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Background: Atrial fibrillation (AF) is underdiagnosed and especially undertreated in China. We aimed to investigate the prevalence of unknown and untreated AF in community residents (≥65 years old) and to determine whether an education intervention could improve oral anticoagulant (OAC) prescription. Methods and findings: We performed a single–time point screening for AF with a handheld single-lead electrocardiography (ECG) in Chinese residents (≥65 years old) in 5 community health centers in Shanghai from April to September 2017. Disease education and advice on referral to specialist clinics for OAC treatment were provided to all patients with actionable AF (newly detected or undertreated known AF) at the time of screening, and education was reinforced at 1 month. Follow-up occurred at 12 months. In total, 4,531 participants were screened (response rate 94.7%, mean age 71.6 ± 6.3 years, 44% male). Overall AF prevalence was 4.0% (known AF 3.5% [n = 161], new AF 0.5% [n = 22]). The 183 patients with AF were older (p < 0.001), taller (p = 0.02), and more likely to be male (p = 0.01), and they had a higher prevalence of cardiovascular disease than those without AF (p < 0.001). In total, 85% (155/183) of patients were recommended for OAC treatment by the established guidelines (CHA2DS2-VASc ≥ 2 for men; ≥ 3 for women). OAC prescription rate for known AF was 20% (28/138), and actionable AF constituted 2.8% of all those screened. At the 12-month follow-up in 103 patients (81% complete), despite disease education and advice on specialist referral, only 17 attended specialist clinics, and 4 were prescribed OAC. Of those not attending specialist clinics, 71 chose instead to attend community health centers or secondary hospital clinics, with none prescribed OAC, and 15 had no review. Of the 17 patients with new AF and a class 1 recommendation for OAC, only 3 attended a specialist clinic, and none were prescribed OAC. Of the 28 AF patients taking OAC at baseline, OAC was no longer taken in 4. Ischemic stroke (n = 2) or death (n = 3) occurred in 5/126 (4%), with none receiving OAC. As screening was performed at a single time point, some paroxysmal AF cases may have been missed; thus, the rate of new AF may be underestimated. Conclusions: We demonstrated a noticeable gap in AF detection and treatment in community-based elderly Chinese: actionable AF constituted a high proportion of those screened. Disease education and advice on specialist referral are insufficient to close the gap. Before more frequent or intensive screening for unknown AF could be recommended in China, greater efforts must be made to increase appropriate OAC therapy in known AF to prevent AF-related stroke. Ji-Guang Wang and colleagues highlight the gap between AF screening and treatment in Chinese residents over 65 years of age. Author summary: Why was this study done?: Atrial fibrillation (AF) is a common heart rhythm problem that often has no symptoms, so it is often underdiagnosed. People with AF can have a very high stroke risk, which is highly preventable with appropriate oral anticoagulant (OAC) medications. Neither the prevalence of unknown and untreated AF in the Chinese community nor whether patient education in the community health center has the potential to improve OAC prescription are known. What did the researchers do and find?: We screened for AF in residents aged ≥65 years in community health centers in Shanghai and provided disease education and advice on referral to specialist clinics for OAC treatment to people with newly detected or undertreated known AF. We demonstrated a noticeable gap in AF detection and treatment: 2.8% of those screened had unknown or untreated AF. At 12 months, only 17/103 people with newly detected or undertreated known AF attended specialist clinics, and only 4/17 had commenced OAC therapy. What do these findings mean?: We highlight a serious public health issue in China with underdiagnosis and undertreatment of AF in the community that requires a whole-of-system approach. To prevent AF-related stroke in China, greater efforts must be made to increase appropriate OAC therapy in people with AF. [ABSTRACT FROM AUTHOR]

Background: A rare member of metallo-β-lactamases genes, blaSIM-1, carried by a 316-kb plasmid designated pSIM-1-BJ01 was isolated from a clinical cephalosporins- and carbapenem-resistant Klebsiellapneumoniae 13624. This is the first sequence report of a transferable blaSIM-1-carrying conjugative plasmid isolated from K. pneumoniae. Purpose: The sequence analysis of pSIM-1-BJ01 will help us to identify genes responsible for conjugation, plasmid maintenance and drug resistance, to understand the evolution and control the dissemination of resistance plasmids. Patients and methods: K. pneumoniae 13624 was isolated from the urine specimen of a patient. Bacterial genomic DNA was sequenced with PacBio RSII platform. Results: Most of the pSIM-1-BJ01 backbone matches that of pRJA166a, which was isolated from a clinical hypervirulent K. pneumoniae ST23 strain at Shanghai, China, recently. The highly homologous backbones between the two plasmids imply the close relationship of evolution. Two different multidrug-resistant regions both carrying the class 1 integrons with different resistance genes have been assembled into the pSIM-1-BJ01. Besides, the other two resistance plasmids, pKP13624-1 carrying blaTEM-1 and blaCTX-M-15 and pKP13624-2 carrying blaCTX-M-14 and blaLAP-2 were also identified. Conclusion: The emergence of the blaSIM-1-carrying IncHI1B pSIM-1-BJ01 suggests the spread of blaSIM among Enterobacteriaceae is possible. We should pay more attention to supervise and control the dissemination of hypervirulent carbapenem-resistant K. pneumonia in public hospitals. [ABSTRACT FROM AUTHOR]

Men who have sex with men (MSM) have recently accounted for an alarmingly increasing proportion of HIV-1 transmission in China. In order to investigate the immune status as a result of CRF01_AE infection and CXCR4 co-receptor usage in a young Shanghai-based HIV-1-infected MSM population in Shanghai, 364 HIV-1-infected MSM with average age of 22.7 years old, newly diagnosed between Jan 2009 and Jul 2013 were analyzed for CD4+T cell count, subtyping using phylogenetic analysis, and viral co-receptor tropism using Geno2pheno and webPSSM in combination. A total of 276 individuals were identified as recently infected. Subtype assignment were as follows: 176 (63.8%) CRF01_AE, 77 (27.9%) CRF07_BC, and 23 (8.3%) subtype B. Besides, 24 second-generation recombinant strains were identified. A lower CD4+T cell count at baseline survey was observed among CRF01_AE strain-infected individuals, compared to those who were infected with CRF07_BC (P<0.01). The frequency of baseline CD4+T cell count <200 was higher and the frequency of CD4 T counts >500 lower in CRF01_AE infection than CRF07_BC infection. It is worth noting that 32.4%–40.9% of CRF01_AE strain-infected individuals were predicted to carry CXCR4-tropic viruses whereas none of CRF07_BC and subtype B were found to be as CXCR4-tropic viruses (P<0.001). As could be expected CXCR4 tropism was associated with lower CD4 T counts. This study revealed that CRF01_AE strains with high frequency of CXCR4 tropism are prevailing in the young MSM population in China and could potentially cause a severe loss of CD4+T cell count and rapid disease progression. A regular surveillance of HIV-1 subtypes, CD4+T cell count and viral co-receptor usage would be greatly beneficial for effectively monitoring disease progression, improvement of antiretroviral therapy strategy and prompt intervention of transmission. [ABSTRACT FROM AUTHOR]

In China, hepatocellular carcinoma (HCC) incidence rates in several registry catchment populations are amongst the highest worldwide. The incidence rates in urban Shanghai were analyzed between 1976 and 2005 to describe and interpret the time trends. Age-specific and age-standardized rates were calculated and graphically presented. An age-period-cohort model was fitted to assess the effects of age at diagnosis, calendar period, and birth cohort on the changing HCC incidence rates. In total, 35,241 and 13,931 men and women were diagnosed with HCC during 1976-2005 in urban Shanghai. The age-standardized incidence rates in urban Shanghai were 33.9 per 10 among men and 11.4 per 10 among women in 1976-1980, but decreased in both sexes to 25.8 per 10 and 8.5 per 10, respectively by 2001-2005. Accelerating rates in birth cohorts born in the early-1930s and decelerating rates circa 1945 were observed in both sexes, with further accelerations noted in the late-1950s (in women) and early-1960s (in men). Given the parameterization, increases in risk of HCC were seen in successive male and female generations between 1900 and 1935, followed by a further increase among successive cohorts born around 1960, with a reduction in risk in the most recent generations. The incidence rates of HCC in urban Shanghai from 1976 to 2005 have declined in both sexes, with the complex but similar patterns observed in successive generations suggestive of a shared changing prevalence in risk factors in men and women, with a role possibly for HBV interventions reducing risk of HCC in cohorts born after 1960. [ABSTRACT FROM AUTHOR]