Transforming economic growth mode is one of the most important guiding ideologies of the National twelfth Five-year development program. Since governmental hospitals are non-profit institutional organizations, it is a new topic for hospital managers to transform economic growth. Current situation of governmental hospitals is analyzed and the three main misunderstandings are pointed out. Take the Taian central hospital as the main object and analyzed the practice process of “putting hospital development scale control and revenue growth as the base and premise, shortening the average hospital stay, reducing the medicine proportion and consumable items proportion as the main means, and usd charging level, patients personal commitment to the cost proportion as important evaluation indicators of transformation economic growth mode” . By analyzing the practice process, the experience of transformation of economic growth mode is concluded, which provides some references for transforming economic growth mode in governmental hospitals.

Objective To analyze the medical and audiological features of trauma induced stapes fracture ,and to summarize the key diagnostic points and to observe the effects of surgical treatment .Methods Five patients with trauma induced stapes fracture confirmed by the surgical exploration from January 1995 to October 2013 were retro_spectively reviewed .Ossicular chain reconstruction was performed on each patient .The preoperative and postopera_tive pure-tone thresholds were compared to judge the effects of surgical treatment .ResuIts The surgical explora_tion revealed 4 cases of stapes feet fracture ,1 case of stapes neck fracture with temporal bone fracture and peripheral paralysis of the facial nerve .Different types of ossicular reconstruction were performed according to the exploration results:2 cases with autogenous stapes remodeling ,1 case with allogenous stapes remodeling ,1 case with bone piece of external acoustic meatus ,and 1 case with artificial auditory ossicle(TORP) implanting .Additionally ,the case of peripheral paralysis of the facial nerve received facial nerve decompression .After the operation ,5 patients felt that their hearing was improved .The mean postoperative pure-tone threshold was 30 .7 dB HL ,and the mean ABG(air-bone-gap) was 18 dB HL while the mean preoperative pure-tone threshold was 61 dB HL(t=6 .725 ,P<0 .05) and the mean ABG was 38 .7 dB HL(t=3 .616 ,P<0 .05) .The facial nerve functions of the case with facial paralysis recovered to House-Brackmann Grade I three months after receiving facial nerve decompression .ConcIu_sion Stapes fractures are rare .Being different from the general conductive hearing loss ,patients with stapes fracture usu_ally have the acoustic stapedius reflex .Through ossicular reconstruction ,we can yield a satisfying hearing recovery .

Objective To study the effects of epigallocatechin-3-gallate(EGCG) on noise-induced cochlear injuries.Methods A total of 45 guinea pigs were divided into three groups: the EGCG+noise exposure group, the normal saline+noise exposure group, and the control group.15 Guinea pigs in each group.For EGCG administration, the guinea pigs were given abdominal injection (25 mg/1 000 g) 1 day before and 1 hour before noise exposure (120 dB SPL, 4 h),where for the control group, the guinea pigs received nothing.The hearing function was detected by the auditory brainstem response (ABR) recording after noise exposure immediately, and at 1,3,7, and 14 days after noise exposure.On the 14th day, the cochlea were isolated, and the cells morphology of basal membrane and vascular stria, the outer hair cell movement protein (Prestin), and the 3-nitrotyrosine (3-NT) were examined by immunohistochemistry staminy.Results After noise exposure, ABR thresholds in the EGCG group were higher than that of in the control group(P<0.05), but lower than the normal saline group(P<0.05),though the differences between the other two groups became smaller from day 3.Immunohistochemistry (IHC) staining showed that the three rows of outer hair cells of the control group with Prestin protein stained were arranged neatlyand lack of cell absent, and 3-NT was mainly distributed in the cytoplasm and epidermis.Compared with the normal saline + noise group, after noise exposure, the outer hair cells of EGCG + noise group were in better shape, and prestin staining was clear.Besides, the basal membrane and vascular stria were slightly damaged, the cells arranged neatly and the 3-NT distribution was decreased.Conclusion Preventive intraperitoneal injection of EGCG may reduce cochlea damage caused by noise.

Objective To summarize and analyze the pathogenesis ,methods of hearing reconstruction and curative effect of mixed hearing loss .Methods Patients with mixed hearing loss who underwent hearing reconstruc-tion from Jan 2009 to Dec 2011 in the ENT department of PLA General hospital were reviewed retrospectively .Af-ter the operation ,air conduction (AC) ,bone conduction (BC) ,air-bone gap (ABG) at main frequencies and audi-ometry changes were analyzed .Results Among 32 cases ,15 cases were chronic otitis media ,13 cases otosclerosis , 2 cases Van der Hoeve ,and 2 cases congenital middle ear malformations .There were 26 cases with significantly im-proved hearing after surgery ,and the effective rate was 81 .25% .AC showed great improvement at 0 .25~4 kHz (P<0 .05) while there was no change at 8 kHz (P>0 .05) .BC showed improvements at 1 and 2 kHz and improved significantly only at 2 kHz .After operation ,pure tone audiometry at AC and BC separately improved 24 .94 ± 8 .15 dB and 5 .90 ± 7 .96 dB;ABG narrowed down to 19 .04 ± 11 .06 dB .Conclusion Mixed hearing losses are mostly seen in chronic otitis media and tympanosclerosis .After auditory rehabilitation ,patients can experience improved hearing .

Abstract:Objective To better understand the cholinergic receptors in vestibular hair cells (VHC) and their subtypes, and to investigate the effects of cholinergic agonists on intracellular calcium concentration ([Ca2+]i ) in guinea pig VHCs.Methods VHCs were isolated from guinea pig crista ampullaris by enzymatic and mechanical methods. The effect of cholinergic agonists on [Ca2+]i was examined using laser scanning confocal microscopy and the Ca2+ sensitive dye Fluo-3.Results The results showed that the addition of acetylcholine (ACh) and carbachol (CCh), muscarnic and nicotinic agonists, induced [Ca2+]i increases in all the VHCs, whereas acetylcholine bromide (ACh-Br), a nicotinic agonist, induced the [Ca2+]i increase in only a small percentage of VHCs. The ACh or CCh-induced Ca2+ response could be partially suppressed by atropine. In the presence of 0.1?mmol/L atropine, the amplitudes of ACh or CCh-induced [Ca2+]i responses became significantly smaller than those in atropine free medium (P<0.01). Conclusions The results suggest the existence of cholinergic receptors in guinea pig VHCs. It is the muscarnic agonists rather than nicontic receptors that dominate [Ca2+]i variation. Atropine can suppress muscarnic agonist-induced Ca2+ responses.

OBJECTIVE: To analyze the diagnosis, therapy and prognosis of the rare cases of malignant tumors in external auditory canal. METHOD: Eight cases of rare malignant tumors in external auditory canal were collected except squamous cell carcinoma and adenoid cystic carcinoma. The clinical manifestation, staging, surgical method, secondary treatment and prognosis were analysed. RESULT: There were 5 cases of basal cell carcinoma and 2 cases of mucoepidermoid carcinoma and 1 case of myoepithelial carcinoma. Three cases of the 5 basal cell carcinoma in external auditory canal have been misdiagnosed for a long time. After admission, 4 of the 5 basal cell carcinoma were T1 stage and cured only by a complete resection of tumor. One case of T2 stage basal cell carcinoma was found recurrence 2 years later after the first excision of tumor, and was treated with radiotherapy. Tumor was controlled. Two cases of mucoepidermoid carcinoma had been misdiagnosed as a benign tumor and received a resection. One case was found metastasis to the parapharyngeal space and nasopharynx and was treated with concurrent chemotherapy. Tumor was also controlled after 5-years follow-up. Another case was found metastasis to parotid gland and received an expanding tumor resection. No recurrence was detected after a 1-year followed up. One case of T4 stage myoepithelial carcinoma in external auditory canal was a metastasis of parotid and received a partial temporal bone resection. No-recurrence was found 1 year later. CONCLUSION Because the tumors above have a very low incidence in external ear canal and the location of tumors are hidden, they are often misdiagnosed and delayed in treatment. Therefore, otologists should pay more attention to avoid the misdiagnosis. To the treatment, complete surgical resection of early-stage tumor is important and for late-stage tumor, a supplemented by chemoradiotherapy may be needed.
Carcinoma, Adenoid Cystic ; diagnosis ; surgery ; Carcinoma, Basal Cell ; diagnosis ; surgery ; Carcinoma, Squamous Cell ; diagnosis ; surgery ; Ear Canal ; pathology ; Ear Neoplasms ; diagnosis ; surgery ; Humans ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Parotid Gland ; pathology ; Prognosis ; Retrospective Studies ; Temporal Bone ; surgery

OBJECTIVE: To investigate the clinical features of labyrinthine fistula and obtain the diagnosis, treatment and prognosis of different types of fistula. METHOD: A retrospective analysis of 42 cases (43 ears) with labyrinthine fistula in our hospital from January 2007 to November 2014 was conducted. Data of preoperative clinical manifestation, auditory function, CT image, operative findings, treatment and postoperative recovery were collected and statistically analysed. RESULT: Thirty-nine cases (40 ears) of the 42 cases (43 ears) which were diagnosed as labyrinthine fistula according to operative findings occurred in the lateral semicircular canal, 1 case occurred in the posterior semicircular canal, 1 case occurred in the superior semicircular canal, and 1 case occurred both in lateral and posterior semicircular canal. Before operation, 24 ears (55.8% ) experienced vertigo and 14 ears (32.6%) showed impaired bone conduction hearing threshold. According to Dornhoffer classification standard, 22 cases (23 ears) were diagnosed as type I fistula, 9 cases as type II fistula and 11 cases as type III fistula. There was no statistical difference among the 3 groups on type of hearing loss, vertigo, CT, facial nerve canal damage before operation and bone conduction hearing threshold, vertigo after operation. CONCLUSION An accurate diagnosis of labyrinthine fistula relies on the operative findings rather than preoperative clinical manifestation, auditory function or CT The surgical intervention should be individualized. There is no significant difference on postoperative recovery among different types of labyrinthine fistula.
Bone Conduction ; Cholesteatoma, Middle Ear ; complications ; Deafness ; Facial Nerve Injuries ; Fistula ; etiology ; Humans ; Labyrinth Diseases ; etiology ; Otitis Media ; complications ; Postoperative Period ; Prognosis ; Retrospective Studies ; Vertigo

OBJECTIVE: To investigate the sources of foreign bodies in the middle ear, and to analyze experience and lessons of clinical diagnosis and therapy. METHOD: Five cases of foreign bodies in the middle ear with general information presenting to our department and receiving surgical treatment were reviewed retrospectively. RESULT: The foreign bodies of 4 cases were inserted by trauma, while 1 case by iatrogenic injury. The remain of foreign bodies result in symptoms such as otorrhea and hearing loss, and long-term foreign bodies in the middle ear might cause mental effects. All 5 patients received surgical intervention under general anesthesia to remove the foreign bodies. We found that the foreign bodies of 3 cases located in the mesotympanum, 1 located in the epitympanum and the aperture of the eustachian tube, 1 located in the squamous portion of the temporal bone and the gas room of lateral wall of epitympanum. CONCLUSION Foreign bodies in the middle ear are prone to be missed diagnosed and misdiagnosed. Careful specialized examination is appreciated. Patients who are suspected with foreign bodies in the middle ear should regularly take temporal bone HRCT scan. Foreign bodies could be removed by surgery when a definite diagnosis is made.
Adult ; Ear, Middle ; Female ; Foreign Bodies ; diagnosis ; surgery ; Humans ; Male ; Retrospective Studies

Congenital facial palsy is unilateral or bilateral facial nerve palsy at birth due to genetic or different pathogenic factors. It can be divided into syndromic type and non-syndromic type according to its accompanying symptom. The pathogeny and symptom of each type are different, in part with genetic heterogeneity. Congenital facial palsy cannot recover spontaneously. Different types of congenital facial palsy have different treatment schemes. The treatment is significant to the improvement of life quality and physical and mental development of children with congenital facial palsy.

Objective:The research is to study the expression and distribution of matrix metalloproteinase (MMPs)-2 and -9 in the guinea pig cochlea after noise exposure, and to explore the role of MMPs in the blood-labyrinth-barrier (BLB). In addition, the role of MMPs inhibitor doxycycline in noise-induced BLB trauma was studied as well, which provides the basis for further studies and prophylaxis of noise-induced hearing loss.Methods:A total of 45 healthy adult guinea pigs were randomly divided into the control group (15 received intraperitoneal injection of 0.9% saline for 4 consecutive days), the noise-exposure group (15 exposed by 120 dB SPL white noise for 4 h per day for continuous 2 d, intraperitoneal injection of normal saline for 4 consecutive days) and the noise-exposure + doxycycline group (15 exposed by 120 dB SPL white noise exposure for 4 h per day for 2 consecutive days, and intraperitoneal injection of doxycycline 50 mg/kg/d for 4 consecutive days), respectively. Immunofluorescence staining, western blot, and real-time quantitative PCR were used to analyze the distribution and differential expression of MMP-2 and -9 in the stria vascularis of guinea pigs in comparison with the normal control group, noise only group, and noise & doxycycline treatment group. Immunofluorescence staining was used to observe the changes in tight junction (TJ) protein ZO-1 in stria vascularis in three groups and to investigate the effect of acoustic injury on TJs. And ABR tests were utilized to detect the hearing function of guinea pigs in the three groups. Intravenous Evans blue was administrated intravenously as an indicator of vascular leakage among three groups to study the changes in BLB permeability in context of acoustic injury. SPSS 22.0 was used for statistical analysis.Results:There was no significant difference in hearing function between the noise-exposure group and the noise & doxycycline group two hours after noise exposure. After seven, 14 and 28 days noise exposure, the hearing recovery of the noise & doxycycline treatment group was significantly greater than that of the noise-exposure group ( P<0.05) . Immunofluorescence staining showed that there was only a small amount of MMP-2 and -9 in the stria vascular in the normal control group, and ZO-1 showed dense linear expression. While, in the noise-explore group, MMP-2 and -9 in the stria vascular was significantly elevated ( P<0.05), and the configuration of ZO-1 became loose and discontinuous. However, the MMP-2 and -9 in the noise & doxycycline treatment group were not significantly different from the normal control group ( P>0.05), which were significantly less than that in the noise-exposure group, and just a little break of ZO-1 was observed, however, the overall structure remained dense. The leakage of Evans blue from stria vascular capillary in the noise-exposure group was significantly increased, and the difference between the other two groups did not show any statistical significance ( P>0.05). Conclusions:The damage of tight junction structure induced by MMP-2 and -9 may play an important role in BLB destruction. In addition, doxycycline can inhibit MMPs secretion, thereby, to some extent, protecting the integrity of BLB from acoustic injury, and contributing to the long-term hearing recovery.