Zhonghua yi xue za zhi最新文献

The effects of tinnitus on human health are receiving increasing attention, and it is currently believed that the central compensatory response caused by peripheral hearing loss is the main pathogenesis of chronic tinnitus. Tinnitus, psychological problems and sleep disorders affect and worsen each other, and should be taken seriously in treatment strategies. Chronic tinnitus treatment strategy advocates comprehensive treatment based on sound therapy, including reducing tinnitus sound perception and improving patients' negative mood and poor sleep. Whether treating tinnitus alone or treating relevant psychological problems and sleep disorders can break the vicious circle of tinnitus, psychological problems and sleep disorders. Therefore, balancing both psychological and sleep problems, is the direction of tinnitus treatment and research. The clinical study of the treatment of tinnitus should shift from the previous single tinnitus treatment mode and a single tinnitus evaluation index to the comprehensive treatment and comprehensive evaluation indicators that balance both psychotherapy and sleep improvement.

Objective: To explore the related factors of anxiety and anxiety tendency in patients with tinnitus. Methods: A cross-sectional study was carried out. Basic information, tinnitus characteristics, and psychological status of patients who complained of tinnitus in the Outpatient Department of Eye & ENT Hospital, Fudan University between January 2020 and December 2023 were collected. All patients filled out the self-rating anxiety scale (SAS) and underwent pure tone audiometry testing. According to the SAS scores, patients were divided into three groups: non-anxiety group (SAS<40), anxiety tendency group (40≤SAS<50), and anxiety group (SAS≥50). The related factors of anxiety and anxiety tendency were analyzed using multivariate ordered logistic regression analysis. Results: A total of 176 patients (57 males and 119 females) aged (49.4±10.7) years (range: 13-76 years)were included, with the onset time of 3 days-37 years. There were 78 cases (44.3%), 65 cases (36.9%) and 33 cases (18.8%) in the non-anxiety group, the anxiety tendency group and the anxiety group, respectively. The duration of disease in the anxiety group [(43.4±15.1) months] was significantly longer than that in the anxiety tendency group [(27.2±5.3) months] and the non-anxiety group [(19.6±3.5) months], with statistically significant differences (both P<0.05). The proportion of female patients in the anxiety group [81.8% (27/33)] and anxiety tendency group [75.4% (47/65)] was significantly higher than that in the non-anxiety group [57.7% (45/78)], and the differences were statistically significant (both P<0.05). The proportion of patients with emotional disorders [12.1% (4/33) vs 2.6% (2/78)], stress [15.1% (5/33) vs 3.9% (3/78)], and sleep disorders [48.5% (16/33) vs 23.1% (18/78)] in the anxiety group was significantly higher than that in the non-anxiety group (all P<0.05). The proportion of patients only had sleep disorders in the anxiety tendency group [38.5% (25/65) vs 23.1% (18/78)] was higher than that in the non-anxiety group, with a statistically significant difference (P<0.05). The results of multivariate ordered logistic regression analysis showed that sleep disorders werethe most significant factor affecting anxiety and anxiety tendency in tinnitus patients (OR=2.667, 95%CI: 1.451-4.909, P=0.002). Conclusion: A significant proportion of tinnitus patients exhibit anxiety and anxiety tendency, and sleep disorders play a major role in the development of anxiety and anxiety tendencies in tinnitus patients.

Objective: To verify the consistency between changes in Mandarin Tinnitus Questionnaire (MTQ) scores and tinnitus treatment outcomes. Methods: Tinnitus patients attending the Department of Otorhinolaryngology-Head & Neck Surgery, West China Hospital of Sichuan University from September 2020 to September 2021were prospectively enrolled. The tinnitus severity was evaluated by the doctor's assessment, the patient's self-assessment, the MTQ, and the Visual Analogue Scale (VAS). Follow-up assessments were conducted 3 to 6 months later to evaluate the severity of tinnitus post-treatment, and information on the interventions received (pharmacologic/non-pharmacologic) and patients' self-reported clinical impressions of their treatment outcomes (tinnitus cured/improved/no change/exacerbated) was collected. Results: A total of 54 tinnitus patients aged (43.5±12.7) years were included, consisting of 16 males and 38 females. There were 38 cases in the medication group and 16 cases in the non-medication group. No statistically significant differences in baseline clinical data were observed (all P>0.05). The proportion of primary tinnitus in the medication group was higher than that in the non-medication group [97.4% (37/38) vs 75.0% (12/16), P=0.023]. The correlation coefficients of MTQ scores at the initial and follow-up visits with doctor's assessment, patient's self-assessment, and VAS scores were 0.679, 0.483, 0.606, 0.774, 0.779, and 0.756, respectively (all P<0.001). The ΔMTQ correlation coefficient with ΔVAS was 0.694 (P<0.001), with a mean difference of 3.704×10^-7 and 95% limits of agreement ranging from -1.534 to 1.534 in Bland-Altman analysis. There were no statistically significant differences of ΔVAS and ΔMTQ between two groups (both P>0.05). Conclusions: MTQ correlates well with the doctor's assessment, the patient's self-assessment, and VAS. Changes in MTQ scores associate well with changes in VAS scores. Additionally, changes in MTQ scores are consistent with the effect of tinnitus treatment.

In recent years, the treatment of malignant tumors has continually advanced, significantly extending the survival period of cancer patients. Tumors are increasingly present as chronic diseases over the long term, and the cardiovascular toxicity associated with cancer treatment has become increasingly prominent, severely affecting the effective treatment and survival of cancer patients. As a result, cardio-oncology has gained considerable attention as an emerging discipline. However, cardiovascular diseases in cancer patients often have an insidious onset, and early identification and treatment are frequently overlooked. Throughout the course of cancer treatment, it is crucial to reasonably apply cardiac biomarkers for risk stratification, early identification, and screening of cardiovascular diseases in patients, as well as to improve the early diagnosis and treatment levels of cardiovascular diseases in cancer patients. To this end, Cardio-Oncology Group, Chinese Society of Cardiology in conjunction with Cardiovascular Expert Committee, China Medical Doctor Association of Laboratory Medicine, organized experts in relevant fields to compile this consensus. It aims to provide a basis for clinicians to standardize the screening and management of cardiovascular toxicity related to cancer treatment through the reasonable application of cardiac biomarkers.

Objective: To analyze MRI and clinical characteristics of idiopathic inflammatory myopathy (IIM) activity and construct a prediction model. Methods: A retrospective analysis was conducted on 326 patients with IIM from December 2019 to December 2023 at General Hospital of Ningxia Medical University, including 112 males and 214 females, aged(53.7±15.3) years. According to histopathology and electromyography, they were divided into active phase group(n=86) and inactive phase group (n=240). The two groups were randomly divided into the training set and the verification set according to the ratio of 7∶3. The single factor analysis, least absolute shrinkage and selection operator (Lasso), random forest algorithm, and multivariate logistic regression model were used to screen the risk factors of IIM activity and construct a prediction model. Receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the performance of prediction model. Results: There were significant differences in gender, age, T₁ value, T₂ value, creatine kinase-MB(CKMB), creatine kinase (CK) and lactate dehydrogenase (LDH) between the two groups(all P<0.05). Lasso and random forest algorithm screened 5 variables for analysis, age (λ=-0.009), T₂ value (λ=-2.564), CKMB (λ=-0.256), CK (λ=-0.492), LDH (λ=-2.786) respectively. Multivariate logistic regression model showed that age (OR=1.603, 95%CI: 1.030-1.096), T₂(OR=352.269, 95%CI: 13.303-9 328.053), CKMB (OR=2.470, 95%CI: 1.497-4.075), CK(OR=4.973, 95%CI: 2.583-9.575), LDH(OR=1 155.247, 95%CI: 152.387-8 757.954) were risk factors for active IIM patients. A prediction model nomograms were drawn with the above risk factors included. The area under the ROC curve (AUC) of the prediction model for the training set MRI combined with clinical indicators was higher than that of the clinical indicator model [0.914 (95%CI: 0.873-0.955) vs 0.901 (95%CI: 0.858-0.945), P<0.001], with sensitivity of 88.3% and 90.7%, and specificity of 81.7% and 75.0%, respectively. The AUC of the prediction model for the validation set MRI combined with clinical indicators was higher than that of the clinical model [0.982 (95%CI: 0.873-0.955) vs 0.934 (95%CI: 0.858-0.945), P<0.001], with sensitivity of 97.2% and 88.5%, and specificity of 100.0% and 92.3%, respectively. The calibration curves plotted in the training set and test set, respectively, fit well with the ideal curve. Conclusion: The nomogram model of MRI combined with clinical indicators can effectively predict the activity of IIM.

Objective: To explore the validity of the Chinese version of tinnitus handicap inventory (THI-CM) using confirmatory factor analysis. Methods: A cross-sectional study was carried out. The patients who complained of tinnitus and visited the Department of Otolaryngology, Head and Neck Surgery at West China Hospital of Sichuan University from March 15 to June 28, 2023 were included. All participants underwent pure tone audiometry and acoustic impedance testing before filling out THI-CM, and the results were subjected to confirmatory factor analysis. Results: A cross-sectional study was carried out. A total of 300 patients aged (47±13) years participated in this study. There were 175 females (58.3%) and 125 males (41.7%). The confirmatory factor analysis showed that χ²/df was 1.597<3.00, root mean square error of approximation (RMSEA) was 0.039<0.05, and standardized root mean square residual (SRMR) was 0.091>0.08. The incremental fit index (IFI), Tucker-Lewis index (TLI), comparative fit index (CFI), and goodness of fit index (GFI) were 0.960, 0.954, 0.960, and 0.902, respectively. The overall model fitted well. Except for one item with a load of 0.493, the load values of the other items were between 0.553 and 0.771. The composite reliability (CR) values of the three dimensions of the scale were between 0.769 and 0.901 (all CR>0.7). The average variance extracted (AVE) values ranged from 0.403 to 0.505 (all AVE<0.7), indicating poor convergent validity of the scale. The square value of AVE in each dimension of the scale was smaller than the correlation coefficient between factors, indicating poor discriminant validity of the scale. Conclusions: The THI-CM has good structural validity, which can be used as an effective tool to evaluate the overall severity of tinnitus. However, its convergent validity and discriminant validity are poor.

Autogenous bone has always been the gold-standard bone graft material. As such, it is the primary choice for bony grafts. Autogenous bone grafting has been performed for hundreds of years, and more than 2 million cases of autogenous bone transplantation are performed each year worldwide. It has become the most commonly used surgical method in orthopedics. Numerous studies have suggested methods to select the appropriate donor area, standardize the surgical procedure, and reduce donor site complications, but clinical standards and guidelines remain to be established. To better guide the clinical practice of physicians in China, the Trauma Orthopedic Branch of the Chinese Orthopedic Association, the External Fixation and Limb Reconstruction Branch of the Chinese Orthopedic Association, and the Microsurgery Branch of the Beijing Orthopedic Association developed the "Clinical practice guideline for autogenous bone grafting in China (2024 edition)" based on current medical evidence. This guideline systematically evaluates recent domestically and internationally published literature and medical research evidence in the field of autologous bone grafting in the Chinese population. The guideline was produced with the aim of standardizing the indications and techniques for autogenous bone transplantation, as well as preventing complications at the harvesting site of autologous bone, in the Chinese population.