Objective:This study aimed to compare the effects of cochlear implantation（CI） on vestibular function in patients with large vestibular aqueduct syndrome（LVAS） and in patients with extremely severe deafness with normal inner ear structure. Methods:A total of 28 LVAS patients and 28 patients with normal inner ear structure who suffered from extremely severe deafness were selected. The parameters of caloric tests, bone conduction evoked cervical vestibular-evoked myogenic potentials（cVEMP）, bone conduction evoked ocular vestibular-evoked myogenic potentials（oVEMP） and video head impulse tests（v-HIT） were compared between the two groups before and after CI. The data were analyzed using SPSS 26.0 software. Results:There was no significant difference in the results of the preoperative caloric test, v-HIT, and oVEMP（P1, N1） between the LVAS group and the control group（P>0.05）. Compared to the control group, the LVAS group exhibited a shorter cVEMP P1[（13.41±0.71）ms vs （16.28±0.89）ms, P<0.000 1], shorter N1[（19.83±0.54）ms vs （28.18±1.56）ms, P<0.000 1], higher amplitude[（123.60±83.80）μV vs （73.92±79.85）μV, P=0.049 4] and higher oVEMP amplitude[（16.60±13.87）μV vs （9.96±10.47）μV, P=0.028 5] before CI. The abnormal rate of caloric test increased in both groups after CI（25.00% vs 57.14%, P=0.028 8, 32.14% vs 82.14%, P=0.000 3, respectively）. There was no significant difference in the v-HIT parameters in both groups before and after the operation. As for the LVAS group, there was no statistically significant difference in cVEMP and oVEMP induction rates before and after operation. In the control group, there was a decrease in cVEMP induction rate（96.42% vs 64.28%, P=0.005 2） and oVEMP induction rate（96.42% vs 57.14%, P=0.000 9） after CI. LVAS group showed a shorter cVEMP P1[（13.41±0.71）ms vs （10.30±0.60）ms, P<0.000 1]; shorter cVEMP N1[（19.86±0.53）ms vs （18.97±1.33）ms, P=0.004 7]; decreased amplitude[（124.50±84.86）μV vs （64.35±61.57）μV, P=0.001 0] and shorter oVEMP amplitude[（15.92±13.03）μV vs （9.16±9.20）μV, P=0.009 9] after CI. The oVEMP N1 in the control group was longer than that before operation[（11.73 ± 0.91）ms vs （13.35 ± 2.60）ms, P=0.019 6], whereas there was no significant difference in other VEMP parameters after CI. Conclusion:Before CI, there was no significant difference in the results of the caloric test and v-HIT between the LVAS group and the control group, but the LVAS group exhibited increased sensitivity to acoustic stimulation-induced myogenic potentials. After CI, the function of the semicircular canal was impaired in both groups in the low-frequency area, and remained largely unaffected in the high-frequency area. Additionally, the function of the otolith in the LVAS group was less affected than that in the control group after CI, which may be related to the fact that the enlarged vestibular aqueduct of the LVAS patients acted as the third window of the inner ear.
Humans ; Vestibular Aqueduct/physiopathology* ; Cochlear Implantation ; Male ; Female ; Vestibular Evoked Myogenic Potentials ; Deafness/physiopathology* ; Child ; Adolescent ; Adult ; Young Adult ; Hearing Loss, Sensorineural/physiopathology* ; Vestibular Function Tests

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 study the changes of tinnitus after cochlear implantation in post-lingual adault recip-ients and analyze the factors that affect tinnitus.Methods A total of 47 postilingually-deafened adult subjects with tinnitus who underwent cochlear implantation at the Department of Otology,the first affiliated hospital of Zheng-zhou University,from January 2017 to December 2021.The subjects were evaluated using tinnitus handicap invento-ry(THI)and visual analogue scale(VAS)before cochlear implantation and 6 months after cochlear implant surger-y.Results Among 47 subjects who were eligible for this study,the THI scores were 36.94±13.337,14.48± 12.726,respectively,before CI and 6 months after cochlear implantation.The VAS scores were 5.13±1.676 be-fore and 2.34±1.903 after cochlear tmplantation.Statistical analysis showed significant differences in THI and VAS scores before and after cochlear implantation(P＜0.05).A total of 18 patients experienced complete tinnitus suppression,14 patients experienced alleviation of tinnitus,tinnitus remained unchanged in 13 patients,tinnitus worsened in 2 patients,and the overall efficiency was 66.0％(31/47).The tinnitus alleviation rate was signifant higher in the patients with tinnitus history of &le;5 years than the patients with tinnitus history of＞5 years(P＜0.05).There was a statistically significant difference in tinnitus alleviation between the patients with mild tinnitus and the patients with more than mild tinnitus before surgery(P＜0.001).Conclusion Cochlear implantation has an inhibitory effect on tinnitus in adults.Patients with shorter duration of the tinnitus and higher tinnitus handicap are more likely to experience tinnitus improvement after cochlear implantation.

BACKGROUND:Ankylosing spondylitis is a progressive inflammation of spinal stiffness deformity caused by tissue ossification and fibrosis.The posture of ankylosing spondylitis patients is abnormal and their activities are limited that minor injuries can lead to thoracolumbar fractures.Traditional medical image observation limits doctors'preoperative decision planning and postoperative disease prevention for ankylosing spondylitis treatment. OBJECTIVE:Based on the spinal model of ankylosing spondylitis patients before and after posterior spinal cancellous ossification osteotomy("Y"osteotomy for short),to explore the biomechanical changes of"Y"osteotomy and fixation in the treatment of ankylosing spondylitis. METHODS:Based on the preoperative and postoperative CT images of an ankylosing spondylitis patient who went to the Second Affiliated Hospital of Inner Mongolia Medical University,a three-dimensional spine model(T11-S1)before and after"Y"osteotomy(L3 osteotomy)was reconstructed in Mimics 19.0 software.A 7.5 Nm torque was applied to the top of T11 vertebral body to simulate the movement of the spine under six conditions:flexion,extension,left bending,right bending,left rotation and right rotation.Finally,the range of motion of each vertebral body,the stress of each intervertebral disc,and the stress of the screw rod system were simulated. RESULTS AND CONCLUSION:(1)After"Y"type osteotomy and posterior fixation,the range of motion of all vertebrae in the spine decreased,and the loss rate of upper vertebrae was large(L1:77.95%).(2)The maximum stress of the spinal intervertebral disc before operation occurred at the L1-L2 segment(0.55 MPa),and the maximum stress of the spinal intervertebral disc after operation occurred at the T11-T12 segment(0.50 MPa),and the stress of intervertebral disc below T12 was far less than that before operation.(3)The maximum stress of the screw rod system(166.67 MPa)occurred in the upper and middle segments of the rod body and the root of the pedicle screw.(4)In conclusion,the"Y"type posterior fixation operation enhances the stability of the spine and reduces the range of motion of the spine.The vertebral body decompression of the fixed segment is great and the stress-shielding phenomenon of the lower vertebral body is significant.The stiffness of the rod body and the stress concentration area of the pedicle screw should be strengthened to avoid the fracture of the rod caused by stress fatigue.

Objective To systematically evaluate the application efficacy of failure mode and effect analysis(FMEA)management mode in the prevention and control of healthcare-associated infection(HAI).Methods Li-terature on the application of FMEA management mode in HAI prevention and control were retrieved from PubMed,Embase,the Cochrane Library,China National Knowledge Infrastructure(CNKI),VIP Database,Wanfang Data-base,and China Biomedical Literature Database(CBM).Two researchers independently screened the literature,ex-tracted data,and conducted cross checking.Risk and quality assessments were performed on the included studies of randomized controlled trials by ROB tool,the included cohort studies were scored by Newcastle-Ottawa(NOS)scale,and Meta-analysis was conducted by RevMan 5.4 software.Results A total of 22 studies involving 42 815 patients were included in the analysis,with 21 784 in the FMEA management mode group and 21 031 in the control group.Meta-analysis results showed that the incidence of HAI in the FMEA management mode group was lower than that in the control group(OR=0.31,95％CI[0.24,0.40]).Compared with the conventional management mode,incidences of superficial surgical site infection(OR=0.53,95％CI[0.36,0.78]),respiratory system infec-tion(OR=0.44,95％CI[0.35,0.56]),urinary system infection(OR=0.45,95％CI[0.38,0.53]),and blood system infection(OR=0.29,95％CI[0.18,0.45])in the FMEA management mode group were all lower(all P＜0.01).Conclusion The application of FMEA management mode in HAI prevention and control can reduce the inci-dence of HAI,which should be actively promoted in hospital management.

Objective To observe the safety and efficacy of perioperative short-duration platelet membrane glycoprotein Ⅱ b/Ⅲ a receptor antagonist(GPI)in elderly patients undergoing primary percutaneous coronary intervention(PPCI)for acute ST-segment elevation myocardial infarction(STEMI)with high thrombotic burden.Methods A total of 140 elderly patients with acute STEMI admitted to our department from October 2021 to January 2024 were recruited and ran-domly divided into experimental group(short duration)and control group(standard duration),with 70 cases in each group.The occurrence of MACE,complete rate of ST segment resolution 2 h after surgery,blood flow classification thrombolysis in myocardial infarction(TIMI),left ventric-ular ejection fraction(LVEF),N-terminal pro-B-type natriuretic peptide(NT-proBNP),inhibition of platelet aggregation(IPA)by thromboelastography(TEG),maximum amplitude of adenosine diphosphate receptor pathway(MAADP),platelet-related indicators,and incidences of thrombocy-topenia and bleeding events were observed in the 2 groups after operation.Results There were no significant differences in postoperative recurrence of angina pectoris,acute heart failure,malignant arrhythmia,rate of ST segment resolution,TIMI blood flow grade 3,no reflow,LVEF,NT-proBNP level before discharge,and incidences of severe hemorrhage and thrombocytopenia during hospi-talization between the two groups(P＞0.05).The experimental group had significantly lower IPA[(76.1±15.3)％vs(96.3+19.4)％,P=0.016]and higher MAADP(45.6±8.2 mm vs 26.7±9.7 mm,P=0.028)in 18 h after operation,and lower incidence of minor bleeding(7.1％vs 24.3％,P＜0.05)during hospitalization when compared with the control group.Conclusion Under the premise of using a novel oral purinergic receptor P2Y12 inhibitor,short-term GPI is not inferior to the standard time course in achievement of IPA,with similar efficacy and relatively better safety.

To investigate the effect of inactivated new tu-berculosis vaccine strain(B/R strain)on immune memory of T lymphocytes in mice,C57BL/6 mice were immunized with PBS,BCG strain,B/R strain and inactivated B/R strain.At week 9,12 and 15 after immunization,the spleens of each group were taken,and the spleen lymphocytes were extracted.Half of the spleen lymphocytes in each group were directly de-tected,and the rest were cultured in vitro and stimulated with PPD according to the experimental design.Flow cytometry was used to detect the number of central memory T cells(TCM)and effector memory T cells(TEM)in spleen lymphocytes of uns-timulated and stimulated mice.Without PPD stimulation after immunization,the CD4+TCM(F=13.20,P＜0.05)and CD4+TEM(F=28.15,P＜0.05)induced by inactivated B/R group,B/R group and BCG group was higher than that of PBS group at week 9.The induced CD8+TCM(F=8.92,P＜0.05)and CD8+TEM(F=6.13,P＜0.05)was higher than that of PBS group.At week 12,the CD4+TCM(F=15.97,P＜0.05)and CD4+TEM(F=13.60,P＜0.05)induced by each group was higher than that of PBS group.The induced CD8+TCM(F=5.52,P＜0.05)and CD8+TEM(F=20.15,P＜0.05)was higher than that of PBS group.At week 15,the CD4+TCM(F=15.40,P＜0.05)and CD4+TEM(F=7.43,P＜0.05)induced by each group was higher than that of PBS group.The induced CD8+TCM(F=6.57,P＜0.05)and CD8+TEM(F=9.27,P＜0.05)was higher than that of PBS group.At week 9,the CD4+TCM(F=9.66,P＜0.05)and CD4+TEM(F=11.20,P＜0.05)induced by inacti-vated B/R group,B/R group and BCG group was higher than that of PBS group.The induced CD8+TCM(F=7.24,P＜0.05)and CD8+TEM(F=9.30,P＜0.05)was higher than that of PBS group.At week 12,the CD4+TCM(F=9.33,P＜0.05)and CD4+TEM(F=6.94,P＜0.05)induced by each group was higher than that of PBS group.The induced CD8+TCM(F=67.71,P＜0.05)and CD8+TEM(F=10.86,P＜0.05)was higher than that of PBS group.At week 15,the CD4+TCM(F=39.88,P＜0.05)and CD4+TEM(F=11.93,P＜0.05)induced by each group was higher than that of PBS group.The induced CD8+TCM and CD8+TEM(F=38.47,P＜0.05)was higher than that of PBS group(F=138.80,P＜0.05).It is worth noting that at week 15,the CD8+TCM(qinactivated B/R=12.24,qB/R=12.61,P＜0.05)and CD8+TEM(qinactivated B/R=7.19,qB/R=5.00,P＜0.05)induced by inactivated B/R group and B/R group were higher than those of BCG group.The immunizing mice with inactivated B/R strain,the ability of inducing immune memory of T lymphocytes in mice was equivalent to that of B/R strain.Heat-inacti-vation did not affect the ability of B/R strain to induce immune memory in mice.