Herb-Drug Pharmacokinetic Interaction of a Traditional Chinese Medicine Jia-Wei-Xiao-Yao-San with 5-Fluorouracil in the Blood and Brain of Rat Using Microdialysis

According to a survey from the National Health Insurance Research Database (NHIRD), Jia-Wei-Xiao-Yao-San (JWXYS) is the most popular Chinese medicine for cancer patients in Taiwan. 5-Fluorouracil (5-FU) is a general anticancer drug for the chemotherapy. To investigate the herb-drug interaction of JWXYS on pharmacokinetics of 5-FU, a microdialysis technique coupled with a high-performance liquid chromatography system was used to monitor 5-FU in rat blood and brain. Rats were divided into four parallel groups, one of which was treated with 5-FU (100 mg/kg, i.v.) alone and the remaining three groups were pretreated with a different dose of JWXYS (600, 1200, or 2400 mg/kg/day for 5 consecutive days) followed by a combination with 5-FU. This study demonstrates that 5-FU with JWXYS (600 mg/kg/day or 1200 mg/kg/day) has no significant effect on the pharmacokinetics of 5-FU in the blood and brain. However, JWXYS (2400 mg/kg/day) coadministered with 5-FU extends the elimination half-life and increases the volume of distribution of 5-FU in the blood. The elimination half-life of 5-FU in the brain for the pretreatment group with 2400 mg/kg/day of JWXYS is significantly longer than that for the group treated with 5-FU alone and also reduces the clearance. This study provides practical dosage information for clinical practice and proves the safety of 5-FU coadministered with JWXYS

Test-time Defense against Adversarial Attacks: Detection and Reconstruction of Adversarial Examples via Masked Autoencoder

Existing defense methods against adversarial attacks can be categorized into training time and test time defenses. Training time defense, i.e., adversarial training, requires a significant amount of extra time for training and is often not able to be generalized to unseen attacks. On the other hand, test time defense by test time weight adaptation requires access to perform gradient descent on (part of) the model weights, which could be infeasible for models with frozen weights. To address these challenges, we propose DRAM, a novel defense method to Detect and Reconstruct multiple types of Adversarial attacks via Masked autoencoder (MAE). We demonstrate how to use MAE losses to build a KS-test to detect adversarial attacks. Moreover, the MAE losses can be used to repair adversarial samples from unseen attack types. In this sense, DRAM neither requires model weight updates in test time nor augments the training set with more adversarial samples. Evaluating DRAM on the large-scale ImageNet data, we achieve the best detection rate of 82% on average on eight types of adversarial attacks compared with other detection baselines. For reconstruction, DRAM improves the robust accuracy by 6% ~ 41% for Standard ResNet50 and 3% ~ 8% for Robust ResNet50 compared with other self-supervision tasks, such as rotation prediction and contrastive learning

The role of echocardiographic study in patients with chronic kidney disease

Despite the recent enormous advances in medicine, high mortality and morbidity rates among the chronic kidney disease (CKD) patients remain an important but unresolved issue. Cardiovascular disease is a major cause of mortality and morbidity in patients with CKD. Abnormal left ventricular geometry and functions are common in this patient group and have been proven to be correlated with a high cardiovascular mortality/morbidity and all-cause mortality. For this reason, echocardiographic study plays an important role in evaluating cardiac structure and functions as well as in stratifying prognostic risk. We here summarize the reported findings on the usefulness of echocardiographic methodologies and identify their roles in diagnostic and prognostic clinical approaches

Survival Prediction of Initial Blood pH for Nontraumatic Out-of-hospital Cardiac Arrest Patients in the Emergency Department

SummaryBackgroundMost nontraumatic out-of-hospital cardiac arrest (NTOHCA) patients who fail in prehospital resuscitation receive continued cardiopulmonary resuscitation in the emergency department (ED). Initial blood pH, which can be assessed rapidly in the ED, was examined to see whether it is a strong survival predictor for these patients.MethodsA 1-year retrospective study included consecutive 225 NTOHCA patients at a medical center in northern Taiwan who presented through the emergency medical services system. On arrival at the ED, these patients received continued cardiopulmonary resuscitation, and their initial blood pH data were assessed.ResultsThe pH value was positively correlated with variables such as return of spontaneous circulation, witnessed arrest, short prehospital time (≤20 minutes), and survival. The best cut-off value of initial blood pH, revealed by the receiver operating characteristic curve, was 7.068. The lowest pH value of the survivors was 6.856. The results of logistic regression model analysis shows that the odds ratios of survival was 10.0 (95% confidence interval [CI], 2.1–47.7) for patients with initial blood pH ≥ 7.068, 5.3 (95% CI, 1.48–18.9) for those with nonasystole rhythm, 4.0 (95% CI, 1.1–14.8) for those with prehospital time ≤20 minutes, and 9.1 (95% CI, 2.3–35.2) for those without NaHCO3 administration during resuscitation, respectively.ConclusionA cut-off value of an initial blood pH of 7.068 can serve as a predictor for survival among NTOHCA patients. In addition, patients whose initial blood pH is lower than 6.85 in the ED may not survive until hospital discharge

Effects of ranibizumab on human corneal endothelial cells

AbstractPurposeThis study aims to evaluate corneal endothelial changes occurring over a 3-month period after intravitreal injections of ranibizumab in patients with wet age-related macular degeneration.MethodsThis is a prospective case series. A total of 29 patients (29 eyes) received a 0.5-mg intravitreal injection of ranibizumab. Specular microscopy, including measurement of central corneal thickness and endothelial cell count, was performed on each patient prior to and after completing three intravitreal injections.ResultsAll patients received three intravitreal injections and were followed up for a mean of 3 months. There was no significant change in corneal thickness (p = 0.32) or endothelial cell density (p = 0.38) after ranibizumab injections.ConclusionIntravitreal ranibizumab injections (0.5 mg) have no harmful effects on corneal endothelial cells

Changes in corneal curvature after wearing the orthokeratology lens

AbstractIntroductionThe orthokeratology lens (OK lens) is designed to reshape the cornea and correct refraction error. Owing to the convenience of ceasing the use of glasses during the day, the use of the OK lens is increasing in myopic children. In this study, changes in corneal curvature and astigmatism after wearing the OK lens were analyzed.MethodsThis retrospective cohort study included 65 children (130 eyes) who underwent full and regular examinations. None of the participants had any ocular disease other than myopia and astigmatism. The OK lenses used in this study were four-zone, reverse-geometry lenses. The corneal curvature of each patient was checked annually after the patients discontinued daily wearing of the OK lens for 10 days. Student t test and repeated measures analysis of variance (ANOVA) analyses were performed to compare the results.ResultsThe radius of corneal curvature showed a progressive annual increase with significant differences, both in the steepest and flattest radius of the corneal curvature (p < 0.001 and p = 0.001, respectively). The mean radius of the steepest and flattest corneal curvature increased significantly from baseline to the following years consecutively (all p < 0.001). Nevertheless, astigmatism did not change significantly in any of the tests.ConclusionCorneal curvature changed as the patients grew older. There was a statistically significant increase in the radius of the corneal curvature in the myopic children studied. For correct fit of OK lenses, the radius of the corneal curvature should be regularly checked prior to dispensing a new set of lenses

Training Effects of Virtual Reality on Reaching Behaviors in Children with Cerebral Palsy: Case Report

Virtual reality (VR) is a computer technology that artificially generates sensory information in a form that people perceive as real-world objects and events. It has been proposed that VR can improve upper-extremity function in children with cerebral palsy (CP) by decreasing physical disabilities, precisely adjusting the difficulty of task and feedback, enhancing motivation and manipulating perceptual information. The purpose of this study was to investigate the training effects of VR on reaching behavior in a child with CP. This case was a 6-year-old boy with spastic quadriplegic CP who had good cooperation and normal cognition. A single-subject A-B-A design was used. The case received 3 baseline, 4 intervention, and 2 follow-up measures. He received a 4-week (3 times a week) individualized VR training using VR-hand function training system and Eyetoy-play system with therapist\u27s manual guidance. The outcome measures included (1) four reaching kinematic parameters (movement time (MT), path, peak velocity (PV), and number of movement units (MU)) in 2 activities (pegboard and mail-delivery) at 3 directions (abduction, adduction, and forward); (2) touching a swing ball; and (3) the fine motor domain of Peabody Development Motor Scale-2nd edition (PDMS2). Visual inspection and 2-standard deviation band method were used to compare the outcome measures between the two adjacent phases. Improvements were found in the kinematic parameters in all directions from baseline to intervention, and the effects were maintained in some directions from intervention to follow-up. Improvement was also shown in the ability to touch a swing ball, but the effect was not maintained from intervention to follow-up. Furthermore, there was an increase (11 points) in the PDMS2 scores from baseline to intervention and an increase (1 point) from intervention to follow-up. This case study demonstrated the potential effect of VR training program to improve the upper-extremity function in children with CP. The training effects might retain for 1 month post intervention

Effects of and satisfaction with short message service reminders for patient medication adherence: a randomized controlled study

BACKGROUND: Medication adherence is critical for patient treatment. This study involved evaluating how implementing Short Message Service (SMS) reminders affected patient medication adherence and related factors. METHODS: We used a structured questionnaire to survey outpatients at three medical centers. Patients aged 20 years and older who were prescribed more than 7 days of a prescription medication were randomized into SMS intervention or control groups. The intervention group received daily messages reminding them of aspects regarding taking their medication; the control group received no messages. A phone follow-up was performed to assess outcomes after 8 days. Data were collected from 763 participants in the intervention group and 435 participants in the control group. RESULTS: After participants in the intervention group received SMS reminders to take medication or those in the control group received no messages, incidences of delayed doses were decreased by 46.4 and 78.8% for those in the control and intervention groups, respectively. The rate of missed doses was decreased by 90.1% for participants in the intervention group and 61.1% for those in the control group. We applied logistic regression analysis and determined that participants in the intervention group had a 3.2-fold higher probability of having a decrease in delayed doses compared with participants in the control group. Participants in the intervention group also showed a 2.2-fold higher probability of having a decrease in missed doses compared with participants in the control group. CONCLUSIONS: Use of SMS significantly affected the rates of taking medicine on schedule. Therefore, daily SMS could be useful for reminding patients to take their medicine on schedule