Effects of respiratory muscle training on post-stroke rehabilitation:A systematic review and meta-analysis

BACKGROUND Stroke often results in significant respiratory dysfunction in patients.Respiratory muscle training(RMT)has been proposed as a rehabilitative intervention to address these challenges,but its effectiveness compared to routine training remains debated.This systematic review and meta-analysis aim to evaluate the effects of RMT on exercise tolerance,muscle strength,and pulmonary function in post-stroke patients.AIM To systematically assess the efficacy of RMT in improving exercise tolerance,respiratory muscle strength,and pulmonary function in patients recovering from a stroke,and to evaluate whether RMT offers a significant advantage over routine training modalities in enhancing these critical health outcomes in the post-stroke population.METHODS Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines,a comprehensive search across PubMed,Embase,Web of Science,and the Cochrane Library was conducted on October 19,2023,without temporal restrictions.Studies were selected based on the predefined inclusion and exclusion criteria focusing on various forms of RMT,control groups,and outcome measures[including forced expiratory volume in the first second(FEV1),forced vital capacity(FVC),maximal voluntary ventilation(MVV),peak expiratory flow(PEF),maximal inspiratory pressure(MIP),maximal expiratory pressure(MEP),and 6-min walking test(6MWT)].Only randomized controlled trials(RCTs)were included.Data extraction and quality assessment were conducted independently by two reviewers using the Cochrane Collaboration's risk of bias tool.Statistical analyses,including those using the fixed-effect and random-effects models,sensitivity analysis,and publication bias assessment,were performed using Review Manager software.RESULTS A total of 15 RCTs were included.Results indicated significant improvements in MIP(12.51 cmH2O increase),MEP(6.24 cmH2O increase),and various pulmonary function parameters(including FEV1,FVC,MVV,and PEF).A substantial increase in 6MWT distance(22.26 meters)was also noted.However,the heterogeneity among studies was variable,and no significant publication bias was detected.CONCLUSION RMT significantly enhances walking ability,respiratory muscle strength(MIP and MEP),and key pulmonary function parameters(FEV1,FVC,MVV,and PEF)in post-stroke patients.These findings support the incorporation of RMT into post-stroke rehabilitative protocols.

Correlation and predictive value of pathological complete response and ultrasound characteristic parameters in neoadjuvant chemotherapy for breast

BACKGROUND Breast cancer ranks as one of the most prevalent malignant tumors among women,significantly endangering their health and lives.While radical surgery has been a pivotal method for halting disease progression,it alone is insufficient for enhancing the quality of life for patients.AIM To investigate the correlation between ultrasound characteristic parameters of breast cancer lesions and clinical efficacy in patients undergoing neoadjuvant chemotherapy(NAC).METHODS Employing a case-control study design,this research involved 178 breast cancer patients treated with NAC at our hospital from July 2019 to June 2022.According to the Miller-Payne grading system,the pathological response,i.e.efficacy,of the NAC in the initial breast lesion after NAC was evaluated.Of these,59 patients achieved a pathological complete response(PCR),while 119 did not(non-PCR group).Ultrasound characteristics prior to NAC were compared between these groups,and the association of various factors with NAC efficacy was analyzed using univariate and multivariate approaches.RESULTS In the PCR group,the incidence of posterior echo attenuation,lesion diameter≥2.0 cm,and Alder blood flow grade≥II were significantly lower compared to the non-PCR group(P<0.05).The area under the curve values for predicting NAC efficacy using posterior echo attenuation,lesion diameter,and Alder grade were 0.604,0.603,and 0.583,respectively.Also,rates of pathological stage II,lymph node metastasis,vascular invasion,and positive Ki-67 expression were significantly lower in the PCR group(P<0.05).Logistic regression analysis identified posterior echo attenuation,lesion diameter≥2.0 cm,Alder blood flow grade≥II,pathological stage III,vascular invasion,and positive Ki-67 expression as independent predictors of poor response to NAC in breast cancer patients(P<0.05).CONCLUSION While ultrasound characteristics such as posterior echo attenuation,lesion diameter≥2.0 cm,and Alder blood flow grade≥II exhibit limited predictive value for NAC efficacy,they are significantly associated with poor response to NAC in breast cancer patients.

One-year status of hepatic venous pressure gradient measurement from 85 hospitals in China

Aims:Surveys and research on the applications of the hepatic venous pressure gradient(HVPG)are important for understanding the current status and future development of this technology in China.This article aimed to investigate the status of hepatic venous pressure gradient measurement in China in 2022.Methods:We investigated the overall status of HVPG technology in China-including hospital distribution,hospital level,annual number of cases,catheters used,average cost,indications,and current challenges by using online questionnaire.By counting the number and percentages of cases of these results,we hope to clarify the current status of HVPG measurements in China.Results:According to the survey,85 hospitals in China used HVPG technology in 2022 distributed across 29 provinces.A total of 4989 HVPG measurements were performed in all of the surveyed hospitals in 2022,of which 2813 cases(56.4%)were measured alone.The average cost of HVPG measurement was 5646.8±2327.9 CNY.Of the clinical teams who performed the measurements(sometimes multiple per hospital),94.3%(82/87)used the balloon method,and the majority of the teams(72.4%,63/87)used embolectomy catheters.Conclusions:This survey clarified the clinical application status of HVPG in China and confirmed that some medical institutions in China have established a foundation for this technology.It is still necessary to continue promoting and popularizing this technology in the future.

Effects and mechanism of adenovirus-mediated phosphatase and tension homologue deleted on chromosome ten gene on collagen deposition in rat liver fibrosis

AIM To evaluate the effects of phosphatase and tension homologue deleted on chromosome ten(PTEN) gene on collagen metabolism in hepatic fibrosis and the underlying mechanisms.METHODS rat primary hepatic stellate cells(HSCs) and human LX-2 cells were transfected with adenovirus containing c DNA constructs encoding wild-type PTEN(Ad-PTEN), PTEN mutant G129 E gene(Ad-G129E), and r NA interference constructs targeting the PTEN sequence PTEN short hairpin r NA to up-regulate and downregulate the expression of PTEN. HSCs were assayed using fluorescent microscopy, real-time polymerase chain reaction, and western blotting. Moreover, a CCl_4-induced rat hepatic fibrosis model was established to investigate the in vivo effects. Hematoxylin and eosin, and Masson's trichrome were used to assess the histological changes. The expression of collagen Ⅰ and Ⅲ was assessed using immunohistochemistry and western blot analysis.RESULTS Elevated expression of PTEN gene reduced serum levels of alanine transaminase and aspartate transaminase, decreased collagen deposition in the liver, and reduced hepatocyte necrosis. In contrast, knockdown of PTEN expression had an opposite effect, such as increased collagen deposition in the liver, and was molecularly characterized by the increased expression of matrix metalloproteinase(MMP)-13(P < 0.01) and MMP-2(P < 0.01), as well as decreased expression of the tissue inhibitor of metalloproteinase(TIMP)-1(P < 0.01) and TIMP-2(P < 0.01).CONCLUSION These data indicated that gene therapy using recombinant adenovirus encoding PTEN might be a novel way of treating hepatic fibrosis.

Predictive Factors of Lymph Node Metastasis in Early Mucinous Adenocarcinoma

OBJECTIVE To identify clinicopathologic factors which predictlymph node metastases (LNM) in early mucinous adenocarcinomapatients, and to further explore the possibility of using minimallyinvasive treatment for patients with the disease.METHODS Data was collected from 38 patients with earlymucinous adenocarcinoma who were surgically treated, and theassociation between clinicopathologic factors and the presenceof LNM was retrospectively analyzed using univariate andmultivariate logistic regression analysis.RESULTS Tumor size greater than 2.0 cm, the developmentof submucosal invasion, and the presence of lymphatic vesselinvolvement (LVI) were confirmed through univariate analysis ashaving a significant association with LNM and were consideredto be significant and independent risk factors for LNM throughmultivariate analysis.CONCLUSION Tumor size > 2.0 cm, the development ofsubmucosal invasion, and the presence of LVI are independentpredictive factors for LNM in early mucinous adenocarcinoma.Minimally invasive treatment may be an effective treatment forintramucosal early mucinous adenocarcinoma when the tumorsize is 2.0 cm or less, and if LVI has not occurred, as confirmed bypostoperative histologic examination.

Ureteral-artificial iliac artery fistula:A case report

BACKGROUND Ureteral-iliac artery fistula is a rare disease resulting from the pathological connection between the ureter and iliac artery,with artificial iliac artery-ureteral fistula being rarer.Iliac artery ureteral fistula is challenging to diagnose,and the misdiagnosis and mortality rates are high.CASE SUMMARY A case of artificial iliac artery ureteral fistula was reported in this paper.The patient was a 69-year-old male with paroxysmal painless hematuria.The artificial iliac artery ureteral fistula was diagnosed by angiography.The hematuria was stopped after intravascular embolization,and no bleeding occurred after 6 months of follow-up.CONCLUSION Ureteral arterial fistula should be considered when inconspicuous hematuria with previous iliac vessels is encountered in addition to local ureteral surgery history.A rapid endovascular approach is recommended for fistula identification.

Quantitative Real-Time Reverse Transcription-PCR Assay for the Expression of Tob mRNA in Human Colorectal Cancer

OBJECTIVE Tob is a member of Tob/BTG antiproliferative family. To date, Tob expression in human carcinoma using clinical specimens has not been studied in depth except for lung carcinoma and thyroid carcinoma. This study is the first to investigate the expression levels of Tob gene in human colorectal cancer tissues, and their corresponding para-cancerous tissues. The correlation of expression of the Tob gene with clinicopathological characteristics of colorectal cancer was also analyzed. METHODS Quantitative real time RT-PCR was used to detect the expression of Tob mRNA in 31 colorectal cancers. RESULTS Compared with normal tissues, up-regulation of Tob mRNA was observed in 31 colorectal cancer tissues （P = 0.020）. The expression level of Tob at Dukes C ＋ D phase was higher than Dukes A ＋ B phase, and the difference was significant （P 〈 0.05）. However, in this study, it was found that the expression of Tob mRNA was not related with age, gender, and pathological type of colorectal cancer. CONCLUSION The up-regulation of Tob may be closely associated with tumorigenesis of colorectal carcinoma.

The Right Decision on the Vaginal Construction in Mayer- Rokitansky-Kiister-Hauser syndrome

Vaginal agenesis is a congenital anomaly that affects the life of one of each four thousand women around the world. There is a trend that patients request immediate surgical correction, instead of passive vaginal dilatation. Therefore a differentiated counselling should be provided. We present a comparative chart, based on published evidence, with aspect to the available techniques, which will facilitate the decision- making process in the clinical practice. From our point of view, the best results are achieved with techniques that combine the advantages of the minimal-invasive surgery with those derived of the use of peritoneum as coveting tissue of the neovagina. Nevertheless there is a lack on interdisciplinary consensus about the best option to restore the physical and sexual quality of life.

Effects of Yiqi Yangyin Prescription combined with radiotherapy on the tumor load and anti-tumor immune response of patients with advanced lung cancer

Objective: To investigate the effects of Yiqi Yangyin Prescription combined with radiotherapy on the tumor load and anti-tumor immune response of patients with advanced lung cancer. Methods: A total of 78 patients with advanced non-small cell lung cancer who were diagnosed and treated in our hospital between August 2015 and January 2017 were reviewed and then divided into the routine group (n=41) who received chemoradiotherapy alone and the Yiqi Yangyin Prescription group (n=37) who received chemoradiotherapy combined with Yiqi Yangyin Prescription therapy. The differences in serum levels of tumor markers, Th1/Th2 cytokines and Th17/Treg cytokines were compared between the two groups before and after treatment. Results: After treatment, serum tumor markers CA15-3, Cyfra21-1, HSP90 and CEA levels of Yiqi Yangyin Prescription group were lower than those of routine group;serum Th1 cytokines IFN-γ and IL-2 levels were higher than those of routine group while Th2 cytokines IL-4 and IL-5 levels were lower than those of routine group;serum Th17 cytokines IL-17 and IL-23 as well as Treg cytokines IL-10 and TGF-β levels were lower than those of routine group. Conclusion: Routine chemoradiotherapy combined with Yiqi Yangyin Prescription therapy can effectively reduce the tumor load and optimize the anti-tumor immune function in patients with advanced non-small cell lung cancer.

Effect of atorvastatin and clopidogrel on inflammatory factors, blood coagulation and platelet activation in patients with acute cerebral infarction

Objective: To investigate the effects of atorvastatin combined with clopidogrel on inflammatory factors, coagulation and platelet activation in patients with acute cerebral infarction. Methods: A total of 140 cases patients with acute cerebral infarction who were confirmed by clinical and imaging diagnoses were randomly divided into treatment group (70 cases) and control group (70 cases). Both groups were treated routinely before treatment. The observation group was treated with clopidogrel and atorvastatin, while the control group was treated with aspirin and atorvastatin. The changes of inflammatory factors, coagulation function and platelet activation index before and after treatment were compared between the two groups. Result: Before treatment, the levels of serum soluble intercellular adhesion molecule-1 (sICAM-1), transforming growth factor-β (TGF-β), coagulation parameters prothrombin time(PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), coagulation index of platelets platelet -membrane glycoprotein (CD62p), lysosomal granular membrane glycoprotein (CD63), platelet-monocyte aggregates (PMA), coagulation parameters were not statistically significant. After treatment, the levels of sICAM-1, CD62p, CD63, PMA and FIB in both groups decreased and the levels of TGF-β, PT and APTT increased. The levels of sICAM-1, FIB, CD62p, CD63 and PMA in the observation group were (370.32±37.13) ng/mL, (1.97±0.21) g/L, (1.38±0.14)%, (0.22±0.02)%, and (18.47+1.85)% respectively, which were lower than those in the control group ((410.47±42.32) ng/mL, (2.58±0.26) s, (2.67±0.27)%, (0.35±0.03)% and (22.87±2.91)%)While the levels of TGF-β, PT and APPT were (231.53±23.52) ng/mL, (15.42±1.53) s, (37.31±3.54) s were higher than the control group ((218.56±22.17) ng/mL, (12.32±1.27) s and (29.89±3.01)s)And the differences were significant. Conclusion: Atorvastatin combined with clopidogrel treatment can effectively relieve the inflammatory response, reduce the release of inflammatory cytokines, improve blood coagulation and inhibit platelet aggregation in patients with acute cerebral infarction. So it deserves further clinical promotion.

Correlation of serum E-FABP content with glucose lipid metabolism,endothelial injury and inflammatory response in children with metabolic syndrome

Objective: To study the correlation of serum E-FABP content with glucose lipid metabolism, endothelial injury and inflammatory response in children with metabolic syndrome. Methods:A total of 49 children with metabolic syndrome who were treated in the hospital between January 2016 and February 2017 were collected as observation group, and 50 healthy children who received vaccination in the hospital over the same period were collected as normal control group. Serum levels of E-FABP as well as glucose lipid metabolism, endothelial injury and inflammatory response indexes of two groups of subjects were detected, and the Pearson test was used to evaluate the correlation of E-FABP content with glucose lipid metabolism, endothelial injury and inflammatory response. Results: Serum E-FABP content of observation group was higher than that of control group;glucose metabolism indexes FBG and HOMA-IR levels in peripheral blood were higher than those of normal control group;lipid metabolism indexes TC, LDL-C and ApB contents in peripheral blood of observation group were higher than those of normal control group while HDL-C and ApA1 contents were lower than those of normal control group;endothelial injury index ET-1 content in serum was higher than that of normal control group while NO content was lower than that of normal control group;inflammatory response indexes CRP, IL-1β, IL-6 and IL-17 contents in serum were higher than those of normal control group. Pearson test showed that serum E-FABP content in children with metabolic syndrome was directly correlated with glucose lipid metabolism, endothelial injury and inflammatory response indexes. Conclusion: Serum E-FABP content increases abnormally in children with metabolic syndrome and is directly correlated with the abnormal degree of glucose lipid metabolism, endothelial injury and inflammatory response.

Preliminary exploration of a multidisciplinary management model for cirrhotic portal hypertension

To the Editor,Portal hypertension(PH)refers to a group of clinical syndromes caused by increased pressure in the portal venous system resulting from a variety of etiologies.The most common disease is liver cirrhosis,mainly manifesting as ascites,esophageal and gastric variceal bleeding,and hepatic encephalopathy.These complications can affect the quality of life of patients and even directly threaten their lives.

Immunogenicity and safety of a booster COVID-19 vaccination in patients with chronic liver disease:A multicenter study

Aim:Patients with chronic liver disease(CLD),especially cirrhosis,are at a high risk of severe illness or death from coronavirus disease-2019(COVID-19)and may have a suboptimal immune response to the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)vaccine.This study aimed to evaluate the safety and immunogenicity of the COVID-19 booster vaccination in patients with CLD.Methods:The study protocol was prospectively registered at ClinicalTrials.gov(No.NCT05204602)after approval by the Ethics Committee.Adult participants with CLD were enrolled in this multicenter prospective study.They completed two doses of the inactivated COVID-19 vaccine and received booster doses at least 6 months later.Adverse reactions were recorded within 14 days after the booster dose.Serum samples of the enrolled patients were collected before and after booster vaccination and tested for SARS-CoV-2 receptor-binding domain(RBD)immunoglobulin G and neutralizing anti-bodies.The chi-squared or Fisher's exact test was used to compare categorical data,and the Mann-Whitney U test was used to compare continuous variables.Two-sided p<0.05 were considered statistically significant.Results:In total,63 patients were enrolled from four hospitals in China,including 29 patients with cirrhosis.The median age of all patients was 55 years,and 61.9%(39/63)were male.The vaccines were well tolerated;most adverse reactions were mild and transient,and injection site pain(6.4%;4/63)and fatigue(3.2%,2/63)were the most frequent local and systemic adverse events.Following the booster vaccination,our results showed that in the whole cohort,the levels and positive rates of anti-RBD IgG and neutralizing antibodies were significantly higher than baseline levels(all p<0.05).Conclusions:The inactivated COVID-19 booster vaccine was safe and significantly increased antibody levels and positivity rates following standard vaccination regimens in patients with CLD,especially those with cirrhosis.

Meta-analysis of the immunogenicity of standard and booster SARS-CoV-2 vaccination in patients with chronic liver disease and post-liver transplantation

Aims:Patients with liver disease may exhibit higher infection rates and mortality rates from coronavirus disease 2019(COVID-19)than healthy individuals,and vaccination against severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is an effective prevention strategy.This metaanalysis aimed to assess the effectiveness and safety of SARS-CoV-2 vaccines in patients with chronic liver disease(CLD)and post-liver transplantation(LT).Methods:The PubMed,Embase,and Cochrane databases were searched.A random-effects model meta-analysis was used to determine the seropositivity rates of SARS-CoV-2 antibodies,odds ratio(OR)compared with healthy controls(HC),risk ratio(RR)between the booster and standard vaccination regimen,and the rate of adverse reactions(ADR).Results:In the standard vaccination regimen analysis,17 controlled articles were included for effectiveness analysis,and six articles for ADR analysis.The pooled seropositivity rates of SARS-CoV-2 antibodies in patients with CLD and post-LT were 93.3%(95%confidence interval[CI]:89.0%-97.6%)and 69.1%(95%CI:63.0%-75.3%),respectively.Both rates were lower than those in HC(p<0.001).The differences remained significant after sorting by detection interval,vaccine type,antibody type,or CLD type.LT recipients showed much lower seropositivity rates of antibodies than patients with CLD(69.1%vs.93.3%)or HC(OR:0.055).The pooled total ADR rate of patients was 24.0%(95%CI:16.2%-31.8%).In the booster vaccination regimen analysis,11 prospective studies were enrolled,and the seropositivity rates of antibodies after the booster dose were increased by 27%compared with those of the standard vaccination regimen(RR:1.27,95%CI:1.15-1.41,p<0.001).Conclusion:Patients with CLD and post-LT can gain protection against COVID-19 from standard vaccines,demonstrating a potentially weaker immunogenic response than HC.Booster vaccines can compensate for this deficiency.Therefore,patients with CLD and post-LT should be prioritized for receiving the COVID-19 booster vaccine.

Prevalence and risk factors for minimal hepatic encephalopathy in cirrhotic patients with different etiologies

Aims:Minimal hepatic encephalopathy(MHE)significantly affects the prognosis of patients with cirrhosis.This study was performed to determine whether there is a difference in the prevalence of MHE among patients with cirrhosis of different etiologies and whether the etiology directly influences the occurrence of MHE.Methods:This multicenter,cross-sectional study enrolled 1879 patients with confirmed cirrhosis at 40 hospitals from October 25,2021,to January 10,2023(Trial registration:https://clinicaltrials.gov/[NCT05140837]).The patients'demographics,etiologies of cirrhosis,and laboratory test results were collected.The psychometric hepatic encephalopathy score(PHES)was determined in all patients to screen for MHE.Multivariate logistic analyses were performed to identify the risk factors for MHE.Results:In total,736 patients with cirrhosis were analyzed.The prevalence of MHE was 42.0%(n=309).The primary etiology among all patients was hepatitis B virus(HBV)-related cirrhosis(71.9%[529/736]).The prevalence of MHE was significantly higher in patients with alcoholic cirrhosis(57.1%[40/70])than in those with HBV-related cirrhosis(40.6%[215/529],p=0.009)or hepatitis C virus(HCV)-related cirrhosis(38.2%[26/68],p=0.026).Age(odds ratio[OR],1.042;95%confidence interval[CI],1.024-1.059;p<0.001),duration of education(OR,0.935;95%CI,0.899-0.971;p=0.001),etiology(OR,1.740;95%CI,1.028-2.945;p=0.039),and high MELD-Na scores(OR,1.038;95%CI,1.009-1.067;p=0.009)were independent risk factors for MHE.When patients with cirrhosis of different etiologies were analyzed separately,the results showed that age(OR,1.035;95%CI,1.014-1.057;p=0.001)and duration of education(OR,0.924;95%CI,0.883-0.966;p=0.001)were risk factors for MHE among patients with HBV-related cirrhosis,whereas age(OR,1.138;95%CI,1.033-1.254;p=0.009)and creatinine concentration(OR,16.487;95%CI,1.113-244.160;p=0.042)were risk factors for MHE in patients with HCV-related cirrhosis.No risk factors for MHE were found in patients with autoimmune cirrhosis.For patients with alcoholic cirrhosis,the platelet count(OR,1.014;95%CI,1.000-1.027;p=0.045)was a risk factor for MHE.The PHES subtest results were inconsistent among patients who had MHE with cirrhosis of different etiologies.Patients with HBV-related cirrhosis performed better on Number Connection Test B and the serial dotting test than those with alcoholic cirrhosis(p=0.007 and p<0.001),better on Number Connection Test B than those with HCV-related cirrhosis(p=0.020),and better on the line tracing test than those with autoimmune cirrhosis(p=0.037).Conclusion:The etiology of cirrhosis affected the prevalence of MHE and risk factors for MHE.The domains of major cognitive impairment varied among patients with cirrhosis of different etiologies.Further studies are required to verify these findings.

Effect of hypoglycemic anti-deafness capsules in diabetic patients with deafness and toxicological assessment in rats

OBJECTIVE:Through experiment on animals and clinical trials to explore the safety and efficacy of hypoglycemic anti-deafness capsules on diabetic patients with deafness.METHODS:Total 296 patients with non-insulin dependent diabetes mellitus(NIDDM)were randomly divided into two groups.A treatment group of 164patients(208 ears)was treated with hypoglycemic anti-deafness capsules based onTCM syndrome differentiation.A control group of 132 patients(184ears)was treated with glibenclamide and conventional drug treatment for deafness.The following were observed:hearing,fasting plasma glucose(FPG),2 h postprandial plasma glucose(2hPG),24 h urine glucose(24hUG),improvement of main symptoms,platelet function,and changes in superoxidedismutase(SOD)and lipid peroxide(LPO)levels.In animal studies,Kunming mice,weighing 18-22 g were used.Half of the mice were males and half were females.Wistar rats,weighing 80-120 g were used.Half of the rats were males and half were females.Male Wistar rats,weighing 200-220 g,were also used.Their acute and chronic toxicity was studied.RESULTS:The hearing improvement was 56.7%in the treatment group and 26.6%in the control group.FPG,2hPG,and 24hUG were improved significantly(P<0.05,P<0.01,P<0.01,respectively)in the treatment group and 2hPG and 24hUG improved significantly in the control group(P<0.05,P<0.05).The improvement in 2hPG and 24hUG in the treatment group was significantly greater than that in the control group P<0.01).There was no significant difference in FPG between the two groups(P<0.05).Main symptoms in the treatment group were significantly more improved than those in the control group(P<0.05,P<0.01).In the treatment group,platelet adhesion and aggregation,SOD,and LPO were all significantly improved from before treatment(P<0.05,P<0.01).However,in the control group,except LOP(P<0.05),there were no significant differences from before treatment to after(P<0.05).In animal studies,no obvious acute or long-term toxicity was observed from capsule administration.CONCLUSION:Through experiment on animals and clinical trials,we can found that hypoglycemic anti-deafness capsules could decrease blood glucose and serum triglycerides of alloxan-induced diabetic rats.This herbal capsule is effective for safely treating diabetic patients with deafness.

Identification of a novel mutation in the SRD5A2 gene of one patient with 46,XY disorder of sex development

Dear Editor, 46,XY disorder of sex development （DSD） is characterized by a female phenotype in an individual with a normal 46,XY karyotype.1 The clinical phenotTpe of 46,XY DSD is characterized by bilateral undescended testes and a normal female appearance, including breasts, female external genitalia, and other secondary sex characteristics, but the absence of a uterus or ovaries.2 Development of the male external genitalia in the fetal period depends on the biosynthesis of testosterone （T）, the conversion ofT into dihydrotestosterone （DHT） by steroid 5α-reductase type 2 （SRD5A2）, and the response of functionally active androgen receptors in genital tissues） The disruption of any of these stages will block the differentiation of internal and external genitalia and cause 46,XY DSD.

Delivery room resuscitation and short-term outcomes of extremely preterm and extremely low birth weight infants: a multicenter survey in North China

Background:Delivery room resuscitation assists preterm infants,especially extremely preterm infants(EPI)and extremely low birth weight infants(ELBWI),in breathing support,while it potentially exerts a negative impact on the lungs and outcomes of preterm infants.This study aimed to assess delivery room resuscitation and discharge outcomes of EPI and ELBWI in China.Methods:The clinical data of EPI(gestational age[GA]<28 weeks)and ELBWI(birth weight[BW]<1000 g),admitted within 72 h of birth in 33 neonatal intensive care units from five provinces and cities in North China between 2017 and 2018,were analyzed.The primary outcomes were delivery room resuscitation and risk factors for delivery room intubation(DRI).The secondary outcomes were survival rates,incidence of bronchopulmonary dysplasia(BPD),and risk factors for BPD.Results:A cohort of 952 preterm infants were enrolled.The incidence of DRI,chest compressions,and administration of epinephrine was 55.9%(532/952),12.5%(119/952),and 7.0%(67/952),respectively.Multivariate analysis revealed that the risk factors for DRI were GA<28 weeks(odds ratio[OR],3.147;95%confidence interval[CI],2.082–4.755),BW<1000 g(OR,2.240;95%CI,1.606–3.125),and antepartum infection(OR,1.429;95%CI,1.044–1.956).The survival rate was 65.9%(627/952)and was dependent on GA.The rate of BPD was 29.3%(181/627).Multivariate analysis showed that the risk factors for BPD were male(OR,1.603;95% CI,1.061–2.424),DRI(OR,2.094;95% CI,1.328–3.303),respiratory distress syndrome exposed to≥2 doses of pulmonary surfactants(PS;OR,2.700;95%CI,1.679–4.343),and mechanical ventilation≥7 days(OR,4.358;95% CI,2.777–6.837).However,a larger BW(OR,0.998;95% CI,0.996–0.999),antenatal steroid(OR,0.577;95%CI,0.379–0.880),and PS use in the delivery room(OR,0.273;95%CI,0.160–0.467)were preventive factors for BPD(all P<0.05).Conclusion:Improving delivery room resuscitation and management of respiratory complications are imperative during early management of the health of EPI and ELBWI.

Tolerance and acceptance of hepatic venous pressure gradient measurement in cirrhosis(CHESS1904):An international multicenter study

Aim:To determine the tolerance and acceptance of hepatic venous pressure gradient(HVPG)measurements in patients with liver cirrhosis.Methods:This prospective international multicenter study included 271 patients with cirrhosis who were scheduled to undergo HVPG measurement between October 2019 and June 2020.Data related to the tolerance and acceptance of HVPG measurements were collected using descriptive questionnaires.Results:HVPG measurements were technically successful in all 271 patients,with 141(52.0%)undergoing HVPG measurement alone.The complication rate was 0.4%.Postoperative pain was significantly lower than preoperative expected pain(p<0.001)and intraoperative pain(p<0.001),and intraoperative pain was also significantly lower than preoperative expected pain(p=0.036).No,mild,moderate,severe,and intolerable discomfort scores were reported by 36.9%,44.6%,11.1%,6.3%,and 0.4%of these patients,respectively,during HVPG measurement and by 54.6%32.5%,11.4%,1.5%,and 0%,respectively,after HVPG measurement.Of these patients,39.5%had little understanding and 10%had no understanding of the value of HVPG measurement,with 35.1%and 4.1%regarding HVPG measurements as being of little or no help,respectively.Most patients reported that they would definitely(15.5%),probably(46.9%),or possibly(29.9%)choose to undergo additional HVPG measurements again,and 62.7%regarded the cost of the procedure as acceptable.Conclusion:HVPG measurement was safe and well‐tolerated in patients with cirrhosis,but patient education and communication are warranted to improve the acceptance of this procedure.