ObjectiveTo develop basic training courses for family doctor teams for people with disabilities. MethodsUtilizing the methods and theories of the World Health Organization (WHO) rehabilitation competency framework (RCF), and referring to the WHO universal health coverage global competency framework, the rehabilitation competency characteristics of family doctor teams for people with disabilities in community settings were analyzed, and a basic training course system for these teams based on the RCF was developed. Results and ConclusionBased on RCF, a competency framework for family doctor teams serving people with disabilities has been constructed. The objectives, content and training course system for basic rehabilitation training has been established.

Objective:To investigate the teaching effect of flipped classroom combined with problem-based learning (PBL) in the teaching of the Diagnostic Audiology course.Methods:A total of 72 undergraduate students majoring in audiology and speech rehabilitation in the classes of 2019 and 2020 in Chongqing Medical University were enrolled as subjects, and three chapters of the Diagnostic Audiology course were selected for teaching reform. The 34 students in the class of 2019 were enrolled as control group and received lecture-based learning (LBL), and the 38 students in the class of 2020 were enrolled as experimental group and received flipped classroom combined with PBL. The teaching effect was evaluated by comparing the two groups in terms of classroom test scores, classroom participation scores, degree of satisfaction with teaching effect, and overall satisfaction with teaching. SPSS 23.0 software was used to perform the t-test, the chi-square test, and the Mann-Whitney U test. Results:The experimental group had a significantly higher classroom test score than the control group (25.95±1.21 vs. 23.21±1.55, P<0.001). In terms of classroom participation scores, the experimental group had significantly higher scores of participation in class discussion, cooperative and collaborative abilities, and questioning skills than the control group (all P<0.001). In terms of the degree of satisfaction with teaching, compared with the control group, the experimental group had significantly higher degrees of satisfaction in the dimensions such as interest in learning, mastery of theoretical knowledge, teamwork and collaboration abilities, self-learning ability, and self-presentation ( P=0.005, 0.009, 0.001, 0.016, and 0.005). In addition, the experimental group had a significantly higher degree of overall satisfaction with teaching than the control group ( P=0.006). Conclusion:Flipped classroom combined with PBL has a good teaching effect in the Diagnostic Audiology course and thus holds promise for further application.

To explore the organ-system oriented integrated program, this project constructed a new clinical skill training program of sensory system for"5+3" medical students. According to the current trend and requirement of medical teaching reform, taking into consideration of the present status of clinical skills teaching, this project integrated the basic and clinical teaching contents of otolaryngology, ophthalmology and dermatology to design a new training program of clinical skills for"5+3"medical students. Specifically, the project group edited a new textbook and syllabus, and set up a specialized teaching group. In this system, the training models included simulation training and practical bedside training, the assessment included operation ability and analyzing ability for clinical cases, and the training contents involved all conventional skills of each specialty. It has been demonstrated that the new training program is capable of promoting the clinical skills of students quickly and effectively.

Objective: To investigate the proper time of intratympanic steroid as combination therapy in treatment of patients with profound sudden sensorineural hearing loss(SSNHL) of total frequency type. Methods: This prospective study included 50 patients with SSNHL in the First Affiliated Hospital of Chongqing Medical University from June 2017 to February 2018.All these patients had profound hearing loss averaged more than 81 dB at all frequencies (250-8 000 Hz). They were divided into two groups.The patients in group A were treated with simultaneous oral prednisone (1 mg/kg, qd) and intratympanic methylprednisolone (40 mg, qd) for 5 days.The patients in group B were treated with oral prednisone for 5 days as in group A, and then those who had no significant improvement were subsequently treated with intratympanic methylprednisolone (40 mg, qd)for further 5 days.All patients were treated with additional intravenous batroxobin and ginkgo biloba leaves extract.Following examination of pure tone audiogram, hearing gains and effective rates were statistically analyzed in both groups with SPSS software package(version 20.0). Results: Hearings in both groups were improved significantly after treatment.In group A(20 cases), hearing gain was (29.2±22.7) dB and total effective rate was 65.0%, while in group B(22 cases), they were (27.3±22) dB and 68.2% respectively.There were no significant differences in hearing gain and recovery rate between two groups (hearing gain, P=0.793; total effective rate, P=0.827). Conclusions For patients with profound SSNHL of total frequency type, the efficacies of intratympanic steroid as simultaneous and subsequent therapy are equivalent. Therefore, subsequent intratympanic glucocorticoid is recommended for SSNHL patient of total frequency type to reduce complications and medical expenses.

OBJECTIVE To analyze the clinical features of 8 patients with sigmoid sinus diverticulum and to improve the level of diagnosis and treatment. METHODS The tinnitus patients were asked in detail about the history, and performed a series of routine hearing tests (pure tone audiometry, acoustic impedance audiometry, otoacoustic emission inspection and brainstem auditory evoked potential (BAEP) etc.) and temporal bone HRCT scan. Eight cases were diagnosed with sigmoid sinus diverticulum, in which six cases undertook a surgery to reconstruct the sinus wall while the other 2 cases chose conservative treatment. RESULTS The diagnosis of 6 cases was proved to be correct by surgery, and the pulsatile tinnitus disappeared after reconstructing the sinus wall. No one recurred after following up from 2 to 12 months. Two cases of conservative treatment had no obvious improvement in symptoms. CONCLUSION Clinical manifestation, hearing examination, temporal bone CT/HRCT and Cranial CTA/CTV contributed to the diagnosis of sigmoid sinus diverticulum. Sinus wall reconstruction is a better approach.

Objective To investigate the possible factors related to recurrence and prognosis of sudden sensorineural hearing loss (SSNHL).Methods Four hundred and ninety-five patients with unilateral sudden sensorineural hearing loss between January 2013 to April 2014 were analyzed retrospectively(34 patients lost to follow-up with a dropout rate of 6.87％).Twenty of the 495 patients were diagnosed as recurrent SSNHL and treated again in the same hospital.The data of the patients were summarized to analyze the related factors which might influence the recurrence and prognosis of SSNHL.Results In the 20 patients with recurrent SSNHL,19 had the second attack in same ear as the first attack,and the other one had in both ears.There were seven male patients,and thirteen female patients.Patients ranged in age from 24 to 77years,with a median age of 39.5 years.Types of hearing loss:low frequency in eight patients,high frequency in two patients,fiat frequency in eight patients,total deafness in two patients,the types of the second attack in 17 patients were same as the first attack,only one patient was changed from total deafness to fiat frequency,one case was changed from fiat frequency to high frequency,one case changed from fiat frequency to total deafness.The intervals between of the first attack time and the second attack time were 1-36 months with the median time of 3.5 months.After systemic oral and (or) transtympanic steroid treatment,recovered in three cases,effective in three cases and 14 cases invalid,the cure rate was 15％,and the total effective rate was 30％.There were statistically significant differences in the recovery rate(x2 =8.640,P ＜ 0.05) and the overall response rate(x2 =12.379,P ＜ 0.01) between the first and the second treatments.For the patients with vertigo and/or dizziness,with a history more than seven days,with hypertension or diabetes mellitus,and with a type of hearing loss except low frequency type,the treatment effect was invalid.The patients with hearing loss at low frequency had the best outcomes.The total effective rates were significant different between patients younger and old than 34 years old (P ＜ 0.05).There was no difference in the total effective rate between genders,and patients with or without tinnitus and/ or aural fullness in the recurrent SSNHL(P ＞0.05).The recurrence rates of patients with various types of hearing loss were different(F =7.744,P ＜0.05),with a highest recurrence rate in patients with hearing loss at low frequency.Other factors such as gender,age,accompanied diseases (hypertension or diabetes mellitus),associated symptoms,interval from onset to treatment had no effects on the recurrence rate.Conclusiors Recurrence of SSNHL is more likely to be found in patients with hearing loss of low frequency and flat type.The prognosis of recurrent SSNHL is poorer than that of the first episode,and may be related to the age and type of hearing loss.

[ABSTRACT]OBJECTIVETo evaluate the efficacy of combined oral and intratympanic glucocorticoids treatment for severe to profound sudden sensorineural hearing loss(SSNHL).METHODSFifty-four patients with severe to profound SSNHL were retrospectively studied. They were treated with oral steroids, vasodilators, anticoagulants. The patients who accepted intratympanic methylprednisolone sodium succinate were included the therapy group, the others were included in the control group. Hearing improvements were analyzed respectively after two weeks.RESULTSHearing in both groups were improved significantly after treatment(P<0.01), but there was no difference in hearing improvements between two groups(P=0.194). The efficacy for severe SSNHL patients in therapy group was equal to those who were in control group (P=0.251), so was the efficacy for profound SSNHL patients in both groups(P=0.380).CONCLUSIONThe combined systemic and intratympanic glucocorticoids treatment was effective for patients with severe to profound SSNHL, but while with no better efficacy than oral glucocorticoid alone.

Objective To examine survival differences in prognosis and survival between patients with HPV-positive and those with HPV-negative oropharyngeal squamous cell carcinoma (OPSCC).Methods Pubmed,Embase,Web of science and Medline databases were searched from their inception till June 2014.A random-effect meta-analysis was used to pool study estimates evaluating overall (all-cause mortality),disease-specific (death from OPSCC),disease-free (recurrence free),progression-free survival outcomes and local regional control rate in HPV-positive vs HPV-negative OPSCC.After study selection,two reviewers assessed and extracted data independently.Meta-analysis was performed using the STATA 11.0software.Results Thirty-seven studies were included.HPV-positive OPSCC patients had a better overall survival compared to HPV-negative patients (HR 0.39,95％ CI 0.32-0.46).HPV-positive OPSCC patients had a significantly lower disease specific mortality (HR 0.31,95％ CI 0.22-0.39) and were less likely to experience progression or recurrence of their cancers than HPV-negative patients (HR 0.34,95％CI 0.25-0.42).Both disease-free survival and progression-free survival were significantly improved in patients with HPV-positive OPSCC (HR 0.38,95％ CI 0.29-0.47 and HR 0.46,95％ CI 0.29-0.63,respectively).Conclusions HPV infection is an important prognostic factor of OPSCC.Stratified therapies can be applied in OPSCC based on HPV status of tumours.

Objective To investigate the expression of aquaporin 2 (AQP2) in an endolymphatic hydrops ani-mal model .Methods Forty adult guinea pigs were randomly divided into experiment group and control group (20 animals in each group ) . Guinea pigs in the experiment group were treated with deamino arginine vasopressin (DDAVP) intraperitoneally at the dosage of 4 μg · kg -1 · d-1 for 7 days ,while those in the control group were treated with physiological saline .The endolymphatic hydrops and expression of AQP2 in cochleas of all animals were evaluated by Hematoxylin and Eosin stain ,immunohistochemistry and Western blot .Results The endolymphatic hydrops in the experiment group were more severe than that in the control group(P<0 .05) .Expression of AQP2 were found in the stria vascularis and spiral ganglions in both groups with similar patterns .Both immunohistochem-istry and Western blot showed that the expressions of AQP2 in the experiment group were significantly stronger(P<0 .05 ) .Conclusion DDAVP can up-regulate the expression of AQP2 in the cochleae of guinea pigs ,thus may be closely related to the pathogenesis of endolymphatic hydrops .

This paper discussed the current status of hearing aids fitting practitioners in China and proposed some proposals on how to cultivate qualified practitioners.The proposals includes setting up short-term training program,launching hearing aids fitting major in occupational schools and cultivating the hearing aids fitting practitioners from the would-be audiologists or otologists in an aim to meet the urgent hearing aids fitting need of Chinese deafness.