Objective Using cochlear metabolomics to study the mechanisms underlying age-related hearing loss in rat.Methods A total of 30 rats with 2-month-old(young group)and 14-month-old(old group)were select-ed,with 15 rats in each group.The auditory function in each group was detected by auditory brainstem response(ABR),the morphology of cochlear tissue in both groups was observed using HE staining,and the oxidative stress status of cochlear tissue was detected by flow cytometry.Five rats/groups were selected for metabolomic examina-tion of cochlear tissue by untargeted ultra-high performance liquid chromatography-mass spectroscopy(LC-MS/MS)to analyze the metabolic differences in the aging cochlea.Results Compared with young group,ABR detection of tone burst at 8,16,and 32 kHz and click response thresholds were significantly higher in old group(P＜0.05),HE staining showed cochlear senescence-related vascular stripe atrophy(P＜0.05),and flow cytometric techniques suggested significantly higher levels of oxidative stress in old group(P＜0.05).Metabolomics detection revealed that a total of 124 differential metabolites were identified in the cochlea of the old group,of which 16 metabolites in-cluding sphingosine,all-trans-retinoic acid,and oleamide were significantly upregulated,while the levels of 108 me-tabolites such as purine,taurine,thiamine,and proline and its derivatives were significantly decreased.The results suggested that physiopathological mechanisms such as protein synthesis and catabolism,sphingolipid metabolism,purine metabolism,oxidative stress-related signaling,cell death,and coenzyme biosynthesis may be involved in co-chlear aging.Conclusion Cellular senescence and cochlear metabolic dysfunction may be important mechanisms of age-related hearing loss.

Objective To investigate the diagnosis value of narrow band imaging(NBI)endoscopy in evalua-ting the degenerative properties of vocal cord leukoplakia.Methods A retrospective analysis of clinical data from 95 cases(153 sides)of vocal cord leukoplakia patients was conducted.All patients underwent electronic laryngoscopy before microlaryngoscopy.The lesions of vocal cords were examined with white light and then with NBI mode.The superficial IPCL patterns were classified into six types(types Ⅰ-Ⅵ).Under the NBI endoscope,the vocal cord leu-koplakia was classified as 1)Group A:types Ⅰ,Ⅱ,and Ⅲ.The pathological results were regarded as the gold standard for definitive diagnosis of vocal cord leukoplakia.and 2)Group B:types Ⅳ,Ⅴ,and Ⅵ.All patients un-derwent laryngeal microsurgery under general anesthesia,and lesions were sent for pathological examination.The results of NBI assessment were compared with those of pathology.The sensitivity,specificity,accuracy and Kappa-Cohen index of NBI in assessing the nature of lesions were calculated.Results According to NBI endoscopy,123 lesions(80.4％)were classified as low-risk group(type Ⅰ:18,type Ⅱ:41,type Ⅲ:64)and possibly benign le-sions,while 30 lesions(19.6％)were classified as high-risk group(type Ⅳ:2,type Ⅴ:25,type Ⅵ:3)and possi-bly malignant lesions.The pathological results showed that the 121 lesions(79.1％)were hyperkeratosis(20 le-sions),mild(39 lesions),moderate atypical hyperplasia(62 lesions),and the 32 lesions(20.9％)were severe a-typical hyperplasia(5 lesions),carcinoma in situ(22 lesions),and invasive carcinoma(5 lesions).In the low-risk group,2 lateral lesions were pathologically severe atypical hyperplasia.The sensitivity,specificity,positive predic-tive value,negative predictive value,and accuracy of NBI in predicting the malignancy of leukoplacia were 100％,97.6％,90％,100％,and 98％,respectively.Kappa-Cohen index was 0.90(95％confidence interval 82.3％to 100％).Conclusion NBI endoscopy can accurately evaluate the pathological properties of vocal cord leukoplakia.

Cognitive dysfunction refers to dysfunction of individual perception,memory,understanding,learning,creation and other dysfunctions caused by abnormal brain function and structure.Based on the fact that the spleen can't regulate transportation and transformation,govern blood and send up essential substance,combined with the microbiota-gut-brain axis,this article discussed the etiology and pathogenesis of intestinal flora imbalance affecting cognitive dysfunction in TCM.It was proposed that the spleen in TCM and intestinal flora are connected in physiology and pathology:the spleen regulates spirit and governs cognition,when the spleen fails to function normally that it can't dominate transportation and transformation,govern blood and send up essential substance will cause that the brain spirit can not be nourished;intestinal flora is closely related to the spleen in TCM,and affects brain function through the nervous system,endocrine,immune and metabolic mechanisms.This article can provide explore new ideas for the clinical research and treatment of cognitive dysfunction of traditional Chinese and Western medicine.

Sensory nerves belong to the afferent nerve part of the peripheral nervous system.Their role is to accept the stimuli inside and outside the body and transmit them to the center nerve system to form sensations or reflexes.Sensory nerve damage can be caused by trauma,tumor invasion,surgical injury,etc.Sensory nerve injury may cause decline or loss of some sensory organs function in patients.Damage of important sensory nerves such as optic nerves and auditory nerves can bring profound troubles to patients'lives.So far,the main clinical method to repair sensory nerves is autologous nerve transplantation.However,its application is limited by various factors,and the recovery effect of nerve function is often limited.Stem cells have the potential of multi-directional differentiation,which can differentiate into Schwann cells,and then secrete neurotrophic factors to promote axonal growth and myelin regeneration.Schwann cells directionally proliferate and form Bungner zones which guide nerve regeneration.Stem cells can also differentiate into neurons and construct nerve defect repair materials,which is an ideal choice for nerve repair.At present,the tissue engineering technology based on stem cells,combined with several key biotechnology,such as the use of biopolymerized or artificial surface micro-patterning nerve conduit to bridge nerve defects,and the use of microspheres to achieve the controlled release of extracellular matrix proteins and neurotrophic factors,is being widely studied and has achieved certain research results.This article reviews the research progress of stem cells in the repair of several major sensory nerves,such as optic nerves,olfactory nerves,cochlear nerves and sensory nerve fibers of sciatic nerve,expecting to provide a new perspective for neural repair of stem cells,broaden the preclinical research in nerve repair,and provide reference for follow-up clinical application.

Objective:To study the efficacy of Barbed reposition pharyngoplasty (BRP) combined with Han-Uvulopalatopharyngoplasty (H-UPPP) in surgical treatment of OSAHS patients.Methods:OSAHS patients admitted to our department from June 2021 to February 2022 who met the surgical enrollment criteria were divided into two groups by surgical procedure: H-UPPP operation group [Control group, 47 cases, including 42 males and 5 females, aged 18-64 (37.77±11.65)years, and H-UPPP+BRP group [Study group, 48 cases, including 45 males and 3 females, aged 23-60 (39.10±9.86) years]. The surgical efficacy 6 months after operation was retrospectively analyzed. Meanwhile, the relationship between the surgical efficacy and modified Friedman pharyngeal anatomical stages was analyzed. The postoperative pain VAS score at first 3 days and the incidence of foreign body sensation in pharynx after 6 months of operation were compared between the two groups. Statistical analysis was conducted by SPSS 23.0.Results:There were no significant differences in gender, age, BMI, Friedman pharyngeal anatomical stages, ESS score, AHI and LSpO 2 between the two groups, preoperatively ( P>0.05). There was significant difference between the two groups in ratio of cumulative time of oxygen saturation below 90% to total sleep time(CT90), preoperatively. Surgical efficacy of H-UPPP operation group was 48.9% (23/47), while H-UPPP+BRP operation group was 70.8% (34/48), which was statistically significant ( χ2=4.74, P=0.029). H-UPPP+BRP group seemed to have a higher surgical efficacy than H-UPPP group in patients with Friedman Ⅱb (87% vs. 61.9%) and Ⅲ stage (44.4% vs. 15%), but there was no statistically significant difference ( P>0.05). H-UPPP+BRP group had a higher pain VAS score in first three days ( t=-3.10, P=0.003), also had higher incidence of pharyngeal foreign body sensation after 6 months of operation ( χ2=4.727, P=0.030). Conclusions:In the surgical treatment of OSAHS patients, the overall efficacy of BRP combined H-UPPP surgery is higher than that of H-UPPP surgery alone. It may be more suitable for OSAHS patients with modified Friedman type Ⅱb and type Ⅲ stage.

Squamous cell carcinoma of the head and neck (HNSCC) is one of the cancers with the highest incidence rate in the world. Due to the presence of postoperative recurrence and resistance to some chemotherapeutics after the surgery, the prognosis of advanced HNSCC patients is not optimistic. Therefore, it is urgent to improve the efficiency of chemotherapeutics for HNSCC and the prognosis of HNSCC patients. Recent studies have found that ferroptosis has regulatory effect on the growth and proliferation of some types of tumor cells, reducing drug resistance in tumor treatment to a certain extent, and showing great potential in the prevention and treatment of tumors. Therefore, this article will summarize the anti-tumor mechanism of ferroptosis and the current research progress in HNSCC, providing new evidence for the treatment of HNSCC.

Objective:To explore the clinical features and treatment strategy of rare tumor in the internal auditory canal(IAC).Methods:A retrospective study was carried out in 213 patients with lesion of ICA form January 2010 to December 2020. According to imaging features, surgical findings, and pathological diagnosis, there were 7 cases of non-sporadic acoustic neuroma, including 2 cases of cavernous hemangioma, 2 cases of aneurysm, 1 case of intralabyrinthical schwannoma, 1 case of meningioma, and 1 case of unilateral neurofibromatosis type 2 (NF2). The clinical manifestations, imaging data and intraoperative conditions as well as the formulation of individualized treatment strategies and prognosis were comprehensively analyzed.Results:In addition to hearing loss, cavernous hemangioma early appeared damage of facial nerve. CT showed expansion and calcification of IAC. Patients with aneurysm appeared tinnitus and vertigo early. CT showed enlargement of ampulla shape of IAC. DSA or MRA can help confirm the diagnosis. Patients with intralabyrinthine schwannoma early appeared refractory vertigo. High resolution MRI was helpful for diagnosis. “Dural tail sign” can be seen on enhanced MRI of meningeoma. Neurofibromatosis type 2 usually presented as bilateral vestibular schwannomas,but a few patients presented only with unilateral vestibular schwannomas.. All patients underwent labyrinth approach resection except one patient with NF2 for followed-up. Their postoperative symptoms were relieved. No tumor recurrence was observed during 6-3 years of follow-up.Conclusions:The clinical and imaging manifestations of rare tumors of the internal auditory canal are different. The principle of treatment is also different. It is helpful to avoid the serious consequences caused by blind operation to confirm diagnosis before operation.

Objective:The construction of public medical group is an important strategic measure to deepen the health reform in China. Taking Beijing Traditional Chinese Medicine Hospital as an example, the article introduces the measures, achievements, existing problems and possible development direction of the discipline co-construction in the entrusted district hospital.Methods:The article analyzes the measures of discipline co-construction and its implementation effect in detail.Results:It has effectively promoted the reasonable allocation of resources between " well-developed leading disciplines" and " disciplines to be nurtured" in the medical group, these disciplines entering a new rapid development phase through optimized organization and management, system construction, new research platform construction.Conclusions:" Disciplines to be nurtured" has been improved in medical service, scientific research capabilities, talent training, academic inheritance and quality of scientific research achievements, based on which, the goal of promoting the development of medical group through discipline co-construction was achieved.

Objective:To illustrate the diagnosis and treatment of carotid body tumor (CBT) based on our experience of previous patients.Methods:A total of 92 patients with CBT who received surgery between October 2003 and October 2017 were included to summarize the operation process and experience and obsever the postoperative follow-up, postoperative complications and prognosis.Results:92 patients (102 lesions) in total, 27 lesions were categorized into Shamblin grade Ⅰ, 37 were grade Ⅱ, and 28 were grade Ⅲ. Surgical resection of CBT was performed for 63 lesions, resection of CBT and the external carotid artery was performed for 28 lesions, and resection of CBT and the internal carotid artery was performed for 1 lesion. No hemiplegia was observed. Hoarseness and bucking were observed in 2 patients of Shamblin grade Ⅲ, and were eliminated 1 month subsequent to the administration of hormone therapy and a nerve-nurturing strategy. No relapse or mortality was observed during the follow-up.Conclusions:Surgical resection of CBT is recommended following diagnosis. The evaluation of imaging features and cerebral collateral circulation is important for treatment.

Objective:To explore the application effect of whole-course guided management under the concept of enhanced recovery after surgery (ERAS) in perioperative period of patients with acoustic neuroma.Methods:Retrospective analysis was performed on the patients with acoustic neuroma treated by inpatient surgery in our department from January 2018 to December 2019. The patients before January 2019 adopted the traditional outpatient and inpatient treatment management mode were in the control group. Patients admitted after January 2019 were in the observation group. The experimental group adopted the guided management mode under the concept of enhanced recovery after surgery. In other words, on the basis of the traditional management, the whole-course guided management under the concept of enhanced recovery after surgery was added, which mainly included outpatient documentation, introduction of basic disease knowledge, preoperative and postoperative life guidance, preoperative and postoperative psychological guidance and family follow-up. Patients in both groups were observed for their first medical contact-discharge time, medical and nursing satisfaction, and psychological status was assessed by self-rating depression Scale (SDS) and self-rating anxiety scale (SAS) before surgery, on the day of discharge, and 1 month after discharge.Results:The first medical contact discharge time of the whole-course oriented management group under the concept of accelerated rehabilitation surgery was significantly shorter than that of the traditional group, and its medical and nursing satisfaction was significantly improved ( P<0.05); the SDS score and SAS score before operation, on the day of discharge and 1 month after discharge in the observation group were significantly lower than those of the control group ( P<0.05). Conclusions:The whole-process guided management under the concept of enhanced recovery after surgery can significantly shorten the time of patients′ first medical contact and discharge, reduce anxiety and depression in patients with acoustic neuroma before and after surgery, and improve patients′ satisfaction with medical treatment and care.