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 analyze the influencing factors of thyroid volume in children aged 8 - 10 in Yunnan Province, and provide scientific basis for improving iodine deficiency disorders monitoring.Methods:From March to July 2020, in 129 counties (cities, districts) under the jurisdiction of Yunnan Province, each county (city, district) was divided into 5 sampling areas based on east, west, south, north, and middle. One township was selected from each area, and 40 non-boarding children aged 8 - 10 from one primary school were selected from each township (age balanced, half male and half female) as survey subjects. One random urine sample and household edible salt samples were collected for urine iodine and salt iodine testing, and physical examination and thyroid volume measurement were conducted for children. The influencing factors of thyroid volume were analyzed using Pearson correlation.Results:A total of 24 934 urine samples were collected from children, with a median urine iodine of 233.2 μg/L. A total of 24 933 household edible salt samples were collected from children, the median salt iodine was 24.17 mg/kg, and the qualified rate of iodized salt was 96.63% (24 003/24 839); A total of 24 937 children were examined of their thyroid gland, with a median thyroid volume of 2.62 ml and a goiter rate of 1.12% (280/24 937). Among them, there were 12 410 boys and 12 527 girls, with thyroid volumes of 2.61 and 2.64 ml, respectively. The thyroid volume of boys was positively correlated with age, height, weight, body mass index, body surface area, and salt iodine ( r = 0.15, 0.21, 0.26, 0.18, 0.25, 0.03, P < 0.001). The thyroid volume of girls was positively correlated with age, height, weight, body mass index, and body surface area ( r = 0.17, 0.26, 0.28, 0.17, 0.27, P < 0.001). Conclusion:Children aged 8 - 10 in Yunnan Province are at an iodine excess level; the age, weight, height, body mass index, and body surface area are influencing factors of thyroid volume.

Objective:To investigate the iodine nutritional status of adults and pregnant women in Jianshui County and Zhenxiong County, Yunnan Province.Methods:From May to August 2021, one urban area and one rural area in Jianshui County and Zhenxiong County, Yunnan Province were selected as investigation sites. At least 100 adults (half male and half female) and 100 pregnant women were selected as survey subjects in each investigation site. Random urine samples were collected from all survey subjects once to detect urine iodine, creatinine and sodium contents. Venous blood samples of all pregnant women were collected to detect the serum iodine content, and the 95% medical reference range of serum iodine was established using the percentile method.Results:The medians urinary iodine, creatinine and sodium of adults in Jianshui County and Zhenxiong County were 184.7 μg/L ( n = 432), 12 355.0 μmol/L ( n = 431) and 156.5 mmol/L ( n = 420), respectively. The median urinary iodine of adults in Jianshui County was higher than that in Zhenxiong County (197.3 vs 170.2 μg/L), the difference was statistically significant ( Z = - 2.90, P = 0.003). The median serum iodine of pregnant women in Jianshui County and Zhenxiong County was 92.1 μg/L ( n = 412), with a 95% medical reference value ranged from 45.3 to 183.5 μg/L; the medians urinary iodine, creatinine and sodium of pregnant women were 138.6 μg/L ( n = 413), 12 173.0 μmol/L ( n = 408) and 152.2 mmol/L ( n = 409), respectively. The urinary iodine (154.1 vs 115.8 μg/L), urinary creatinine (13 216.0 vs 11 376.0 μmol/L) and urinary sodium (161.8 vs 141.8 mmol/L) of pregnant women in Jianshui County were higher than those in Zhenxiong County, with statistical differences ( Z = - 5.12, - 2.29, - 4.30, P < 0.05). Conclusion:Adults in Jianshui County and Zhenxiong County are at an appropriate level of iodine, but pregnant women in Zhenxiong County are at an iodine deficiency level.

Objective:To understand the contents of edible salt iodine and urinary iodine of children and pregnant women in Yunnan Province, and to evaluate the iodine nutrition status, so as to provide a basis for scientific prevention and treatment of iodine deficiency disorders (IDD).Methods:From November to December 2020, one county (city) was selected from each prefecture (city), two townships (towns and streets) were selected from each county (city) and two villages (neighborhood committees) were selected from each township (town and street) from each of the 16 prefectures (cities) in Yunnan Province as the investigation sites. A total of 20 non-boarding children (male and female balanced) aged 8 - 10 years old were selected from each primary school in each village (neighborhood committee) to collect salt and urine samples. A total of 80 children were investigated in each county (city). A total of 20 pregnant women were selected from each township (town and street) to collect salt and urine samples. A total of 40 pregnant women were investigated in each county (city). All salt samples and urine samples were tested for iodine contents.Results:A total of 2 009 salt samples and 2 041 urine samples (1 375 for children, 666 for pregnant women) were collected from children aged 8 - 10 years old and pregnant women in 16 counties (cities) of Yunnan Province. Among them, the median salt iodine was 26.0 mg/kg, the coverage rate of iodized salt was 100.0% (2 009/2 009), the qualified rate of iodized salt was 98.7% (1 982/2 009), and the consumption rate of qualified iodized salt was 98.7% (1 982/2 009). The difference of salt iodine content in key populations in different counties (cities) was statistically significant ( H = 258.98, P < 0.01). The median urinary iodine of children aged 8 - 10 years old was 188.5 μg/L. There was statistically significant difference in urinary iodine content among children of different ages ( H = 29.45, P < 0.01), but there was no statistically significant difference in urinary iodine content among children of different genders ( H = 1.43, P > 0.05). In addition, the median urinary iodine of pregnant women was 141.9 μg/L, 52.1% (347/666) was < 150 μg/L. There was statistically significant difference in urinary iodine content of pregnant women in different counties (cities, H = 88.32, P < 0.01). Conclusions:The qualified rate of iodized salt, the coverage rate of iodized salt and the consumption rate of qualified iodized salt in key populations of Yunnan Province are more than 90%, and the iodized salt supply is good. Iodine nutrition of children aged 8 - 10 years old is at an appropriate level (100 - 199 μg/L); iodine nutrition of pregnant women is in an state of iodine deficiency ( < 150 μg/L). It is suggested to strengthen IDD monitoring and health education among key populations, improve residents' awareness of disease prevention, and make scientific iodine supplementation.

Objective:To investigate whether the squirrels in Yunnan Province carried Yersinia pestis phages and their epidemiological significance. Methods:From 2015 to 2018, plague host animals were investigated in five of Yunnan plague foci and non-plague foci. The spleen, liver and intestinal specimens of the squirrels captured in the investigation were taken and stored at low temperature for later use. Intestinal specimens with PBS solution, were filtered by 0.22 μm and added to LB liquid medium containing 100 μl suspension of plague vaccine strain (EV76) and then oscillated in a constant temperature gas bath at 28 ℃ and 220 r/min for 18 to 24 h. The double-layer plate method was used to isolate and observe the growth of plaque. The morphology and structure of Yersinia pestis phages were observed under electron microscope. Meanwhile, spleen, liver and intestinal specimens were taken for detection of Yersinia pestis specific marker gene caf1. Results:A total of 10 squirrels were captured (8 Callosciurus erythraeus and 2 Dremomys pernyi), and four Yersinia pestis phages were isolated (2 in Callosciurus erythraeus and 2 in Dremomys pernyi). Two were isolated from non-plague foci (Yongshan County), two from house rats plague foci (Mile County and Xinping County), and none was isolated from wild radents plague foci (Jianchuan County and Eryuan County). By naked eye observation, two bacteriophages from the plague foci produced transparent plaques and grew well, while two bacteriophages from non-plague foci produced translucent plaques and with poor growth. By electron microscopy, these Yersinia pestis phages were of typical Myoviridae family, their head diameter was about 40 nm, muscle tail was about 120 nm, and tail filament cluster was slightly visible at the end of muscle tail. And all the 10 samples of squirrels were negative of plague-specific caf1 gene. Conclusions:The proportion of plague phages carried by Yunnan squirrels is relatively high. Although the detection of caf1 is negative. Squirrels may be a carrier of plague transmission due to the existence of Yersinia pestis phages.

Objective: To investigate whether plague phages were present in the indicator animals of plague foci in Yunnan Province, and to explore their epidemiological significance. Methods: Anus swabs were collected from indicator animals (dogs or cats) of the 41 plague affected villages in 26 towns of 10 cities (counties, districts) of Yunnan plague foci from November of 2015 to March of 2018. The Yersinia pestis phages were isolated by plague vaccine strain EV76. The isolation of plague phages from different plague foci, the isolation of plague phages from different canine species (cats), the polymorphism of plaque and the host spectrum of phages were analyzed. Results: A total of 1 014 indicator animals (1 003 dogs and 11 cats) were studied, and 102 of plague phages were isolated. In the 10 cities (counties, districts), plague phages were only not isolated from Lancang County, and the plague phages were isolated from the other 9 cities (counties, districts). The separation rates from high to low were as follows: Yiliang County (21.00%, 21/100), Menghai County (19.23%, 25/130), Yuanjiang County (11.63%, 10/86), Midu County (11.50%, 13/113), Wenshan County (10.10%, 10/99), Mile Country (7.07%, 7/99), Lianghe County (6.67%, 7/105), Baoshan Longyang District (4.90%, 5/102) and Gengma County (3.81%, 4/105). Of the 102 plague phages, 75 were isolated from the native dogs (Chinese pastoral dogs, 9.32%, 75/805), 20 from the pug dogs (13.70%, 20/146), 5 from the wolf dogs (17.24%, 5/29), 1 from Samoye (1/4) and 1 from Alaska dog (1/2). The plaque of the phage was divided by five appearance of complete lysis (the plate was clear), large (2.5-4.0 mm), big (1.5-< 2.5 mm), middle (0.5-< 1.5 mm) and small (< 0.5 mm). The representative phages were all of the Myoviridae family. Most of the phages could lysis the strains of Yersinia pestis, and some phages could lysis Shigella and type 5 Yersinia pseudotuberculosis (PST5). Conclusion The plague phages are present in the plague foci of Yunnan, and the phages are polymorphic.

Objective To understand the situation of iodine deficiency disorders and iodine nutrition of children in Yunnan Province after the implementation of new standard of salt iodine,and provide the basic data for prevention and control of iodine deficiency disorders.Methods Using multistage sampling method,Yunnan provincial evaluations for iodine deficiency disorders elimination were carried out.According to the comparative analysis of 2010 (pre-adjustment) and 2015 (post-adjustment) evaluation results,the changes of the median of salt iodine,the coverage rate of iodized salt,the qualified rate of iodized salt,the rate of qualified iodized salt consumption,goiter rate of school children aged 8-10 and the median of urinary iodine were evaluated.Salt iodine was tested using the "Salt Industry General Test Method for Determination of Iodine" (GB/T 13025.7-1999);thyroid volume examination of children using B-scan ultrasonography,thyroid volume calculation and enlargement judgment using "Diagnostic Criteria for Endemic Goiter" (WS 276-2007);and urinary iodine detection using "Urinary Iodine Arsenic Cerium Catalytic Spectrophotometry" (WS/T 107-2006).Results The medians of salt iodine in 2010 and 2015 were 30.6 and 22.4 mg/kg,respectively,the difference was statistically significant (U =317 503.50,P ＜ 0.01).The coverage rates of iodized salt in 2010 and 2015 were 99.6％ (1 681/1 688) and 98.9％ (2 592/2 622),the qualified rates of iodized salt were 98.6％ (1 657/1 681) and 89.7％ (2 325/2 592),and the rates of qualified iodized salt consumption were 98.2％ (1 657/1 688) and 88.7％ (2 325/2 622),and the differences were statistically significant (x2 =6.42,125.11,130.18,P ＜ 0.01);the rates of children goiter in 2010 and 2015 were 0.8％ (25/3 272) and 1.4％(44/3 245),respectively;the medians of urinary iodine of children were 289.0 and 157.3 μg/L,respectively,the difference was statistically significant (U =1 121 669.50,P ＜ 0.01).Conclusion After decreasing of salt iodine level starting from 2012 in Yunnan Province,the children iodine nutrition condition is in a more proper level.

Objective To analyze the iodine nutritional status in the key populations before and after the adjustment of iodized salt in Yunnan Province,and to provide scientific basis for adjusting the strategy of prevention and treatment timely.Methods The probability proportional to size sampling method was employed in the investigation.In the pre-adjustment period (2011) and the post-adjustment period (2014),the changes in the residents' iodized salt,the urinary iodine and goiter prevalence of children aged 8-10,the urinary iodine of pregnant women and lactating women were analyzed.Results Before and after adjusting the salt iodine concentration,the coverage rate of iodized salt was 99.1％ (1 196/1 207) and 99.2％ (1 532/1 545),respectively,the mean of salt iodine after the adjustment (23.6 mg/kg) was significantly lower than that of before (30.1 mg/kg,F =17.287,P ＜ 0.01).There was significant difference in the iodine nutritional status of children from 271.4 to 180.9 μg/L (Z=-12.883,P ＜ 0.01).The difference of iodine nutritional status in pregnant women between pre-adjustment (217.3 μg/L) and postadjustment (143.7 μg/L) was also significant (Z =9.997,P ＜ 0.01).The thyroid goiter rate of children had inceased from 1.7％ (21/1 207) to 2.1％ (33/1 549),the difference was not statistically significant between the groups (x2=0.539,P ＞ 0.05).Conclusions After adjusting the salt iodine concentration in Yunnan Province,iodine nutrition of children has decreased from more than adequate level to adequate level,thyroid goiter rate of children has remained at the low level,and iodine nutrition of pregnant women is sightly lower than adequate level,but iodine deficiency of pregnant women is at a low risk because of the good iodized salt coverage.The new standard of iodized salt is appropriate,and it is more favorable to health in Yunnan Province.

Objective To conduct an epidemiological investigation on a case of familial arsenic poisoning in Yunnan Province,to find arsenic poisoning source and create a archive of typical cases,in order to raise awareness of endemic arsenicosis and provide scientific materials for prevention and treatment of the disease.Methods In Xiaxiaoying Village of Yunnan Province,all members of a family with arsenic poisoning patients were investigated in 2013,their health examination and epidemiological survey of arsenic poisoning were carried out,and arsenic poisoning family profiles and personal files were established.Drinking water,hair and urine samples were collected for arsenic content determination,blood samples were collected for biochemical detection,excessively keratose skin was collected for pathological biopsy.Results A total of 33 family members were investigated.Among them 15 were exposed to arsenic and 18 were not exposed to arsenic.Fifteen people exposed to arsenic were found to be have skin lesions,and two eldest males died of skin cancer and cerebral hemorrhage in 1994 and 2009,respectively.The survey found out that 15 patients born in 1935-1983 had been drinking arsenic pesticides polluted well water for 5 to 16 years from 1973 to 1989.As of 2013,the arsenic exposure had been stopped for 24 years,the content of arsenic in the polluted wells was 0.624 mg/L,which was 62.4 times the recommended maximum limit (0.01 mg/L) of the World Health Organization.The median of hair and urinary arsenic in arsenic exposed population and non-arsenic exposed population was 4.2,3.7 mg/kg and 60.9,41.0 μg/L,respectively.There was no statistically significant difference in hair arsenic (Z =-1.905,P ＞ 0.05),but the difference of urinary arsenic was statistically significant (Z =-3.002,P ＜ 0.05).The median of aspartate aminotransferase (AST),gammaglutamyltransferase (γ-GT) and 24 hours urinary ereatinine (Cr) in arsenic exposed population and non-arsenic exposed population was 37.5,31.0 U/L,25.5,12.0 U/L,13 834.0,and 6 843.0 μmol/L,respectively.The differences between the two groups were statistically significant (Z =-2.776,-2.311,-2.502,P ＜ 0.05).Twelve cases of arsenic poisoned patients who were conducted health examination and epidemiological investigation showed typical triad of skin,among them 2 cases were moderate and 10 cases were severe.Pathological biopsy results showed 8 cases had basal cell carcinoma or squamous cell carcinoma.Conclusions Drinking arsenical pesticide contaminated water can induce chronic arsenic poisoning,even after the cessation of arsenic exposure.We should pay close attention to its long-term serious harmful effect.

Objective:To explore the relationship between type I hypersensitivity reaction and the mechanism of the viral hepatitis B through the research of interleukin(IL-13 ) and prostaglandin(PGE1) levels in serum of patients with viral hepatitis B, and therefore, to provide new theory for the perfection of the immunological mechanism of hepatitis B, especially acute hepatitis B.Methods:Serum IL-13 and PGE1 levels were measured in 50 patients with viral hepatitis B and 35 normal cases using double antibody sandwich ELISA method. AST and ALT levels were studied using omni automatic biochemistry analyzer and those correlation with IL-13 and PGE1 were observed.Results:①The IL-13 and PGE1 levels of 10 acute hepatitis B were significantly higher than those of the normal cases; ②The IL-13 and PGE1 levels of 35 chronic hepatitis B were also significantly higher than those of the normal cases; ③The levels of IL-13 and PGE1 were significantly positively correlated with serum ALT and AST.Conclusion:IL-13 and PGE1 levels in patients with acute hepatitis B are most remarkably increased, and correlate with the damage of liver.