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Haijing Sui,1,&ast; Hong Shen,1,&ast; Chi Zhang,1 Minghui Wang,1 Zhen Zhen,1 Junbo Zhang2 1Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, People’s Republic of China; 2Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Junbo Zhang, Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People’s Republic of China, Email zhangjunbo354@163.com Zhen Zhen, Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, People’s Republic of China, Email zhen_ent@163.comObjective: This study aimed to explore whether saliva pepsin concentration (SPC) could be regarded as a risk factor for the occurrence and unfavorable control of asthma in children with allergic rhinitis.Methods: A prospective study was conducted on a group of 20 consecutive children newly diagnosed with allergic rhinitis and asthma (referred to as the asthma group). All these children underwent fractional exhaled nitric oxide (FeNO) measurement, lung function tests, and assessment of asthma control using the 7-item Childhood Asthma Control Test (C-ACT) score. Simultaneously, a control group consisting of 20 children with simple allergic rhinitis, matched for baseline characteristics, was included. SPC measurement was performed in the two groups.Results: The SPC value was significantly higher in the asthma group than that in the control group (165.0 ± 82.8 ng/mL vs 68.4 ± 34.5 ng/mL) (P < 0.001). In the asthma group, SPC was independently associated with FeNO, the ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC), and forced expiratory flow at 50% and 75% of FVC (FEF50 and FEF75) (all P < 0.05). The severity of nasal symptoms evaluated by the visual analogue scale (N-VAS) was independently associated with FEF75, the maximal mid-expiratory flow (MMEF), and C-ACT score (P < 0.05).Conclusion: Direct pepsin exposure and uncontrolled nasal symptoms may play crucial roles in the pathogenesis and progression of childhood allergic asthma. The SPC value can be considered as a risk factor for asthma in children with allergic rhinitis.Keywords: saliva pepsin concentration, asthma, allergic rhinitis, gastroesophageal reflux disease

Hao Fu,1 Ping Li,2 Qianchao Xing,3 Hui Jiang,1 Hangshuo Sui4 1Nutrition Department, Affiliated Hospital of Chengde Medical University, Chengde, Heibei, People’s Republic of China; 2Gastroenterology, Affiliated Hospital of Chengde Medical University, Chengde, Heibei People’s Republic of China; 3Radiology Department, Affiliated Hospital of Chengde Medical University, Chengde, Heibei, People’s Republic of China; 4Nutrition Department, Chengde Central Hospital, Chengde, Heibei, People’s Republic of ChinaCorrespondence: Hangshuo Sui, Nutrition Department, Chengde Central Hospital, No. 11, Guangren Street, Chengde, Heibei, 067000, People’s Republic of China, Tel +86 0314 2028780, Email xyjw05@cdmc.edu.cnObjective: The Global Leadership Initiative on Malnutrition (GLIM) has proposed criteria for the diagnosis of malnutrition, one of which is reduced muscle mass. Computed tomography (CT) assessment of psoas muscle area (PMA) has been used to estimate muscle mass in patients, including those with acute pancreatitis (AP). The present study aimed to define the cutoff value of PMA indicative of reduced muscle mass in patients with AP and to assess the impact of reduced muscle mass on the severity and early complications of AP.Methods: Clinical data of 269 patients with AP were analyzed retrospectively. The severity of AP was determined according to the revised Atlanta classification. PMA was evaluated by CT and used to calculate the psoas muscle index (PMI). Cutoff values for reduced muscle mass were calculated and validated. Logistic regression analysis was performed to assess the relationship between PMA and the severity of AP.Results: PMA was a better indicator of reduced muscle mass than PMI, with cutoff values of 11.50 cm2 for men and 8.22 cm2 for women. Rates of local complications, splenic vein thrombosis, and organ failure were significantly higher in AP patients with low than high PMA (all p < 0.05). PMA showed good ability to predict splenic vein thrombosis in women, with an area under the receiver operating characteristic curve of 0.848 (95% confidence interval 0.768– 0.909, sensitivity 100%, specificity 83.64%). Multivariate logistic regression revealed that PMA was an independent risk factor for moderately severe plus severe AP (odds ratio 5.639, p = 0.001) and severe AP (odds ratio 3.995, p = 0.038).Conclusion: PMA is a good predictor of the severity and complications of AP. The PMA cutoff value is a good indicator of reduced muscle mass.Keywords: acute pancreatitis, psoas muscles, sarcopenia, malnutrition, cutoff value

Background Idiopathic intracranial hypertension (IIH) is a neurometabolic condition severely impacting the quality of life of people living with IIH (PwIIH). Most PwIIH are overweight or live with obesity, and weight loss is recommended by healthcare professionals (HCPs) as it is central to disease management. There is currently no research evaluating patient–clinician interactions when discussing weight management in IIH. The aim of this study was to evaluate the patient experience of communication with HCPs regarding weight management from the perspective of PwIIH.Methods A cross-sectional online survey was developed and distributed by the IIH UK charity via their mailing list and social media network. Eligible participants were adults with IIH who have been recommended to lose weight by their HCP. Descriptive statistics were used to summarise quantitative responses and content analysis was used to inductively draw out themes from open-ended free-text responses.Results There were 625 respondents. One-fifth of PwIIH (n=127/603, 21%) felt that HCPs were supportive and empathetic about weight management. Five themes were identified on how experiences regarding weight management for IIH can be improved, with PwIIH recommending for HCPs to: (1) detail the relationship between IIH and weight, (2) individualise care, (3) give advice, (4) provide support and (5) adapt communication.Conclusion The majority of PwIIH recalled a poor experience and negative emotions when engaged in discussions regarding weight management with their HCPs. Further research should explore the HCPs perspective and evaluate interventions aiming to improve the quality of patient–HCPs communication in IIH.

He Sui,1,&ast; Yu Gong,2,&ast; Lin Liu,1 Zhongwen Lv,1 Yunfei Zhang,3 Yongming Dai,3 Zhanhao Mo1 1Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, People’s Republic of China; 2Medical Imaging Department, Linyi People’s Hospital, Linyi, People’s Republic of China; 3MR Collaboration, Central Research Institute, United Imaging Healthcare, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhanhao Mo, Department of Radiology, China-Japan Union Hospital of Jilin University, No. 126 Xiantai St., Erdao Dist., Changchun, People’s Republic of China, Email mozhanhao@jlu.edu.cnPurpose: To evaluate and compare the image quality and diagnostic accuracy of Artificial Intelligence-assisted Compressed Sensing (ACS) sequences for lumbar disease, as an acceleration method for MRI combining parallel imaging, half-Fourier, compressed sensing and neural network and routine 2D sequences for lumbar spine.Methods: We collected data from 82 healthy subjects and 213 patients who used 2D ACS accelerated sequences to examine the lumbar spine while 95 healthy subjects and 234 patients used routine 2D sequences. Acquisitions included axial T2WI, sagittal T2WI, T1WI, and T2-fs sequences. All obtained images of these subjects were analyzed in the light of calculating image quality factors such as signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) for selected regions of interest. The lumbar image quality, artifacts and visibility of lesion structure were assessed by two radiologists independently. Differences between the evaluation values above were tested for statistical significance by the Wilcoxon signed-ranks test. Inter-observer agreements of image quality between two radiologists were measured using Cohen’s kappa correlation coefficient.Results: The ACS accelerated sequences not only reduced the scanning time by 18.9%, but also retained basically the same image quality as the routine 2D sequences in both healthy subjects and patients. Artifacts are less produced on ACS accelerated sequences compared with routine 2D sequences (p < 0.05). Apart from this, there were no significant differences in quantitative SNR, CNR measurements and qualitative scores within reviewing radiologists for each group (p > 0.05). Moreover, inter-observer agreement between two radiologists in scoring image quality was substantial consistently for ACS accelerated sequences and routine sequences (kappa = 0.622– 0.986).Conclusion: Compared with routine 2D sequences, ACS accelerated sequences allow for faster lumbar spine imaging with similar imaging quality and present reliable diagnostic accuracy, which can potentially improve workflow and patient comfort in musculoskeletal examinations.Keywords: accelerated MRI, lumbar imaging, AI-assisted compressed sensing

Cui Shao,1,&ast; Mengxue Sun,2,&ast; Wanwen Liu,2 Shaoyang Zhao,1 Yang Liu,2 Yuna Chen,1 Shu-Nung Liang,2 Haoyu Yuan,2 Huacheng Sui,2 Baohua Wang,1 Saimei Li1 1Department of Endocrinology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China; 2First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Baohua Wang; Saimei Li, Department of Endocrinology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China, Tel +8613580515855 ; +8615818159018, Fax +86 20-36588726, Email wangbaohua@gzucm.edu.cn; lsm@gzucm.edu.cnPurpose: We aimed to assess the efficacy of the Jiang Tang San Huang (JTSH) tablet for the treatment of patients with type 2 diabetes mellitus (T2DM).Methods: All data for this retrospective cohort study were acquired from the outpatient clinic database of our institution, and all enrolled patients received JTSH tablet for at least two months. Overall, 147 patients were included in the analysis. The primary outcome was patient-reported outcomes on the efficacy of the JTSH tablets using a questionnaire survey. Correlation analysis evaluated the duration of JTSH tablet administration and glycemic control in patients with T2DM. The secondary outcome measures included: changes in glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), 2-hour postprandial blood glucose, homeostasis model assessment of insulin resistance index (HOMA-IR) and homeostasis model assessment of β-cell function (HOMA-β) after 2 months of treatment with JTSH tablets.Results: Overall,120 patients (81.63%) reported a JTSH tablet treatment satisfaction score of ≥ 60 points, and believed that JTSH tablets had satisfactory hypoglycemic effects and could improve symptoms. The average duration of JTSH tablet treatment was 2.57± 1.45 years. Overall, 111 patients achieved good blood glucose control, while 36 patients had poor glycemic control. Multivariate logistic regression model analysis showed that taking JTSH tablets for 1 year might reduce the risk of poor hypoglycemic effect by 17.00% (Risk ratio=0.830, 95% confidence interval:0.578, 1.021, P=0.066). Compared with the baseline data, the levels of HbA1c, FPG and HOMA-IR decreased significantly and HOMA-β levels increased significantly (P< 0.05).Conclusion: Good blood glucose control may be positively correlated with the duration of JTSH tablets administration. Patients with T2DM were satisfied with the anti-diabetic effects of JTSH tablets, which can significantly reduce blood glucose and insulin resistance, and improve the function of islet cells.Keywords: type 2 diabetes mellitus, Jiang Tang San Huang tablet, patient-reported outcomes, blood glucose control, multiple logistic regression

He Sui,1,&ast; Jin Li,2,3,&ast; Lin Liu,1 Zhongwen Lv,1 Yunfei Zhang,4 Yongming Dai,4 Zhanhao Mo1 1China-Japan Union Hospital of Jilin University, Changchun, People’s Republic of China; 2Jilin Province People’s Hospital, Changchun, People’s Republic of China; 3The Department of Trauma Surgery, Shanghai Oriental Hospital, Shanghai, People’s Republic of China; 4Central Research Institute, United Imaging Healthcare, Shanghai, 201800, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhanhao Mo, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Erdao District, Changchun, People’s Republic of China, Email mozhanhao@jlu.edu.cnPurpose: The three-dimensional (3D) sequence of magnetic resonance imaging (MRI) plays a critical role in the imaging of musculoskeletal joints; however, its long acquisition time limits its clinical application. In such conditions, compressed sensing (CS) is introduced to accelerate MRI in clinical practice. We aimed to investigate the feasibility of an isotropic 3D variable-flip-angle fast spin echo (FSE) sequence with CS technique (CS-MATRIX) compared to conventional 2D sequences in knee imaging.Methods: Images from different sequences of both the accelerated CS-MATRIX and the corresponding conventional acquisitions were prospectively analyzed and compared. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the structures within the knees were measured for quantitative analysis. The subjective image quality and diagnostic agreement were compared between CS-MATRIX and conventional 2D sequences. Quantitative and subjective image quality scores were statistically analyzed with the paired t-test and Wilcoxon signed-rank test, respectively. Diagnostic agreements of knee substructure were assessed using Cohen’s weighted kappa statistic.Results: For quantitative analysis, images from the CS-MATRIX sequence showed a significantly higher SNR than T2-fs 2D sequences for visualizing cartilage, menisci, and ligaments, as well as a higher SNR than proton density (pd) 2D sequences for visualizing menisci and ligaments. There was no significant difference between CS-MATRIX and 2D T2-fs sequences in subjective image quality assessment. The diagnostic agreement was rated as moderate to very good between CS-MATRIX and 2D sequences.Conclusion: This study demonstrates the feasibility and clinical potential of the CS-MATRIX sequence technique for detecting knee lesions The CS-MATRIX sequence allows for faster knee imaging than conventional 2D sequences, yielding similar image quality to 2D sequences.Keywords: knee MRI, compressed sensing, 3D variable-flip-angle fast spin echo

Objective We aim to systematically assess the clinical characteristics of ocular myasthenia gravis (OMG) and report on the proportion of patients who develop secondary generalised myasthenia gravis (SGMG).Introduction OMG is an autoimmune neuromuscular junction disorder resulting in ptosis and diplopia. A proportion of patients with OMG develop weakness in their limbs, respiratory or bulbar muscles, that is, convert to SGMG. The proportion of patients converting to SGMG reported in the literature have been varied. We therefore aim to systematically assess the clinical characteristics of OMG and outcomes of SGMG reported in the literature to date.Inclusion criteria Studies describing a population of adults with OMG, that is, MG with ocular symptoms and signs only, seen consecutively through a clinical service, reporting on patient characteristics and the outcome of SGMG. Studies on paediatric and congenital myasthenia gravis will be excluded.Methods We will conduct an electronic database search for randomised controlled trials, prospective non-randomised studies, observational studies and retrospective studies in MEDLINE, Embase, Cochrane Central Register of Controlled Trials and Web of Science. Exploratory database search was conducted on 1 December 2021. Eligibility criteria will include quantitative and qualitative articles written in any language and containing data on OMG. Additional studies will be identified by reviewing bibliographies of retrieved articles. Two independent reviewers will screen titles and abstracts and extract data from full texts, reporting outcomes according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data extraction of key characteristics will be completed using customised forms. Methodological quality will be assessed using the Joanna Briggs Institute critical appraisal forms.Ethics and dissemination Ethical approval is not required for this review, as it will only include published data. Findings will be published in a peer-reviewed journal and disseminated across ophthalmic networks.PROSPERO registration number CRD42021285257.

Human movement into insect vector and wildlife reservoir habitats determines zoonotic disease risks; however, few data are available to quantify the impact of land use on pathogen transmission. Here, we utilise GPS tracking devices and novel applications of ecological methods to develop fine-scale models of human space use relative to land cover to assess exposure to the zoonotic malaria Plasmodium knowlesi in Malaysian Borneo. Combining data with spatially explicit models of mosquito biting rates, we demonstrate the role of individual heterogeneities in local space use in disease exposure. At a community level, our data indicate that areas close to both secondary forest and houses have the highest probability of human P. knowlesi exposure, providing quantitative evidence for the importance of ecotones. Despite higher biting rates in forests, incorporating human movement and space use into exposure estimates illustrates the importance of intensified interactions between pathogens, insect vectors and people around habitat edges.

The photopic negative response (PhNR) is a negative component of the photopic flash electroretinogram that follows the b-wave and is thought to arise from the retinal ganglion cells. Reduction in its amplitude in idiopathic intracranial hypertension (IIH) has been previously documented using formal electroretinography. This study explored the use of a handheld device (RETeval, LKC technologies, Gaithersburg, MD, USA) in 72 IIH patients of varying stages and severity (and seven controls) and investigated associations between PhNR parameters and disease severity. PhNR amplitudes at 72 ms (P72) and p-ratio (ratio to b-wave peak value) differed significantly across groups, with a trend towards smaller amplitudes in those with severe IIH, defined as papilloedema with Modified Frisén Scale (MFS) ≥ 3, retinal nerve fibre layer (RNFL) ≥ 150 μm or atrophic papilloedema (p = 0.0048 and p = 0.018 for P72 and p-ratio, respectively). PhNR parameters did not correlate with MFS, RNFL thickness, standard automated perimetry mean deviation or macular ganglion cell layer volume. This study suggests that PhNR measurement using a handheld device is feasible and could potentially augment the assessment of disease severity in IIH. The clinical utility of PhNR monitoring in IIH patients requires further investigation.

Hongying Sui, Caixia Shi, Zhipeng Yan, Hucheng LiDepartment of Gynecological Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha City, People’s Republic of ChinaBackground: Ovarian cancer is the leading cause of death in women with gynecological malignancy worldwide. Despite multiple new approaches to treatment, relapse remains almost inevitable in patients with advanced disease. The poor outcome of advanced ovarian cancer treated with conventional therapy stimulated the search for new strategies to improve therapeutic efficacy. Although epidermal growth factor receptor (EGFR) and poly(ADP-ribose) polymerase (PARP) inhibitors have known activity in advanced ovarian cancer, the effect of combined therapy against EGFR and PARP in this population has not been reported. In the current study, we investigated the mechanisms of erlotinib used alone or in combination with olaparib (AZD2281), a potent inhibitor of PARP, in an EGFR-overexpressing ovarian tumor xenograft model.Methods: A2780 (EGFR-overexpressing, BRCA1/2 wild-type) cells were subcutaneously injected into nude mice, which were then randomly assigned to treatment with vehicle, erlotinib, AZD2281, or erlotinib + AZD2281, for up to 3 weeks. All mice were then sacrificed and tumor tissues were subjected to Western blot analysis and monodansylcadervarine staining (for analysis of autophagy).Results: Erlotinib could slightly inhibit growth of A2780 tumor xenografts, and AZD2281 alone had similar effects on tumor growth. However, the combination treatment had a markedly enhanced antitumor effect. Western blot analysis revealed that treatment with erlotinib could significantly reduce the phosphorylation level of ERK1/2 and AKT in A2780 tumor tissue. Of interest, monodansylcadervarine staining showed that the autophagic effects were substantially enhanced when the agents were combined, which may be due to downregulation of apoptosis.Conclusion: These results suggest that combination of a selective EGFR inhibitor and a PARP inhibitor is effective in ovarian cancer A2780 xenografts, and depends on enhanced autophagy.Keywords: erlotinib, poly(ADP-ribose) polymerase, PARP, olaparib, tyrosine kinase inhibitor, ovarian cancer, autophagy, apoptosis

Supplemental Digital Content is Available in the Text. Background: Visual snow syndrome (VSS) is associated with functional connectivity (FC) dysregulation of visual networks (VNs). We hypothesized that mindfulness-based cognitive therapy, customized for visual symptoms (MBCT-vision), can treat VSS and modulate dysfunctional VNs. Methods: An open-label feasibility study for an 8-week MBCT-vision treatment program was conducted. Primary (symptom severity; impact on daily life) and secondary (WHO-5; CORE-10) outcomes at Week 9 and Week 20 were compared with baseline. Secondary MRI outcomes in a subcohort compared resting-state functional and diffusion MRI between baseline and Week 20. Results: Twenty-one participants (14 male participants, median 30 years, range 22–56 years) recruited from January 2020 to October 2021. Two (9.5%) dropped out. Self-rated symptom severity (0–10) improved: baseline (median [interquartile range (IQR)] 7 [6–8]) vs Week 9 (5.5 [3–7], P = 0.015) and Week 20 (4 [3–6], P < 0.001), respectively. Self-rated impact of symptoms on daily life (0–10) improved: baseline (6 [5–8]) vs Week 9 (4 [2–5], P = 0.003) and Week 20 (2 [1–3], P < 0.001), respectively. WHO-5 Wellbeing (0–100) improved: baseline (median [IQR] 52 [36–56]) vs Week 9 (median 64 [47–80], P = 0.001) and Week 20 (68 [48–76], P < 0.001), respectively. CORE-10 Distress (0–40) improved: baseline (15 [12–20]) vs Week 9 (12.5 [11–16.5], P = 0.003) and Week 20 (11 [10–14], P = 0.003), respectively. Within-subject fMRI analysis found reductions between baseline and Week 20, within VN-related FC in the i) left lateral occipital cortex (size = 82 mL, familywise error [FWE]-corrected P value = 0.006) and ii) left cerebellar lobules VIIb/VIII (size = 65 mL, FWE-corrected P value = 0.02), and increases within VN-related FC in the precuneus/posterior cingulate cortex (size = 69 mL, cluster-level FWE-corrected P value = 0.02). Conclusions: MBCT-vision was a feasible treatment for VSS, improved symptoms and modulated FC of VNs. This study also showed proof-of-concept for intensive mindfulness interventions in the treatment of neurological conditions. [ABSTRACT FROM AUTHOR]