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

The policy system for the construction and management of public hospital with multiple districts is gradually being established and improved,the game among stakeholders affects the effect of policy implementation.There are differences in the strictness of policy implementation on national and local health commission,deviations between local government urban development requirements and the hospital's own construction goals in the process of policy implementation.Based on the game theory of public policy implementation,it analyzes the influencing factors of one hospital with multiple districts and the focus issues encountered in policy implementation,put forward management suggestions for health commission and public hospitals.

The policy system for the construction and management of public hospital with multiple districts is gradually being established and improved,the game among stakeholders affects the effect of policy implementation.There are differences in the strictness of policy implementation on national and local health commission,deviations between local government urban development requirements and the hospital's own construction goals in the process of policy implementation.Based on the game theory of public policy implementation,it analyzes the influencing factors of one hospital with multiple districts and the focus issues encountered in policy implementation,put forward management suggestions for health commission and public hospitals.

The policy system for the construction and management of public hospital with multiple districts is gradually being established and improved,the game among stakeholders affects the effect of policy implementation.There are differences in the strictness of policy implementation on national and local health commission,deviations between local government urban development requirements and the hospital's own construction goals in the process of policy implementation.Based on the game theory of public policy implementation,it analyzes the influencing factors of one hospital with multiple districts and the focus issues encountered in policy implementation,put forward management suggestions for health commission and public hospitals.

The policy system for the construction and management of public hospital with multiple districts is gradually being established and improved,the game among stakeholders affects the effect of policy implementation.There are differences in the strictness of policy implementation on national and local health commission,deviations between local government urban development requirements and the hospital's own construction goals in the process of policy implementation.Based on the game theory of public policy implementation,it analyzes the influencing factors of one hospital with multiple districts and the focus issues encountered in policy implementation,put forward management suggestions for health commission and public hospitals.

The policy system for the construction and management of public hospital with multiple districts is gradually being established and improved,the game among stakeholders affects the effect of policy implementation.There are differences in the strictness of policy implementation on national and local health commission,deviations between local government urban development requirements and the hospital's own construction goals in the process of policy implementation.Based on the game theory of public policy implementation,it analyzes the influencing factors of one hospital with multiple districts and the focus issues encountered in policy implementation,put forward management suggestions for health commission and public hospitals.

The policy system for the construction and management of public hospital with multiple districts is gradually being established and improved,the game among stakeholders affects the effect of policy implementation.There are differences in the strictness of policy implementation on national and local health commission,deviations between local government urban development requirements and the hospital's own construction goals in the process of policy implementation.Based on the game theory of public policy implementation,it analyzes the influencing factors of one hospital with multiple districts and the focus issues encountered in policy implementation,put forward management suggestions for health commission and public hospitals.

The policy system for the construction and management of public hospital with multiple districts is gradually being established and improved,the game among stakeholders affects the effect of policy implementation.There are differences in the strictness of policy implementation on national and local health commission,deviations between local government urban development requirements and the hospital's own construction goals in the process of policy implementation.Based on the game theory of public policy implementation,it analyzes the influencing factors of one hospital with multiple districts and the focus issues encountered in policy implementation,put forward management suggestions for health commission and public hospitals.

The policy system for the construction and management of public hospital with multiple districts is gradually being established and improved,the game among stakeholders affects the effect of policy implementation.There are differences in the strictness of policy implementation on national and local health commission,deviations between local government urban development requirements and the hospital's own construction goals in the process of policy implementation.Based on the game theory of public policy implementation,it analyzes the influencing factors of one hospital with multiple districts and the focus issues encountered in policy implementation,put forward management suggestions for health commission and public hospitals.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is an independent risk factor for colorectal cancer (CRC), and the patients with CRC and T2DM have worse survival. The human gut microbiota (GM) is linked to the development of CRC and T2DM, respectively. However, the GM characteristics in patients with CRC and T2DM remain unclear. METHODS: We performed fecal metagenomic and targeted metabolomics studies on 36 samples from CRC patients with T2DM (DCRC group, n = 12), CRC patients without diabetes (CRC group, n = 12), and healthy controls (Health group, n = 12). We analyzed the fecal microbiomes, characterized the composition and function based on the metagenomics of DCRC patients, and detected the short-chain fatty acids (SCFAs) and bile acids (BAs) levels in all fecal samples. Finally, we performed a correlation analysis of the differential bacteria and metabolites between different groups. RESULTS: Compared with the CRC group, LefSe analysis showed that there is a specific GM community in DCRC group, including an increased abundance of Eggerthella , Hungatella , Peptostreptococcus , and Parvimonas , and decreased Butyricicoccus , Lactobacillus , and Paraprevotella . The metabolomics analysis results revealed that the butyric acid level was lower but the deoxycholic acid and 12-keto-lithocholic acid levels were higher in the DCRC group than other groups ( P < 0.05). The correlation analysis showed that the dominant bacterial abundance in the DCRC group ( Parvimonas , Desulfurispora , Sebaldella , and Veillonellales , among others) was negatively correlated with butyric acid, hyodeoxycholic acid, ursodeoxycholic acid, glycochenodeoxycholic acid, chenodeoxycholic acid, cholic acid and glycocholate. However, the abundance of mostly inferior bacteria was positively correlated with these metabolic acid levels, including Faecalibacterium , Thermococci , and Cellulophaga . CONCLUSIONS Unique fecal microbiome signatures exist in CRC patients with T2DM compared to those with non-diabetic CRC. Alterations in GM composition and SCFAs and secondary BAs levels may promote CRC development.
Humans ; Gastrointestinal Microbiome/genetics* ; Diabetes Mellitus, Type 2 ; Microbiota ; Bacteria/genetics* ; Fatty Acids, Volatile ; Colorectal Neoplasms/metabolism* ; Butyrates ; Feces/microbiology*