Objective To study the morphology of the persistent foramen of Huschke (PHF)and the weakness of the remains of foramen of Huschke (WRHF)in the external auditory canal (EAC)by high resolution computer tomography (HRCT)in vivo. Methods The thin HRCT images of 525 cases elder than 5 years were retrospectively reviewed by two radiologists,to detect the PHF or WRHF,and to depict the precise location,size and the distance to the tympanic membrane.The incidence,sex differences, and morphologic data of PHF and WRHF were statistical analyzed.Results ①PHFs were found in 146 EACs of 40 males and 77 fe-males with the prevalence of 13.91%,and were found on both sides in 29 cases.Mean maximum axial diameter was 2.35 mm± 1.1 6 mm (0.6-5.8 mm)and sagittal diameter was 2.09 mm±1.2 mm (0.5-6.2 mm).Mean distance between the inner edge of PFH and the sulcus tympanicus was 1.61 mm±2.4 mm (0-10 mm).②WRHFs were found in 233 EACs of 58 males and 122 fe-males with the prevalence of 22.1 9%,and were found on both sides in 53 cases.Mean maximum axial diameter was 2.43 mm± 0.89 mm (0.8-5.4 mm)and sagittal diameter was 2.08 mm±0.73 mm (0.6-4.3 mm).Mean distance between the inner edge of WRPFH and the sulcus tympanicus was 1.55 mm±1.2 mm (0 - 9.9 mm).③The distance to the sulcus tympanicus was within 3 mm in 137 cases (90.73%)of PFHs and 221 cases (94.43%)of WRFHs.Conclusion Both PHF and WRFH are common by the CT morphological study in vivo.The medial part of EAC is predominant and female is predominant.The incidence and the location of PHF and WRFH are no significant difference.

Objective To analyze the CT and MRI manifestations of congenital cholesteatoma of petrous bone ,and evaluate the efficacy of it in the clinical practice.Methods Imaging findings in 27 pathological-proved cases were review. Imaging materials included CT scan in 26,MRI scan in 11.Results Petrous bone wall erosion and expanding tumor was observed with CT(n=23),tumor was not oberved with CT(n=3).Congenital choleseatoma signal intensity was intermediate or low on T 1W images and high on T 2W images in 11 cases.Conclusion The role of MRI and CT is affirming in the evaluation of congenital choleseatoma of the petrous bone. MRI is superior to CT for the evaluations of involvement of the membranous labyrinth and intracranial structures.

Objective To study the CT and MRI features of primary middle ear carcinoma invading jugular foramen.Methods CT and MRI images of 7 patients with surgically and pathologically confirmed primary middle ear carcinoma invading jugular foramen were analyzed retrospectively,including high resolution CT (HRCT) scan in 6 cases,CT enhancement scan in 1 case and MR plain and enhancement scan in 7 cases.Results On HRCT,the soft tissue lesions mainly located in tympanum,tympanic sinus,the deep of external auditory canal and jugular foramen,and irregular “moth-eaten” bone destruction could be seen,including the destruction of jugular foramen in 7 cases,eustachian tube in 7 cases,facial nerve canal in 4 cases,carotid artery canal in 4 cases,external auditory canal wall in 3 cases,auditory ossicles in 2 cases,vestibular window and horizontal semicircular canal in 1 case.CT plain scan showed the density of soft tissue mass was uniform in 4 cases with CT value of 30-55 HU,and heterogeneous in 2 cases,in which small pieces high density lesions could be found.CT enhancement scan in 1 case revealed moderate and homogeneous enhancement.On MR plain scan,the soft tissue masses with hazy margins could be seen,and compared to the gray matter of brain,the lesions were isointense or slightly hypointense on T1 WI and isointense or slightly hyperintense on T2 WI.The signal was homogeneous in 5 cases and inhomogeneous in 2 cases with small pieces of hypointensity both on T1WI and T2WI.After enhancement,the lesions were enhanced moderately and homogeneously in 5 cases and inhomogeneously in 2 cases with small pieces of nonenhanced area.MRI also showed the erosion of carotid artery in 4 cases,sigmoid sinus in 1 case.Conclusion The primary middle ear carcinoma can invade the jugular foramen area extensively,which may lead to misdiagnosis.HRCT can precisely depict the bone destruction and the invasion of the important anatomic structures in the primary middle ear carcinoma,and the destruction of eustachian tube can help to reduce misdiagnosis.MRI can more clearly show the extent of tumor and the mass signal and enhancement pattern.

Objective To evaluate the imaging diagnosis value of glomus tympanicum tumors.Methods Images of 10 patients with surgically and pathologically confirmed glomus tympanicum tumors were reviewed.The image characteristics and diagnostic value were summarized.Results In 8 patients with high resolution CT scan and 2 patients with routine CT scan,soft tissue nodules within the tympanic cavity were identified on axial or coronal images in 7 of them.And in 3 patients with chronic tympanitis,glomus tympanicum tumors were not differentiated on CT images.Eight patients had undergone MR examination,on T2WI the tumors were moderate hyperintense(n=6)and hyperintense(n=2),and the tumors were enhanced obviously after contrast.In 3 patients with chronic tympanitis,moderate high signal of the tumor can be differentiated with the high signal of tympanitis on T2WI.On contrast MRI,the signal of enhanced tumor or unenhanced tympanitis was identified clearly.Conclusion On diagnosis of glomus tympanicum tumors,MRI is prior to CT,especially in patient with glomus tympanicum and tympanitis.

Objective To compare the effect of applying low molecular weight heparin calcium in different periods of reteplase for acute myocardial infarction(AMI).Methods Ninety-one cases of AMI were divided into group A(30 cases),group B(30 cases)and group C(31 cases)by random digits table.The patients in three groups were given reteplase intravenous thrombolysis,and 5000 U low molecular weight heparin calcium was abdominal wall subcutaneous injections once 12 h at intravenous thrombolysis immediately(group A),after intravenous thrombolysis 6 h(group B)and 12 h(group C).They all were treated for 7-10 d.The rate of coronary artery recanalization,acute phase complication and adverse reaction were compared among three groups.Results The rate of coronary artery recanalization in group A,B and C was 76.7％(23/30),96.7％(29/30),74.2％(23/31)respectively.The rate of coronary artery recanalization in group B was significantly higher than that in group A and C(P ＜ 0.05).The rate of acute phase complication and adverse reaction in group B[33.3％(10/30)]was significantly lower than that in group A and C[70.0％ (21/30)and 61.3％(19/31)](P ＜ 0.05).Conclusions After reteplase intravenous thrombolysis in 6 h,applying low molecular weight heparin calcium can significantly improve the rate of coronary artery recanalization and reduce the rate of acute phase complication and adverse reaction.

Objective To evaluate the correlation between the degree of cochlea endolymphatic hydrops(EH) and hearing loss and symptoms in patients with unilateral Meniere's disease. Methods Fifty seven patients with unilateral Meniere's patients were retrospectively quantitatively analyzed, which evaluated the correlation between the cochlea EH and hearing loss and symptoms. The affected ears in the experimental group(57 ears) and the asymptomatic ears in the control group(57 ears), were confirmed by bilateral intratympanic Gd-DTPA injection and 3D real IR MRI scan after 24 h. The maximum length of endolymph space and labyrinth chamber along the modiolus cochleae and their ratio which represented the endolymph space proportion of each turn(R1, the basal turn;R2, the middle turn;R3, the apical turn) were calculated. And the paired t test was used to compare the differences in EH degree between the experimental and control group;Pearson correlation analysis was used to analyze the correlation between the cochlea EH degree and hearing loss and duration of symptoms. Results R1, R1 and R3 of ipsilateral cochlea were higher than normal cochlea(ipsilateral R1:0.354±0.097 vs. normal R1:0.185±0.031, P<0.01;ipsilateral R2:0.445 ± 0.098 vs. normal R2:0.201 ± 0.046, P<0.01;ipsilateral R3:0.467 ± 0.102 vs. normal R3:0.221 ± 0.053, P<0.01). A positive correlation was found between the degree of EH in each turn and high-frequency hearing loss(r=0.275, 0.281, 0.329, respectively;all P<0.05), whereas no correlation was found between the extent of EH and the time of vertigo, tinnitus and hearing loss(P>0.05). In addition, there was a correlation between the degree of EH in the apical turn and low, medium, high-frequency hearing loss(r=0.271, 0.269, 0.329, respectively; all P<0.05). Conclusions The degree of cochlea EH in the basal and second turn showed great relevance with the high-frequency hearing loss, and the apical turn EH degree was relevant with the low, medium, high-frequency hearing loss, but there was no correlation between the EH degree of each turn, ages and symptoms.

Objective　 To study the clinicopathologic relevance of a thymic epithe lial tumor (TET) grading standard with the WHO classification. Methods　 A gradi ng system for TET was proposed based on the application of WHO histological typi ng of thymic tumors and analyzed in relation to clinical therapy results and fol low-up data of 200 TET cases. Results　 In this series, 8 patients (4.0%) belong ed to type A, 68 (34.0%) were type AB, 17 (8.5%) were type B1, 39 (19.5%) were t ype B2, 27 (13.5%) were type B3 and 36 (18.0%) were type C. The remaining 5 case s were rare thymomas. The overall postoperative survival data showed highly sign ificant differences among the histological subtypes (P<0.001). Typ e A & type AB thymomas showed excellent prognosis, none of these patients died of tu mor; in type B1, only 1 case (5.9%) died at 22 months postoperatively. Types B2, B3 and C thymomas shared the bad, worse and worst prognosis. Ninety-six patien t s (48.0%) were in stage I, 26 (13.0%) in stage II, 65 (32.5%) in stage III and 1 3 (6.5%) in stage IV. Clinical stage is also highly significant in predicting su rvival (P<0.001). It was found that tumor histology could predict surv ival expectancies well in stage I and stage II cases. It was also found that typ e B2, B3 and C thymomas had a statistically significant worse prognosis than typ e A, AB and B1 thymomas (P<0.001). According to the histology, cli nica l data, biological behavior and prognosis, it is proposed that thymomas be divid ed into 4 grades: grade I, II, III and IV. Follow-up is the best strategy for g r ade I & II patients after radical surgery. In this series, the 30 patients (15.0 %) presenting clinical signs of myasthenia gravis were mostly in type B2 and B3 groups (P<0.01). Conclusions　 The WHO classification for TET provides good patho logical definitions and criteria for diagnosis, which can independently predict the invasiveness and prognosis of TET. TET grading is of use in unifying patholo gical and clinical findings, in selection of proper therapy and in predicting pr ognosis.

Objective To summarize the otoscopy,CT and MRI features of spontaneous herniation of the temporomandibular joint(TMJ) into the external auditory canal (EAC) through the persistence Huschke's foramen(PHF).Methods The otoscopy,CT and MRI images of three cases with the herniation of the TMJ into the EAC through the PHF were analyzed retrospectively.Results Otoscopy revealed the masses located in the antero-inferior aspect of the bony EAC,and the mass displayed an alternative of forward and backward motion during opening and closing of the mouth.CT of the temporal bone showed a bony defect and a consecutive soft mass in the antero-inferior wall of the bony EAC.The margin of the bony defects were well-defined in all cases,the bone adjacent to PHF was pressed and partially wrapped around the soft mass as ‘ holding ball’ in two cases,partly peripheral pseudo bony shell of the soft mass were showed in two cases.The soft mass in EAC appeared equal attenuated with the soft tissue of TMJ,and on enhanced CT scans showed no enhancement of the soft mass.On MRI scans,the imaging displayed a bony defect in the antero-inferior wall of the EAC with a soft mass which was formed by the capsule of the TMJ,and the mass showed iso-signal to the capsule of the TMJ on all sequences,and there was no enhancement after contrast administration.Conclusion The otoscopy,CT and MRI features of the spontaneous herniation of the TMJ into the EAC through the PHF is special,and the above examinations are valuable for diagnosis of the disease.

Objective To explore the protective effect of polypeptide Apelin on podocyte mitochondria in diabetic nephropathy and underling mechanisms.Methods Human renal podocytes were divided into four experimental groups:control group,high glucose(HG)group(glucose 25 mmol/L,48 h),Apelin intervention HG group(Ape-lin-13 1 μmol/L,48 h)and Apelin group(Apelin-13 1 μmol/L,48 h).The podocyte apoptosis was observed by TUNEL staining,the expression of mitochondrial membrane protein FUNDC1 was detected by Western blot,and the binding of mitochondrial fission protein DRP1 to FUNDC1 was examined by immunoprecipitation.The 8-week-old male mice were divided into three experimental groups:control group,diabetes group(intraperito-neal injection of streptozotocin 150 mg/kg,only one time)and Apelin intervention DM group(intraperitoneal injection of Apelin-13 0.3 μmol/kg,daily).The morphology of renal was observed by PAS staining and trans-mission electron microscopy.Plasma creatinine(Cr),urea nitrogen,urinary albumin and creatinine were de-tected by ELISA kit.The level of creatinine clearance rate(Ccr)and urinary albumin/creatinine(ACR)was calculated.Results Compared with the control group,the podocyte apoptosis and expression of FUNDC1 in the HG group increased significantly(P＜0.05),and the combination of mitochondrial fission division protein DRP1 to FUNDC1 raised.Meanwhile,compared with the HG group,the number of apoptosis,the expression of FUNDC1(P＜0.05),and the combination of DRP1 to FUNDC1 all reduced in Apelin intervention HG group.Animal experiments showed that the kidney structure of the control group was intact.In the DM group,the num-ber of podocytes decreased significantly,the foot processes were fused and dropped off.In the Apelin intervention DM group,podocyte lesions were less severe than those in the DM group.Compared with the control group,the level of plasma Cr,BUN and urine ACR in the DM group increased,while the level of Ccr decreased significantly(P＜0.05).However,compared with the DM group,the level of above biomarkers in the Apelin intervention DM group was improved(P＜0.05).Conclusions Apelin keeps mitochondrial homeostasis and reduces podocyte ap-optosis by inhibiting the expression of mitochondrial membrane protein FUNDC1,which may contribute to allevia-tion of diabetic nephropathy.

Objective:To investigate the clinical effects of modified fascia flap from cutaneous branch of dorsal metacarpal artery in repairing the wound at the proximal and middle finger segments.Methods:From January 2017 to September 2018, 12 patients with wounds at the proximal and middle finger segments were admitted to the Affiliated Hospital of Zunyi Medical University, including 8 males and 4 females, aged 35-70 years. The areas of wounds ranged from 3.4 cm×2.4 cm to 6.5 cm×4.0 cm. The modified fascia flaps from cutaneous branch of dorsal metacarpal artery were resected to repair the wounds, with the size ranging from 3.5 cm×2.5 cm to 6.7 cm×4.1 cm. The flap donor sites of 5 patients were repaired with direct intermittent suture, the flap donor sites of 4 patients were repaired with full-thickness skin grafts from ipsilateral medial forearm, and the flap donor sites of 3 patients were repaired with wrist pedicled flaps. The survival of the flaps was recorded. Healing of donor site and recipient site was followed. The hand functions were evaluated with trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association.Results:All the flaps survived in 12 cases. During 3 to 12 months of follow-up, the flaps recovered satisfactorily in texture and shape. The donor sites of 11 patients were healed, and the skin graft edge area was partially necrotic in the other patient but healed later after dressing change. The distances of two-point discrimination of the patients ranged from 5.6 to 9.0 mm. Hand functions were evaluated as excellent in 5 cases, good in 4 cases, and fair in 3 cases.Conclusions:Modified fascia flap from cutaneous branch of dorsal metacarpal artery for repairing the wounds at the proximal and middle finger segments has reliable blood supply. The operation is simple and safe with short course of treatment, which is worthy of clinical promotion.