This narrative review focuses on the epidemiologic, clinical, and molecular aspects of Meniere disease, comparing studies from European and East Asian populations. Meniere disease is a complex, heterogeneous, chronic disorder of the human inner ear characterized by recurrent episodes of spontaneous vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural fullness.The overall prevalence of Meniere disease is generally between 0.05% and 0.2% among adults worldwide. In Europe and North America, the reported point prevalence is generally higher than in East Asia, at ∼50-200 per 100,000 adults, with a female-to-male ratio of around 1.5-2:1. This contrasts with a slightly higher Meniere disease female-to-male ratio in East Asian populations, based on Korean data (∼2.17:1). Epidemiological data and genetic studies from China and other East Asian countries remain limited, with a reportedly lower incidence of Meniere disease in Japan (∼17 per 100,000/year based on national hospital surveys). In terms of clinical aspects of Meniere disease, the core symptom spectrum does not differ substantially between European and East Asian patients. Interestingly, comorbidity patterns appear to differ, whereby European studies in Meniere disease report an association with migraine and autoimmunity, whereas in East Asian data, this association is less frequently observed. Conversely, allergies and systemic inflammatory responses mediated by Th2 or autoinflammation have been reported in both European and East Asian studies. Familial Meniere disease is more commonly observed in European than East Asian populations, suggesting that the genetic structure may contribute to its susceptibility. We summarize the commonalities and differences with respect to the clinical manifestations and treatment of Meniere disease. We propose that multinational research on the molecular diagnosis and treatment of Meniere disease will facilitate a better understanding of the condition and provide impetus for future research.

Lateral medullary syndrome is a collection of different neurological symptoms after ischemic/hemorrhagic insult to either the posterior inferior cerebellar artery/vertebral artery or rarely the anterior inferior cerebellar artery, causing infarction of ipsilateral cerebellum and posterolateral medulla (Tiedt and Weidauer, 2013). Dizziness, nausea, vertigo, vomiting, nystagmus, ataxia, dysphagia, hoarseness of voice, ptosis, and sensory impairment of face and body are typical. Here we report an unusual presentation of a 47-year-old female who was hypertensive and diabetic and who complained of vertigo, nausea, vomiting, slurring of speech, facial deviation toward the left, and loss of pain and temperature over the right side of the face and body without any difficulty in swallowing or nasal regurgitation. The patient was eventually diagnosed with left lateral medullary syndrome, drawing attention to the rare and unusual presentation of the same.

Using multiple statistical methods, this study investigated the core diagnostic information from the four diagnostic methods, the distribution patterns of syndrome elements, and their relationship with laboratory biochemical indicators in diabetic peripheral neuropathy(DPN). The aim is to deepen the understanding of the disease-symptom-syndrome relationship in DPN. A retrospective study was conducted on 1 420 inpatients diagnosed with DPN patients at the Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, from June 2014 and June 2023. Data mining techniques, including frequency statistics, association rule analysis, factor analysis, cluster analysis, and Bayesian network analysis, were applied to examine general patient information, TCM diagnostic data from the four diagnostic methods, and laboratory biochemical indicators. The core clinical manifestations in DPN patients were dry mouth, limb numbness, blurred vision, fatigue, thirst, and a thready pulse. Association rule analysis indicated Yin deficiency leading to blood stasis is the core pathogenesis. Factor analysis indicated that the disease location primarily involved the spleen, kidney, and liver, while main disease nature elements were Yin deficiency, Qi deficiency, and blood stasis, often complicated by concomitant phlegm turbidity, Yang deficiency, and essence depletion. Cluster analysis identified five syndrome patterns: Yin deficiency with blood stasis syndrome, Qi deficiency with blood stasis syndrome, Yang deficiency with cold aggregation syndrome, phlegm stasis obstructing collateral syndrome, and liver-kidney deficiency syndrome. Among these, Yin deficiency with blood stasis syndrome and Qi deficiency with blood stasis syndrome were the most prevalent. Bayesian network analysis revealed associations between abnormal fasting blood glucose(FBG) and symptoms such as chest tightness, palpitations, dizziness, insomnia, and constipation. Abnormal glycosylated hemoglobin(HbA1c) was associated with frequent urination, polyphagia, polydipsia, thirst and dry mouth. Abnormal total cholesterol(TC) was linked to emaciation, fear of cold and cold limbs, and a weak pulse. Abnormal serum creatinine(SCr) was associated with slow reaction, a wiry pulse, and limb pain. The distribution of TCM syndromes in DPN primarily involves Yin deficiency with blood stasis syndrome and Qi deficiency with blood stasis syndrome. The core pathogenesis is Yin deficiency leading to blood stasis, with the disease location in the spleen, kidney, and liver. The identified associations between FBG, HbA1c, TC, SCr and specific TCM syndromes provide an objective basis for the microscopic syndrome differentiation of DPN and its integrated diagnosis and treatment combining Chinese and western medicine.

Hypertension is a leading cause of cardiovascular morbidity and mortality, yet the management remains suboptimal especially with monotherapy. Recently, low-dose triple and quadruple (quadpill) combinations have emerged as a promising therapeutic advancement resulting in control of hypertension. However, there still remains controversy around the long-term safety and efficacy of these therapies. We conducted an updated meta-analysis on the influence of these combinations on hypertension control. A systematic review and meta-analysis was conducted according to 2020 PRISMA guidelines and the protocol was prospectively registered in the PROSPERO. An extensive search on several databases including PubMed, Google scholar, C , and Cochrane Central Register of Trials. Primary outcome assessed was reduction in systolic blood pressure, and proportion of participants in range and secondary outcomes included: reduction in diastolic blood pressure, along with various safety outcomes. Low-dose combination significantly reduced systolic BP as compared to the placebo at 4-12 weeks (MD -14.97 mmHg), along with sustained reduction at 6 months (MD -6.58 mmHg). Patients who received low-dose combinations were more likely to reach target BP < 140/90, compared with a placebo drug (RR 2.18) and standard therapy (RR 1.37). Dizziness, headaches and pedal edema were noted more frequently in the intervention group, while MSK complaints were higher in the control populations. Our study's findings suggest that low-dose combinations with triple and quadruple therapies are significantly more efficacious in reducing systolic and diastolic BPs of adult populations. However, generally higher adverse events were noted for the intervention group receiving low-dose combination therapy.

Patients with treatment-resistant depression (TRD) have higher rates of relapse and pronounced decreases in daily functioning and health-related quality of life compared to patients with major depressive disorder who are not treatment-resistant, underscoring the need for treatment choices with sustained efficacy and long-term tolerability. Adults with TRD who participated in ≥1 of 6 phase 3 "parent" studies could continue esketamine treatment, combined with an oral antidepressant, by enrolling in phase 3, open-label, long-term extension study, SUSTAIN-3. Based on their status at parent-study end, eligible participants entered a 4-week induction phase followed by an optimization/maintenance phase, or directly entered the optimization/maintenance phase of SUSTAIN-3. Intranasal esketamine dosing was flexible, twice-weekly during induction and individualized to depression severity during optimization/maintenance. At the interim data cutoff (01 December 2020), 1148 participants were enrolled, 458 at induction and 690 at optimization/maintenance. Mean (median) cumulative duration of maintenance esketamine treatment was 31.5 (37.7) months (totaling 2769 cumulative patient-years). Common treatment-emergent adverse events (≥20%) were headache, dizziness, nausea, dissociation, somnolence, and nasopharyngitis. Mean Montgomery-Åsberg Depression Rating Scale (MADRS) total score decreased during induction, and this reduction persisted during optimization/maintenance (mean [SD] change from the baseline to the endpoint of each phase: induction -12.8 [9.73]; optimization/maintenance +1.1 [9.93]), with 35.6% and 46.1% of participants in remission (MADRS total score ≤12) at induction and optimization/maintenance endpoints, respectively. Improvement in depression ratings generally persisted among participants who remained in maintenance treatment, and no new safety signal was identified during long-term treatment (up to 4.5 years) using intermittent-dosed esketamine in conjunction with daily antidepressant. Appeared originally in Neuropsychopharmacology 2023; 48: 1225-1233.

Ping-Gan-Yi-Shen formula (PGYS) is mainly used for patients with severe hypertension accompanied by dizziness and headache, and has shown good clinical efficacy. In this study, liquid chromatography-tandem mass spectrometry (LC-MS/MS), targeted network pharmacology, multi-omics analysis, as well as molecular docking, and in vivo experiments were employed to systematically analyze the blood-absorbed components of PGYS, predict its active ingredients, and validate its mechanisms of action. A total of 8 blood-absorbed components were identified in the serum of PGYS-treated rats. Through network pharmacology analysis, myosin light chain kinase (MLCK) was screened as a key target. In vivo experiments showed that PGYS significantly reduced blood pressure, improved cardiac function, and attenuated vascular and cardiac fibrosis. Multi-omics analysis revealed that PGYS downregulated the expression of Tsc22 domain family member 4 (Tsc22D4) in cardiac tissue, thereby improving myocardial insulin sensitivity and reducing lipid accumulation. Molecular docking confirmed that caffeic acid and cellobiose, stably bind to MLCK and Tsc22D4 proteins. Furthermore, in vivo experiments demonstrated that PGYS alleviated cardiovascular remodeling, potentially by modulating vascular MLCK and cardiac Tsc22D4, and these regulatory effects were associated with decreased levels of TGF-β1 and ApoE, enhanced inositol metabolism, and reduced insulin resistance. These findings indicate that PGYS exerts antihypertensive and cardioprotective effects putatively by regulating vascular MLCK and cardiac Tsc22D4 to mitigate cardiovascular remodeling.