ObjectiveTo investigate the therapeutic effects of direct-acting antiviral agents (DAAs) combined regimens for hepatitis C virus (HCV) patients in Dehong Prefecture, Yunnan Province from 2022 to 2024, to analyze the characteristics of treatment failure patients, so as to provide a basis for discovering more effective treatment regimens in the future. MethodsData on HCV prevention and treatment in Dehong Prefecture was extracted from the China Disease Control and Prevention Information System. A total of 617 patients with HCV antiviral therapy were included, and the differences in variable characteristics among patients with different genotypes were analyzed using comparative statistical tests, including basic socio-demographic characteristics, biochemical testing indicators, and information on previous treatment and current treatment. In addition, the cure rate of HCV patients with diverse characteristics was compared, and the potential causes of treatment failure were explored simultaneously. ResultsThe cure rate of HCV was 96.8%, and statistically significant differences were observed in aspartate transaminase (AST) and alanine transaminase (ALT) levels, previous antiviral therapy history and initial treatment regimens among patients with different HCV genotypes (all P<0.05). Among the multi-type combination regimens, the cure rate of sofosbuvir (SOF)-containing regimens was 97.00%, that of velpatasvir (VEL)-containing regimens was 95.45%, and the cure rate of other treatment regimens, including the regimens with ribavirin (RIB) intervention, was 93.10%. Among the patients with treatment failure, 45.00% had genotype 3, 40.00% had abnormal abdominal ultrasound results, and all presented with elevated baseline AST test levels. ConclusionThe clinical treatment of HCV patients should consider the differences in genotype and biochemical test results. DAAs combined regimens for HCV have achieved a high cure rate in Dehong Prefecture and are applicable to HCV patients with diverse clinical characteristics, providing research evidence for wider application.

Objective:To analyze the efficacy of unilateral arytenoid chondroplasty combined with minimally invasive mucosal flap plasty in the management bilateral vocal cord paralysis.Methods:A total of 66 patients with bilateral vocal cord paralysis hospitalized in the First Hospital of Sun Yat-sen University from January 2018 to December 2023 were retrospectively analyzed, among whom there were 8 males and 58 females, with ages ranging from 35 to 86 years old(mean age (57.8±11.6) years). All patients underwent suspension laryngoscopic CO 2 laser unilateral arytenoid chondroplasty and mucosal flap under general anesthesia. Postoperative follow-up period extended from 6 months to 6 years, with a median duration of 28 months. The study compared the degree of dyspnea and voice quality (subjective and objective evaluation) of the patients pre- and post-operatively, and analyzed the clinical differences between patients with and without preoperative or intraoperative tracheotomy, the extubation rate of tracheotomized patients, the recurrence rate, and the complication rate. Continuous variables conforming to normal distribution were tested by t-test and categorical variables by χ2 test,the Wilcoxon rank-sum test was used to analyze the improvement in dyspnea before and after surgery. Results:Compared with the preoperative period, 59 patients showed improvement in postoperative dyspnea ( U=161.5, P<0.01); there was no significant difference in voice disorder index 10, subjective auditory-perceptual assessment, and maximal vocalization time ( P>0.05), all of which remained within the relative normal range. Tracheotomy was performed in 32 out of 66 patients, with predominantly degree Ⅲ- dyspnea (46.9%, 15/32), including 26 patients with preoperative tracheotomy and 6 patients with intraoperative tracheotomy. Among the 34 patients who did not undergo tracheotomy, the majority presented with degree Ⅱ-dyspnea (82.4%, 28/34). All patients achieved successful extubation following surgery, with a mean median time to extubation of 1 month. Conclusions:The combination of unilateral arytenoid chondroplasty and minimally invasive mucosal flap plasty represents a refined and effective therapeutic approach for bilateral vocal cord paralysis. This minimally invasive technique has the potential to reduce the rate of tracheotomy.

【Objective】 To investigate the practice and benefit of national standardized management of type 2 diabetes in Yulin City. 【Methods】 We recruited the adult type 2 diabetes patients who sought medical help at our hospital from May 2020 to October 2022 as subjects. We collected their basic information (sex and age); measured height, weight, waist and hip circumference, and blood pressure; calculated body mass index (BMI); and detected blood glucose, c-peptide, HbA1c, biomarkers, urinary microalbumin, sensory nerve conduction velocity of lower limbs, ABI, and subcutaneous and visceral fat at the time of MMC recruited and the end of six months. T test and Mann-Whitney U rank sum test were used for measurement data and χ² test or Fisher’s exact probability method for counting data to analyze the data. 【Results】 After 6 months, the levels of fasting blood glucose, postprandial blood glucose, HbA1c, and visceral and subcutaneous fat in all the patients decreased, but the level of fasting c-peptide increased compared with the baseline (all P<0.05). Secondly, compared with the baseline, the control rate of HbA1c (35.21% vs. 13.71% ) and the comprehensive control rate (13.97% vs. 7.26% ) were both significantly increased at six months (P<0.05). Thirdly, after 6 months, the levels of fasting blood glucose, postprandial blood glucose, HbA1c, TG, TC, and UA were decreased more, while the fasting c-peptide and postprandial c-peptide were increased more in the patients of the HbA1c standard group (HbA1c<7% ) than those of the non-standard group. 【Conclusion】 The multiple benefits of blood glucose, blood lipid, uric acid and islet function can be achieved by taking type 2 diabetes patients into MMC. Meanwhile, the rates of HbA1c control and comprehensively reaching the standard are significantly increased. Therefore, MMC can explore a new way for the management of type 2 diabetic patients in this area.

Extracellular vesicles (EVs) have recently received much attention about the application of drug carriers due to their desirable properties such as nano-size, biocompatibility, and high stability. Herein, we demonstrate orange-derived extracellular vesicles (OEV) nanodrugs (DN@OEV) by modifying cRGD-targeted doxorubicin (DOX) nanoparticles (DN) onto the surface of OEV, enabling significantly enhancing tumor accumulation and penetration, thereby efficiently inhibiting the growth of ovarian cancer. The obtained DN@OEV enabled to inducement of greater transcytosis capability in ovarian cancer cells, which presented the average above 10-fold transcytosis effect compared with individual DN. It was found that DN@OEV could trigger receptor-mediated endocytosis to promote early endosome/recycling endosomes pathway for exocytosis and simultaneously reduce degradation in the early endosomes-late endosomes-lysosome pathway, thereby inducing the enhanced transcytosis. In particular, the zombie mouse model bearing orthotopic ovarian cancer further validated DN@OEV presented high accumulation and penetration in tumor tissue by the transcytosis process. Our study indicated the strategy in enhancing transcytosis has significant implications for improving the therapeutic efficacy of the drug delivery system.

Objective:To explore the predictive factors associated with the pregnancy outcome for poor ovarian response (POR) patients, and to establish Nomogram prediction model to evaluate the probability of the live birth of POR patients.Methods:The clinical data of 2667 patients who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment in the Center of Reproductive Medicine, the First People's Hospital of Shangqiu and the First Affiliated Hospital of Xinjiang Medical University from February 1, 2015 to February 28, 2019 were retrospectively analyzed by a cohort study. Logistic regression was used to screen out the independent predictive factors on the pregnancy outcome of IVF/ICSI in poor ovarian reserve patients, which was the model enrollment variable, and the Nomogram model was established according to the regression coefficient of the relevant variables. The prediction accuracy of the pregnancy outcome nomogram model was evaluated by calculating the receiver operating characteristic (ROC) curve and the area under the curve (AUC). Results:Multivariate logistic regression analysis showed that female age ( OR=0.876, 95% CI=0.849-0.902, P<0.001), antral follicle count (AFC) ( OR=1.283, 95% CI=1.133-1.463, P<0.001), total dosage of gonadotropin (Gn) used ( OR=1.002, 95% CI=1.001-1.004, P<0.001), duration of Gn used ( OR=0.786, 95% CI=0.636-0.963, P=0.018), No. of M II oocytes ( OR=0.842, 95% CI=0.712-0.985, P=0.033) and No. of transferable embryos ( OR=2.052, 95% CI=1.762-2.403, P<0.001) were independent predictive factors of live birth. According to the independent predictive factors, the prediction model of pregnancy outcome of POR patients was established, and the AUC of the modeling group was 0.894(95% CI=0.879-0.909), the AUC of the validation group was 0.902(95% CI=0.896-0.912), indicating good model compliance. Conclusion:Age, AFC, total dosage of Gn used, duration of Gn used, No. of M II oocytes and No. of transferable embryos are independent predictive factors of the pregnancy outcome for poor ovarian reserve patients, the successful establishment of nomogram model can effectively predict the live birth for POR patients.

Objective:To explore the predictive factors associated with the pregnancy outcome for poor ovarian response (POR) patients, and to establish Nomogram prediction model to evaluate the probability of the live birth of POR patients.Methods:The clinical data of 2667 patients who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment in the Center of Reproductive Medicine, the First People's Hospital of Shangqiu and the First Affiliated Hospital of Xinjiang Medical University from February 1, 2015 to February 28, 2019 were retrospectively analyzed by a cohort study. Logistic regression was used to screen out the independent predictive factors on the pregnancy outcome of IVF/ICSI in poor ovarian reserve patients, which was the model enrollment variable, and the Nomogram model was established according to the regression coefficient of the relevant variables. The prediction accuracy of the pregnancy outcome nomogram model was evaluated by calculating the receiver operating characteristic (ROC) curve and the area under the curve (AUC). Results:Multivariate logistic regression analysis showed that female age ( OR=0.876, 95% CI=0.849-0.902, P<0.001), antral follicle count (AFC) ( OR=1.283, 95% CI=1.133-1.463, P<0.001), total dosage of gonadotropin (Gn) used ( OR=1.002, 95% CI=1.001-1.004, P<0.001), duration of Gn used ( OR=0.786, 95% CI=0.636-0.963, P=0.018), No. of M II oocytes ( OR=0.842, 95% CI=0.712-0.985, P=0.033) and No. of transferable embryos ( OR=2.052, 95% CI=1.762-2.403, P<0.001) were independent predictive factors of live birth. According to the independent predictive factors, the prediction model of pregnancy outcome of POR patients was established, and the AUC of the modeling group was 0.894(95% CI=0.879-0.909), the AUC of the validation group was 0.902(95% CI=0.896-0.912), indicating good model compliance. Conclusion:Age, AFC, total dosage of Gn used, duration of Gn used, No. of M II oocytes and No. of transferable embryos are independent predictive factors of the pregnancy outcome for poor ovarian reserve patients, the successful establishment of nomogram model can effectively predict the live birth for POR patients.

Objective:To compare the efficiency of the early-follicular phase long-acting gonadotropin-releasing hormone agonist (GnRH-a) long protocol, the mid-luteal phase short-acting GnRH-a long protocol and the gonadotropin-releasing hormone antagonist (GnRH-A) protocol in poor ovarian responders classified by Poseidon criteria, and to explore the most appropriate and effective ovarian hyperstimulation protocol in each Poseidon criteria.Methods:The clinical data from poor ovarian responders according to the Poseidon criteria who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) in the Reproductive Medicine Center of the First Clinical College of Zhengzhou University were retrospectively analyzed by a cohort study. The patients were further divided into lower age group (<35 years) and high age group (≥35 years). The data of baseline characteristics and clinical outcomes in each ovarian hyperstimulation protocol group were analyzed and compared. Results:Totally 1249 eligible subjects were recruited in the study, including 410 patients in lower age group and 839 patients in high age group. In lower age group, early-follicular phase long-acting GnRH-a long protocol was associated with higher oocyte number (5.6±3.6 vs. 4.6±3.2 vs. 2.4±1.7, P<0.001) and No. of transferable embryos (2.2±1.6 vs. 1.6±1.6 vs. 1.1±1.1, P<0.001), lower cancellation rate of embryo transfer [20.8% (33/159) vs. 39.5% (49/124) vs. 69.3% (88/127), P<0.001], higher pregnancy rate per transfer [40.9% (65/159) vs. 29.0% (36/124) vs. 15.7% (20/127), P<0.001], and higher live birth rate [31.4% (50/159) vs. 23.4% (29/124) vs. 12.6% (16/127), P<0.001] than mid-luteal phase short-acting GnRH-a long protocol and GnRH-A protocol. However, there was no significant difference in implantation rate and abortion rate among three protocols ( P>0.05). In high age group, the early-follicular phase long-acting GnRH-a long protocol was associated with higher oocyte number (3.9±2.8 vs. 3.1±2.3 vs. 2.5±1.8, P<0.001) and No. of transferable embryos (2.8±2.0 vs. 2.4±2.0 vs. 2.1±1.7, P<0.001), lower cancellation rate of embryo transfer [19.5% (60/307) vs. 28.7% (102/355) vs. 53.3% (56/105), P<0.001] than mid-luteal phase short-acting GnRH-a long protocol and GnRH-A protocol. However, there was no statistical significance in implantation rate, pregnancy rate, abortion rate and live birth rate among the three protocols ( P>0.05). Conclusion:It seems that the early-follicular phase long-acting GnRH-a long protocol was more effective in clinical outcomes than the mid-luteal phase short-acting GnRH-a long protocol and the GnRH-A protocol for young patients with POR. It is worth emphasizing that the older the patient is, the lower the live birth rate will be. The characteristics and prognosis of patients should be used to develop clinical management strategies especially for the POR crowd.

Objective:To compare the efficiency of the early-follicular phase long-acting gonadotropin-releasing hormone agonist (GnRH-a) long protocol, the mid-luteal phase short-acting GnRH-a long protocol and the gonadotropin-releasing hormone antagonist (GnRH-A) protocol in poor ovarian responders classified by Poseidon criteria, and to explore the most appropriate and effective ovarian hyperstimulation protocol in each Poseidon criteria.Methods:The clinical data from poor ovarian responders according to the Poseidon criteria who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) in the Reproductive Medicine Center of the First Clinical College of Zhengzhou University were retrospectively analyzed by a cohort study. The patients were further divided into lower age group (<35 years) and high age group (≥35 years). The data of baseline characteristics and clinical outcomes in each ovarian hyperstimulation protocol group were analyzed and compared. Results:Totally 1249 eligible subjects were recruited in the study, including 410 patients in lower age group and 839 patients in high age group. In lower age group, early-follicular phase long-acting GnRH-a long protocol was associated with higher oocyte number (5.6±3.6 vs. 4.6±3.2 vs. 2.4±1.7, P<0.001) and No. of transferable embryos (2.2±1.6 vs. 1.6±1.6 vs. 1.1±1.1, P<0.001), lower cancellation rate of embryo transfer [20.8% (33/159) vs. 39.5% (49/124) vs. 69.3% (88/127), P<0.001], higher pregnancy rate per transfer [40.9% (65/159) vs. 29.0% (36/124) vs. 15.7% (20/127), P<0.001], and higher live birth rate [31.4% (50/159) vs. 23.4% (29/124) vs. 12.6% (16/127), P<0.001] than mid-luteal phase short-acting GnRH-a long protocol and GnRH-A protocol. However, there was no significant difference in implantation rate and abortion rate among three protocols ( P>0.05). In high age group, the early-follicular phase long-acting GnRH-a long protocol was associated with higher oocyte number (3.9±2.8 vs. 3.1±2.3 vs. 2.5±1.8, P<0.001) and No. of transferable embryos (2.8±2.0 vs. 2.4±2.0 vs. 2.1±1.7, P<0.001), lower cancellation rate of embryo transfer [19.5% (60/307) vs. 28.7% (102/355) vs. 53.3% (56/105), P<0.001] than mid-luteal phase short-acting GnRH-a long protocol and GnRH-A protocol. However, there was no statistical significance in implantation rate, pregnancy rate, abortion rate and live birth rate among the three protocols ( P>0.05). Conclusion:It seems that the early-follicular phase long-acting GnRH-a long protocol was more effective in clinical outcomes than the mid-luteal phase short-acting GnRH-a long protocol and the GnRH-A protocol for young patients with POR. It is worth emphasizing that the older the patient is, the lower the live birth rate will be. The characteristics and prognosis of patients should be used to develop clinical management strategies especially for the POR crowd.

Objective:To investigate the technical points and clinical application of combined infratemporal fossa approaches (CIFA) by analyzing the clinical results with CIFA for lesions involved skull base.Methods:A retrospective study was performed on 11 patients underwent CIFA for skull base lesions dissection from December 2014 to January 2019 in the department of otolaryngology, Peking Union Medical College Hospital. There were 6 male and 5 female patients, with age range of 16-72 years old and median age of 53 years old. Five patients underwent CIFA Type B and D, and the other 6 underwent CIFA A and B. All patients were followed up regularly by CT and MRI to observe possible recurrence.Results:Among the 5 patients with CIFA Type B and D, 3 were giant cell tumor and 2 were giant cell reparative granuloma, and median maximum cross-section size was 42 mm×46 mm (range from 37 mm×18 mm to 56 mm×53 mm). Among the 6 patients with CIFA Type A and B, 4 were paraganglioma of head and neck, 1 was schwannoma of skull base, 1 was petrous cholesteatoma, and median maximum cross-section size was 43 mm×36 mm (range from 24 mm×22 mm to 63 mm×35 mm). Nine patients underwent complete resection of the tumor in the first stage. In 2 patients, the extracranial parts were removed in the first stage, and the intracranial part was removed in the second stage. Tympanum and ossicular reconstruction were done in one of the CIFA Type B and group D, and 1 year′s postoperative hearing was mild conductive hearing loss. There was no cerebrospinal fluid leakage of all patients. All the 5 patients with normal facial nerve function before surgery recovered to H-B grade Ⅰ to Ⅱ within 3 months after surgery. Among the 4 patients whose preoperative facial nerve function were grade Ⅱ, 2 recovered to grade I after surgery and the other 2 were still grade Ⅱ. For the patient whose preoperative facial nerve function was grade Ⅴ, his postoperative recovery was grade Ⅲ. There was 1 patient whose pre-operative FN function was H-B grade Ⅲ, and the post-operative FN function was grade Ⅵ due to FN resection. Except for 2 cases with cochlear involved before surgery, cochleae of the other 9 cases were preserved. The follow-up time was 14 to 58 months. No recurrence was observed in all patients.Conclusions:The CIFA can safely and completely remove the extensive lesions that invade the skull base, and the facial nerve function can be well protected and recovered intro-and post-operation. Appropriate use of combined IFA can not only achieve good exposure and complete resection of lesions, but also create conditions for functional reconstruction.

For otitis media patients with severe mucosal lesions, adhesion is the most common poor prognosis of tympanoplasty. We generally consider tympanic cavity adhesion is due to eustachian tube dysfunction and poor middle ear ventilation. The mechanism of adhesion is unclear so far, which we thought is mainly associated with wounded surface and activation of the fibrinolytic system. To solve the problem of adhesion, several materials have been used in the middle ear surgery, such as plastic sheet, silicone sheet and absorbable material. And there are some benefits. The most widely used is silicone sheet, and there are some researches focused on its thickness, shape and components to achieve better anti-adhesion effect. In this article, we will do a review for the research advances of anti-adhesion materials in tympanoplasty.