1.Advances in crystal nucleation for amorphous drugs
Jie ZHANG ; Kang LI ; Zi-qing YANG ; Zi-han DING ; Sai-jun XIAO ; Zhi-ming YUE ; Li-mei CAI ; Jia-wen LI ; Ding KUANG ; Min-zhuo LIU ; Zhi-hong ZENG
Acta Pharmaceutica Sinica 2024;59(7):1962-1969
		                        		
		                        			
		                        			 Amorphous solid dispersion (ASD) is one of the most effective formulation approaches to enhance the water solubility and oral bioavailability of poorly water-soluble drugs. However, maintenance of physical stability of amorphous drug is one of the main challenges in the development of ASD. Crystallization is a process of nucleation and crystal growth. The nucleation is the key factor that influences the physical stability of the ASD. However, a theoretical framework to describe the way to inhibit the nucleation of amorphous drug is not yet available. We reviewed the methods and theories of nucleation for amorphous drug. Meanwhile, we also summarized the research progress on the mechanism of additives influence on nucleation and environmental factors on nucleation. This review aims to enhance the better understanding mechanism of nucleation of amorphous drug and controlling over the crystal nucleation during the ASD formulation development. 
		                        		
		                        		
		                        		
		                        	
2.Disposition of medical support equipment support unit for medical service support of synthetic battalion
Yu XIANG ; Jing YANG ; Xi ZENG ; Zi-Fang SHU
Chinese Medical Equipment Journal 2024;45(4):83-87
		                        		
		                        			
		                        			Objective To analyze the disposition of medical support equipment support units for medical service support of the synthetic battalion to carry out efficiently demand matching and replenishment for war loss,so as to enhance the efficiency of deployment and decision making of medical support equipment.Methods War loss of the medical support equipment was analyzed with queuing theory with the support service of the synthetic battalion as the basic research framework and desired equipment intact rate in the battlefield as the goal.A M/M/1/∞/∞ model and a M/M/c/∞/∞ model were established to investigate the disposition process of medical support equipment support units by simulating actual conditions of the battlefield.Multi synthetic battalions were assumed to be deployed to carry out 2 missions with different tasks and combat intensities,of which 40 synthetic battalions were involved in for mission 1 and 35 synthetic battalions for mission 2.The disposition of medical support equipment support units was calculated with the two models constructed.Results With the M/M/c/∞/∞ model it's suggested 5 medical support equipment support units be deployed to serve for 40 synthetic battalions;with the M/M/1/∞/∞ model only one unit was employed to support 35 battalions.The two models both met the requirements of 90%intact rate.Conclusion The research contributes to the decision making of medical support equipment support forces during synthetic battalion medical support and enhances the precision support of medical support equipment.[Chinese Medical Equipment Journal,2024,45(4):83-87]
		                        		
		                        		
		                        		
		                        	
3.Psychological nursing contributes to the prognosis of the male patients with urethral riding injury treated by ureteroscopic urethral catheter implantation
Shu-Ya YAN ; Lin-Lin DAI ; Hui-Fen ZHANG ; Yue YANG ; Si-Jun ZENG ; Yan ZHANG ; Ying-Zi HUANG
National Journal of Andrology 2024;30(5):435-438
		                        		
		                        			
		                        			Objective:To explore the effect of psychological nursing on the prognosis of male patients with urethral riding inju-ry treated by ureteroscopic urethral catheter implantation(UCI).Methods:This study included 63 male patients with urethral strad-dle injury treated in the General Hospital of Southern Theater Command from February 2020 to March 2023.We divided the patients into a control(n=29)and an experimental group(n=34)according to the odd-or even-numbered days of admission and treated them by ureteroscopic UCI.Meanwhile those of the former group received routine nursing care and the latter underwent psychological nursing intervention in addition.We obtained the Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)scores of the patients,recorded their postoperative pain scores,catheter-removal time,hospitalization days,postoperative complications and o-verall recovery status,and compared the data collected between the two groups.Results:At 3 days after surgery,both the SAS and SDS scores were significantly lower in the experimental group than in the control(SAS:45.2±2.9 vs 50.4±3.6,P<0.05;SDS:41.9±2.5 vs 48.3±4.0,P<0.05),and so were the pain scores at24 hours(6.2±0.6 vs 6.8±0.9,P<0.05),48 hours(4.9±0.7 vs 6.1±0.8,P<0.05)and 72 hours after surgery(2.5±0.6 vs 3.9±0.9,P<0.05).The hospitalization time was remarkably shorter in the experimental than in the control group([14.1±2.9]vs[16.1±3.4]d,P<0.05),but there was no statistically significant difference in the time of postoperative catheterization between the two groups of patients([19.3±3.7]vs[19.6±4.4]d,P>0.05).A30-day postoperative follow-up found2 cases of difficult urination in the control group but no com-plications in the experimental group.Conclusion:Ureteroscopic UCI is a safe,effective and minimally invasive treatment method for male urethral riding injury,and psychological nursing helps not only shorten the time of catheterization and hospitalization but also a-void postoperative complications.
		                        		
		                        		
		                        		
		                        	
4.Chronic Injury of Mice Bone Marrow Multipotent Hematopoietic Progenitor Cells Induced by Ionizing Radiation.
Ying-Ying LUAN ; Juan YANG ; Shuo YANG ; Han-Cheng FAN ; Zi-Hao YANG ; Jin-Fu ZHANG ; Rong DENG ; Hua WANG ; Hui-Hong ZENG ; Li-Jian SHAO
Journal of Experimental Hematology 2023;31(3):871-879
		                        		
		                        			OBJECTIVE:
		                        			To explore the chronic injury and its possible mechanism of ionizing radiation on multipotent hematopoietic progenitor cells (MPPs) by determining the related indicators of MPPs in bone marrow of mice post-radiation.
		                        		
		                        			METHODS:
		                        			Sixteen C57BL/6 adult mice were randomly divided into normal control and irradiation groups, 8 mice in each group. The mice in irradiation group were exposed to 6 Gy X-ray. The proportion of bone marrow MPPs, their apoptosis and proliferation 2 months after irradiation were detected by flow cytometry. Mitochondrial activity and levels of reactive oxygen species (ROS) in each MPPs population were detected by Mitotracker Red and DCFDA probes, and the senescent state of MPPs in the bone marrow was analyzed.
		                        		
		                        			RESULTS:
		                        			Ionizing radiation could reduce the proportion of MPPs in mouse bone marrow. The proportions and numbers of MPP1, MPP3 and MPP4 in the bone marrow were significantly decreased after whole-body irradiation with 6 Gy X-ray (P<0.05). In addition, radiation significantly reduced the colony-forming capacity of MPPs in bone marrow (P<0.05), the proportions of apoptotic cells in the MPP1 and MPP4 cell populations increased significantly in the bone marrow (P<0.05). The activity of mitochondria was significantly reduced in the bone marrow MPP2, MPP3 and MPP4 cell populations compared with that of the control group (P<0.05). It was also found that the radiation could significantly increase the ROS levels of MPPs in bone marrow, and the content of ROS in the MPP2, MPP3 and MPP4 cell population of the bone marrow was significantly increased(P<0.05). The senescent cells ratios of MPP1, MPP3 and MPP4 cells in the bone marrow after irradiation were significantly higher than those in the control group (P<0.05).
		                        		
		                        			CONCLUSION
		                        			Ionizing radiation can cause chronic MPPs damage in mice, which is closely associated with persistent oxidative stress, cells apoptosis, and cellular senescence.
		                        		
		                        		
		                        		
		                        			Mice
		                        			;
		                        		
		                        			Animals
		                        			;
		                        		
		                        			Bone Marrow
		                        			;
		                        		
		                        			Reactive Oxygen Species
		                        			;
		                        		
		                        			Mice, Inbred C57BL
		                        			;
		                        		
		                        			Hematopoietic Stem Cells
		                        			;
		                        		
		                        			Whole-Body Irradiation
		                        			;
		                        		
		                        			Radiation, Ionizing
		                        			;
		                        		
		                        			Bone Marrow Cells
		                        			
		                        		
		                        	
5.Application of supraclavicular fasciocutaneous island flap for reconstruction after removal of tumors in parotid and auricle area.
Yu Chao LUO ; Qing Lai TANG ; Xin Ming YANG ; Zi An XIAO ; Gang Cai ZHU ; Dan Hui YIN ; Qian YANG ; Pei Ying HUANG ; Shi Ying ZENG ; Shi Sheng LI
Chinese Journal of Otorhinolaryngology Head and Neck Surgery 2023;58(5):486-491
		                        		
		                        			
		                        			Objective: To evaluate the efficacy of supraclavicular fasciocutaneous island flap (SIF) for repairing the defect of parotid or auricle regions after tumor resection. Methods: From February 2019 to June 2021, 12 patients (11 males and 1 female, aged 54-77 years old), of whom 4 with parotid adenoid cystic carcinoma and 8 with auricular basal cell carcinoma underwent reconstruction surgery for postoperative defects in the parotid gland area and auricular area with SIF in the Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital of Central South University and their clinical data were retrospectively analyzed. Size of the SIF, time for harvesting SIF, neck lymph node dissection and postoperative complications were recorded. Results: The flap areas were (6-9) cm × (8-13) cm, and the harvesting time for SIF ranged from 40 to 80 min, averaging 51.7 min. The donor sites were directly closed. All patients underwent ipsilateral levels Ⅰ-Ⅲ neck dissection, with 4 cases undergoing additional level Ⅳ neck dissection and 2 cases undergoing level Ⅳ-Ⅴ neck dissection. Of the 12 SIF, 10 were completely survival and 2 had flap arterial crisis with partial flap necrosis, in addition, 1 had donor site wound dehiscence. With follow-up of 10-42 months, there were no tumor recurrences in 10 patients, 1 patient was lost to follow-up at 10 months postoperatively, and 1 patient experienced local tumor recurrence at 11 months after surgery and died 15 months later. Conclusion: SIF is an easily harvested flap with good skin features matching the skin in parotid and auricle regions and less damage to donor site, and this flap has no need for microvascular anastomosis technique. SIF is feasible and effective for repairing defects in parotid and auricle area.
		                        		
		                        		
		                        		
		                        			Male
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			Middle Aged
		                        			;
		                        		
		                        			Aged
		                        			;
		                        		
		                        			Plastic Surgery Procedures
		                        			;
		                        		
		                        			Parotid Gland/surgery*
		                        			;
		                        		
		                        			Retrospective Studies
		                        			;
		                        		
		                        			Neoplasm Recurrence, Local
		                        			;
		                        		
		                        			Surgical Flaps/blood supply*
		                        			;
		                        		
		                        			Skin Transplantation/methods*
		                        			;
		                        		
		                        			Postoperative Complications
		                        			;
		                        		
		                        			Treatment Outcome
		                        			
		                        		
		                        	
6.Experimental study of cardioprotective effects of Cinnamomi Ramulus and Cinnamomi Cortex formula granules on myocardial ischemia/reperfusion injury in rats based on efficacy of "warming and coordinating heart Yang".
Fei LUAN ; Zi-Qin LEI ; Li-Xia PENG ; Zhi-Li RAO ; Ruo-Cong YANG ; Nan ZENG
China Journal of Chinese Materia Medica 2023;48(3):725-735
		                        		
		                        			
		                        			This study aimed to parallelly investigate the cardioprotective activity of Cinnamomi Ramulus formula granules(CRFG) and Cinnamomi Cortex formula granules(CCFG) against acute myocardial ischemia/reperfusion injury(MI/RI) and the underlying mechanism based on the efficacy of "warming and coordinating the heart Yang". Ninety male SD rats were randomly divided into a sham group, a model group, CRFG low and high-dose(0.5 and 1.0 g·kg~(-1)) groups, and CCFG low and high-dose(0.5 and 1.0 g·kg~(-1)) groups, with 15 rats in each group. The sham group and the model group were given equal volumes of normal saline by gavage. Before modeling, the drug was given by gavage once a day for 7 consecutive days. One hour after the last administration, the MI/RI rat model was established by ligating the left anterior descending artery(LAD) for 30 min ischemia followed by 2 h reperfusion except the sham group. The sham group underwent the same procedures without LAD ligation. Heart function, cardiac infarct size, cardiac patho-logy, cardiomyocyte apoptosis, cardiac injury enzymes, and inflammatory cytokines were determined to assess the protective effects of CRFG and CCFG against MI/RI. The gene expression levels of nucleotide-binding oligomerization domain-like receptor family pyrin domain protein 3(NLRP3) inflammasome, apoptosis-associated speck-like protein containing a CARD(ASC), cysteinyl aspartate specific proteinase-1(caspase-1), Gasdermin-D(GSDMD), interleukin-1β(IL-1β), and interleukin-18(IL-18) were determined by real-time quantitative polymerase chain reaction(RT-PCR). The protein expression levels of NLRP3, caspase-1, GSDMD, and N-GSDMD were determined by Western blot. The results showed that both CRFG and CCFG pretreatments significantly improved cardiac function, decreased the cardiac infarct size, inhibited cardiomyocyte apoptosis, and reduced the content of lactic dehydrogenase(LDH), creatine kinase MB isoenzyme(CK-MB), aspartate transaminase(AST), and cardiac troponin Ⅰ(cTnⅠ). In addition, CRFG and CCFG pretreatments significantly decreased the levels of IL-1β, IL-6, and tumor necrosis factor-α(TNF-α) in serum. RT-PCR results showed that CRFG and CCFG pretreatment down-regulated the mRNA expression levels of NLRP3, caspase-1, ASC, and downstream pyroptosis-related effector substances including GSDMD, IL-18, and IL-1β in cardiac tissues. Western blot revealed that CRFG and CCFG pretreatments significantly decreased the protein expression levels of NLRP3, caspase-1, GSDMD, and N-GSDMD in cardiac tissues. In conclusion, CRFG and CCFG pretreatments have obvious cardioprotective effects on MI/RI in rats, and the under-lying mechanism may be related to the inhibition of NLRP3/caspase-1/GSDMD signaling pathway to reduce the cardiac inflammatory response.
		                        		
		                        		
		                        		
		                        			Male
		                        			;
		                        		
		                        			Animals
		                        			;
		                        		
		                        			Rats
		                        			;
		                        		
		                        			Rats, Sprague-Dawley
		                        			;
		                        		
		                        			Interleukin-18
		                        			;
		                        		
		                        			Myocardial Reperfusion Injury
		                        			;
		                        		
		                        			NLR Family, Pyrin Domain-Containing 3 Protein
		                        			;
		                        		
		                        			Tumor Necrosis Factor-alpha
		                        			;
		                        		
		                        			Myocardial Infarction
		                        			;
		                        		
		                        			Caspase 1
		                        			
		                        		
		                        	
7.Clinical characteristics and risk factors for early-onset necrotizing enterocolitis in preterm infants with very/extremely low birth weight.
Zeng-Yuan YU ; Shu-Jing XU ; Hui-Qing SUN ; Ming-Chao LI ; Shan XING ; Ping CHENG ; Hong-Bo ZHANG ; Ying-Ying WANG ; Zi-Jiu YANG
Chinese Journal of Contemporary Pediatrics 2023;25(2):147-152
		                        		
		                        			OBJECTIVES:
		                        			To investigate the clinical characteristics and risk factors for early-onset necrotizing enterocolitis (NEC) in preterm infants with very/extremely low birth weight (VLBW/ELBW).
		                        		
		                        			METHODS:
		                        			A retrospective analysis was performed on the medical data of 194 VLBW/ELBW preterm infants with NEC who were admitted to Children's Hospital Affiliated to Zhengzhou University from January 2014 to December 2021. These infants were divided into early-onset group (onset in the first two weeks of life; n=62) and late-onset group (onset two weeks after birth; n=132) based on their onset time. The two groups were compared in terms of perinatal conditions, clinical characteristics, laboratory examination results, and clinical outcomes. Sixty-two non-NEC infants with similar gestational age and birth weight who were hospitalized at the same period as these NEC preterm infants were selected as the control group. The risk factors for the development of early-onset NEC were identified using multivariate logistic regression analysis.
		                        		
		                        			RESULTS:
		                        			Compared with the late-onset group, the early-onset group had significantly higher proportions of infants with 1-minute Apgar score ≤3, stage III NEC, surgical intervention, grade ≥3 intraventricular hemorrhage, apnea, and fever or hypothermia (P<0.05). The multivariate logistic regression analysis showed that feeding intolerance, blood culture-positive early-onset sepsis, severe anemia, and hemodynamically significant patent ductus arteriosus were independent risk factors for the development of early-onset NEC in VLBW/ELBW preterm infants (P<0.05).
		                        		
		                        			CONCLUSIONS
		                        			VLBW/ELBW preterm infants with early-onset NEC have more severe conditions compared with those with late-onset NEC. Neonates with feeding intolerance, blood culture-positive early-onset sepsis, severe anemia, or hemodynamically significant patent ductus arteriosus have a higher risk of early-onset NEC.
		                        		
		                        		
		                        		
		                        			Child
		                        			;
		                        		
		                        			Infant
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			Pregnancy
		                        			;
		                        		
		                        			Infant, Newborn
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Infant, Premature
		                        			;
		                        		
		                        			Infant, Extremely Low Birth Weight
		                        			;
		                        		
		                        			Ductus Arteriosus, Patent
		                        			;
		                        		
		                        			Enterocolitis, Necrotizing/etiology*
		                        			;
		                        		
		                        			Retrospective Studies
		                        			;
		                        		
		                        			Infant, Newborn, Diseases
		                        			;
		                        		
		                        			Infant, Premature, Diseases/etiology*
		                        			;
		                        		
		                        			Risk Factors
		                        			
		                        		
		                        	
8.Yigong Powder regulates CXCL12/CXCR4 signaling to reduce glutamate release and prevent cognitive decline in mouse model of aging.
Jiang-Ping WEI ; Zi-Xuan ZHAO ; Jing ZENG ; Fang-Hong SHANG ; Lei HUA ; Yong YANG ; Xiao-Mei ZHANG
China Journal of Chinese Materia Medica 2023;48(23):6483-6491
		                        		
		                        			
		                        			This study aims to explore the effect of preventive administration of Yigong Powder on the learning and memory abilities of the mouse model of aging induced by D-galactose and decipher the underlying mechanism, so as to provide a basis for the application of Yigong Powder in the prevention and treatment of cognitive decline. Forty KM mice were randomized into control, model, donepezil(1.5 mg·kg~(-1)), and high-dose(7.5 g·kg~(-1)) and low-dose(3.75 g·kg~(-1)) Yigong Powder groups. The mice in other groups except the control group were injected with D-galactose(200 g·kg~(-1)) at the back of the neck for the modeling of aging. At the same time, the mice were administrated with corresponding drugs by gavage for one month. Morris water maze was used to examine the learning and memory abilities of the mice. Hematoxylin-eosin staining was employed to observe the pathological and morphological changes of the hippocampus. The immunofluorescence assay was employed to detect the expression of ionized calcium-binding adapter molecule 1(IBA1), glial fibrillary acidic protein(GFAP), chemokine C-X-C-motif ligand 12(CXCL12), chemokine C-X-C-motif receptor 4(CXCR4) in the hippocampus and observe the positional relationship between IBA1, GFAP, and CXCR4. Western blot was employed to determine the protein levels of extracellular regulated kinase(ERK), p-ERK, and tumor necrosis factor receptor 1(TNFR1). Enzyme-linked immunosorbent assay was employed to measure the levels of glutamate and tumor necrosis factor(TNF-α) in the brain tissue and the level of TNF-α in the serum and spleen. Yigong Powder significantly shortened the escape latency, increased the times crossing platforms, and prolonged the cumulative time in quadrants of the aging mice. It alleviated the nerve cell disarrangement, increased intercellular space, and cell degeneration or death in the hippocampus and reduced the pathology score of the damaged nerve. Moreover, Yigong Powder reduced the positive area of IBA1 and GFAP, reduced the levels of TNF-α in the brain tissue, serum, and spleen, and decreased spleen index. Furthermore, Yigong Powder decreased the average fluorescence intensity of CXCL12 and CXCR4, reduced CXCR4-positive astrocytes and microglia, down-regulated the protein levels of p-ERK/ERK and TNFR1, and lowered the level of glutamate in the brain tissue. This study showed that the preventive administration of Yigong Powder can ameliorate the learning and memory decline of the D-galactose-induced aging mice by regulating the immune function of the spleen and the CXCL12/CXCR4 signaling in the brain to reduce glutamate release. However, the mechanism of Yigong San in preventing and treating dementia via regulating spleen and stomach function remains to be studied.
		                        		
		                        		
		                        		
		                        			Mice
		                        			;
		                        		
		                        			Animals
		                        			;
		                        		
		                        			Powders
		                        			;
		                        		
		                        			Receptors, Tumor Necrosis Factor, Type I
		                        			;
		                        		
		                        			Glutamic Acid
		                        			;
		                        		
		                        			Tumor Necrosis Factor-alpha/metabolism*
		                        			;
		                        		
		                        			Galactose/adverse effects*
		                        			;
		                        		
		                        			Disease Models, Animal
		                        			;
		                        		
		                        			Cognitive Dysfunction/prevention & control*
		                        			;
		                        		
		                        			Chemokines
		                        			;
		                        		
		                        			Drugs, Chinese Herbal
		                        			
		                        		
		                        	
9.Discussion on discipline of herbalism.
Ying-Zhan YANG ; Bing LI ; Jia-Lun WANG ; Zi-Ling ZENG ; Wei ZHANG ; Hua-Min ZHANG
China Journal of Chinese Materia Medica 2023;48(23):6519-6525
		                        		
		                        			
		                        			Since the emergence of the term "materia medica", scholars have proposed different opinions on its concept. This term has been used to refer to traditional Chinese medicines, or medical books, or traditional pharmacology. Due to the differences in the concept of materia medica, scholars also have controversies about the concept of herbalism. Herbalism is usually understood as traditional Chinese pharmacology. After years of evolution, the term "herbalism" has now possessed the characteristics of an independent discipline, which can be defined as an applied basic discipline that comprehensively utilizes traditional and modern technological methods to study the formation, development, and changes of traditional pharmacology and reveal the basic theories and application laws of traditional medicine. At present, the research content of herbalism mainly includes three aspects: materia medica history, materia medica literature, and traditional pharmacology. This study explores the disciplinary concepts and main research content of herbalism based on a systematic review of the literature about the concepts of materia medica and herbalism, with the aim of attracting more attention to promote the establishment and development of the discipline of herbalism.
		                        		
		                        		
		                        		
		                        			China
		                        			;
		                        		
		                        			Drugs, Chinese Herbal
		                        			;
		                        		
		                        			Herbal Medicine
		                        			;
		                        		
		                        			Materia Medica
		                        			;
		                        		
		                        			Medicine, Chinese Traditional
		                        			;
		                        		
		                        			Technology
		                        			
		                        		
		                        	
10.Catheter ablation versus medical therapy for atrial fibrillation with prior stroke history: a prospective propensity score-matched cohort study.
Wen-Li DAI ; Zi-Xu ZHAO ; Chao JIANG ; Liu HE ; Ke-Xin YAO ; Yu-Feng WANG ; Ming-Yang GAO ; Yi-Wei LAI ; Jing-Rui ZHANG ; Ming-Xiao LI ; Song ZUO ; Xue-Yuan GUO ; Ri-Bo TANG ; Song-Nan LI ; Chen-Xi JIANG ; Nian LIU ; De-Yong LONG ; Xin DU ; Cai-Hua SANG ; Jian-Zeng DONG ; Chang-Sheng MA
Journal of Geriatric Cardiology 2023;20(10):707-715
		                        		
		                        			BACKGROUND:
		                        			Patients with atrial fibrillation (AF) and prior stroke history have a high risk of cardiovascular events despite anticoagulation therapy. It is unclear whether catheter ablation (CA) has further benefits in these patients.
		                        		
		                        			METHODS:
		                        			AF patients with a previous history of stroke or systemic embolism (SE) from the prospective Chinese Atrial Fibrillation Registry study between August 2011 and December 2020 were included in the analysis. Patients were matched in a 1:1 ratio to CA or medical treatment (MT) based on propensity score. The primary outcome was a composite of all-cause death or ischemic stroke (IS)/SE.
		                        		
		                        			RESULTS:
		                        			During a total of 4.1 ± 2.3 years of follow-up, the primary outcome occurred in 111 patients in the CA group (3.3 per 100 person-years) and in 229 patients in the MT group (5.7 per 100 person-years). The CA group had a lower risk of the primary outcome compared to the MT group [hazard ratio (HR) = 0.59, 95% CI: 0.47-0.74, P < 0.001]. There was a significant decreasing risk of all-cause mortality (HR = 0.43, 95% CI: 0.31-0.61, P < 0.001), IS/SE (HR = 0.73, 95% CI: 0.54-0.97, P = 0.033), cardiovascular mortality (HR = 0.32, 95% CI: 0.19-0.54, P < 0.001) and AF recurrence (HR = 0.33, 95% CI: 0.30-0.37, P < 0.001) in the CA group compared to that in the MT group. Sensitivity analysis generated consistent results when adjusting for time-dependent usage of anticoagulants.
		                        		
		                        			CONCLUSIONS
		                        			In AF patients with a prior stroke history, CA was associated with a lower combined risk of all-cause death or IS/SE. Further clinical trials are warranted to confirm the benefits of CA in these patients.
		                        		
		                        		
		                        		
		                        	
            
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