Volume 106 ·  Issue 20 ·  2026

Congenital ossicular chain malformation constitutes a pivotal etiological factor in conductive hearing loss. Despite its relatively low clinical incidence, the diagnosis and management of this condition persist as a formidable challenge in contemporary otological practice. In recent years, the expeditious evolution of high-resolution imaging modalities, minimally invasive endoscopic surgical techniques, innovative artificial ossicular prostheses, advanced hearing implant systems, and artificial intelligence (AI)-assisted clinical decision-making frameworks has precipitated a paradigm shift in diagnostic and therapeutic paradigms. This article systematically elaborates on the diagnostic strategies, therapeutic modalities, and future research directions pertaining to congenital ossicular chain malformation, with the overarching goal of advancing the precision and individualization of clinical care for affected populations.

To investigate the effects of fasting on anxiety-and depression-like behaviors in mice, and to elucidate the underlying neural mechanisms.

Eight-week-old male C57BL/6J mice (n=44) and Fos-2A-iCreER transgenic mice (n=48) were randomly assigned using a random number table.The male C57BL/6J mice were divided into six groups (n=36): anxiety-like models were established by 2-hour acute restraint stress (ARS), depression-like models were induced by intraperitoneal injection of lipopolysaccharide, and control groups were also set up. Within each model, mice were further divided into a fasting group (24-hour food deprivation) and an ad libitum feeding group. Fasting efficacy was assessed by monitoring changes in body weight and food intake. Anxiety-like behaviors were evaluated using the open field test and elevated plus maze test, while depression-like behaviors were assessed using the tail suspension test and forced swimming test. Whole-brain neuronal activation in response to fasting was detected in both fasted and non-fasted C57BL/6J mice (n=8) was detected through c-Fos immunofluorescence staining. Subsequently, the Fos-2A-iCreER transgenic mice were selected. The targeted recombination into active promoters (TRAP) technique was employed to specifically label fasting-activated neurons, and chemogenetic techniques were employed to activate or inhibit fasting-related neuronal ensembles (n=24 per experiment). Anxiety-like and depression-like models were re-established separately, and mice in each model were divided into a fasting group (24-hour food deprivation) and an ad libitum feeding group, in order to investigate the effects of activating or inhibiting neurons related to fasting on anxiety-and depression-like behaviors.

The open field test and the elevated plus maze test provided evidence that anxiety-like models had been successfully established. In addition, the tail suspension test and the forced swimming test provided evidence that depression models had been successfully established. In comparison with the ad libitum feeding group, the mice fasted for 24 h showed lower body weight and higher food intake (all P<0.05). Fasted mice demonstrated increased distance travelled, prolonged duration, and elevated entries in the central area of the open field, as well as greater distance traveled, higher percentage of duration, and more entries in the open arms of the elevated plus maze. Additionally, fasted mice showed shorter immobility times in both the tail suspension test and the forced swimming test. All differences were statistically significant (all P<0.05). c-Fos staining revealed enhanced neuronal activation in the paraventricular thalamus (PVT) region after fasting (all P<0.05). Chemogenetic activation of fasting-related neuronal ensembles in the PVT mimicked the anti-anxiety and anti-depression effects observed following fasting: anxious mice showed greater distance traveled, longer duration, and more entries in the central area of the open field, as well as greater distance traveled, higher percentage of duration, and more entries in the open arms of the elevated plus maze; depressed mice showed shorter immobility times in both the tail suspension test and the forced swim test (all P<0.05).Conversely, chemogenetic inhibition of these neuronal ensembles reversed these effects (all P<0.05).

Fasting activates PVT-related neuronal ensembles to elicit anti-anxiety and antidepression effects in mice.

Congenital ossicular chain malformation is a rare disease caused by morphological aberration or absence of ossicular bone due to embryonic development disorder, which is mostly in men and unilateral. This paper reviews the epidemiological characteristics, embryonic development theory, classification and surgical treatment strategies of congenital ossicular chain malformations, focusing on comparing the advantages and disadvantages of endoscopic otoscopic surgery (EES) and microscopic otoscopic surgery (MES). EES has advantages in visual field clarity, trauma size, postoperative recovery time, etc., and is especially suitable for Teunissen Class III deformity; MES is more suitable for complex cases and situations requiring two-hand operation. Studies have shown that the two procedures are comparable in hearing improvement, but EES may have shorter surgery time and higher patient comfort. With the progress of endoscopic technology in the future, EES is expected to become the preferred method for more ossicular chain deformity surgery.

Congenital ossicular chain deformity is the most common middle ear deformity, and accurate evaluation of its lesion features before surgery is the key to hearing reconstruction. At present, high-resolution CT is an important method to evaluate ossicular chain deformities, but its evaluation of subtle lesions and ossicular chain mobility still has limitations. Ultra-high resolution CT and CT-related three-dimensional imaging technology can further improve the detection ability of subtle lesions of the ossicular chain, and clearly demonstrate the spatial position relationship between the deformed ossiculae and the surrounding structures of the middle ear. At the same time, broadband acoustic impedance correlation derived techniques can indirectly assess the degree of ossicular chain fixation or interruption before surgery. Laser vibrometer or force feedback detection can quantitatively analyze the movement of ossicular chain during operation, which provides theoretical basis for the choice of surgical mode. In addition, some congenital ossicular chain malformations have a genetic background, and further molecular diagnosis can help to clarify the cause and guide clinical diagnosis and treatment. This article focuses on the diagnosis and research progress of congenital ossicular chain malformation, and reviews the aspects of imaging, audiology, molecular diagnosis and new intraoperative evaluation techniques.

low-grade serous ovarian carcinoma (LGSOC) is a rare pathological type of ovarian cancer, with young onset age, mild biological behavior, slow progression and good prognosis. Most LGSOCs are advanced at the time of diagnosis, their pathogenesis is still unclear, their sensitivity to chemotherapy is poor, and there is a lack of effective treatment for advanced and recurrent patients. LGSOC has unique molecular characteristics, its common MAPK pathway molecular changes, and corresponding targeted therapies such as mitogen-activated protein kinase kinase (MEK) inhibitors have certain curative effects, and have been clinically recommended for use in the treatment of patients with recurrent LGSOC. At the same time, estrogen and progesterone receptors are usually highly expressed, and hormone therapy occupies an important position in the first-line and recurrent treatment. Other targeted therapeutic preparations such as bevacizumab have limited clinical application experience and need to be further studied. This article reviews the clinicopathological characteristics, molecular characteristics and targeted therapy progress of LGSOC, aiming to provide reference for individualized and standardized diagnosis and treatment of LGSOC.