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 To systematically analyze the risk factors for comorbid ischemic cardiovascular and cerebrovas-cular diseases using principal component analysis.It seeks to identify key risk factors influencing comorbidity and to con-struct a predictive model to serve as a screening tool for the prevention and management of comorbidities.Methods This retrospective study included patients diagnosed with coronary artery disease from December 1,2009 to June 30,2020,at the First Affiliated Hospital of Xinjiang Medical University,using data from the hospital's integrated coronary heart dis-ease prevention platform.Patients were divided into two groups:those with both cardiovascular and cerebrovascular disea-ses and those with only coronary artery disease based on inclusion and exclusion criteria.Clinical indicators during hospi-tal admission were collected.The sample was randomly divided into a modeling set and a validation set in a 7∶3 ratio.In the modeling set,principal component analysis was used to explore the distribution differences in risk factors between the comorbid group and the single-disease group.By analyzing factor load contributions,the most significant variables were i-dentified.Logistic regression was then used to construct a predictive model,and a nomogram was generated.The model's predictive ability and robustness were evaluated in the validation set.Results A total of 11 808 participants were included,with 2 781(23.6%)in the comorbid group and 9 027(76.4%)in the coronary heart disease-only group.Compared with the single-disease group,the comorbid group had a higher average age,a greater proportion of females,and higher systolic blood pressure levels at admission(P<0.001).Additionally,thelevelsof hemoglobin,platelet distri-bution width,low density lipoprotein,and blood sodium were significantly higher in the comorbid group(P<0.05).A total of 8 265 participants were randomly assigned to the modeling set.Principal component analysis identified seven key factors with factor load contributions greater than 5:sodium level,systolic blood pressure,diastolic blood pressure,age,hemoglobin concentration,platelet distribution width,and total bilirubin level.Using these factors,a nomogram was con-structed via Logistic regression.The nomogram's area under the receiver operating characteristic curve for predicting co-morbid ischemic cardiovascular and cerebrovascular diseases was 0.630(95%CI:0.600～0.768,P<0.001).A total of 3 543 participants were randomly assigned to the validation set.In the validation set,the receiver operating characteristic curve was 0.628.Conclusion Elevated sodium level,higher systolic and diastolic blood pressure at admission,older age,increased hemoglobin concentration,higher platelet distribution width,and lower total bilirubin level are risk factors for comorbid ischemic cardiovascular and cerebrovascular diseases.The nomogram constructed has clinical value for screening patients with such comorbidities.

Objective:To summarize the experience of repairing partial areolar necrosis following reduction mammaplasty.Methods:A retrospective analysis was conducted on clinical data from patients who experienced partial areola necrosis after reduction mammaplasty. These patients were treated or consulted at the Department of Plastic Surgery, Zhongshan Hospital, Fudan University, between January 2017 and February 2023. Preoperatively, daily dressing changes were performed on the necrotic areola wounds until the boundaries of necrosis were clearly defined. Debridement and repair were then carried out by resecting bilateral breast glandular tissue through the original incision to reduce breast volume, followed by narrowing the areola radius. If no areola defect remained after narrowing, direct suturing was performed; if defects persisted, the resected normal areola skin was used for grafting. Postoperative follow-up was conducted to observe areola recovery and complications. At the 6-month postoperative mark, patient satisfaction was evaluated using a 5-level scale (very satisfied, satisfied, neutral, dissatisfied, very dissatisfied). An experienced plastic physician, not involved in the surgery, assessed areolar outcomes based on four criteria: color, softness, shape, and scarring, with each criterion scored from 1 to 4 (higher scores indicating better outcomes).Results:Eight female patients (9 necrotic areolas) were included in the study, with a mean age of (31.8±5.4) years and a mean body mass index of (24.1±1.8) kg/m 2. Among the 9 necrotic areolas, 3 had defect areas greater than 50% of the total areola area, while 6 had defects less than 50%. Direct suturing after areola narrowing was performed in 3 areolas, while free areola skin grafting was used in 6 areolas. Postoperatively, 2 cases exhibited mild epidermal erosion at the graft site, which improved with dressing changes. No complications such as infection, bleeding, hematoma, or seroma occurred. At the 6-month follow-up, all 8 patients demonstrated good wound healing, and all 9 areolas survived. The areolas exhibited consistent shape and color bilaterally, without significant pigmentation changes, depigmentation, or irregular shapes. In the 6 grafted areolas, the grafted skin color closely matched the surrounding native areola tissue, with no obvious demarcation or scar hyperplasia. Patient satisfaction was rated as very satisfied in 3 cases and satisfied in 5 cases. According to the physician’s evaluation, the scores for color, softness, shape, and scarring were (3.7±0.5), (3.8±0.4), (3.3±0.7) and (3.2±0.7) points, respectively. Conclusion:Partial areola necrosis following reduction mammaplasty can be effectively repaired by further reducing breast volume and narrowing the areola for direct suturing or by grafting excess areola skin to the defect site. A satisfactory appearance can be achieved after surgery.

Aim To explore the relationship between serum levels of proprotein convertase subtilisin/kexin type 9(PCSK9),macrophage migration inhibitory factor(MIF)and the severity of coronary artery lesions in patients with coro-nary heart disease(CHD).Methods A cross-sectional study was conducted involving 139 patients with CHD and 69 control subjects who underwent coronary angiography during the same period,all of whom were admitted to the People's Hospital of Xinjiang Uygur Autonomous Region from November 2023 to May 2024.Clinical data and coronary angiography results were collected,and the severity of coronary artery stenosis was quantitatively assessed using the Gensini score.Pa-tients with the Gensini scores＞0 were classified into three groups based on tertiles:the mild stenosis group(1～18 points,54 cases),the moderate stenosis group(19～36 points,54 cases),and the severe stenosis group(＞36 points,54 ca-ses).Serum levels of PCSK9 and MIF were measured by ELISA kit.Results Serum levels of PCSK9 and MIF were significantly higher in the CHD group than those in the control group(P＜0.05).Multivariable Logistic regression analy-sis revealed that high levels of serum PCSK9 and MIF were independent risk factors for CHD.Spearman correlation analy-sis showed that serum PCSK9 and MIF levels were positively correlated with Gensini score(rs=0.619 6 and r,=0.411 4,both P＜0.001).Further subgroup analysis showed that serum total cholesterol and low density lipoprotein cholesterol lev-els were significantly increased in patients with high-level PCSK9,while patients with high-level MIF had higher inflamma-tory coefficients such as systemic inflammatory response index(SIRI)and systemic immune-inflammation index(SII)(all P＜0.05).Conclusion Serum levels of PCSK9 and MIF are positively correlated with the severity of coronary artery stenosis.High levels of serum PCSK9 and MIF are independent risk factors for CHD.

Objectives:This study aims to evaluate the causal relationship between plasma proteins and myocardial infarction(MI)using two-sample bidirectional Mendelian randomization(MR)analysis,identify key biomarkers,and validate their expression.Methods:The study utilized publicly available genome-wide association study(GWAS)data of 4 907 plasma proteins as the exposure factor,with single nucleotide polymorphisms(SNPs)as instrumental variables,and four MI datasets as outcomes.Two-sample MR analysis was performed using the inverse variance weighted(IVW)method,complemented by simple model,weighted model,weighted median estimator(WME),and MR-Egger regression methods to assess the causal relationship between exposure factors and outcomes.Venn diagrams and word clouds were used to screen proteins associated with MI as candidate biomarkers.Reverse MR analysis was conducted to evaluate reverse causality.Sensitivity analysis was performed to assess the robustness of the results.Immunohistochemistry(IHC)was used to validate the expression of proteasome activator subunit 1(PSME1)and vacuolar protein sorting 29(VPS29)in the aorta of mice,and enzyme-linked immunosorbent assay(ELISA)was used to verify the expression of PSME1 and VPS29 in plasma from patients with acute myocardial infarction(AMI).Results:The two-sample MR analysis indicated that PSME1 was significantly negatively associated with myocardial infarction in all four datasets,with OR(95%CI)of 0.684(0.557-0.839),0.990(0.987-0.993),0.579(0.448-0.748),and 0.993(0.990-0.996),respectively,with all P<0.001.Similarly,VPS29 also showed a significant negative association with MI in all four datasets,with OR(95%CI)of 0.902(0.862-0.945),0.998(0.997-0.999),0.866(0.808-0.929),and 0.998(0.997-0.999),respectively,with all P<0.001.Reverse MR analysis did not detect reverse causality,and sensitivity analysis confirmed the robustness of the results.IHC results showed significantly reduced expression of PSME1 and VPS29 in the aortas of AMI mice with an atherosclerotic background compared to control mice(both P<0.05).ELISA results indicated significantly lower plasma levels of PSME1 and VPS29 in AMI patients compared to healthy controls(both P<0.05).Conclusions:Higher levels of PSME1 and VPS29 are negatively associated with the risk of MI,suggesting that PSME1 and VPS29 may serve as protective biomarkers for cardiovascular diseases.

Objectives:This study aims to explore the value of the baseline extracellular volume(ECV)measured by cardiac magnetic resonance(CMR)in predicting cardiac response in patients with light chain cardiac amyloidosis(AL-CA)after treatment.Methods:This single-center retrospective cohort study included AL-CA patients diagnosed between May 2020 and March 2023.Baseline ECV measurement and other relevant parameters were derived from CMR.Therapeutic cardiac response was assessed through serial measurements of N-terminal pro-B-type natriuretic peptide(NT-proBNP).Complete recovery was defined as achieving NT-proBNP≤350 pg/ml post-treatment.Patients demonstrating>60%reduction from baseline NT-proBNP without attaining complete response criteria were classified as very good partial recovery.Those showing 31%-60%decreases from baseline NT-proBNP without meeting the threshold for very good partial recovery were qualified as partial recovery,while≤30%reductions from baseline were considered as non-recovery.The study evaluated two endpoints:the initial emergence of any cardiac recovery(encompassing partial recovery,very good partial recovery,or complete recovery)and the subsequent attainment of optimal cardiac recovery(encompassing partial recovery,very good partial recovery,or complete recovery).The patients were divided into two groups based on whether they experienced cardiac recovery at the end of follow-up:the recovery group(n=24,comprising 7 with partial recovery,14 with very good partial recovery,and 3 with complete recovery)and the non-recovery group(n=16).Cox Proportional hazards regression models were used to analyse the impact of baseline ECV on the cardiac recovery.The Kaplan-Meier method and log-rank test were used to assess and compare the probability and timing of cardiac recovery between different baseline ECV groups.Results:Among the 40 patients,28(70%)were male,with a mean age of(58?±?8)years.32 patients(80%)had the λ subtype of AL-CA.During a median follow-up of 568(155,1 049)days,15 patients showed partial cardiac recovery at 60 days post-treatment,and 3 patients achieved very good partial cardiac recovery;by 720 days of treatment and until the end of follow-up,3 patients achieved complete cardiac recovery.Multivariate Cox regression analysis revealed that baseline ECV(HR=0.937,95%CI:0.879-0.999,P=0.045)and daratumumab-based regimens(HR=3.279,95%CI:1.098-9.796,P=0.033)were significant predictors of the initial cardiac recovery.Similarly,baseline ECV(HR=0.931,95%CI:0.867-1.000,P=0.048)and daratumumab-based regimens(HR=3.132,95%CI:1.052-9.319,P=0.040)were also independent predictors for the best cardiac recovery.Kaplan-Meier analysis demonstrated that patients with baseline ECV<54%achieved an earlier first cardiac recovery than those with baseline ECV≥54%(log-rank P=0.014)and the group with baseline ECV<55%were more likely to achieve the best cardiac recovery compared to those with baseline ECV≥55%(log-rank P=0.006).Conclusions:Baseline ECV measured by CMR can serve as an independent predictor of cardiac recovery in AL-CA patients after treatment.Lower baseline ECV levels are associated with a faster and more favorable cardiac recovery.The daratumumab-based regimens demonstrated superior cardiac recovery outcomes.

Objectives:To investigate the clinical value of cardiac magnetic resonance imaging(CMR)feature-tracking strain analysis in risk stratification of diabetic heart failure with preserved ejection fraction(HFpEF).Methods:In this retrospective study,a total of 215 patients with diabetic HFpEF who underwent CMR at Chinese Academy of Medical Sciences Fuwai Hospital from January 2012 to December 2018 were included.Myocardial strain parameters were calculated using CMR feature-tracking technology.Patients were followed up by medical records or telephone calls.Composite endpoint event,all-cause death or heart failure hospitalization during follow-up were recorded.Patients were divided into event group and event-free group.Univariable and multivariable Cox proportional hazard regression analyses were performed to determine the risk factors for the outcomes in diabetic HFpEF.The effects of hypertension and obesity on the prognosis of diabetic HFpEF patients and whether they affect the prognostic value of CMR feature-tracking strain analysis were also analyzed.Results:During a follow-up of(7.1±1.8)years,93(43.3%)patients had endpoint events(event group),including 28 all-cause deaths and 65 heart failure hospitalization.Compared with the event-free group(n=122),patients in the event group had significantly lower left ventricular ejection fraction,higher prevalence and extent of late gadolinium enhancement,and significantly reduced global longitudinal strain(GLS),global circumferential strain,global radial strain,and global systolic longitudinal strain rate(all P<0.05).The absolute GLS value was significantly lower in event group than in event-free group,regardless of the presence of hypertension and obesity.Multivariate Cox regression analysis showed that estimated glomerular filtration rate(HR=0.983,95%CI:0.972-0.993,P=0.001),left atrial volume index(HR=1.015,95%CI:1.005-1.026,P=0.004),and GLS(HR=1.142,95%CI:1.060-1.231,P<0.001)were independent risk factors for adverse cardiovascular events in diabetic HFpEF patients.However,adjusted N-terminal pro-brain natriuretic peptide was not an independent prognostic factor.The cut-offvalue of GLS to predict outcome was-14.09%from ROC curve analysis.The Kaplan-Meier curve showed that in patients with and without hypertension and obesity,patients with the GLS>-14.09%had lower event-free survival compared to patients with GLS≤-14.09%(all P<0.05),and the ability of GLS to predict adverse outcomes was not affected by hypertension and obesity.Conclusions:GLS obtained by CMR feature-tracking strain analysis is an independent predictor of adverse outcomes in diabetic HFpEF,and its ability to predict adverse outcomes is independent of hypertension and obesity.

Objective:To investigate the relationship between nonalcoholic fatty liver disease (NAFLD) and the long-term prognosis in patients with acute myocardial infarction (AMI).Methods:It was a retrospective cohort study. A total of 712 patients diagnosed with AMI who were admitted to the People′s Hospital of Xinjiang Uygur Autonomous Region from January 2018 to December 2019 were continuously included as subjects. The fatty liver index (FLI) was used to evaluate the degree of hepatic steatosis. Subjects were divided into No NAFLD group (FLI?30), grade 1 NAFLD group (30≤FLI?60), and grade 2 NAFLD group (FLI≥60). The endpoint event was defined as the occurrence of major cardiovascular adverse events (MACEs). The Cox proportional risk model was used to assess the risk of MACEs. The Kaplan-Meier curve was used to analyze the survival differences between the groups, and subgroup analysis was performed for age, gender, and complicity with hypertension, diabetes, dyslipidemia, and abdominal obesity.Results:During the follow-up period, the incidence of MACEs was 10.92% (26/238) in the No NAFLD group, it was 18.01% (47/261) in the grade 1 NAFLD group, and 24.41% (52/213) in the grade 2 NAFLD group, there was significant difference in the incidence of adverse events among the groups ( χ2=9.136, P?0.05). After adjusting for confounding factors, compared with the No NAFLD group, the risk of MACEs in grade 1 NAFLD group was increased by 69.0%( HR=1.690, 95% CI: 1.026-2.783, P=0.039) and 131.2%( HR=2.312, 95% CI: 1.415-3.773, P=0.001), respectively. Kaplan-Meier curve analysis indicated that the cumulative incidence of MACEs was significantly increased and the prognosis was worse in grade 2 NAFLD group (Log-rank test χ2=13.500, P=0.001). The results of subgroup analysis suggested that grade 2 NAFLD could significantly increase the risk of MACEs in all age groups, women, dyslipidemia, normal body type, and people with or without hypertension or diabetes. In particular, it had higher predictive value in women and normal-size people (interaction P?0.05). Conclusion:The degree of NAFLD is closely related to the long-term prognosis of AMI patients, the more severe the NAFLD, the higher the risk of adverse events in AMI patients.

Objective To observe the clinical,CT and MRI manifestations of CIC-rear ranged sarcoma(CRS).Methods Eight patients with single CRS lesion ranged from 3.79 to 98.81 cm and the median of 21.37 cm were retrospectively enrolled,6 lesions located in deep soft tissue and 2 located in the femur.The clinical and imaging data were observed.Results All 8 CRS lesions presented as rapidly growing local masses,including 6 solid cystic soft tissue lesions and 2 non enlarged bone lesions with osteolytic bone destruction,which were all lobulated lesions with uneven equal-low density/slightly high T1 and slightly high T2 signals,with multiple focal map like necrosis.Diffusion weighted imaging showed lesions with limited diffusion and invasion of adjacent tissue,and"ice melting sign"was observed in 4 cases.After administration of contrast agents,the solid components of lesions enhanced unevenly and moderately or significantly and sustainedly,with slightly more pronounced enhancement at the edges,abundant blood vessels were visible inside and at the edges."Vascular floating sign"was noticed in 2 cases.Conclusion The clinical,CT and MRI manifestations of CRS had certain characteristics.

Objective: To explore the correlation between allogeneic red blood cell (RBC) transfusion and healthcare-associated infections (HAIs) in patients undergoing coronary artery bypass grafting (CABG) during the perioperative period. Methods: A single-center retrospective cohort of 1,170 patients undergoing isolated CABG was analyzed. Multivariable logistic regression and restricted cubic splines (RCS) were employed to explore the nonlinear association between perioperative RBC transfusion (from intraoperative period to 72 hours postoperatively) and HAIs. Results: Among the 1,170 CABG patients, 109 patients (9.2%) received RBC transfusion during the operation or within 3 days after the operation. The risk of HAIs in those who received ≥4 units of RBCs during and within 3 days after the operation was 6.89 times higher than that in the non-transfusion group (95% CI: 3.65-17.20). Furthermore, there was a nonlinear threshold effect between the blood transfusion volume and postoperative HAIs (inflection point: 7.8 units). When the transfusion volume was ≤7.8 units, the risk of HAIs increased by 61% for each additional unit transfused (OR=1.61, 95% CI: 1.21-2.15). Beyond this threshold, no statistically significant association was observed (P=0.289). Conclusion: Perioperative RBC transfusion in CABG patients is associated with an increased incidence of HAIs. The perioperative blood transfusion volume has a curvilinear relationship with the risk of postoperative HAIs. When the blood transfusion volume is ≤7.8 units, the blood transfusion volume has a dose-dependent relationship with postoperative infection, with higher blood transfusion volumes correlating with greater postoperative infection risk. When the blood transfusion volume is >7.8 units, the relationship between the two is not statistically significant. The preventive effect of reducing RBC transfusion on HAIs requires further validation in the future.