnancy outcomes.It is recommended to monitor the iodine nutrition level of pregnant women in early pregnancy,provide iodine supplementation or low iodine diet according to different iodine nutrition levels,correct abnormal iodine nutrition during pregnancy,and strengthen health educa-tion intervention to improve pregnancy outcomes.