The morphological variations and congenital malformations of the auditoryossicles are not so rare as previously considered.The congenital anomalies of themhave sometimes been documented in the periodicals of the otorhinolaryngology,buttheir variations reported are scanty and incomplete.With dissecting microscope,weobserved 588 ossicles(200 mallei,224 incudis 164 stapes)from 120 full term foe-tuses without congenital defect except one case of anencephaly.We found that theauditory ossicles vary greatly in their form,length,size,angulation,curvature orthickness,etc.Those are variations of anterior fovea of caput mallei,anteriorcurvature of manubrium mallei,form of lateral margin of manubrium mallei,formof crus breve of incus,form of crus stapedis and patterns of basis stapedis.In 240 ears,five cases of congenital malformations of ossicular chain(2.1%)were discovered and listed as follows:1.One case of congenital stapes footplate fixation,2.One case of ring form stapes detached from the basis stapedis,3.Two cases of columella stapes,4.One case of triple fusion of ossicles by osteoid tissue.Embryology of auditory ossicles available for understanding the variability anddeformity was briefly reviewed.According to our investigations we come to the conclusion that the stapesis probably the most frequently involved in the morphological variation andmalformation.

The arteries of auditory ossicles of 40 ears from 20 full term feotuses weredemonstrated by injection of liquid latex containing a small amount of Chinese inkthrough common carotid arteries.We found that the malleus and incus possess thenutrient arteries as well as the mucosal arteries,whereas the stapes gets its bloodsupply from the mucosal arteries only.The anterior tympanic artery is the principal source of blood supply of the mal-leus and the incus.It enters the middle ear through the petrotympanic fissure andramifies into five branches:malleolar artery,incudal artery,superior branch,posteriorbranch and chorda tympani branch.The malleolar and incudal arteries are nutrientarteries.The vascular network in mucosa over the manubrium mallei is supplied bythe branches of the deep auricular and stylomastoid arteries over the tympanic mem-brane.The mucosal arteries of the long crus of the incus is supplied by the smallvessels given off by incudal artery before entering the nutrient foramen,the finevessels from the arteries around the chorda tympani and the vessels passing to it fromstapes.The blood supply of the stapes is derived from the vessels located in two majorareas:one from the facial canal and the other from the promontory.The arteries tothe stapes from the promontory vascular plexus are the artery of the head of thestapes,the artery of the posterior crus and the artery of the anterior crus.The for-mer two vessels have not been reported previously.In the facial canal there are thestylomastoid artery and the superficial petrosal artery.The arterial supply of incudostapedial joint and the distal portion of the incuscomes from the vessels passing to them from the stapes rather than from the incudalsource.From above account,it would appear that the head of the malleus and thebody and short crus of the incus derived from first branchial cartilage are mainlysupplied by the anterior tympanic artery,and the remainder of the auditory ossiclesderived from second branchial cartilage are supplied by the stylomastoid artery.

Objective To study the different extraction methods for the content of tanshinoneⅡA in water decocted Radix Salviae Miltiorrhiza, in order to develop comprehensive utilization of Salvia miltiorrhiza. Method Tanshinone ⅡA was extracted by supercritical carbon dioxide fluid and compared with ultrasonic extraction. Result When the extraction pressure was 35 MPa, extraction temperature was 40 ℃, extraction time was 2 h and entrainer (ethanol) was 100 %, the yields of the tanshinone ⅡA was up to 3.87 mg, while the ultrasonic extraction was 2.89 mg. Conclusion TanshinoneⅡA extracted by supercritical carbon dioxide fluid was better than ultrasonic extraction and had higher purity. The comprehensive utilization of Salvia miltiorrhiza is available.

Objective To explore the relationship between the size of the kidney and gender,age,height,weight,waist circumference then derive an estimation formula of a normal kidney size for different people.Methods We investigated 1 000 normal cases who accepted the examination in Tianjin Medical University General Hospital from December 2011 to April 2012,including 462 males,538 females,aged 21-78 years.All the investigated subjects were healthy except for hypertension,diabetes,coronary heart disease.Blood urea nitrogen (BUN) and creatinine (Cr),fasting glucose,uric acid,routine urine test were all in the normal range.Height,weight,and waist circumference were measured for all the subjects.The renal length and transverse diameter in supine coronal sections,anteroposterior diameter in vertical cross-section of the renal hilum were measured by the same technical experts with Philip iU22 C5-1,3.5 MHz convex array probe.Results The right and left kidney size both are significantly related to height (right r=0.845,left r=0.876,P＜0.01).By multiple regression analysis,there was a significant association between height,weight,body surface area and kidney size (R2＞0.5).Linear regression formula for the kidney length and the height(H,cm):Kidney length of men:right 0.059×H+0.144; left:0.061 ×H+0.287.Kidney length of women:right 0.039×H+3.679; left:0.035×H+4.454.Regardless of gender,the formula of left kidney length:0.052× H+0.721.Linear regression formula about the left kidney length and the height,body weight and body surface area (unit:H cm,W kg,BSA m2):0.114×H+0.139×W-10.287×BSA+2.112.Conclusion There is the best correlation between kidney length and height.Height,weight,body surface area have great influence on kidney size.

Objective To compare the continuous subarachnoid block with ropivacaine or sufen?tanil either alone or in combination for labor analgesia. Methods Ninety nulliparous parturients who re?quired labor analgesia voluntarily, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 23-35 yr, with a body height of 155-170 cm, were included in this study. When regular uterine contrac?tion appeared, labor analgesia was performed in the first stage of labor. The parturients were divided into 3 groups ( n=30 each ) using a random number table: ropivacaine group ( group R ) , sufentanil group (group S), and combination of ropivacaine and sufentanil group ( group RS). The spinal catheter was placed at L3,4 interspace. In group R, ropivacaine was given as an initial bolus of (0.6 mg∕ml) 5 ml fol?lowed by an infusion of 0.2 mg∕ml after the analgesia pump was connected. In group S, sufentanil was given as an initial bolus of (1.6 μg∕ml) 5 ml followed by an infusion of 0.2μg∕ml after the analgesia pump was connected. In group RS, the mixture of ropivacaine 0. 3 mg∕ml plus sufentanil 0. 8 μg∕ml was given as an initial bolus of 5 ml, followed by an infusion of the mixture of ropivacaine 0. 1 mg∕ml plus sufentanil 0.1 μg∕ml after the analgesia pump was connected. The analgesia pump was programmed to deliver a 5 ml bolus dose with a 15 min lockout interval, background infusion at a rate of 5 ml∕h, and the total volume of 100 ml in the three groups. The analgesia pump was connected at 30 min after the initial bolus was given, and the infusion was stopped at 2 h after delivery in the three groups. Visual analog scale ( VAS) scores were maintained ≤3. VAS scores were recorded before analgesia and at 5, 10 and 30 min after the initial bolus was given. The interval and duration of uterine contraction were recorded before analgesia, in 0-30 min, 30-60 min and 90-120 min of analgesia periods, and in the second stage of labor. The development of nausea and vomiting, pruritus, lateral episiotomy, assisted vaginal delivery, cesarean section, and post?dural puncture headache and requirement for oxytocin were recorded. Apgar scores at 1, 5 and 10 min after birth were recorded. Results The Apgar score of the newborn was more than or equal to 7 at 1, 5 and 10 min after birth in the three groups. Compared with the value before analgesia, the interval of uterine contraction was significantly prolonged, and the duration of uterine contraction was significantly shortened in the 0-30 min of analgesia period in group R ( P<0.05) , and no significant change was found in the inter?val and duration of uterine contraction in each analgesia period in S and RS groups ( P>0.05) . Compared with group R, the VAS scores were significantly increased at 5 and 10 min after the initial bolus was given, the interval of uterine contraction was significantly shortened, and the duration of uterine contraction was significantly prolonged in S and RS groups, and the incidence of pruritus was significantly decreased in group S ( P<0.05 or 0.01) . Compared with group S, the incidence of pruritus was significantly decreased ( P<0.01) , and no significant change was found in the VAS scores at each time point and interval and du?ration of uterine contraction in each analgesia period in group RS ( P>0.05) . Conclusion Continuous sub?arachnoid block with combination of ropivacaine and sufentanil provides better efficacy for labor analgesia than ei?ther alone.

Objective To investigate the clinical features of cerebral infarction complicated with diabetes mellitus (DCI) compared withthose without diabetes mellitus (NCI). Methods 80 DCI and 86 NCI hospitalized patients were reviewed with their serumal glucose, lipid,uric acid, hemorheology and carotid ultrasound. Results The total cholesterol, low density lipoprotein and uric acid were significantly higherin DCI group than in NCI group (P<0.05), while high density lipoprotein was significantly lower (P<0.05). There were significant differencesbetween these two groups in Hemorheological indicators except hematokrit (P<0.01). The carotid intima media thickness (IMT) wassignificantly higher in the DCI group than in the NCI group (P<0.05). Conclusion DCI patients suffered in more serious lipid, uric acid,hemorheological disorder, and IMT compared with NCI.

Objective To compare the assessment results of Loewenstein occupational therapy cognitive assessment (LOTCA) and mini-mental state examination(MMSE) in stroke patients,and to analyze the correlation between the two assessments and to explore the applicable values of LOTCA in assessing vascular cognitive function impairment (VCI).Methods According to the diagnostic standard of cognitive impairment with MMSE,thirty stroke patients with cognitive impairment were selected as cognitive impairment group,thirty stroke patients without markedly cognitive impairment as stroke control group,and thirty normal subjects served as normal control group.All the subjects' age,gender and level of education were matched in the three groups. All the subjects were assessed with LOTCA and MMSE.ResultsThe total scores of LOTCA had high positive correlation with the total scores of MMSE in cognitive impairment group ( r =0.934,P ＜ 0.01 ),the correlations were also found between every sub-items of LOTCA and those of MMSE (P ＜ 0.01 ).The total scores and the scores of sub-items of LOTCA in cognitive impairment group were significantly lower than those in stroke control group and were those in normal control group(P ＜ 0.01 ),particularly lower scores in LOTCA sub-items of thinking operations,orientation,visuomotor organization.The scores of sub-items of LOTCA,including thinking operations,visuo-motor organization,attention,orientation,spatial perception were all significantly lower in stroke control group than those in normal control group(P ＜0.01 ),especially in thinking operations and visuo-motor organization sub-items.Conclusions Correlations were found between LOTCA and MMSE.Compared to MMSE,LOTCA could detect vascular cognitive function impairment earlier and is much more comprehensive,so it is suitable to assess vascular cognitive impairment patients with no dementia.

OBJECTIVETo investigate surgical methods and effects of unstable scapular fracture.

METHODSFrom October 2008 to August 2011, 14 patients with unstable scapular fracture were treated. There were 12 males and 2 females with an average age of 38.7 years (ranging, 21 to 55 years).The time from injury to hospitalization was 1 hour to 10 days (mean 3 days). Among patients,3 patients had scapular body fracture,4 patients had scapular neck and body fracture,4 patients had scapular neck and acromion fracture,2 patients had glenoid cavity and coracoid fracture, 1 patient with scapular spine and coracoid fracture. All patients were treated by operation, Hardegger classification system was applied to evaluate the function.

RESULTSAll patients were followed up for 2 to 36 months (mean 12.4 months). The healing time ranged from 6 to 8 weeks. No infection and internal fixation failure occurred. The effect result of Hardegger scoring system was excellent in 9 cases, good in 3 cases, fair in 2 cases.

CONCLUSIONSurgical treatment for unstable scapular fracture can reconstruct stability of shoulder joint, promote early rehabilitation of joint function, and maximally restore shoulder function.

Adult ; Female ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; diagnostic imaging ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Radiography ; Recovery of Function ; Scapula ; injuries ; physiopathology ; surgery ; Young Adult

Objective To discuss the cause,treatment and prevention of splenic injury during the urological surgery.Methods The clinical data of 16 cases with splenic injury in operation for renal and adrenal tumors in 496 cases were retrospectively analyzed.Nine cases were left radical nephrectomy,3 cases were left renal hamartoma enucleation,4 cases were left adrenal tumor resection.Damage located at outer edge of the spleen in 8 cases,the splenorenal ligament in 6 cases,and the splenic hilum in 2 cases.In these 16 cases,14 patients spared the spleen (Ⅰ Grade injury 8 cases,Ⅱ grade 6 cases).The injuryed spleen was directly pressed with hemostatic gauze in 3 cases; 5 patients used coagulation,bonding,hemostatic gauze to stop bleeding; 2 cases of grade Ⅱ injury used U-shaped suture and coated with fibrin glue,then compressed with hemostatic gauze to stop bleeding; 2 cases of grade Ⅱ injuries with the greater omentum stitched into the seam,sprayed biological glue,were compressed with gelatin sponge; 2 cases of grade Ⅱ injury underwent splenic artery branch ligation.The other 2 cases (1 Ⅱ grade and 1 Ⅲ grade) underwent splenectomy.Results All of the 16 patients were cured and followed up for 6 months to 5 years.There was no delayed bleeding of spleen and splenic dysfunction.One patient died of tumor recurrence 6 months after operation.Conclusions Splenic injury is a common complication during urological surgery,especially the tumor is large or adhered to spleen in the upper pole of left kidney.Once spenic injury occurs,doctors should choose the right treatment plan according to surgical injury,and try to save the spleen.

Objective To study the effect of clinical nursing path with graph and text instructions (GTI) on health education to patients with complex retinal detachment.Methods Toally 76 inpatients with complex retinal detachment were enrolled in the study:38 of them hosptalized from March to August 2015 were put in the control group received routine treatment and the others hosptalized from September 2015 to March 2016 as the experiment group treated with GTI.The clinical outcomes were compared.Result The patients treated with GTI were better in the knowledge of the complex retinal detachment and moreover,they felt significantly more satisfied compared to that of the control group (P＜0.05).Conclusion It is beneficial to use GTI in the patients with complex retinal detachment.GTI is effective for improving their knowledge on the disease,and increasing their satisfaction with the clinical nursing.