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*

Objective:To investigate the alterations in gut microbiota diversity and inflammatory cytokine levels among patients with varying severities of insomnia, and to explore their interrelationships, in order to provide a theoretical basis for understanding the pathophysiology of insomnia.Methods:A total of 42 patients with chronic insomnia who visited the First Hospital of Hebei Medical University between March and December 2023 were enrolled in the insomnia group, and 22 age-and sex-matched healthy volunteers were recruited from the same hospital as the control group. General demographic data were collected, and Mini-International Neuropsychiatric Interview (MINI) was used to screen for comorbid psychiatric disorders. The Self-Rating Depression Scale (SDS) and the Self-Rating Anxiety Scale (SAS) were employed to evaluate individual′s depressive and anxiety symptoms. Sleep quality and insomnia severity were assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI), Participants′ gastrointestinal function and symptoms over the past week were evaluated using the Gastrointestinal Symptom Rating Scale (GSRS). Fecal and blood samples were collected from all participants. Gut microbiota diversity was analyzed using 16S rRNA sequencing. Differential taxa were identified using linear discriminant analysis effect size (LEfSe) and random forest analysis. Serum levels of inflammatory cytokines were measured by enzyme-linked immunosorbent assay (ELISA). Spearman correlation analysis was used to explore the relationships between insomnia symptoms, microbial diversity indices, key microbial taxa, and inflammatory markers. Multiple linear regression analysis was conducted to identify factors associated with insomnia severity.Results:Compared to the control group, both the mild insomnia group and the moderate-to-severe insomnia group showed significantly higher GSRS scores ( Z=-3.51, -2.72, both P<0.05). The Chao1 index was significantly lower in the mild and moderate-to-severe insomnia groups than in controls ( Z=-3.53, -3.87, both P<0.05). Similarly, the Observed species index was lower in both the mild and moderate-to-severe groups ( Z=-3.33, -3.74, both P<0.05). The Shannon index was significantly reduced in the moderate-to-severe group compared to both the mild group and controls ( Z=-2.81, -2.23, both P<0.05). The Simpson index in the moderate-to-severe group also tended to be lower than in the mild group ( Z=-1.95, P=0.051). Beta diversity differed significantly among the mild insomnia group, the moderate-to-severe insomnia group ( P<0.05), and the control group ( F=2.96, 3.12, both P<0.05). Random forest analysis identified Ruminococcus_D and Klebsiella as key microbial genera distinguishing between mild and moderate-to-severe insomnia. Inflammatory cytokine levels were significantly elevated in both insomnia groups compared to controls ( P<0.05). PSQI scores were negatively correlated with the Shannon index, the Observed species index, and the relative abundance of Ruminococcus_D ( r=-0.34, -0.30, and -0.25, respectively; all P<0.05). Multiple linear regression revealed that serum IL-1β (β=0.339, 95% CI=0.014-0.716, P=0.042) and Ruminococcus_D (β=-0.309, 95% CI=-194.591--8.318, P=0.034) were independent predictors of insomnia severity. Conclusion:Elevated inflammatory cytokine levels and reduced gut microbial richness may be closely associated with increased insomnia severity. Additionally, Ruminococcus_D and IL-1β may be important factors contributing to the severity of insomnia in affected individuals.

Objective:To investigate the alterations in gut microbiota diversity and inflammatory cytokine levels among patients with varying severities of insomnia, and to explore their interrelationships, in order to provide a theoretical basis for understanding the pathophysiology of insomnia.Methods:A total of 42 patients with chronic insomnia who visited the First Hospital of Hebei Medical University between March and December 2023 were enrolled in the insomnia group, and 22 age-and sex-matched healthy volunteers were recruited from the same hospital as the control group. General demographic data were collected, and Mini-International Neuropsychiatric Interview (MINI) was used to screen for comorbid psychiatric disorders. The Self-Rating Depression Scale (SDS) and the Self-Rating Anxiety Scale (SAS) were employed to evaluate individual′s depressive and anxiety symptoms. Sleep quality and insomnia severity were assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI), Participants′ gastrointestinal function and symptoms over the past week were evaluated using the Gastrointestinal Symptom Rating Scale (GSRS). Fecal and blood samples were collected from all participants. Gut microbiota diversity was analyzed using 16S rRNA sequencing. Differential taxa were identified using linear discriminant analysis effect size (LEfSe) and random forest analysis. Serum levels of inflammatory cytokines were measured by enzyme-linked immunosorbent assay (ELISA). Spearman correlation analysis was used to explore the relationships between insomnia symptoms, microbial diversity indices, key microbial taxa, and inflammatory markers. Multiple linear regression analysis was conducted to identify factors associated with insomnia severity.Results:Compared to the control group, both the mild insomnia group and the moderate-to-severe insomnia group showed significantly higher GSRS scores ( Z=-3.51, -2.72, both P<0.05). The Chao1 index was significantly lower in the mild and moderate-to-severe insomnia groups than in controls ( Z=-3.53, -3.87, both P<0.05). Similarly, the Observed species index was lower in both the mild and moderate-to-severe groups ( Z=-3.33, -3.74, both P<0.05). The Shannon index was significantly reduced in the moderate-to-severe group compared to both the mild group and controls ( Z=-2.81, -2.23, both P<0.05). The Simpson index in the moderate-to-severe group also tended to be lower than in the mild group ( Z=-1.95, P=0.051). Beta diversity differed significantly among the mild insomnia group, the moderate-to-severe insomnia group ( P<0.05), and the control group ( F=2.96, 3.12, both P<0.05). Random forest analysis identified Ruminococcus_D and Klebsiella as key microbial genera distinguishing between mild and moderate-to-severe insomnia. Inflammatory cytokine levels were significantly elevated in both insomnia groups compared to controls ( P<0.05). PSQI scores were negatively correlated with the Shannon index, the Observed species index, and the relative abundance of Ruminococcus_D ( r=-0.34, -0.30, and -0.25, respectively; all P<0.05). Multiple linear regression revealed that serum IL-1β (β=0.339, 95% CI=0.014-0.716, P=0.042) and Ruminococcus_D (β=-0.309, 95% CI=-194.591--8.318, P=0.034) were independent predictors of insomnia severity. Conclusion:Elevated inflammatory cytokine levels and reduced gut microbial richness may be closely associated with increased insomnia severity. Additionally, Ruminococcus_D and IL-1β may be important factors contributing to the severity of insomnia in affected individuals.

Objective To investigate correlation between preoperative thyroid-related serological indicators and benign and malignant thyroid nodules.Methods Clinical data of 401 patients with thyroid nodules underwent surgical treatment in Guizhou Provincial People's Hospital from January to December 2020 were retrospectively analyzed.According to the results of postoperative pathological examination,they were divided into benign group(129 cases)and malignant group(272 cases).Clinical data and preoperative thyroid-related serological indicators were compared between two groups.Results Age and preoperative serum thyroglobulin(Tg)level in malignant group were significantly lower than those in benign group,and proportion of males was significantly higher than that in benign group(P<0.05).The receiver operating characteristic(ROC)curve showed that preoperative serum Tg value of 35.41ng/ml was cut-off point for the risk factor of distinguishing benign and malignant thyroid nodules.Subgroup analysis showed that serum Tg level in malignant group of patients≤40 years old was significantly lower than that in benign group,thyroid stimulating hormone(TSH)×thyroglobulin antibodies(TGAb),TGAb/thyroid peroxidase antibodies(TPOAb)values in malignant group of patients≤40 years old were significantly higher than those in benign group(P<0.05).Among patients over 40 years old,serum Tg level in malignant group was significantly lower than that in benign group(P<0.05).Serum Tg and TPOAb levels in malignant group of male patients were significantly lower than those in benign group(P<0.05).Serum Tg level in malignant group of female patients was significantly lower than that in benign group(P<0.05).ROC curve showed that preoperative serum TSH×TGAb value of 15.87,TGAb/TPOAb value of 1.06 were risk factor cut-off points for distinguishing benign and malignant thyroid nodules in young adults,and preoperative serum TPOAb value of 9.40IU/ml was risk factor cut-off point for distinguishing benign and malignant thyroid nodules in males.Conclusion Male,young age and decreased Tg value are independent risk factors for thyroid cancer.Serum Tg value has certain diagnostic value for differentiating benign and malignant thyroid nodules.Decrease of preoperative serum TPOAb level is a risk factor for male thyroid cancer.Preoperative elevated TSH×TGAb and TGAb/TPOAb are independent risk factors for development of thyroid cancer in young adults.

Objective To explore the correlation between preoperative thyroid-related serological indicators[including thyroid stimulating hormone(TSH),thyroglobulin(Tg),anti-thyroglobulin antibody(TGAb),thyroid peroxidase antibody(TPOAb)and thyrotropin receptor antibody(TRAb)]and the clinicopathological features of papillary thyroid cancer.Methods The clinical data of 272 patients with papillary thyroid cancer who underwent surgery in Guizhou Provincial People's Hospital from January to December 2020 were retrospectively analyzed,and the relationship between the clinicopathological characteristics of papillary thyroid cancer patients and preoperative thyroid-related serological indicators was compared.Results The incidence of BRAF gene V600E mutation in the low TSH×TRAb group was lower than that in the high TSH×TRAb group,and the difference was statistically significant(P<0.01);Tumor size of patients in the low Tg×TGAb group was lower than that in the high Tg×TGAb group,the metastasis rate in the lateral cervical region was lower than that in the high Tg×TGAb group,and the incidence of BRAF gene V600E mutation was lower than that in the high Tg×TGAb group,and the difference was all statistically significant(P<0.05);The incidence of BRAF gene V600E mutation in the low TGAb/TPOAb group was significantly lower than that in the high TGAb/TPOAb group(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the preoperative TSH×TRAb value guided the diagnosis of BRAF gene V600E mutation in papillary thyroid cancer(with sensitivity was 61.3%,specificity was 71.7%),followed by TGAb/TPOAb value(with sensitivity was 39.2%,specificity was 76.1%),and finally Tg×TGAb(with sensitivity was 60.9%,specificity was 53.9%);The sensitivity and specificity of preoperative Tg×TGAb value in guiding tumor size of papillary thyroid cancer was 61.6%and 64.7%respectively.The sensitivity and specificity of preoperative Tg×TGAb value in guiding lateral cervical region metastasis of papillary thyroid cancer was 60.0%and 73.5%respectively.Conclusion Preoperative TSH×TRAb,Tg×TGAb,and TGAb/TPOAb values are independent risk factors for BRAF geneV600E mutation in Papillary thyroid cancer,and have certain diagnostic value for BRAF gene V600E mutation in papillary thyroid cancer.Preoperative Tg×TGAb value has certain diagnostic value for tumor size and lateral cervical metastasis of papillary thyroid cancer,which is helpful to evaluate the development and prognosis of papillary thyroid cancer.

Objective To explore the correlation between preoperative thyroid-related serological indicators[including thyroid stimulating hormone(TSH),thyroglobulin(Tg),anti-thyroglobulin antibody(TGAb),thyroid peroxidase antibody(TPOAb)and thyrotropin receptor antibody(TRAb)]and the clinicopathological features of papillary thyroid cancer.Methods The clinical data of 272 patients with papillary thyroid cancer who underwent surgery in Guizhou Provincial People's Hospital from January to December 2020 were retrospectively analyzed,and the relationship between the clinicopathological characteristics of papillary thyroid cancer patients and preoperative thyroid-related serological indicators was compared.Results The incidence of BRAF gene V600E mutation in the low TSH×TRAb group was lower than that in the high TSH×TRAb group,and the difference was statistically significant(P<0.01);Tumor size of patients in the low Tg×TGAb group was lower than that in the high Tg×TGAb group,the metastasis rate in the lateral cervical region was lower than that in the high Tg×TGAb group,and the incidence of BRAF gene V600E mutation was lower than that in the high Tg×TGAb group,and the difference was all statistically significant(P<0.05);The incidence of BRAF gene V600E mutation in the low TGAb/TPOAb group was significantly lower than that in the high TGAb/TPOAb group(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the preoperative TSH×TRAb value guided the diagnosis of BRAF gene V600E mutation in papillary thyroid cancer(with sensitivity was 61.3%,specificity was 71.7%),followed by TGAb/TPOAb value(with sensitivity was 39.2%,specificity was 76.1%),and finally Tg×TGAb(with sensitivity was 60.9%,specificity was 53.9%);The sensitivity and specificity of preoperative Tg×TGAb value in guiding tumor size of papillary thyroid cancer was 61.6%and 64.7%respectively.The sensitivity and specificity of preoperative Tg×TGAb value in guiding lateral cervical region metastasis of papillary thyroid cancer was 60.0%and 73.5%respectively.Conclusion Preoperative TSH×TRAb,Tg×TGAb,and TGAb/TPOAb values are independent risk factors for BRAF geneV600E mutation in Papillary thyroid cancer,and have certain diagnostic value for BRAF gene V600E mutation in papillary thyroid cancer.Preoperative Tg×TGAb value has certain diagnostic value for tumor size and lateral cervical metastasis of papillary thyroid cancer,which is helpful to evaluate the development and prognosis of papillary thyroid cancer.

Regression discontinuity design (RDD) is a rigorous quasi-experimental method. Based on the randomness of the distribution of samples around the critical value, the data on both sides are used for regression respectively, so as to avoid the interference of potential confounding factors and provide strong evidence for the inference of causal correlation. This study introduces the RDD and its research progress, and expounds its application in detail combined with cases, in order to provide reference for the application of RDD in epidemiological research.

Regression discontinuity design (RDD) is a rigorous quasi-experimental method. Based on the randomness of the distribution of samples around the critical value, the data on both sides are used for regression respectively, so as to avoid the interference of potential confounding factors and provide strong evidence for the inference of causal correlation. This study introduces the RDD and its research progress, and expounds its application in detail combined with cases, in order to provide reference for the application of RDD in epidemiological research.

Objective: To analyze the therapeutic effect of endoscopic myringoplasty. Methods: A retrospective analysis of 523 patients with chronic otitis media who underwent endoscopic myringoplasty between June 2016 and June 2017 in eight tertiary hospitals in China. Among all the patients, 256 were male and 267 were female, aged from 18 to 68 years old. The grafts used to repair the tympanic membrane were all tragus cartilage-perichondrium complex. All patients were followed up at 1 month, 3 months, 6 months, 9 months, and 12 months after surgery, at least 3 months. The closure rate of tympanic membrane perforation by different factors, the hearing results, and the incidence of postoperative complications were analyzed. SPSS 21.0 software was used to analyze the data. Results: Three months after operation, the closure rates of anterior, inferior, posterior and subtotal perforation were 92.4% (109/118), 94.9% (93/98), 95.6% (129/135), and 89.0% (153/172) respectively, the difference was not statistically significant (χ²=5.779, P=0.123). The closure rates of small, medium and large perforations were 100.0% (82/82), 93.7% (178/190) and 89.2% (224/251) respectively. The difference was statistically significant (χ²=10.927, P=0.004). The closure rates of dry ear and wet ear tympanic membrane perforation were 93.1% (392/421), 90.2% (92/102), the difference was not statistically significant (χ²=1.011, P=0.915). The preoperative pure tone audiometry(PTA) was (38.4±5.3) dBHL, while, the 3-month postoperative PTA was (25.1±5.7) dBHL. The difference was statistically significant (t=39.079, P<0.001). The preoperative air bone gap (ABG) was (22.4±4.3) dB, while 3 months postoperative ABG was (9.1±3.8) dB. The difference was statistically significant (t=53.004, P<0.001). Of all 523 patients, 14 (2.7%) had middle ear infection, 8 (1.5%) had dislocated tympanic membrane, 12 (2.3%) had parageusia, 35 (6.7%) had tinnitus, 28 (5.4%) had hearing loss, 26 (5.0%) had vertigo,33 (6.3%) had reperforation, 2 (0.4%) had secondary cholesteatoma, and none had facioplegia. Conclusions Endoscopic myringoplasty is a safe and effective surgical method with good postoperative outcome.