Objective:The aim of this study was to present an institution's experience with cochlear reimplantation（CRI）, to assess surgical challenges and post-operative outcomes and to increase the success rate of CRI. Methods:We retrospectively evaluated data from 76 reimplantation cases treated in a tertiary center between 2001 and 2022. Clinical features include caused of CRI, type of failure, surgical issues, and auditory speech performance were analyzed. Categorical Auditory Performance （CAP） and Speech Intelligibility Rating （SIR） scores were used to evaluate pre-and post-CRI outcomes. Our center's consecutive cohort of 1 126 patients had seven patients, while 69 patients were from other cochlear implant centers. Device failure was the most common cause of CRI（68/76）, with the remaining cases including flap complications（3/76）, magnet displacement（3/76）, secondary meningitis（1/76）, and foreign bodies around the implant（1/76）. Postoperative auditory and speech outcome improved in 31.6%（24/76） of patients, remained unchanged in 63.2%（48/76）, and decreased in CAP and SIR scores in 5.2%（4/76） of patients. Postoperatively, the seven patients with cochlear ossification and fibrosis scored lower on the overall CAP and SIR scale than non-ossification individuals, which is a significant factor in surgical success rates and auditory-speech outcomes. Conclusion:CRI surgery is a challenging but relatively safe procedure, and most reimplanted patients experience favorable postoperative outcomes. Medical complications and intracochlear damage are the main causes of poor postoperative results. Therefore, minimally invasive CI has a positive significance for reducing the difficulty of CRI surgery and improving the CI performance.
Humans ; Cochlear Implantation/methods* ; Retrospective Studies ; Cochlear Implants ; Male ; Female ; Postoperative Period ; Treatment Outcome ; Adult ; Speech ; Middle Aged ; Postoperative Complications ; Replantation ; Cochlea/surgery*

Objective:To investigate the association between blood pH measured by blood gas analysis during the first postnatal week and mortality in periviable extremely preterm infant (PEPI).Methods:This retrospective study analyzed 48 PEPIs (gestational age<24 weeks) admitted to the neonatal intensive care unit of Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University between January 2021 and December 2023. According to the clinical outcomes during hospitalization, they were divided into two groups: death group ( n=12, including deaths despite active treatment and deaths due to treatment withdrawal) and survival group ( n=36, including cured and improved cases). Blood gas pH and base excess (BE) values during the first week were collected. Mann-Whitney U test and Chi-square test (or Fisher exact test) were used to compare maternal perinatal conditions and neonatal blood pH values between the two groups. The percentiles ( P3 and P90) of blood pH and BE values were described for the survival group by age. Results:(1) Among the 48 PEPIs, four were born at 21 weeks, 11 at 22 weeks, and 33 at 23 weeks of gestation. The clinical outcomes showed a cure rate of 60.4% (29/48), improvement rate of 14.6% (7/48), mortality due to poor prognosis with treatment withdrawal of 8.3% (4/48), and mortality under active treatment of 16.7% (8/48). (2) There was statistically significant difference in the death after treatment withdrawal among the PEPIs born at 21, 22, and 23 weeks of gestation [1/4, 2/11, and 3.0% (1/33); χ2=7.41, P=0.025]. The death group had higher proportions of infants with Apgar score≤3 at 1, 5, or 10 min after birth as compared with the survival group [7/12 vs. 25.0% (9/36), χ 2=4.50; 7/12 vs.16.7% (6/36), χ 2=7.91; 5/12 vs. 5.6% (2/36), χ 2=9.42; all P<0.05]. (3) The median blood pH values in the death group were lower than those in the survival group at 1-4, and 6 d after birth [7.13 (7.06-7.24) vs. 7.25 (7.23-7.31), Z=－3.44; 7.03 (7.00-7.18) vs. 7.21 (7.16-7.24), Z=－3.07; 7.02 (7.02-7.11) vs. 7.18 (7.13-7.21), Z=－3.51; 7.14 (7.13-7.20) vs. 7.18 (7.16-7.21), Z=－2.38; 7.15 (7.13-7.19) vs. 7.19 (7.17-7.22), Z=－2.08; all P<0.05].The pH value of the deceased infants rapidly declined within three days after birth, with the median pH values at two days and three days of age both falling below 7.05. In deceased infants due to poor prognosis, the median pH value at 4-7 days of age remained consistently at or below 7.15. In the survivors, the blood pH and BE values decreased after birth and hit the bottom at 3 and 5 days of age, respectively ( P3: pH=7.10, BE=－16.10 mmol/L) before gradual recovery. Conclusions:PEPI tend to present with low blood pH during the first postnatal week. However, excessively low blood pH warrants vigilance against adverse outcomes.

Objective To investigate the impact of recent rhythmic interventions on the depth of sedation during anesthesia induction in patients undergoing general anesthesia with remazolam toluene sulfonate.Methods Patients aged 18～65 years who underwent elective surgery under general anesthesia were selected and divided into a day group(7:00～19:00)and a night group(19:00～7:00 the following day)based on the start time of anesthesia induction.Each group comprised 70 patients,further subdivided into five equal dose groups of remazolam toluene sulfonate at 0.11,0.13,0.16,0.18,and 0.22 mg/kg,with 14 patients in each subgroup.The Modified Observer's Assessment of Alertness/Sedation(MOAA/S)score and Bispectral Index(BIS)value were recorded 3 minutes post-administration,and the correlation coefficient between these two parameters was calculated.The induction dose and unit body weight dose of remazolam toluene sulfonate were documented when the MOAA/S score was≤1.Addition-ally,the induction dose of remazolam for both day and night groups as well as for patients of different genders was recorded.The half effective dose(ED50),95％effective dose(ED95),and 95％confidence interval(CI)for both the day and night groups were also calculated.Results When MOAA/S≤1,the induced dose of remazolam in the night group(12.34±3.51)mg was significantly lower than that in the day group(13.98±4.21)mg.Additionally,the dose per unit body weight of remazolam in the night group(0.20±0.049)mg/kg was also significantly lower than that in the day group(0.22±0.056)mg/kg.Statistically significant differences were observed in the ED50 and ED95 values of remazolam between the day and night groups(P<0.05).The correlation coefficient between BIS and MOAA/S was 0.902(95％CI:0.876～0.925)in the day group and 0.905(95％CI:0.879～0.929)in the night group,indicating a strong correlation between MOAA/S and BIS in both groups.However,there was no significant difference in the correlation coefficients between the two groups(P>0.05).The correlation coefficients between BIS and MOAA/S were 0.763(95％CI:0.726～0.799)in the daytime group and 0.777(95％CI:0.739～0.808)in the nighttime group.In a separate analysis,the correlation coefficients were 0.768(95％CI:0.723～0.804)for the day-time group and 0.771(95％CI:0.723～0.811)for the nighttime group.A strong correlation was observed between MOAA/S and BIS in both male and female patients during both day and night,with no significant difference in corre-lation coefficients between groups(P>0.05).However,BIS values were significantly lower in the nighttime group compared to the daytime group(P<0.05).Additionally,male patients required a higher total induced dose of rem-azolam than female patients during both day and night,with this difference being statistically significant(P<0.05).Furthermore,female patients exhibited a significant decrease in BIS values at night(P<0.05).Conclusions Recent studies have shown that circadian rhythm significantly influences anesthesia-induced sedation in patients undergoing general anesthesia with remazolam toluenesulfonate.Specifically,the sedation effect is more pronounced in nighttime procedures,and there is a notable gender difference,with female patients exhibiting better sedation outcomes during nighttime surgeries.

Objective To investigate the impact of recent rhythmic interventions on the depth of sedation during anesthesia induction in patients undergoing general anesthesia with remazolam toluene sulfonate.Methods Patients aged 18～65 years who underwent elective surgery under general anesthesia were selected and divided into a day group(7:00～19:00)and a night group(19:00～7:00 the following day)based on the start time of anesthesia induction.Each group comprised 70 patients,further subdivided into five equal dose groups of remazolam toluene sulfonate at 0.11,0.13,0.16,0.18,and 0.22 mg/kg,with 14 patients in each subgroup.The Modified Observer's Assessment of Alertness/Sedation(MOAA/S)score and Bispectral Index(BIS)value were recorded 3 minutes post-administration,and the correlation coefficient between these two parameters was calculated.The induction dose and unit body weight dose of remazolam toluene sulfonate were documented when the MOAA/S score was≤1.Addition-ally,the induction dose of remazolam for both day and night groups as well as for patients of different genders was recorded.The half effective dose(ED50),95％effective dose(ED95),and 95％confidence interval(CI)for both the day and night groups were also calculated.Results When MOAA/S≤1,the induced dose of remazolam in the night group(12.34±3.51)mg was significantly lower than that in the day group(13.98±4.21)mg.Additionally,the dose per unit body weight of remazolam in the night group(0.20±0.049)mg/kg was also significantly lower than that in the day group(0.22±0.056)mg/kg.Statistically significant differences were observed in the ED50 and ED95 values of remazolam between the day and night groups(P<0.05).The correlation coefficient between BIS and MOAA/S was 0.902(95％CI:0.876～0.925)in the day group and 0.905(95％CI:0.879～0.929)in the night group,indicating a strong correlation between MOAA/S and BIS in both groups.However,there was no significant difference in the correlation coefficients between the two groups(P>0.05).The correlation coefficients between BIS and MOAA/S were 0.763(95％CI:0.726～0.799)in the daytime group and 0.777(95％CI:0.739～0.808)in the nighttime group.In a separate analysis,the correlation coefficients were 0.768(95％CI:0.723～0.804)for the day-time group and 0.771(95％CI:0.723～0.811)for the nighttime group.A strong correlation was observed between MOAA/S and BIS in both male and female patients during both day and night,with no significant difference in corre-lation coefficients between groups(P>0.05).However,BIS values were significantly lower in the nighttime group compared to the daytime group(P<0.05).Additionally,male patients required a higher total induced dose of rem-azolam than female patients during both day and night,with this difference being statistically significant(P<0.05).Furthermore,female patients exhibited a significant decrease in BIS values at night(P<0.05).Conclusions Recent studies have shown that circadian rhythm significantly influences anesthesia-induced sedation in patients undergoing general anesthesia with remazolam toluenesulfonate.Specifically,the sedation effect is more pronounced in nighttime procedures,and there is a notable gender difference,with female patients exhibiting better sedation outcomes during nighttime surgeries.

Objective:To investigate the association between blood pH measured by blood gas analysis during the first postnatal week and mortality in periviable extremely preterm infant (PEPI).Methods:This retrospective study analyzed 48 PEPIs (gestational age<24 weeks) admitted to the neonatal intensive care unit of Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University between January 2021 and December 2023. According to the clinical outcomes during hospitalization, they were divided into two groups: death group ( n=12, including deaths despite active treatment and deaths due to treatment withdrawal) and survival group ( n=36, including cured and improved cases). Blood gas pH and base excess (BE) values during the first week were collected. Mann-Whitney U test and Chi-square test (or Fisher exact test) were used to compare maternal perinatal conditions and neonatal blood pH values between the two groups. The percentiles ( P3 and P90) of blood pH and BE values were described for the survival group by age. Results:(1) Among the 48 PEPIs, four were born at 21 weeks, 11 at 22 weeks, and 33 at 23 weeks of gestation. The clinical outcomes showed a cure rate of 60.4% (29/48), improvement rate of 14.6% (7/48), mortality due to poor prognosis with treatment withdrawal of 8.3% (4/48), and mortality under active treatment of 16.7% (8/48). (2) There was statistically significant difference in the death after treatment withdrawal among the PEPIs born at 21, 22, and 23 weeks of gestation [1/4, 2/11, and 3.0% (1/33); χ2=7.41, P=0.025]. The death group had higher proportions of infants with Apgar score≤3 at 1, 5, or 10 min after birth as compared with the survival group [7/12 vs. 25.0% (9/36), χ 2=4.50; 7/12 vs.16.7% (6/36), χ 2=7.91; 5/12 vs. 5.6% (2/36), χ 2=9.42; all P<0.05]. (3) The median blood pH values in the death group were lower than those in the survival group at 1-4, and 6 d after birth [7.13 (7.06-7.24) vs. 7.25 (7.23-7.31), Z=－3.44; 7.03 (7.00-7.18) vs. 7.21 (7.16-7.24), Z=－3.07; 7.02 (7.02-7.11) vs. 7.18 (7.13-7.21), Z=－3.51; 7.14 (7.13-7.20) vs. 7.18 (7.16-7.21), Z=－2.38; 7.15 (7.13-7.19) vs. 7.19 (7.17-7.22), Z=－2.08; all P<0.05].The pH value of the deceased infants rapidly declined within three days after birth, with the median pH values at two days and three days of age both falling below 7.05. In deceased infants due to poor prognosis, the median pH value at 4-7 days of age remained consistently at or below 7.15. In the survivors, the blood pH and BE values decreased after birth and hit the bottom at 3 and 5 days of age, respectively ( P3: pH=7.10, BE=－16.10 mmol/L) before gradual recovery. Conclusions:PEPI tend to present with low blood pH during the first postnatal week. However, excessively low blood pH warrants vigilance against adverse outcomes.

OBJECTIVE To investigate the effect of polymorphisms of solute carrier organic anion transporter family, member 1B3(SLCO1B3) gene on the pharmacodynamics of mycophenolate mofetil(MMF) in patients with lupus nephritis. METHODS Patients with lupus nephritis who were treated in Jieyang People’s Hospital from September 2019 to April 2021 were selected. All subjects were treated with MMF for at least 12 months, or discontinued due to poor efficacy. The efficacy of MMF was evaluated. The SLCO1B3 334T>G/699G>A(rs4149117/rs7311358) genotype was detected using Agena MassARRAY®, and the correlation between gene polymorphisms and MMF pharmacodynamics was analyzed using SPSS 25.0 software. RESULTS The genotype frequencies of SLCO1B3 334T>G/699G>A were in Hardy-Weinberg equilibrium. The probability of poor MMF treatment effect of 334GG/699AA carriers was significantly higher than that of 334TT/699AA and 334TG/699GA carriers(P<0.001); Logistic regression showed that both 334GG/699AA and urine protein>2.5 g·(24 h)−1 were the risk factors for poor MMF treatment[OR=4.038(1.731, 9.420), P<0.001; OR=4.157(1.705, 10.137), P=0.002]. Combined analysis showed that patients with both 334GG/699AA genotype and urine protein>2.5 g·(24 h)−1 were at higher risk for poor efficacy[OR=8.563(3.301, 22.216), P<0.001]. CONCLUSION SLCO1B3 334T>G/699G>A is related to the efficacy of MMF treating lupus nephritis, and 334GG/699AA carriers are more likely to result in poor efficacy.

Objective:To explore the high-risk factors for parenteral nutrition associated cholestasis（PNAC）in extremely/ultra-low birth weight infants，and establish a risk Alignment Diagram prediction model.Methods:We retrospectivly analyzed the clinical data of hospitalized extremely/ultra-low birth weight infants admitted to Neonatology Department at Quanzhou Children's Hospital from January 2019 to December 2020，using multivariate Logistic regression analysis to screen for independent risk factors for the occurrence of PNAC.An Alignment Diagram model prediction model for PNAC was constructed by using R software，and the performance of the model was evaluated through receiver operating characteristic curves.Results:A total of 203 extremely/ultra-low birth weight infants were included，with a median gestational age of 29.14（28.00，30.86）weeks and a median birth weight of 1　170（1　000,1　300）g.Among them，26（12.81%）cases developed PNAC.Multivariate Logistic regression analysis showed that the duration of parenteral nutrition（ OR=1.015 ，95% CI 1.003-1.034），the cumulative amount of glucose（ OR=1.014 ，95% CI 1.001-1.028），small for gestational age（ OR=3.455 ，95% CI 1.127-10.589），and neonatal sepsis（ OR=3.142 ，95% CI 1.039-9.503）were independent risk factors for PNAC（ P＜0.05）；The four independent risk factors mentioned above were introduced into R software to construct an Alignment Diagram model，the area under the receiver operating characteristic curve was 0.835（95% CI 0.842-0.731），and the results of the Hosmer Limeshow goodness of fit test show that：χ 2=5.34，degree of freedom=8， P=0.72.A calibration curve indicated good consistency between the predicted probability of the model and the actual occurrence rate，with good accuracy. Conclusion:The Alignment Diagram model constructed based on four independent risk factors of the duration of parenteral nutrition，glucose accumulation，small for gestational age infants，and neonatal sepsis exhibits high predictive ability，and is expected to provide an intuitive and convenient visualization tool for preventing or reducing the occurrence of PNAC in extremely/ultra-low birth weight infants

Objective To explore the clinical efficacy of the arthroscopic"Three Suture-Trident Star"technique in treating avulsion fractures of the distal point of the anterior cruciate ligament(ACL).Meth-ods A retrospective analysis was conducted on 46 patients undergoing the arthroscopic"Three Suture-Trident Star"technique for ACL distal point avulsion fractures between January 2019 and January 2022.The physical examinations(including stability and mobility),International Knee Documentation Committee(IKDC)scores,Tegner activity level scores,visual analogue scale(VAS)scores,postopera-tive satisfaction,complications,and return-to-sports time were compared among before the operation,as well as 6 and 12 months after the operation,respectively.Results The average age of the 46 pa-tients,26 male and 20 female,was 37.6±10.3 years.Their average follow-up period was 14.4±2.7 months.The IKDC scores before surgery and at 6 and 12 months postoperatively were 59.7±5.4,86.1±5.7,and 89.5±5.0(P<0.001),respectively,the corresponding Lysholm scores,Tegner scores and VAS scores were 56.7±5.0,84.8±4.4 and 90.6±4.2(P<0.001),0.5±0.3,4.6±1.7 and 6.6±2.1(P<0.001),as well as 7.1±1.1,1.7±1.0 and 0.7±0.8(P<0.001),respectively.Postoper-ative satisfaction was rated as excellent in 42 cases,good in 3 cases,and fair in 1,with a good-to-excellent rate of 97.8%.The physical examinations at 6 and 12 months postoperatively were of nega-tive results in the anterior drawer and Lachman tests,while the average return-to-sports time was 8.3±2.5 months.All patients had primary healing of the avulsion fractures without any postoperative com-plications such as infection,joint stiffness,displacement or loosening of the fracture block,or mal-union,and none required secondary surgery.Conclusion The arthroscopic"Three Suture-Trident Star"technique demonstrates significant clinical efficacy in treating patients with avulsion fractures of the ACL distal point,effectively restoring postoperative joint stability and function.

Mucinous adenocarcinoma of the renal pelvis is rare in clinical practice. This article reported a case of primary renal pelvis mucinous adenocarcinoma mixed with signet ring cell carcinoma. The patient was admitted to hospital due to right low back pain, and was diagnosed with right kidney stones accompanied by hydrops and infection, right kidney abscess, and nonfunctional right kidney after complete examination. Right renal puncture drainage was performed twice, followed by laparoscopic robot assisted right neprectomy. The postoperative pathological diagnosis was right renal pelvis primary mucinous adenocarcinoma (mixed with signet-ring cell carcinoma). Eleven months after the operation, regular "sodium folinate + oxaliplatin + 5-fluorouracil" chemotherapy was performed for 12 courses, and imaging showed no signs of recurrence or metastasis.