Objective To develop and validate a"quick self-assessment questionnaire for cochlear implant out-come(QSACI)".Methods A research team,composed of audiologists,otolaryngologists,data analysis experts,and cochlear implant(CI)recipients,was formed to establish objectives,research subject criteria,and framework of the QSACI.An item pool was creaed through literature review and brainstorming.Question items were evaluated and screened,and the framework and answer options of the questionnaire were established.The comprehensibility,etc.,was analyzed and refined through pilot test,interviews,and expert consultation,leading to the development of the final version.A total of 39 post-lingually deafened adults with known stable outcomes completed the question-naire.The split-half and test-retest reliabilty of the questionnaire was analyzed,and the validity was quantitatively analyzed by comparing scores with the categories of auditory performance(CAP)scores.Results The initial item pool of the questionnaire had 18 items,and the final questionnaire consisted of 12 questions in four dimensions:com-munication status,audiological status,medical factors,and other factors.The average score of 39 recipients was 88.81±6.17 and CAP was 6.19±0.94.The questionnaire showed good reliability and validity,with a Cronbach's alpha coefficient of 0.71 and a test-retest reliability of 0.824(P＜0.05).The criterion-related validity,assessed by the correlation between the self-assessment questionnaire scores and CAP scores,showed a significant moderate pos-itive correlation(r=0.512,P＜0.05).The correlation coefficient between self-assessment and professional assess-ment was 0.720(P＜0.05),indicating a significant correlation.The area under the receiver operating characterstic(ROC)curve was 0.82(P＜0.05),the cutoff values corresponding to the maximal Youden index were 82.5 and 88.6,therefore score of 85 was taken as the median threshold score of judgement.Conclusion The QSACI reflects the post-imlplant outcomes,and it can serve as a tool for people with postlingually deafness and their families to un-derstand the eligbility of CI and the expected outcomes,helping to establish realistic expectations before CI surgery.

Objective:To investigate the distribution of Traditional Chinese Medicine (TCM) syndromes in older adult patients with pneumonia who face nutritional risks, malnutrition, sarcopenia, and frailty, as well as the extent to which these syndromes affect their nutritional status.Methods:This study used a cross-sectional research design. A total of 1 263 older adult patients with pneumonia who received treatment at the Department of Traditional Chinese Medicine, The Second Hospital of Tianjin Medical University, from July 2021 to July 2024 were included in this study. These patients underwent TCM syndrome differentiation and nutritional assessments. The top 10 distribution patterns of TCM syndromes related to nutritional risk, malnutrition, sarcopenia, and frailty were identified. Logistic regression analysis was performed to analyze the effect of each syndrome pattern on nutritional risk, malnutrition, sarcopenia, and frailty. The odds ratio ( OR) value was used as the effect indicator of effect, with an OR > 1 indicating that the syndrome pattern is a risk factor for nutritional status; the larger the value, the higher the risk. Results:In older adults with pneumonia, the TCM syndrome patterns most commonly associated with nutritional risk, malnutrition, sarcopenia, and frailty were concentrated in phlegm-damp accumulation, phlegm-heat obstructing the lung, qi and blood deficiency, qi deficiency with blood stasis, qi and yin depletion, yang deficiency with water retention, spleen-stomach deficiency, lung qi depletion, and kidney deficiency with failure to grasp qi. Qi deficiency with blood stasis ( OR = 3.70) and qi and blood deficiency ( OR = 4.90) were risk factors for malnutrition. Phlegm-damp accumulation ( OR = 3.46), qi deficiency with blood stasis ( OR = 3.87), and qi and blood deficiency ( OR = 4.52) were risk factors for sarcopenia. Phlegm-damp accumulation ( OR = 2.63), phlegm-heat obstructing the lung ( OR = 3.14), qi deficiency with blood stasis ( OR = 5.78), and qi and blood deficiency ( OR = 6.33) were risk factors for frailty. Conclusions:Phlegm-dampness accumulation, phlegm-heat obstructing the lungs, deficiency of both qi and blood, and qi deficiency with blood stasis are all risk factors for nutritional risks, malnutrition, sarcopenia, and frailty in older adults. Patients with pneumonia exhibiting these patterns should pay special attention to their nutritional status, and early nutritional intervention should be implemented to prevent adverse clinical outcomes.

Objective:To explore the efficacy of interventional therapy for transplant renal artery stenosis (TRAS) and the 1-, 2-, and 3-year survival rates of recipients after treatment.Methods:This is a retrospective case series study. Forty TRAS recipients who underwent interventional treatment at Zhengzhou University People's Hospital between April 2016 and April 2021 were included as the study group. The Kaplan-Meier method was used to calculate the survival rates of the transplanted kidneys and recipients, and survival curves were plotted. The improvement in graft function and blood pressure after interventional therapy in the study group was further analyzed.Results:The 1- and 3-year graft survival rates in the study group after interventional therapy were 87.5% and 82.5%, respectively; the 1-, 2-, and 3-year recipient survival rates were all 100%. One month after interventional therapy, the peak systolic velocity (PSV) and resistance index (RI) of the transplanted kidneys were (235.4±135.1) cm/s and 0.60±0.07, respectively, which were significantly different from the pre-treatment values [(482.8±180.6) cm/s and 0.52±0.12, respectively; both P<0.001]. Serum creatinine levels at 1, 2, and 3 years after interventional therapy were (166.6±93.7) μmol/L, (137.4±57.2) μmol/L, and (137.4±57.9) μmol/L, respectively, all significantly lower than the pre-treatment level [(242.9±156.8) μmol/L; P=0.001, P<0.001, and P<0.001, respectively]. Systolic blood pressure at 1, 2, and 3 years after treatment was (138.5±11.1) mmHg (1 mmHg=0.133 kPa), (134.0±12.0) mmHg, and (130.8±10.8) mmHg, respectively, all significantly lower than the pre-treatment value [(153.8±9.8) mmHg; all P<0.001]. Diastolic blood pressure at 1, 2, and 3 years after treatment was (84.4±9.9) mmHg, (83.7±10.1) mmHg, and (81.9±6.9) mmHg, respectively, all significantly lower than the pre-treatment value [(93.5±12.8) mmHg; P=0.002, P=0.001, and P<0.001, respectively]. Conclusions:Interventional therapy can enable the majority of kidney transplant recipients diagnosed with TRAS to avoid the need for further dialysis, and it has positive effects on both transplant renal function and blood pressure control.

Objective To develop and validate a"quick self-assessment questionnaire for cochlear implant out-come(QSACI)".Methods A research team,composed of audiologists,otolaryngologists,data analysis experts,and cochlear implant(CI)recipients,was formed to establish objectives,research subject criteria,and framework of the QSACI.An item pool was creaed through literature review and brainstorming.Question items were evaluated and screened,and the framework and answer options of the questionnaire were established.The comprehensibility,etc.,was analyzed and refined through pilot test,interviews,and expert consultation,leading to the development of the final version.A total of 39 post-lingually deafened adults with known stable outcomes completed the question-naire.The split-half and test-retest reliabilty of the questionnaire was analyzed,and the validity was quantitatively analyzed by comparing scores with the categories of auditory performance(CAP)scores.Results The initial item pool of the questionnaire had 18 items,and the final questionnaire consisted of 12 questions in four dimensions:com-munication status,audiological status,medical factors,and other factors.The average score of 39 recipients was 88.81±6.17 and CAP was 6.19±0.94.The questionnaire showed good reliability and validity,with a Cronbach's alpha coefficient of 0.71 and a test-retest reliability of 0.824(P＜0.05).The criterion-related validity,assessed by the correlation between the self-assessment questionnaire scores and CAP scores,showed a significant moderate pos-itive correlation(r=0.512,P＜0.05).The correlation coefficient between self-assessment and professional assess-ment was 0.720(P＜0.05),indicating a significant correlation.The area under the receiver operating characterstic(ROC)curve was 0.82(P＜0.05),the cutoff values corresponding to the maximal Youden index were 82.5 and 88.6,therefore score of 85 was taken as the median threshold score of judgement.Conclusion The QSACI reflects the post-imlplant outcomes,and it can serve as a tool for people with postlingually deafness and their families to un-derstand the eligbility of CI and the expected outcomes,helping to establish realistic expectations before CI surgery.

Objective:To investigate the distribution of Traditional Chinese Medicine (TCM) syndromes in older adult patients with pneumonia who face nutritional risks, malnutrition, sarcopenia, and frailty, as well as the extent to which these syndromes affect their nutritional status.Methods:This study used a cross-sectional research design. A total of 1 263 older adult patients with pneumonia who received treatment at the Department of Traditional Chinese Medicine, The Second Hospital of Tianjin Medical University, from July 2021 to July 2024 were included in this study. These patients underwent TCM syndrome differentiation and nutritional assessments. The top 10 distribution patterns of TCM syndromes related to nutritional risk, malnutrition, sarcopenia, and frailty were identified. Logistic regression analysis was performed to analyze the effect of each syndrome pattern on nutritional risk, malnutrition, sarcopenia, and frailty. The odds ratio ( OR) value was used as the effect indicator of effect, with an OR > 1 indicating that the syndrome pattern is a risk factor for nutritional status; the larger the value, the higher the risk. Results:In older adults with pneumonia, the TCM syndrome patterns most commonly associated with nutritional risk, malnutrition, sarcopenia, and frailty were concentrated in phlegm-damp accumulation, phlegm-heat obstructing the lung, qi and blood deficiency, qi deficiency with blood stasis, qi and yin depletion, yang deficiency with water retention, spleen-stomach deficiency, lung qi depletion, and kidney deficiency with failure to grasp qi. Qi deficiency with blood stasis ( OR = 3.70) and qi and blood deficiency ( OR = 4.90) were risk factors for malnutrition. Phlegm-damp accumulation ( OR = 3.46), qi deficiency with blood stasis ( OR = 3.87), and qi and blood deficiency ( OR = 4.52) were risk factors for sarcopenia. Phlegm-damp accumulation ( OR = 2.63), phlegm-heat obstructing the lung ( OR = 3.14), qi deficiency with blood stasis ( OR = 5.78), and qi and blood deficiency ( OR = 6.33) were risk factors for frailty. Conclusions:Phlegm-dampness accumulation, phlegm-heat obstructing the lungs, deficiency of both qi and blood, and qi deficiency with blood stasis are all risk factors for nutritional risks, malnutrition, sarcopenia, and frailty in older adults. Patients with pneumonia exhibiting these patterns should pay special attention to their nutritional status, and early nutritional intervention should be implemented to prevent adverse clinical outcomes.

Objective:To explore the efficacy of interventional therapy for transplant renal artery stenosis (TRAS) and the 1-, 2-, and 3-year survival rates of recipients after treatment.Methods:This is a retrospective case series study. Forty TRAS recipients who underwent interventional treatment at Zhengzhou University People's Hospital between April 2016 and April 2021 were included as the study group. The Kaplan-Meier method was used to calculate the survival rates of the transplanted kidneys and recipients, and survival curves were plotted. The improvement in graft function and blood pressure after interventional therapy in the study group was further analyzed.Results:The 1- and 3-year graft survival rates in the study group after interventional therapy were 87.5% and 82.5%, respectively; the 1-, 2-, and 3-year recipient survival rates were all 100%. One month after interventional therapy, the peak systolic velocity (PSV) and resistance index (RI) of the transplanted kidneys were (235.4±135.1) cm/s and 0.60±0.07, respectively, which were significantly different from the pre-treatment values [(482.8±180.6) cm/s and 0.52±0.12, respectively; both P<0.001]. Serum creatinine levels at 1, 2, and 3 years after interventional therapy were (166.6±93.7) μmol/L, (137.4±57.2) μmol/L, and (137.4±57.9) μmol/L, respectively, all significantly lower than the pre-treatment level [(242.9±156.8) μmol/L; P=0.001, P<0.001, and P<0.001, respectively]. Systolic blood pressure at 1, 2, and 3 years after treatment was (138.5±11.1) mmHg (1 mmHg=0.133 kPa), (134.0±12.0) mmHg, and (130.8±10.8) mmHg, respectively, all significantly lower than the pre-treatment value [(153.8±9.8) mmHg; all P<0.001]. Diastolic blood pressure at 1, 2, and 3 years after treatment was (84.4±9.9) mmHg, (83.7±10.1) mmHg, and (81.9±6.9) mmHg, respectively, all significantly lower than the pre-treatment value [(93.5±12.8) mmHg; P=0.002, P=0.001, and P<0.001, respectively]. Conclusions:Interventional therapy can enable the majority of kidney transplant recipients diagnosed with TRAS to avoid the need for further dialysis, and it has positive effects on both transplant renal function and blood pressure control.

Objective:To evaluate the influence of cytomegalovirus (CMV) infection on T cell senescence and cardiovascular disease (CVD) in maintenance hemodialysis (MHD) patients.Methods:It was a single center cross sectional study. Patients aged over 18 years old and received hemodialysis for at least 6 months at the Blood Purification Centre of the Department of Nephrology of Zhongshan Hospital Affiliated to Fudan University from January 2021 to April 2021 were enrolled. Demographic, hematological, nutritional and inflammatory markers were obtained. Anti-CMV-IgM and IgG antibodies were detected using the Roche Elecsys assay. CD28 - T cell was evaluated by flow cytometry. Mann-Whitney U test or Kruskal-Wallis H test was used for anti-CMV-IgG comparison among groups. Spearman correlation and linear regression were used to assess the relationship between anti-CMV-IgG and CD28 - T cell compartment. Logistic regression was used to assess the relationship between anti-CMV-IgG and CVD. Results:A total of 438 MHD patients (270 men and 168 women) were enrolled in the study. The median age was 62 (51, 70) years. The median time on hemodialysis was 57 (21, 100) months. The primary diseases included chronic glomerulonephritis [213 cases (48.6%)], diabetic nephropathy [82 cases (18.7%)], polycystic kidney disease [34 cases (7.8%)], hypertensive renal disease [34 cases (7.8%)], etc. Of these patients, 430 (98.2%) were seropositive for anti-CMV-IgG, 206 (47.0%) had anti-CMV-IgG titers exceeding the upper limit of 500 U/ml. Patients aged over 70 years old were 100% seropositive for anti-CMV-IgG. Patients on HD for more than 5 years had a higher seropositive rate of 99.1% than those with shorter HD duration, although these results were not statistically significant. Spearman correlation analysis showed that the anti-CMV-IgG titers in MHD patients were positively correlated with the proportion of CD4 + CD28 - T cells and CD8 + CD28 - T cells ( r=0.316, P<0.001; r=0.272, P<0.001). Multiple linear regression analysis showed that after adjusting for age and gender, lg[CD4 + CD28 - T cells(%)] and lg[CD8 + CD28 - T cells(%)] were positively correlated with lg[anti-CMV-IgG titers (U/ml)], respectively ( β=0.455, t=8.315, P<0.001; β=0.412, t=7.282, P<0.001). In analyzing the relationship between anti-CMV-IgG titers and CVD, patients were divided into six groups according to age and anti-CMV-IgG level. Group 1 included young patients with a lower anti-CMV-IgG titers (age ≤55 years old, anti-CMV-IgG <400 U/ml); Group 2 included young patients with a higher anti-CMV-IgG titers (age≤55 years old, anti-CMV-IgG ≥400 U/ml); Group 3 included middle-aged patients with a lower anti-CMV-IgG titers (5565 years old, anti-CMV-IgG<400 U/ml); Group 6 included old aged patients with a higher anti-CMV-IgG titers (age>65 years old, anti-CMV-IgG≥400 U/ml). The incidence of CVD was significantly different among the six groups ( χ2=18.780, P=0.002) and patients aged over 55 years old with higher anti-CMV-IgG level had a higher CVD incidence compared with group 1 ( P<0.05). Multivariate logistic regression analysis showed that increased age ( OR=1.020, 95% CI 1.002-1.038, P=0.033), male ( OR=1.855, 95% CI 1.161-2.965, P=0.010), history of diabetes ( OR=1.867, 95% CI 1.145-3.046, P=0.012), increased lg[NT-proBNP(μg/L)] ( OR=2.848, 95% CI 1.816-4.467, P<0.001) and lg[anti-CMV-IgG (U/ml)] ( OR=3.183, 95% CI 1.582- 6.405, P=0.001) were independent factors associated with CVD in MHD patients. Conclusions:CMV infection is extremely common in MHD patients. Increased anti-CMV-IgG is related to T cell senescence and CVD complications in MHD patients.

Background::Transplant renal artery stenosis (TRAS) is a vascular complication after kidney transplantation associated with poor outcomes. This study aimed to analyze the efficacy and safety of low-dose aspirin for preventing TRAS.Methods::After kidney transplantation, patients were enrolled from January 2018 to December 2020 in Henan Provincial People’s Hospital. A total of 351 enrolled recipients were randomized to an aspirin group with low-dose intake of aspirin in addition to standard treatment ( n = 178), or a control group with only standard treatment ( n = 173). The patients was initially diagnosed as TRAS (id-TRAS) by Doppler ultrasound, and confirmed cases were diagnosed by DSA (c-TRAS). Results::In the aspirin and control groups, 15.7% (28/178) and 22.0% (38/173) of the recipients developed id-TRAS, respectively, with no statistical difference. However, for c-TRAS, the difference of incidence and cumulative incidence was statistically significant. The incidence of c-TRAS was lower in the aspirin group compared with the control group (2.8% [5/178] vs. 11.6% [20/173], P = 0.001). Kaplan–Meier estimates and Cox regression model identified the cumulative incidence and hazard ratio (HR) of TRAS over time in two groups, showing that recipients treated with aspirin had a significantly lower risk of c-TRAS than those who were not treated (log-rank P = 0.001, HR = 0.23, 95% confidence interval [CI]: 0.09–0.62). The levels of platelet aggregation rate ( P < 0.001), cholesterol ( P = 0.028), and low-density lipoprotein cholesterol ( P = 0.003) in the aspirin group were decreased compared with the control group in the third-month post-transplantation. For the incidence of adverse events, there was no statistical difference. Conclusion::Clinical application of low-dose aspirin after renal transplant could prevent the development of TRAS with no significant increase in adverse effects.Trial Registration::Clinicaltrials.gov, NCT04260828.

Objective:To identify the disease-causing mutation in a Chinese family with Stickler syndrome type 1.Methods:The pedigree investigation was conducted.A Chinese family with Stickler syndrome type 1 was enrolled in the Shantou International Eye Center in June 2012.Medical history collection and clinical examinations, such as vision, intraocular pressure, slit lamp microscopy and fundus, were carried out in all the included family members and the diagnosis was made by clinical experts.Total genomic DNAs were extracted from the peripheral blood samples (5 ml) obtained from 5 patients and 4 healthy members.The potential variant of the proband's father Ⅲ-5 were screened by whole exome sequencing (WES) and stepwise bioinformatic analysis.The segregation and mutation conformation of the variant was verified by Sanger sequencing.The pathogenicity of the variant was predicted by SIFT, Polyphen2, and MutationTaster.Conservation and three-dimensional structure of amino acid mutation were analyzed by multiple sequence alignment and UniProt.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Joint Shantou International Eye Center (No.EC20110310[2]-P02).Written informed consent was obtained from each subject or the guardian.Results:An autosomal dominant inherence in 39 members of 4 generations including 15 patients and 24 phenotypically normal members was found in the family.The proband (Ⅳ-4) showed high myopia, retinal detachment and strabismus in the right eye, and the left eye was blind.A patient (Ⅲ-5) showed high myopia and cataract in the right eye, atrophy in the left eye.A patient (Ⅳ-9) showed binocular high myopia.A heterozygous variation, c.1693C>T: p.Arg565Cys, within the exon 26 of COL2A1 gene was revealed in patient Ⅲ-5, which was only found in the patients and not in phenotypically normal members, indiacating co-separation in this family.The variant was predicted to be a severe damage by SIFT, Polyphen2 and MutationTaster.The amino acid mutation at position 565 was highly conservative among human, mouse, rat, bovine and Xenopus laevis, which caused the arginine to cysteine substitution at the X position in triple helix repeat region Gly-X-Y, affecting the function of fibrous protein and becoming pathogenic. Conclusions:Variant c.1693C>T: p.Arg565Cys in COL2A1 gene is disease-causing in this family and this is the first report about the variant in China.

Objective:To evaluate the effect of controlled low central venous pressure with milrinone on laparoscopic hepatectomy in the patients.Methods:Fifty American Society of Anesthesiologists physical statusⅠ-Ⅲ patients of both sexes, aged 18-64 yr, with body mass index of 18-30 kg/m 2, of Child-Pugh grade A or B, undergoing elective laparoscopic hepatectomy, were divided into 2 groups ( n=25 each) using a random number table method: milrinone group (group M) and nitroglycerin group (group NG). After the start of surgery, milrinone 0.5 μg·kg -1·min -1 was continuously infused in group M, and nitroglycerin was continuously infused with the initial dose of 0.5 μg·kg -1·min -1 to maintain central venous pressure (CVP)≤5 mmHg in group NG.Mean arterial pressure and heart rate were recorded on admission to the operation room (T 0), at skin incision (T 1), at the beginning of liver resection (T 2), at completion of liver resection (T 3), at the end of operation (T 4), and CVP, cardiac index and stroke volume variation were recorded at T 1-4.Internal jugular vein blood samples were collected to determine the concentrations of hemogloblin, blood lactate at T 1 and T 4, and serum alanine aminotransferase, aspartate aminotransferase and creatinine concentrations at 1, 3 and 7 days after surgery.The score of blood oozing in hepatic surgical field, amount of norepinephrine used, blood loss, postoperative recovery and occurrence of complications within 7 days after operation were recorded. Results:Compared with group NG, cardiac index was significantly increased at T 2, 3, the CVP was decreased at T 2, the blood oozing score, blood loss, consumption of norepinephrine, and concentrations of blood lactate were decreased, and the postoperative drainage indwelling time was shortened in group M ( P<0.05). There was no significant difference in the serum alanine aminotransferase, aspartate aminotransferase and creatinine concentrations and incidence of postoperative complications at 1, 3 and 7 days after operation between the two groups ( P>0.05). Conclusions:Milrinone is better than nitroglycerin in decreasing central venous pressure, reducing blood loss, maintaining stable circulatory function and tissue perfusion in laparoscopic hepatectomy.