Objective:To explore the clinical characteristics and treatment methods of middle ear cholesteatoma with intracranial and extracranial complications as the first diagnosis. Methods:A total of 244 patients were initially diagnosed with intracranial and/or extracranial complications associated with middle ear cholesteatoma at the First Affiliated Hospital of Zhengzhou University from January 2015 to January 2022, and medical records were collected and retrospectively analyzed. Results:Among 244 patients with intracranial and extracranial complications of middle ear cholesteatoma, 203 cases had one complication, 34 cases had 2 complications, and 7 cases had 3 or more complications. One hundred and eighty-six cases presented labyrinthitis, 41 cases had peripheral facial paralysis, 27 cases had periauricular abscess, 12 cases had meningitis, 10 cases had brain abscess, 7 cases had sigmoid sinus lesions, 6 cases had epidural abscess, and 4 cases demonstrated hydrocephalus. Conclusion:The destructive nature of middle ear cholesteatoma can lead to intracranial and extracranial complications. The incidence rate of extracranial complications is highest for labyrinthitis. Patients with otitis media who complained dizziness should raise clinical suspicion for potential labyrinthitis. The second most prevalent extracranial complication is peripheral facial paralysis, and early facial nerve decompression surgery is critical for better recovery of facial paralysis symptoms. Brain abscess is the most common intracranial complications, which has the highest fatality rate. Clinicians should be alert to otogenic brain abscess. Otolaryngology and neurosurgery teams should cooperate and evaluate patients' middle ear lesions and brain abscess, and jointly develop personalized treatment plans.
Humans ; Cholesteatoma, Middle Ear/surgery* ; Retrospective Studies ; Facial Paralysis/etiology* ; Brain Abscess/diagnosis* ; Male ; Female ; Otitis Media/complications* ; Meningitis/etiology* ; Labyrinthitis/etiology* ; Adult ; Middle Aged ; Young Adult

Objective:X-linked non-syndromic hearing loss is an extremely rare type of hearing impairment. This study conducted a phenotypic and genetic analysis of a family with X-linked dominant inheritance to explore the causes of hearing loss. Methods:Clinical data were collected from a patient with non-syndromic hearing loss who visited the Otorhinolaryngology Department of the First Affiliated Hospital of Zhengzhou University in June 2023. Phenotypic and genetic analyses were performed on family members, including audiometric tests, whole-exome sequencing, and PCR-Sanger sequencing verification. Audiological assessments comprised pure-tone audiometry, impedance audiometry, auditory brainstem response, and otoacoustic emission tests. Results:The affected individuals in this pedigree have X-linked dominant non-syndromic deafness caused by mutations in the SMPX gene. The proband, along with their mother and maternal grandmother, exhibit varying degrees of sensorineural hearing loss. Whole-exome sequencing revealed a novel pathogenic variant, NM_014332.3: c. 133-2A>C, in the SMPX gene in the proband. Sanger sequencing confirmed that the proband, proband's mother, and grandmother all carried this pathogenic variant. Conclusion:This study reports a novel pathogenic variant in the SMPX gene, providing additional medical evidence for the diagnosis and treatment of X-linked dominant inherited non-syndromic hearing loss. It enriches the mutation spectrum of the SMPX gene.
Humans ; Pedigree ; Mutation ; Phenotype ; Male ; Hearing Loss, Sensorineural/genetics* ; Exome Sequencing ; Female ; Adult ; Hearing Loss/genetics* ; Evoked Potentials, Auditory, Brain Stem ; Muscle Proteins

Objective To investigate the application value of multiple audiological testing methods in the audi-ological diagnosis of children with no response at maximum output intensity of auditory brainstem response(ABR).Methods We retrospectively studied the clinical data of 69 cases(138 ears)of children with no ABR response with maximum intensity,aged 42 days to 5 years old,with an average of 1 year and 6 months.The tympanogram showed type-A or positive single peak,and acoustic reflex was absent.Imaging examination showed no malformation of the inner ear.All 69 children underwent ABR,cochlear microphonic potential(CM),distortion product otoacoustic e-missions(DPOAE),and auditory steady-state response(ASSR)tests.Results Among 69 cases(138 ears),8 ca-ses(11.59％)recorded CM in 16 ears,of which 10 ears(7.25％)recorded DPOAE.The ASSR response thresh-olds at 0.5,1,2,and 4 kHz were 83.2±13.1,82.9±13.0,75.3±12.4,and 63.1±9.1 dB nHL,respectively.Combined with other examination results,these subjects were diagnosed with auditory neuropathy.The CM and DPOAE responses of the remaining 61 cases(122 ears)were absent,and the extraction rates of ASSR at 0.5,1,2,and 4 kHz were 82.3％,81.9％,76.9％,and 60.2％,respectively.Among them,20 ears of ASSR were absent at all frequencies,and 102 ears had responses in at least one frequency.The response thresholds of ASSR at 0.5,1,2,and 4 kHz were 93.2±6.1,99.8±7.0,105.4±5.4,108.2±9.8 dB nHL,respectively.These subjects were diagnosed with profound sensorineural hearing loss.Conclusion For children with no ABR response at maximum output intensity,while CM and/or DPOAE responses are present and ASSR frequency response thresholds are low-er than those with sensorineural hearing loss are helpful in the diagnosis of auditory neuropathy.Neither CM nor DPOAE response is helpful in the diagnosis of profound sensorineural hearing loss,and ASSR testing is helpful in e-valuating residual hearing.

Objective:To explore the risk factors of osteosarcopenia in maintenance hemodialysis patients, construct a diagnostic nomogram model and verify the effect.Methods:Usingthe convenient sampling method, a total of 697 patients who underwent regular hemodialysis in six hospitals in Shanghai from July 2020 to April 2021 were selected as the modeling set, and 132 patients who underwent regular hemodialysis in Tongji Hospital in Shanghai in November 2020 were selected as the validation set. General information, laboratory indicators, human parameters, physical functions, nutritional status, physical activity, cognitive function, and depression were collected. Logistic regression was used to analyze the risk factors of osteosarcopenia in maintenance hemodialysis patients and to construct a nomogram model. The effect of the model was evaluated by the area under the receiver operating characteristic curve, calibration curve, and decision curve.Results:A total of 697 maintenance hemodialysis patients were included in the modeling set, including 171 patients with osteosarcopenia, with an incidence rate of 24.53% (171/697). The results of the binomial logistic regression analysis showed that age, body mass index, physical activity intensity, and Charlson Comorbidity Index (CCI) were the influencing factors for the occurrence of osteosarcopenia in maintenance hemodialysis patients ( P<0.05). The area under the receiver operating characteristic curve in the modeling set, ten-fold cross-validation, and validation set were 0.835, 0.827, and 0.851, respectively. The calibration curves of the modeling and validation sets fitted well. The decision curve showed that the clinical utility of the nomogram was good. Conclusions:Maintenance hemodialysis patients are prone to osteosarcopenia. Old age, low body mass index, high Charlson Comorbidity Index, and low-intensity physical activity are risk factors for osteosarcopenia in maintenance hemodialysis patients. A nomogramdiagnostic model based on the above-mentioned influencing factors can help medical staff identify high-risk populations early and develop prevention and treatment measures.

Objective:To study the efficacy and safety of anlotinib in the treatment of advanced radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC) and the effect of anlotinib on iodine uptake of lesions.Methods:A retrospective analysis was performed on 23 patients (10 males and 13 females, age (59.1±8.7) years) with advanced RAIR-DTC who were treated with anlotinib in Liaocheng Hospital Affiliated to Shandong First Medical University between January 2019 and February 2023 and met the enrollment criteria. Thyroid function, serum thyroglobulin (Tg) and Tg antibody (TgAb) were determined every 6 weeks during the treatment with anlotinib, and maximum diameter of target lesion (TL) was monitored by CT every 12 weeks, in order to evaluate the therapeutic efficacy, and treatment-related adverse reactions were observed. Diagnostic 131I whole body scan (Dx-WBS) was performed in some patients to evaluate the changes in iodine uptake of lesions after anlotinib treatment. In this study, the posttreatment changes of patients within 24 weeks during the treatment were analyzed. The maximum diameter of TL and Tg at different time points were compared by Friedman test, and were further compared in pairs with P values corrected by Bonferroni method. Results:After 24 weeks of treatment with anlotinib, 8 of 23 patients achieved partial response, 15 had stable disease, and no patients achieved complete response. Serum Tg levels at 6, 12, 18, 24 weeks after anlotinib treatment were 189.5(85.0, 483.3), 127.7(52.4, 319.8), 82.0(40.2, 213.5) and 80.1(39.9, 205.0) μg/L, all of which were lower than the baseline level of Tg (384.5(210.9, 1 605.0) μg/L; χ2 values: 4.23-7.86, all P<0.001). Tg level at 18 weeks after treatment was statistically different from that at 12 weeks after treatment ( χ2 =3.06, P<0.001), but was not statistically different from that at 24 weeks after treatment ( χ2 =12.57, P=0.059). The maximum TL diameters of lung and cervical lymph nodes were significantly reduced at week 12 and 24 of anlotinib treatment compared with baseline ( χ2 values: 14.76-31.12, all P<0.001), while there was no significant difference in TL maximum diameter at 12 and 24 weeks of treatment ( χ2 values: 5.65, 9.02, P values: 0.314, 0.070). Common adverse reactions included hypertension, hand-foot syndrome, hyperacylglyceremia and proteinuria. No adverse reactions above grade 4 or death related to adverse reactions occurred. Dx-WBS evaluation was performed in 7 patients after anlotinib treatment, and no change in iodine uptake was found. Conclusions:Anlotinib has a clear effect on advanced RAIR-DTC with less adverse reactions. The efficacy of anlotinib reaches the strongest at around 12-18 weeks and becomes stable at 24 weeks. No effect of anlotinib on inducing redifferentiation of RAIR-DTC cells and enhancing iodine uptake is found.

Objective:To search, evaluate and integrate the best evidence of exercise rehabilitation intervention after PCI in patients with acute myocardial infarction, so as to provide evidence-based basis for clinical doctors and nurses to intervene in exercise rehabilitation of patients.Methods:We searched PubMed, China National Knowledge Infrastructure, Wanfang Data and other domestic and foreign databases, guide websites and professional association websites about the evidence of exercise rehabilitation intervention in patients with acute myocardial infarction after PCI. The search period is from January 2010 to June 2021. The quality of the included literature was evaluated by two researchers, and the literature evidence in accordance with the quality standard was extracted.Results:A total of 20 articles were included, and 39 pieces of evidence were summarized from 11 aspects, such as the establishment of multidisciplinary team, evaluation, exercise prescription, exercise monitoring and so on.Conclusions:This study summarized the best evidence of exercise rehabilitation intervention in patients with acute myocardial infarction after PCI, and provided theoretical support for clinical practice. It is suggested to combine the clinical situation and patients' wishes to promote the transformation of the best evidence to clinical practice.

Objective:To investigate the association between cardiorespiratory fitness (CRF) and muscle strength, and the influencing factors of CRF in maintenance hemodialysis (MHD) patients.Methods:It was a single-center cross-sectional study. Patients who were treated with regular MHD from September 1, 2020 to December 31, 2020 were recruited. Baseline data of MHD patients including body circumference (upper arm circumference of non-fistula, triceps skinfold thickness, and calf circumference), exercise capacity [6-min walking test (6MWT), timed up and go test (TUGT)] and upper and lower limb muscle strength (grip strength, knee extension strength) as well as clinical and biochemical data, Charlson comorbidity index were collected or measured. Cardiopulmonary exercise test (CPET) was used to test peak oxygen consumption per kg body weight (peakVO 2/kg) for reflecting CRF. Pearson correlation or Spearman correlation was used to analyze the correlation between peakVO 2/kg and clinical parameters. Multiple linear regression analysis (stepwise) was performed to analyze the influencing factors of peakVO 2/kg. Results:A total of 48 patients were enrolled in the study, of whom 34 were males (70.8%). The age was (60.31±10.44) years old. The median dialysis duration was 48(15, 84) months, and the peakVO 2/kg was (12.37±2.71) ml·kg -1·min -1, which was well below the normal value of 30-50 ml·kg -1·min -1. Furthermore, peakVO 2/kg was positively correlated with lower extremity muscle strength ( r=0.322, P=0.026) and 6MWT ( r=0.307, P=0.034), and negatively correlated with age ( r=-0.300, P=0.038). Multiple linear regression analysis demonstrated that lower extremity muscle strength ( β=0.241, P=0.009) and age ( β=-0.235, P=0.022) were the influencing factor of peakVO 2/kg. Conclusions:CRF of MHD patients is significantly decreased. The decrease of lower extremity muscle strength is an influencing factor of CRF reduction.

Objective:To evaluate the practicability and effectiveness of nursing plan for elderly patients with urinary incontinence after operation.Methods:The patients admitted to the Department of Urology and Gynecology in a Grade 3A general hospital from September to October 2019 were selected as the control group, and the patients admitted from December 2019 to January 2020 as the intervention group. In the quasi-experimental study, the control group was given routine discharge guidance, and the intervention group was given a nursing plan for elderly patients with urinary incontinence to observe the preliminary effect of the nursing program for a period of 2 months.Results:Two months after implementation, the total scores of discharge preparation, quality of life and satisfaction of urinary incontinence in the intervention group was (125.08 ±17.64), (58.79 ±5.52) and (96.09 ±2.53) respectively, which were significantly different from those in the control group ( P<0.05). Conclusion:The preliminary verification of the scheme has a certain feasibility, has a certain guiding significance for nurses, and is helpful to improve the discharge preparation of elderly surgical patients with urinary incontinence and improve their satisfaction and quality of life when they are discharged.

Objective:To systematically retrieve, evaluate, and summarize the best evidence of self-management in patients with gastroesophageal reflux disease, so as to provide references for clinical nurses to formulate self-management intervention programs for patients with gastroesophageal reflux disease.Methods:Through systematic retrieval of domestic and foreign guides and literature databases, the quality of the included literature was evaluated separately according to requirements of literature quality evaluation. Experts were invited to evaluate the summarized evidence according to the feasibility, appropriateness, meaningfulness, and effectiveness (FAME) structure.Results:A total of 9 articles were included. Finally, the 5 aspects of diet, lifestyle, medication, abdominal breathing training, and follow-up of patients with gastroesophageal reflux disease were summarized, and a total of 21 best recommendations were made.Conclusions:The best evidence for self-management intervention in patients with gastroesophageal reflux disease is rich in content. In clinical work, clinical nurses should apply relevant evidence based on the specific circumstances of the hospital, combined with the promotion and obstacle factors of evidence application.

Objective? To construct the perioperative urinary incontinence nursing outcomes intervention plan suitable for elderly patients with rectal cancer. Methods? From December 2017 to June 2018, we preliminarily developed the perioperative urinary incontinence nursing plan for elderly patients with rectal cancer by literature review and case investigation. We selected 11 experts undertaking rectal cancer and urinary incontinence clinical care, clinical nursing and nursing management by purpose sampling in Shanghai to demonstrate the intervention plan with the method of expert meeting so as to confirm the final intervention plan. Results? The expert authority coefficient was 0.93. The nursing plan included 4 primary indexes, 9 secondary indexes and 42 tertiary indexes. Conclusions? The expert authority coefficient is high in this study. The construction of perioperative urinary incontinence nursing plan based on nursing outcomes classification system for elderly patients with rectal cancer provides the reference for carrying out practice and researches of perioperative urinary incontinence management for elderly patients with rectal cancer.