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.

With transmission electron microscopy,the endoplasmic reticulum of the parathyroid chief cells in normal and cadmium-treated golden hamsters was observed. After 1 month treatment of cadmium, there were dilated and whorl-shaped rough endoplasmic reticulum in the chief cells. After 3 and 6 months treatment of cadmium, there were concentric membranous body and paired endoplasmic reticulum in the chief cells. The mechanism responsible for the morphological change of the endoplasmic reticulum after cadmium treatment and the possible toxicologic effect were discussed.

The computer three-dimensional reconstruction of serial sections is an important research area in the world at precent. In this paper, we combine the computer graphics, image processing and biomedical techniques to reconstruct the stereo model of intra-glandular lymphatics, veins, arteries and duets with the serial semithin sections of human submandibular gland.

Objective To explore the etiology and pathogenesis of Hirschsprung disease(HD) and the role of nitric oxide in pathophysiology of HD. Methods The whole amount preparations of dilative and transitional segments were stained by NADPH\|diaphorase histochemistry mothod,and colonic walls were digested by dispase. Then the NOS positive nervous structure were observed by light and scanning electron microscope. Results In dilative segment, under light microscope, ganglion and neuron were bigger and more darkly stained. Intraganglionic neurons distributed mostly in peripheral area of ganglion and basal part of ganglionic fiber bundles. Under scanning electron microscope, the neurons were denser, more nerve fibers from them and connected with each other in all dimensions. And more transverse connected fibers between neurons which were arranged along muscle fibers. Myenteric plexus even connected with the submucosal plexus by nerve fibers which passed through circular muscle layer. In transitional segment, under light microscope, intraganglionic neurons cytoplasm were lightly stained and also variedly. The ganglion and neurons of the segment were smaller, and the fibers from them were thinner and paler than those of the dilative segment. Under scanning electron microscope, neurons' density was lower, the fiber connection between neurons and muscle fibers/neurons was lesser. In the transitional segment, neurons and nerve fibers were distributed linearly along the longitudinal muscle fibers. Conclusion Our results indicated that an intimate relationship existed between the development of Hirschsprung disease and abnormal distribution and metabolism of NOS positive neuron in colonic wall. [

Objective:To investigate the clinical significance of soluble growth stimulating expression gene 2 protein (sST2) combined with neutrophil/lymphocyte ratio (NLR) in the prediction of nosocomial cardiovascular adverse events in patients with acute carbon monoxide poisoning (ACOP) myocardial injury.Methods:Patients with ACOP myocardial injury from January 2017 to December 2019 in Emergency Ward and EICU of Harrson International Peace Hospital, Hebei Medical University were enrolled. NLR was calculated by routine blood examination on admission, and sST2 (T 0sST2, T 3dsST2) was detected by ELISA on admission and at 3 days after admission. According to the occurrence of cardiovascular adverse events, the patients were divided into the event group and the non-event group. Logistic regression was used to analyze the risk factors of in-hospital cardiovascular adverse events. ROC curve was used to analyze the value of sST2, NLR, sST2 and NLR combined in predicting the occurrence of in-hospital cardiovascular adverse events in patients with ACOP myocardial injury. Results:Totally 255 patients with ACOP myocardial injury were included in the final analysis. NLR was (13.38±4.33) in the event group and (9.57±4.22) in the non-event group, T 3dsST2 was (61.59±22.67) ng/mL in the event group and (40.52±13.14) ng/mL in the non-event group, with statistically significant differences (all P<0.01). T 0sST2 was (265.34±89.95) ng/mL in the event group and (242.43±93.09) ng/mL in the non-event group, with no statistically significant difference ( P=0.333). Logistic regression analysis showed that NLR ( OR=1.270, 95% CI: 1.125-1.434, P<0.01) and T 3dsST2 ( OR=1.082, 95% CI: 1.052-1.114, P<0.01) were independent risk factors for nosocomial cardiovascular adverse events in patients with ACOP myocardial injury. The optimal cutoff value of T 3dsST2 was 44.5 ng/mL, and of NLR was 12.08. The sensitivity and specificity of dual T 3dsST2 and NLR in predicting nosocomial cardiovascular adverse events was 79.3% and 82.7%, respectively (AUC 0.857, Youden index 0.620). Conclusions:T 3dsST2 and NLR are independent risk factors for the nosocomial cardiovascular adverse events in patients with ACOP myocardial injury. The predictive cutoff values are 44.5 ng/mL for T 3dsST2 and 12.08 for NLR. Combination of T 3dsST2 and NLR has a practical predictive value for nosocomial cardiovascular adverse events in patients with ACOP myocardial injury.

Objective To discuss the feasibility of enzymatic reference methods in Routine Chemistry external quality assessment (EQA)inlaboratorymedicine.Methods Samplesofthe1stEQAin2012byNationalCenterforClinicalLaboratories(NCCL)and patients′sera were measured by reference methods and 5 clinical analytic systems for the catalytic activity of CK ,LDH ,ALP ,ALT , AST ,GGT and AMY ,then the results of 5 clinical systems were compared with the reference methods′or target value of NCCL by calculating the bias ,and evaluated them according to the criteria of EQA by NCCL .Results The results of EQA samples measured by reference methods was within ± 10% compared with NCCL target value .Compared with the results of reference method ,the through put was 100 .0% for wet clinical chemistry systems measuring both EQA samples and patients′serum ,and the dry clinical chemistry systems was 77 .1 for EQA samples and 97 .1% for patients′serum according to the criterion of EQA ,and the through put was 72 .9% and 63 .6% of wet clinical chemistry systems according to the standard of enzymatic trueness of NCCL .Conclusion Reference method could be applied to EQA ,and will be a great help for the trueness of clinical testing .

Objective:To analyze the characteristics of elderly patients with moyamoya disease and clinical outcomes after combined revascularization, and to evaluate the safety and efficacy of this method in elderly patients.Methods:Moyamoya disease patients aged 60 years or older who had undergone combined revascularization at the Neurosurgery Center of Aeronautical General Hospital from January 2016 to September 2021 were selected as study subjects.Then patients' clinical data and postoperative complications within two weeks of surgery were collected and a followed-up was conducted.The results were compared with those of previous reports.Results:A total of 46 combined revascularization procedures were carried out in 30 patients.The ages at surgery ranged between 60-75 years, with a mean age of(66.1±4.4)years.The rate of complications within two weeks after surgery was 37%, and the most common complication was speech dysfunction, followed by epilepsy and hyperperfusion.No serious complications such as cerebral hemorrhage and death occurred.The follow-up varied between 3-67 months, with an average follow-up time of(26.8±18.4)months.The MRS score was <3 at 3 months after surgery, and there was no death or severe disability.Conclusions:Perioperative complications in elderly patients with moyamoya disease have a higher incidence rate than in other populations, but patients can usually recover after close perioperative management for 2 weeks.The follow-up has demonstrated that outcomes at 3 months and in longer terms after surgery are satisfactory and clinical symptoms will improve significantly.

Objective To investigate the effects of three-dimensional titanium mesh repair on cerebral perfusion,intracranial pressure and nerve function after decompression with bone flap.Methods From October 2015 to October 2018,132 hypertensive cerebral hemorrhage patients of bone disc decompression in the Fifth People's Hospital of Jinan were selected and divided into observation group (66 cases) and control group(66 cases) by double blind random method.The observation group received three-dimensional titanium mesh repair at 24 ～ 42 d after bone disc decompression surgery.The control group received three-dimensional titanium mesh repair at 90 ～ 150 d(3 ～ 5 months) after surgery.The changes of operation,cerebral perfusion,intracranial pressure and nerve function were compared between the two groups.Results The operative time,blood loss and free time of the flap in the observation group were (92.5 ± 12.4) min,(354.3 ± 17.5) mL and (13.2 ± 3.1) min,respectively,which were shorter or less than those in the control group [(142.8 ± 15.3) min,(518.3 ± 22.3) mL and (38.3 ± 4.3) min],the differences between the two groups were statistically significant (t=4.745,6.831,4.963,all P ＜ 0.05).After treatment,the abnormal indices of intracranial pressure and cerebral perfusion in the observation group were (0.1 ±0.0) and(0.2 ± 0.1),respectively,which were lower than those in the control group [(0.2 ± 0.1),(0.3 ± 0.1)] (t =3.657,2.579,all P ＜0.05).There were statistically significant differences in neurological deficit scores between the two groups at different time points(all P ＜0.05).The incidence of treatment complications in the observation group was 10.94％ (7/64),which was significantly lower than that in the control group [38.7％ (24/62)] (x2 =14.094,P ＜ 0.05).Conclusion Three-dimensional titanium mesh repair is helpful to shorten the operation time,restore the intracranial pressure on the affected side,improve the abnormal cerebral perfusion,and reduce the neurological damage in patients with hypertensive cerebral hemorrhage.

Objective To investigate the intra- and interobserver repeatability of coronary artery disease (CAD) diagnosis based on invasive coronary angiography (ICA) and CT coronary angiography (CTCA).Methods Two readers with comparable experience ( over 10 years) independently evaluated ICA results of 42 consecutive patients with a blind method. After 30 days,one of them reviewed the same patients again.Another two comparable-experience (over 10 years) readers evaluated the results of CTCA (prospectively ECG-triggering) from the same 42 patients in the same way.The inter-reader and intra-reader repeatability of ICA and CTCA were analyzed by performing Kappa test and calculating the percentage of the segments with agreement on stenotic degree.Using ICA as reference,the accuracy of CTCA in diagnosing CAD was studied by comparing the area under ROC. Results The Kappa between readers for ICA and CTCA were 0.91 and 0.81.Intra-reader Kappa were 0.92 and 0.83 respectively (x2 =509.4 and 432.5,all P ＜0.01 ).The percentage of the segments with agreement between readers on the degree of stenosis were 80.8％ (494/611) in ICA and 75.2％ (469/624) in CTCA ( x2 =2.75,P =0.10),and within the same reader,86.9％ (531/611)in ICA and 81.9％ (511/624) in CTCA(x2 =3.76,P =0.053).With≥ 50％narrowing as a CAD diagnosis criterion,the agreement rates for two readers were 96.6％ (590/611 ) in ICA and 94.4％ (589/624) in CTCA( x2 =3.36,P =0.07),and for the same reader,97.4％ (595/611) in ICA,95.4％ (595/624) in CTCA ( x2 =3.62,P =0.06).Using ICA as reference,two readers of CTCA results achieved a sensitivity and specificity of 84.9％ (530/624)and 98.1％ (612/624).The area under ROC was 0.94 (95％ CI 0.91-0.97).Conclusions Both ICA and CTCA demonstrate good repeatability in diagnosing CAD.The repeatability of ICA is superior to that of CTCA.A certain discrepancy exists in two readings from the same reader or two readers.