Hearing loss is the most prevalent disabling disease. Cochlear implantation（CI） serves as the primary intervention for severe to profound hearing loss. This consensus systematically explores the value of genetic diagnosis in the pre-operative assessment and efficacy prognosis for CI. Drawing upon domestic and international research and clinical experience, it proposes an evidence-based medicine three-tiered prognostic classification system（Favorable, Marginal, Poor）. The consensus focuses on common hereditary non-syndromic hearing loss（such as that caused by mutations in genes like GJB2, SLC26A4, OTOF, LOXHD1） and syndromic hereditary hearing loss（such as Jervell & Lange-Nielsen syndrome and Waardenburg syndrome）, which are closely associated with congenital hearing loss, analyzing the impact of their pathological mechanisms on CI outcomes. The consensus provides recommendations based on multiple round of expert discussion and voting. It emphasizes that genetic diagnosis can optimize patient selection, predict prognosis, guide post-operative rehabilitation, offer stratified management strategies for patients with different genotypes, and advance the application of precision medicine in the field of CI.
Humans ; Cochlear Implantation ; Prognosis ; Hearing Loss/surgery* ; Consensus ; Connexin 26 ; Mutation ; Sulfate Transporters ; Connexins/genetics*

Objective To investigate the 1 year mortality after hip fractures in super advanced age patients and summarize the death associated risk factors in order to provide basis for targeted intervention countermeasures.Methods The clinical data of 332 super advanced age patients with femoral neck or intertrochanteric fractures treated by hip replacement or in-tramedullary femoral nail fixation from January 2015 to January 2023 were retrospectively analyzed.There were 128 males and 204 females with the mean age of(92.2±2.5)years ranging from 90 to 103 years old.Among them,92 cases died within 1 year after surgery.Correlation with the occurrence of death on age,gender,body mass index,fracture type,treatment method,timing of operation,preoperative hemoglobin and serum albumin level,operation time,combined medical diseases,pre-injury mobil-ityand American Society of Anesthesiology(ASA)classification were analyzed.The risk factors of death within 1 year after op-eration were screened by univariate analysis.The results were entered into the multivariate Logistic regression analysis,screen-ing the high risk factors for 1 year mortality after hip fractures.Results The mortality of super advanced age patients with hip fracture within 1 year after surgery accounted for 27.7％(92/332).Univariate analysis showed high body mass index,long in-terval from injury to surgery,low preoperative serum albumin levels,inability to walk independently before injury,accompanied by heart failure,pulmonary infection,obstructive pulmonary disease,stroke,and a higher proportion of ASA grades Ⅲ-Ⅳ.Multivariate Logistic regression analysis showed preoperative serum albumin below 30g g L-1[OR=2.973,95％CI(2.461,5.344),P=0.039],inability to walk independently before injury[OR=3.519,95％CI(2.224,5.413),P=0.018],heart function grade C-D[OR=4.213,95％CI(2.952,6.99),P=0.021],pulmonary infection[OR=3.927,95％CI(2.187,7.731),P=0.016]and ASA Ⅲ-1V[OR=5.124,95％CI(3.092,8.235),P=0.032]were the independent risk factors for death within 1 year in super advanced age patients with hip fractures.Conclusion Preoperative serum albumin below 30g.L-l,poor preinjury ac-tivity,heart function grade C-D,pulmonary infection,and ASA grade Ⅲ-Ⅳ are independent risk factors for postoperative mortality in super advanced age patients with hip fractures.

Since the implementation of drug registration in China, the classification of Chinese medicine has greatly met the needs of public health and effectively guided the transformation, inheritance, and innovation of research achievements on traditional Chinese medicine(TCM). In the past 30 years, the development of new Chinese medicine has followed the registration transformation model of " one prescription for single drug". This model refers to the R&D and registration system of modern drugs, and approximates to the " law-abiding" medication method in TCM clinic, while it rarely reflects the sequential therapy of syndrome differentiation and comprehensive treatment with multiple measures. In 2017, Opinions on Deepening the Reform of Review and Approval System and Encouraging the Innovation of Drugs and Medical Devices released by the General Office of the CPC Central Committee and the General Office of the State Council pointed out that it is necessary to " establish and improve the registration and technical evaluation system in line with the characteristics of Chinese medicine, and handle the relationship between the traditional advantages of Chinese medicine and the requirements of modern drug research". Therefore, based on the development law and characteristics of TCM, clinical thinking should be highlighted in the current technical requirements and registration system of research and development of Chinese medicine. Based on the current situation of registration supervision of Chinese medicine and the modern drug research in China, the present study analyzed limitations and deficiency of " one prescription for single drug" in the research and development of Chinese medicine. Additionally, a new type of " series prescriptions" was proposed, which was consistent with clinical thinking and clinical reality. This study is expected to contribute to the independent innovation and high-quality development of the TCM industry.
China ; Drugs, Chinese Herbal/therapeutic use* ; Medicine, Chinese Traditional ; Prescriptions ; Public Health

Objective: To compare the efficacy between laparoscopic and open proximal gastrectomy with double-tract reconstruction for Siewert type II and III adenocarcinoma of the esophagogastric junction (AEG). Methods: A retrospective cohort study was conducted. Inclusion criteria: (1) 18 to 80 years old; (2) Siewert II and III AEG was confirmed by preoperative gastroscopy and biopsy, which could not be resected by endoscopy; patients undergoing radical proximal gastrectomy with double-tract reconstruction; (3) contrast-enhanced abdominal CT staging was cT1-2N0M0; (4) Eastern Cooperative Oncology Group (ECOG) physical status score <2 points, American Association of Anesthesiologists (ASA) grade 1 to 2; (5) patients agreed to perform proximal gastrectomy and signed an informed consent. Those who had undergone neoadjuvant radiochemotherapy, suffered from serious mental diseases and had incomplete data were excluded. According to the above criteria, clinical data of 84 consecutive patients with Siewert II and III AEG undergoing surgery at General Surgery Department of The Affiliated Tumor Hospital of Zhengzhou University from October 2010 to December 2018 were collected and analyzed. Of 84 patients, 61 underwent open proximal gastrectomy with double-tract reconstruction (OPG group), while 23 underwent laparoscopic proximal gastrectomy with double-tract reconstruction (LPG group). The perioperative complications and postoperative reflux esophagitis of two groups were compared. A P-value of <0.05 was considered to be statistically significant. Results: Among 84 cases, 74 were male and 10 were female. There were 43 cases of Siewert type II and 41 cases of Siewert type III. There were no significant differences in age, gender, body mass index, comorbidities, Siewert type, and tumor staging between the two groups (all P>0.05). As compared to the OPG group, the LPG group had longer operation duration [(223±21) minutes vs. (161±14) minutes, t=15.352, P<0.001], less intraoperative blood loss [195 (150, 215) ml vs. 208 (192, 230) ml, Z=2.143, P=0.032], and shorter time to flatus [(2.8±0.7) days vs. (3.3±0.9) days, t=2.477, P=0.015]. There were no significant differences in the number of harvested lymph nodes, time to the first meal and postoperative hospital stay between the two groups (all P>0.05). Postoperative complications developed in 2 cases (8.7%, 1 case each for anastomotic leakage and intestinal obstruction) in the LPG group and 5 cases (8.2%, 1 case each for anastomotic leakage, anastomotic bleeding, and anastomotic stenosis, 2 cases of incision infection) in the OPG group (χ(2)=5.603, P=0.231). The median follow-up was 41.2 (12.8-110.5) months. One patient (1.6%,1/61) had obvious reflux symptoms in the OPG group, compared with none in the LPG group (χ(2)=0.644, P=0.422). Esophagitis occurred in 1 case (4.8%, 1/21) in LPG group, compared with 4 patients (7.1%, 4/56) in the OPG group, without significant difference between the two groups (χ(2)=0.505, P=0.477). Conclusion: Laparoscopic proximal gastrectomy with double-tract reconstruction is safe and feasible without increasing the risk of postoperative complication and reflux esophagitis.
Adenocarcinoma/surgery* ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Esophagogastric Junction/surgery* ; Female ; Gastrectomy ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms/surgery* ; Treatment Outcome ; Young Adult

Objective To summarize the clinical experience in the treatment of allogeneic lung transplantation with ABO-different donor. Methods Data of three cases of lung transplantation carried out in Tianjin First Central Hospital from August to September 2015 were retrospectively analysed. ABO blood groups were different but compatible in three donors who were with brain death, and their panel reactive antibody (PRA) and lymphocyte poison cross matching test were negative. The surgical approaches were left single-lung transplantation and sequential bilateral single-lung transplantation. After the surgery, measures for pneumonedema control, immuno suppression (mycophenolate mofetil + tacrolimus +glucocorticoids) and anti-infection (imipenem and cilastatin sodium+ micafungin sodium+ganciclovir) were carried out. Results The operation wsa completed successfully in all 3 patients, and the operative time was 5-6 hours. The cold ischemia time was less than 4 hours. The blood loss during the operation was 800-1000 mL. The trachea cannula extubation was pulled out within 24 h, thoracic drainage tube was pulled out within 72 h. All the patients were moved into general ward in 5-8 days. Patients discharged from hospital in 5 weeks after operation. Pneumonia infection occurred in 2 cases on the 6 th day after operation, and antibiotic treatment was upgraded and infection was cured after 3 weeks. All patients were followed up for 21-22 months, and 3 patients survived without serious complications such as graft rejection. Conclusion Comprehensive and effective surgical techniques, reasonable choice of donor lung and preservation method, active anti-infection strategy and triple immunosuppressive program can improve the survival rate after transplantation.

Objective To summarize the value of extracorporeal membrane oxygenation (ECMO) in right ventricular failure after heart transplantation. Methods Data of 31 cases with orthotopic heart transplantations from January 2016 to January 2018, in Tianjin First Central Hospital were retrospectively analyzed. Three patients received ECMO support because of right ventricular failure after operation.There were two males and one female in these three patients.Their ages were 52,38 and 67 years old.ECMO was performed in the heart transplantation(2 patients)and eight hours after the surgery. ECMO was established in these patients via femoral artery and femoral vein,V-A model.The mean blood flow was about 3.0 L/min.Continuous ventilator supports,low temperature sedation,anti-infection and nutrition support therapy were applied in the ECMO procedure.Results ECMO was weaned off successfully in all three patients.The time for ECMO was(144-177) h. All three patients were treated with continuous renal replacement therapy (CRRT). One patient had renal failure, the transition was given to regular dialysis after CRRT treatment, and the regular dialysis treatment after discharged from hospital.The ventilator time was(168.6±24.6)h in the three patients.The duration of staying in the intensive care unit was (31.8 ± 12.5) d. All three patients were discharged from the hospital successfully, and their cardiac function was normal. Conclusion ECMO can be used to treat right heart failure after heart transplantation,and the clinical effect is satisfactory.

Objective To evaluate the clinical efficacy and reliability of the minimally invasive treatment of patent ductus arteriosus (PDA) via the second intercostal incision on the left margin of sternum. Methods Clinical data of 31 infantile children undergoing ligation of PDA in Tianjin First Center Hospital from January 2014 to November 2017 were collected. All cases were performed operation through the second intercostal incision on the left margin of sternum. The operative process of this operation was summarized, and its clinical outcome was analyzed. Results The operation went smoothly,the length of the incision was(2.5±1.0)cm,the operation time was(1.5±0.2)h,the intraoperative bleeding was less than 5 mL,and the average length of hospital stay was(15.1±4.2)d.There were no complications such as death and massive hemorrhage in the perioperative period.The thoracic drainage tube was not needed after the operation.During the follow-up from 1 month to 4 years, catheter recanalization and aneurysm formation were undetected. Conclusion The treatment of PDA with the second intercostal incision on the left margin of sternum is safe and reliable.It has fewer complications and better long-term effect.

Objective To evaluate the clinical value of low kVp with iterative reconstruction in multislice spiral computed tomography of lumber vertebrae in young soldiers. Methods Sixty young soldiers who suffered from lumbar diseases were randomly divided into a control group(120 kVp)and a test group(100 kVp),who underwent CT examination with 120 kVp tube voltage in the control group and 100 kVp tube voltage in the test group.The control group went through filtered back projection (FBP)for image reconstruction.The test group applied FBP or sinogram-affirmed iterative reconstruction(SAFIRE)based on image reconstruction requirements,and then were divided into FBP test group and SAFIRE test group.The noise and SNR (signal to noise ratio)of the images were measured in each group.Meanwhile two experienced radiologists evaluated the quality of images.CTDIvol,DLP and ED were used to measure the scan dose in each group.Mean tube current was recorded by CARE Dose 4D.The data were analyzed with SPSS.Results There were no significant difference between the objective and subjective image evaluations in SAFIRE test group and the control group (P>0.05),while there were statistical differences between FBP test group and the control group or between the two test groups(P<0.05).The radiation doses in the test groups were both lower significantly than that in the control group,and the ED values in the test groups were decreased by 43% when compared with the control group. The test groups had the tube voltages not obviously different from that in the control group (P>0.05). Conclusion The radiation dose in the lumbar multislice spiral CT examination of young soldiers is decreased significantly when the tube voltage falls to 100 kVp,the same image quality as that by conventional 120 kVp tube voltage can be obtained by combining iterative reconstruction.

Objective to compare and contrast the diagnosis results on 2D and 3D Ultrasonogrpahy against MRI. Method A 2D Ultrasonography was applied during a conventional prenatal sonography checking with a 3D Sonography assessment subsequently conducted to follow up on 49 fetus suspected of brain malformation.Furthermore, a MRI scan was taken within 24 hours after the 3D Sonography checking in our hospital as a final test. Data collections from all three assessments were completed, and an analysis of the comparisons of these three methods were done. Results Among these 49 fetus with confirmed or suspected brain malformation, there were two cases of misdiagnoses of Dandy-Walker Malformation assessed by 2D sonography, with a misdiagnosis rate of 40％, (P ＜ 0.05) indicating a statistically significant result; misdiagnosis rate of Fetal Ventriculomegaly and Isolated Broadening Posterior Fossa were calculated as 26.7％ and 33.3％ respectively (P ＜0.05), a statistically significant result. Overall, there were two cases with Cerebellum Malformation, from in which one case was identified by MRI, and the other one was misdiagnosed, with a misdiagnosis rate of 50.0％.In total, there were 2 cases of Holoprosencephaly, in which one was identified by Prenatal MRI, and the other was misdiagnosed (P ＜ 0.05), a statistically significant result. Conclusions All three assessments of 2D ultrasonography, 3D ultrasonography and MRI have their own advantages and disadvantages. In short, 2D Sonography is suggested to be applied for screening out cases with brain malformation, together with 3D Sonography as a complementary assessment. MRI can also be an effective and significant complement for sonography in completing and readdressing the final ultrasonic results.

OBJECTIVETo study the clinical significance of P53, C-MYC and BCL-6 abnormality in the patients with diffuse large B cell lymphoma (DLBCL).

METHODSFrom July 2011 to January 2013, 80 patients with DLBCL were admitted in our hospital and were chosen as study objects, their clinical data were collected. The abnormality of P53, C-MYC and BCL-6 was examined by using I-FISH for all the patients. The correlation of abnormality of P53, C-MYC and BCL-6 with clinical staging, curative efficacy and prognosis of the patients were analyzed.

RESULTSOut of 80 patients 27 patients (33.75%) had P53 deletion, 24 patients (30.00%) had C-MYC rearrangement/amplification, and 46 patients (57.50%) had BCL-6 rearrangement. The P53 deletion, C-MYC rearrangement/amplification and BCL-6 rearrangement significantly correlated with staging, curative effect and prognosis of the patients (P < 0.05).

CONCLUSIONThe curative efficacy and prognosis of the DLBCL patients with abnormality of P53, C-MYC and BCL-6 have been confirmed to be unsatisfactory.

DNA-Binding Proteins ; genetics ; metabolism ; Humans ; In Situ Hybridization, Fluorescence ; Lymphoma, Large B-Cell, Diffuse ; diagnosis ; genetics ; metabolism ; Prognosis ; Proto-Oncogene Proteins c-bcl-6 ; Proto-Oncogene Proteins c-myc ; genetics ; metabolism ; Tumor Suppressor Protein p53 ; genetics ; metabolism