Objective To investigate extended high-frequency hearing in young adults and to analyse its char-acteristics.Methods A total of 230 freshmen(101 males and 129 females,aged 17-19 years old)from the class of 2023 at the Air Force Medical University underwent audiometric tests,including acoustic impedance,conventional frequency and extended high-frequency audiometry,and distortion product otoacoustic emissions(DPOAE).Ac-cording to the results of extended high-frequency audiometry,the students were divided into normal and abnormal groups,and the hearing thresholds at conventional frequencies were compared between the two groups.Results Of the 230 students,47.83％(110/230)showed abnormal extended high-frequency hearing.The hearing thresholds of the right ear were 1 to 3 dB higher than those of the left ear at most frequencies.The hearing thresholds of the ab-normal group were higher than those of the normal group in the conventional frequencies(P＜0.05).The difference in extended high-frequency thresholds between the two groups increased with higher frequency.Conclusion Ex-tended high-frequency hearing loss occurs earlier,and has a higher prevalence in young adults,and right ear hearing is worse than that of left ear.Extended high-frequency audiometry can be used as a predictive tool for detecting con-ventional frequency hearing loss.

Objective:To compare the clinical application of the anterolateral thigh perforator flap (ALTPF) and the calf pedicled propeller perforator flap (PPPF) in reconstruction of soft tissue defect of foot and ankle.Methods:A retrospective observational study was conducted. From March 2013 to June 2019, 48 patients with soft tissue defect around ankle and in foot were reconstructed with ALTPF and PPPF in the Department of Orthopaedics, 920th Hospital of the Joint Logistic Support Force, People's Liberation Army of China. According to the types of flap, the patients were divided into 2 groups: ALTPF group (21 patients,13 males and 8 females, aged 16-67 years, mean 38.71 years±15.30 years. Donor sites were all directly sutured.) and PPPF group (27 patients, 12 males and 15 females, aged 12-69 years, mean 35.18 years±13.96 years. Five cases in the donor site required partial skin grafting, and the rest 22 cases were repaired by directly suture.). The wound size of the former was 5 cm×6 cm-15 cm×18 cm, and at 2 cm×3 cm-14 cm×17 cm for the latter. The surgical time and flap size of the 2 groups were recorded during the surgery. The survival and complications of the flap were observed, and the days of hospital stay were recorded after surgery. Follow-ups were conducted by outpatient clinic and via telephone and WeChat interviews. The colour, texture, appearance, donor scar, complications and thinning of the flap were observed during the follow-up. The ankle function was evaluated according to the score of American Orthopaedic Foot and Ankle Society (AOFAS), and the donor scar was evaluated according to the score of Vancouver Scar Scale (VSS). SPSS 22.0 statistical software was used for data analysis, and P<0.05 was considered statistically significant. Results:The surgical time for the ALTPF group was 118-203 (154.71±25.42) min, and that for the PPPF group was 52-92 (72.78±10.04) min. The size of the flap in the ALTPF group was 5 cm×8 cm-8 cm×18 cm (75.00 cm 2±8.69 cm 2), while it was 3 cm×7 cm-7 cm×17 cm (53.56 cm 2±19.49 cm 2) in the PPPF group. In the ALTPF group, 3 flaps had vascular complications within 24 hours after surgery, which survived after exploration and thrombectomy. Partial necrosis occurred in 1 flap. The rest 17 flaps survived uneventfully. In the PPPF group, 2 flaps had partial necrosis due to infection and they healed after dressing changes, 3 flaps had venous occlusion and survived after phlebotomy, partial suture removal and massage. The rest 22 flaps in 2 groups survived uneventfully. The postoperative days of hospital stay for the ALTPF group was 6-14 (8.71±2.03) days, and that was 4-12 (6.03±2.16) days in the PPPF group. Flap thinning was performed on 19 flaps in the ALTPF group and 2 in the PPPF group. Follow-up was performed for 7 to 21 months. All the flaps were good in colour, shape and texture. All donor sites healed well. At the final follow-up, 19 patients achieved ankle function of excellent, 1 of good and 1 of fair in the ALTPF group, and 21 patients achieved ankle function of excellent, 4 of good and 2 of fair in the PPPF group, according to the AOFAS. According to the VSS, scores of donor site scar was rated 4-8 (6.33±1.35) points for the ALTPF group, and 3-10 (5.92±1.80) points for the PPPF group. Statistical analysis showed no significant differences between the 2 groups in terms of early postoperative complications, flap survival rate, ankle function, and VSS scores ( P>0.05). However, there were statistically significant differences between the 2 groups in terms of surgical time, hospital stay, flap size, and the number of flap thinning ( P<0.05). Conclusion:Both ALTPF and PPPF have good clinical effects in reconstruction of soft tissue defect of foot and ankle. For small to medium-sized wounds, PPPF is the preferred choice due to the advantages in surgical time and postoperative hospital stay. For larger wounds, the ALTPF is the first choice with multiple surgery.

Objective To explore the application effect of a BOPPPS-based blended teaching model in adult nursing course.Methods A total of 188 undergraduate nursing students from the school of Nursing,Kunming Medical university,in the class of 2021 were enrolled as research subjects and grouped by classes(97 students in the control group and 91 students in the experimental group).During the teaching process,the control group and the experimental group respectively adopted the traditional teaching model and the blended teaching model based on BOPPPS.The teaching effect was evaluated through the pre-assessment and post-assessment theoretical scores,learning engagement,independent learning ability and teacher quality of the two groups of students.Results The differences between the pre-assessment and post-assessment theoretical scores of the two groups were statistically significant,and the scores of the experimental group were 86.80(78.73,94.09),which were higher than those of the control group 79.45(69.39,87.97)(P<0.05).There were also statistically significant differences in the scores of learning engagement and independent learning ability between the two groups after teaching(P<0.05).Conclusion The blended teaching model based on BOPPPS used in the teaching of adult nursing for undergraduate nursing students can effectively improve the teaching effect,which is conducive to improving their learning engagement and stimulating students'learning autonomy.

Objective:To investigate the clinical value of changes in serum total cholesterol (TC), chitinase protein-40 (YKL-40), and B7 homolog 4 (B7-H4) levels in patients with severe acute pancreatitis (SAP) complicated with abdominal compartment syndrome (ACS).Methods:A total of 388 SAP patients admitted to the First Affiliated Hospital of Xi'an Medical College from January 2022 to May 2024 were selected as the study group. They were grouped into the ACS group (227 cases) and a non-ACS group (161 cases) based on whether they had concurrent ACS. Another 215 individuals who underwent health check up were selected as the control group. Enzyme linked immunosorbent assay (ELISA) was applied to detect serum levels of TC, YKL-40, and B7-H4. Spearman test was applied to analyze the correlation between serum TC, YKL-40, B7-H4 levels and Acute Physiology and Chronic Health Status Scoring System Ⅱ(APACHE Ⅱ) score and intra-abdominal pressure (IAP)value. Multivariate Logistic regression was applied to analyze the influencing factors of SAP patients complicated ACS. The receiver operating characteristic (ROC) curve was applied to analyze the clinical diagnostic value of serum TC, YKL-40, B7-H4 levels in SAP patientscomplicated with ACS.Results:The serum levels of TC, YKL-40, and B7-H4 in the study group were higher than those in the control group : (5.79 ± 0.81) mmol/L vs. (4.67 ± 0.57) mmol/L, (49.46 ± 7.51) μg/L vs. (36.82 ± 5.93) μg/L, (63.66 ± 11.23) μg/L vs. (52.85 ± 9.21) μg/L, there were statistical differences ( P<0.05). The results of single factor analysis showed that time of stay in intensive care unit (ICU), C-reactive protein (CRP), white blood cell count (WBC), blood amylase (AMY), APACHEⅡ score, IAP value, serum TC, YKL-40, B7-H4 levels and heart rate were the risk factors for ACS in SAP patients ( P<0.05). The results of correlation analysis showed that the levels of serum TC, YKL-40 and B7-H4 were positively correlated with APACHEⅡ score and IAP value (the r value were 0.459, 0.511, 0.445 and 0.742, 0.794, 0.761, P<0.05). Multivariate Logistic regression analysis showed that time of stay in ICU, APACHE Ⅱ score, IAP value and high levels of serum TC, YKL-40 and B7-H4 were independent risk factors for ACS in SAP patients ( P<0.05). ROC curve analysis results showed that the area under the curve(IUC) of serum TC, YKL-40 and B7-H4 predicted SAP patients with ACS was 0.868. Conclusions:The levels of serum TC, YKL-40, and B7-H4 are higher in patients with SAP complicated with ACS, and their combined detection has better clinical value for SAP complicated with ACS patients.

Objective To investigate extended high-frequency hearing in young adults and to analyse its char-acteristics.Methods A total of 230 freshmen(101 males and 129 females,aged 17-19 years old)from the class of 2023 at the Air Force Medical University underwent audiometric tests,including acoustic impedance,conventional frequency and extended high-frequency audiometry,and distortion product otoacoustic emissions(DPOAE).Ac-cording to the results of extended high-frequency audiometry,the students were divided into normal and abnormal groups,and the hearing thresholds at conventional frequencies were compared between the two groups.Results Of the 230 students,47.83％(110/230)showed abnormal extended high-frequency hearing.The hearing thresholds of the right ear were 1 to 3 dB higher than those of the left ear at most frequencies.The hearing thresholds of the ab-normal group were higher than those of the normal group in the conventional frequencies(P＜0.05).The difference in extended high-frequency thresholds between the two groups increased with higher frequency.Conclusion Ex-tended high-frequency hearing loss occurs earlier,and has a higher prevalence in young adults,and right ear hearing is worse than that of left ear.Extended high-frequency audiometry can be used as a predictive tool for detecting con-ventional frequency hearing loss.

Objective:To investigate the clinical value of changes in serum total cholesterol (TC), chitinase protein-40 (YKL-40), and B7 homolog 4 (B7-H4) levels in patients with severe acute pancreatitis (SAP) complicated with abdominal compartment syndrome (ACS).Methods:A total of 388 SAP patients admitted to the First Affiliated Hospital of Xi'an Medical College from January 2022 to May 2024 were selected as the study group. They were grouped into the ACS group (227 cases) and a non-ACS group (161 cases) based on whether they had concurrent ACS. Another 215 individuals who underwent health check up were selected as the control group. Enzyme linked immunosorbent assay (ELISA) was applied to detect serum levels of TC, YKL-40, and B7-H4. Spearman test was applied to analyze the correlation between serum TC, YKL-40, B7-H4 levels and Acute Physiology and Chronic Health Status Scoring System Ⅱ(APACHE Ⅱ) score and intra-abdominal pressure (IAP)value. Multivariate Logistic regression was applied to analyze the influencing factors of SAP patients complicated ACS. The receiver operating characteristic (ROC) curve was applied to analyze the clinical diagnostic value of serum TC, YKL-40, B7-H4 levels in SAP patientscomplicated with ACS.Results:The serum levels of TC, YKL-40, and B7-H4 in the study group were higher than those in the control group : (5.79 ± 0.81) mmol/L vs. (4.67 ± 0.57) mmol/L, (49.46 ± 7.51) μg/L vs. (36.82 ± 5.93) μg/L, (63.66 ± 11.23) μg/L vs. (52.85 ± 9.21) μg/L, there were statistical differences ( P<0.05). The results of single factor analysis showed that time of stay in intensive care unit (ICU), C-reactive protein (CRP), white blood cell count (WBC), blood amylase (AMY), APACHEⅡ score, IAP value, serum TC, YKL-40, B7-H4 levels and heart rate were the risk factors for ACS in SAP patients ( P<0.05). The results of correlation analysis showed that the levels of serum TC, YKL-40 and B7-H4 were positively correlated with APACHEⅡ score and IAP value (the r value were 0.459, 0.511, 0.445 and 0.742, 0.794, 0.761, P<0.05). Multivariate Logistic regression analysis showed that time of stay in ICU, APACHE Ⅱ score, IAP value and high levels of serum TC, YKL-40 and B7-H4 were independent risk factors for ACS in SAP patients ( P<0.05). ROC curve analysis results showed that the area under the curve(IUC) of serum TC, YKL-40 and B7-H4 predicted SAP patients with ACS was 0.868. Conclusions:The levels of serum TC, YKL-40, and B7-H4 are higher in patients with SAP complicated with ACS, and their combined detection has better clinical value for SAP complicated with ACS patients.

Objective:To compare the clinical application of the anterolateral thigh perforator flap (ALTPF) and the calf pedicled propeller perforator flap (PPPF) in reconstruction of soft tissue defect of foot and ankle.Methods:A retrospective observational study was conducted. From March 2013 to June 2019, 48 patients with soft tissue defect around ankle and in foot were reconstructed with ALTPF and PPPF in the Department of Orthopaedics, 920th Hospital of the Joint Logistic Support Force, People's Liberation Army of China. According to the types of flap, the patients were divided into 2 groups: ALTPF group (21 patients,13 males and 8 females, aged 16-67 years, mean 38.71 years±15.30 years. Donor sites were all directly sutured.) and PPPF group (27 patients, 12 males and 15 females, aged 12-69 years, mean 35.18 years±13.96 years. Five cases in the donor site required partial skin grafting, and the rest 22 cases were repaired by directly suture.). The wound size of the former was 5 cm×6 cm-15 cm×18 cm, and at 2 cm×3 cm-14 cm×17 cm for the latter. The surgical time and flap size of the 2 groups were recorded during the surgery. The survival and complications of the flap were observed, and the days of hospital stay were recorded after surgery. Follow-ups were conducted by outpatient clinic and via telephone and WeChat interviews. The colour, texture, appearance, donor scar, complications and thinning of the flap were observed during the follow-up. The ankle function was evaluated according to the score of American Orthopaedic Foot and Ankle Society (AOFAS), and the donor scar was evaluated according to the score of Vancouver Scar Scale (VSS). SPSS 22.0 statistical software was used for data analysis, and P<0.05 was considered statistically significant. Results:The surgical time for the ALTPF group was 118-203 (154.71±25.42) min, and that for the PPPF group was 52-92 (72.78±10.04) min. The size of the flap in the ALTPF group was 5 cm×8 cm-8 cm×18 cm (75.00 cm 2±8.69 cm 2), while it was 3 cm×7 cm-7 cm×17 cm (53.56 cm 2±19.49 cm 2) in the PPPF group. In the ALTPF group, 3 flaps had vascular complications within 24 hours after surgery, which survived after exploration and thrombectomy. Partial necrosis occurred in 1 flap. The rest 17 flaps survived uneventfully. In the PPPF group, 2 flaps had partial necrosis due to infection and they healed after dressing changes, 3 flaps had venous occlusion and survived after phlebotomy, partial suture removal and massage. The rest 22 flaps in 2 groups survived uneventfully. The postoperative days of hospital stay for the ALTPF group was 6-14 (8.71±2.03) days, and that was 4-12 (6.03±2.16) days in the PPPF group. Flap thinning was performed on 19 flaps in the ALTPF group and 2 in the PPPF group. Follow-up was performed for 7 to 21 months. All the flaps were good in colour, shape and texture. All donor sites healed well. At the final follow-up, 19 patients achieved ankle function of excellent, 1 of good and 1 of fair in the ALTPF group, and 21 patients achieved ankle function of excellent, 4 of good and 2 of fair in the PPPF group, according to the AOFAS. According to the VSS, scores of donor site scar was rated 4-8 (6.33±1.35) points for the ALTPF group, and 3-10 (5.92±1.80) points for the PPPF group. Statistical analysis showed no significant differences between the 2 groups in terms of early postoperative complications, flap survival rate, ankle function, and VSS scores ( P>0.05). However, there were statistically significant differences between the 2 groups in terms of surgical time, hospital stay, flap size, and the number of flap thinning ( P<0.05). Conclusion:Both ALTPF and PPPF have good clinical effects in reconstruction of soft tissue defect of foot and ankle. For small to medium-sized wounds, PPPF is the preferred choice due to the advantages in surgical time and postoperative hospital stay. For larger wounds, the ALTPF is the first choice with multiple surgery.

Background: Several risk factors have been identified that compromise the treatment outcome in patients with early-to-mid-stage cervical cancer (CC) who are primarily treated with radical surgery. However, there is no report on the impact of intraoperative frozen pathology examination of vaginal margins on the prognosis of patients with CC. This study aimed to conduct a randomized controlled trial (RCT) to determine whether selective vaginal resection can reduce the incidence of operative complications and the risk of postoperative radiotherapy. The impact of the length of the vagina removed in radical hysterectomy (RH) on prognosis and quality of life (QoL) for IB2–IIA2 CC patients will be investigated. Methods A multicenter, non-inferiority, RCT at 7 institutions in China is designed to investigate the effect of intraoperative frozen pathology exam of vaginal margin in RH on the survival outcomes for patients with IB2–IIA2 CC. Eligible patients aged 18–70 years will be randomly assigned online by one-to-one random allocation to receive intraoperative frozen pathology exam of vaginal margin or not. If frozen pathology indicates positive margin, continue resection of 1 centimeter of vaginal tissue until negative margin is achieved. The primary end point is 2-year disease-free survival (DFS). Adverse events (AEs) caused by further vagina resection, 5-year DFS, 2-year overall survival (OS), 5-year OS and AEs caused by radiotherapy and QoL are secondary end points. A total of 310 patients will be enrolled from 7 tertiary hospitals in China within 3-year period and followed up for 5 years.Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2000035668

Background: Several risk factors have been identified that compromise the treatment outcome in patients with early-to-mid-stage cervical cancer (CC) who are primarily treated with radical surgery. However, there is no report on the impact of intraoperative frozen pathology examination of vaginal margins on the prognosis of patients with CC. This study aimed to conduct a randomized controlled trial (RCT) to determine whether selective vaginal resection can reduce the incidence of operative complications and the risk of postoperative radiotherapy. The impact of the length of the vagina removed in radical hysterectomy (RH) on prognosis and quality of life (QoL) for IB2–IIA2 CC patients will be investigated. Methods A multicenter, non-inferiority, RCT at 7 institutions in China is designed to investigate the effect of intraoperative frozen pathology exam of vaginal margin in RH on the survival outcomes for patients with IB2–IIA2 CC. Eligible patients aged 18–70 years will be randomly assigned online by one-to-one random allocation to receive intraoperative frozen pathology exam of vaginal margin or not. If frozen pathology indicates positive margin, continue resection of 1 centimeter of vaginal tissue until negative margin is achieved. The primary end point is 2-year disease-free survival (DFS). Adverse events (AEs) caused by further vagina resection, 5-year DFS, 2-year overall survival (OS), 5-year OS and AEs caused by radiotherapy and QoL are secondary end points. A total of 310 patients will be enrolled from 7 tertiary hospitals in China within 3-year period and followed up for 5 years.Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2000035668

Background: Several risk factors have been identified that compromise the treatment outcome in patients with early-to-mid-stage cervical cancer (CC) who are primarily treated with radical surgery. However, there is no report on the impact of intraoperative frozen pathology examination of vaginal margins on the prognosis of patients with CC. This study aimed to conduct a randomized controlled trial (RCT) to determine whether selective vaginal resection can reduce the incidence of operative complications and the risk of postoperative radiotherapy. The impact of the length of the vagina removed in radical hysterectomy (RH) on prognosis and quality of life (QoL) for IB2–IIA2 CC patients will be investigated. Methods A multicenter, non-inferiority, RCT at 7 institutions in China is designed to investigate the effect of intraoperative frozen pathology exam of vaginal margin in RH on the survival outcomes for patients with IB2–IIA2 CC. Eligible patients aged 18–70 years will be randomly assigned online by one-to-one random allocation to receive intraoperative frozen pathology exam of vaginal margin or not. If frozen pathology indicates positive margin, continue resection of 1 centimeter of vaginal tissue until negative margin is achieved. The primary end point is 2-year disease-free survival (DFS). Adverse events (AEs) caused by further vagina resection, 5-year DFS, 2-year overall survival (OS), 5-year OS and AEs caused by radiotherapy and QoL are secondary end points. A total of 310 patients will be enrolled from 7 tertiary hospitals in China within 3-year period and followed up for 5 years.Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2000035668