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 investigate the diagnostic value of plasma calprotectin in childern with refractory mycoplasma pneumoniae pneumonia(RMPP). Methods : A multicenter, prospective cohort study was conducted, enrolling 228 children with mycoplasma pneumoniae pneumonia(MPP). Among these, 177 cases were diagnosed with general mycoplasma pneumoniae pneumonia(GMPP), while the remaining 51 cases were RMPP. Plasma was collected at the time of admission of the children in both groups, and calprotectin levels were measured. A one-way difference analysis was performed on the blood test indexes of the children in the two groups, and the difference variables withP<0.05 between the two groups were included in a multifactorial logistic regression to analyze the risk factors for the progression of GMPP to RMPP. The differential diagnostic value of plasma calprotectin for GMPP and RMPP was analyzed by the receiver operating characteristic(ROC) curves. Results : Univariate analysis showed that plasma calprotectin levels were significantly higher in the RMPP group than those in the GMPP group, and the difference was statistically significant(P<0.05). Logistic regression analysis showed that plasma calprotectin was an independent risk factor for RMPP(OR=1.323,P<0.001), ROC curve analysis showed that plasma calprotectin had a higher diagnostic value for the differential diagnosis of GMPP and RMPP(AUC =0.839), and its combination with C-reactive protein and albumin could significantly improve the diagnostic efficiency. Conclusion Plasma calprotectin has good clinical value for the diagnosis of RMPP.

The incidence and mortality rate of hepatocellular carcinoma rank among the top of all cancer types,seriously threatening the life and health of human beings. In recent years,the rapid development of artificial intelligence and the deepening of the concept of precision medicine have led to a boom in interdisciplinary research. Pathomics,as an emerging omics technology driven by artificial intelligence,can mine massive information from high-resolution whole slide images,and shows broad application prospects in the diagnosis,treatment and prognosis assessment of hepatocellular carcinoma. However, pathomics research in hepatocellular carcinoma is still in its infancy, and its research patterns and clinical applications still face several controversies and challenges, including data security, ethics, and “black box” issues. Future research should focus on conducting prospective studies, integrating multimodal data, improving computational technologies, and establishing professional standards to promote the high-quality development of pathomics technology in both clinical and basic research of hepatocellular carcinoma.

The incidence and mortality rate of hepatocellular carcinoma rank among the top of all cancer types,seriously threatening the life and health of human beings. In recent years,the rapid development of artificial intelligence and the deepening of the concept of precision medicine have led to a boom in interdisciplinary research. Pathomics,as an emerging omics technology driven by artificial intelligence,can mine massive information from high-resolution whole slide images,and shows broad application prospects in the diagnosis,treatment and prognosis assessment of hepatocellular carcinoma. However, pathomics research in hepatocellular carcinoma is still in its infancy, and its research patterns and clinical applications still face several controversies and challenges, including data security, ethics, and “black box” issues. Future research should focus on conducting prospective studies, integrating multimodal data, improving computational technologies, and establishing professional standards to promote the high-quality development of pathomics technology in both clinical and basic research of hepatocellular carcinoma.

Objective This study proposes a chairside digital design and manufacturing method for band and loop space maintainers and preliminarily validates its clinical feasibility.Methods Clinical cases of 10 children requiring space maintenance caused by premature loss of primary teeth were collected.Intraoral scan data of the affected children were also collected to establish digital models of the missing teeth.Using a pediatric band and loop space maintainer de-sign software developed by our research team,a rapid personalized design of band and loop structures was achieved,and a digital model of an integrated band and loop space maintainer was ultimately generated.A chairside space maintainer was manufactured through metal computer numerical control machining for the experimental group,whereas metal 3D printing in the dental laboratory was used for the control group.A model fitting assessment was conducted for the space maintainers of both groups,and senior pediatric dental experts were invited to evaluate the clinical feasibility of the space maintainers with regard to fit and stability using the visual analogue scale scoring system.Statistical analysis was also performed.Results The time spent in designing and manufacturing the 10 space maintainers of the experimental group was all less than 1 h.Statistical analysis of expert ratings showed that the experimental group outperformed the control group with regard to fit and stability.Both types of space maintainers met clinical requirements.Conclusion The chairside digital design and manufacturing method for pediatric band and loop space maintainers proposed in this study can achieve same-day fitting of space maintainers at the first appointment,demonstrating good clinical feasibility and significant potential for clinical application.

Objective:To investigate the effectiveness of sequential flap transfer technique in the reconstruction of extensive faciocervical scar.Methods:The clinical data of patients with extensive faciocervical scar admitted to the Scar Comprehensive Treatment Center of Plastic Surgery Hospital of Chinese Academy of Medical Sciences from June 2010 to April 2022 were retrospectively analyzed. Pre-expanded medial arm flap or supraclavicular artery perforator plus flap were harvested and used as the first flap to repair the defects left by faciocervical scar resection. Latissimus dorsi myocutaneous flaps or thoracodorsal artery perforator flaps were harvested from the ipsilateral back and used as the second flap to repair the donor sites of the first flap. Donor sites at the back were directly sutured. The survival of flaps, the morphology of donor sites and recipient sites and the scar of donor site were followed up.Results:A total of 13 patients, aged from 5 to 36 years (median age, 14 years), were included, including 8 males and 5 females. Twelve of the 13 cases were post-burn scar, including facial scars in 5 cases, cervical scar in 1 case and faciocervical scar in 6 cases. One case of scar was caused by radiotherapy for facial hemangioma. The size of defects after scar resection and release ranged from 12.0 cm × 8.0 cm to 24.5 cm × 8.0 cm. The operation was successfully completed in all cases. Three pre-expanded supraclavicular artery perforator plus flaps and 10 pre-expanded medial arm flaps, measuring 23.0 cm × 7.0 cm to 27.0 cm ×14.0 cm, were used as the first flap; five latissimus dorsi myocutaneous flaps and eight thoracodorsal artery perforator flaps, measuring 18.0 cm × 7.0 cm to 25.0 cm × 10.0 cm, were used as the second flap. One patient developed hematoma at two days after the pedicle division of medial arm flap and the flap survived completely after removal of the hematoma. Other flaps survived without complications and the incisions were healed in one stage. Patients were followed up for 1 to 48 months, with a median follow-up of 13 months. The color, texture, and thickness of flaps were similar to those of the recipient site. All patients were satisfied with the cosmetic result of recipient sites and donor sites.Conclusion:The sequential flap transfer technique could improve the reconstructive ability of pre-expanded medial arm flap and supraclavicular artery perforator plus flap in surgical treatment of extensive faciocervical scar, minimize the donor site morbidities, assist the closure of donor site and improve the overall outcomes.

Objective:To investigate the effectiveness of sequential flap transfer technique in the reconstruction of extensive faciocervical scar.Methods:The clinical data of patients with extensive faciocervical scar admitted to the Scar Comprehensive Treatment Center of Plastic Surgery Hospital of Chinese Academy of Medical Sciences from June 2010 to April 2022 were retrospectively analyzed. Pre-expanded medial arm flap or supraclavicular artery perforator plus flap were harvested and used as the first flap to repair the defects left by faciocervical scar resection. Latissimus dorsi myocutaneous flaps or thoracodorsal artery perforator flaps were harvested from the ipsilateral back and used as the second flap to repair the donor sites of the first flap. Donor sites at the back were directly sutured. The survival of flaps, the morphology of donor sites and recipient sites and the scar of donor site were followed up.Results:A total of 13 patients, aged from 5 to 36 years (median age, 14 years), were included, including 8 males and 5 females. Twelve of the 13 cases were post-burn scar, including facial scars in 5 cases, cervical scar in 1 case and faciocervical scar in 6 cases. One case of scar was caused by radiotherapy for facial hemangioma. The size of defects after scar resection and release ranged from 12.0 cm × 8.0 cm to 24.5 cm × 8.0 cm. The operation was successfully completed in all cases. Three pre-expanded supraclavicular artery perforator plus flaps and 10 pre-expanded medial arm flaps, measuring 23.0 cm × 7.0 cm to 27.0 cm ×14.0 cm, were used as the first flap; five latissimus dorsi myocutaneous flaps and eight thoracodorsal artery perforator flaps, measuring 18.0 cm × 7.0 cm to 25.0 cm × 10.0 cm, were used as the second flap. One patient developed hematoma at two days after the pedicle division of medial arm flap and the flap survived completely after removal of the hematoma. Other flaps survived without complications and the incisions were healed in one stage. Patients were followed up for 1 to 48 months, with a median follow-up of 13 months. The color, texture, and thickness of flaps were similar to those of the recipient site. All patients were satisfied with the cosmetic result of recipient sites and donor sites.Conclusion:The sequential flap transfer technique could improve the reconstructive ability of pre-expanded medial arm flap and supraclavicular artery perforator plus flap in surgical treatment of extensive faciocervical scar, minimize the donor site morbidities, assist the closure of donor site and improve the overall outcomes.

Objective:To systematically evaluate the efficacy and safety of general anesthesia versus conscious sedation in patients with endovascular therapy for acute ischemic stroke.Methods:Databases, including English databases PubMed, Embase and Cochrane, as well as Chinese databases Wan Fang Data and CNKI, were screened for randomized controlled trials (RCT) of general anesthesia versus conscious sedation on the effect of endovascular treatment for acute anterior circulation ischemic stroke. The searching period was from the establishment of databases to July 14, 2022. Two researchers independently screened literatures, extracted data and evaluated the risk of bias. And meta-analysis was performed using RevMan5.3 software.Results:A total of 7 RCTs involving 923 patients were included, with 461 in the general anesthesia group and 462 in the other. As the meta-analysis showing, general anesthesia could significantly improve the good outcomes (modified Rankin Scale score≤2) at 3 months after endovascular treatment in comparison with conscious sedation ( OR=1.34, 95% CI 1.01-1.78, P=0.04), and significantly increased the rate of successful revascularization ( OR=1.87, 95% CI 1.32-2.65, P<0.001). In addition, there were no statistically significant differences between the two groups in mortality ( OR=0.93, 95% CI 0.66-1.29, P=0.65), symptomatic intracranial hemorrhage ( OR=0.88, 95% CI 0.57-1.35, P=0.55) and intervention-related complications ( OR=0.83, 95% CI 0.50-1.36, P=0.46). However, general anesthesia was associated with higher risk for both 20% reduction in mean arterial pressure ( OR=4.76, 95% CI 1.49-15.19, P=0.008) and pneumonia ( OR=2.58, 95% CI 1.51-4.39, P<0.001). Conclusions:Compared with conscious sedation, endovascular treatment under general anesthesia in patients with acute anterior circulation ischemic stroke may contribute to better outcomes and higher successful revascularization. However, this method will lead to the risk of blood pressure variability and the incidence of pneumonia.

Functional dyspepsia (FD) is a common and frequently occurring disease in clinic. With the influence of environmental factors, social factors and dietary factors, the incidence rate of FD in the general population is yearly increasing. Traditional Chinese medicine has a long history and far-reaching influence in the treatment of FD. It can prevent and treat FD in the form of multiple-components, targets and channels, with obvious effect and prominent advantages. This article starts with the common syndrome types of FD, and discusses the research progress of single Chinese medicine, effective ingredients and the mechanism of traditional Chinese medicines in treating FD, in order to provide a theoretical basis for the treatment of FD with traditional Chinese medicines.

Objective: To understand the real experience and feelings of self injurious cutting in adolescents with depression, to provide guidance for clinical targeted interventions. Methods: During November 2021 to May 2022, 19 adolescent patients with depression who had cut themselves as the type of non suicidal self injury were recruited from a tertiary first class psychiatric hospital in Chengdu, Sichuan Province. All the participants were interviewed in a semi structured manner, which used the interpretative phenomenological analysis to analyze the transcription data. Results: The experience and feelings of non suicidal self injury in adolescent with depression could be summarized into five themes: self injury thoughts that arise under external interference; self injurious behavior in a thousand thoughts; painful but a happy experience of self injury; cutting as the most frequently selected form of non suicidal self injury; decreases in self injurious behavior reduced when they feel love and responsibility. Conclusion Non suicidal self injury of adolescent patients with depression are affected by various factors. Clinicians should provide targeted clinical care according to the characteristics of patients, as well as the no suicide contract, alternative skills of non suicidal self injury behaviors, and a multi dimensional social support platform with the families of patients.