Objective:To compare the preoperative presentation, intraoperative findings, and postoperative outcomes between middle ear cholesteatoma with tympanosclerosis （MECwTS） and middle ear cholesteatoma without tympanosclerosis （MECw/oTS）, thereby investigating the clinical characteristics of MECwTS. Methods:A retrospective analysis was conducted on the clinical data of 120 patients with middle ear cholesteatoma. Patients were divided into two groups based on the presence or absence of concomitant tympanosclerosis: the MECwTS group （n=49） and the MECw/oTS group （n=71）. All patients underwent preoperative evaluations including temporal bone CT, otoscopic examination, pure-tone audiometry, tympanometry, and assessment using the Zurich Chronic Middle Ear Inventory （ZCMEI-21） quality of life scale. All patients underwent canal wall down mastoidectomy with tympanoplasty. Concurrent ossicular chain reconstruction was performed: partial ossicular replacement prosthesis （PORP） in 83 cases and total ossicular replacement prosthesis （TORP） in 37 cases. Intraoperative disease severity was assessed using the Cholesteatoma Comprehensive Score Scale （CCSS）. Postoperative follow-up lasted at least one year and included pure-tone audiometry, otoscopic examination, and the ZCMEI-21 scale administered at ≥1 year post-surgery. Preoperative and postoperative air-bone gap （ABG） and ZCMEI-21 scores were compared between the MECwTS and MECw/oTS groups. Additionally, surgical efficacy was defined as a postoperative ABG ≤20 dB; the hearing improvement efficacy of PORP versus TORP was compared based on this criterion. Results: ①Preoperative ABG showed no significant difference between the MECw/oTS and MECwTS groups（P>0.05）. Postoperative ABG was （18.65±10.21） dB in the MECw/oTS group versus （22.55±9.53） dB in the MECwTS group, demonstrating a statistically significant intergroup difference （P<0.05）. ②Intraoperative CCSS scores were significantly higher in the MECwTS group （8.04±2.18） compared to the MECw/oTS group （5.93±1.44） （P<0.05）. ③Preoperative ZCMEI-21 scores showed no significant difference between groups （P>0.05）. Postoperative ZCMEI-21 scores were （22.24±8.11） in the MECw/oTS group versus （27.02±7.21） in the MECwTS group, indicating a statistically significant difference （P<0.05）. ④Postoperative ABG ≤20 dB was achieved in 54 patients （65.06%, 54/83） in the PORP group and 16 patients （43.24%, 16/37） in the TORP group. This difference in efficacy rates was statistically significant （P<0.05）. The overall efficacy rate for ossiculoplasty was 58.33% （70/120）. Conclusion: Patients with MECwTS exhibit more severe middle ear and mastoid pathology compared to those with MECw/oTS, resulting in poorer postoperative hearing levels and quality of life outcomes. Both PORP and TORP implantation can improve postoperative hearing to some extent; however, PORP appears to offer superior hearing improvement efficacy compared to TORP.
Humans ; Cholesteatoma, Middle Ear/complications* ; Retrospective Studies ; Tympanoplasty ; Myringosclerosis/surgery* ; Female ; Male ; Adult ; Middle Aged ; Ossicular Replacement ; Ossicular Prosthesis ; Young Adult ; Ear, Middle ; Treatment Outcome ; Mastoidectomy ; Audiometry, Pure-Tone ; Adolescent ; Quality of Life

Objective:To investigate the factors affecting clinical pregnancy outcomes in fresh embryo transfer cycles of patients undergoing ovulation induction with antagonist protocol.Methods:Data from 1001 patients un-dergoing their first antagonist protocol fresh embryo transfer cycle at Department of Reproductive Medicine,The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine,from December,2016 to June,2024 were collected.Patients were stratified into two groups based on pregnancy outcomes:clinical pregnancy(502 cases)and non-clinical pregnancy(499 cases).General characteristics,controlled ovarian stimulation pa-rameters,and laboratory data were analyzed.Independent factors affecting clinical pregnancy were identified through univariate analysis and multivariate binary Logistic regression analysis.Results:Multivariate binary Logis-tic regression analysis indicated that advanced maternal age(≥35 years)and HCG-day progesterone(P)levels were identified as inhibitory factors for clinical pregnancy(OR 0.571,95％CI 0.400-0.815,P＜0.05;OR 0.832,95％CI 0.720-0.961,P＜0.05).Endometrial thickness on HCG-day,2PN cleavage rate,and the number of trans-ferable embryos were significant positive predictors of clinical pregnancy(OR 1.095,95％CI 1.011-1.186;OR 1.036,95％CI 1.006-1.067,P＜0.05;OR 1.122,95％CI 1.039-1.211,P＜0.05).Embryo transfer strategy signifi-cantly impacted outcomes:transferring one cleavage-stage embryo or one blastocyst resulted in lower pregnancy rates compared to dual cleavage-stage embryo transfer(OR0.359,95％CI 0.195-0.658,P＜0.05;OR 0.457,95％CI 0.285-0.733,P＜0.05).Conclusions:Maternal age,HCG-day P levels,endometrial thickness on HCG-day,2PN cleavage rate,number of transferable embryos and embryo transfer strategy are independent pre-dictors of clinical pregnancy in antagonist protocol of fresh cycles.Individualized treatment protocols should con-sider these factors and maternal-infant health priorities to optimize pregnancy success.

Objective:To investigate the factors affecting clinical pregnancy outcomes in fresh embryo transfer cycles of patients undergoing ovulation induction with antagonist protocol.Methods:Data from 1001 patients un-dergoing their first antagonist protocol fresh embryo transfer cycle at Department of Reproductive Medicine,The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine,from December,2016 to June,2024 were collected.Patients were stratified into two groups based on pregnancy outcomes:clinical pregnancy(502 cases)and non-clinical pregnancy(499 cases).General characteristics,controlled ovarian stimulation pa-rameters,and laboratory data were analyzed.Independent factors affecting clinical pregnancy were identified through univariate analysis and multivariate binary Logistic regression analysis.Results:Multivariate binary Logis-tic regression analysis indicated that advanced maternal age(≥35 years)and HCG-day progesterone(P)levels were identified as inhibitory factors for clinical pregnancy(OR 0.571,95％CI 0.400-0.815,P＜0.05;OR 0.832,95％CI 0.720-0.961,P＜0.05).Endometrial thickness on HCG-day,2PN cleavage rate,and the number of trans-ferable embryos were significant positive predictors of clinical pregnancy(OR 1.095,95％CI 1.011-1.186;OR 1.036,95％CI 1.006-1.067,P＜0.05;OR 1.122,95％CI 1.039-1.211,P＜0.05).Embryo transfer strategy signifi-cantly impacted outcomes:transferring one cleavage-stage embryo or one blastocyst resulted in lower pregnancy rates compared to dual cleavage-stage embryo transfer(OR0.359,95％CI 0.195-0.658,P＜0.05;OR 0.457,95％CI 0.285-0.733,P＜0.05).Conclusions:Maternal age,HCG-day P levels,endometrial thickness on HCG-day,2PN cleavage rate,number of transferable embryos and embryo transfer strategy are independent pre-dictors of clinical pregnancy in antagonist protocol of fresh cycles.Individualized treatment protocols should con-sider these factors and maternal-infant health priorities to optimize pregnancy success.

Objective:To develop a mesenteric creeping fat index (MCFI) based on CT enterography (CTE) to characterize the degree of creeping fat wrapping around the inflamed gut in Crohn disease (CD), and to assess the relationship between MCFI and the inflammatory intestinal stricture.Methods:From December 2018 to July 2019, the patients with CD who underwent surgery in the First Affiliated Hospital of Sun Yat-Sen University were prospectively collected. The extent of perienteric mesenteric vessels wrapping around the gut was reconstructed to develop MCFI based on CTE images. The intestinal stricture index was obtained by calculating the ratio of the maximal upstream luminal diameter divided by the minimum luminal diameter apparent within the stricturing region. Using region-by-region correlation between CTE and surgical specimen, creeping fat score in intestinal specimen was obtained by assessing the extent of creeping fat wrapping around the resected bowel segment, and HE staining was performed on the bowel specimen corresponding to creeping fat to obtain the pathological inflammatory score. The Spearman correlation analysis was used to evaluate the correlation between MCFI, creeping fat score in intestinal specimen, and inflammatory score, intestinal stricture index. The ROC curve analysis was used to assess the accuracy of MCFI in distinguishing moderate-severe and mild inflammatory bowel walls.Results:Totally 30 CD patients were enrolled. The creeping fat score in intestinal specimen positively correlated with pathological inflammatory score ( r s=0.403, P=0.027) and with intestinal stricture index ( r s=0.642, P<0.001). MCFI positively correlated with creeping fat score in intestinal specimen ( r s=0.840, P<0.001), with pathological inflammatory score ( r s=0.497, P=0.005), and with intestinal stricture index ( r s=0.599, P<0.001). ROC analysis showed that the area under the curve of MCFI for differentiating moderate-severely from mildly inflammatory bowel walls was 0.718 (95%CI 0.522-0.913). Using MCFI≥4 as a cutoff value, the sensitivity and specificity were 81.8% and 47.4%, respectively. Conclusions:There was a correlation between creeping fat and inflammatory intestinal strictures in CD. MCFI can non-invasively depict the degree of creeping fat wrapping around the gut and assess the inflammatory intestinal stricture.

Inflammatory bowel disease (IBD) mainly includes Crohn′s disease (CD) and ulcerative colitis (UC) . The imaging diagnosis of CD is difficult because of its complex disease and varied imaging manifestations. Standardizations of imaging techniques and reports are helpful to improve the imaging diagnosis level of CD. This article aims to provide guideline for the imaging technique selection, scanning scheme formulation, imaging features interpretation and imaging report writing of CD in China.

Inflammatory bowel disease (IBD) mainly includes Crohn′s disease (CD) and ulcerative colitis (UC) . The imaging diagnosis of CD is difficult because of its complex disease and varied imaging manifestations. Standardizations of imaging techniques and reports are helpful to improve the imaging diagnosis level of CD. This article aims to provide guideline for the imaging technique selection, scanning scheme formulation, imaging features interpretation and imaging report writing of CD in China.

OBJECTIVE: To establish a novel standardized magnetization transfer ratio (MTR) parameter which considers the element of the normal bowel wall and to compare the efficacy of the MTR, normalized MTR, and standardized MTR in evaluating intestinal fibrosis in Crohn's disease (CD).MATERIALS AND METHODS: Abdominal magnetization transfer imaging from 20 consecutive CD patients were analyzed before performing elective operations. MTR parameters were calculated by delineating regions of interest in specified segments on MTR maps. Specimens with pathologically confirmed bowel fibrosis were classified into one of four severity grades. The correlation between MTR parameters and fibrosis score was tested by Spearman's rank correlation. Differences in MTR, normalized MTR, and standardized MTR across diverse histologic fibrosis scores were analyzed using the independent sample t test or the Mann-Whitney U test. The area under the receiver operating characteristic curve (AUC) was computed to test the efficacies of the MTR parameters in differentiating severe intestinal fibrosis from mild-to-moderate fibrosis.RESULTS: Normalized (r = 0.700; p < 0.001) and standardized MTR (r = 0.695; p < 0.001) showed a strong correlation with bowel fibrosis scores, followed by MTR (r = 0.590; p < 0.001). Significant differences in MTR (t = −4.470; p < 0.001), normalized MTR (Z = −5.003; p < 0.001), and standardized MTR (Z = −5.133; p < 0.001) were found between mild-to-moderate and severe bowel fibrosis. Standardized MTR (AUC = 0.895; p < 0.001) had the highest accuracy in differentiating severe bowel fibrosis from mild-to-moderate bowel wall fibrosis, followed by normalized MTR (AUC = 0.885; p < 0.001) and MTR (AUC = 0.798; p < 0.001).CONCLUSION: Standardized MTR is slightly superior to MTR and normalized MTR and therefore may be an optimal parameter for evaluating the severity of intestinal fibrosis in CD.
Crohn Disease ; Fibrosis ; Humans ; Magnetic Resonance Imaging ; ROC Curve

Objective:To explore the diagnostic efficacy of nomogram based on multi-parameter MRI for assessment of bowel fibrosis in patients with Crohn disease（CD).Methods:The clinical and imaging data of CD patients diagnosed by surgical histopathology in the First Affiliated Hospital of Sun Yat-sen University from June 2015 to March 2018 were prospectively collected. All the patients underwent conventional MRI and diffusion kurtosis imaging（DKI) within 2 weeks before surgery. Patients who underwent surgery between June 2015 and September 2017 were included in the model building group, and those who underwent surgery between October 2017 and March 2018 were included in the model validation group. We measured the apparent diffusion coefficient（ADC) from monoexponential model of diffusion-weighted imaging（DWI), apparent diffusional kurtosis（K app), and apparent diffusion for non-Gaussian distribution（D app) from non-Gaussian DKI model, and observed T 2WI signal intensity and enhancement pattern of the same segment. One to three intestinal specimens per patient were stained with Masson′s trichrome for the histological grading of fibrosis. Correlations between qualitative/quantitative MRI indexes and histological grades were evaluated using the Spearman rank test. Multivariate logistic regression analysis was performed to identify independent factors to be included into the nomogram for predicting the degree of bowel fibrosis and its diagnostic performance was assessed by internal and external validation. Results:A total of 40 CD patients were included, including 31 in the model construction group and 9 in the model verification group. A total of 81 intestinal specimens from 31 patients were graded as none-to-mild bowel fibrosis（ n=32) and moderate-to-severe bowel fibrosis（ n=49) according to a scoring system of fibrosis. In the training cohort, the K app value of moderate-to-severely fibrotic bowel walls was significantly higher than that of none-to-mildly fibrotic bowel walls, and the D appand ADC values of moderate-to-severely fibrotic bowel walls were significantly lower than those of none-to-mildly fibrotic bowel walls（ Z=-5.999, -4.521 and -3.893; P<0.001). There was no significant difference in T 2WI signal intensity or enhancement pattern between these two groups（χ2=1.571 and 0.103; P>0.05). Moderate and mild correlations of histological fibrosis grades with K appand D app( r=0.721 and -0.483; P<0.001), and a mild correlation with ADC（ r=-0.445, P<0.001) were found. Independent factors derived from multivariate logistic regression analysis to predict the degree of bowel fibrosis were K app and D app. Internal and external validation revealed good performance of the nomogram with concordance index of 0.901（95% confidence interval, 0.824-0.978) and 1.000, respectively, for differentiating none-to-mild from moderate-to-severe fibrosis. Conclusion:The DKI-based nomogram can be used to evaluate the bowel fibrosis in CD patients and provides a visual and simple prediction method for clinic.

Objective To determine the correlation between intravoxel incoherent motion (IVIM) parameters and both histologic inflammatory and fibrotic grades of Crohn disease (CD) in adults. Methods Prospectively, 17 patients (77 lesions) with a clinical and pathological diagnosis of CD in the first affiliated hospital of sun yat-sen university from July 2015 to June 2016 underwent MRE 15 days before surgery. All patients underwent T2WI, IVIM and enhanced MRI and calculated IVIM parameters include diffusion-related coefficient (D), perfusion-related coefficient (D*) and perfusion-related fraction (f). Histological intestinal inflammation and fibrosis was scored using the surgical histopathology as reference standard and further divided into mild-moderate (score 1 to 2) and severe (score 3 to 4) groups. Intestinal microvessel density (MVD) were also analyzed. Differences in IVIM parameters among different histological inflammation and fibrosis grades were assessed with the Kruskal-Wallis test. The Wilcoxon test was used for assessing differences in f between mild-moderate and severe fibrosis. The bivariate correlations between IVIM parameters and histological inflammation and fibrosis grades were analyzed using partial correlation . The bivariate correlations between IVIM parameters and MVD were analyzed using Spearman rank correlation. The areas under the receiver operating characteristics curves (AUROC) were analyzed to evaluate the efficacy for distinguishing severe from mild-moderate fibrosis. Results Of 77 surgical specimens, there were 41 mild-moderate and 36 severe inflammatory bowel segments, along with 22 mild-moderate and 55 severe fibrotic bowel segments. Positive correlation was shown between histologic inflammatory and fibrotic scores (r=0.592, P<0.01). MVD (42.7 ± 39.9)/HP presented weak positive correlation with histologic inflammatory scores (r=0.332, P=0.003) while no correlation with histologic fibrotic scores (r=0.129, P=0.262) was presented. Neither the D nor the D* values significantly correlated with histologic inflammation or fibrosis (P>0.05) while the f value significantly correlated with both histologic inflammation and fibrosis (P<0.05). Significant correlation was present between the f value and histologic inflammatory and fibrotic scores, respectively (r=-0.280, -0.520;P<0.05). There was significant difference in the f value between mild-moderate and severe fibrosis(Z=-5.255,P<0.01). The AUROC for the f value to distinguish between patients with mild-moderate fibrosis and severe fibrosis were 0.885. Using a threshold fractional perfusion of 0.33, the sensitivity and specificity values were 95.5％ and 81.8％, respectively. No correlation between f, D and D*value with histologic fibrotic scores (r=0.129, P=0.262) was presented. Conclusion The f value derived from IVIM could help to evaluate the severity of intestinal inflammation and fibrosis CD in adults.

Objective To explore the effects of "hospital-community-family" continuous nursing model in continuous nursing among diabetics. Methods From February 2018 to February 2019, a total of 102 diabetic out-patients at the Third Affiliated Hospital of South Medical University were selected by stratified random sampling. Patients were divided into control group and observation group with the random number table, 51 cases in each group. Control group carried out routine follow-up nursing. Observation group implemented "hospital-community-family" continuous nursing. We compared the fasting blood glucose (FBG), 2-hour postprandial blood glucose (2h PG), glycosylated hemoglobin (HbA1c), scores of the Champion Health Belief Model Scale (CHBMS), Health-Promoting Lifestyle Profile-Ⅱ (HPLP-Ⅱ) and Quality of Life Scale for Patients with Type 2 Diabetes Mellitus (DMQLS) of two groups before and after intervention. Results After intervention, the FBG, 2 h PG and HbA1c of observation group were (7.11±1.25)mmol/L, (9.15±1.24) mmol/L and (8.15±0.59)% respectively lower than those [(8.56±1.31)mmol/L, (11.21±1.35)mmol/L and (10.99±1.12)%]of control group with statistical differences (t=5.719, 8.026, 16.022; P＜ 0.05). After intervention, the scores of CHBMS, HPLP-Ⅱ and DMQLS of observation group were (4.16±0.34), (4.09±0.35) and (165.24±5.21) respectively higher than those [(3.52±0.42), (3.24±0.41) and (154.18±4.39)]of control group with statistical differences (t=8.458, 11.260, 11.593;P＜0.05). Conclusions Application of "hospital-community-family" continuous nursing in patients with type 2 diabetes mellitus helps the glucose control, improves health belief, health behavior and quality of life which is worthy of being used widely in clinical application.