Modified intratympanic steroid therapy for sudden sensorineural hearing loss via tympanic tube and gelfoam as a salvage treatment

Background: Sudden sensorineural hearing loss(SSNHL) is a prevalent emergency in ear, nose, and throat practice. Previous studies have demonstrated that intratympanic steroid therapy(IST) can serve as a salvage treatment for SSNHL after the failure of systemic steroid therapy(SST).Objective: This study aimed to analyze the efficacy of modified IST involving the insertion of a tympanic tube and gelfoam as a salvage treatment for patients with SSNHL, and to explore its associated factors.Methods: Totally, 74 patients who were aged 22–81 years with SSNHL were enrolled and allocated to either the control group(n = 25) or the treatment group(n = 49) based on their treatment modalities. All patients received SST lasting for at least 7 days. Subsequently, patients in the treatment group, after SST failure, underwent IST twice a week for 2–6 weeks, while the control group did not. Efficacy was assessed by the improvement in pure tone average at the affected frequency at the beginning and end of IST.Results: Hearing improvement in all patients after IST in the treatment group was 9.71 ± 14.84 dB, with significant improvement at affected frequencies(250-8000 Hz) compared with the control group(P < 0.05). The findings indicated the duration from the onset of SSNHL to the beginning of IST as an independent factor for pure tone average improvement after treatment(P = 0.002), whereas age, duration of SST, and time of IST were not(P > 0.05).Conclusion: The modified IST was demonstrated to be a safe and effective method as a salvage treatment for SSNHL. This study explored the efficacy of a modified IST approach, incorporating the utilization of tympanic tubes and gelfoam as key components. The findings underscore the advantages of gelfoam as a strategic drug carrier placed in the round window niche. By minimizing drug loss, extending action time, and increasing perilymph concentration, gelfoam enhances the therapeutic impact of IST, contributing to improved hearing outcomes in patients with SSNHL.

Effect of psychological nursing interventions on effectiveness and quality of life in schizophrenia patients receiving modified electroconvulsive therapy

BACKGROUND Schizophrenia is a common and severe mental disorder characterized by severe thought disturbances,hallucinations,delusions,and emotional instability.For some patients,conventional treatment methods may not effectively alleviate symptoms,necessitating the use of alternative therapeutic approaches.Modified electroconvulsive therapy(MECT)is an effective treatment modality for schizophrenia,inducing anti-depressive and antipsychotic effects through the stimulation of brain electrical activity.AIM To explore the impact of psychological nursing intervention(PNI)before and after MECT on the efficacy and quality of life of patients with schizophrenia.METHODS Eighty patients with schizophrenia who received MECT treatment from 2021 to 2023 were randomly divided into two groups:The intervention group(n=40)and the control group(n=40).The intervention group received PNI before and after MECT,while the control group received routine nursing care.The efficacy of MECT was evaluated by the Positive and Negative Syndrome Scale(PANSS)and the Clinical Global Impression Scale(CGI)before and after the treatment.The quality of life was assessed by the Short Form 36 Health Survey(SF-36)after the treatment.RESUITS The intervention group had significantly lower scores of PANSS and CGI than the control group after the treatment(P<0.05).The intervention group also had significantly higher scores of SF-36 than the control group in all domains except physical functioning(P<0.05).CONCLUSION PNI before and after MECT can improve the efficacy and quality of life of patients with schizophrenia.It is suggested that nurses should provide individualized and comprehensive psychological care for patients undergoing MECT to enhance their recovery and well-being.

Preemptive analgesia with butorphanol in psychotic patients following modified electroconvulsive therapy A randomized controlled trial

BACKGROUND： Preemptive .analgesia involves introducing an analgesic prior to the onset of pain stimulation to prevent sensitizing the nervous system to subsequent stimuli that could amplify pain. OBJECTIVE： To treat psychiatric patients with intravenous （i.v.） injection of butorphanol prior to modified electroconvulsive therapy, and to observe its effect on alleviating myalgia after treatment and adverse reactions. DESIGN： A randomized controlled observation. SETTING： Renmin Hospital of Wuhan University. PARTICIPANTS： A total of 120 psychiatric patients, who accepted modified electroconvulsive therapy, were selected from the Mental Health Center of Wuhan University from June to September in 2006. All patients corresponded to the Chinese Classification and Diagnostic Criteria of Mental Disorders, and those with diseases of heart, liver, lung and kidney, glaucoma, intracranial hypertension, hyperthyreosis, and hyperkalemia were excluded. The patients were randomly divided into a control group （n = 60） and treatment group （n = 60）. In the control group, there were 42 males and 18 females, aged 17-50 years, with a mean age of （34 ± 11） years. The patients weighed 50-70 kg, with a mean body mass of （63 ± 18） kg. In the treatment group, there were 40 males and 20 females, aged 20-54 years, with a mean age of （36 ± 13） years. The patients weighed 48-72 kg, with a mean body mass of （64 ± 16） kg. Approval was obtained from the Hospital＇s Ethics Committee. Informed consents were obtained from the patients＇ relatives. A SPECTRUM5000Q multifunctional mobile electroconvulsive therapy apparatus （CORPERATION, USA） was used. METHODS： （1） Treatments： In the control group, the patients were anesthetized by i.v. injection of propofol （AstraZeneca, Italy, No.CN309） containing 0.075% efedrina, and then modified electroconvulsive therapy was performed. Circulation, respiration, and firing of brain electrical activity were continuously monitored. In the treatment group, the patients were i.v. injected with 1 mg of butorphanol tartrate parenteral solution （Jiangsu Hengrui Medicine Co., Ltd., No.05100732） 5 minutes prior to anesthesia; the remaining treatments were the same as in the control group. （2） Evaluations： myalgia conditions were assessed 6 hours after the patients opened their eyes. The patients were evaluated by a visual analogue scale and Ramsay sedation scale immediately, and at 3 minutes and 6 hours after they opened their eyes. MAIN OUTCOME MEASURES： （1） Conditions of myalgia. （2） Scores of visual analogue scale and Ramsay sedation scale. RESULTS： All 120 psychiatric patients were involved in the final analysis. （1） Conditions of myalgia： 6 hours after modified electroconvulsive therapy, 22 patients in the control group and 1 patient in the treatment group complained of myalgia, which resulted in a significant difference between the two groups （P 〈 0.05）. （2） Scores of visual analogue scale and Ramsay sedation scale： the scores of visual analogue scale at 30 minutes and 6 hours after opening eyes were significantly lower in the treatment group than the control group （P 〈 0.05）, and the scores of Ramsay sedation scale were not significantly different between the two groups （P 〉 0.05）. CONCLUSION： Preemptive analgesia by butorphanol can effectively alleviate modified electroconvulsive therapy-induced myalgia, without adverse reactions.

Modified constraint-induced movement therapy enhances cortical plasticity in a rat model of traumatic brain injury:a resting-state functional MRI study

Modified constraint-induced movement therapy(mCIMT)has shown beneficial effects on motor function improvement after brain injury,but the exact mechanism remains unclear.In this study,amplitude of low frequency fluctuation(ALFF)metrics measured by resting-state functional magnetic resonance imaging was obtained to investigate the efficacy and mechanism of mCIMT in a control co rtical impact(CCI)rat model simulating traumatic brain injury.At 3 days after control co rtical impact model establishment,we found that the mean ALFF(mALFF)signals were decreased in the left motor cortex,somatosensory co rtex,insula cortex and the right motor co rtex,and were increased in the right corpus callosum.After 3 weeks of an 8-hour daily mClMT treatment,the mALFF values were significantly increased in the bilateral hemispheres compared with those at 3 days postoperatively.The mALFF signal valu es of left corpus callosum,left somatosensory cortex,right medial prefro ntal cortex,right motor co rtex,left postero dorsal hippocampus,left motor cortex,right corpus callosum,and right somatosensory cortex were increased in the mCIMT group compared with the control cortical impact group.Finally,we identified brain regions with significantly decreased mALFF valu es at 3 days postoperatively.Pearson correlation coefficients with the right forelimb sliding score indicated that the improvement in motor function of the affected upper limb was associated with an increase in mALFF values in these brain regions.Our findings suggest that functional co rtical plasticity changes after brain injury,and that mCIMT is an effective method to improve affected upper limb motor function by promoting bilateral hemispheric co rtical remodeling.mALFF values correlate with behavio ral changes and can potentially be used as biomarkers to assess dynamic cortical plasticity after traumatic brain injury.

Evaluation of modified hemodilution combined therapy in the treatment of acute ischemic stroke in the elderly

BACKGROUND： Thrombolysis therapy is not suitable for the elderly patients with acute ischemic stroke who delayed to be diagnosed for more than 3 hours, but traditional medicine is also not very ideal. OBJECTIVE： To observe the clinical therapeutic effect of modified hemodilution combined therapy applied in elderly patients with acute cerebral thrombosis and analyze the mechanism of this therapeutic method. DESIGN： 1：1 paired grouping according to gender and controlled observation SETTING： Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University. PARTICIPANTS： Totally 90 elderly patients with acute ischemic stroke who received the treatment in the Cadre Ward and Mental Ward, Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University from March 1996 to June 2004 were recruited. They all met the diagnosis criteria revised by the Fourth Academic Conference of National Cerebrovascular Diseases in 1995 and were diagnosed as acute ischemic stroke by skull CT. They were informed of therapeutic plan and detected items. According to 1：1 paired principle in gender, 90 enrolled patients were assigned into treated group （n=45） and control group （n=45）. There were 39 male and 6 female in the treatment group, and they were aged （76±6）years, ranging from 71 to 84 years, and hospitalized at the 14^th to 76^th hours after onset. There were 39 male and 6 female in the control group, and they were aged （76±6）years , ranging from 70 to 82 years, and hospitalized at the 16^th to 72^th hours after onset. METHODS： Therapeutic method： Patients of treated group received modified hemodilution combined therapy. 200 mL whole blood of patients was exchanged with 500 mL dextran-40 （including 20 mL danshen parenteral solution and 32 mg heparin） at the beginning of therapy; From the 2^nd day, compound huangqi tea bag （Huangqi mainly, including danshen, honghua, chuanxiong, shishao and a little acetyl salicylic acid） was made, twice a day, 1 bag once. At the same time, the above-mentioned dextran-40 liquid of 500 mL was intravenously injected, once a day, 14 days in total; On the 6^th day after therapy, the above-mentioned aseptic autoblood stored in refrigerator at 4℃ was transfused back into the patients following pre-treatment of high-concentration oxygenation and ultraviolet irradiation by light quantum instrument. Patients of control group were intravenously injected of 0.4 g venoruton（Traditional Chinese medicine compound parenteral solution for promoting blood circulation and removing blood stasis ） and 50 g/L glucose of 500 mL, 75 mg acetosal was taken orally, once a day, 14 days in total. ② Measurement and observation of index： Blood coagulation index, change of platelet aggregation rate and change of hemorrheology of patients in two groups were monitored before and after therapy. The level of blood lipid of patients in two groups was measured with American Beckman automatic biochemistry analyzer. Blood flow rate of middle cerebral artery of resting electrocardiogram were measured with American HP SONOS 2500 sonoscope. Neuro-dysfunction score revised in the national conference （1995） was used to evaluate the recovery of neurological function of the patients in two groups at the 3rd, 5^th, 7^th and 14^th days after therapy. ③Therapeutic effect and adverse effect were observed at the same time. MAIN OUTCOME MEASURES ： ① Changes of coagulation index, blood lipid level and hemorheology; ② Blood flow rate of middle cerebral artery and NDS of patients with acute ischemic stroke in two groups; ③Adverse effect of drug. RESULTS： Totally 90 patients were enrolled in the experiment. One patient from treated group died of hyperosmolar nonketotic diabetic coma of complicated diabetes mellitus. One patient from control group died of severe pulmonary infection. The rest 88 patients entered the stage of result analysis. ① Change of coagulation index and platelet aggregation rate： prothrombin time （PT）, activated partial thromboplastin time （APTT） and thrombin time （TT） of patients after therapy were significantly longer than those before therapy in the treated group and those after therapy in control group [After therapy in treated group： （18.4±1.9）, （41.8±2.1）, （19.7±1.7） s, Before therapy in treated group： （13.4±1.3）, （35.8±1.3）, （12.5±0.9） s, After therapy in control group： （16.9±1.5）, （39.1±1.1）, （11.9±2.1） s, P〈 0.05]：Concentration of fibrinogen （Fbg） after therapy was significantly lower than that before therapy in the treated group and that after therapy in control group[After therapy in treated group： （3.4±0.4） g/L; Before therapy in treated group： （4.3±0.7） g/L; After therapy in control group：（4.0±0.6） g/L; P 〈 0.05]. Platelet aggregation rate decreased from （37.92 ±0.85）% before therapy to （26.42±1.01）% after therapy （P 〈 0.01）. ②Change of blood lipid level： Levels of total cholesterol （TC）, triacylglycerol（TG） and low density lipoprotein cholesterol （LDL-C） of patients after therapy were significantly lower than those before therapy in treated group and those after therapy in control group [After therapy in treated group： （5.2±0.9）, （1.9±0.9）, （2.08±1.1） mmol/L, before therapy in treated group： （5.9±1.2）, （2.8±0.9）, （3.94±0.5） mmol/L, After therapy in control group： （6.0±1.1）, （2.6±0.8）, （3.84±0.9） mmol/L, P 〈 0.05]. ③Change of hemorheology index： Hematocrit of patients of treated group was significantly lower after therapy than before therapy [Before therapy： （43.84±4.55）% ;After therapy： （40.48±4.02）%;P 〈 0.05]. Blood flow rate of middle cerebral artery of patients of treated group was significantly lower before therapy than after therapy [（90±1.2）, （97±2.1） cm/s,P〈 0.01]. ⑤NDS of patients in treated group was significantly lower than of control group 14 days after therapy. The total effective rate after therapy was significantly higher in the treated group than in the control group （93%,78%, P 〈 0.05）. ⑥There was no obvious adverse effect. CONCLUSION： Modified hemodilution combined therapy can improve hemorheology, decrease hematocrit, increase blood flow rate of middle cerebral artery, so as to improve the impaired clinical neurological function of elderly patients with acute cerebral thrombosis through anticoagulation and antiplatelet aggregative activity as well as regulating blood lipid.

Modified moist occlusive burn therapy:a novel therapeutic approach for thermal burns

Severe thermal burns usually result in complex facial problems such as contracture and formation of hyper/hypopigmentation,contracture,hypertrophic scars or deformity,with patients often requiring reconstructive surgery.Therefore,seeking a superior and reliable burn therapy remains a great challenge for plastic and burn surgeons.However,the optimal treatment of thermal injuries remains controversial.In the 1960s,a new therapeutic concept,that sterile polyethylene film might be used as a type of moist occlusive dressing,was successively proposed.Below we present a hypothesis that combined utilization of sterile polyethylene film and burn cream may be a novel and superior therapeutic approach for thermal burns.To distinguish this method from traditional moist burn therapy,this new therapy we proposed is named modified moist occlusive burn therapy(MMOBT).

Promises and pitfalls of immune-based strategies for Huntington's disease

Huntington＇s disease （HD） is an autosomal-dominant neurodegenerative disease characterized by the selec- tive loss of neurons in the striatum and cortex, leading to progressive motor dysfunction, cognitive decline and behavioral symptoms. HD is caused by a trinucleotide （CAG） repeat expansion in the gene encoding for huntingtin. Several studies have suggested that inflammation is an important feature of HD and it is already observed in the early stages of the disease. Recently, new molecules presenting anti-inflammatory and/or immunomodulatory have been investigated for HD. The objective of this review is to discuss the data obtained so far on the immune-based therapeutic strategies for HD.

Promoting remyelination for the treatment of multiple sclerosis:opportunities and challenges

Multiple sclerosis （MS） is a chronic and devastating autoimmune demyelinating disease of the central nervous system. With the increased understanding of the pathophysiology of this disease in the past two decades, many disease-modifying therapies that primarily target adaptive immunity have been shown to prevent exacerbations and new lesions in patients with relapsing-remitting MS. However, these therapies only have limited efficacy on the progression of disability. Increasing evidence has pointed to innate immunity, axonal damage and neuronal loss as important contributors to disease progression. Remyelination of denuded axons is considered an effective way to protect neurons from damage and to restore neuronal function. The identification of several key molecules and pathways controlling the differentiation of oligodendrocyte progenitor cells and myelination has yielded clues for the development of drug candidates that directly target remyelination and neuroprotection. The long-term efficacy of this strategy remains to be evaluated in clinical trials. Here, we provide an overview of current and emerging therapeutic concepts, with a focus on the opportunities and challenges for the remyelination approach to the treatment of MS.

Disease modification and Neuroprotection in neurodegenerative disorders

Background:Disease modifying therapies(DMTs)are urgently needed for neurodegenerative diseases(NDD)such as Alzheimer’s disease(AD)and many other disorders characterized by protein aggregation and neurodegeneration.Despite advances in understanding the neurobiology of NDD,there are no approved DMTs.Discussion:Defining disease-modification is critical to drug-development programs.A DMT is an intervention that produces an enduring change in the trajectory of clinical decline of an NDD by impacting the disease processes leading to nerve cell death.A DMT is neuroprotective,and neuroprotection will result in disease modification.Disease modification can be demonstrated in clinical trials by a drug-placebo difference in clinical outcomes supported by a drug-placebo difference on biomarkers reflective of the fundamental pathophysiology of the NDD.Alternatively,disease modification can be supported by findings on a staggered start or delayed withdrawal clinical trial design.Collecting multiple biomarkers is necessary to support a comprehensive view of disease modification.Conclusion:Disease modification is established by demonstrating an enduring change in the clinical trajectory of an NDD based on intervention in the fundamental pathophysiology of the disease leading to nerve cell death.Supporting data are collected in clinical trials.Effectively defining a DMT will assist in NDD drug development programs.