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

AIM:The aim of this study was to explore the effects of Yiqi-Yangyin-Quyu prescription(YP)on skeletal muscle injury and related metabolic disorders in mice with Sj?gren syndrome(SS),and to clarify the role of hy-droxyacyl-CoA dehydrogenase trifunctional multienzyme complex subunit beta(Hadhb)in mediating the effect of YP on skeletal muscle in SS.METHODS:The SS mice underwent YP treatment for 8 weeks.The morphological changes of the submandibular gland and muscle tissue were examined using hematoxylin-eosin staining.The mitochondrial status in mus-cle tissue was assessed through transmission electron microscopy.Additionally,combined transcriptome and proteome se-quencing was conducted on skeletal muscle samples.The omics sequencing results were validated by RT-qPCR.Immuno-fluorescence was used to confirm the levels of key proteins involved in the P53/peroxisome proliferator-activated receptor gamma(PPARG)signaling pathway.Immunohistochemistry and Western blot were employed to determine the levels of Hadhb key targets.RESULTS:Combined transcriptome and proteome analysis identified 1 523 differentially expressed genes(DEGs)and 182 differentially expressed proteins(DEPs)between the muscle tissue of SS mice(model group)and that of control animals(ICR group),12 of which showed co-differential expression at both transcriptomic and proteomic levels.Compared with model group,1 232 genes and 432 proteins were found to be differentially expressed in the muscle tissue of the mice in YP group.Among these,23 exhibited co-differential expression at both mRNA and protein levels.Gene Ontology(GO)analysis showed that the DEGs and DEPs between ICR and model groups were mainly involved in ener-gy metabolism and fatty acid oxidation,while the DEGs and DEPs between YP and model groups were primarily associated with sarcomere tissue and actin structure.Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis indi-cated that the DEGs and DEPs between ICR and model groups and between model and YP groups were enriched in the com-plement and coagulation cascade and lipid and pyruvate metabolism.The RT-qPCR validation results were consistent with those of the transcriptome analysis.Furthermore,the protein expression of the tumor suppressor P53 was significantly de-creased in YP group compared with model group,whereas that of PPARG was significantly increased.Western blot analy-sis showed that compared with ICR group,Hadhb protein expression was significantly decreased in model group,whereas the opposite trend was detected in YP group.CONCLUSION:The SS-related skeletal muscle damage is closely related to amino acid metabolism disorder and fatty acid degradation.Treatment with YP modulates innate immune defenses,lipid metabolism and energy metabolism in SS,and Hadhb is the key target of YP in SS-related skeletal muscle.

ObjectiveTo establish preliminary diagnostic criteria for spleen and kidney deficiency syndrome in ischemic stroke patients and provide a basis for standardized diagnosis and treatment of ischemic stroke. MethodsRelevant literature on the diagnostic criteria for spleen and kidney deficiency syndrome in ischemic stroke patients was retrieved， and data were mined and extracted to form an item pool. Based on the formation of the item pool， this study used the Delphi method to initiate two rounds of questionnaire surveys with selected experts to complete the initial screening of items and the discrimination of symptom importance. A prospective clinical investigation method was adopted to collect clinical information from patients， and statistical analysis methods and data mining techniques were comprehensively used to determine their primary and secondary symptoms. Based on the clear main and secondary symptoms identified， combined with expert group discussions， the study established preliminary diagnostic criteria for spleen and kidney deficiency syndrome in ischemic stroke patients. ResultsA total of 25 relevant syndrome differentiation standards were included. After splitting， standardizing， and screening the items， the study established a pool of 48 items. The first round of questionnaire survey consulted 30 experts， with both the positive coefficient of experts and the effectiveness rate of the questionnaire reaching 100%. The Kendall's coefficient of concordance was 0.359. According to the item screening criteria， 26 items were retained in this round of questionnaire survey. A total of 176 cases were collected through clinical information investigation， including 94 cases with spleen and kidney deficiency syndrome and 82 cases without spleen and kidney deficiency syndrome. The statistical results were as follows： ① Descriptive statistics： The main symptoms with a frequency of ≥ 30% included mental fatigue and lack of strength， weakness of the lower back and knees， etc. The secondary symptoms with a frequency of ≥ 10% and ≤ 30% were lassitude and disinclination to talk， shortness of breath， etc. ② Binary logistic regression analysis： The main symptoms with an odds ratio （OR） value of ≥ 3 were mental fatigue and lack of strength， weakness of the lower back and knees， etc. The secondary symptoms with an OR value of ≥ 1 and ≤ 3 were lassitude and disinclination to talk， shortness of breath， etc. Artificial neural network： The main symptoms with a weight value（W_ij）of ≥ 0.5 and < 1 were mental fatigue and lack of strength， lassitude and disinclination to talk， etc. The secondary symptoms with W_ij of ≥ 0.3 and < 0.5 were shortness of breath， flaccid limbs， etc. In the second round of questionnaire survey， a total of 37 experts were consulted， with both the positive coefficient of experts and the effectiveness rate of the questionnaire reaching 100%. The Kendall's coefficient of concordance was 0.237. According to the criteria to determine primary and secondary symptoms based on the Delphi method， the main symptoms included in this round of the questionnaire were mental fatigue and lack of strength， lassitude and disinclination to talk， etc.， and the secondary symptoms were shortness of breath， dizziness， etc. ConclusionThe main symptoms of spleen and kidney deficiency syndrome in ischemic stroke patients are mental fatigue and lack of strength， weakness of the lower back and knees， loose stool， pale and edematous tongue texture possibly with tooth marks， and deep and thready pulse or weak pulse. The secondary symptoms include shortness of breath， dizziness， tinnitus and deafness， decreased appetite or postprandial abdominal distension， pale complexion， frequent micturition at night， dull tongue texture， and white and slippery tongue coating. The preliminarily established diagnostic criteria for spleen and kidney deficiency syndrome in ischemic stroke patients can provide a standardized and objective basis， thereby better guiding clinical diagnosis and treatment of ischemic stroke.

Objective:This study aims to explore the independent and interactive effects of childhood trauma (CT) and major depressive disorder (MDD) on amygdala subregion volumes and to examine whether volumetric changes in these subregions mediate the relationship between CT and depressive severity.Methods:A total of 129 MDD patients and 127 age- and sex-matched healthy controls were recruited from Nanjing Brain Hospital between October 2022 and November 2024. All participants underwent 3D-T 1 weighted MRI scans,and amygdala subregions were segmented using the FreeSurfer software. Depressive and anxiety symptoms were assessed with the 17-item Hamilton Depression Rating Scale (HAMD 17) and the Hamilton Anxiety Scale (HAMA),respectively. Childhood trauma exposure was evaluated via the Childhood Trauma Questionnaire (CTQ). Generalized linear models (GLM) were applied to analyze the main and interactive effects of MDD diagnosis (depression/healthy controls) and CT (presence/absence),adjusting for age,estimated intracranial volume,sex,medication history,and education years. Partial correlation and mediation analyses were conducted to explore associations between amygdala subregion volumes and clinical measures in MDD patients. Results:MDD diagnosis was independently associated with increased volumes in the right central nucleus ( Wald χ2=9.09, P=0.026) and medial nucleus ( Wald χ2=10.08, P=0.026). CT exposure was independently associated with reduced volumes in the right central nucleus ( Wald χ2=7.99, P=0.047) and medial nucleus ( Wald χ2=9.20, P=0.047). No significant interaction effects between MDD and CT were observed in any amygdala subregion. Mediation analysis revealed that reduced right medial nucleus volume partially mediated the relationship between total CTQ scores and depressive severity (proportion mediated: 26.69%,95% CI=0.002-0.060) and mediated the association between emotional neglect and depressive severity (proportion mediated: 26.75%,95% CI=0.006-0.150). Such mediating effects were not found for the right central nucleus. Conclusion:CT and MDD exhibit divergent patterns of influence on amygdala subregions. CT is linked to volumetric reductions,whereas MDD is associated with volumetric enlargement. Reduced volume of the right medial nucleus mediates the relationship between CT and depression severity.

Objective:To explore the fatigue status and its influencing factors in acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI) .Methods:This study is a cross-sectional study. A convenient sampling method was used to select 98 ACS patients who underwent PCI in the Department of Cardiology at China-Japan Union Hospital of Jilin University in February 2024. A general data questionnaire and the Multidimensional Fatigue Inventory-20 (MFI-20) were used to investigate the patients.Results:The total score of MFI-20 for the 98 ACS patients post-PCI was (57.38±15.14). Multiple linear regression analysis showed that hypertension was influencing factor of fatigue in ACS patients after PCI ( P<0.05) . Conclusions:The fatigue level of ACS patients after PCI is at a moderate level. The degree of fatigue is influenced by hypertension. Clinical targeted nursing measures should be implemented to alleviate the fatigue of the patients.

AIM:The aim of this study was to explore the effects of Yiqi-Yangyin-Quyu prescription(YP)on skeletal muscle injury and related metabolic disorders in mice with Sj?gren syndrome(SS),and to clarify the role of hy-droxyacyl-CoA dehydrogenase trifunctional multienzyme complex subunit beta(Hadhb)in mediating the effect of YP on skeletal muscle in SS.METHODS:The SS mice underwent YP treatment for 8 weeks.The morphological changes of the submandibular gland and muscle tissue were examined using hematoxylin-eosin staining.The mitochondrial status in mus-cle tissue was assessed through transmission electron microscopy.Additionally,combined transcriptome and proteome se-quencing was conducted on skeletal muscle samples.The omics sequencing results were validated by RT-qPCR.Immuno-fluorescence was used to confirm the levels of key proteins involved in the P53/peroxisome proliferator-activated receptor gamma(PPARG)signaling pathway.Immunohistochemistry and Western blot were employed to determine the levels of Hadhb key targets.RESULTS:Combined transcriptome and proteome analysis identified 1 523 differentially expressed genes(DEGs)and 182 differentially expressed proteins(DEPs)between the muscle tissue of SS mice(model group)and that of control animals(ICR group),12 of which showed co-differential expression at both transcriptomic and proteomic levels.Compared with model group,1 232 genes and 432 proteins were found to be differentially expressed in the muscle tissue of the mice in YP group.Among these,23 exhibited co-differential expression at both mRNA and protein levels.Gene Ontology(GO)analysis showed that the DEGs and DEPs between ICR and model groups were mainly involved in ener-gy metabolism and fatty acid oxidation,while the DEGs and DEPs between YP and model groups were primarily associated with sarcomere tissue and actin structure.Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis indi-cated that the DEGs and DEPs between ICR and model groups and between model and YP groups were enriched in the com-plement and coagulation cascade and lipid and pyruvate metabolism.The RT-qPCR validation results were consistent with those of the transcriptome analysis.Furthermore,the protein expression of the tumor suppressor P53 was significantly de-creased in YP group compared with model group,whereas that of PPARG was significantly increased.Western blot analy-sis showed that compared with ICR group,Hadhb protein expression was significantly decreased in model group,whereas the opposite trend was detected in YP group.CONCLUSION:The SS-related skeletal muscle damage is closely related to amino acid metabolism disorder and fatty acid degradation.Treatment with YP modulates innate immune defenses,lipid metabolism and energy metabolism in SS,and Hadhb is the key target of YP in SS-related skeletal muscle.

Objective:To explore the fatigue status and its influencing factors in acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI) .Methods:This study is a cross-sectional study. A convenient sampling method was used to select 98 ACS patients who underwent PCI in the Department of Cardiology at China-Japan Union Hospital of Jilin University in February 2024. A general data questionnaire and the Multidimensional Fatigue Inventory-20 (MFI-20) were used to investigate the patients.Results:The total score of MFI-20 for the 98 ACS patients post-PCI was (57.38±15.14). Multiple linear regression analysis showed that hypertension was influencing factor of fatigue in ACS patients after PCI ( P<0.05) . Conclusions:The fatigue level of ACS patients after PCI is at a moderate level. The degree of fatigue is influenced by hypertension. Clinical targeted nursing measures should be implemented to alleviate the fatigue of the patients.

Objective:This study aims to explore the independent and interactive effects of childhood trauma (CT) and major depressive disorder (MDD) on amygdala subregion volumes and to examine whether volumetric changes in these subregions mediate the relationship between CT and depressive severity.Methods:A total of 129 MDD patients and 127 age- and sex-matched healthy controls were recruited from Nanjing Brain Hospital between October 2022 and November 2024. All participants underwent 3D-T 1 weighted MRI scans,and amygdala subregions were segmented using the FreeSurfer software. Depressive and anxiety symptoms were assessed with the 17-item Hamilton Depression Rating Scale (HAMD 17) and the Hamilton Anxiety Scale (HAMA),respectively. Childhood trauma exposure was evaluated via the Childhood Trauma Questionnaire (CTQ). Generalized linear models (GLM) were applied to analyze the main and interactive effects of MDD diagnosis (depression/healthy controls) and CT (presence/absence),adjusting for age,estimated intracranial volume,sex,medication history,and education years. Partial correlation and mediation analyses were conducted to explore associations between amygdala subregion volumes and clinical measures in MDD patients. Results:MDD diagnosis was independently associated with increased volumes in the right central nucleus ( Wald χ2=9.09, P=0.026) and medial nucleus ( Wald χ2=10.08, P=0.026). CT exposure was independently associated with reduced volumes in the right central nucleus ( Wald χ2=7.99, P=0.047) and medial nucleus ( Wald χ2=9.20, P=0.047). No significant interaction effects between MDD and CT were observed in any amygdala subregion. Mediation analysis revealed that reduced right medial nucleus volume partially mediated the relationship between total CTQ scores and depressive severity (proportion mediated: 26.69%,95% CI=0.002-0.060) and mediated the association between emotional neglect and depressive severity (proportion mediated: 26.75%,95% CI=0.006-0.150). Such mediating effects were not found for the right central nucleus. Conclusion:CT and MDD exhibit divergent patterns of influence on amygdala subregions. CT is linked to volumetric reductions,whereas MDD is associated with volumetric enlargement. Reduced volume of the right medial nucleus mediates the relationship between CT and depression severity.

Objective:To explore the characteristics of hippocampal subfield volume changes in bipolar disorder (BD) patients with childhood trauma and investigate the correlation between these volume changes and the severity of depressive symptoms.Methods:A total of 112 BD patients in the depressive phase and 62 healthy controls (HC) were recruited from April 2019 to April 2024. All participants were assessed using 17-item Hamilton depression scale (HAMD-17), Hamilton anxiety scale (HAMA), and the childhood trauma questionnaire (CTQ). Based on CTQ scores, BD patients were divided into two groups: the BD with childhood trauma group (BD-CT group, n=51) and the BD without childhood trauma group (BD-nCT group, n=61). T1-weighted magnetic resonance imaging (MRI) scans of the brain were collected for all participants, and hippocampal subfield volumes were segmented using FreeSurfer software.SPSS 26.0 software and Rv 4.1.1 software were used for data analysis.Generalized linear models were used to compare volume differences among three groups. Partial correlation analysis was performed to examine the relationship between the hippocampal subfield volumes showing significant differences and HAMD scores. Results:Significant differences were observed among the three groups in the left CA3(221.49(185.83, 243.02), 194.02(163.53, 226.19), 227.39(200.65, 247.47)), left CA4(261.68(240.89, 285.45), 236.86(210.76, 264.78), 269.75(244.90, 286.03)), left granule cell layer of the dentate gyrus (GC-ML-DG)(307.84(283.35, 328.85), 277.92(249.51, 308.25), 315.39(285.18, 330.25)), and left molecular layer(586.72(549.38, 635.25), 548.16(500.34, 605.24), 602.15(557.63, 637.13)) (Wald χ2=12.81-17.60, all P<0.05). The BD-CT group had significantly smaller volumes in the left CA3, left CA4, left GC-ML-DG, and left molecular layer compared to the BD-nCT group (all P<0.05). The BD-CT group also showed significantly smaller volumes in the left CA3, left CA4, and left GC-ML-DG compared to the HC group (all P<0.05). The volumes of left CA3 ( r=-0.33), left CA4 ( r=-0.31), left GC-ML-DG ( r=-0.31), and left molecular layer ( r=-0.28) regions were negatively correlated with HAMD scores (all P<0.05, Bonferroni correction). Conclusion:BD patients with childhood trauma exhibit reduced volumes in the left hippocampus subfields, including left CA3, left CA4, left GC-ML-DG and left molecular layer.These volume reductions are negatively correlated with the severity of depression.

Objective:To explore the characteristics of hippocampal subfield volume changes in bipolar disorder (BD) patients with childhood trauma and investigate the correlation between these volume changes and the severity of depressive symptoms.Methods:A total of 112 BD patients in the depressive phase and 62 healthy controls (HC) were recruited from April 2019 to April 2024. All participants were assessed using 17-item Hamilton depression scale (HAMD-17), Hamilton anxiety scale (HAMA), and the childhood trauma questionnaire (CTQ). Based on CTQ scores, BD patients were divided into two groups: the BD with childhood trauma group (BD-CT group, n=51) and the BD without childhood trauma group (BD-nCT group, n=61). T1-weighted magnetic resonance imaging (MRI) scans of the brain were collected for all participants, and hippocampal subfield volumes were segmented using FreeSurfer software.SPSS 26.0 software and Rv 4.1.1 software were used for data analysis.Generalized linear models were used to compare volume differences among three groups. Partial correlation analysis was performed to examine the relationship between the hippocampal subfield volumes showing significant differences and HAMD scores. Results:Significant differences were observed among the three groups in the left CA3(221.49(185.83, 243.02), 194.02(163.53, 226.19), 227.39(200.65, 247.47)), left CA4(261.68(240.89, 285.45), 236.86(210.76, 264.78), 269.75(244.90, 286.03)), left granule cell layer of the dentate gyrus (GC-ML-DG)(307.84(283.35, 328.85), 277.92(249.51, 308.25), 315.39(285.18, 330.25)), and left molecular layer(586.72(549.38, 635.25), 548.16(500.34, 605.24), 602.15(557.63, 637.13)) (Wald χ2=12.81-17.60, all P<0.05). The BD-CT group had significantly smaller volumes in the left CA3, left CA4, left GC-ML-DG, and left molecular layer compared to the BD-nCT group (all P<0.05). The BD-CT group also showed significantly smaller volumes in the left CA3, left CA4, and left GC-ML-DG compared to the HC group (all P<0.05). The volumes of left CA3 ( r=-0.33), left CA4 ( r=-0.31), left GC-ML-DG ( r=-0.31), and left molecular layer ( r=-0.28) regions were negatively correlated with HAMD scores (all P<0.05, Bonferroni correction). Conclusion:BD patients with childhood trauma exhibit reduced volumes in the left hippocampus subfields, including left CA3, left CA4, left GC-ML-DG and left molecular layer.These volume reductions are negatively correlated with the severity of depression.