OBJECTIVE To compare the short-term efficacy of autologous frozen tragus perichondrium and fresh perichondrium in repairing tympanic membrane perforations,and to explore the clinical application value of autologous frozen tragus perichondrium.METHODS Twenty-five patients with bilateral tympanic membrane perforations from March 2021 to October 2023 were selected,including 7 males and 18 females.Bilateral tympanoplasty was completed in stages.The initial operation was set as the control group,in which the ventral perichondrium of the tragus was used for tympanoplasty,and the dorsal perichondrium of the tragus was reserved and stored at-80℃ultra-low temperature in a sterile container.The second operation was set as the observation group,in which the thawed frozen perichondrium was used for contralateral tympanoplasty.The differences in the healing rate of tympanic membrane,postoperative hearing,operation time and surgical bleeding volume were compared between the two groups.RESULTS All patients were followed up for three months.The success rate of tympanic membrane healing in the observation group was 96%(24/25),and that in the control group was 92%(23/25).There was no statistically significant difference between the two groups(χ2=0.36,P>0.05).The operation time and surgical bleeding volume of patients in the observation group were lower than those in the control group[(48.64±4.64)min vs.(67.92±5.69)min,(5.32±1.54)ml vs.(9.65±1.73)ml],and the differences were statistically significant(t=13.93,t=12.09,P all<0.05).The postoperative air conduction hearing thresholds and air-bone conduction gap of the two groups of patients were lower than those before operation(all P<0.05).There was no difference in air conduction hearing threshold,bone conduction hearing threshold and air-bone conduction difference between the groups(all P>0.05).CONCLUSION The application of autologous frozen tragus perichondrium has effectively shortened the operation time of the contralateral ear,avoided the trauma caused by taking materials again,and has the characteristics of minimally invasive and high efficiency.The method is feasible and the curative effect is accurate.

Chronic limb-threatening ischemia(CLTI)is a serious peripheral arterial disease(PAD)characterized by reduced blood flow in the limbs,resulting in tissue damage and dysfunction.Mesenchymal stem cells(MSCs)have become a research hotspot in the field of CLTI treatment in recent years due to their unique regenerative ability and immunomodulatory properties.In the environment of hypoxia and tissue injury,MSCs can promote angiogenesis,reduce inflammation and promote tissue repair by secreting cytokines,cell differentiation and inter-cellular signal transduction,so as to improve the symptoms and prognosis of patients with CLTI,showing a broad clinical application prospect.

Objective:To investigate the clinical characteristics of patients with myocardial infarction with non-obstructive coronary arteries(MINOCA)and the risk factors of major adverse cardiovascular events(MACE)within 1 year of follow-up.Methods:A total of 1 866 patients who met the diagnosis of acute myocardial infarction and underwent coronary angiography in the Department of Cardiovascular Medicine of our hospital from Sep 2018 to Sep 2021 were selected.According to the results of coronary angiography,the patients were divided into MINOCA group and myocardial infarction with obstructive coronary artery disease(MI-CAD)group.The clinical characteristics and the occurrence of MACE in the two groups were compared.According to the occurrence of MACE,patients in MINOCA group were divided into MACE group and non-MACE group.Binary logistic regression analysis was used to explore the risk factors for MACE in MINOCA patients.Results:The age of patients in MINOCA group was lower than that in MI-CAD group,and more patients were female(P＜0.05).The risk factors of cardiovascular diseases in MINOCA group were less than those in MI-CAD group(P＜0.05).Some indexes of laboratory were lower than those in MI-CAD group(P＜0.05).Left ventricular ejection fraction(LVEF)were higher than that in MI-CAD group(P＜0.05).Left ventricular end-diastolic inner diameter(LVEDD)was lower than that in MI-CAD group,and the proportion of patients with abnormal ventricular wall motion and high cardiac function grade was lower than that in MI-CAD group,and the difference was statistically significant(P＜0.05).The 1-year follow-up showed no significant difference in the incidence of MACE between the two groups(P=0.115).Binary logistic regression analysis showed that smoking(OR=13.095,95%CI:1.799-7.398)and low LVEF(OR=0.036,95%CI:0.012-0.679)were independent risk factors for MACE in MIONCA patients.Conclusions:MINOCA patients are more common in women,with lower age and fewer cardiovascular risk factors,but the incidence of MACE is not less than that of MI-CAD patients.Smoking and low LVEF are independent risk factors for MACE in MINOCA patients.

Objective:To analyze the disease characteristics, diagnosis and treatment methods of venous pulsatile tinnitus treated by intervention of sigmoid sinus.Methods:Fifty patients (from Shandong Provincial ENT Hospital, Shandong University between February 2014 and July 2020) with venous pulsatile tinnitus treated by sigmoid sinus surgery were analyzed retrospectively. The tinnitus characteristics, imaging findings, surgical methods, intraoperative findings and postoperative tinnitus changes were recorded. The patients were followed up for 6-12 months. The sign rank sum test was used to analyze the difference in tinnitus grading before and after surgery. There were 50 patients with unilateral venous pulsatile tinnitus, including 49 females and 1 male. The age ranged from 17 to 67 years, with a median age of 44 years. There were 45 cases of right tinnitus and 5 cases of left tinnitus. The degree of tinnitus before operation was grade Ⅱ or above, including 4 cases of gradeⅡ, 11 cases of grade Ⅲ, 22 cases of grade Ⅳ and 13 cases of grade Ⅴ.Results:Thirty-seven cases were cured, 8 cases were ineffective (no change in tinnitus), 3 cases were markedly effective (tinnitus grade decreased by 3 in 2 cases, 4 in 1 case), and 2 cases were effective (tinnitus grade decreased by 1). The difference of tinnitus grade before and after operation was statistically significant ( Z=-5.70, P<0.05). Temporal bone CT showed 36 cases of sigmoid diverticulum (including 17 cases with sigmoid sinus dehiscence), 12 cases of sigmoid sinus dehiscence and 2 cases of absence of the temporal bone cortex abutting to sigmoid sinus. Thirty-five cases were performed with closure of sigmoid sinus diverticulum, 4 cases were performed with resurfacing of the sigmoid plate, 5 cases were performed with narrowing of sigmoid sinus, 4 cases were performed with simple opening of pre sigmoid mastoid air chamber, 1 case of opening was performed with pre sigmoid mastoid air chamber combined with narrowing of sigmoid sinus, and 1 case was performed with opening of pre sigmoid mastoid air chamber combined with closure of sigmoid sinus diverticulum. Conclusions:Venous pulsatile tinnitus is common in women. The common causes may be sigmoid sinus wall abnormalities such as sigmoid sinus diverticulum and perisigmoid bone defect. Imaging examinations are helpful for diagnosis. Venous pulsatile tinnitus can be treated with surgery.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To investigate the safety and efficacy of the surgical strategy of reversely opening under the protection of distal thrombectomy stent on anterior circulation tandem lesions.Methods A total of 42 patients with acute ischemic stroke with anterior circulation tandem lesions receiving opening surgery from January 2018 to December 2023 were selected as the study subjects.According to the surgical strategy,the pa-tients were divided into the observation group (n=23,adopting the distant stent protection) and the control group (n=19,adopting the protective umbrella protection).The intraoperative thrombus escape rate,inci-dence rate of 24 h symptomatic intracranial hemorrhage (SICH),successful opening rate,total operation time,good prognosis rate and mortality rate on postoperative 90 d were compared between the two groups. Results All patients in the both groups were successfully opened,and the opening rate was 100％.There were no statistically significant differences in the 90 d good prognosis rate and mortality rate,SICH incidence rate at postoperative 24 h and total operation duration between the both groups (P>0.05).The thrombus distal end escape rate in the observation group was lower than that in the control group with statistically significant difference (4.3％ vs. 26.3％,P=0.043).Conclusion In the opening operation of anterior circulation tandem lesions,adopting the reverse opening surgical strategy under the distal stents protection has a lower thrombus escape rate,which is comparable to that of reverse opening under the traditional carotid artery protective um-brella in the aspects of effect and safety.

With the increasing incidence of tic disorders in children，the treatment of tic disorders in children has attracted more and more attention. Drug therapy is the main treatment method at present，but not all cases are effective to drug therapy. As a new treatment method，noninvasive neuromodulation technology has made some progress in the treatment of tic disorders in children. Studies have shown that noninvasive neuromodulation techniques can reduce the severity of tics and have less side effects. This article reviews the application of noninvasive neuromodulation techniques in children with tic disorders，in order to provide new ideas for the treatment of children with tic disorders and improve the quality of their life．

Objective:To develop an Enteral Nutrition Knowledge, Attitude and Practice Questionnaire for ICU Nurses in Prone Position Ventilation Patients, and test its reliability and validity.Methods:Based on the theory of knowledge, attitude and practice, the item pool was initially constructed through literature review, group discussions, and semi-structured interviews. The initial questionnaire was formed through two rounds of Delphi expert consultation, and the initial questionnaire items were adjusted based on semi-structured interviews. From November to December 2023, convenience sampling was used to select 254 ICU nurses from six Class Ⅲ Grade A hospitals in Henan Province to test the reliability and validity of the questionnaire. Project analysis method was used for item screening, exploratory factor analysis and expert consultation method were used to evaluate the validity of the questionnaire, and internal consistency coefficient, split half reliability, and test-retest reliability were used to evaluate the reliability of the questionnaire.Results:The Enteral Nutrition Knowledge, Attitude and Practice Questionnaire for ICU Nurses in Prone Position Ventilation Patients was divided into three levels, with a total of 7 dimensions and 30 items. The knowledge level included three dimensions and 12 items, the attitude level consisted of three dimensions and 8 items, and the practice level includes one dimension and 10 items. Exploratory factor analysis proposed 7 common factors with a cumulative variance contribution rate of 65.516%. The content validity index at the questionnaire level was 0.92, and the content validity index at the item level was 0.80 to 1.00. The overall Cronbach's α coefficient of the questionnaire was 0.874, the split half reliability coefficient was 0.813, and the test-retest reliability coefficient was 0.989.Conclusions:The Enteral Nutrition Knowledge, Attitude and Practice Questionnaire for ICU Nurses in Prone Position Ventilation Patients has good reliability and validity, and can be used as an evaluation tool for ICU nurses to assess the knowledge, attitude, and practice of enteral nutrition for prone position ventilation patients.

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OBJECTIVE: To present on a prenatally diagnosed case with complex structural rearrangements of chromosome 8. METHODS: Chromosome karyotyping, chromosomal microarray analysis (CMA) and fluorescence in situ hybridization (FISH) were carried out for a fetus with increased nuchal thickness. RESULTS: The karyotype of the amniotic fluid sample showed extra materials on 8p. FISH revealed a centromeric signal at the terminal of 8p with absence of telomeric signal. CMA revealed partial deletion of 8p23.3 [(208049_2256732)×1], partial duplication of 8p23.3p23.2 [(2259519_3016818)×3], and partial duplication of 8q [8q11.1q12.2(45951900_60989083)×3]. CONCLUSION The complex structural rearrangements of chromosome 8 in this case has differed from the commonly seen inv dup del(8p).
Female ; Pregnancy ; Humans ; Chromosomes, Human, Pair 8/genetics* ; In Situ Hybridization, Fluorescence ; Gene Rearrangement ; Prenatal Diagnosis ; Centromere