Single-cell insights: pioneering an integrated atlas of chromatin accessibility and transcriptomic landscapes in diabetic cardiomyopathy.

BACKGROUND: Diabetic cardiomyopathy (DCM) poses a growing health threat, elevating heart failure risk in diabetic individuals. Understanding DCM is crucial, with fibroblasts and endothelial cells playing pivotal roles in driving myocardial fibrosis and contributing to cardiac dysfunction. Advances in Multimodal single-cell profiling, such as scRNA-seq and scATAC-seq, provide deeper insights into DCM's unique cell states and molecular landscape for targeted therapeutic interventions. METHODS: Single-cell RNA and ATAC data from 10x Multiome libraries were processed using Cell Ranger ARC v2.0.1. Gene expression and ATAC data underwent Seurat and Signac filtration. Differential gene expression and accessible chromatin regions were identified. Transcription factor activity was estimated with chromVAR, and Cis-coaccessibility networks were calculated using Cicero. Coaccessibility connections were compared to the GeneHancer database. Gene Ontology analysis, biological process scoring, cell-cell communication analysis, and gene-motif correlation was performed to reveal intricate molecular changes. Immunofluorescent staining utilized various antibodies on paraffin-embedded tissues to verify the findings. RESULTS: This study integrated scRNA-seq and scATAC-seq data obtained from hearts of WT and DCM mice, elucidating molecular changes at the single-cell level throughout the diabetic cardiomyopathy progression. Robust and accurate clustering analysis of the integrated data revealed altered cell proportions, showcasing decreased endothelial cells and macrophages, coupled with increased fibroblasts and myocardial cells in the DCM group, indicating enhanced fibrosis and endothelial damage. Chromatin accessibility analysis unveiled unique patterns in cell types, with heightened transcriptional activity in myocardial cells. Subpopulation analysis highlighted distinct changes in cardiomyocytes and fibroblasts, emphasizing pathways related to fatty acid metabolism and cardiac contraction. Fibroblast-centered communication analysis identified interactions with endothelial cells, implicating VEGF receptors. Endothelial cell subpopulations exhibited altered gene expressions, emphasizing contraction and growth-related pathways. Candidate regulators, including Tcf21, Arnt, Stat5a, and Stat5b, were identified, suggesting their pivotal roles in DCM development. Immunofluorescence staining validated marker genes of cell subpopulations, confirming PDK4, PPARγ and Tpm1 as markers for metabolic pattern-altered cardiomyocytes, activated fibroblasts and endothelial cells with compromised proliferation. CONCLUSION: Our integrated scRNA-seq and scATAC-seq analysis unveils intricate cell states and molecular alterations in diabetic cardiomyopathy. Identified cell type-specific changes, transcription factors, and marker genes offer valuable insights. The study sheds light on potential therapeutic targets for DCM.

Tunable zinc benzamidinate complexes: coordination modes and catalytic activity in the ring-opening polymerization of L-lactide.

Seven asymmetric zinc benzamidinate complexes featuring or lacking side-arm functionalities were synthesized. Using equimolar zinc reagent produced distinct dinuclear motifs [(C6H5-C = NC6H5)ZnEt]2 (R = tBu, 1; (CH2)2OMe, 2; (CH2)2NMe2, 3). Half the zinc reagent yielded dinuclear [(C6H5-C = NC6H5)2Zn]2 (R = tBu, 4) or mononuclear zinc bis(chelate) complexes (R = (CH2)2OMe, 5; (CH2)2NMe2, 6; CH2Py, 7). Molecular structures of 1-4 and 7 were determined via single-crystal X-ray diffraction. Altering benzamidinate substituents modifies both coordination modes and catalytic activities in ring-opening polymerization of L-lactide. Specifically, complex 7 exhibits enhanced catalytic activity at 25 °C using 100 equivalents of L-lactide with a turnover frequency of 1820 h-1.

Robust bistatic ghost imaging with no physical synchronization.

Ghost imaging (GI) requires each echo from the object being correctly matched with the corresponding illuminiation pattern. We proposed a way for such matching with no physical synchronization towards bistatic configuration. The illumination is dually encoded in spatial and time domain. With aperiodic waveform and progressive correlation, the echoes can be correctly located and images can be obtained. In the experiments, our scheme is verified under different levels of signal to noise ratios, as well as different intensity of crosstalk. Ghost imaging with two transmitters and one receiver is also demonstrated. With our method, it is also possible to improve the imaging speed with multiple sources.

Out-of-Mold Sensor-Based Process Parameter Optimization and Adaptive Process Quality Control for Hot Runner Thin-Walled Injection-Molded Parts.

Injection molding is a highly nonlinear procedure that is easily influenced by various external factors, thereby affecting the stability of the product's quality. High-speed injection molding is required for production due to the rapid cooling characteristics of thin-walled parts, leading to increased manufacturing complexity. Consequently, establishing appropriate process parameters for maintaining quality stability in long-term production is challenging. This study selected a hot runner mold with a thin wall fitted with two external sensors, a nozzle pressure sensor and a tie-bar strain gauge, to collect data regarding the nozzle peak pressure, the timing of peak pressure, the viscosity index, and the clamping force difference value. The product weight was defined as the quality indicator, and a standardized parameter optimization process was constructed, including injection speed, V/P switchover point, packing, and clamping force. Finally, the optimized process parameters were applied to the adaptive process control experiments using the developed control system operated within the micro-controller unit (MCU). The results revealed that the control system effectively stabilized the product weight variation and standard deviation of 0.677% and 0.0178 g, respectively.

Implementation of Lightweight Convolutional Neural Networks with an Early Exit Mechanism Utilizing 40 nm CMOS Process for Fire Detection in Unmanned Aerial Vehicles.

The advancement of unmanned aerial vehicles (UAVs) enables early detection of numerous disasters. Efforts have been made to automate the monitoring of data from UAVs, with machine learning methods recently attracting significant interest. These solutions often face challenges with high computational costs and energy usage. Conventionally, data from UAVs are processed using cloud computing, where they are sent to the cloud for analysis. However, this method might not meet the real-time needs of disaster relief scenarios. In contrast, edge computing provides real-time processing at the site but still struggles with computational and energy efficiency issues. To overcome these obstacles and enhance resource utilization, this paper presents a convolutional neural network (CNN) model with an early exit mechanism designed for fire detection in UAVs. This model is implemented using TSMC 40 nm CMOS technology, which aids in hardware acceleration. Notably, the neural network has a modest parameter count of 11.2 k. In the hardware computation part, the CNN circuit completes fire detection in approximately 230,000 cycles. Power-gating techniques are also used to turn off inactive memory, contributing to reduced power consumption. The experimental results show that this neural network reaches a maximum accuracy of 81.49% in the hardware implementation stage. After automatic layout and routing, the CNN hardware accelerator can operate at 300 MHz, consuming 117 mW of power.

Outcomes of FETD versus UBE in the treatment of L5S1 foraminal stenosis: A comparative study.

Background: The L5S1 level exhibits unique anatomical features compared with other levels. This makes minimally invasive surgery for L5S1 foraminal stenosis (FS) challenging. This study compared the surgical outcomes of full endoscopic transforaminal decompression (FETD) and unilateral biportal endoscopy with the far-lateral approach (UBEFLA) in patients with L5S1FS. Methods: In this retrospective study, 49 patients with L5S1FS were divided into two groups. Of these, 24 patients underwent FETD, 25 patients underwent UBEFLA. The study assessed demographic data, leg pain visual analog scale (VAS) score, back pain VAS score, Oswestry Disability Index (ODI), modified MacNab outcome scale, and radiographic parameters including postoperative lateral facet preservation (POLFP). Results: The Mann-Whitney U test revealed that the UBEFLA group exhibited a higher VAS score for back pain at one week after the operation, whereas the FETD group exhibited a higher leg pain VAS score 6 weeks after the operation. All four undesired MacNab outcomes in the FETD group were attributed to residual leg pain, whereas all five undesired MacNab outcomes in the UBEFLA group were due to recurrent symptoms. Radiographically, the FETD group exhibited greater POLFP. Conclusions: When L5S1FS is performed, there may be challenges in adequately clearing the foraminal space in FETD. On the other hand, UBEFLA allowed for a more comprehensive clearance. However, this advantage of UBEFLA was associated with spinal instability as a future outcome.

Lignin-Based Nanospheres as Environmental Remediation Platforms for Anionic Dye Contaminants.

Modern manufacturing of textiles, pharmaceuticals, food, cosmetics, plastics, paper, etc. involves the utilization of anionic and cationic dyes that lead to significant water contamination. Recent research has explored the use of nanomaterials toward developing nanoadsorbents for water decontamination caused by industrial pollution. Here, we report on a novel platform for anionic dye remediation, consisting of a polyethylenimine-functionalized lignin nanosphere (PEI-LNS). The designed nanomaterial shows significant ability to adsorb an anionic dye selected as a proof-of-concept-Sulforhodamine B, from aqueous solutions. The PEI lignin nanoadsorbents (PEI-LNS) showed a better ability to adsorb Sulforhodamine B sodium salt (SBSS) when compared to the raw lignin nanosphere adsorbent (LNS), especially in acidic conditions. The nanomaterial was characterized through transmission electron microscopy, scanning electron microscopy, Brunauer-Emmett-Teller surface area analysis, elemental analysis, zeta potential, thermogravimetric analysis, Fourier transform infrared spectroscopy, and nuclear magnetic resonance. The impacts of ionic strength, contact time, pH, and adsorbent concentration have been evaluated. The ability of PEI-LNS to adsorb SBSS was found to be consistent with Langmuir isotherms and pseudo-second-order kinetic models. The PEI-LNS could be recycled three times, reaching a good (85%) adsorbing capacity even in the third cycle. The study demonstrates that PEI-LNS has a strong affinity as a novel adsorbent for anionic dyes and could be employed in environmental cleanups pertaining to such contaminations.

Size-Controlled Cu3VSe4 Nanocrystals as Cathode Material in Platinum-Free Dye-Sensitized Solar Cells.

In this work, we report the first single-step, size-controlled synthesis of Cu3VSe4 cuboidal nanocrystals, with the longest dimension ranging from 9 to 36 nm, and their use in replacing the platinum counter electrode in dye-sensitized solar cells. Cu3VSe4, a ternary semiconductor from the class of sulvanites, is theoretically predicted to have good hole mobility, making it a promising candidate for charge transport in solar photovoltaic devices. The identity and crystalline purity of the Cu3VSe4 nanocrystals were validated by X-ray powder diffraction (XRD) and Raman spectroscopy. The particle size was determined from the XRD data using the Williamson-Hall equation and was found in agreement with the transmission electron microscopy imaging. Based on the electrochemical activity of the Cu3VSe4 nanocrystals, studied by cyclic voltammetry, the nanomaterials were further employed for fabricating counter electrodes (CEs) in Pt-free dye-sensitized solar cells. The counter electrodes were prepared from Cu3VSe4 nanocrystals as thin films, and the charge transfer kinetics were studied by electrochemical impedance spectroscopy. The work demonstrates that Cu3VSe4 counter electrodes successfully replace platinum in DSSCs. CEs fabricated with the Cu3VSe4 nanocrystals having an average particle size of 31.6 nm outperformed Pt, leading to DSSCs with the highest power conversion efficiency (5.93%) when compared with those fabricated with the Pt CE (5.85%).

The impact of surgeon's academic leave on surgical outcomes for endoscopic transsphenoidal resection of pituitary tumors.

Background: Endoscopic surgery has become the mainstay of pituitary surgery, but requires comprehensive surgical training. We evaluate the impact of a surgeon's academic leave during endoscopic training on surgical outcomes of patients with pituitary tumors. Methods: This retrospective study reviewed the surgical outcomes of endoscopic transsphenoidal surgery for pituitary tumors performed by a single surgeon. The last 56 surgical cases were performed between July 2010 and August 2014 before academic leave (Phase 1 surgery group), while another 56 consecutive cases were performed between November 2017 and March 2020 immediately after the surgeon's academic leave (Phase 2 surgery group). Demographic and clinical characteristics were collected and compared between the two surgery groups. Results: Overall, most surgical outcomes of endoscopic transsphenoidal surgery were not affected adversely by the period of academic leave. The operative time and length of hospital stay was lower in the Phase 2 surgery group compared to the Phase 1 surgery group (P<0.05). Postoperative tumor residual, intraoperative cerebrospinal fluid (CSF) leaks and reoperation also decreased significantly in the Phase 2 group compared to the Phase 1 group (P<0.05). Similar results were observed in patients operated using a one-hand/mono-nostril and two-hand/one-and-half nostril technique. Conclusions: Academic leave had no negative impact on most surgical outcomes for endoscopic transsphenoidal resection of pituitary tumors. Moreover, a trend toward shorter operative times and length of hospital stays was noted for patients receiving surgery immediately after surgeon's return from leave.

False Liver Metastasis by Positron Emission Tomography/Computed Tomography Scan after Chemoradiotherapy for Esophageal Cancer-Potential Overstaged Pitfalls of Treatment.

In patients with esophageal cancer undergoing neoadjuvant chemoradiotherapy (nCRT), subsequent restaging with F-18-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET-CT) can reveal the presence of interval metastases, such as liver metastases, in approximately 10% of cases. Nevertheless, it is not uncommon in clinical practice to observe focal FDG uptake in the liver that is not associated with liver metastases but rather with radiation-induced liver injury (RILI), which can result in the overstaging of the disease. Liver radiation damage is also a concern during distal esophageal cancer radiotherapy due to its proximity to the left liver lobe, typically included in the radiation field. Post-CRT, if FDG activity appears in the left or caudate liver lobes, a thorough investigation is needed to confirm or rule out distant metastases. The increased FDG uptake in liver lobes post-CRT often presents a diagnostic dilemma. Distinguishing between radiation-induced liver disease and metastasis is vital for appropriate patient management, necessitating a combination of imaging techniques and an understanding of the factors influencing the radiation response. Diagnosis involves identifying new foci of hepatic FDG avidity on PET/CT scans. Geographic regions of hypoattenuation on CT and well-demarcated regions with specific enhancement patterns on contrast-enhanced CT scans and MRI are characteristic of radiation-induced liver disease (RILD). Lack of mass effect on all three modalities (CT, MRI, PET) indicates RILD. Resolution of abnormalities on subsequent examinations also helps in diagnosing RILD. Moreover, it can also help to rule out occult metastases, thereby excluding those patients from further surgery who will not benefit from esophagectomy with curative intent.

Liquid lens based holographic camera for real 3D scene hologram acquisition using end-to-end physical model-driven network.

With the development of artificial intelligence, neural network provides unique opportunities for holography, such as high fidelity and dynamic calculation. How to obtain real 3D scene and generate high fidelity hologram in real time is an urgent problem. Here, we propose a liquid lens based holographic camera for real 3D scene hologram acquisition using an end-to-end physical model-driven network (EEPMD-Net). As the core component of the liquid camera, the first 10 mm large aperture electrowetting-based liquid lens is proposed by using specially fabricated solution. The design of the liquid camera ensures that the multi-layers of the real 3D scene can be obtained quickly and with great imaging performance. The EEPMD-Net takes the information of real 3D scene as the input, and uses two new structures of encoder and decoder networks to realize low-noise phase generation. By comparing the intensity information between the reconstructed image after depth fusion and the target scene, the composite loss function is constructed for phase optimization, and the high-fidelity training of hologram with true depth of the 3D scene is realized for the first time. The holographic camera achieves the high-fidelity and fast generation of the hologram of the real 3D scene, and the reconstructed experiment proves that the holographic image has the advantage of low noise. The proposed holographic camera is unique and can be used in 3D display, measurement, encryption and other fields.

Stroke and suicide among people with severe mental illnesses.

The associations between people with severe mental illnesses (SMI) and the risks of stroke, suicide, and death remain unclear. We examined healthcare service usage among adults with and without SMI and explored the risk of stroke, suicide, and death. We divided 18-80-year-old adults with SMI into catastrophic and non-catastrophic illness groups. These groups were subjected to a 1:5:5 propensity score matching with people without SMI. Data on demographic characteristics, economic factors, environmental factors, comorbid conditions, self-injury behavior, the number of outpatients and ED visits, and hospitalization were collected. The primary outcomes were risks of stroke, suicide, and death. We included 19,570 people with catastrophic SMI, 97,850 with non-catastrophic SMI, and 97,850 controls. Patients with SMI, especially those with catastrophic illnesses, had higher stroke risk, suicide, and death than those without SMI. People with SMI used health services more frequently than those without SMI. Patients with a history of hospitalization or ED access had a higher risk of stroke, suicide, and death. Our data indicate that special attention should be given to patients with SMI, particularly those with a history of healthcare service utilization, such as through more extended hospital stays with high-intensity interventions.

Tenascin-C as a potential biomarker and therapeutic target for esophageal squamous cell carcinoma.

PURPOSE: To establish a prognostic model of esophageal squamous cell carcinoma (ESCC) patients based on tenascin-C (TNC) expression level and clinicopathological characteristics, and to explore the therapeutic potential of TNC inhibition. METHODS: The expression of TNC was detected using immunohistochemistry (IHC) in 326 ESCC specimens and 50 normal esophageal tissues. Prognostic factors were determined by Cox regression analyses and were incorporated to establish the nomogram. The effects of TNC knockdown on ESCC cells were assessed in vitro and in vivo. Transcriptome sequencing (RNA-seq) and gene set enrichment analysis (GSEA) were performed to reveal signaling pathways regulated by TNC knockdown. The therapeutic significance of TNC knockdown combined with small-molecule inhibitors on cell proliferation was examined. RESULTS: TNC protein was highly expressed in 48.77 % of ESCC tissues compared to only 2 % in normal esophageal epithelia (p < 0.001). The established nomogram model, based on TNC expression, pT stage, and lymph node metastasis, showed good performance on prognosis evaluation. More importantly, the reduction of TNC expression inhibited tumor cell proliferation and xenograft growth, and mainly down-regulated signaling pathways involved in tumor growth, hypoxia signaling transduction, metabolism, infection, etc. Knockdown of TNC enhanced the inhibitory effect of inhibitors targeting ErbB, PI3K-Akt, Ras and MAPK signaling pathways. CONCLUSION: The established nomogram may be a promising model for survival prediction in ESCC. Reducing TNC expression enhanced the sensitivity of ESCC cells to inhibitors of Epidermal Growth Factor Receptor (EGFR) and downstream signaling pathways, providing a novel combination therapy strategy.

Alginate di-aldehyde-modified metal-organic framework nanocarriers as delivery platform and adjuvant in inactivated pseudorabies vaccination.

Pseudorabies virus (PRV) is a highly contagious viral disease, which leads to severe financial losses in the breeding industry worldwide. Presently, PRV is mainly controlled using live attenuated and inactivated vaccines. However, these vaccines have an innate tendency to lose their structural conformation upon exposure to environmental and chemical stressors and cannot provide full protection against the emerging prevalent PRV variants. In this work, first, we synthesized aminated ZIF-7/8 nanoparticles (NPs), and then chemical bond-coated alginate dialdehyde (ADA, a type of dioxide alginate saccharide) on their surface via Schiff base reaction to obtain ZIF-7/8-ADA NPs. The as-fabricated ZIF-7/8-ADA NPs exhibited high stability, monodispersity and a high loading ratio of antigen. Furthermore, the ZIF-7/8-ADA NPs showed good biocompatibility in vitro and in vivo. Using ZIF-7/8-ADA NPs as an adjuvant and inactivated PRV as a model antigen, we constructed a PR vaccine through a simple mixture. The immunity studies indicated that ZIF-7/8-ADA induced an enhancement in the Th1/Th2 immune response, which was superior to that of the commercial ISA201, alum adjuvant and ZIF-7/8. Due to the pH-sensitive release of the antigen in lysosomes, the as-prepared PR vaccine subsequently accelerated the antigen presentation and improved the immune responses in vitro and in vivo. The results of PRV challenge using mice as the model demonstrated that ZIF-7/8-ADA achieved the same preventive effect as the commercial ISA201 and was much better than the alum adjuvant, and thus can serve as a promising delivery system and adjuvant to enhance humoral and cellular responses against PRV infection.

Acute pancreatitis presented with diffuse ST-segment elevation: A case report and literature review.

INTRODUCTION: Although electrocardiographic changes have been previously reported in patients with acute pancreatitis, diffuse ST-segment elevation without occluded coronary arteries is rarely documented. PATIENT CONCERNS: A 45-year-old man presented to our emergency department due to persistent epigastric pain for 2 hours. However, ECG in the emergency department revealed regular sinus rhythm at 67 beats per minute, peaked T waves in lead V3-5, and upsloping ST-segment elevation in leads II, III, aVF, and V2-6. DIAGNOSIS: He was diagnosed with acute pancreatitis and presented with diffuse ST-segment elevation. INTERVENTIONS: Laboratory workup and computed tomography supported the diagnosis of acute gallstone pancreatitis and endoscopic retrograde cholangiopancreatography was performed. Coronary angiography showed patent coronary arteries finally. OUTCOMES: Endoscopic retrograde cholangiopancreatography and endoscopic papillo-sphincterotomy were performed, and the stone in the common bile duct was removed smoothly without immediate complication. Due to his relatively stable condition, he was discharged on day 7 of admission. CONCLUSION: We presented an uncommon case of acute pancreatitis demonstrating similar features of AMI. This reminds cardiologists and emergency physicians to make the judgment with more caution to avoid jumping to conclusions and providing inappropriate treatment.

Graphene Electrode for Studying CO2 Electroreduction Nanocatalysts under Realistic Conditions in Microcells.

The ability to resolve the dynamic evolution of electrocatalytically induced processes with electrochemical liquid-phase electron microscopy (EM) is limited by the microcell configuration. Herein, a free-standing tri-layer graphene is integrated as a membrane and electrode material into the electrochemical chip and its suitability as a substrate electrode at the high cathodic potentials required for CO2 electroreduction (CO2ER) is evaluated. The three-layer stacked graphene is transferred onto an in-house fabricated single-working electrode chip for use with bulk-like reference and counter electrodes to facilitate evaluation of its effectiveness. Electrochemical measurements show that the graphene working electrode exhibits a wider inert cathodic potential range than the conventional glassy carbon electrode while achieving good charge transfer properties for nanocatalytic redox reactions. Operando scanning electron microscopy studies clearly demonstrate the improvement in spatial resolution but reveal a synergistic effect of the electron beam and the applied potential that limits the stability time window of the graphene-based electrochemical chip. By optimizing the operating conditions, in situ monitoring of Cu nanocube degradation is achieved at the CO2ER potential of -1.1 V versus RHE. Thus, this improved microcell configuration allows EM observation of catalytic processes at potentials relevant to real systems.

Psoriatic arthritis increases the risk of venous thromboembolism following degenerative lumbar spine surgery: An analysis of U.S. Nationwide Inpatient Sample 2005-2018.

Background: This retrospective study aimed to determine the risk of venous thromboembolism (VTE) in patients with PsA after surgery for lumbar degenerative disease (LDD). Methods: The study data of adults aged ≥20 years admitted to U.S. hospitals with diagnoses of LDD and undergoing spinal decompression or fusion between 2005 and 2018 were extracted from the National Inpatient Sample (NIS) database. Patients were further divided into two groups based on a diagnosis of PsA or not via codes ICD-9: 696.0 and ICD-10: L40.50. Patients with missing information were excluded. Propensity score matching (PSM) was employed to enhance comparability between groups. Logistic regression was used to determine associations between PsA and various outcomes, including complications, unfavorable discharge, and prolonged length of stay (LOS). Results: Data on 471,283 patients with LDD was extracted from the NIS database.from 2005 to 2018. Before propensity score matching, patients with PsA had higher proportions of overall morbidity (8.8 % vs. 6.9 %), VTE (1.4 % vs. 0.7 %), and unfavorable discharge (20.8 % vs. 16.9 %). After matching, patients with PsA still had higher VTE incidence and unfavorable discharge proportions. After adjustments, multivariable regression analysis indicated that patients with PsA had a higher risk of unfavorable discharge (aOR: 1.26, 95 % CI: 1.03-1.55) and VTE (aOR: 1.99, 95 % CI: 1.05-3.75). Conclusions: Among patients undergoing surgery for LDD, pre-existing PsA may be associated with increased risks of unfavorable discharge and VTE occurrence. The findings may benefit preoperative risk stratifications before LDD surgeries.

Salvage therapy for refractory sudden sensorineural hearing loss (RSSNHL): a systematic review and network meta-analysis.

OBJECTIVE: Approximately 30-50% of sudden sensorineural hearing loss (SSNHL) patients show poor response to systemic steroid therapy. Additionally, the most appropriate treatment for patients with refractory sudden sensorineural hearing loss (RSSNHL) is unknown. This study aimed to explore the best treatment for RSSNHL. DESIGN: Using a frequentist contrast-based model and PRISMA guidelines, this study compared five salvage regimes: intratympanic injection of steroids (ITS), hyperbaric oxygen (HBO) therapy, post auricle steroid injection (PSI), ITS combined with HBO therapy, and continued systemic steroids. STUDY SAMPLE: We searched the PubMed, EMBASE, Web of Science, and Cochrane Library databases for randomised controlled trials and cohort studies comparing treatment regimens for RSSNHL. RESULTS: Compared with the control group (no additional treatment), PSI and ITS demonstrated significant improvements. The mean hearing gain was greater after PSI (11.1 dB [95% CI, 4.4-17.9]) than after ITS (7.7 dB [95% CI, 4.8-10.7]). When a restricted definition of RSSNHL was used, the ITS + HBO therapy showed the largest difference in improvement for pure tone average compared with the control group (14.5 dB [95% CI, 4.2-25.0]). CONCLUSIONS: The administration of either PSI or ITS leads to the greatest therapeutic effect in patients with RSSNHL. However, a consensus on the definition of RSSNHL is needed.