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

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Objective:To investigate whether malignant tumors affect the laboratory outcomes of patients in their first controlled ovarian hyperstimulation (COH) cycle.Methods:This study was a retrospective case-control study that analyzed the clinical and laboratory data of patients who underwent fertility preservation before chemotherapy and radiotherapy due to malignant tumors, as well as patients with infertility caused by tubal factors who first underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University from January 2020 to May 2024. Patients who underwent fertility preservation were designated as the research group, while patients who underwent assisted reproduction due to tubal factors during the same period were designated as control group. After 1∶3 propensity score matching (PSM), 40 patients were included in the research group and 118 patients were included in control group. The ovarian response, oocyte retrieval outcomes, and embryonic development after fertilization in the first COH cycle were compared between the two groups. Results:After PSM, the research group and control group showed statistically significant differences in the gonadotropin (Gn) starting dosage [225.00 (162.50, 300.00) U vs. 193.75 (150.00, 225.00) U, P=0.002], duration of Gn used [10.00 (8.00, 11.00) d vs. 12.00 (10.00, 13.00) d, P<0.001], and average estradiol levels on human chorionic gonadotropin trigger day [2 487.00 (1 461.25, 4 090.25) pmol/L vs. 10 738.50 (8 400.00, 16 507.25) pmol/L, P<0.001]. However, no statistically significant difference was found in the total dosages of Gn used between the two groups ( P>0.05). There were no significant differences between the groups in terms of the number of oocytes retrieved, the number of metaphase Ⅱ oocytes, two pronuclei (2PN) rate, 2PN cleavage rate, available embryo rate, high-quality embryo rate, blastocyst formation rate, and available blastocyst formation rate (all P>0.05). Conclusion:Compared with infertility patients with tubal factors, there is no significant difference in the laboratory outcomes of malignant tumor patients undergoing COH for fertility preservation prior to chemotherapy and radiation.

Objective:To investigate the effects of male body mass index (BMI) on semen parameters and perinatal outcomes following artificial insemination by husband (AIH) treatment.Methods:A retrospective cohort study was conducted to analyze the clinical data of 5 053 patients underwent AIH treatment at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University, from January 2017 to February 2024. The study focused on factors such as male semen parameter abnormalities, male sexual dysfunction, female cervical factors, reproductive tract malformations, and unexplained infertility. Patients were classified into three groups based on male BMI: normal weight group (18.5-23.9 kg/m2, n=1 673), overweight group (24.0-27.9 kg/m2, n=2 078), and obese group (BMI≥28.0 kg/m2, n=1 302). The primary objective was to assess the differences in semen parameters and perinatal outcomes among the three groups. Multivariable logistic regression and linear regression analyses were applied to adjust for potential confounders that could influence semen parameters and perinatal outcomes. Results:Semen volume in the normal weight group and overweight group [4.00 (3.00, 5.50) mL, 4.00 (3.00, 5.50) mL] was higher than that in the obese group [4.00 (3.00, 5.00) mL], with a significant difference among the three groups ( P<0.001, a P<0.001). The total sperm count in the normal group and overweight group [207.60 (121.90, 341.75)×10 6, 211.80 (119.88, 334.83)×10 6] was higher than that in the obese group [188.40 (110.96, 323.41)×10 6], with a significant difference among the three groups ( P=0.007, a P<0.001). The total progressive sperm motility count in the normal group [88.18 (43.63, 163.80)×10 6] was higher than that in the obese group [75.30 (40.29, 147.86)×10 6], with a significant difference among the three groups ( P=0.001, a P<0.001). The percentage of forward motile sperm in the normal group [(45.37±17.16)%] was higher than that in the overweight group [(44.03±17.36)%] and the obese group [(43.80±17.21)%], with a significant difference compared among the three groups ( P=0.020, a P=0.016]. In terms of perinatal outcomes, after multivariate logistic regression analysis, only the overweight and obese groups had higher newborn birth weights [(3 389.53±472.65) g, (3 408.57±507.90) g] compared with the normal group [(3 271.32±532.02) g], with a significant difference among the three groups ( P=0.010, a P=0.009). Conclusion:Higher male BMI is associated with decreased semen quality and may increase newborn birth weight following AIH treatment.

Objective:To investigate the mediating role of serum β-human chorionic gonadotropin (hCG) levels on the relationship between embryo quality and pregnancy outcomes following single frozen-thawed blastocyst transfer 14 d post-transfer.Methods:This retrospective cohort study collected data from patients who underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) frozen-thawed single blastocyst transfer at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University between August 2017 and June 2021. Patients were grouped according to embryo quality into good-quality blastocyst group ( n=3 191) and available blastocyst group ( n=2 027). Differences in serum β-hCG levels and pregnancy outcomes at 14 d post-transfer were compared between the two groups. Mediation analysis and receiver operating characteristic (ROC) analysis were used to explore the mediating effect of β-hCG levels on the relationship between embryo quality and pregnancy outcomes and to evaluate the differences in the incidence of placental-related diseases between the two groups. Results:The good-quality blastocyst group had significantly higher serum β-hCG levels [1 177.0 (1.8, 2 278.5) U/L], clinical pregnancy rate [65.62% (2 094/3 191)], and live birth rate [52.55% (1 667/3 191)] compared with the available blastocyst group [54.4 (0.1, 1 453.5) U/L, P<0.001; 46.13% (935/2 027), P<0.001; 34.19% (693/2 027), P<0.001]. The early miscarriage rate in the good-quality group [13.47% (282/2 094)] was lower than that in the available blastocyst group [19.14% (179/935), P<0.001]. Serum β-hCG levels at 14 d post-transfer showed significant mediating effects on clinical pregnancy rate ( r=-0.126), live birth rate ( r=-0.122), and early miscarriage rate ( r=0.028) in both groups (all P<0.001). The cut-off values for β-hCG to predict live birth in the available and good-quality blastocyst groups were 366.9 U/L and 485.5 U/L, with positive predictive values of 76.28% (672/881) and 82.84% (1 628/1 965), respectively, and negative predictive values of 98.15% (1 114/1 135) and 96.14% (1 170/1 217). The cut-off values for predicting clinical pregnancy were 118.8 U/L and 226.5 U/L, with positive predictive values of 95.43% (919/963) and 98.45% (2 037/2 069), and negative predictive values of 99.72% (1 050/1 053) and 94.89% (1 059/1 116). The cut-off values for predicting early miscarriage were 1 337.0 U/L and 1 162.6 U/L, with positive predictive values of 32.75% (130/397) and 30.18% (150/497), and negative predictive values of 90.89% (489/538) and 91.73% (1 465/1 597). No differences were found in the incidence of placental-related diseases between the two groups (all P>0.05). Conclusion:This study indicates that both embryo quality and serum β-hCG levels at 14 d post-transfer significantly affect pregnancy outcomes. β-hCG levels play an important mediating role between embryo quality and pregnancy outcomes. ROC analysis demonstrates the good predictive efficacy of serum β-hCG levels for pregnancy outcomes, providing scientific evidence for optimizing embryo selection.

Collaborative diagnosis and treatment between Traditional Chinese Medicine(TCM)and Western Medicine,as an important measure for the modernization and innovation of TCM,faces great challenges such as inadequate medical resource supply and supply-demand imbalance in the context of high-quality development strategy.Supply-demand analysis and the input-output framework of modern economic theory were applied to systematically analyze the operational status of collaborative diagnosis and treatment of TCM and Western Medicine in China,and explore the intrinsic economic mechanism of its development.Furthermore,in line with the concept of the"Three Medical Synergistic Collaborations",it proposes policy recommendations from the dimension of medical care,medical insurance,and medicine.

Objective:To investigate whether malignant tumors affect the laboratory outcomes of patients in their first controlled ovarian hyperstimulation (COH) cycle.Methods:This study was a retrospective case-control study that analyzed the clinical and laboratory data of patients who underwent fertility preservation before chemotherapy and radiotherapy due to malignant tumors, as well as patients with infertility caused by tubal factors who first underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University from January 2020 to May 2024. Patients who underwent fertility preservation were designated as the research group, while patients who underwent assisted reproduction due to tubal factors during the same period were designated as control group. After 1∶3 propensity score matching (PSM), 40 patients were included in the research group and 118 patients were included in control group. The ovarian response, oocyte retrieval outcomes, and embryonic development after fertilization in the first COH cycle were compared between the two groups. Results:After PSM, the research group and control group showed statistically significant differences in the gonadotropin (Gn) starting dosage [225.00 (162.50, 300.00) U vs. 193.75 (150.00, 225.00) U, P=0.002], duration of Gn used [10.00 (8.00, 11.00) d vs. 12.00 (10.00, 13.00) d, P<0.001], and average estradiol levels on human chorionic gonadotropin trigger day [2 487.00 (1 461.25, 4 090.25) pmol/L vs. 10 738.50 (8 400.00, 16 507.25) pmol/L, P<0.001]. However, no statistically significant difference was found in the total dosages of Gn used between the two groups ( P>0.05). There were no significant differences between the groups in terms of the number of oocytes retrieved, the number of metaphase Ⅱ oocytes, two pronuclei (2PN) rate, 2PN cleavage rate, available embryo rate, high-quality embryo rate, blastocyst formation rate, and available blastocyst formation rate (all P>0.05). Conclusion:Compared with infertility patients with tubal factors, there is no significant difference in the laboratory outcomes of malignant tumor patients undergoing COH for fertility preservation prior to chemotherapy and radiation.

Objective:To investigate the effects of male body mass index (BMI) on semen parameters and perinatal outcomes following artificial insemination by husband (AIH) treatment.Methods:A retrospective cohort study was conducted to analyze the clinical data of 5 053 patients underwent AIH treatment at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University, from January 2017 to February 2024. The study focused on factors such as male semen parameter abnormalities, male sexual dysfunction, female cervical factors, reproductive tract malformations, and unexplained infertility. Patients were classified into three groups based on male BMI: normal weight group (18.5-23.9 kg/m2, n=1 673), overweight group (24.0-27.9 kg/m2, n=2 078), and obese group (BMI≥28.0 kg/m2, n=1 302). The primary objective was to assess the differences in semen parameters and perinatal outcomes among the three groups. Multivariable logistic regression and linear regression analyses were applied to adjust for potential confounders that could influence semen parameters and perinatal outcomes. Results:Semen volume in the normal weight group and overweight group [4.00 (3.00, 5.50) mL, 4.00 (3.00, 5.50) mL] was higher than that in the obese group [4.00 (3.00, 5.00) mL], with a significant difference among the three groups ( P<0.001, a P<0.001). The total sperm count in the normal group and overweight group [207.60 (121.90, 341.75)×10 6, 211.80 (119.88, 334.83)×10 6] was higher than that in the obese group [188.40 (110.96, 323.41)×10 6], with a significant difference among the three groups ( P=0.007, a P<0.001). The total progressive sperm motility count in the normal group [88.18 (43.63, 163.80)×10 6] was higher than that in the obese group [75.30 (40.29, 147.86)×10 6], with a significant difference among the three groups ( P=0.001, a P<0.001). The percentage of forward motile sperm in the normal group [(45.37±17.16)%] was higher than that in the overweight group [(44.03±17.36)%] and the obese group [(43.80±17.21)%], with a significant difference compared among the three groups ( P=0.020, a P=0.016]. In terms of perinatal outcomes, after multivariate logistic regression analysis, only the overweight and obese groups had higher newborn birth weights [(3 389.53±472.65) g, (3 408.57±507.90) g] compared with the normal group [(3 271.32±532.02) g], with a significant difference among the three groups ( P=0.010, a P=0.009). Conclusion:Higher male BMI is associated with decreased semen quality and may increase newborn birth weight following AIH treatment.

Objective:To investigate the mediating role of serum β-human chorionic gonadotropin (hCG) levels on the relationship between embryo quality and pregnancy outcomes following single frozen-thawed blastocyst transfer 14 d post-transfer.Methods:This retrospective cohort study collected data from patients who underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) frozen-thawed single blastocyst transfer at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University between August 2017 and June 2021. Patients were grouped according to embryo quality into good-quality blastocyst group ( n=3 191) and available blastocyst group ( n=2 027). Differences in serum β-hCG levels and pregnancy outcomes at 14 d post-transfer were compared between the two groups. Mediation analysis and receiver operating characteristic (ROC) analysis were used to explore the mediating effect of β-hCG levels on the relationship between embryo quality and pregnancy outcomes and to evaluate the differences in the incidence of placental-related diseases between the two groups. Results:The good-quality blastocyst group had significantly higher serum β-hCG levels [1 177.0 (1.8, 2 278.5) U/L], clinical pregnancy rate [65.62% (2 094/3 191)], and live birth rate [52.55% (1 667/3 191)] compared with the available blastocyst group [54.4 (0.1, 1 453.5) U/L, P<0.001; 46.13% (935/2 027), P<0.001; 34.19% (693/2 027), P<0.001]. The early miscarriage rate in the good-quality group [13.47% (282/2 094)] was lower than that in the available blastocyst group [19.14% (179/935), P<0.001]. Serum β-hCG levels at 14 d post-transfer showed significant mediating effects on clinical pregnancy rate ( r=-0.126), live birth rate ( r=-0.122), and early miscarriage rate ( r=0.028) in both groups (all P<0.001). The cut-off values for β-hCG to predict live birth in the available and good-quality blastocyst groups were 366.9 U/L and 485.5 U/L, with positive predictive values of 76.28% (672/881) and 82.84% (1 628/1 965), respectively, and negative predictive values of 98.15% (1 114/1 135) and 96.14% (1 170/1 217). The cut-off values for predicting clinical pregnancy were 118.8 U/L and 226.5 U/L, with positive predictive values of 95.43% (919/963) and 98.45% (2 037/2 069), and negative predictive values of 99.72% (1 050/1 053) and 94.89% (1 059/1 116). The cut-off values for predicting early miscarriage were 1 337.0 U/L and 1 162.6 U/L, with positive predictive values of 32.75% (130/397) and 30.18% (150/497), and negative predictive values of 90.89% (489/538) and 91.73% (1 465/1 597). No differences were found in the incidence of placental-related diseases between the two groups (all P>0.05). Conclusion:This study indicates that both embryo quality and serum β-hCG levels at 14 d post-transfer significantly affect pregnancy outcomes. β-hCG levels play an important mediating role between embryo quality and pregnancy outcomes. ROC analysis demonstrates the good predictive efficacy of serum β-hCG levels for pregnancy outcomes, providing scientific evidence for optimizing embryo selection.

Objective: There were associations between emotional abuse and neglect (EAN) and depression, but few studies had tested potential mechanisms underlying these relationships. We aimed to provide insights on how (the mediation role of neuroticism), and under what conditions (the moderator role of psychological resilience), led to a higher level of depression. Methods: This study was a cross-sectional study that used a random cluster sampling method. We randomly selected 3,993 participants from four junior middle schools in northern city of China. Participants were asked to complete four self-reported questionnaires, including the Childhood Trauma Questionnaire, Children Depression Inventory-Short Form, Chinese Big Five Personality Inventory Brief Version, and Chinese Resilience Scale. Results: The results showed that neuroticism mediated the associations between EAN and depression. In addition, the mediating effect of neuroticism was moderated by psychological resilience (p<0.05). Conclusion EAN and neuroticism could have an adverse impact on depression, and psychological resilience could alleviate these negative effects as a moderator. Our model suggested psychological resilience could be a particularly effective intervention point for victims of EAN.