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 evaluate the efficacy and safety of botulinum toxin A (BTX-A) injection into the external urethral sphincter in combination with sacral neuromodulation (SNM) for the treatment of idiopathic non-obstructive urinary retention (INOUR). Methods A total of 57 INOUR patients treated in our hospital during May 2022 and May 2024 were enrolled. Patients were divided into the BTX (n=30) and combined groups (n=27) according to whether they chose SNM after BTX-A injection. The baseline, postoperative 1-month and 6-month consecutive 3-day voiding diaries, quality of life score (QoL), and post-void residual (PVR), preoperative and postoperative 1-month urodynamic results, and postoperative complications were recorded and compared between the two groups. Results One month after surgery, the average number of voiding frequency per day and PVR were lower in both groups than those before surgery (P<0.05), while the average daily urine volume and maximum flow rate (MFR) were higher (P<0.05). There was no statistically significant difference between the maximum detrusor pressure during micturition in both groups before and after surgery (P>0.05). One month after surgery, the average number of voiding frequency per day, average daily urine volume, PVR, QoL, MFR, bladder compliance (BC), and maximum cystometric capacity (MCC) were better in the combined group than in the BTX group (P<0.05), and the efficiency was higher in the combined group (88.9% vs.63.3%, P<0.05). Six months after surgery, the efficacy of the BTX group returned to the baseline level with no statistically significant difference, whereas the efficacy of the combined group was stable (not different from the postoperative 1-month indicators, but better than the baseline level). During the follow-up, there was no difference in the incidence of complications between the BTX group and combined group [43.3% (13/30) vs. 48.1% (13/27), P>0.05]. Conclusion BTX-A injection into the external urethral sphincter combined with SNM improves the short-term outcomes of INOUR patients and maintains the efficacy 6 months postoperatively, which is a safe and reliable treatment option.

Objective:To deeply explore the potential mechanism of Kangmin Zhisou Granules in the treatment of bronchial asthma through network pharmacology method; To verify it with animal experiments.Methods:The active components and corresponding target information of Kangmin Zhisou Granules were screened with the help of BATMAN-TCM database, and the related disease targets of bronchial asthma were obtained through GeneCards and OMIM databases. The drug targets and bronchial asthma targets were intersected and imported String database was used to establish PPI network. Cytoscape 3.9.1 software was used to draw the network diagram of "Chinese materia medica-active components-intersection targets" and the core targets were screened. GO and KEGG enrichment analysis was performed on the core targets using DAVID database. A mouse model of asthma induced by ovalbumin was prepared. After the intervention of Kangmin Zhisou Granules, the pathological changes of mouse lung tissue were observed, and the contents of serum TNF-α, IL-6, IL-1 β were detected by ELISA.Results:Totally 240 active components and 1 364 potential targets were obtained from Kangmin Zhisou Granules. Tumor necrosis factor (TNF), interleukin-6 (IL-6), protein kinase B (AKT1), albumin (ALB), interleukin 1-beta (IL-1β) and other 11 core targets were obtained after screening. The results of GO enrichment analysis showed that the treatment of bronchial asthma by Kangmin Zhisou Granules mainly involved the positive regulation of protein phosphorylation, the regulation of inflammatory response, lipopolysaccharide response and other biological processes, as well as TNF, activated protein kinase (MAPK), interleukin-17 (IL-17) and other signaling pathways. Animal experiments confirmed that Kangmin Zhisou Granules could reduce the expression levels of TNF-α, IL-6 and IL-1β in serum ( P<0.05), and reduce the infiltration of inflammatory cells in the lung tissue of mice, thereby relieving asthma symptoms. Conclusion:Kangmin Zhisou Granules may exert anti-inflammatory effects by acting on TNF-α, IL-6, IL-1β and other targets to alleviate asthma symptoms.

Objective To investigate the clinical values of heparinase-modified thromboelastography(hmTEG)in heparin monitoring during continuous renal replacement therapy.Methods A total of 97 cases who were undergoing continuous renal replacement therapy(CRRT)in the intensive care unit of the 94th People's Liberation Army Hospital from Jan 2014 to Jun 2019 were enrolled in this stud-y.The patients were divided into TEG group and APTT group according to different means of heparin monitoring during continuous renal replacement therapy.In total,278 hemofilters were used in all the blood purification therapies.Complication of bleeding,CRRT time,total heparin dose and SOFA(sequential organ failure assessment)score of the patients were compared between the TEG and APTT groups.The filter life span and survival time in hospital were also compared using Kaplan-Meier analysis.Rusults Compared with APTT group,the total heparin dose in TEG group were significantly higher(P＜0.05).The CRRT time of patients and the average filter life span in TEG group were significantly longer than those of APTT group(P＜0.05).Compared to APTT group,the 28-day SOFA in TEG group was significantly lower(P＜0.05).Survival analysis showed that the 28-day risk of death in the patients of APTT group was 2.01 times higher than that in TEG group(P＜0.05).The 72-hour filter life of TEG group was significantly longer than that of APTT group(P＜0.05).Conclusion The use of hmTEG for monitoring heparin in blood purification should be superior in terms of safety and efficacy with longer filter life span and higher survival rate of patients.

Objective:To conduct systematic review of symptom-cluster assessment tools in adult leukemia patients based on Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines.Methods:Computer searches were conducted on PubMed, Cochrane Library, Web of Science, Wiley Online Library, Embase, China Biology Medicine disc, China National Knowledge Infrastructure, Wanfang and VIP databases. The search period was from the establishment of the database to March 2022, and the references included in the study were traced back. Two researchers trained in evidence-based methodology independently selected the title, abstract and full text of the literature according to the inclusion and exclusion criteria, and extracted and evaluated the data based on the COSMIN guidelines.Results:Finally, 10 evaluation tools were included, among which only the methodological quality and measurement attribute quality of M.D. Anderson Symptom Inventory-Chronic Myeloid Leukemia (MDASI-CML) were rated above "good" and "adequate", respectively. Therefore, the recommended strength of the evidence was Class A, and the recommendation strength of the other 9 tools was Class B.Conclusions:MDASI-CML has good methodology, quality of measurement attributes and grading of evidence, which is recommended for use in symptom cluster assessment of adult patients with leukemia. Meanwhile, more targeted assessment tools need to be developed.

Objective To investigate the value of thromboelastography ( TEG) in evaluating the prognosis of polytrauma patients. Methods A retrospective case control study was conducted to analyze the clinical data of 155 polytrauma patients admitted to 94th Hospital of People's Liberation Army from September 2015 to December 2017. There were 118 males and 37 females, aged 18-88 years [(49. 0 ± 1. 3)years]. Injury severity score (ISS) was (26. 4 ± 11. 0)points. According to the prognosis of patients 90 days after injury, the patients were divided into survival group ( 143 patients ) and death group (12 patients). The ISS on admission, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), Glasgow coma score ( GCS ) , systolic blood pressure ( SBP ) , respiratory rate ( RR ) and outcome of 90 days after injury were collected. Red blood cells( RBC) , hemoglobin( Hb) , plasma prothrombin time ( PT) , activated partial thromboplastin time ( APTT) , fibrinogen ( FIB) , international normalized ratio ( INR) , thrombin time ( TT) , platelet count ( PLT) and TEG-related indicators within 2 hours after ICU admission were collected. TEG-related indicators including TCG clotting reaction time ( R ) , clot formation rate (K), clot formation kinetics (α angle), maximum amplitude (MA), coagulation index (CI), blood clotting strength (G), elasticity constant (E) and clot lysis time (CLT) were collected within 2 hours after admission to ICU. The changes of TEG-related indicators were compared between the two groups, and logistic regression analysis and receiver operating characteristic ( ROC) curve analysis were performed. Results Compared with the survival group, ISS and APACHE II scores in the death group were significantly higher, while GCS, SBP, RR, RBC and Hb were significantly lower (P<0. 05). Compared with the survival group, death group showed significantly prolonged PT [(21. 1 ± 9. 1) s vs. (16. 5 ± 4. 3)s] as well as reduced FIB [(1. 7 ± 1. 5)g/L vs. (2. 7 ± 1. 7)g/L] (P<0. 05). Compared with the survival group, the K value in the death group was significantly prolonged [5. 2(1. 8,8. 0)min vs. 2. 9(2. 1,4. 2)min] (P<0. 05). Compared with the survival group, death group showed significant decrease in G value (3762. 4 ± 3346. 7 vs. 6366. 5 ± 3886. 1), E value (75. 3 ± 67. 0 vs. 127. 3 ± 77.7),αangle[(38.4±19.7)°vs. (49.4±16.6)°],MA[(37.4±17.5)mmvs.(52.0±13.3)mm], CI [-6. 8(-9. 5, 1. 5) vs. -2. 9 ( -5. 9, -0. 7)] and CLT [39. 2 (32. 5, 46. 9) min vs. 46. 4 (32. 7, 60.8) min] (P<0. 05). There were no significant differences in APTT, TT, INR, PLT and R between the two groups (P>0. 05). Logistic regression analysis showed that MA was significantly associated with the prognosis of polytrauma patients (OR=1. 15, 95％ CI 1. 04-1. 28, P<0. 05). The area under the ROC curve of MA was 0. 756 (P <0. 05). When the MA threshold was 43. 1 mm, the sensitivity, specificity, positive predictive value and negative predictive value of predicted survival were 77. 5％, 76. 9％, 76. 1％ and 97. 3％, respectively. Conclusion TEG index MA can determine the prognosis of polytrauma patients, and the mortality rate is significantly increased at MA<43. 1 mm.

Objective Secretion and aggregation dysfunction of platelets are closely related with uncontrollable septic inflammation and abnormal blood coagulation.This study was to investigate the effect of emodin on platelet aggregation (PA) and secretion in mice with late sepsis.Methods We randomly divided 111 healthy SPF male C57BL/6 mice into a sham operation (SO) group, a cecal ligation (CL) group, and an emodin (Em) group and treated those of the Em group intragastrically with emodin after cecal ligation.At 72 hours after operation, we recorded the survival rate of the mice, measured the platelet count and the levels of serum alanine aminotransferase (ALT) and creatinine (Cr), and detected the PA rate by aggregometry, the P-selectin level by flow cytometry, the serum 5-HT concentration by ELISA, and the expressions of Rab27 mRNA and protein by RT-PCR and Western blot, respectively.Results At 72 hours after cecal ligation, the survival rates in the SO, CL and Em groups were 100%, 60% and 66.7%, respectively.The platelet count was significantly decreased in the CL group as compared with that in the SO group ([461.00±64.77] vs [775.00±65.89]×109/L, P<0.05) but remarkably increased in the Em group ([635.20±83.57]×109/L) in comparison with that in the CL group (P<0.05);the levels of ALT and Cr were markedly higher in the CL than in the SO group (ALT: [194.02±31.85] vs [41.55±1.24] U/L, P<0.05;Cr: [1.94±0.29] vs [0.72±0.11] mg/dL, P<0.05), but lower in the Em (ALT: [162.56±31.51] U/L;Cr: [1.53±0.30] mg/dL) than in the CL group (P<0.05);the PA rate and serum 5-HT concentration were significantly reduced in the CL group as compared with the SO group (PA: [12.67±4.04] vs [43.33±2.89]%, P<0.05;5-HT: [13.18±2.31] vs [34.35±5.79] ng/L, P<0.05), but the former was remarkably elevated ([24.67±2.52]%) while the latter showed no significant difference in the Em group ([17.41±2.16] ng/L) as compared with the CL group (P<0.05);the P-selectin expression was markedly higher in the CL than in the SO group ([16.78±1.60] vs [2.33±0.14] %, P<0.05), but lower in the Em ([12.58±2.28] %) than in the CL group (P<0.05).No statistically significant differences were observed at 72 hours postoperatively among the SO, CL and Em groups in the expression Rab27b mRNA (1.85±0.04 vs 1.84±0.02 vs 1.87±0.29, P>0.05).The Rab27b protein expression was markedly lower in the CL and Em groups than in the SO group (0.093±0.015 and 0.140±0.026 vs 10.380±0.036, P<0.05) but with no significant difference between the former two groups (P>0.05).Conclusion Emodin can improve platelet count and aggregation, down-regulate the expression of P-selectin, protect the liver and kidney function, and reduce mortality from late sepsis.

This study aimed to establish human IFN-gamma (hIFN-gamma) in vitro release assay and to apply it in diagnosis of human tuberculosis. Human IFN-gamma gene was cloned and expressed in Escherichia coli. The recombinant hIFN-gamma was purified and used as immunogen to immunize mice and rabbits respectively. Monoclonal and polyclonal antibodies were respectively developed and a sandwich ELISA was established. The heparized whole blood from 111 active tuberculosis patients and 292 clinical healthy controls were collected. The blood was stimulated with tuberculosis specific fused antigen ESAT-6/CFP-10 and the plasma was collected for IFN-gamma detection. The sensitivity for tuberculosis diagnosis was 95.5%, whereas the positive detection rate for the healthy controls was 16.7%. There was a significant difference between the patients and healthy controls (P<0.01) indicating that this assay had a high sensitivity and specificity, and thus could be promising in tuberculosis diagnosis.
Animals ; Antibodies, Monoclonal ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Interferon-gamma ; immunology ; secretion ; Mice ; Mice, Inbred BALB C ; Mycobacterium tuberculosis ; immunology ; Rabbits ; T-Lymphocytes ; immunology ; Tuberculosis ; diagnosis ; immunology