OBJECTIVE To separate and identif y the chemical constituen ts in 70％ ethanol extract of Sabia parviflora ，and to preliminarily evaluate their in vitro antioxidant activity. METHODS The chemical constituents were separated and purified by silica gel，ODS reversed-phase silica gel ，Sephadex-LH20 column and preparative high performance liquid chromatography. The structures of the isolated compounds were identified by 1H-NMR，13C-NMR and ESI-MS. The in vitro antioxidant activities of the compounds were investigated by 2，2-diphenyl-1-picrylhydrazyl radical （DPPH·），2，2′-azino-bis（3-ethylbenzothiazoline-6- sulfonate）diammonium radical （ABST+）and hydroxyl radical （OH·）. RESULTS A total of 9 compounds were isolated from the 70％ ethanol extracts of S. parviflora . They were identified as rutin （1），diiononyl phthalate （2），dibutyl phthalate （3），vomifoliol （4），rhododendrol（5），quercetin-3-O-gentiobioside（6），narcissoside（7），kaempferol-3-O-rutinoside（8）and bonaroside （9）. The in vitro antioxidant results showed that compound 1-9 showed certain in vitro antioxidant activity ，and the half scavenging concentrations of compound 1，6，7 and 8 to DPPH ·，ABST+，OH·were lower than 70 μg/mL. CONCLUSIONS Vomifoliol， rhododendrol and bonaroside are isolated from S. parviflora for the first time ，and rutin ，quercetin-3-O-gentiobioside，narcissoside and kaempferol- 3-O-rutinoside show good in vitro antioxidant activity.

OBJECTIVETo evaluate the safety and effectiveness of totally implantable hearing aid (Carina) was assessed in adult patients with bilateral moderate to severe hearing loss.

METHODSSurgical implantations of Carina were performed in three adult patients with bilateral moderate to severe hearing loss. The safety and effectiveness were evaluated in a more than 12 months follow-up by comparison of outcomes of PTA and speech audiometry pre and post-operatively. The daily usage of implants was observed and compared with traditional hearing aids.

RESULTSThe average elevation of unaided threshold elevation on surgical side was 8.3 dB postoperatively. The average functional gain in four speech frequencies of PTA was 35.4 dB HL and the average threshold decrease of speech discrimination was 22.5 dB HL. The subjective scoring of performance of the implants is significantly higher than traditional hearing aid.

CONCLUSIONSTotally implantable hearing aid (Carina) is an ideal implant to treat moderate to severe hearing loss. Long term follow-up is needed to validate the results.

Adult ; Auditory Threshold ; Cochlear Implants ; Equipment Safety ; Female ; Hearing Aids ; Hearing Loss ; rehabilitation ; Humans ; Male ; Middle Aged

OBJECTIVETo explore an ideal skin substitute with its appearance and texture similar to normal skin, to repair wounds with full-thickness skin defect.

METHODSComposite skin (CS) in question was composed of allo/xenogeneic acellular dermal matrix (ADM) and razor thin autoskin. One step skin grafting was employed in the experimental study and clinical trial. Razor thin autoskin alone was used as the control in the study. Changes in the antigenicity of ADM and the reformation of basement membrane (BM) structure at epidermis-dermis junction (EDJ) of ADMs were studied at designated time points after the grafting with biochemical and immunohistochemical methods. Fifty-three patients with full thickness skin defects due to various causes, including scar excision were grafted with CS, and survival rate and long-term result were observed.

RESULTSThe grafted CS survived satisfactory. The reformation of the basement membrane structure was clearly observed at the 28th post-graft week. The basement membrane cells grew with polarization in an undulating arrangement. There was reformation of dermal papillae and ridges. The antigenicity of allo-ADM was obviously lower than that of xeno-ADM. Sixty-five out of 70 pieces of CS grafting (92.9%) survived totally, two of them survived partially, and three failed due to infection. The longest follow-up period was 8 and a half years. The grafted CS appeared similar to the normal skin in regard to the texture and color, especially allo-ADM, and no evident rejection reaction was seen.

CONCLUSIONADM possessed very low antigenicity, thus serving a lasting framework after grafting. In addition, it could serve as a "dermal template" for the induction of tissue regeneration.

Animals ; Burns ; surgery ; Dermis ; transplantation ; Follow-Up Studies ; Graft Survival ; Humans ; Male ; Rabbits ; Skin Transplantation ; methods ; Swine ; Transplantation, Autologous ; Transplantation, Heterologous ; Transplantation, Homologous ; Treatment Outcome ; Wound Healing

Objective:To compare the efficacy and safety of different dosages of new drugs in the treatment of PsA by using network meta-analysis.Methods:Three medical databases (PubMed, Web of Science, Cochrane Library) were searched for the studies that compared the efficacy and safety of 4 new drugs (secukinumab, ixekizumab, apremilast, tofacitinib) with different dosages in the treatment of PsA. Data from included studies were analyzed by Stata 15.0.Results:A total of 16 RCTs were included. The results of the network meta-analysis showed that: (1) Among the overall patients, in terms of ACR20 response rate, the larger the surface under the cumulative ranking (SUCRA), the more effective it is. Secukinumab 300 mg Q4W(96.1%) had the best efficacy, followed by ixekizumab 80 mg Q4W(79.0%), ixekizumab 80 mg Q2W(75.1%), secukinumab 150 mg Q4W(73.2%), apremilast 30 mg BID(50.6%), apremilast 20 mg BID(38.6%), tofacitinib 5 mg BID(18.1%), tofacitinib 10 mg BID(17.7%) and placebo(2.0%). (2) In terms of PASI75 response rate, the larger the area under the SUCRA curve, the more effective it is. Ixekizumab 80 mg Q4W(96.1%) had the best efficacy, followed by ixekizumab 80 mg Q2W(88.7%), secukinumab 300 mg Q4W(75.6%), secukinumab 150 mg Q4W(63.3%), apremilast 30 mg BID(44.5%), apremilast 20 mg BID(38.4%), tofacitinib 10 mg BID(30.0%), tofacitinib 5 mg BID(12.5%) and placebo(1.0%). (3) Among the overall patients, in terms of safety, the smaller the area under the SUCRA curve, the higher the safety it is. Secukinumab 300 mg Q4W (17.3%) has the best safety. (4) The results of subgroup analysis showed that in terms of ACR20 response rate, ixekizumab 80 mg Q2W(85.3%) had the best efficacy in bDMARDs-na?ve patients, while in bDMARDs-IR patients, secukinumab 300 mg Q4W(83.9%) had the best efficacy.Conclusion:Among all patients, secukinumab 300 mg Q4W is the best in terms of ACR20 response rate and safety, but ixekizumab 80 mg Q4W is more effective in improving PsA lesions comparing yo other drugs.

Polycystic liver is the most common extra-renal manifestation associated with autosomal dominant polycystic kidney disease (ADPKD), comprising up to 80% of all features. Patients with polycystic liver often suffer from abdominal discomfort, dyspepsia, or dyspnea; however, there have been few ways to relieve their symptoms effectively and safely. Therefore, we tried transcatheter arterial embolization (TAE), which has been used in treating hepatocellular carcinoma. We enrolled four patients with ADPKD in Seoul National University Hospital, suffering from enlarged polycystic liver. We embolized the hepatic arteries supplying the dominant hepatic segments replaced by cysts using polyvinyl alcohol particles and micro-coils. The patients were evaluated 12 months after embolization for the change in both liver and cyst volumes. Among four patients, one patient was lost in follow up and 3 patients were included in the analysis. Both liver (33%; 10%) and cyst volume (47.7%; 11.4%) substantially decreased in two patients. Common adverse events were fever, epigastric pain, nausea, and vomiting. We suggest that TAE is effective and safe in treating symptomatic polycystic liver in selected ADPKD patients.
Aged ; Catheterization ; Cysts/*therapy ; Embolization, Therapeutic/instrumentation/*methods ; Female ; Hepatic Artery ; Humans ; Liver/pathology/physiology ; Liver Diseases/pathology/*therapy ; Middle Aged ; Polycystic Kidney, Autosomal Dominant/diagnosis/*therapy ; Polyvinyl Alcohol/therapeutic use ; Tomography, X-Ray Computed

Metabolic dysfunction-associated fatty liver disease (MAFLD) is an increasingly common liver disease worldwide. MAFLD is diagnosed based on the presence of steatosis on images, histological findings, or serum marker levels as well as the presence of at least one of the three metabolic features: overweight/obesity, type 2 diabetes mellitus, and metabolic risk factors. MAFLD is not only a liver disease but also a factor contributing to or related to cardiovascular diseases (CVD), which is the major etiology responsible for morbidity and mortality in patients with MAFLD. Hence, understanding the association between MAFLD and CVD, surveillance and risk stratification of MAFLD in patients with CVD, and assessment of the current status of MAFLD management are urgent requirements for both hepatologists and cardiologists. This Taiwan position statement reviews the literature and provides suggestions regarding the epidemiology, etiology, risk factors, risk stratification, nonpharmacological interventions, and potential drug treatments of MAFLD, focusing on its association with CVD.

Coronavirus disease 2019 (COVID-19) is a global pandemic that had affected more than eight million people worldwide by June 2020. Given the importance of the presence of diabetes mellitus (DM) for host immunity, we retrospectively evaluated the clinical characteristics and outcomes of moderate-to-severe COVID-19 in patients with diabetes.

We conducted a multi-center observational study of 1,082 adult inpatients (aged ≥18 years) who were admitted to one of five university hospitals in Daegu because of the severity of their COVID-19-related disease. The demographic, laboratory, and radiologic findings, and the mortality, prevalence of severe disease, and duration of quarantine were compared between patients with and without DM. In addition, 1:1 propensity score (PS)-matching was conducted with the DM group.

Compared with the non-DM group (n=847), patients with DM (n=235) were older, exhibited higher mortality, and required more intensive care. Even after PS-matching, patients with DM exhibited more severe disease, and DM remained a prognostic factor for higher mortality (hazard ratio, 2.40; 95% confidence interval, 1.38 to 4.15). Subgroup analysis revealed that the presence of DM was associated with higher mortality, especially in older people (≥70 years old). Prior use of a dipeptidyl peptidase-4 inhibitor or a renin-angiotensin system inhibitor did not affect mortality or the clinical severity of the disease.

DM is a significant risk factor for COVID-19 severity and mortality. Our findings imply that COVID-19 patients with DM, especially if elderly, require special attention and prompt intensive care.

OBJECTIVE： To prepare Resveratrol-hydroxypropyl-β-cyclodextrin-chitosan sustained-release pellets （RES-HP-β- CD-Chitosan）， and to characterize it. METHODS： Resveratrol raw material， HP-β-cyclodextrin and chitosan were collected with ratio of 1 ∶ 7 ∶ 0.25. Resveratrol-HP-β-cyclodextrin inclusion compound were prepared by solvent method， and then added into chitosan， RES-HP-β-CD-Chitosan were prepared by spray drying method. Particle size of prepared sustained-released pellets were observed by optical microscope. X-ray， DSC， IR and SEM were used to characterize RES-HP-β-CD-Chitosan. The contents of resveratrol in prepared sustained-released pellets were determined by UV spectrum， and drug-loading amount and encapsulation efficiency were calculated. RESULTS： Particle size of prepared RES-HP-β-CD-Chitosan was （2.23±0.35） μm （n＝300）. Characterization results show that RES-HP-β-CD-Chitosan was spherical in shape； shrinkage was found on the surface of microspheres， and resveratrol was included in HP-β-cyclodextrin in molecule or amorphous state. Drug-loading amount of prepared RES-HP-β-CD-Chitosan was 11.67％ （n＝3）， encapsulation efficiency was 96.27％ （n＝3）. CONCLUSIONS： RES-HP-β-CD- Chitosan is prepared successfully.