BackgroundSmall vessel disease (SVD) has been linked to adverse outcomes after acute ischemic stroke (AIS), but existing studies often rely on post-treatment imaging or single SVD markers, limiting pre-therapeutic risk assessment. Furthermore, most studies have not accounted for infarct location (defined as the brain region affected by the AIS event)–particularly failing to focus on regions highly vulnerable to SVD, such as the basal ganglia or corona radiata. To address these gaps, this study utilized pretreatment multimodal magnetic resonance imaging (MRI) to comprehensively assess SVD burden and its individual markers in patients with a single AIS lesion in one of these regions (i.e., basal ganglia or corona radiata) who underwent intravenous thrombolysis (IVT), aiming to improve pre-treatment individualized outcome prediction following IVT.MethodsThis study recruited patients admitted to Tianjin Huanhu Hospital between August 2023 and January 2025 who presented within 4.5 h of stroke symptom onset. The SVD burden was calculated by analyzing MRI data and quantified using a validated 0–4 point scale, which incorporated the assessment of four established MRI markers: white matter hyperintensities (WMH), lacunar infarcts (LI), cerebral microbleeds (CMBs), and enlarged perivascular spaces (EPVS). The primary outcomes were defined as follows: ① early neurological deterioration (END), operationalized as an increase of ≥ 4 points in the National Institutes of Health Stroke Scale (NIHSS) score within 24 h after thrombolysis; and ② poor functional outcome, defined as a modified Rankin Scale (mRS) score > 2 at 90 days post-onset, indicating moderate-to-severe disability. Secondary outcomes included symptomatic intracranial hemorrhage (sICH) and malignant cerebral edema (MCE) occurring within 24 h after IVT. Subsequently, multivariable logistic regression models were employed, with adjustment for potential confounding factors, to evaluate SVD burden and each individual SVD subtype separately against clinical outcomes after IVT; subtypes were not entered simultaneously in the same model. Furthermore, To evaluate the independence of each SVD marker in the presence of co-existing lesions, a comprehensive model was further constructed with all SVD markers entered simultaneously. This fully adjusted analysis allowed us to identify which markers retained significance after mutual adjustment.ResultsA total of 346 patients who met the inclusion criteria were enrolled in the study (mean age: 62.88 ± 10.21 years; 70.8% male). Based on the SVD scoring system described in the Methods, patients were categorized into two groups: the absent-to-mild SVD group, exibiting a score of 0–1 (n = 207, 60%) and the moderate-to-severe SVD group, exibiting a score ≥ 2 (n = 139, 40%). Compared with Absent-to-Mild SVD, Moderate-to-Severe SVD was significantly associated with increased risks of END (9.4 vs. 2.9%; OR = 2.534, 95%CI: 1.540–4.170), mRS > 2 (12.9 vs. 4.3%; OR = 1.928, 95% CI: 1.303–2.852), and sICH (6.4 vs. 2.1%; OR = 1.639, 95% CI: 1.015–2.647). Further subtype analysis revealed that CMBs were most strongly linked to an elevated risk of sICH (OR = 6.080, 95% CI: 1.834–20.156). In contrast, deep white matter hyperintensities (DWMHs) independently predicted END (OR = 2. 187, 95% CI: 1.343–3.560), mRS > 2 (OR = 1.620, 95% CI: 1.093–2.400), and sICH (OR = 1.763, 95% CI: 1.057–2.942). However, in a fully adjusted model including all SVD markers, CMBs remained significantly associated with sICH (OR = 5.353, 95% CI: 1.400–20.471), whereas associations for other markers were no longer statistically significant.ConclusionThese findings suggest that pre-treatment SVD burden and specific markers—particularly CMBs and DWMHs—may serve as independent predictors of adverse outcomes following IVT in patient patients with basal ganglia or corona radiata infarcts. Furthermore, When all SVD markers are adjusted for simultaneously, only CMBs remained significantly associated with sICH. If validated in prospective studies, the incorporation of rapid, non-invasive SVD assessment into routine pre-IVT imaging protocols could enable more refined individualized risk stratification, supporting informed, patient-centered decision-making regarding treatment risks and benefits while affirming IVT's overall net clinical benefit.

Objective:The objective of this study was to evaluate the safety and efficacy of dual antiplatelet pretreatment combined with low-dose rtPA therapy in patients with acute mild ischemic stroke, guided by multimodal MRI. Methods:In this study, 383 patients with acute mild ischemic stroke (NIHSS ≤ 5) who had symptom onset within 4.5 hours of MRI screening were selected. Patients in the dual antiplatelet pretreatment plus low-dose rtPA group (164 cases) received dual antiplatelet therapy combined with low-dose (0.6 mg/kg) rtPA intravenous thrombolysis. Patients in the standard-dose group (112 cases) received conventional-dose (0.9 mg/kg) rtPA intravenous thrombolysis. Additionally, patients in the dual antiplatelet group who did not receive intravenous thrombolysis (107 cases) underwent 21 days of oral dual antiplatelet treatment. Results:There was no significant difference in the baseline NIHSS scores among the three groups before treatment (p > 0.05). The proportion of early neurological improvement within 24 hours and within 7 days was significantly higher in the DAPT plus low-dose group compared to both the standard-dose group and the DAPT group, with statistical significance (p < 0.05). After 90 days of follow-up, the proportion of good functional outcomes in the DAPT plus low-dose group was significantly higher than in both the standard-dose group and the DAPT group (p < 0.05), but there was no significant difference between the standard-dose group and the DAPT group. Safety studies indicated that, under MRI guidance, the DAPT plus low-dose group and the standard-dose group had lower incidences of intracranial hemorrhage transformation and symptomatic intracranial hemorrhage, with no statistical difference among the three groups (p > 0.05). Mortality rates were also similar across the three groups (p > 0.05), with only one patient passing away in the standard-dose group. Conclusion:After dual antiplatelet pretreatment combined with low-dose rtPA intravenous thrombolysis for acute mild stroke under multimodal MRI guidance, the proportion of patients with good functional outcomes within 90 days was higher compared to the DAPT group and the standard-dose group, with statistical significance. There was no significant increase in the risk of cerebral hemorrhage compared to the standard-dose group and the DAPT group.

OBJECTIVE:To evaluate the efficacy and safety of short-term high-dose of dual antiplatelet therapy after 0.6 mg/kg rt-PA intravenous thrombolysis for acute ischemic stroke (AIS). METHODS:All 208 patients with AIS were randomized into group 1 (103 cases, after 0.6 mg/kg rt-PA, 300 mg of oral aspirin(ASP) q.d. and 225 mg of oral clopidogrel (CLO) q.d. for for 5 days, then 100 mg of oral ASP q.d. for the next 85 days and 75 mg of oral CLO q.d. for the next 16 days) and group 2 (105 cases, after 0.9 mg/kg rt-PA, 100 mg of oral ASP q.d. for 90 days and 75 mg of oral CLO q.d. for 21 days).The efficacy index was the mRS score, NIHSS score and recurrence risk of stroke, while the safety index was the incidence of bleeding events and mortality. All parameters were evaluated at 30 and 90 days after thrombolysis. Patients whose characteristics may provide the best treatment benefit were further analyzed using the logistic regression model in group 1. RESULTS:The proportion of mRS scores between 0 and 1 in group 1 was higher than that in group 2 at both 30 days (44.7% vs 32.4%, P < .05) and 90 days (50.5% vs 35.2%, P < .05). Compared to group 2, the proportion of NIHSS scores less than 4 was significantly higher in group 1 at both 30 days (37.9% vs 25.7%, P < .05) and 90 days (46.6% vs 30.5%, P < .05). At 90 days, Group 1 had a lower stroke recurrence risk than Group 2 (3.9% vs 10.5%, P < .05). The incidence of SICH was significantly different between the 2 groups at both 30 days (2.9% vs 9.5%, P < .05) and 90 days (2.9% vs 10.5%, P < .05). However, other bleeding events and mortality rates were not significantly different between the 2 groups. The lower the baseline NIHSS score and the shorter the OTT, the more favorable the outcomes obtained at 90 days. CONCLUSIONS:Compared to standard doses, short term high-dose dual antiplatelet therapy after 0.6 mg/kg rt-PA intravenous thrombolysis may be a good choice for AIS patients.

Objective. The aim of this study is to investigate the influence of grading rehabilitation nursing mode on limb function, speech function, and QOL of stroke patients. Methods. From January 2018 to April 2019, the stroke patients who received treatment in our hospital were selected as the study participants. Based on the random number table, they were assigned to CG (n = 60) and OG (n = 60). The routine rehabilitation nursing mode was used in the CG, and the grading rehabilitation nursing mode was used in the OG. The limb function, speech function, QOL, and nursing satisfaction were evaluated in both the groups, and the survival curve was analyzed after 12 months of follow-up. Results. The motor function of upper and lower limbs in OG was significantly higher than that in CG, and the total effective rate of speech function recovery in OG was 95.00%, which was obviously higher than 81.67% in CG ( P < 0.05 ); the total QOL score in OG was (80.72 ± 7.15), which was significantly higher than (69.53 ± 6.42) in CG. The nursing satisfaction of the OG was higher ( P < 0.05 ). The Kaplan–Meier curve analysis revealed that the difference of 12-month survival rate between CG and OG was statistically significant (χ2 = 4.710, P = 0.030 ). Conclusion. The application of grading rehabilitation nursing mode in stroke patients can effectively facilitate the recovery of extremity function and speech function, ameliorate the QOL and nursing satisfaction of patients, reduce the death and disability of patients, and prolong the survival time of patients.

Aims: In-stent restenosis (ISR) remains an Achilles heel of drug-eluting stents despite technical advances in devices and procedural techniques. Neointimal hyperplasia (NIH) is the most important pathophysiological process of ISR. The present study mapped normal arteries and stenotic arteries to uncover potential cellular targets of neointimal hyperplasia.Methods and Results: By comparing the left (control) and right (balloon injury) carotid arteries of rats, we mapped 11 clusters in normal arteries and 11 mutual clusters in both the control and experimental groups. Different clusters were categorized into 6 cell types, including vascular smooth muscle cells (VSMCs), fibroblasts, endothelial cells (ECs), macrophages, unknown cells and others. An abnormal cell type expressing both VSMC and fibroblast markers at the same time was termed a transitional cell via pseudotime analysis. Due to the high proportion of VSMCs, we divided them into 6 clusters and analyzed their relationship with VSMC phenotype switching. Moreover, N-myristoyltransferase 1 (NMT1) was verified as a credible VSMC synthetic phenotype marker. Finally, we proposed several novel target genes by disease susceptibility gene analysis, such as Cyp7a1 and Cdk4, which should be validated in future studies.Conclusion: Maps of the heterogeneous cellular landscape in the carotid artery were defined by single-cell RNA sequencing and revealed several cell types with their internal relations in the ISR model. This study highlights the crucial role of VSMC phenotype switching in the progression of neointimal hyperplasia and provides clues regarding the underlying mechanism of NIH.

Vascular smooth muscle cell (VSMC) phenotypic modulation plays an important role in the occurrence and development of in-stent restenosis (ISR), the underlying mechanism of which remains a key issue needing to be urgently addressed. This study is designed to investigate the role of plasma small extracellular vesicles (sEV) in VSMC phenotypic modulation. sEV were isolated from the plasma of patients with ISR (ISR-sEV) or not (Ctl-sEV) 1 year after coronary stent implantation using differential ultracentrifugation. Plasma sEV in ISR patients are elevated markedly and decrease the expression of VSMC contractile markers α-SMA and calponin and increase VSMC proliferation. miRNA sequencing and qRT-PCR validation identified that miRNA-501-5p was the highest expressed miRNA in the plasma ISR-sEV compared with Ctl-sEV. Then, we found that sEV-carried miRNA-501-5p level was significantly higher in ISR patients, and the level of plasma sEV-carried miRNA-501-5p linearly correlated with the degree of restenosis (R2 = 0.62). Moreover, miRNA-501-5p inhibition significantly increased the expression of VSMC contractile markers α-SMA and calponin and suppressed VSMC proliferation and migration; in vivo inhibition of miRNA-501-5p could also blunt carotid artery balloon injury induced VSMC phenotypic modulation in rats. Mechanically, miRNA-501-5p promoted plasma sEV-induced VSMC proliferation by targeting Smad3. Notably, endothelial cells might be the major origins of miRNA-501-5p. Collectively, these findings showed that plasma sEV-carried miRNA-501-5p promotes VSMC phenotypic modulation-mediated ISR through targeting Smad3.

Background Pressure ulcers (PUs) are encountered in all types of care settings. The incidence of PUs in the intensive care unit (ICU) is higher for a variety of reasons. The Braden Scale is a widely used tool to assess the risk of PU, but its predictive power is controversial in ICU settings. In this systematic review and meta-analysis, we aimed to evaluate the predictive accuracy of the Braden Scale for measurement of risk of PU in adult ICU patients. Methods A comprehensive literature search in English databases (PubMed, Cochrane Library, OVID, and Web of Science), Chinese databases (SinoMed, CNKI, and Wanfang), and gray literature was performed. Studies assessing the predictive value of the Braden Scale for risk of PU in adult ICU patients were searched. Quality of the studies was scored with Quality Assessment of Diagnostic Accuracy Studies-2. Country, study design, setting, blinding, and characteristics of included studies were extracted. Results Eleven full-text articles containing 10 044 patients, comprising 1058 patients with PUs were included. The pooled sensitivity and specificity of the Braden Scale for predicting PU risk in ICU adults were 0.89 (95% CI, 0.87-0.91; I-2 = 94.9%, P = .0000) and 0.28 (95% CI, 0.27-0.29; I-2 = 99.2%, P = .0000), respectively. The pooled DOR was 6.29 (95% CI: 4.09-9.68). The overall weighted AUC was 0.7812 +/- 0.0331 (95% CI: 0.7163-0.8461) and the Q* value was 0.7196 +/- 0.0283 (95% CI: 0.6641-0.7751). Significant heterogeneity was noted among the included studies. Meta-regression analysis showed that there was no heterogeneity in blinding (P = .074), study design (P = .679), or cut-off value (P = .821). Conclusions This meta-analysis demonstrated that the Braden Scale had a moderate predictive validity with good sensitivity and low specificity in adult critically ill patients. Further development and modification of this tool or generation of a new tool with higher predictive power is warranted for use in ICU populations. Relevance to clinical practice The first step in prevention of PU is risk assessment. In this meta-analysis, we aimed to evaluate the predictive power of the Braden Scale for assessing risk of PU in ICU adult patients, which could potentially guide clinical practice.

The aim of the study was to investigate the efficacy of homemade tolcapone in treatment of patients with Parkinson's disease (PD). Eighty patients with PD were subjected to randomized, double-blind, placebo-controlled and parallel-group study. PD patients were randomly divided into the tolcapone treatment group (41 cases) and placebo group (39 cases). Each patient received 1 pill of tolcapone or placebo, 3 times per day for 26 weeks. Efficacy was evaluated using the internationally used unified Parkinson's disease rating scale (UPDRS) scoring system for PD symptoms. After the treatment for 26 weeks, the cognitive function, tremor, muscle stiffness, voluntary movement and autonomic nerve symptoms were compared between the two groups using UPDRS scores. Compared with the placebo group, cognitive function, muscle stiffness and voluntary movement reduction were significantly improved in patients of the tolcapone group (P<0.05). However, no significant differences in UPDRS scores of autonomic nerve symptoms and tremor were found between two groups after treatment (P>0.05). Tolcapone, a catechol-O-methyl transferase (COMT) inhibitor, can improve the motor function of patients with PD, especially exercise and muscle stiffness. Tolcapone can also improve the cognitive function of patients.

Objective: The safety and efficacy of treatment with IV-rtPA between 4.5-6 hours after onset is unclear. Similarly there is little data on outcome of patients treated with rtPA with normal or low NIHSS. Background: Stroke in China is the leading cause of death. We report on a collaboration between a large metropolitan hospital in China, Tianjin Huanhu Hospital, and Inova Fairfax and Alexandria Stroke Programs presenting data on the first 1000 (of more than 3300 treated since 2012) patients treated with IV-rtPA. Methods: Patients were treated with thrombolysis between late 2012 and fall of 2014. Patients had MRI scans at 24 hours. Patients had NIHSS scores before and after treatment, and modified Rankin Scores (mRS) at 90 days after treatment. Results: There was not a significant correlation between onset to treatment times up to 6 hours, and mRS at 90 days (while controlling for baseline NIHSS). Thus, those with longer treatment times did not do worse. Eight-five [percnt] of patients treated beyond 4.5 hours had excellent outcomes. Many of these patients had NIHSS scores <5. Conclusions: 1) IV-rtPA can be given safely between 4.5-6 hours without significant risk of sICH and worsening outcomes. 2) Higher NIHSS before thrombolysis was correlated with poorer outcomes. 3) There was no significant correlation between onset to treatment time up to 6 hours and outcome. 4) Outcome was excellent (mRS 0-1) in 72[percnt] treated 0-3 hours, 74[percnt] 3-4.5 hours and remarkably 85[percnt] 4.5-6 hours. Comment: This cohort represents one of the largest series of acute stroke patients treated with IV-rtPA > 4.5 hours after onset. It also reveals outcome of treatment in patients with low NIHSS treated at various intervals after last know well.

Introduction: Stroke in China is the leading cause of death. We report on a collaboration between a large metropolitan hospital in China, Tianjin Huanhu Hospital, and Inova Fairfax and Inova Alexandria Stroke Programs presenting data on the first 1000 (of more than 3300 treated since 2012) patients treated with IV-rtPA. The safety and efficacy of treatment with rtPA between 4.5-6 hours after onset is unclear. Similarly there is little data on outcome of patients treated with rtPA with normal or low NIHSS. Methods: Patients were treated with thrombolysis between late 2012 and fall of 2014. Patients had MRI scans at 24 hours. Patients had NIHSS scores before and after treatment, and modified Rankin Scores (mRS) at 90 days after treatment. Results: See Chart. Conclusions: 1) IV-rtPA can be given safely between 4.5-6 hours without significant risk of sICH and worsening outcomes. 2) Higher NIHSS before thrombolysis was correlated with poorer outcomes. 3) There was no significant correlation between onset to treatment time up to 6 hours and outcome. 4) Outcome was excellent (mRS 0-1) in 72% treated 0-3 hours, 74% 3-4.5 hours and remarkably 85% 4.5-6 hours. The data set includes many patients who were asymptomatic or nearly so prior to treatment. This will need to be more fully evaluated in the remainder (2300) of this cohort of more than 3300 treated patients. Comment: This cohort represents one of the largest series of acute stroke patients treated with IV-rtPA u003e 4.5 hours after onset. It also reveals outcome of treatment in patients with low NIHSS treated at various intervals after last know well.

The outcome of early intravenous thrombolysis for ischemic stroke in patients with atrial fibrillation (AF) is worse than that without thrombosis. How to increase the efficacy of intravenous thrombolysis for AF-related ischemic stroke remains largely unknown. In this study, we investigated factors that influence the effect of intravenous thrombolysis in these patients. Our results showed that thrombolysis was independently associated with a favorable outcome (P < 0.001) and did not influence the mortality of AF-related ischemic stroke, although it increased the risk of hemorrhage within 24 h after treatment. Risk factors for a poor outcome at admission were: heart failure (P = 0.045); high systolic pressure (P = 0.039); high blood glucose (P = 0.030); and a high National Institutes of Health Stroke Scale (NIHSS) score (P < 0.001). Moreover, high systolic pressure at admission (P = 0.007), high blood glucose (P = 0.027), and a high NIHSS score (P < 0.001) were independent risk factors for mortality at 3 months. Besides thrombolysis, a high NIHSS score (P = 0.006) and warfarin taken within 48 h before stroke onset (P = 0.032) were also independent risk factors for symptomatic hemorrhage within 24 h after treatment. Ischemic stroke patients with AF benefited from intravenous thrombolysis with recombinant tissue plasminogen activator within 4.5 h after stroke.

This study aims to explore the safety and efficacy of intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) in elderly (≥80 years old) acute ischemic stroke (AIS) patients. The clinical data of patients who were treated in Tianjin Huanhu Hospital from June 2012 to November 2013 were retrospectively analyzed; among them, 404 patients had received IVT with rt-PA and 200 patients had not received IVT. Among ≥80-year-old patients, 204 had received IVT and 200 had not. And the 404 patients who had received IVT were divided into two subgroups: elderly (≥80 years of age; n = 204) and controls (<80 years old; n = 200). The incidence of intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage, case fatality rate, and other prognostic indicators were compared. Among all ≥80-year-old patients, the IVT subgroup had significantly superior good outcome rates than the non-IVT subgroup at 24-h and 3-month along with significantly lower case fatality rate. But for the patients those who had received IVT, the incidence of ICH and the 7-day case fatality rate were not significantly increased in both the elderly and control subgroups. The 24-h and 3-month good outcome rates were not significantly different between these two subgroups as well. IVT with rt-PA is a safe and effective treatment for ≥80-year-old AIS patients.

The use of intravenous thrombolytic therapy (ITT) in acute ischemic stroke (AIS) patients is still debated in China. We present the analysis of clinico-demographic retrospective data of 646 AIS patients that were treated by alteplase ITT at our hospital. The data collected included age, gender, education, income, drug use before disease onset, and awareness of stroke/ITT. The risk factors studied were hypertension, diabetes, hyperlipidemia, atrial fibrillation, coronary heart disease, cerebral infarction, transient ischemic attack, valvular heart disease, thyroid disease, migraine, asymptomatic carotid stenosis, family history of stroke, hyperhomocysteinemia, smoking, drinking, and gingivitis. Pre-ITT patient data included blood pressure and time from onset to hospital. Post-ITT patient data included National Institutes of Health Stroke Scale (NIHSS) scores, clinical outcome, revascularization, hemorrhage, healing rate, and 90-day mortality. Hospital management information included monthly ITT cases, discharges, bed turnaround times, length of hospital stay, bed utilization, drug ratio, massive cerebral infarction decompressive craniectomy, and social impact. Prognosis evaluation was based on post-ITT NIHSS and modified Rankin Scale (mRS) scores. We found that ITT success rate was 75.85 %, with a bleeding rate of 1.55 % and a 90-day mortality rate of 2.01 %. Overall, the data suggest that the ITT therapy was highly successful in AIS patients treated at our hospital.

To explore the effectiveness and safety of intravenous thrombolysis (IVT) using recombinant tissue plasminogen activator in treating acute ischemic stroke patients with concomitant intracranial aneurysms (IA) of ≤3 mm. Clinical data of patients who were treated in Tianjin Huanhu Hospital from June 2012 to September 2013 were retrospectively analyzed. Patients were divided into the following groups: (a) IVT group, in which there were 30 acute ischemic stroke patients with IA of ≤3 mm and 30 patients without aneurysms; and (b) IA group, in which there were 30 patients who did not receive IVT and 30 patients who received IVT. The incidence of intracranial hemorrhage, case-fatality, and good outcome rate was compared within these two groups. Inside the IVT group, the incidence of systematic intracranial hemorrhage and case-fatality showed no significant differences between patients with concomitant IA and those without IA. The 3-month good outcome rate was also not significantly different (24 [80.0 %] vs. 27 [90 %]; P = 0.278). In IA group, patients who had received IVT showed significantly superior good outcome rate than those who had not received IVT (24 [80.0 %] vs. 16 [53.3 %]; P = 0.028).The incidence of intracranial hemorrhage and case-fatality rate were not significantly different between these two subgroups as well. IVT is effective and safe method for the treatment of acute ischemic stroke patients with saccular IA of ≤3 mm.

To determine the impact of partial reimbursement on antivirals which was first implemented in July 1, 2011 on antiviral utilization and compliance for CHB patients in Beijing. Two separate cohorts were enrolled. These consisted 14,163 CHB outpatients who were referred to Beijing You’an Hospital during Jan 1, 2010 to Dec 30, 2010 and 16,228 between Jul 1, 2011 and Jun 30, 2012. Follow-up ended on Jun 30, 2011 and Dec 31, 2012, respectively. Demographic characteristics, routine biochemical and virological detection results, and antiviral prescription information were collected from electronic database. Antiviral utilization, medication possession ratio (MPR) and persistence rate were compared between patients with medical insurance (PMI) and paid out-of-pocket (PPO). Questionnaire survey was given to randomly sample 307 outpatients to confirm the validity of the electronic database. A total of 13,364 outpatients from each cohort were enrolled after propensity score matching. The antiviral utilization rate for PMI increased from 57.4 to 75.9% (P<0.001) after the reimbursement policy and the rate among PPO increased from 54.9 to 56.7% (P=0.028). A 5% increase (83.4%±24.3 vs. 88.7%±19.4%, P<0.0001) in MPR was observed among PMI after reimbursement and an increase of under 2% was observed among PPO (83.7±24.2 vs. 85.2±23.1%, P=0.0055). About 71% of the patients had more than 80% MPR in each cohort before reimbursement. This increased to 79.3% (P<0.0001) and 73.0% (P=0.0228) for PMI and PPO, respectively. PMI had a higher 6-, 12-, 15-month persistence rate than PPO, especially for outpatients receiving ETV and ADV. The questionnaire with 100% respond rate showed that more than 90% outpatients only took antiviral medicine at You’an Hospital, suggesting the validity of the electronic database. The new reimbursement policy showed a positive impact on antivirals utilization as well as compliance for insured CHB patients, especially for patients receiving ETV and ADV.