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

Threatened abortion is a common disease of obstetrics and gynecology and one of the diseases responding specifically to traditional Chinese medicine （TCM）. The China Association of Chinese Medicine organized experts in TCM obstetrics and gynecology， Western medicine obstetrics and gynecology， and pharmacology to deeply discuss the advantages of TCM and integrated Chinese and Western medicine treatment as well as the medication plans for threatened abortion. After discussion， the experts concluded that chromosome， endocrine， and immune abnormalities were the key factors for the occurrence of threatened abortion， and the Qi and blood disorders in thoroughfare and conception vessels were the core pathogenesis. In the treatment of threatened abortion， TCM has advantages in preventing miscarriages， alleviating clinical symptoms and TCM syndromes， relieving anxiety， regulating reproductive endocrine and immune abnormalities， personalized and diversified treatment， enhancing efficiency and reducing toxicity， and preventing the disease before occurrence. The difficulty in diagnosis and treatment of threatened abortion with traditional Chinese and Western medicine lies in identifying the predictors of abortion caused by maternal factors and the treatment of thrombophilia. Recurrent abortion is the breakthrough point of treatment with integrated traditional Chinese and Western medicine. It is urgent to carry out high-quality evidence-based medicine research in the future to improve the modern diagnosis and treatment of threatened abortion with TCM.

ObjectiveTo explore the mechanism of modified Shuyuwan in treating vascular dementia （VaD） complicated with depression in mice. MethodThe VaD model was established by bilateral carotid artery stenosis （BCAS） in seven 3-month-old male C57/BL6 mice. The regional cerebral blood flow （rCBF） of mice was measured by laser speckle imaging before and after BCAS surgery. Then， the BCAS method was combined with chronic unpredictable mild stress （CUMS） to establish a mouse model of VaD complicated with depression. BCAS/CUMS mice were assigned into BCAS/CUMS， fluoxetine （0.01 g·kg^-1）， and high-， medium-， and low-dose （20， 10， 5 g·kg^-1， respectively） modified Shuyuwan groups. The shame group underwent sham operation without CUMS （n=10）. The tail suspension test and sucrose preference test were carried out to examine the depressive behaviors of mice. The distribution and expression of myelin-associated glycoprotein （MAG）， myelin basic protein （MBP）， neurofilament heavy polypeptide （NF200）， and anti-non-phosphorylated neurofilament epitope antibody （SMI32） in the corpus callosum （CC） were detected by the immunofluorescence assay. Western blot was employed to determine the protein levels of monocarboxylate transporter 1 （MCT1）， MBP， MAG， oligodendrocyte glycoprotein （MOG）， amyloid precursor protein （APP）， NF200， contactin-associated protein （Caspr）， and voltage-gated sodium channel （Nav1.6） in the corpus callosum. The level of lactic acid in the serum was measured by the lactic acid assay kit， and the ultrastructure of myelin was observed by ultraprojective electron microscope. ResultLaser speckle imaging showed that rCBF decreased immediately 10 min after BCAS surgery （P<0.01）， and the rCBF was still cerebral hypoperfusion and did not return to the preoperative level 2 weeks after surgery. Behavioral test results showed that compared with the sham group， the BCAS/CUMS group presented decreased percentage of sucrose preference （P<0.01） and prolonged immobile time in the tail suspension test （P<0.01）. Compared with the BCAS/CUMS group， fluoxetine and modified Shuyuwan increased the percentage of sucrose preference （P<0.01） and shortened the immobile time in the tail suspension test （P<0.01）. The level of lactic acid was the highest in the BCAS/CUMS mice （P<0.01）， and modified Shuyuwan lowered the lactic acid level （P<0.01）. Immunofluorescence results showed that compared with the sham group， the BCAS/CUMS group presented decreased fluorescence intensity of MAG， MBP and NF200 and increased fluorescence intensity of SMI32 in the corpus callosum， and such changes were reversed by modified Shuyuwan at different doses and fluoxetine. Western blot results showed that compared with the sham group， the BCAS/CUMS modeling down-regulated the protein levels of MCT1， MBP， MOG， MAG， NF20， and Caspr （P<0.05， P<0.01） and up-regulated the protein levels of APP and Nav1.6 in the corpus callosum， and the above trends were reversed by modified Shuyuwan （P<0.05， P<0.01）. Compared with the sham group， BCAS/CUMS modeling led to myelin ultrastructure damage and axon atrophy， which were alleviated by modified Shuyuwan. ConclusionModified Shuyuwan can ameliorate the transport disorder of lactic acid between myelin sheath and axon by upregulating the expressin of MCT1， promote the regeneration of myelin sheath in the corpus callosum， and improve the integrity of myelin sheath structure， thereby alleviating depression in VaD mice.

Objective To analyze the mortality and its changing trend, and composition and order of causes of death of residents in Mengzi City, and to provide a basis for further disease prevention and control. Methods The death causes surveillance data from 2018 to 2021 were derived from the all-cause-of-death surveillance system in Mengzi City. A retrospective analysis was performed on the mortality rate, life expectancy, life expectancy eliminating causes of death, and life loss. The annual percentage change (APC) was analyzed by the Joinpoint regression model to describe changes in mortality trends. Results The overall crude mortality rate was 633.88/100,000. The age-adjusted mortality was 866.87/100,000. There was a significant downward trend in the crude and standardized mortality (APC=-1.73% , APC=-5.96% , P<0.05). Deaths due to chronic non-communicable diseases (NCDs) accounted for 76.44% of the total deaths. The top 5 causes of death of the residents were cerebrovascular diseases (140.38/100 000), heart diseases (104.24/100 000), malignant neoplasms (92.75/100 000), injuries (79.37/100 000), and respiratory diseases (63.17/100 000) in order, accounting for 75.71% of all causes of death. Life expectancy was 75.67 years, 72.32 years and 79.49 years in the whole-population, males and females, respectively. The potential life expectancy loss due to injury, malignant tumor and cerebrovascular disease accounted for 65.45% of all causes of death. Conclusion Chronic non-communicable diseases are the focus of prevention and control work in Mengzi City. Particular attention should be paid to the damage to health and loss of life caused by injuries, malignancies and cerebrovascular diseases.

Objective:To evaluate the diagnostic value of rapid on-site evaluation (ROSE) performed by endoscopists for solid pancreatic lesions requiring tissue for immunohistochemistry (IHC) staining with different approach of endoscopic ultrasound-guided tissue acquisition (EUS-TA).Methods:After screening 1 573 cases who underwent EUS-TA operation at the Endoscopy Center of Peking Union Medical College Hospital between August 2018 and October 2022, a total of 65 cases of solid pancreatic lesions whose diagnosis rely on IHC staining was collected and summarized with clinical data of each case. Among 65 cases, there were 46 cases of pancreatic neuroendocrine tumors (PNETs), 13 cases of pancreatic solid pseudo-papillary tumors (SPTs), and 6 cases of lymphomas and mesenchymal. Patients were categorized into ROSE group (36 cases) and non-ROSE group (29 cases) according to the presence or absence of endoscopists performed ROSE during EUS-TA operation. They were further divided into subgroups of FNA-ROSE (26 cases), FNB-ROSE (10 cases), FNA-non-ROSE (24 cases) and FNB-non-ROSE (5 cases) according to the type of EUS-TA. Diagnostic accuracy and IHC success rate were compared between different groups and subgroups. Binomial logistic multifactorial regression analysis was used to evaluate the influence of ROSE and EUS-TA type on diagnostic accuracy and IHC success rate.Results:There were no statistically significant differences between ROSE group and non-ROSE group in terms of age, gender, bilirubin level, CA19-9 level, lesion site, lesion size, composition ratio of diagnosis, and surgical rate. The differences in mean size of lesions, needle gauge, location of puncturation, and number of needle pass between subgroups were not statistically significant. The diagnostic accuracy was 88.9% in ROSE group and 79.3% in non-ROSE group, and the difference between the two groups was statistically significant ( P=0.023). The diagnostic accuracy of FNA-ROSE group was higher than that of FNA-non-ROSE group (88.5% vs 75.0%), but the difference was not statistically significant ( P>0.100). The differences in diagnostic accuracy and success rate of IHC between FNB-ROSE group and FNB-non-ROSE group were not statistically significant. Binomial logistic multifactorial regression analysis did not reveal any independent influences on diagnostic accuracy. Conclusions:ROSE performed by endoscopists improved diagnostic accuracy of EUS-TA in solid pancreatic lesions requiring IHC staining, and therefore is potentially valuable for improving the diagnostic efficiency of EUS-TA for such diseases.

To explore the application value of endoscopic ultrasound fine-needle aspiration (EUS-FNA) and endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment ofpatients with pancreatic cancer combined with obstructive jaundice.

【Objective】 To analyze the association of overweight and obesity with elevated blood pressure(BP) among children and adolescents in Mengzi City, in order to provide reference for making effective interventions. 【Methods】 A total of 30 classes of students in 14 schools were selected into this study by a stratified random cluster sampling method from October 2020 to September 2021. The paticipants completed a questionnaire survey, and had their height, weight and BP measured. Logistic regression analysis was used to evaluate the association of overweight and obesity with elevated BP. 【Results】 A total of 4 015 children and adolescents aged 7 - 17 years were involved in the study. The detection rate of overweight, obesity and elevated BP was 12.53%, 10.01% and 12.38%, respectively. The detection rate of elevated BP was 9.96%, 19.48% and 25.62% in normal weight, overweight and obese groups, respectively. The risk of elevated BP in the overweight and obese groups was 2.190 times(95%CI: 1.696 - 2.926, P<0.001) and 3.243 times(95%CI: 2.501 - 4.204, P<0.001) as high as that in normal weight groups. The dietary and exercise behaviors of 1 604 adolescents were analyzed, it was found that the detection rate of obesity was significntly higher in non-boarding students(15.09%) and those who consumed fresh fruits at least once a day(13.49%)(χ²=18.012, 7.225, P<0.05), the detection rate of elevated BP was significantly higher in among those who did not consume sugary beverages(16.88%), and performed moderate-to-high intensity physical exercise of 60 minutes or more ≤ 2 days per week(16.88%)(χ²=9.403, 14.921,P<0.01). 【Conclusions】 The risk of developing hypertension increases with the high prevalence of overweight and obesity and is strongly associated with multiple factors. Therefore, it is essential to conduct effective weight control and behavioral lifestyle interventions among children and adolescents.

Objective To observe the influence of different acceleration factors(AF)on compressed sensing susceptibility weighted imaging(CS-SWI)for cerebral medullary veins of healthy people,and to screen the best AF.Methods Forty healthy volunteers were prospectively enrolled.Axial brain SWI images were obtained with CS technique under different AF(AF0,CS2,CS4,CS6,CS8 and CS10),and the phase value(PV)and standard deviation(SD)of bilateral septal vein(SV),internal cerebral vein(ICV),thalamus vein(TV),basal vein(BV)and dentate nucleus vein(DNV)were measured.Taken PV and SD of parietal white matter as controls,the signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of venous images were calculated.Then the original images were reconstructed with minimum intensity projection,and the subjective quality scoring of reconstructed images were performed using a 5-point scale.SNR,CNR,PV and quality score were compared among images under different AF,and the best AF,i.e.with the best performances for displaying and quantitatively analyzing cerebral medullary veins in healthy people was obtained.Results Compared with those acquired with AF0,SNR and CNR of all cerebral medullary veins acquired with CS6,CS8 and CS10 were significantly different(all adjusted P＜0.05).Meanwhile,significant differences of PV in bilateral SV and right TV were found among CS6,CS8 and CS10,also in bilateral ICV,left TV and bilateral BV between CS8 and CS10(all adjusted P＜0.05).Conclusion Excessive AF might decrease image quality of CS-SWI for cerebral medullary veins.CS4 was the best AF for displaying and quantitatively analyzing cerebral medullary veins in healthy people.

Objective To evaluate the safety and efficacy of transcatheter arterial chemoembolization(TACE)combined with lenvatinib and camrelizumab in the treatment of advanced hepatocellular carcinoma(HCC).Methods The clinical data of a total of 63 patients with advanced HCC,who received TACE combined with lenvatinib and camrelizumab(triple therapy)or TACE combined with lenvatinib(dual therapy)at the Jingmen Municipal People's Hospital of China between April 2020 and December 2021,were retrospectively analyzed.Triple therapy group had 30 patients,and dual therapy group had 33 patients.The post-treatment tumor response,disease progression-free survival(PFS),overall survival(OS),and the incidence of adverse drug reactions were recorded.Results The median follow-up period of the two groups was 14 months(range of 4-26 months).Compared with the dual therapy group,in the triple therapy group the objective response rate(ORR)was remarkably higher(83.3%vs.57.6%,P=0.026),the disease control rate(DCR)was obviously higher(93.3%vs.69.7%,P=0.039),the median PFS was significantly longer(8.0 months vs.5.0 months,P＜0.01),and the median OS was strikingly longer(24.0 months vs.12.0 months,P=0.004).No statistically significant difference in the incidence of adverse drug reactions existed between the two groups(P＞0.05).Conclusion For the treatment of advanced HCC,TACE combined with lenvatinib and camrelizumab is clinically safe and effective.(J Intervent Radiol,2024,32:57-62)

The Menghe Medical School is a highly influential academic school of Chinese medicine in China.Its academic features are mainly learning from others'strengths,openness and tolerance;integrity as the foundation,communication as the strength;harmo-ny as the way,and agility as the technique.The Menghe Medical School originated in Menghe,developed in Shanghai,spread all over the country,and spread around the world.The reasons for the prosperity and development of the Menghe Medical School are analyzed.Among them,imperial doctors being rewarded and supported,the stars having their roots in Menghe,inheritance from teach-ers by blood,help from in-laws,and the establishment of education and leadership in development are the main factors.On the basis of inheriting the scholarship of Menghe Medical School,Professor Tong Xiaolin innovatively proposed academic ideas such as the train-ing path of Xiang thinking,state-target differentiation and treatment,and dosage and effectiveness of prescriptions and medicines,pushing the academic thought of Menghe Medical School to a new theoretical peak in the new era.Based on the majestic development path of the Menghe Medical School,the implications for the inheritance,innovation and development of modern Chinese medicine are analyzed.