Objective To improve the efficiency and accuracy of videonystagmography calibration test results while enabling effective recognition of saccadic undershoot waveform by developing a dual-stream architecture-based deep learning model. Methods A vestibular function calibration test recognition model with cross-modal feature fusion was constructed by integrating vision transformer (ViT) and a modified ConvNeXt convolutional network. The model utilized trajectory pictures and spatial distribution maps as inputs, employed a multi-task learning framework to classify calibration data, and to directly evaluate undershoot waveform. Results The model showed outstanding performance in assessing calibration compliance. The accuracy, sensitivity, specificity of the model in left side, middle, and right side were all greater than 90%, and AUC values were all greater than 0.99, with 97.66% of optimal accuracy (middle), 98.98% of optimal sensitivity (middle), 96.87% of optimal specificity (right side), and 0.997 of AUC (right side). The model also showed promising performance in undershoot waveform recognition with 87.50% of accuracy, 89.66% of sensitivity, 85.71% of specificity, 86.67% of F1 score, and 0.931 of AUC. Conclusions The proposed method not only significantly enhances the efficiency and accuracy of calibration test results, but also provides a novel solution for undershoot waveform recognition.

BACKGROUND: The problem of prolonged emergency department length of stay (EDLOS) is becoming increasingly crucial. This study aims to develop a machine learning (ML) model to predict EDLOS, with EDLOS as the outcome variable and demographic characteristics, triage level, and medical resource utilization as predictive factors. METHODS: A retrospective analysis was performed on the patients who visited the emergency department of the Second Affiliated Hospital of Guangzhou Medical University from March 2019 to September 2021, and a total of 321,012 cases were identified. According to the inclusion and exclusion criteria, 187,028 cases were finally included in the analysis. ML analysis was performed using R-squared (R2), and the predictive factors and the EDLOS were used as independent variables and dependent variables, respectively, to establish models. The performance evaluation of the ML models was conducted through the utilization of the mean absolute error (MAE), root mean square error (RMSE), and R2, enabling an objective comparative analysis. RESULTS: In the comparative analysis of the six ML models, light gradient boosting machine (LightGBM) model demonstrated the lowest MAE (443.519) and RMSE (826.783), and the highest R² value (0.48), indicating better model fit and predictive performance. Among the top 10 predictive factors associated with EDLOS according to the LightGBM model, the emergency waiting time, age, and emergency arrival time had the most significant impact on the EDLOS. CONCLUSION: The LightGBM model suggests that the emergency waiting time, age, and emergency arrival time may be used to predict the EDLOS.

As new evidence emerges, treatment strategies toward the functional cure of chronic hepatitis B are evolving. In 2019, a panel of national hepatologists published a Consensus Statement on the functional cure of chronic hepatitis B. Currently, an international group of hepatologists has been assembled to evaluate research since the publication of the original consensus, and to collaboratively develop the updated statements. The 2.0 Consensus was aimed to update the original consensus with the latest available studies, and provide a comprehensive overview of the current relevant scientific literatures regarding functional cure of hepatitis B, with a particular focus on issues that are not yet fully clarified. These cover the definition of functional cure of hepatitis B, its mechanisms and barriers, the effective strategies and treatment roadmap to achieve this endpoint, in particular new surrogate biomarkers used to measure efficacy or to predict response, and the appropriate approach to pursuing a functional cure in special populations, the development of emerging antivirals and immunomodulators with potential for curing hepatitis B. The statements are primarily intended to offer international guidance for clinicians in their practice to enhance the functional cure rate of chronic hepatitis B.

As new evidence emerges, treatment strategies toward the functional cure of chronic hepatitis B are evolving. In 2019, a panel of national hepatologists published a Consensus Statement on the functional cure of chronic hepatitis B. Currently, an international group of hepatologists has been assembled to evaluate research since the publication of the original consensus, and to collaboratively develop the updated statements. The 2.0 Consensus was aimed to update the original consensus with the latest available studies, and provide a comprehensive overview of the current relevant scientific literatures regarding functional cure of hepatitis B, with a particular focus on issues that are not yet fully clarified. These cover the definition of functional cure of hepatitis B, its mechanisms and barriers, the effective strategies and treatment roadmap to achieve this endpoint, in particular new surrogate biomarkers used to measure efficacy or to predict response, and the appropriate approach to pursuing a functional cure in special populations, the development of emerging antivirals and immunomodulators with potential for curing hepatitis B. The statements are primarily intended to offer international guidance for clinicians in their practice to enhance the functional cure rate of chronic hepatitis B.

As new evidence emerges, treatment strategies toward the functional cure of chronic hepatitis B are evolving. In 2019, a panel of national hepatologists published a Consensus Statement on the functional cure of chronic hepatitis B. Currently, an international group of hepatologists has been assembled to evaluate research since the publication of the original consensus, and to collaboratively develop the updated statements. The 2.0 Consensus was aimed to update the original consensus with the latest available studies, and provide a comprehensive overview of the current relevant scientific literatures regarding functional cure of hepatitis B, with a particular focus on issues that are not yet fully clarified. These cover the definition of functional cure of hepatitis B, its mechanisms and barriers, the effective strategies and treatment roadmap to achieve this endpoint, in particular new surrogate biomarkers used to measure efficacy or to predict response, and the appropriate approach to pursuing a functional cure in special populations, the development of emerging antivirals and immunomodulators with potential for curing hepatitis B. The statements are primarily intended to offer international guidance for clinicians in their practice to enhance the functional cure rate of chronic hepatitis B.

BACKGROUND: Chronic kidney disease (CKD)-associated anemia (CKD-anemia) is associated with poor survival, and hemoglobin targets are often not achieved with current therapies. Phase 3 trials have demonstrated the treatment efficacy of roxadustat for CKD-anemia. This phase 4 study aims to evaluate the long-term (52-week) safety and effectiveness of roxadustat in a broad real-world patient population with CKD-anemia with and without dialysis in China. METHODS: This Phase 4 multicenter, open-label, prospective study, conducted from 24 November 2020 to 11 November 2022, evaluated the long-term safety and effectiveness of roxadustat for CKD-anemia in China. Patients aged ≥18 years with CKD-anemia with or without dialysis were included. The initial oral dose was 70-120 mg (weight-based followed by dose adjustment) over 52 weeks. The primary endpoint was safety based on adverse events (AEs). The secondary endpoints were hemoglobin changes from baseline and the proportion of patients who achieved mean hemoglobin ≥100 g/L. Effectiveness evaluable populations 1 (EE1) and EE2 included roxadustat-naïve and previously roxadustat-treated patients, respectively. The safety analysis set (SAF) included all patients who received ≥1 occasion. RESULTS: The EE1, EE2, and SAF populations included 1804, 193, and 2021 patients, respectively. In the SAF, the mean age was 50 ± 14 years, and 1087 patients (53.8%) were male. Mean baseline hemoglobin was 96.9 ± 14.0 g/L in EE1 and 100.3 ± 12.9 g/L in EE2. In EE1, the mean (95% confidence interval) hemoglobin changes from baseline over weeks 24-36 and 36-52 were 14.2 (13.5-14.9) g/L and 14.3 (13.5-15.0) g/L, respectively. Over weeks 24-36 and 36-52, 83.3% and 86.1% of patients in EE1 and 82.7% and 84.7% in EE2 achieved mean hemoglobin ≥100 g/L, respectively. In the SAF, 1643 (81.3%) patients experienced treatment-emergent AEs (TEAEs). Overall, 219 (10.8%) patients experienced drug-related TEAEs. Thirty-eight (1.9%) patients died of TEAEs (unrelated to the study drug). Vascular access thrombosis was uncommon. CONCLUSIONS: Roxadustat (52 weeks) increased hemoglobin and maintained the treatment target in Chinese patients with CKD-anemia with acceptable safety, supporting its use in real-world settings. REGISTRATION Chinese Clinical Trial Registry ( www.chictr.org.cn ) ChiCTR2100046322; CDE ( www.chinadrugtrials.org.cn ) CTR20201568.
Humans ; Male ; Female ; Anemia/etiology* ; Middle Aged ; Renal Insufficiency, Chronic/complications* ; Glycine/adverse effects* ; Isoquinolines/adverse effects* ; Aged ; Prospective Studies ; Adult ; Hemoglobins/metabolism* ; Treatment Outcome ; China ; Registries ; East Asian People

Objective To analyze the relationship between type 2 diabetes mellitus(T2DM)and cognitive disorder in middle-aged and elderly patients with Parkinson's disease(PD),and to identify risk factors for cognitive disorder in PD patients.Methods The clinical data of patients aged≥50 years and hospitalized for PD in Xijing Hospital of Air Force Medical University from Jan.2010 to Dec.2021 were collected,including demographic characteristics,general clinical features,laboratory indicators,etc.The cognitive status was evaluated by mini-mental state examination(MMSE).A total of 281 PD patients were assigned to T2DM group or non-T2DM group,and MMSE original score,standardized score,and cognitive status were compared between the 2 groups.The 281 patients were reassigned to normal cognition group or abnormal cognition group,then multivariate logistic regression was used to analyze the risk factors of cognitive disorder in middle-aged and elderly patients with PD.Results The MMSE original score and standardized score in the T2DM group were significantly lower than those in the non-T2DM group(23[18,25]vs 24[21,27],P=0.011;-1[-3,2]vs 1[-1,3],P=0.004),and the detection rate of cognitive disorder was significantly higher than that of the non-T2DM group(53.57%[45/84]vs 33.50%[66/197],P=0.002).Multivariate logistic regression analysis showed that T2DM(odds ratio[OR]=2.452,95%confidence interval[95%CI]1.397-4.306,P=0.002),place of residence(OR=2.208,95%CI 1.261-3.868,P=0.006),and age(OR=1.054,95%CI 1.006-1.104,P=0.028)were risk factors for cognitive disorder in middle-aged and elderly patients with PD,while serum uric acid(OR=0.274,95%CI 0.098-0.768,P=0.014)was protective factor for cognitive disorder in middle-aged and elderly patients with PD.Conclusion T2DM,rural area,advanced age,and hypouricemia are independent risk factors for cognitive disorder in middle-aged and elderly patients with PD.For middle-aged and elderly PD patients with T2DM,screening for cognitive disorder should be strengthened for early prevention and intervention.

Objective To investigate the prescription patterns and potential therapeutic mechanisms of traditional Chinese medicine(TCM)in treating laryngopharyngeal reflux disease(LPRD)based on data mining and network pharmacology.Methods The clinical data from 1 016 LPRD patients treated at the Guangdong Provincial Hospital of Chinese Medicine between February 1,2012,and December 30,2023 were collected.Frequency analysis,property and flavor analysis,meridian tropism analysis,efficacy classification,association rule mining,and cluster analysis were performed on the effective TCM prescriptions to identify medication rules.Core herbs were screened,and their therapeutic mechanisms were explored using network pharmacology.Results A total of 1 976 prescriptions involving 139 medicinals(23 644 medicinal frequencies)were analyzed.The top five most frequently-used medicinals were Glycyrrhizae Radix et Rhizoma(Gancao),Poria(Fuling),Citri Reticulatae Pericarpium(Chenpi),Bombyx Batryticatus(Jiangcan),and Galli Gigerii Endothelium Corneum(Jineijin).The herbs predominantly exhibited sweet flavor and neutral property,with a primary affinity for the lung meridian.The most common therapeutic categories were deficiency-tonifying herbs and phlegm-resolving herbs.The herb combination"Gancao-Chenpi-Fuling"was identified as the core prescription for LPRD.Network pharmacology analysis of this combination revealed 11 shared targets between the core herbs and LPRD,including three key targets.The core herbs may alleviate LPRD by modulating the interleukin-17(IL-17)signaling pathway,tumor necrosis factor(TNF)signaling pathway,and cancer-related pathways.Conclusion TCM treatment for LPRD should primarily target the lung,and employs herbs with mild-sweet properties and tonifying effects,supplemented by phlegm-resolving herbs.The core combination"Gancao-Chenpi-Fuling"may exert therapeutic effects by regulating key targets such as IL-1B,TNF,and IL-6,thereby modulating the IL-17 signaling pathway,TNF signaling pathway,and cancer-related pathways to mitigate inflammatory responses in LPRD.

Professor Wu Kaopan is a famous contemporary Chinese medicine scientist,Chinese medicine literature scientist,and Chinese medicine educator.This paper summarizes Professor Wu Kaopan's academic thoughts.Professor Wu Kaopan not only re-searched classics such as Basic Questions,The Spiritual Pivot,The Classic of Difficult Issues,Treatise on Cold Damage,and Essentials from the Golden Cabinet,but also proposed that we should rationally understand the role and value of the five elements theory;that the way to be a doctor should be familiar with the meridian theory;that we should know the constant and adapt to changes,and oppose the blind adherence to the five movements and six qi like looking for a noble steed to correspond with the one drawn;that the medicine should be effective and the method should be flexible.Professor Wu Kaopan has devoted his life to the inheritance and development of Chinese medicine,and has contributed his life to the fields of Chinese medicine teaching,scientific research,and clinical practice.

Objective:To explore the genetic etiology of pediatric intensive care unit (PICU) mortality cases and summarize their clinical characteristics.Methods:This was a retrospective cohort study. The study population consisted of 234 children who died within 7 d after admitted to the PICU of Children′s Hospital of Fudan University from January 2017 to December 2021. The clinical diagnoses, laboratory test results, and genetic testing results were collected. These patients were divided into the pathogenic gene variation positive (PGVP) group and the pathogenic gene variation negative (PGVN) group according to the results of genetic testing. The Mann-Whitney U test and Pearson′s chi-square test or Fisher′s exact probability method were used to compare the clinical characteristics between the groups. Results:A total of 234 cases were enrolled, including 139 (59.4%) males and 95 (40.6%) females. The age at death was 1.0 (0.4, 3.7) years old and the length of PICU stay was 16 (6, 33) days. There were 62 cases (26.5%) PGVP, and the mutated pathogenic genes included immune genes (23 cases (37.1%)), metabolic genes (11 cases (17.7%)), neuromuscular genes (11 cases (17.7%)), cardiovascular genes (4 cases (6.5%)), and genes of other systems (13 cases (21.0%)). The age at death in PGVP cases was significantly lower than in PGVN cases (0.6 (0.3, 1.4) vs. 1.3(0.5, 4.3) years old, Z=3.85, P<0.001). Compared with the PGVN group, the PGVP group had a higher incidence of family history and chronic complex conditions (CCC) than the PGVN group (6.5% (4/62) vs. 0.6% (1/172) and 93.5% (58/62) vs. 76.2% (131/172), χ2=8.87, P=0.018 and 0.003, respectively). Children in the PGVP group were admitted with higher incidence of severe infection, decreased consciousness or coma, moderate-to-severe anemia, thrombocytopenia, protracted diarrhea, and abnormalities in muscle strength or tone than those in the PGVN group (74.2%(46/62) vs. 45.9%(79/172), 50.0%(31/62) vs. 35.5%(61/172), 32.3%(20/62) vs. 18.0%(31/172), 21.0%(13/62) vs. 10.5%(18/172), 25.8%(16/62) vs. 4.1%(7/172), 16.1%(10/62) vs. 5.2%(9/172), χ2=14.63, 4.04, 5.41, 4.37, 24.30, 7.25, all P<0.05). Pathogenic genes that occurred more than twice included IL2RG (5 cases), SMN1 (4 cases), and SH2D1A (3 cases, including 2 single gene varients and 1 copy number varient). Conclusions:Among the deceased cases in the PICU, the main genetic causes are immune-related, metabolic, and neuromuscular genetic disorders. Critically ill children with a family history, CCC, and early features such as severe infections, decreased consciousness or coma, moderate to severe anemia, thrombocytopenia, protracted diarrhea, or abnormalities in muscle strength or tone should be closely monitored and undergo early genetic testing.