Protective effect of stress-associated endoplasmic reticulum protein 1 on glucose and oxygen deprivation-induced injury in cardiomyocytes / 中华老年医学杂志

Objective To study the protective effect of stress-associated endoplasmic reticulum protein 1 (SERP1)on glucose and oxygen deprivation-induced injury in cardiomyocytes.Methods Gene expression was analyzed in the public database Gene Expression Omnibus(GEO)and screened for any difference in gene expression in myocardial tissues between the control group and the ischemiareperfusion group(IR group).Rat H9C2 cardiomyocytes were cultured and a myocardial cell injury model was established by oxygen glucose deprivation(OGD).The effect of SERP1 expression on cell viability,apoptosis and the endoplasmic reticulum stress pathway in cardiomyocytes were examined.Results Western blot results showed that the expression of SERP1 in myocardial tissues decreased in the IR group,compared with the control group(t =6.83,P =0.006).Oxygen and glucose deprivation induced decreased levels of SERP1 mRNA and protein expression in H9C2 cardiomyocytes in a timedependent manner (F =8.50 and 15.70,P =0.007 and 0.001).In addition,oxygen and glucose deprivation led to decreased cell viability and increased apoptosis,while exogenous addition of SERP1 had protective effects in H9C2 cardiomyocytes by promoting cell viability and reduced cell apoptosis.The lncRNA microarray and real-time PCR results showed that SERP1 could inhibit the expression of lncRNA CDKN2B-AS1 and further increase the phosphorylation of JAK2 and STAT3,leading to decreased expression of endoplasmic reticulum stress markers GRP78 and CHOP(all P＜ 0.05).Conclusions SERP1 can inhibit cardiomyocyte injury induced by glucose deprivation,and the underlying molecular mechanism may be related to the inhibition of CDKN2B-AS1 expression,promotion of the JAK2/STAT3 signaling pathway,and suppression of endoplasmic reticulum stress.

Protective effect and mechanism of chemokine C-C motif ligand 6 on glucose and oxygen deprivation induced injury of cardiomyocytes / 中华急诊医学杂志

Objective To study the protective effect of chemokine C-C motif ligand 6 (CCL6) on glucose-oxygen deprivation induced injury in cardiomyocytes and its possible molecular mechanism.Methods Gene expression was analyzed in the public database Gene Expression Omnibus (GEO) database and gene expression of analyzed for myocardial tissue was analyzed gene expression in the sham group and the ischemia-reperfusion group (IR group).Rat H9C2 cardiomyocytes were cultured in vitro,and myocardial cell injury model was established by oxygen glucose deprivation (OGD).Cell viability was detected by MTT assay;apoptosis was determined by Annex V/PI double staining;the expression of related genes was detected by real-time PCR and Western blot.Results Compared with the sham group,transcriptome analysis and real-time PCR showed that the expression of CCL6 in the myocardial tissue of the IR group was significantly decreased (P＜0.01).Oxygen glucose deprivation induced a decrease in CCL6 expression levels in H9C2 cardiomyocytes in a time-dependent manner.In addition,oxygen glucose deprivation leads to decreased cell viability and increased apoptosis;while addition of CCL6 promotes cell viability and reduces apoptosis.The IncRNA microarray and real-time PCR showed that CCL6 treatment of cardiomyocytes resulted in a significant decrease in the expression of hicRNA IGF2-AS and further increased the phosphorylation of Akt and GSK-3β.Conclusion CCL6 can inhibit cardiomyocyte injury induced by glucose deprivation,and its molecular mechanism may be related to inhibition of IGF2-AS and enhancement of Akt/GSK-3β signaling pathway.

One-stage ascending-to-abdominal aortic bypass with concomitant aortic valve procedures for aortic coarctation combined with aortic valve pathology in adult patients / 中华胸心血管外科杂志

Objective This study aims to evaluate the results of one-stage ascending-to abdominal aortic bypass and aortic valve replacement for concomitant aortic coarctation with aortic valve pathology.Methods From June 2009 to March 2017,28 consecutive adult patients(23males and 5 females) with aortic coarctation combined with aortic valve pathology underwent one-stage ascending-to-abdominal aorta bypass and aortic valve replacement or a Bentall procedure.Age 19-59,mean age (33.6 ± 11.6) years;1 case of coronary heart disease and 12 cases of aortic root tumor.Results All patients successfully underwent the one-stage procedure.The mean aortic cross-clamp and cardiopulmonary bypass times were (71 ± 23) and (113 ±37) mins respectively.The average post-operative hospital stay was(15.9 ± 4.9) days and the average operation time was (5.2 ± 4.0)h.Systolic blood pressure decreased from (158 ± 36)mmHg(1 mmHg =0.133 kPa) pre-operatively to(121 ± 18)mmHg post-operatively.After the operation,follow-up 3-96 months,No deaths or significant gradients between the upper and lower extremities occurred during follow-up.Conclusion Ascending-to-abdominal aortic bypass and concomitant aortic valve procedures are a suitable therapeutic option for severe aortic coarctation combined with aortic valve pathology in adult patients.

Comparison of Clinical Effects between Percutaneous Transluminal Septal Myocardial Ablation and Modified Morrow Septal Myectomy on Patients with Hypertrophic Cardiomyopathy / 中华医学杂志(英文版)

<p><b>Background</b>Percutaneous transluminal septal myocardial ablation (PTSMA) and modified Morrow septal myectomy (MMSM) are two invasive strategies used to relieve obstruction in patients with hypertrophic cardiomyopathy (HCM). This study aimed to determine the clinical outcome of these two strategies.</p><p><b>Methods</b>From January 2011 to January 2015, 226 patients with HCM were treated, 68 by PTSMA and 158 by MMSM. Both ultrasonic cardiograms and heart functional class were recorded before, after operations and in the follow-up. Categorical variables were compared using Chi-square or Fisher's exact tests. Quantitative variables were compared using the paired samples t-test.</p><p><b>Results</b>Interventricular septal thickness was significantly reduced in both groups (21.27 ± 4.43 mm vs. 18.72 ± 4.13 mm for PTSMA, t = 3.469, P < 0.001, and 21.83 ± 5.03 mm vs. 16.57 ± 3.95 mm for MMSM, t = 10.349, P < 0.001, respectively). The left ventricular outflow tract (LVOT) pressure gradient (PG) significantly decreased after the operations in two groups (70.30 ± 44.79 mmHg vs. 39.78 ± 22.07 mmHg for PTSMA, t = 5.041, P < 0.001, and 74.58 ± 45.52 mmHg vs. 13.95 ± 9.94 mmHg for MMSM, t = 16.357, P < 0.001, respectively). Seven patients (10.29%) in the PTSMA group required a repeat operation in the follow-up. Eight (11.76%) patients were evaluated for New York Heart Association (NYHA) III/IV in the PTSMA group, which was significantly more than the five (3.16%) in the same NYHA classes for the MMSM group at follow-up. Less than 15% of patients in the PTSMA group and none of the patients in the MMSM group complained of chest pain during follow-up.</p><p><b>Conclusions</b>Both strategies can not only relieve LVOT PG but also improve heart function in patients with HCM. However, MMSM might provide a more reliable reduction in gradients compared to PTSMA.</p>

Efficacy of two bariatric surgeries in type 2 diabetic patients with a body mass index of 25-27.5 / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the therapeutic effects of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic duodenal-jejunal bypass with sleeve gastrectomy (SADJB-SG) in patients with type 2 diabetes mellitus and a low body mass index (BMI) of 25-27.5.</p><p><b>METHODS</b>Thirty-one type 2 diabetic patients with a BMI of 25-27.5 underwent bariatric surgeries in the General Hospital of Guangzhou Military Command between August, 2013 and August, 2015. The patients receiving LRYGB (17 cases) and SADJB-SG (14 cases) were compared for physical indexes, glucose metabolism and of pancreatic islet function at 1 year after the surgeries.</p><p><b>RESULTS</b>No mortality occurred in the patients after the operations. At 1 year after the operation, the patients in LRYGB group showed significant improvements in body weight, BMI, glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), oral glucose tolerance test 2 h (OGTT2h), C-peptide, fasting insulin (FINS), and postprandial 2 hour insulin (2 hPINS) (P<0.05); in SADJB-SG group, significant improvements were observed in the body weigh, BMI, HbA1c, FPG, OGTT2h, and FINS after the operation (P<0.05). The postoperative improvements in body weigh, BMI, HbA1c, FPG, OGTT2h, C-peptide, and 2hPINS were comparable between SADJB-SG group and LRYGB group (P>0.05), but the incidence of postoperative anastomotic ulcer was lower in SADJB-SG group.</p><p><b>CONCLUSION</b>SADJB-SG and LRYGB produce similar therapeutic effects in type 2 diabetic patients with a low BMI, but SADJB-SG is associated with a low incidence of postoperative complications and is therefore more suitable in such patients.</p>

Effect of pharmacological intervention on MIP-1α, MIP-1β and MCP-1 expression in patients with psoriasis vulgaris

OBJECTIVE@#To detect the expression level of macrophage inflammatory protein-1 (MIP-1)α, MIP-1β and monocyte chemoattractant protein-1 (MCP-1) in with psoriasis vulgaris and explore the role in the pathogenesis of psoriasis vulgaris.@*METHODS@#The level of MIP-1α, MIP-1β and MCP-1 in peripheral blood from 50 patients with psoriasis vulgaris and 50 normal controls were measured by enzyme linked immunosorbent assay. The correlation with psoriasis area and severity index (PASI) was analyzed. The level of MIP-1α, MIP-1β and MCP-1 was compared between psoriasis vulgaris patients at active stage and resting stage. And the change in MIP-1α, MIP-1β and MCP-1 before and after therapy was also observed.@*RESULTS@#The content of MIP-1α, MIP-1β and MCP-1 in patients with psoriasis vulgaris was (1342.78 ± 210.30), (175.28 ± 28.18) and (266.86 ± 32.75) ng/L, respectively, significantly higher than those in control group (P<0.05). The expression level of MIP-1α, MIP-1β and MCP-1 in peripheral blood of patients with psoriasis vulgaris was positively correlated with PASI (P<0.01). After acitretin therapy, expression level of MIP-1α, MIP-1β and MCP-1 in peripheral blood of patients with psoriasis vulgaris was significantly decreased.@*CONCLUSIONS@#Chemokine factor MIP-1α, MIP-1β and MCP-1 may be involved in the pathogenesis of psoriasis vulgaris.

Effect of Yinxieling decoction on PASI, TNF-α and IL-8 in patients with psoriasis vulgaris

OBJECTIVE@#To study the effect of Yinxieling decoction on PASI, TNF-α and IL-8 in patients with psoriasis vulgaris.@*METHODS@#A total of 120 cases of psoriasis vulgaris were divided into 4 groups according to syndrome differentiation of TCM and randomized controlled method: wind heat syndrome group (group A), blood stasis syndrome group (group B), blood dryness syndrome group (group C) and control group (group D) (n=30 per group). Patients in observation groups were treated with Yinxieling decoction, while patients in control group were treated by placebo for 8 weeks. Levels of TNF-α and IL-8 were determined before treatment, 4 and 8 weeks after treatment. psoriasis area and severity index score was also performed before and after treatment.@*RESULTS@#psoriasis area and severity index score and serum level of TNF-α, IL-8 were significantly decreased in all groups. The decrease in three observation groups was more significant (P<0.05 or P<0.01), and the decrease in wind heat syndrome group was the most significant (P<0.01). psoriasis area and severity index was positively correlated with TNF-α and IL-8, respectively (P<0.05).@*CONCLUSIONS@#Yinxieling decoction has therapeutical effect on psoriasis vulgaris via regulating TNF-α and IL-8.

Meta analysis of the association between CYP11 B2 gene polymorphism and left ventricle hypertrophy / 中华胸心血管外科杂志

Objective To investigate the association between CYP11 B2 gene polymo-rphism and left ventricle hypertrophy with meta analysis.Methods Literatures about the association of CYP11 B2 gene polymorphism and left ventricle hypertrophy from January 1992 to December 2011 were searched.The electronic databases retrieved from Pubmed,Embase,China national knowledge intemet,Chinese biological medicine disk,VIP fulltext database and Wanfang fulltext database.Odds ratio of CYP11 B2 genotype distributions in left ventricle hypertrophy patients comparing with healthy control were analyzed.RevMan5.1 software was applied for investigating hereogeneity among individual studies and summarizing effects with proper statistical methods.Six case control studies were enrolled.Results A total of 541 cases and 553 controls were enrolled for the study.The pooled OR of CC vs TT + TC genotype was 1.15 (95％ CI:0.74 ～ 1.80) (Z =0.63,P =0.53) in the subgroup of hypertension,and the pooled OR of CC vs TT + TC genotype was 1.15 (95 ％ CI:0.74 ～ 1.80) (Z =0.63,P =0.53) in the subgroup of race.The pooled OR of C vs T allele was 1.15 (95％ CI:0.76 ～ 1.74) vs 0.87 (95％ CI:0.58 ～ 1.31) (Z =0.67,P =O.50).Conclusion Whether the hypertension or the race,the genotype of CYP11 B2 polymorphism has no association with an increased risk of left ventricle hypertrophy.

The influence of interventricular septal thickness to trans-aortic valve pressure after aortic valve replacement / 中华胸心血管外科杂志

Objective To investigate the effects of interventticular septal thickness (IST) on postoperative trans-aonic valve pressure after aortic valve replacement (AVR).Methods 273 patients were divided into 3 groups with different mechanical valves and postoperative trans-aortic valve pressure (TAVP).Hemodynamic parameters including left ventricular end diastolic diameter,left ventricular end systolic diameter,ejection fraction and IST were analyzed.Results There was no significant difference in left ventricular diastolic diameter,left ventricular systolic diameter and ejection fraction in three groups with different mechanical valves ( P ＞ 0.05 ).In patients with St.Jude Regent valve,preoperative IST in severe TAVP group was significantly thicker than those of moderate and mild groups ( P ＜ 0.05 ).In patients with On-x valve,preoperative IST in severe and moderate TAVP groups were thicker than that of mild group ( P ＜0.05 ).In patients with other mechanical valve,preoperative IST in severe TAVP group is greater than those of moderate and mild groups ( P ＜ 0.05 ).Conclusion Interventricular septal thickness did have positive influence on postoperative trans-aortic valve pressure after AVR.When IST was more than 13.6mm,the postoperative trans-aortic valve pressure after aortic valve replacement was higher than the IST was less than 13.6mm.When IST was thicker than 15.3mm,partial ventticular septal resection or replacement of stentless valve should be considered.

The effects of preventative intra-aortic balloon pump in high-risk patients undergoing coronary artery bypass grafting / 中华胸心血管外科杂志

ObjectiveTo compare the effects of preventative intra-aortic balloon pump (IABP) insertion with intra-or post-operative IABP insertion in high-risk patients undergoing coronary artery bypass grafting (CABG).MethodsFrom Jan 2008 to May 2011,one hundred and four patients received CABG or off-pump CABG (OPCABG) and IABP therapy in our hospital.The enrolled criteria of IABP insertion included left ventricular ejection fraction (EF) less than 0.40,unstable angina,AMI,left main stenosis,emergency CABG,refractory ventricular arrhythmia.Group1 included thirty eight patients with preoperative IABP insertion,thirty one for intra-operative IABP insertion ( group 2 ) and thirty four for postoperative IABP insertion ( group 3 ).The indications for IABP insertion for group 2 and 3 were unstable hemodynamics,failure to wean off cardiopulmonary bypass and low output syndrome during or after operation.Clinical data including operative mortality,ventricular fibrillation,chest drainage,hospital stay,ICU stay,ventilator supporting time,IABP supporting time,EF improvement rate,mechanical assist device and Inotropic drugs utilizations were analyzed among three groups.ResultsGroup 1 demonstrated good therapeutic results.There were significant statistic differences in operative mortality ( group 1 2.6％,group 2 12.9％,Group 3 47.1％),hospital stay[group 1 (23.6 ± 9.8) days,group 2 (21.5 ±9.7) days,group 3 (28.9 ±13.3) days],ICU stay[group 1 (2.3 ± 1.1 ) days,group 2 (3.5 ± 1.5 ) days,group 3 (5.2 ± 3.4) days],ventilator supporting time [group 1 (29.5 ± 23.0) hours,group 2 (38.7 ± 20.6) hours,group 3 (84.1 ± 48.0) hours],IABP supporting time [group 1 (77.0 ± 43.7 ) hours,group 2 ( 93.8 ± 44.8 ) hours,group 3 ( 121.5 ± 71.7 ) hours],EF improvement rate [group 1 (7.5 ± 7.2),group 2 ( 8.5 ± 7.5 ),group 3 (2.0 ± 6.7)],inotropic drugs utilization[group 1 ( 3.7 ± 4.9) days,group2 (6.2±4.6) days,group3 (10.8±5.4) days](P＜0.05).ConclusionComparing with intra- or post-operative IABP insertion,high-risk patients undergoing CABG could significantly benefit from preventative IABP insertion.Early IABP insertion was recommended for high-risk patients undergoing coronary artery bypass grafting.

Expression of Oct-4 transcription factor in squamous cell skin carcinoma and seborrheic keratosis / 南方医科大学学报

<p><b>OBJECTIVE</b>To detect the expression of stem cell transcription factor Oct-4 in squamous cell carcinoma (SCC) and seborrheic keratosis (SK) and its association with cancer stem cells.</p><p><b>METHODS</b>Immunohistochemistry was used to detect Oct-4 expression in 35 SCC cases, 21 SK cases and 15 normal control skin tissues.</p><p><b>RESULTS</b>Oct-4 expression was negative in normal skin and showed a significant difference between SCC and SK tissues (P<0.05).</p><p><b>CONCLUSION</b>The Oct-4-positive cells in SCC and SK are probably tumor stem cells. Oct-4 expression may provide an important evidence for isolation and identification of human SCC and SK stem cells.</p>

Analysis of risk factors for left atrial thrombosis in patients with rheumatic mitral stenosis / 中华胸心血管外科杂志

Objective To analysis of risk factors for left atrial thrombosis in patients with rheumatic mitral stenosis.Methods From January 2001 to December 2008, 2277 patients with rheumatic mitral stenosis underwent operations in our hospital. There were 737 males and 1540 female, the age ranged from 19 to 84 years [average (50.9 ±10.2) years]. Left atrial thrombosis group (554 cases) and no thrombosis group (1723 cases) were divided, retrospectively collected data were analyzed with univariate and multivariate Logistic regression. Results 12 bvariables, including age, mitral valve orifice area, left atrial diameter, left ventricular diastole diameter, CRP, gender , degree of mitral stenosis, or regurgitation, degree of bicuspid regurgitation, degree of pulmonary hypertension, atrial fibrillation and heart function had statistic difference between two groups. With multivariate Logistic regression for these 12 factors, age, mitral valve orifice area, left atrial diameter, degree of mitral regurgitation and atrial fibrillation were found to be the affecting factors for left atrial thrombosis in patients with rheumatic mitral stenosis. Conclusion For patients with rheumatic mitral stenosis, age, mitral valve orifice area, left atrial diameter and atrial fibrillation are the risk factors for left atrial thrombosis. Mitral regurgitation is a protective factor for left atrial thrombosis.

Congenital stenosis of external auditory canal with cholesteatoma and skin fistulae or sinuses / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical features, differential diagnosis and management of congenital stenosis of external auditory canal (CSEAC) with cholesteatoma.</p><p><b>METHODS</b>The clinical information for 10 cases of CSEAC with cholesteatoma was retrospectively reviewed.</p><p><b>RESULTS</b>The patients' ages ranged from 4.75 to 22 years (average 12 years). The diameter of the external auditory canal (EAC) was < 2 mm. All 10 ears had a history of postural fistulae or sinuses. Bone erosion of EAC was distinctly shown in high-resolution computed tomography (HRCT) of all cases, as well as soft tissue masses, which led to enlargement of the bony canals. All patients underwent canaloplasty; eight ears received hearing reconstructions at the same time. Cholesteatoma in EACs was confirmed during the operations, accompanied by compression and destruction of the post-superior and/or inferior bony wall. Postoperative pathologic examinations proved the diagnosis of cholesteatoma, and excluded any tissue of bronchial cleft cyst or fistula. After a follow-up 1 to 3 years, no recurrent cholesteatoma was found in any of the 10 cases. All reconstructed EACs were clean and smooth. The hearing levels in the eight ears that received hearing reconstructions improved 20 - 35 dBHL.</p><p><b>CONCLUSIONS</b>In CSEAC with cholesteatoma, the bony wall of EAC is most commonly involved. This involvement will lead to bone erosion of the EAC and may subsequently lead to the formation of postural or cervical sinuses. HRCT of temporal bone can show characteristic signs of soft tissue mass in EAC, with adjacent bone erosion.</p>

Long-term results and an analysis of surgically related factors in myringoplasty with sandwich method / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of the prognostic factors on long-term surgical outcome in myringoplasty.</p><p><b>METHODS</b>Retrospective cohort 205 patients (223 ears) with sandwich temporal fascia myringoplasty were analyzed using the multiple logistic regression analysis. The charts of inpatients had undergone myringoplasty before at least 2 years between January 1999 and November 2003 at Beijing Tongren Hospital. Postoperative follow-up rate was 78.2%. Their ages ranged from 12 to 65 years (mean = 34. 3 years). Their durations of disease ranged from 1 month to 25 years (mean = 16.07 months). The effect of prognostic factors on myringoplasty were investigated by variables noted from patients' files such as age, sex, causes of disease, duration of disease, period of dry ear of disease, operation types, places of tympanic membrane perforation, size of tympanic membrane perforation, status of middle ear and status of eardrum.</p><p><b>RESULTS</b>There were 11 ears with re-perforation of eardrum at the last follow-up. Successful closure of the tympanic membrane perforation was obtained in 95.1% of the ears (212 ears) with 2 to 5 years follow-up. There were 26 ears with other complications at the last follow-up. Operations were successful in 186 patients. The overall take rate of the myringoplasty was 83.4%. Multiple logistic regression analysis (ward) was subsequently carried out on these prognostic factors on overall take rate of the myringoplasty and yielded the following classification. Relative importance of the predictive variables was as follows: size of tympanic membrane perforation (OR = 1.900), duration of disease (OR = 1.003) and period of dry ear of disease (OR = 0.908). Hearing outcomes: the average air-bone gap improvement was 7.0 dB and the average air conduction improvement was 6.8 dB for all 175 myringoplasty procedures.</p><p><b>CONCLUSIONS</b>A long term follow-up was important. Late atelectatic pocket was a late complication and a cause of failure. A relatively smaller tympanic membrane perforation, a relatively shorter duration of disease and a relatively longer period of dry ear of disease were found to be significant prognostic factors positively influencing the success rate of myringoplasty.</p>

Long-term surgical results for congenital aural atresia and hearing reconstruction / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the stability of hearing results and complications in long-term following-up who underwent reconstruction surgery.</p><p><b>METHODS</b>Six hundreds and seventy five cases (700 ears) of congenital aural atresia were reviewed from January 1984 to January 2001 at the Department of Otorhinolaryngology Head and Neck Surgery, Tongren hospital. Except 40 ears undone hearing reconstruction, 635 cases (660 ears) underwent long-term following-up for 3 to 19 years, with an average of 7.9 years.</p><p><b>RESULTS</b>Stenosis and recurrent infection of the external auditory canal (EAC) were the most frequent complications. Stenosis was seen in 120 ears, and 2 ears re-atresia, with an incidence of 18.48% (122/660). Recurrent infection of the cavity and canal skin happened in 6 ears. Closure of the air-bone gap (ABG) post-operation were gained in all cases, and ABG gains 20 dB or more occurred in 512 ears (77.57%), but 30 dB or more in 231 ears (35%). Following-up results: Stable hearing results gained in 450 ears over the length of following-up; the hearing worsened than that of 3 weeks postoperatively occurred in 160 ears, including 2 ears with sensorineural hearing loss. Hearing deteriorated more than 20 dB happened in 35 ears, and 10-15 dB in others cases but still be improved compared with that of preoperation.</p><p><b>CONCLUSIONS</b>Atresiaplasty surgery in individuals with congenital aural atresia can yield reliable, lasting hearing results in 68.2% (450/660), with a low incidence of complications; the initial improved hearing deteriorated gradually over the first 6 months post-operation, which are related with the stenosis and infection of canal. Cavity adhesion, bony EAC re-growth, ossicular chain re-fixation or displace may affect the hearing results in some cases. Even unilateral aural atresia may benefit from the reconstruction surgery and achieve serviceable hearing results.</p>