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 review the research progress on silk fibroin (SF)-nerve guidance conduits (NGCs) for peripheral nerve injury (PNI) repair. METHODS: To review the recent literature on PNI and SF-NGCs, expound the concepts and treatment strategies of PNI, and summarize the construction of SF-NGCs and its application in PNI repair. RESULTS: Autologous nerve transplantation remains the "gold standard" for treating severe PNI. However, it's clinical applications are constrained by the limitations of limited donors and donor area damage. Natural SF exhibits good biocompatibility, low immunogenicity, and excellent physicochemical properties, making it an ideal candidate for the construction of NGCs. SF-NGCs constructed using different technologies have been found to have better biocompatibility and bioactivity. Their configurations can facilitate nerve regeneration by enhancing regenerative guidance and axonal extension. Besides, the adhesion, proliferation and differentiation of neurons and Schwann cells related to PNI repair can be effectively promote by NGCs. This accelerates the speed of nerve regeneration and improves the efficiency of repair. In addition, SF-NGCs can be used as regenerative scaffolds to provide biological templates for nerve repair. CONCLUSION The biodegradable natural SF has been extensively studied and demonstrated promising application prospects in the field of NGCs. It might be an effective and viable alternative to the "gold standard" for PNI treatment.
Fibroins/chemistry* ; Peripheral Nerve Injuries/therapy* ; Nerve Regeneration ; Tissue Scaffolds/chemistry* ; Humans ; Guided Tissue Regeneration/methods* ; Biocompatible Materials ; Animals ; Tissue Engineering/methods* ; Schwann Cells/cytology* ; Peripheral Nerves ; Neurons/cytology*

Objective:To discuss the effects and mechanism of triptolide regulating Caspase1/GSDMD pathway in bone destruction in collagen-induced arthritis rats.Methods:The rats were divided into blank group, model group, triptolide group, and methotrexate group using a random number table method, with 5 rats in each group. Except for the blank group, all other groups were injected with bovine typeⅡ collagen at the tail root to establish an arthritis model. After 7 days of strengthening immunity, the dosage of triptolide A was calculated based on the body surface area in rats, and the triptolide A group was orally administered with triptolide A for 18 μg/kg, 1 d/time; the methotrexate group received intraperitoneal injection of 0.3 mg/kg methotrexate for 3 days per dose, with continuous intervention for 15 days. The arthritis index (AI) score and toe volume changes of the rats were recorded. The ankle joint histological changes were observed with HE staining, and the ankle joint cartilage and bone changes were observed with ferruginine solid green staining. The contents of IL-18 and IL-1β in serum were determined by ELISA. The mRNA levels of GSDMD, Caspase-1, OPG and RANKL in ankle joints were detected by real-time quantitative PCR. The expressions of GSDMD, Caspase-1, OPG and RANKL in ankle tissues were detected by Western blot.Results:After 1 and 2 weeks of administration, compared with the model group, the AI scores and toe volume values of the triptolide group, and methotrexate group decreased ( P<0.01); in the model group, a large number of inflammatory cell infiltration, synovial pannus formation, and blurred defects of the tide line of cartilage and bone staining were observed. The inflammatory infiltration, synovial pannus formation, articular cartilage and bone destruction were improved to varying degrees in each administration group. Compared with model group, serum IL-18 and IL-1β contents in triptolide group and methotrexate group significantly decreased ( P<0.01), mRNA and protein expressions of GSDMD, Caspase-1 and RANKL decreased ( P<0.01), and mRNA and protein expression of OPG increased ( P<0.01). Conclusion:Triptolide can effectively improve joint inflammation and bone destruction in collagen-induced arthritis rats, and its mechanism may be related to down-regulating the expressions of GSDMD, Caspase-1 and RANKL, and up-regulating the expression of OPG.

Background Geriatric depression is a common psychiatric problem among older adults.Animal-assisted interventions(AAI)can aid in the treatment of psychiatric disorders,but their effectiveness in geriatric depression remains controversial.Objective To provide an overview of the current research on AAI in alleviating geriatric depression,in order to provide references for developing AAI programs for this population.Methods Based on Arksey's scoping review method,a comprehensive literature search was conducted on April 16,2023.The databases searched included China Knowledge Network,VIP,Wanfang Medical Network,China Biomedical Literature Database,Web of Science,PubMed,CINAHL,Cochrane Library and Embase.The search aimed to collect studies related to AAI and geriatric depression from the inception of each database until April 15,2023.Two trained researchers independently screened the literature and extracted data on basic information.Results A total of 13 studies were included in the final review.AAI settings included nursing homes,hospitals,communities,day care centers and residences.Interventions involved touching and naming the animals,verbally interacting with the animals,playing games with the animals,communicating with the therapists and learning to care for the animals.AAI was found to improve social interaction and communication abilities,bring positive emotional experiences and enhance life satisfaction in geriatric depression.However,its effect on cognitive function improvement was inconclusive.Conclusion AAI can potentially alleviate negative mood and depressive symptoms in geriatric depression.

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.

Objective:To summarize the clinical characteristics and prognosis of acute hyperextension spinal cord injury (SCI) in children, and to provide some recommendations for the treatment and prevention of this disease.Methods:Reviewed the data of children of SCI after sustained or repeated hyperextension of the spine at Wuhan Union Hospital and Wuhan Children's Hospital from September 2010 to September 2020. According to the American Spinal Injury Association impairment scale (AIS grade), the patients were divided into complete SCI group and incomplete SCI group. The age, symptoms and evolution after injury, neurological level of injury, imaging data, laboratory examination data, prognosis and complications of the two groups were analyzed. Retrospectively summarize the characteristics of this type of injury.Results:Forty-four cases of acute hyperextension SCI in children were included. Their age ranged from 3 to 10 years old, 95% of them were under 8 years old and 95% of them were female. There was no significant difference in age at injury and time of dance training between children with complete SCI and incomplete SCI. Back and leg pain, lower limb weakness or paresthesia, and rapidly progress to complete or incomplete SCI in a short period were typical symptoms. All blood test results anddiagnostic analysis of cerebrospinal fluid were unremarkable or negative. There was no fracture or dislocation in the whole spine. Magnetic resonance imaging showed a longitudinally extended intramedullary high-intensity signal in the thoracolumbar spinal cord. Complete SCI accounted for 60% of all cases, and the prognosis was poor with spinal cord atrophy and various complications.Conclusion:Children younger than 10 years old after sustained or repeated hyperextension of the spine may suffer acute hyperextension SCI. Children with complete SCI have poor prognosis and serious complications. Therefore, prevention of this type of injury is the best strategy.

Objective To survey the basic situation of diagnosis and treatment in clinical nuclear medicine across Guangdong province,evaluate the risks of exposure to the radiation workers and public and explore the countermeasures to control radiation exposre.Methods A survey team was set up to survey,by filling questionnaires,the basic information on nuclear medicine practices for workers,equipment,radionuclide,frequency and dose to workers and radiation protection measures.Results A total of 71 nuclear medicine institutions was involved in the survey with 733 radiation workers in 2016 in Guangdong.The average annual effective dose to nuclear medicine workers was (0.55±0.66) mSv per year.The total pieces of nuclear medical equipment was up to 189 in 2016 including 59 SPECT/CT scanners (5 SPECT),28 PET/CT scanners and 54 thyroid scanners.Total activity of 1.15× 10s MBq in radiopharmaceuticals was used in 325 903 examinations and treatments with the number of frequency of 2.97 examinations per 1 000 population.Concluions There have been a rapid progress in practice of nuclear medicine over the past 20 years in Guangdong province with departments of nuclear medicine set up in 18 of 21 cities.Compared with 1998,the activity in radiopharmaceuticals used has increased by 414％ in 2016 and the number of frequency of examination and treatment has increased by 111％.The rapid expansion of nuclear medicine practice has also caused potential risks of radiation to the public and environment.

Objective To discuss the effect of main organ-preserving pancreatectomy operations on the postoperative complications and the long-term quality of life.Methods The clinical data of 320 patients undergoing pancreatic surgery from January 2013 to December 2016 in the First Affiliated Hospital of Soochow University were retrospectively analyzed and all the patients were divided into traditional pancreatectomy surgery group and organ-preserving pancreatectomy surgery group.The traditional pancreatectomy surgery group included pancreaticoduodenectomy (PD),distal pancreatectomy (DP),and laparoscopic distal pancreatectomy (LDP);and the organ-preserving pancreatectomy surgery group included pylorus-preserving pancreaticoduodenectomy (PPPD),spleen-preserving distal pancreatectomy (SPDP),enucleation pancreatectomy (EP),and middle-preserving pancreatectomy (MSP).Face to face clinic visit or telephone follow-up was scheduled every three months until May 31,2017.The operation time,intraoperative hemorrhage,intraoperative blood transfusion,postoperative complications (hemorrhage,pancreatic fistula,biliary fistula,abdominal infection,delayed gastric emptying),postoperative hospitalization stay,secondary surgery and the survival status within 30 days after surgery,the pancreatic endocrine function,exocrine function and the long-term quality of life were recorded.Results The operation time,intraoperative hemorrhage and intraoperative blood transfusion were not statistically different between PD and PPPD groups,DP and SPDP groups,LDP and LSPDP groups,DP and MSP groups,and DP and EP groups,respectively (all P values ＞0.05).Compared with MSP group,the hospitalization time in DP group was shorter [(18.61 ±12.46)d vs (26.88 ± 15.22)d],the occurrence rate of postoperative pancreatic fistula (24.07％ vs 56.25％),bleeding (3.70％ vs 25.00％),abdominal infection (1.85％ vs 18.75％),delayed gastric emptying (5.56％ vs 31.25％),secondary surgery (0 vs 25.00％),and glycemic control rate were decreased (27.78％ vs 0),and all the differences were statistically significant (all P values ＜ 0.05).After discharge,the incidence of chronic diarrhea in the PD group was higher than that in the PPPD group (17.31％ vs 2.08％).The fatigue in the DP group was higher than that in the SPDP,MSP and EP groups,and fatigue,social function,overall health score of the LDP group were lower than those in LSPDP group;emotional function in the DP group was better than that in MSP group,and all the differences were statistically significant (all P values ＜ 0.05).Conclusions The organ-preserving pancreatectomy can reduce the trauma of the operation,postoperative complications and postoperative pancreatic endocrine and exocrine dysfunction,and improve the long-term quality of life.

Objective To investigate the incidence and risk factors of surgical site infection(SSI) in patients with internal fixation surgery for limb fracture.Methods Medical data of patients with internal fixation surgery for limb fracture in a hospital from January 2013 to January 2016 were collected, 39 patients with SSI following internal fixation was as infection group, according to the 1:2 ratio, 78 patients without SSI following operation during the same period were randomly selected as the control group, risk factors of SSI were analyzed.Results Among 4 125 patients undergoing internal fixation surgery, incidence of SSI was 0.95% (n=39), the positive rate of bacterial culture in infection group was 87.2% (34/39), a total of 38 strains of pathogenic bacteria were isolated, among which 22 were gram-positive strains (57.9%), 15(39.5%)were gram-negative strains,1(2.6%) was fungi,Staphylococcus aureus was the main pathogenic bacteria (47.4%), and there were 20 isolates of multidrug-resistant organisms.Univariate analysis showed that infection group and control group was significantly different in the following aspects: combined underlying diseases, time from injury to operation≥8 hours, open fracture, multiple fracture, duration of operation≥180 minutes, intra-operative blood loss≥400 mL, allogeneic blood transfusion, duration of postoperative indwelling drainage tube≥5 days, and average length of hospital stay≥14 days (all P<0.05).Multivariate logistic regression analysis showed that the following factors were risk factors for SSI following internal fixation surgery for fracture: time from injury to operation≥8 hours, open fracture, duration of operation≥180 minutes, duration of postoperative indwelling drainage tube≥5 days, and average length of hospital stay≥14 days (all P<0.05).Conclusion Risk factors for SSI in patients with internal fixation surgery for limb fracture are multiple, reducing risk factors has a positive effect on decreasing the incidence of SSI and improving the cure rate.

Objective To evaluate the safety of Renaissance spine robot assisted system in spinal injury.Methods From March 2014 to May 2016,38 patients with spinal disease received spinal surgery assisted by spine robot system.They were 20 males and 18 females,with an average age of 42 years (range,from 12 to 69 years).There were 10 lumbar fractures,8 thoracic fractures and 20 spinal deformities.Pedicle screw implantation was conducted in 30 patients (PS group) and percutaneous vertebroplasty in 8 (PV group).One side was chosen randomly to use Mazor spine robot assisted system (assisted group) and the opposite side the conventional method (non-assisted group).The anteroposterior and lateral X-rays and CT scan of the lumbar and/or thoracic spine were performed in all patients after surgery.The precision of pedicle screws implantation in PS group was evaluated by the Abul-Kasimhierarchy grading system;location of the puncture trajectory,time used for puncture and radiation exposure time in PV group were evaluated.Results 208 pedicle screws were implanted in PS group,including 120 lumbar ones and 88 thoracic ones.For lumbar pedicle screw implantation,the excellent to good rate was 95.0％ (57/60) in the assisted group,significantly higher than that in the non-assisted group (80.0％,48/60) (P ＜ 0.05).For thoracic pedicle screw implantation,the excellent to good rate was 95.5％ (42/44) in the assisted group,significantly higher than that in the non-assisted group (77.3％,34/44) (P ＜ 0.05).There were 24 puncture trajectories in 8 patients in PV group,showing no pedicle penetration or cement leaking in any case.The mean time used for puncture was 5.5 ± 1.4 min in the assisted group,significantly shorter than that in the non-assisted group (17.8 ± 7.5 min) (P ＜ 0.05);the X-ray exposure time was 14.0 ± 4.0 s in the assisted group,significantly shorter than that in the non-assisted group (22.4 ± 6.0 s) (P ＜ 0.05).Conclusions Renaissance spine robot-assisted system deserves more clinical application,because in spinal surgery it can make pedicle screw implantation more precise and safer,and can reduce operation time and X-ray exposure time in percutaneous vertebroplasty.