Objective To observe the curative effect of comprehensive traditional Chinese medicine(TCM)therapy for the treatment of refractory sudden hearing loss(i.e.,suffering sudden hearing loss more than 2 weeks),and to analyze the factors that may affect the prognosis.Methods A retrospective analysis was carried out in 405 hospitalized patients with refractory sudden hearing loss who were treated in the Department of Otorhinolaryngology,the First Affiliated Hospital of Guangzhou University of Chinese Medicine from 2005 to 2022.The patients were all treated by comprehensive TCM therapy including oral administration of Chinese medicine,acupuncture,acupoint seed-pressing application after individualized syndrome differentiation.The overall clinical efficacy was evaluated,and the difference of efficacy in the patients with various courses of disease,degrees of deafness,types of hearing curve,concomitant symptoms and TCM syndrome types,having or not having previous treatment history was analyzed.Results For the 405 patients with refractory sudden hearing loss,the cure rate was 5.7％and the total effective rate was 28.1％.Among the 405 patients,the best efficacy was achieved in the patients with mild hearing loss,low-frequency decline type of hearing curve,and having no previous treatment history,and the differences were statistically significant(P＜0.05 or P＜0.01).There was no significant difference in the efficacy of patients with different courses of disease,with or without concomitant symptoms,or with various syndrome types(P＞0.05).Conclusion The comprehensive TCM therapy has a certain effect on refractory sudden hearing loss.Patients with poor efficacy after conventional western medicine can still benefit from the comprehensive TCM therapy.

AIM:To explore the use of attention mechanism and Pix2Pix generative adversarial network to predict the postoperative corneal topography of age-related cataract patients undergone femtosecond laser arcuate keratotomy.METHODS:In this retrospective case series study, the 210 preoperative and postoperative corneal topographies from 87 age-related cataract patients(105 eyes)undergoing femtosecond laser arcuate keratotomy at Shanxi Eye Hospital between March 2018 and March 2020 were selected and divided into a training set(180)and a test set(30)for model training and testing. The peak signal-to-noise ratio(PSNR), structural similarity(SSIM)and Alpins astigmatism vector analysis were used to compare the accuracy of postoperative corneal topography prediction under different attention mechanisms.RESULTS:The model based on attention mechanism and Pix2Pix network can predict postoperative corneal topography, among which the model based on Self-Attention mechanism has the best prediction effect, with PSNR and SSIM reaching 16.048 and 0.7661, respectively. There were no statistically significant differences in the difference vector, difference vector axis position, surgically induced astigmatism, and correction index between real and generated corneal topography on the 3mm and 5mm rings(all P>0.05).CONCLUSION:Based on the Self-Attention mechanism and Pix2Pix network, the postoperative corneal topography can be well predicted, which can provide reference for the surgical planning and postoperative effects of ophthalmic clinicians.

Objective:To investigate the curative efficacy of modified Qilang prescription on drug-dependent constipation with Qi and Yin deficiency and the effects on serum vasoactive intestinal peptide （VIP）， motilin （MTL）， 5-hydroxytryptamine （5-HT）， and 5-hydroxytryptamine 4 receptor （5-HT4R）. Method:A total of 160 patients diagnosed with drug-dependent constipation were randomly divided into a treatment group （n=80， Qilang prescription） and a control group （n=80， lactulose oral solution）. The treatment lasted for eight weeks. Changes in clinical symptoms， traditional Chinese medicine （TCM） syndrome， and serum VIP， MTL， 5-HT， and 5-HT4R before and after treatment were observed. The clinical efficacies of the two groups were compared. An eight-week follow-up was carried out for the observation of recurrent rate and TCM syndrome. Result:The overall response rate of the treatment group （90.91%） was higher than that （75.00%） of the control group （Z=-6.514，P<0.05）. There was no significant difference in serum VIP， MTL， 5-HT， and 5-HT4R between the two groups before treatment. After treatment for eight weeks， both groups showed reduced serum VIP level as compared with those before treatment， and the treatment group was inferior to the control group （P<0.05）. The serum MTL levels of the two groups were both higher than those before treatment （P<0.05）， and the treatment group was superior to the control group （P<0.05）. After treatment， the level of 5-HT in the treatment group was higher than that in the control group （P<0.05）. The post-treatment 5-HT4R level in the treatment group slightly increased （P<0.05）， but no significant difference in 5-HT4R levels between the two groups after treatment was observed. During the eight-week follow-up， the recurrence rate in the treatment group was significantly lower than that in the control group at the 2nd and 4th weeks （P<0.05）. There was no significant difference in the recurrence rate between the treatment group ［57.14% （40/70）］ and the control group ［64.81% （35/54）］ after eight weeks. Conclusion:Modified Qilang prescription was superior to lactulose in the short- and mid-term efficacy on drug-dependent constipation with Qi and Yin deficiency. No significant difference in the long-term efficacy was observed. The underlying therapeutic mechanism might be related to the regulation of serum VIP， MTL， 5-HT， and 5-HT4R levels.

Chloroquine (CQ) phosphate has been suggested to be clinically effective in the treatment of coronavirus disease 2019 (COVID-19). To develop a physiologically-based pharmacokinetic (PBPK) model for predicting tissue distribution of CQ and apply it to optimize dosage regimens, a PBPK model, with parameterization of drug distribution extrapolated from animal data, was developed to predict human tissue distribution of CQ. The physiological characteristics of time-dependent accumulation was mimicked through an active transport mechanism. Several dosing regimens were proposed based on PBPK simulation combined with known clinical exposure-response relationships. The model was also validated by clinical data from Chinese patients with COVID-19. The novel PBPK model allows in-depth description of the pharmacokinetics of CQ in several key organs (lung, heart, liver, and kidney), and was applied to design dosing strategies in patients with acute COVID-19 (Day 1: 750 mg BID, Days 2-5: 500 mg BID, CQ phosphate), patients with moderate COVID-19 (Day 1: 750 mg and 500 mg, Days 2-3: 500 mg BID, Days 4-5: 250 mg BID, CQ phosphate), and other vulnerable populations (.., renal and hepatic impairment and elderly patients, Days 1-5: 250 mg BID, CQ phosphate). A PBPK model of CQ was successfully developed to optimize dosage regimens for patients with COVID-19.

OBJECTIVES: To develop a new Chinese medicine (CM)-based drug and to evaluate its safety and effect for suppressing acute respiratory distress syndrome (ARDS) in COVID-19 patients. METHODS: A putative ARDS-suppressing drug Keguan-1 was first developed and then evaluated by a randomized, controlled two-arm trial. The two arms of the trial consist of a control therapy (alpha interferon inhalation, 50 µg twice daily; and lopinavir/ritonavir, 400 and 100 mg twice daily, respectively) and a testing therapy (control therapy plus Keguan-1 19.4 g twice daily) by random number table at 1:1 ratio with 24 cases each group. After 2-week treatment, adverse events, time to fever resolution, ARDS development, and lung injury on newly diagnosed COVID-19 patients were assessed. RESULTS: An analysis of the data from the first 30 participants showed that the control arm and the testing arm did not exhibit any significant differences in terms of adverse events. Based on this result, the study was expanded to include a total of 48 participants (24 cases each arm). The results show that compared with the control arm, the testing arm exhibited a significant improvement in time to fever resolution (P=0.035), and a significant reduction in the development of ARDS (P=0.048). CONCLUSIONS Keguan-1-based integrative therapy was safe and superior to the standard therapy in suppressing the development of ARDS in COVID-19 patients. (Trial registration No. NCT04251871 at www.clinicaltrials.gov ).
Administration, Inhalation ; Adult ; China ; Coronavirus Infections ; diagnosis ; drug therapy ; mortality ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Follow-Up Studies ; Humans ; Integrative Medicine ; Interferon-alpha ; administration & dosage ; Lopinavir ; administration & dosage ; Male ; Middle Aged ; Pandemics ; Pneumonia, Viral ; diagnosis ; drug therapy ; mortality ; Risk Assessment ; Severe Acute Respiratory Syndrome ; diagnosis ; drug therapy ; mortality ; Severity of Illness Index ; Survival Rate

Objective To investigate the protective effect of magnesium isoglycyrrhizinate on the liver of hepatic arterial chemoembolization.Methods 68 patients with hepatic arterial chemoembolization were selected as research subjects,they were divided into magnesium isoglycyrrhizinate group and control group.All patients were routinely given hepatoprotective drug treatment from seven days before surgery until three days after surgery,magnesium isoglycyrrhizinate group was given magnesium isoglycyrrhizinate treatment on the basis of hepatoprotective treatment. Detected and compared the alanine aminotransferase,aspartate aminotransferase,total bilirubin,total protein,albumin and cholinesterase levels before and after liver cancer before and after surgery.Results The alanine aminotrans-ferase,aspartate aminotransferase levels at 3 days after surgery[(60.2 ±25.8)and (71.5 ±29.6)IU /L]were higher than before surgery in the control group[(34.7 ±18.6)and (49.5 ±20.4)IU /L](t =7.264 and 5.974,all P <0.05).The alanine aminotransferase,aspartate aminotransferase levels at 3 days after surgery had no differences with before surgery in the magnesium isoglycyrrhizinate group (P >0.05).The alanine aminotransferase,aspartate amin-otransferase and total bilirubin levels before surgery in magnesium isoglycyrrhizinate group had no differences with the control group (P >0.05).The alanine aminotransferase,aspartate aminotransferase levels at 3 days after surgery in the magnesium isoglycyrrhizinate group[(44.8 ±22.8)and (57.3 ±24.8)IU /L]were higher than those in the control group[(60.2 ±25.8)and (71.5 ±29.6)IU /L](t =6.385 and 7.358,all P <0.05).The albumin and cholinesterase levels at 3 days after surgery in the magnesium isoglycyrrhizinate group and the control group[(28.4 ± 4.7)g/L,(8.0 ±4.8)kU /L and (29.3 ±3.5)g/L,(6.9 ±4.3)kU /L]were lower than before surgery[(34.2 ± 4.3)g/L,(9.3 ±5.4)kU /L and (33.7 ±3.9)g/L,(9.0 ±5.8)kU /L](t =11.834,6.247 and 10.276,8.743,all P <0.05).The albumin and cholinesterase levels before surgery in the magnesium isoglycyrrhizinate group had no differences with the control group (P >0.05).The albumin and cholinesterase levels at 3 days after surgery in the magnesium isoglycyrrhizinate group[(28.4 ±4.7)g/L,(8.0 ±4.8)kU /L]were lower than those of control group [(29.3 ±3.5 )g/L,(6.9 ±4.3)kU /L](t =8.436 and 6.947,all P <0.05 ).The incidence rates of adverse reactions of the magnesium isoglycyrrhizinate group (upper abdominal pain incidence rate was 35.3%,fever incidence rate was 29.4%,nausea and vomiting incidence rate was 52.9%)were lower than those of the control group(55.9%,88.2%,76.5%)(χ2 =7.246,6.472,6.274,all P <0.05).Conclusion Hepatic arterial chemoem-bolization has some damage to liver function of liver cancer patients.Magnesium isoglycyrrhizinate can reduce liver damage,improve liver synthetic function,and has a protective effect on liver.

BACKGROUNDThe difference between renal oncocytomas (RO) and renal clear cell carcinomas (RCCs) presents the greatest diagnostic challenge. The aim of this study was to retrospectively determine if RO and RCCs could be differentiated on computed tomography (CT) images on the basis of their enhancement patterns with a new enhancement correcting method.

METHODSForty-six patients with a solitary renal mass who underwent total or partial nephrectomy were included in this study. Fourteen of those were RO and 32 were RCCs. All patients were examined with contrast-enhanced CT. The pattern and degree of enhancement were evaluated. We selected the area that demonstrated the greatest degree of enhancement of the renal lesion in the corticomedullary nephrographic and excretory phase images. Regions of interest (ROI) were also placed in adjacent normal renal cortex for normalization. We used the values of the normal renal cortex that were measured at the same time as divisors. The ratios of lesion-to-renal cortex enhancement were calculated for all three phases. The Student's t-test and Pearson's Chi-square test were used for statistical analyses.

RESULTSAll RCCs masses showed contrast that appeared to be better enhanced than RO on all contrast-enhanced phases of CT imaging, but there was no significant difference in absolute attenuation values between these two diseases (P > 0.05). The ratio of lesion-to-cortex attenuation in the corticomedullary phase showed significantly different values between RO and RCCs. The degree of contrast enhancement in RCCs was equal to or greater than that of the normal renal cortex, but it was less than that of the normal cortex in RO in the corticomedullary phase. The ratio of lesion-to-cortex attenuation in the corticomedullary phase was higher than the cut off value of 1.0 in most RCCs (84%, 27/32) and lower than 1.0 in most RO (93%, 13/14) (P < 0.05). In the nephrographic phase, the ratio of lesion-to-cortex attenuation was higher than that in the corticomedullary phase in most RO (71%, 10/14), showing a prolonged enhancement pattern; and was lower than that in most RCCs (97%, 31/32), showing an early washout pattern (P < 0.05). In the differentiation of RO from RCCs, the sensitivity was 93%, specificity 84%, positive predictive value 72%, negative predictive value 84%, and accuracy for RO was 87, if the ratio of lesion-to-cortex attenuation in a cortex phase was lower than the cutoff value of 1.0. The sensitivity was 71%, specificity was 97%, positive predictive value was 91%, negative predictive value was 91%, and accuracy for RO was 89%, if the ratio of lesion-to-cortex attenuation in nephrographic phase was higher than that in the corticomedullary phase.

CONCLUSIONSThe ratios of renal lesion-to-cortex attenuation ratios may be helpful in differentiating RO from RCCs.

Adenoma, Oxyphilic ; diagnosis ; diagnostic imaging ; Adult ; Aged ; Carcinoma, Renal Cell ; diagnosis ; diagnostic imaging ; Female ; Humans ; Kidney Neoplasms ; diagnosis ; diagnostic imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed

Objective To evaluate the feasibility,efficacy and safety of the percutaneous coronary intervention(PCI) guided by computed tomography(CT) coronary angiography derived roadmap and magnetic navigation system(MNS).Methods During June 2011 and May 2012,thirty consecutive patients receiving elective PCI were enrolled,coronary artery disease was primarily diagnosed by dual-source CT coronary angiography(DSCT-CA) at outpatient clinic and successively proved by coronary artery angiography in the hospital.Target vessels from pre-procedure DSCT-CA were transferred to the magnetic navigation system,and consequently edited,reconstructed,and projected onto the live fluoroscopic screen as roadmaps.Parameters including characters of the target lesions,time,contrast volume,radiation dosage for guidewire crossing,and complications of the procedure were recorded.Results Thirty patients with 36 lesions were recruited and intervened by PCI.Among the target lesions,sixteen were classified as type A,11 as type B1,8 as type B2,1 as type C.The average length of the target lesions was (22.0 ± 9.8) mm,and the average stenosis of the target lesions was(81.3 ± 10.3)％.Under the guidance of CT roadmap and MNS,36 target lesions were crossed by the magnetic guidewires,with a lesion crossing ratio of 100％.The time of placement of the magnetic guidewires was 92.5 (56.6-131.3)seconds.The contrast volume and the radiation dosage for guidewire placement were 0.0 (0.0-3.0) ml and 235.0 (123.5-395.1) μGym2/36.5 (21.3-67.8)mGy,respectively.Guidewires were successfully placed in 21 (58.3％) lesions without contrast agent.All enrolled vessels were successfully treated,and there were no MNS associated complications.Conclusions It is feasible,effective and safe to initiate PCI under the guidance of CT derived roadmap and MNS.This method might be helpful for the guidewire placement in the treatment of total occlusions.

OBJECTIVETo investigate the clinical significance of the expression of serum differential protein in patients with chronic hepatitis B (CHB) related liver fibrosis.

METHODSOne hundred and ten CHB patients confirmed by liver biopsies were enrolled, 83 for modeling and 27 for verification. According to Ishak staging, 55 patients in the modeling group were with significant liver fibrosis ( F is more than or equal to 3 ) and 28 patients with normal/mild liver fibrosis ( F0-F2 ). While that in the verification group were 15 ( F is more than or equal to 3 ) and 12 ( F0-F2 ), respectively. MALDI-TOF-MS/MS was used to detect serum proteins and the spectrum for each sample was analyzed in FlexAnalysis3.0 to produce the spectrum of differential proteins. The results were compared with clinicopathologic diagnosis and the diagnosis model based on genetic algorithm was established and evaluated.

RESULTSThere were 15 proteins differentially expressed in significant liver fibrosis group and normal/mild fibrosis group ( P value is less than 0.01), in which the differences on proteins 2081.73 m/z and 1944.41 m/z were the most significant. Based on these two proteins, the coordinate system was set up and the diagnosis model based on genetic algorithm was established by six characteristic peaks. After detecting 12 cases of normal/mild liver fibrosis and 15 cases of significant liver fibrosis, the results showed that the diagnostic model could identify significant fibrosis ( F is more than or equal to 3 ) and normal/mild liver fibrosis ( F0-F2 ) at 100% recognition, 94.14% prediction and 100% accuracy.

CONCLUSIONSerum differential proteins examination can be used for early prediction of CHB related fibrosis. The study provides the basis for non-invasive diagnosis of hepatic fibrosis according to identifying the potential differences of the serum samples from patients with HBV related fibrosis.

Adult ; Blood Proteins ; analysis ; Female ; Hepatitis B, Chronic ; blood ; diagnosis ; pathology ; Humans ; Liver ; pathology ; Liver Cirrhosis ; blood ; diagnosis ; pathology ; Male ; Middle Aged ; Proteomics

OBJECTIVETo evaluate the efficacy and toxicity of a biweekly DOF regimen consisting of docetaxel, oxaliplatin, 5-fluorouracil and leucovorin for advanced gastric cancer.

METHODSThe biweekly DOF regimen was administered in 37 advanced gastric cancer patients. Docetaxel, oxaliplatin and leucovorin were given intravenously at a dose of 35 mg/m2, 85 mg/m2 and 200 mg/m2 for 1 h, 2 h and 2 h on D1, respectively, and 5-Fu was administered as continuous intravenous infusion for 48 h at a dose of 1500 mg/m2 on D1 and D2. This regimen was repeated every 2 weeks. The efficacy and toxicity were evaluated after completion of 3 cycles at least.

RESULTSThe overall response rate (RR) of this series was 67.6%, complete response rate and partial response rate were 27.0% and 40.5%, respectively. The time to progression (TTP) was 9.2 months, and median survival time (MST) was 13.7 months. The RRs of 11 chemotherpy-naïve patients and 26 patients pre-treated with chemotherapy were 81.8% and 61.5%, respectively.

CONCLUSIONOur preliminary results showed that this biweekly combination regimen of docetaxel, oxaliplatin, 5-fluorouracil and leucovorin is effective and tolerable for advanced gastric cancer. However, further investigation of this regimen is mandatory.

Adenocarcinoma ; drug therapy ; pathology ; Adenocarcinoma, Mucinous ; drug therapy ; pathology ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Female ; Fluorouracil ; administration & dosage ; adverse effects ; Follow-Up Studies ; Humans ; Leucovorin ; administration & dosage ; adverse effects ; Leukopenia ; chemically induced ; Liver Neoplasms ; drug therapy ; secondary ; Lung Neoplasms ; drug therapy ; secondary ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Organoplatinum Compounds ; administration & dosage ; adverse effects ; Remission Induction ; Stomach Neoplasms ; drug therapy ; pathology ; Taxoids ; administration & dosage ; adverse effects ; Vomiting ; chemically induced ; Young Adult