Long-term functional outcomes of hearing and speech rehabilitation efficacy among paediatric cochlear implant recipients in Shandong, China.

PURPOSE: To evaluate the auditory performance and speech intelligibility of 100 children with bilateral profound sensorineural hearing loss up to 3 years after cochlear implantation. METHODS: A cohort study was established consisting of 100 children who received cochlear implantation at Shandong Ear Nose and Throat Hospital from 2012 to 2015. Children were examined after 1 month, 1, 2, and 3 years of implantation to assess auditory performance and speech intelligibility using standard tools. The paired Wilcoxon signed-rank test was used to assess whether the scores obtained at different testing points differed significantly. The Mann-Whitney test was utilized to examine the between-group differences (e.g., age at implantation). RESULTS: Three years after implantation, 60% out of 100 children reached the maximal category (7) of categorical auditory performance and 37% achieved the highest category (5) of speech intelligibility rating. Significant improvements were found over time in categorical auditory performance category and speech intelligibility rating (from month 1 to year 1, p < 0.001; from year 1 to year 2, p < 0.001; and from year 2 to year 3, p < 0.001). Larger improvements in auditory outcomes and speech intelligibility were observed in children with a younger age at implantation and those who received speech therapy. CONCLUSIONS: Cochlear implantation appears to make a significant, positive contribution to the development of communication skills of young congenital and prelingually deaf children in China. These improvements continue for up to 3 years after implantation. Positive outcomes appear to be associated with earlier age at implantation and receipt of speech therapy.Implications for rehabilitationBilateral sensorineural hearing loss.Bilateral sensorineural hearing loss in children can cause delay in speech development, poor language skills and potentially disorders in psychological behaviour and social isolation.Cochlear implantation (CI) is an effective strategy that helps children with bilateral sensorineural hearing loss gain the ability to hear and continue to develop language.This study shows that the auditory performance and speech intelligibility of deaf children who speak Mandarin continued to improve up to 3 years of implantation, when follow-up ceased.

Etiology of Childhood Bilateral Sensorineural Hearing Loss in Shandong Province, China.

Objectives The purpose of this study is to ascertain the etiology of bilateral sensorineural hearing loss (SNHL) in children aged ≤ 18 years living in Shandong province. Method Data were taken from a cross-sectional study, which was conducted between 2015 and 2017. The study included children aged ≤ 18 years, recruited from special schools for children with hearing loss and from hearing rehabilitation centers in Shandong province of China. Children were screened for bilateral SNHL through audiological testing. Clinical examination, genetic testing, and structured interviews were conducted for those children who were identified as having hearing loss to identify the potential cause. Results The etiology of bilateral SNHL in our sample was genetic in 874 (39.3%), acquired in 650 (29.3%), and unknown in 697 (31.4%) children. Among children with acquired SNHL, the cause was maternal viral infection in 75 (11.5%); perinatal factors in 238 (36.6%); meningitis, measles, and mumps in 146 (22.5%); and ototoxic exposure in 117 (18%) children. Among the children with genetic SNHL, only 44 (4.9%) were identified as having syndromic hearing loss, and the remainder (95.1%) were classified as nonsyndromic hearing loss. Conclusion The findings indicated that nearly 30% of bilateral SNHL in Shandong province could be preventable through immunization, early prenatal diagnosis, proper treatment of infections, and avoidance of prescription of ototoxic drugs. This finding emphasizes the need for programs aimed at improving the health services at primary and secondary levels of health care, which will in turn prevent childhood hearing loss.

Warfarin maintenance dose Prediction for Patients undergoing heart valve replacement- a hybrid model with genetic algorithm and Back-Propagation neural network.

Warfarin is the most recommended anticoagulant drug for patients undergoing heart valve replacement. However, due to the narrow therapeutic window and individual dose, the use of warfarin needs more advanced technology. We used the data collected from a multi-central registered clinical system all over China about the patients who have undergone heart valve replacement, subsequently divided into three groups (training group: 10673 cases; internal validation group: 3558 cases; external validation group: 1463 cases) in order to construct a hybrid model with genetic algorithm and Back-Propagation neural network (BP-GA), For testing the model's prediction accuracy, we used Mean absolute error (MAE), Root mean squared error (RMSE) and the ideal predicted percentage of total and dose subgroups. In results, whether in internal or in external validation group, the total ideal predicted percentage was over 58% while the intermediate dose subgroup manifested the best. Moreover, it showed higher prediction accuracy, lower MAE value and lower RMSE value in the external validation group than that in the internal validation group (p < 0.05). In conclusion, BP-GA model is promising to predict warfarin maintenance dose.

Shengmai (a traditional Chinese herbal medicine) for heart failure.

BACKGROUND: Heart failure is a major public health problem worldwide. Shengmai, a traditional Chinese herbal medicine, has long been used as a complementary treatment for heart failure in China. This is an update of a Cochrane Review published in 2012. OBJECTIVES: To determine the effect (both benefits and harms) of Shengmai in treatment of people with heart failure. SEARCH METHODS: We searched CENTRAL on The Cochrane Library (Issue 5 of 12, April 2013); DARE on The Cochrane Library (Issue 2 of 4, April 2013); MEDLINE (1948 to June Week 1 2013); EMBASE (1980 to 2013 Week 23); AMED (1985 to August 2008); BIOSIS (1969 to 7 June 2013); CBM (1978 to June 2013); VIP (1989 to June 2013); and CNKI (1979 to June 2013). We also handsearched Chinese journals and did not apply any language restrictions. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of Shengmai plus usual treatment for heart failure versus usual treatment alone, or Shengmai versus placebo, irrespective of blinding status. In this update we only included studies with a clear description of randomisation methods and classified as true RCTs. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials, assessed methodological quality and extracted data. We calculated dichotomous data as risk ratios (RRs) and continuous data as mean differences (MDs) or standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs). We used a fixed-effect model to perform meta-analysis for outcomes without heterogeneity; and a random-effects model to perform meta-analysis for outcomes with heterogeneity. MAIN RESULTS: We included a total of 14 RCTs (858 patients) in this review update, four of which were new trials. Of these 14 RCTs, 11 trials compared Shengmai plus usual treatment with usual treatment alone, and three trials compared Shengmai with placebo. Improvement of NYHA functional classification was more common in patients taking Shengmai plus usual treatment than in those receiving usual treatment alone (RR 0.37; 95% CI 0.26 to 0.51; 10 trials, 672 participants; low quality evidence). Beneficial effects of Shengmai in treating heart failure were also observed in other outcomes, including exercise test, ejection fraction and cardiac output. The three RCTs (106 patients) comparing Shengmai with placebo reported improvement in NYHA functional classification and in stroke volume. Three of the 14 RCTs reported a total of six patients with mild adverse effects and two were withdrawn due to the adverse effects. The adverse events rate was 1.21%. AUTHORS' CONCLUSIONS: Shengmai may exert a positive effect on heart failure, especially for improving NYHA functional classification when Shengmai plus usual treatment is used. The review results should be interpreted with caution due to the high risk of bias of the included studies (particularly regarding allocation concealment and blinding), the small sample size of these studies, and the significant heterogeneity in outcomes such as ejection function, cardiac output and stroke volume. There was no evidence available concerning the effect of Shengmai on mortality, and more high quality studies with long-term follow-up are warranted.