The extracellular matrix（ECM）is a complex network structure composed of collagen，glycoproteins，and proteoglycans.It not only provides structural support and viscoelasticity to tissues but also participates in cell signaling，responding to environmental forces and signals to mediate tissue remodeling in response to environmental cues. Due to the intricate and precise functions of the inner ear，the perception and transmission of sound rely on the complex interactions between cochlear cell structures and the ECM. In the inner ear，the ECM not only constitutes key structures such as the basilar membranes（BM）and tectorial membranes（TM），which are essential for sound perception，but also regulates cell shape，adhesion，and migration.Certain ECM components interact with cell surface receptors to activate signaling pathways that regulate gene expression.Additionally，the ECM modulates the storage and diffusion of ions and secreted factors, creating concentration gradients.These functions are critical for inner ear development，repair，and function.Thus，the ECM plays a vital role in auditory processes，and abnormalities in ECM are a cause of certain hereditary hearing loss.This review primarily summarizes the ECM genes that lead to hearing loss.
Humans ; Extracellular Matrix/genetics* ; Hearing Loss/genetics* ; Mutation ; Cochlea ; Extracellular Matrix Proteins/genetics*

Hearing loss is the most prevalent disabling disease. Cochlear implantation（CI） serves as the primary intervention for severe to profound hearing loss. This consensus systematically explores the value of genetic diagnosis in the pre-operative assessment and efficacy prognosis for CI. Drawing upon domestic and international research and clinical experience, it proposes an evidence-based medicine three-tiered prognostic classification system（Favorable, Marginal, Poor）. The consensus focuses on common hereditary non-syndromic hearing loss（such as that caused by mutations in genes like GJB2, SLC26A4, OTOF, LOXHD1） and syndromic hereditary hearing loss（such as Jervell & Lange-Nielsen syndrome and Waardenburg syndrome）, which are closely associated with congenital hearing loss, analyzing the impact of their pathological mechanisms on CI outcomes. The consensus provides recommendations based on multiple round of expert discussion and voting. It emphasizes that genetic diagnosis can optimize patient selection, predict prognosis, guide post-operative rehabilitation, offer stratified management strategies for patients with different genotypes, and advance the application of precision medicine in the field of CI.
Humans ; Cochlear Implantation ; Prognosis ; Hearing Loss/surgery* ; Consensus ; Connexin 26 ; Mutation ; Sulfate Transporters ; Connexins/genetics*

Depressive disorder is a common psychiatric condition clinically characterized by impaired cognitive function， which profoundly affects patients' daily living and social functioning. Despite extensive research on the mechanism underlying the interaction between ghrelin and depressive disorder， comprehensive reviews， summary， and systematic organization of these findings remain lacking. To address this gap， this study aims to conduct a systematic evaluation of the effects and mechanisms of ghrelin on cognitive function in patients with depressive disorder， thereby providing references for targeted clinical interventions. On October 20， 2024， literature exploring the role and mechanisms of ghrelin in improving cognitive function in depressive disorder was sourced from the CNKI， PubMed and Web of Science databases， covering the period from the inception of the database till October 20， 2024. Two researchers independently conducted literature screening and data extraction. Ultimately， 9 articles were included in this review. The findings suggest that ghrelin improves cognitive function in patients with depressive disorder through multiple mechanisms， including mitigating inflammatory responses， modulating oxidative stress， and activating the cyclic adenosine monophosphate response element binding protein-brain-derived neurotrophic factor （CREB-BDNF） signaling pathway.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective: To explore the safety management of implantable venous infusion port, prevent and reduce the occurrence of catheter rupture and other related complications, and implement effective treatment measures after occurrence. Methods: A patient with an implantable venous transfusion port suffered from complete rupture of the catheter outside the hospital. Under multidisciplinary consultation, the condition of the catheter inside the port was clarified, and a safe treatment plan was worked out. The multidisciplinary venous transfusion treatment team cooperated with each other to correctly implement the capture, catching and nursing in vivo. Results: With the cooperation of multidisciplinary team, the broken port and catheter were successfully and safely removed without any discomfort. Conclusions Establishing a multi-disciplinary cooperation mechanism, standardizing the quality control of implantation in infusion port, popularizing the knowledge of post-implantation maintenance and implementing the safety management of infusion port can ensure the safe and long-term application of implanted intravenous infusion port.

Objective? To investigate the current situation of intravenous therapy in 38 ClassⅡ and above hospitals in Hu'nan Province and analyze the existing problems. Methods? A questionnaire survey was conducted in 38 hospitals in Hu'nan Province in November 2018 using the Nursing Situation of Intravenous Therapy in Hospitals at All Levels designed by the Professional Committee of Intravenous Therapy and Chinese Nursing Association. To understand the status quo of intravenous therapy, quality management of intravenous therapy, and the status of specialist nurses in intravenous therapy. Results? In 38 hospitals, totally 36 hospitals provided continuous intravenous therapy services through intravenous therapy/peripherally inserted central catheter (PICC) clinics and a designated hospital department; 21 hospitals had established intravenous therapy/PICC clinics; the outpatient service was flexible in form, but the qualification certification of outpatient nurses needed further regulation. The proportion of hospitals carrying out medium and long-term catheter infusion and hospitals carrying out PICC transfusion with Modified Sedinger Technique (MST) puncture guided by ultrasound was 100.00% and 72.22%, respectively. In vascular visualization technology, hospitals using infrared, ultrasound and X-ray technology were 2.63%, 63.16% and 34.21% respectively. There were some gaps in the skin disinfectant and disinfection scope, concentration of flushing and sealing fluid and maintenance frequency between the hospitals and the national standards in peripheral and central venipuncture and catheter maintenance. In terms of quality management of intravenous therapy, 34 hospitals had established intravenous therapy teams, whose quality evaluation criteria are different. In terms of specialist nurses team construction, there were 505 specialist nurses in venous therapy/PICC in 38 hospitals. The structure of specialist nurses had been continuously optimized in terms of education, title and length of service. However, hospitals needed to pay more attention to the development of specialist nurses. Conclusions? The contents of continuous nursing of intravenous therapy need to be further expanded, the management of PICC clinic needs to be strengthened, the standardized use of infusion devices and connectors needs to be improved, the knowledge and practice gap between puncture nursing and catheter maintenance of intravenous therapy exists, and the quality control standards of hospitals need to be standardized and regulated, more attention should be paid to the development of specialist nurses.

Objective To evaluate the effects of"PICC fixed standard operation flow chart"in PICC fixed quality management. Methods Patients with PICC were admitted to the control group from January to June in 2014, given the routine PICC fixed method. PICC patients in the observation group who were enrolled from July to December 2014 were given new PICC fixed method that obey the"PICC fixed standard operation flow chart", which was established from relevant norms and guidelines and related literature. The incidence rate of medical adhesive related skin injury and unplanned extubation of PICC were compared with those of the two groups. Results The incidence rate of medical adhesive related skin injury was decreased from 35.20％(70034/198962) to 18.03％(37862/209955) (Z=-3.363, P<0.01) and PICC unplanned extubation decreased from 1.31‰(20/15384) to 0.37‰(7/18919) , the difference was statistically significant (χ2=6.940, P<0.05). Conclusions The PICC fixed standard operating flow chart can be used as a guide to implement the PICC fixation. Based on this, the quantitative management index is applied to the PICC fixed quality management, which can standardize the fixation of the PICC , reduce the related complications caused by the fixation of the catheter, prevent the occurrence of unplanned extubation of PICC , provide effective protection to ensure safe PICC long-term use and improve the patient's comfort.

BACKGROUND: Moxibustion can improve the symptoms of rheumatoid arthritis and reduce inflammation, but there are no uniform operation standards. The moxibustiondistance becomes one of factor influencing the therapeutic efficacy.OBJECTIVE: To compare the effects of different moxibustion distances on rheumatoid arthritis, and to explore the optimal distance.METHODS: The 8 of 40 male Sprague-Dawley rats were randomlyselected as controls. The other 32 were used to make animal modes of collagen type Ⅱ-induced ankle arthritis, and then given moxibustion at Shenshu (BL23) and Zusanli (ST36) at an interval of 1, 2 and 3 cm, respectively, once daily, 10 minutes at each point, 6 days per course for three courses, with a course interval of 1 day. Model rats with no treatment acted as model group.RESULTS AND CONCLUSION: Compared with the control group, the toe volume, arthritis index and serum levels ofinterleukin-1β and tumor necrosis factor-α except the body mass were significantly increased in the model group (P < 0.01).After moxibustion treatment, these indexes were significantly decreased in the three treatment groups (P < 0.01), especially in the 1 and 2 cm groups (P < 0.01). Narrowed articular cavity, intra-articular inflammation and pannus formation were observed in the model group, while only moderate inflammatorycell infiltration and few pannus formation were found in the 1,2, 3 cm groups. These results indicate that moxibustion improvesjoint functions and regulates immune reaction by downregulating the levels of interleukin-1β and tumor necrosisfactor-α, as well as reducing synovial hyperplasia. In addition,the optimal distance for moxibustion is 1 or 2 cm, which is amomentous proposition to improve therapeutic efficacy.

Objective: To observe the effect of different moxibustion durations on rats with rheumatoid arthritis (RA) and to evaluate the relationship between moxibustion amount and moxibustion efficacy.Methods: Eight rats were randomly selected as a normal group from the 40 male Sprague-Dawley (SD) rats, and the other 32 rats were used to establish typeⅡ collagen-induced RA models. After successful modeling, the 32 rats were randomly divided into a model group, a moxibustion for 20 min group, a moxibustion for 40 min group and a moxibustion for 60 min group, with 8 rats in each group. Rats in the normal group did not receive modeling and moxibustion intervention; rats in the model group did not receive moxibustion after modeling; rats in the moxibustion for 20 min group, the moxibustion for 40 min group and the moxibustion for 60 min group were treated with moxibustion at Shenshu (BL 23) and Zusanli (ST 36) for 20 min, 40 min and 60 min, respectively. Six days were a course of treatment, with a total of 3-course treatments and a 1-day rest between the courses of treatment. After treatment, the serum levels of interleukin (IL)-1β and tumor necrosis factor (TNF)-α, arthritis index (AI) scores, toe volumes and pathological score of synovitis were evaluated in the rats.Results: Compared with the normal group, the serum IL-1β and TNF-α levels, and the toe volumes in the model group were increased, and the differences were statistically significant (P<0.01), before the treatment. Compared with the model group, the serum IL-1β and TNF-α levels, toe volumes and arthritis index (AI) scores were significantly decreased in the moxibustion for 20 min group, the moxibustion for 40 min group and the moxibustion for 60 min group (P<0.05 orP<0.01 ). Compared with the moxibustion for 20 min group and the moxibustion for 60 min group, serum IL-1β and TNF-α levels, toe volumes and AI scores were decreased more significantly in moxibustion for 40 min group, and the differences were statistically significant (P<0.05 orP<0.01). There were no significant differences in serum IL-1β and TNF-α levels, AI scores and toe volumes between the moxibustion for 20 min group and the moxibustion for 60 min group (allP>0.05). The synovial histopathological improvement was the most obvious in the moxibustion for 40 min group, when the synovial histopathological changes were compared among the moxibustion for 20 min group, moxibustion for 40 min group and moxibustion for 60 min group.Conclusion: The therapeutic efficacy of moxibustion for 40 min in RA rats was more significant than that of moxibustion for 20 min and moxibustion for 60 min, indicating that the duration of moxibustion is the main factor affecting its therapeutic efficacy.

By means of a planimeter and skulls adjusted in the eye-ear plane, measurements of areas of the foramen ovale, spinosum, lacerum, jugulae and orifice of the canalis caroticus on both sides of the external surface of the skull base have been taken on 100 adult skulls collected in Chengdu. The symmetry of these areas has been studied. The main results of the study are given below: 1. In 4% of the whole series, the area of the foramen ovale is approximately equal on the two sides and the difference in area between the two sides is less than 1%. In 44%, the right side is larger, and in 52%, the left is larger. 2. In 5% of the whole series, the area of the foramen spinosum is approximately equal on the two sides. In 42%, the right side is larger, and in 53%, the left is larger. 3. In 4% of the whole series, the area of the foramen lacerum is approximately equal on the two sides. In 46%, the right side is larger, and in 50%, the left is larger. 4. In 3% of the whole series, the area of the foramen jugulae is approximately equal on the two sides. In 76%, the right side is larger, and in 21%, the left is larger. 5. In 3% of the whole series, the area of the anterior part of the foramen jugulae is approximately equal on the two sides. In 50%, the right side is larger, and in 47%, the left is larger. 6. In 17% of the whole series, the area of the intermediate part of the foramen jugulae is approximately equal on the two sides. In 37%, the right side is larger, and in 46%, the left is larger. 7. In 2% of the whole series, the area of the posterior part of the foramen jugulae is approximately equal on the two sides. In 79%, the right side is larger, and in 19%, the left is larger. 8. In 5% of the whole series, the area of the orifice of the canalis caroticus is approximately equal on the two sides. In 58%, the right side is larger, and in 37%, the left is larger. Moreover, a quantitative analysis of the bilateral areas has been carried out. The foramen area is highly positive in correlation With the product of its length and width. Therefore, the regression formulas of the areas are as follows: The foramen ovale-right, ■=1.5129+0.6699x (r=0.9417); left, ■=0.3695+0.6876x(r=0.8949). The foramen spinosum-right, ■=0.7827+0.6089x (r=0.8755); left, ■=0.3499+0.6695x (r=0.9207). The foramen lacerum-right, ■=9.4190+0.4480x (r=0.9147); left, ■=13.5198+0.4082x (r=0.8493). The foramen jugulaeright, ■=18.3913+0.5092x (r=0.8843); left,■=11.3561+0.5744x (r=0.9193). The anterior part of the foramen jugulae-right, Y=3.3141+0.4858x (r=0.8330); left, ■=3.2294+0.4854x (r=0.8452) The intermediate part of the foramen jugulae-right, ■=2.5434+0.4311x (r=0.7942); left, Y=1.7547+0.5227x (r=0.8366). The posterior part of the foramen jugulae-right,■=1.3470+0.6311x (r=0.8273); left, ■=0.9110+0.6586x (r=0.9480). The orifice of the canalis caroticus-right, ■=1.0986+0.6794x (r=0.9128); left, ■=1.5038+0.6590x (r=0.9219). (x is the product of the length and width of its foramen).