ObjectiveTo evaluate the application effect of morphology driven preparation technique in indirect restoration of posterior teeth. Methods84 patients with dental defects were selected and divided into the control group and the experimental group randomly， with 42 patients in each group （a total of 84 teeth）. Traditional preparation and morphology driven preparation techniques were used to complete dental preparation and adhesive glass ceramic restorations， respectively. The satisfaction， masticatory function， World Dental Federation （FDI） Scores for edge fracture and fixation，edge adaptability index，periodontal bleeding index （BI） and plaque index （PLI） of the two groups of patients were evaluated and various indicator data were recorded and statistically analyzed at 3 and 6 months after restoration completion. ResultsThere was no statistically significant difference in satisfaction between the two groups after 3 and 6 months of repair； Both groups of data showed a significant improvement in masticatory function. There was no statistical difference after 3 and 6 months of repair. However， a statistically significant difference in masticatory function was noted after 6 months of repair compared with before and after 3 months of repair. As the repair time increased， the masticatory effect improved significantly. There was no statistically significant difference in the edge fracture and fixation index between the two groups at 3 months after repair， but there was a statistically significant difference between the two groups at 6 months with the experimental group outperforming the control group（P<0.05）. The edge adaptability， BI， and PLI index were statistically significant between the two groups after 3 and 6 months of repair and the experimental group had a significant advantage （P<0.05）. ConclusionBoth types of tooth preparation techniques can improve patient masticatory function and reach high satisfaction after repair. However， morphology driven preparation technique has significant advantages in edge adaptability， edge fracture and fixation index scores and improve periodontal conditions. This technique is an effective method for improving dental preparation in adhesive indirect restoration of posterior teeth.

Refractory inner ear disease refers to a spectrum of inner ear diseases that fail to achieve good therapeutic effects even after standardized treatment recommended by existing clinical practice guidelines. This disease spectrum is characterized by diverse etiological factors, high phenotypic heterogeneity, unclear subtype characteristics, unknown pathogenic mechanisms, and variable prognosis, making it difficult to define precisely. Refractory inner ear disease accounts for a significant proportion of the total population with inner ear diseases and has not been systematically summarized, refined, and deeply studied to date. This article, for the first time, clearly proposes the concept, definition, and scope of refractory inner ear disease, and elaborates on the current research status, challenges, and coping strategies for refractory inner ear disease. With the development and progress of science and technology, we believe that in the future we will witness more innovative technologies and new drugs applied to the treatment of refractory inner ear disease, bringing hope of cure to patients.
Humans ; Labyrinth Diseases/therapy*

Objective:To investigate the clinical features, imaging characteristics, surgical strategies, and therapeutic outcomes of otitis media complicated with inflammatory response of local meninges.Methods:A retrospective analysis was conducted on the clinical data of 8 patients with chronic suppurative otitis media complicated with inflammatory response of local meninges, treated by the Department of Otolaryngology, Head and Neck Surgery, PLA General Hospital from 2019 to 2023. Appropriate surgical strategies were selected based on the patient′s clinical manifestations, imaging characteristics, extent of lesions, and facial nerve function. Follow-up was performed postoperatively to assess the therapeutic outcomes.Results:Among the eight patients, there were six males and two females, with an average age of (55.9±12.6) years old. The primary clinical manifestations included otorrhea, hearing loss, facial paralysis, earache, headache, and fever. All patients had a history of chronic suppurative otitis media and tympanic membrane perforation, with varying degrees and types of hearing loss. Seven patients presented with peripheral facial palsy preoperatively, with the House-Brackmann (H-B) grading scale as follows: 4 cases (4/7) in grade Ⅳ, 1 case (1/7) in grade Ⅴ, and 2 cases (2/7) in grade Ⅵ. The mean duration of otorrhea and/or hearing loss was (24.68±12.18) years, while, the average duration of severe headache, aggravated otorrhea and facial paralysis was (2.73±3.92) months. Preoperative high-resolution CT scan of the temporal bone revealed soft tissue shadow in the middle ear and mastoid process, with partial defects in the mastoid cortex. Cranial MRI T1WI showed high signal in the meninges on the affected side, with contrast-enhanced MRI indicating localized meningeal thickening. Four patients (4/8) had diabetes mellitus, and 2 patients (2/8) had a history of middle ear/mastoid surgery. All patients underwent surgical treatment, including thorough removal of lesions, adequate drainage, and facial nerve decompression. Tympanoplasty and hearing reconstruction were performed when conditions permitted. Specifically, 5 patients underwent intact canal wall radical mastoidectomy with facial nerve decompression and tympanoplasty, 2 patients underwent canal wall down mastoidectomy with facial nerve exploration decompression, and 1 patient underwent modified radical mastoidectomy. Postoperatively, patients experienced significant relief and gradual disappearance of ear and head pain. The postoperative H-B grading scale of facial nerve function was as follows: 4 cases in grade Ⅰ (4/8, including 1 case without preoperatively facial palsy), 2 cases (2/8) in grade Ⅱ, and 2 cases (2/8) in grade Ⅲ. Postoperative cranial MRI showed a significant reduction in localized meningeal thickening on the affected side.Conclusions:Patients with long-term chronic suppurative otitis media and/or cholesteatoma who suddenly presented with headache, fever, aggravated otorrhea, and facial paralysis should be suspected of having inflammatory response of local meninges. High-resolution CT of temporal bone and cranial MRI provide crucial diagnostic information. Early surgical exploration and thorough lesion removal are effective treatment methods.

Acute lateral ankle sprain (ALAS) is one of the most common sport injuries, with high incidence, recurrence and disability rates. Currently, exercise rehabilitation-based non-surgical treatment is the primary management approach for ALAS. However, there remain improper practices such as excessive immobilization or uncontrolled activity, which contribute to recurrent sprains and chronic ankle instability, significantly impairing patients′ athletic function and quality of life. To standardize the non-surgical management of ALAS, improve the cure rates, and reduce the recurrence and disability rates, Chinese Sports Rehabilitation Medicine Training Project of Chinese Medical Association, Foot and Ankle Basics and Orthopedics Group, Orthopedic Branch of Chinese Medical Doctor Association, and Sports Medicine Branch of Jiangsu Medical Association organized relevant experts to formulate Expert consensus on non-surgical treatment for acute lateral ankle sprain ( version 2025), following the principles of scientific vigor, practicality, and innovation. Thirteen recommendations were proposed for standardized treatment protocols across different healing phases, aiming to provide references for standard management of ALAS and improve the therapeutic outcomes.

Objective: To analyze the risk factors of recurrence after transurethral resection of bladder tumor (TURBT) in patients with non-muscle-invasive bladder cancer (NMIBC)，and establish a risk prediction model，so as to optimize the clinical detection and management of NMIBC. Methods: A total of 174 patients with initial diagnosis of NMIBC who underwent TURBT in the First Affiliated Hospital of Xinjiang Medical University during Jan.2020 and Oct.2022 were followed up for 24 months，and were then divided into the recurrence group (n=74) and non-recurrence group (n=100).After univariate analysis and multivariate logistic regression，risk factors of recurrence were identified，a nomogram was established，and the calibration curve was plotted，which was verified with receiver operator characteristic (ROC) curve. Results: The 2-year recurrence rate was 42.53%.Logistic regression showed high body mass index (BMI)，poor differentiation，multiple tumors，and tumor diameter greater than 3 cm were risk factors of recurrence (P<0.05，OR≥1)，while immediate postoperative intravesical instillation was a protective factor (P<0.05).The C-index of the nomogram was 0.893 (95%CI:0.851-0.938)，the area of ROC curve (AUC) was 0.894 (95%CI：0.847-0.941)，the sensitivity was 82.4%，and the specificity was 83.0%. Conclusion: The prediction model based on BMI，tumor stage，grade，number，diameter，and immediate postoperative intravesical instillation fits well and can provide reference for predicting the risk of tumor recurrence.

Objective: To investigate the coexistence of comorbidity of myopia, overweight/obesity and depressive symptoms among middle school students in Quzhou and its associated factors, so as to provide evidence for integrated prevention and control of common multiple health issues in students. Methods: From September to November 2023, a total of 5 867 middle school students from 6 counties (cities and districts) in Quzhou City were selected by stratified random cluster sampling. Physical and visual examinations were conducted, and the Center for Epidemiological Studies - Depression Scale (CES-D) along with a questionnaire on health status and influencing factors were completed. Multivariate Logistic regression was used to analyze the related factors of coexistence of myopia, overweight/obesity, and depressive symptoms among middle school students, and a nomogram model was constructed based on the results. Results: A total of 161 middle school students in Quzhou City were identified as having comorbid myopia, overweight/ obesity and depressive symptoms, with a detection rate of 2.74%. The results of multivariate Logistic regression analysis showed that the coexistence of myopia, overweight/obesity and depressive symptoms increased among middle school students with older age ( OR =1.11), a greater number unhealthy dietary behaviors (1,2,≥3; OR =2.40, 2.70, 4.63), insufficient sleep( OR =1.78) and alcohol consumption ( OR =2.11)(all P <0.05). Compared with no homework after class, those whose homework duration after class was 1 to < 2 hour had a lower risk of comorbidity of myopia, overweight/obesity and depressive symptoms ( OR =0.53, P <0.05). The results of the nomogram model showed that the AUC (95% CI ) was 0.71 (0.67-0.74). Conclusions The coexistence of myopia, overweight/obesity and depressive symptoms among middle school students in Quzhou City is related to age, sleeping, alcohol consumption, poor dietary behavior and the duration of after school homework. The nomogram model can assist in the early screening and intervention of multiple health issues among students.

Objective To explore the factors influencing the occurrence of sarcopenia following esophageal cancer surgery and to as-sess the association between skeletal muscle fat infiltration and postoperative sarcopenia.Methods The retrospective study analyzed clin-ical data from patients who underwent radical esophagectomy in the Department of Thoracic Surgery at the Second Hospital of Lanzhou Uni-versity between January 2020 and December 2022.Based on whether the postoperative loss of skeletal muscle area exceeded 10％,pa-tients were categorized into a sarcopenia group(n=50)and a non-sarcopenia group(n=69).General clinical information,periopera-tive data,and imaging findings were collected.Statistical analyses were performed using R version 3.1.4,and cutoff values were deter-mined by receiver operating characteristic(ROC)curve analysis.Results There were statistically significant differences between the sar-copenia and non-sarcopenia groups in terms of postoperative chemotherapy,lymphocyte count,skeletal muscle area,skeletal muscle in-dex,prognostic nutritional index,and intramuscular fat content(P＜0.05).At the level of the third lumbar vertebra,intramuscular fat content was significantly correlated with the rate of postoperative skeletal muscle loss(r=0.21,P＜0.05),but showed no correlation with the preoperative skeletal muscle area(r=-0.07,P=0.45).Multivariate Logistic regression analysis revealed that preoperative in-tramuscular fat content,skeletal muscle index,and postoperative chemotherapy were independent predictors of postoperative sarcopenia.ROC curve analysis indicated that a cutoff value of-0.647 for preoperative intramuscular fat content at the third lumbar vertebra provided the optimal predictive efficacy for postoperative sarcopenia in esophageal cancer patients[area under the curve(AUC)=0.630,sensitivi-ty=80.00％,specificity=47.80％].Conclusions The degree of skeletal muscle fat infiltration at the L3 level is significantly associat-ed with the development of postoperative sarcopenia in patients with esophageal cancer.Early nutritional support and rehabilitation training in patients with high fat infiltration may help prevent the occurrence of postoperative sarcopenia.

Objective:To analyze the incidence and risk factors of ocular surface disease among power grid construction workers in plateau.Methods:A total of 11 132 construction personnel from the Ngari prefecture-central Tibet power grid interconnection project were included from 2019 to 2020.Baseline characteristics including age, gender, body mass index, developmental and nutritional status, relevant clinical indicators, etc.and follow-up data regarding incidence of ocular surface diseases were obtained from the medical records of Ali interconnection project staff medical station.The altitude of workplace and residence of the study population were obtained from the website (https: //zh-cn.topographic-map.com/legal/).The mean age of the subjects was (36.17±10.48) years, of which 95.33%(10, 612 subjects) were male.The median follow-up time was 1.53 years.The altitude of the residence and workplace were (1 954.77±940.64) and (4 535.09±232.71) meters, respectively.The incidence of ocular surface diseases in groups with different characteristics was calculated.Differential variables for the incidence of ocular surface diseases were screened by univariate Cox proportional hazards regression model.Influencing factors of ocular surface diseases multivariate were explored by Cox proportional hazards model.This study was approved by the Ethics Committee of Peking University Health Science Center (No.IRB00001052-21066).Results:During the follow-up period, the incidence of ocular surface disease was 9.27% (1 032 cases), and the incidence of conjunctivitis and keratitis was 6.58% (733 cases) and 1.80% (200 cases), respectively.Multivariate Cox proportional hazards regression analysis showed that for every 1 000 meters increase in altitude of residence, the risk of ocular surface disease decreased by 15% ( HR[95% CI]: 0.85[0.80~0.91], P<0.001).For every 100 meters increase in altitude of workplace, the risk of ocular surface disease increased by 5% ( HR[95% CI]: 1.04[1.01~1.07], P=0.006).Decreased blood oxygen saturation ( HR[95% CI]: 1.09[1.02~1.16], P=0.007), hearing pulmonary dry rales (hazard ratio ( HR)[95% CI]: 1.53[1.12~2.09], P=0.007) and heart murmurs ( HR[95% CI]: 4.44[1.43~13.83], P=0.010) were associated with ocular surface disease. Conclusions:The incidence of ocular surface disease in personnel engaged in electric grid construction at high altitudes should not be ignored.High working altitude, low residence altitude, pulmonary dry rales, heart murmurs and low blood oxygen saturation are factors associated with the incidence of ocular surface disease.

Objective:To analyse the role of economic toxicity on anxiety symptoms in maintenance hemodialysis (MHD) patients, in order to provide reference for reducing anxiety symptoms and improving mental health literacy in MHD patients.Methods:This was a cross-sectional survey. A convenience sampling method was used to select MHD patients from Hangzhou Second People's Hospital Affiliated to Hangzhou Normal University and Deqing Hospital Affiliated to Hangzhou Normal University as the study subjects. The General Information Questionnaire, Economic Toxicity Composite Rating Scale, Family Resilience Questionnaire, Chronic Disease Management Self-Efficacy Scale, Social Support Rating Scale, and Self-rating Anxiety Scale were applied.The pathway of economic toxicity on anxiety symptoms in MHD patients was analyzed by AMOS26.0.Results:A total of 290 questionnaires were distributed, and 274 valid questionnaires were collected, with an effective response rate of 94% (274/290). Among the patients, there were 153 males and 121 females, aged (62.35 ± 12.57) years. The patients' economic toxicity score was (23.07 ± 5.36) points and anxiety symptom score (54.65 ± 17.31) points. The structural equation model was well fitted with χ2/ df=1.452, root mean square error of approximation was 0.041,goodness-of-fit index was 0.946,comparative fit index was 0.982, incremental fit index was 0.983, Tucker-Lewis index was 0.978. The results of the path analysis showed that economic toxicity in patients with MHD directly predicted anxiety symptoms, with an effect size of 36.4%; self-efficacy, family resilience, and social support played a significant role in the pathway between economic toxicity and anxiety symptoms pathways, with effect sizes of 23.4%, 27.4%, and 12.8%, respectively. Conclusions:Economic toxicity and anxiety symptoms in MHD patients are at risk values, and economic toxicity can directly affect anxiety symptoms, or indirectly through the mediating role of self-efficacy, family resilience, and social support.

Objectives:To evaluate the outcomes of cochlear implantation in prelingually deafened late-implanted patients with regular cochlear implant use and to analyze the influencing factors of rehabilitation effects.Methods:This before-after self-controlled study design included 60 subjects, comprising 36 males and 24 females, who had received cochlear implantation at Chinese PLA General Hospital. Post-implantation, all patients demonstrated continuous and regular use of cochlear implants (≥8 hours daily). Rehabilitation outcomes were evaluated by using the Categories of Auditory Performance scale (CAP), Meaningful Auditory Integration Scale (MAIS), Speech Intelligibility of Rating scale (SIR), Meaningful Use of Speech Scale (MUSS) and speech recognition score (SRS) in 2018 and 2023. 9 potential risk factors were analyzed by univariate analysis with SPSS 25.0. The influencing factors associated with outcomes were evaluated through multivariate logistic regression.Results:Longitudinal data of 60 participants followed-up in 2018 and 2023 were analyzed. The average duration of cochlear implant use for all patients was (11.3±3.0) years. The mean score of CAP, SIR and MUSS improved significantly over time. The mean CAP score before surgery was (1.0±0.9). From 2018 to 2023, the mean CAP score improved from (5.1±1.4) to (5.9±1.6), with a statistical significance ( P<0.01); the mean SIR score before surgery was (1.3±0.5), and the mean SIR score improved from (2.7±1.1) to (3.2±1.3), with a statistical significance ( P<0.01); the mean MUSS score increased from (16.8±9.7) to (21.1±10.9) between the two follow-ups, with a statistical significance ( P<0.01); the MAIS was only initiated in the 2023 follow-up, with a mean score of (31.0±10.2). The speech recognition score for monosyllabic words increased from (23.9±16.0)% to (25.2±13.0)%, with no statistically significant difference ( P=0.66). Preoperative residual hearing significantly predicted rehabilitation outcomes at univariate analysis ( P<0.05), but the statistical significance was lost at multivariate analysis ( P>0.05). Age at implantation was identified as an independent predictive factor by both univariate and multivariate analysis (Hazard Ratio, 0.88; 95% Confidence Interval 0.79-0.97; P=0.014). The cut-off point for predicting further rehabilitation effects was 19.2 years old. In the correlation analysis of different scales, the CAP score was positively correlated with the total score of MAIS. So were the SIR score and the total score of MUSS. Conclusions:For prelingually deafened late-implanted patients with regular CI use, there was still potential for further improvement of auditory and speech abilities even after 10 years post-implantation. Age at implantation was an independent predictive factor and the cut-off point was 19.2 years old.