Purpose: This study sought to examine associations between depression and unhealthy lifestyle behaviors in Chinese patients with acute coronary syndromes (ACS). Methods: This cross-sectional study included 4043 ACS patients from 16 hospitals across China who participated in the I-Care (Integrating Depression Care in Acute Coronary Syndromes Patients) trial. Patients were enrolled between November 2014 and January 2017. Depression was assessed with the Patient Health Questionnaire-9 (PHQ-9). Five lifestyle behaviors were assessed: smoking, drinking, body mass index (BMI), physical activity, and sleep quality. Results: A total of 135 patients (3.3%) were considered clinically depressed (PHQ-9 ≥10). After adjusting for covariates, physical activity and sleep quality were inversely related to PHQ-9 scores. Adjusted logistic models showed that depressed patients were 1.7 times likely to be physically inactive (OR = 1.74; 95% CI, 1.15-2.64) and 4.6 times likely to have poor sleep quality (OR = 4.60; 95% CI, 3.07-6.88) compared with nondepressed patients. The association of depression with smoking, unhealthy drinking, and unhealthy BMI was not significant after adjustment for demographic characteristics. Higher depression scores were found to be associated with a greater number of unhealthy lifestyle behaviors ( P for trend < .001). Conclusions: The association of depression and unhealthy lifestyles in post-ACS patients suggests that reducing depressive symptoms and improving healthy lifestyle behaviors could potentially improve clinical outcomes in this vulnerable patient population.
Importance Prior trials of extracranial-intracranial (EC-IC) bypass surgery showed no benefit for stroke prevention in patients with atherosclerotic occlusion of the internal carotid artery (ICA) or middle cerebral artery (MCA), but there have been subsequent improvements in surgical techniques and patient selection. Objective To evaluate EC-IC bypass surgery in symptomatic patients with atherosclerotic occlusion of the ICA or MCA, using refined patient and operator selection. Design, Setting, and Participants This was a randomized, open-label, outcome assessor–blinded trial conducted at 13 centers in China. A total of 324 patients with ICA or MCA occlusion with transient ischemic attack or nondisabling ischemic stroke attributed to hemodynamic insufficiency based on computed tomography perfusion imaging were recruited between June 2013 and March 2018 (final follow-up: March 18, 2020). Interventions EC-IC bypass surgery plus medical therapy (surgical group; n = 161) or medical therapy alone (medical group; n = 163). Medical therapy included antiplatelet therapy and stroke risk factor control. Main Outcomes and Measures The primary outcome was a composite of stroke or death within 30 days or ipsilateral ischemic stroke beyond 30 days through 2 years after randomization. There were 9 secondary outcomes, including any stroke or death within 2 years and fatal stroke within 2 years. Results Among 330 patients who were enrolled, 324 patients were confirmed eligible (median age, 52.7 years; 257 men [79.3%]) and 309 (95.4%) completed the trial. For the surgical group vs medical group, no significant difference was found for the composite primary outcome (8.6% [13/151] vs 12.3% [19/155]; incidence difference, −3.6% [95% CI, −10.1% to 2.9%]; hazard ratio [HR], 0.71 [95% CI, 0.33-1.54]; P = .39). The 30-day risk of stroke or death was 6.2% (10/161) in the surgical group and 1.8% (3/163) in the medical group, and the risk of ipsilateral ischemic stroke beyond 30 days through 2 years was 2.0% (3/151) and 10.3% (16/155), respectively. Of the 9 prespecified secondary end points, none showed a significant difference including any stroke or death within 2 years (9.9% [15/152] vs 15.3% [24/157]; incidence difference, −5.4% [95% CI, −12.5% to 1.7%]; HR, 0.69 [95% CI, 0.34-1.39]; P = .30) and fatal stroke within 2 years (2.0% [3/150] vs 0% [0/153]; incidence difference, 1.9% [95% CI, −0.2% to 4.0%]; P = .08). Conclusions and Relevance Among patients with symptomatic ICA or MCA occlusion and hemodynamic insufficiency, the addition of bypass surgery to medical therapy did not significantly change the risk of the composite outcome of stroke or death within 30 days or ipsilateral ischemic stroke beyond 30 days through 2 years. Trial Registration ClinicalTrials.gov Identifier: NCT01758614
Prior randomized trials have generally shown harm or no benefit of stenting added to medical therapy for patients with symptomatic severe intracranial atherosclerotic stenosis, but it remains uncertain as to whether refined patient selection and more experienced surgeons might result in improved outcomes.To compare stenting plus medical therapy vs medical therapy alone in patients with symptomatic severe intracranial atherosclerotic stenosis.Multicenter, open-label, randomized, outcome assessor-blinded trial conducted at 8 centers in China. A total of 380 patients with transient ischemic attack or nondisabling, nonperforator (defined as nonbrainstem or non-basal ganglia end artery) territory ischemic stroke attributed to severe intracranial stenosis (70%-99%) and beyond a duration of 3 weeks from the latest ischemic symptom onset were recruited between March 5, 2014, and November 10, 2016, and followed up for 3 years (final follow-up: November 10, 2019).Medical therapy plus stenting (n = 176) or medical therapy alone (n = 182). Medical therapy included dual-antiplatelet therapy for 90 days (single antiplatelet therapy thereafter) and stroke risk factor control.The primary outcome was a composite of stroke or death within 30 days or stroke in the qualifying artery territory beyond 30 days through 1 year. There were 5 secondary outcomes, including stroke in the qualifying artery territory at 2 years and 3 years as well as mortality at 3 years.Among 380 patients who were randomized, 358 were confirmed eligible (mean age, 56.3 years; 263 male [73.5%]) and 343 (95.8%) completed the trial. For the stenting plus medical therapy group vs medical therapy alone, no significant difference was found for the primary outcome of risk of stroke or death (8.0% [14/176] vs 7.2% [13/181]; difference, 0.4% [95% CI, -5.0% to 5.9%]; hazard ratio, 1.10 [95% CI, 0.52-2.35]; P = .82). Of the 5 prespecified secondary end points, none showed a significant difference including stroke in the qualifying artery territory at 2 years (9.9% [17/171] vs 9.0% [16/178]; difference, 0.7% [95% CI, -5.4% to 6.7%]; hazard ratio, 1.10 [95% CI, 0.56-2.16]; P = .80) and 3 years (11.3% [19/168] vs 11.2% [19/170]; difference, -0.2% [95% CI, -7.0% to 6.5%]; hazard ratio, 1.00 [95% CI, 0.53-1.90]; P > .99). Mortality at 3 years was 4.4% (7/160) in the stenting plus medical therapy group vs 1.3% (2/159) in the medical therapy alone group (difference, 3.2% [95% CI, -0.5% to 6.9%]; hazard ratio, 3.75 [95% CI, 0.77-18.13]; P = .08).Among patients with transient ischemic attack or ischemic stroke due to symptomatic severe intracranial atherosclerotic stenosis, the addition of percutaneous transluminal angioplasty and stenting to medical therapy, compared with medical therapy alone, resulted in no significant difference in the risk of stroke or death within 30 days or stroke in the qualifying artery territory beyond 30 days through 1 year. The findings do not support the addition of percutaneous transluminal angioplasty and stenting to medical therapy for the treatment of patients with symptomatic severe intracranial atherosclerotic stenosis.ClinicalTrials.gov Identifier: NCT01763320.
Experimental and observational research suggests that combined epidural-general anesthesia may improve long-term survival after cancer surgery by reducing anesthetic and opioid consumption and by blunting surgery-related inflammation. This study therefore tested the primary hypothesis that combined epidural-general anesthesia improves long-term survival in elderly patients.
Background Delirium is a common and serious postoperative complication, especially in the elderly. Epidural anesthesia may reduce delirium by improving analgesia, reducing opioid consumption, and blunting stress response to surgery. This trial therefore tested the hypothesis that combined epidural–general anesthesia reduces the incidence of postoperative delirium in elderly patients recovering from major noncardiac surgery. Methods Patients aged 60 to 90 yr scheduled for major noncardiac thoracic or abdominal surgeries expected to last 2 h or more were enrolled. Participants were randomized 1:1 to either combined epidural–general anesthesia with postoperative epidural analgesia or general anesthesia with postoperative intravenous analgesia. The primary outcome was the incidence of delirium, which was assessed with the Confusion Assessment Method for the Intensive Care Unit twice daily during the initial 7 postoperative days. Results Between November 2011 and May 2015, 1,802 patients were randomized to combined epidural–general anesthesia (n = 901) or general anesthesia alone (n = 901). Among these, 1,720 patients (mean age, 70 yr; 35% women) completed the study and were included in the intention-to-treat analysis. Delirium was significantly less common in the combined epidural–general anesthesia group (15 [1.8%] of 857 patients) than in the general anesthesia group (43 [5.0%] of 863 patients; relative risk, 0.351; 95% CI, 0.197 to 0.627; P < 0.001; number needed to treat 31). Intraoperative hypotension (systolic blood pressure less than 80 mmHg) was more common in patients assigned to epidural anesthesia (421 [49%] vs . 288 [33%]; relative risk, 1.47, 95% CI, 1.31 to 1.65; P < 0.001), and more epidural patients were given vasopressors (495 [58%] vs . 387 [45%]; relative risk, 1.29; 95% CI, 1.17 to 1.41; P < 0.001). Conclusions Older patients randomized to combined epidural-general anesthesia for major thoracic and abdominal surgeries had one third as much delirium but 50% more hypotension. Clinicians should consider combining epidural and general anesthesia in patients at risk of postoperative delirium, and avoiding the combination in patients at risk of hypotension. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
<i>Background:</i> Allergic rhinitis (AR) is a common disease and its prevalence is increasing worldwide. Data on the current prevalence of AR in China, one of the biggest countries in the world, with a population of around 1.3 billion citizens, are scarce. The aim of this study was to investigate the prevalence of self-reported AR in Chinese citizens. <i>Methods:</i> In a cross-sectional, population-based study, telephone interviews were conducted in 11 major cities in China after sampling target telephone numbers through the approach of random digital dialing. The questions for the telephone interviews were based on validated questionnaires. <i>Results:</i> A total of 38,203 telephone interviews were conducted from September 2004 to May 2005. The response rate was 63.7%. After adjustment for age and gender, the self-reported prevalence of AR was lowest in Beijing (8.7%) and highest in Urumqi (24.1%). Among the subjects with self-reported AR, 25.6% were diagnosed with persistent AR and 74.4% suffered from intermittent AR. Less than half of the subjects with self-reported AR had presented at a health clinic. In 37.3% AR had previously been diagnosed by physicians, and 33.1% of subjects with self-reported AR had been treated. Comorbidities reported were asthma (9.2%), rhinosinusitis (13.3%) and atopic dermatitis (16.4%). <i>Conclusions:</i> This study demonstrates that the self-reported prevalence of AR in 11 cities across Mainland China has wide variations, ranging from <10% to >20%; 26% of the self-reported AR subjects were classified as suffering from persistent AR.
Background: Coal and biomass burning for household cooking and heating is a major source of exposure to air pollutants including fine particulate matter (PM2.5). Compared with urban air pollution, little is known about air pollution exposures in rural and peri-urban settings, particularly among men.Objective: Assess personal exposures to PM2.5 among men and women ages 40-79 living in peri-urban villages in northern (Beijing, Shanxi) and southern China (Guangxi).Methods: We enrolled 782 participants into the INTERMAP China Prospective Study from these three regions and measured their integrated gravimetric personal exposures to PM2.5 (Apex pumps; Harvard PEMs; 37 mm PTFE filters) for 2 days in heating and non-heating seasons and also collected information on fuel and energy use patterns.Results: Geometric mean daily exposures to PM2.5 across sites and seasons ranged from 60 (95% CI [56, 64], Guangxi - heating season) – 134 (95% CI [122, 147], Shanxi - heating season) ug/m3. A seasonal difference was observed in the northern sites (GM = 96 ug/m3, 95% CI [90, 101] in heating versus 88 ug/m3 [83, 94] in non-heating). Exposures were highest in Shanxi (GM = 120 ug/m3, 95% CI [113, 128]), followed by Beijing (93 ug/m3 [87, 99]) and Guangxi (60 ug/m3 [56, 64]). This trend persisted across season and gender. The proportion of participants using solid fuels was highest in Beijing (95%), followed by Shanxi (75%), and Guangxi (62%). Notably, individuals not using solid fuels for cooking and heating (GM = 92 ug/m3 [83, 102]) had similar exposures to individuals using solid fuels (93 ug/m3 [89, 97]).Conclusion: Use of solid fuels has persisted across northern and southern China. Exposures across all demographic groups and seasons exceeded the WHO 24-h air quality guideline of 25 ug/m3. On average, exposures in southern China were half that of northern China, where heating is an important energy use practice.
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