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Importance: The optimal strategy of combining left atrial appendage occlusion (LAAO) with catheter ablation (CA) in patients with atrial fibrillation (AF) during a single procedure remains unclear., Objective: To determine the effects of ablation-first vs occlusion-first strategies on long-term clinical outcomes among patients with atrial fibrillation undergoing a combined LAAO and CA procedure., Design, Setting, and Participants: The prospective, multicenter COMBINATION randomized clinical trial was conducted in 14 high-volume centers in China. Enrollment of patients with nonvalvular AF referred for the combined procedure began on July 24, 2020, and concluded on January 20, 2022., Interventions: Patients were randomly assigned to either the ablation-first group or the occlusion-first group. Outcomes of LAAO using an occlusion device and CA using a contact force-sensing catheter following different combination strategies during long-term follow-up were evaluated., Main Outcomes and Measures: The primary end point was a composite of thromboembolic events including stroke or transient ischemic attack, device-related thrombus (DRT), clinically relevant bleeding, and cardiovascular rehospitalization or death. Freedom from AF or atrial tachyarrhythmia (ATA) after a single procedure without antiarrhythmic drugs, at both 1 year and long-term follow-up, was also evaluated., Results: Of the 202 patients enrolled, 194 (96.0%) completed the trial (97 in the ablation-first group and 97 in the occlusion-first group). The mean (SD) age of the cohort was 67.3 (9.2) years, and 110 patients (56.7%) were male. All procedures achieved acute successful LAAO and restoration of sinus rhythm, with similar incidences of periprocedural complications. Compared with the ablation-first group, the occlusion-first group exhibited significantly higher event-free survival of the primary end point (83.5% vs 71.1%; hazard ratio [HR], 0.53 [95% CI, 0.29-0.95]; log-rank P = .04) during the median 2.5 (IQR, 2.3-2.8) years of follow-up. Subgroup analysis indicated that male patients and those with higher CHA2DS2-VASc scores (a composite of factors associated with stroke risk; higher scores indicate higher risk) were at lower risk of thromboembolic events. Rates of long-term freedom from AF (77.3% vs 63.5%; HR, 0.58 [95% CI, 0.34-0.97]; log-rank P = .04) and from ATA (70.1% vs 55.7%; HR, 0.62 [95% CI, 0.39-0.99]; log-rank P = .04) were higher in the occlusion-first group vs the ablation-first group. Additionally, a higher incidence of chronic peridevice leak (15 [15.5%] vs 5 [5.2%]; P = .03) and DRT (8 [8.2%] vs 1 [1.0%]; P = .04) was observed in the ablation-first group vs the occlusion-first group., Conclusions and Relevance: In this randomized clinical trial, the occlusion-first approach was superior due to its higher event-free survival of the primary end point and long-term freedom from ATA. These findings suggest that the occlusion-first approach should be recommended for combined procedures with plug-like device implantation., Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2000031486.

Background: The optimal treatment strategy for elderly patients with ruptured intracranial aneurysms (IAs) remains controversial. We evaluated a national, multihospital database to compare the outcomes of aggressive treatment and medical management for those patients., Methods: We performed a retrospective analysis of 2665 elderly patients with ruptured IAs admitted to 11 hospitals in China. Patients were divided into three age groups (60-69, 70-79, and 80 years or older). Multiple logistic regression was used to estimate the odds ratio for favorable and unfavorable outcomes., Results: Patients between 60 and 69 years old undergoing endovascular treatment (EVT) had significantly decreased morbidity (13.7% versus 19.7% and 29.9%), compared to those who underwent clipping and medical management, similar mortality to patients who underwent clipping (3.6% versus 2.6%), and decreased mortality (3.6% versus 8.7%) to patients who underwent medical management. Coiled patients 70 to 79 years old had lower morbidity (21.3% versus 33.8%) and mortality (2.8% versus 11.3%) compared to patients who underwent medical management and similar mortality (21.3% versus 27.2%) and mortality (2.8% versus 4.8%) to patients who underwent clipping. Multivariate logistic regression analysis demonstrated that factors associated with discharge status were age, poor mFisher grade, poor WFNS grade, hypertension, diabetes, smoking, aneurysms 4 mm or larger, and middle cerebral artery aneurysms., Conclusions: Elderly patients treated with EVT had significantly less morbidity and mortality than those treated with clipping and medical management. A comprehensive assessment of the general state of elderly patients and IAs characteristic may help us to predict patients' prognosis., (Copyright © 2024 Copyright: © 2024 Neurology India, Neurological Society of India.)

Background: With the increasing popularity of the internet, a growing number of patients and their companions are actively seeking health-related information online., Objective: The aim of this study was to assess the quality and readability of online information about Alzheimer's disease (AD) in China., Methods: A total of 263 qualified AD-related web pages from different businesses, governments, and hospitals were obtained. The quality of the web pages was assessed using the DISCERN tool, and the readability of the web pages was assessed using a readability measurement website suitable for the Chinese language. The differences in readability and quality between different types of web pages were investigated, and the correlation between quality and readability was analyzed., Results: The mean overall DISCERN score was 40.93±7.5. The government group scored significantly higher than the commercial and hospital groups. The mean readability score was 12.74±1.27, and the commercial group had the lowest readability score. There was a positive correlation between DISCERN scores and readability scores., Conclusions: This study presents an evaluation of the quality and readability of health information pertaining to AD in China. The findings indicate that there is a need to enhance the quality and readability of web pages about AD in China. Recommendations for improvement are proposed in light of these findings.

Background: The family doctor (FD) contracting system is a key reform in the development of the Chinese health system, and is considered an effective way to ensure equitable access to healthcare services. This study investigates the effects of social integration on FD contracting services among migrant populations., Methods: In total, 120,106 respondents from the 2018 China Migrants Dynamic Survey were included in this study. Two multivariate regression models were used to estimate the effect of social integration and other factors on FD contracting services among migrant populations., Results: This study found that only 14.0% of the migrant populations had a FD. Multiple dimensions of social integration and some covariates were shown to be positively associated with FD contracting services, including average monthly household income, local medical insurance (odds ratio [OR] = 1.34, 95% confidence interval [CI] = 1.29-1.39), employment status (OR = 0.86, 95% CI = 0.82-0.91), settlement intention (OR = 1.15, 95% CI = 1.09-1.22), received health education (OR = 4.88, 95% CI = 4.51-5.27), sex (OR = 1.16, 95% CI = 1.12-1.20), age (OR = 1.66, 95% CI = 1.51-1.82), marital status (OR = 1.38, 95% CI = 1.31-1.46), sickness within a year (OR = 0.84, 95% CI = 0.79-0.89), and flow range (OR = 1.12, 95% CI = 1.07-1.16)., Conclusions: All dimensions of social integration, including economic integration, social identity, and social involvement, are associated with FD contracting services among migrant populations. Policymakers should focus on improving the signing rates of migrant populations and implement more effective measures to enhance their social integration, such as settlement incentives and encouraging social participation., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Linezolid is an oxazolidinone antimicrobial agent often used to treat multidrug-resistant Gram-positive bacterial infections. The common adverse reactions of linezolid are diarrhea, nausea, headache and bone marrow suppression, and so on. Here, we report the first case of teeth discoloration induced by linezolid linked with extrinsic discoloration in China Mainland. This case report highlights a rare adverse reactions of a commonly used antibiotic., (Copyright © 2020 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Objective: To prevent the rapid spread of COVID-19, the Chinese government implemented a strict lockdown in Wuhan starting on 23 January, 2020, which inevitably led to the changes in indications for the mode of delivery. In this retrospective study, we present the changes in the indications for cesarean delivery (CD) and the birth weights of newborns after the lockdown in Wuhan., Methods: A total of 3,432 pregnant women in the third trimester of their pregnancies who gave birth in our hospital from 23 January 2019 to 24 March 2020 were selected as the observation group, while 7,159 pregnant women who gave birth from 1 January 2019 to 22 January 2020 were selected as the control group; control group was matched using propensity score matching (PSM). A comparative analysis of the two groups was performed with the chi-square test, t test and rank sum test., Results: The difference in the overall rate of CD between the two groups was not statistically significant (p<0.05). Among the indications for CD, CD on maternal request (CDMR) and fetal distress were also significantly more common in the observation group (p<0.05) than the control group. Furthermore, we found that the weight of newborns was significantly heavier in the observation group than in the control group when considering full-term or close-to-full-term births (p<0.05)., Conclusions: The results may provide useful information to management practices regarding pregnancy and childbirth after lockdown in other cities or countries, enabling better control of the rate of CD due to CDMR, reducing fetal distress, and controlling newborn weight. We recommend that pregnant women pay more attention to controlling the weight of newborns through diet and exercise., Competing Interests: The authors have declared that no competing interests exist.

Objective: To determine the feasibility and efficacy of breast reconstruction with silicone prosthesis immediately following polyacrylamide gel removal., Study Design: An observational study., Place and Duration of Study: Department of Breast and Thyroid Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China, from November 2013 to May 2017., Methodology: Twenty-seven patients with serious complications resulting from polyacrylamide gel (PAAG) injection were operated in our hospital. Using an inframammary fold incision, the PAAG and surrounding tissues were completely removed. All patients were received mastopexy and immediate breast reconstruction., Results: Of all patients, 26 reported relief of preoperative complications, without obvious postoperative complications. Only one patient developed recurring infections after surgery and removed the prostheses., Conclusion: After removal of PAAG, mastopexy followed by immediate breast reconstruction allows the patient to obtain a satisfactory appearance without serious complications. The key to successful breast reconstruction with prostheses first lies with the complete excision of PAAG and surrounding tissues.

Plants are moving poleward and upward in response to climate warming. However, such movements lag behind the expanding warming front for many reasons, including the impediment of plant movement caused by unusual cold events. In this study, we measured the maximum photochemical efficiency of photosystem II ( F ) in 101 warm-climate angiosperm species to assess their cold tolerance at the end of a severe chilling period of 49 days in a southern subtropical region (Nanning) in China. We found that 36 of the 101 species suffered from chilling-induced physiological injury, with predawn v /F m ) in 101 warm-climate angiosperm species to assess their cold tolerance at the end of a severe chilling period of 49 days in a southern subtropical region (Nanning) in China. We found that 36 of the 101 species suffered from chilling-induced physiological injury, with predawn F v /F m values of less than 0.7. There was a significant exponential relationship between the predawn F v /F m and northern latitudinal limit of a species; species with a lower latitudinal limit suffered more. Our results suggest that the range limits of warm-climate plants are potentially influenced by their physiological sensitivity to chilling temperatures and that their poleward movement might be impeded by extreme cold events. The quick measurement of F v /F m is useful for assessing the cold tolerance of plants, providing valuable information for modelling species range shifts under changing climate conditions and species selection for horticultural management and urban landscape design., (© 2018 The Author(s).)

Background and Purpose: Although flow diverters have been reported with favorable clinical and angiographic outcomes in various literatures, randomized trials determining their true effectiveness and safety are still in lack. The Parent Artery Reconstruction for Large or Giant Cerebral Aneurysms Using the Tubridge Flow Diverter (PARAT) trial was designed to evaluate the safety and efficacy of the Tubridge flow diverter in the treatment of large or giant aneurysms in comparison with Enterprise stent-assisted coiling., Materials and Methods: This prospective, multicenter, randomized trial was conducted at 12 hospitals throughout China. Enrolled adults with unruptured large/giant intracranial aneurysms were randomly assigned (1:1) to receive either Enterprise stent-assisted coiling or Tubridge flow diverter implantation. The primary end point was complete occlusion at 6-month follow-up, while secondary end points included technical success, mortality, target vessel-related stroke, aneurysm bleeding, in-stent stenosis, parent artery occlusion, and the frequency of all adverse events., Results: Among 185 enrolled subjects, 41 withdrew before procedure initiation. Overall, 82 subjects underwent Tubridge implantation, and 62 subjects were primarily treated with stent-assisted coiling. The results of 6-month follow-up imaging included complete occlusion rates of 75.34% versus 24.53% for the Tubridge and stent-assisted coiling groups, respectively, with a calculated common odds ratio of 9.4 (95% confidence interval, 4.14-21.38; P < .001). There was a higher, nonsignificant frequency of complications for Tubridge subjects. Multivariate analysis showed a decreased stroke rate at the primary investigational site, with a marginal P value ( P = .051)., Conclusions: This trial showed an obviously higher rate of large and giant aneurysm obliteration with the Tubridge FD over Enterprise stent-assisted coiling. However, this higher obliteration rate came at the cost of a nonsignificantly higher rate of complications. Investigational site comparisons suggested that a learning curve for flow-diverter implantation should be recognized and factored into trial designs., (© 2018 by American Journal of Neuroradiology.)

Rationale: Premature osteoarthritis (POA) is a rare condition in Wilson disease (WD). Particularly, when POA is the only complaint of a WD patient for a long time, there would be misdiagnosis or missed diagnosis and then treatment delay., Patient Concerns and Diagnosis: Two Chinese Han siblings were diagnosed as WD by corneal K-F rings, laboratory test, and mutation analysis. They presented with isolated POA during the first 2 decades or more of their disease course, and were of missed diagnosis during that long time. The older affected sib became disabled due to his severe osteoarthritis when he was as young as 38 years old. Two compound heterozygous pathogenic variants c.2790&#95;2792del and c.2621C>T were revealed in the ATP7B gene through targeted next-generation sequencing (NGS)., Lessons: Adolescent-onset POA could be the only complaint of WD individual for at least 2 decades. Long delay in the treatment of WD's POA could lead to disability in early adulthood. Detailed physical examination, special biochemical test, and genotyping through targeted NGS should greatly reduce diagnosis delay in atypical WD patients with isolated POA phenotype., (Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To investigate the incidence and risk factors of prehypertension among adults in mainland China and identify the high-risk population., Methods: Six databases including Chinese Biological Medical Literature Database (CBM), Chinese Science and Technology Periodical Database (VIP), China National Knowledge Infrastructure (CNKI), Wanfang Database (WF), PubMed and Web of Knowledge were searched for publications documenting the incidence and risk factors of prehypertension among general population in Chinese adults. Eligible studies were selected according to the inclusion and exclusion criteria for meta-analysis using Stata software and RevMan software., Results: Twenty-one published studies were finally included. The results showed that the incidence of prehypertension was 37% in Chinese adults. The pooled SMD (95% confidence interval [CI]) was 0.37 (0.29-0.46) for body mass index, 0.20 (0.12-0.27) for fasting blood glucose (FPG), 0.17 (0.15-0.19) for total cholesterol (TC), 0.22 (0.17-0.27) for triglyceride (TG), 0.13 (0.10-0.15) for low-density lipoprotein cholesterol (LDL-C), and -0.07 (-0.16-0.02) for high-density lipoprotein cholesterol (HDL-C). For smoking, drinking and family history of hypertension, the pooled OR (95% CI) were 1.44 (1.40-1.47), 1.60 (1.44-1.79), and 1.19 (1.04-1.35), respectively., Conclusion: The incidence of prehypertension among adults in mainland China is relatively high, especially in males. BMI, FBG, TC, TG, LDL-C, smoking, drinking and family history of hypertension are positively related to prehypertension, and early intervention is recommended to reverse these modifiable risk factors.

Background: Intracranial aneurysm (IAN) is a protruding bubble or a sac on a brain artery that balloons out over time, which may lead to spontaneous subarachnoid hemorrhage (SAH), ultimately disability and mortality. Current research indicates that the disease is due to multiple causes, including environmental factors and various congenital abnormalities of blood vessels. Apart from congenital predisposition, various high-risk factors such as sex, age, hypertension, and atherosclerosis are involved in the formation of intracranial aneurysms. The aim of this study was to investigate the risk factors associated with the formation of sporadic intracranial aneurysms in Chinese Han ethnic patients., Methods: A total of 251 patients with intracranial aneurysm and 338 patients with other cerebral diseases (control group) were enrolled in this study. Single factor and logistic regression model were used to analyze the association of intracranial aneurysms with age; sex; cigarette smoking; alcohol or cocaine consumption; history of hypertension, coronary artery disease, diabetes mellitus and inherited connective tissue disease; and the levels of fasting blood glucose and blood fat. The data expressed as mean +/- standard deviation were processed with the statistical software SPSS13. Quantitative and qualitative data were analyzed by the independent-sample t test, and the chi-square test respectively. Logistic regression method was used to analyze the multiple factors., Results: In the 251 patients, 163 (64.94%) were at age of 40 to 60 years. Sex (OR, 1.41; 95% CI, 1.01 - 1.96), cigarette smoking (OR, 1.81; 95% CI, 1.06 - 3.10), hypertension (OR, 2.32; 95% CI, 1.30 - 4.16) and fasting blood glucose were significantly associated with intracranial aneurysm (P < 0.05). Intracranial aneurysm was correlated with alcohol consumption, coronary artery disease, and the level of blood lipids (P > 0.05). Using logistic regression analysis, we identified female sex and advanced age as significant risk factors for sporadic intracranial aneurysms., Conclusions: Sporadic intracranial aneurysms mostly occur in people aged 40 to 60 years. Feminine, cigarette smoking, and hypertension are independent risk factors for the disease, and the gender is the most significant factor. Advanced age can increase the effect of these risk factors.