The retinal microvasculature is one of the few sites where the microcirculation can be directly and non-invasively visualized in vivo, offering a unique window into ocular disease and systemic health. In this study we developed and validated a novel imaging platform integrating a custom-built one-lead electrocardiogram (ECG) with laser Doppler holography (LDH), a high-speed imaging technique that captures Doppler-induced phase shifts, for real-time cardiac cycle-resolved assessment of retinal hemodynamics. Twenty-five healthy adults were imaged (five images per eye), with 563 cardiac cycles meeting analysis quality criteria. Internal system latency combined with synchronization offset amounted to less than 5 ms. LDH-derived beat-to-beat intervals closely tracked ECG R-R intervals, with small mean differences (~ 3 ms), demonstrating excellent temporal stability without measurable drift. ECG-retina latencies, defined as time from the ECG R-peak to LDH peak systolic velocity (R-PSV), maximal systolic upslope (R-MaxSlope), and 50% PSV amplitude (R-PSV½), were measured. R-PSV½ mean ± SD was 128 ± 18 ms and showed the highest repeatability (ICC = 0.78, median CV = 4.8%). ECG-retina latencies were moderately associated with age and heart rate, in exploratory analyses. This integrated ECG-LDH platform provides repeatable, synchronized, high-speed, cardiac-resolved retinal hemodynamic measurements and establishes a quantitative framework for studying the eye-heart relationship.

Hydroa vacciniforme (HV) is a rare pediatric photosensitive dermatosis characterized by sun-induced recurrent lesions on exposed areas and subsequent atrophic scarring, with its pathogenesis remaining unclear. This report aims to improve clinicians' recognition of pediatric HV and provide practical references for its clinical diagnosis and management by detailing a typical case in a young child. We describe a 3-year-old male patient with recurrent erythema, blisters, erosion, crusts, and atrophic scars on the face, nasal dorsum, and auricles for over one year. His skin lesions worsened significantly after sun exposure, alleviated with strict photoprotection, and presented with obvious seasonal variations. A definitive diagnosis of HV was made based on the patient's typical clinical manifestations. The patient was treated with strict sun avoidance, oral vitamin B6, and topical fusidic acid, with notable clinical improvement during follow-up. This case highlights that the definitive diagnosis of pediatric HV relies on typical clinical manifestations combined with the exclusion of relevant differential diagnoses, which is crucial for the early identification and standardized management of this rare disease in young children.

Background: Short stature is a frequent clinical problem with a broad differential diagnosis. Emerging evidence indicates that pathogenic variants in the ACAN gene represent an underrecognized cause of growth failure and are often misclassified as idiopathic short stature. Case presentation: We report two pediatric patients harboring pathogenic ACAN gene variants, both presenting with short stature and distinctive facial dysmorphism. The first patient, a 15-year-old boy, exhibited short stature, advanced bone age, and a characteristic facial gestalt, including ptosis, hypertelorism, down-slanting palpebral fissures, and fleshy auricles, features not previously described in association with aggrecanopathy. Genetic analysis revealed a novel heterozygous frameshift variant, c.5677_5684del (p.Glu1893TrpfsTer8), in exon 12 of the ACAN gene. The second patient, a 5.5-year-old girl, presented with short stature, mild facial dysmorphism (down-slanting palpebral fissures and retracted mandible), and feeding difficulties. Copy number variation analysis identified a heterozygous deletion encompassing exons 15-19 of the ACAN gene. In both patients, the endocrine evaluation was unremarkable, and no chronic systemic disease was identified. The genetic findings were concordant with the clinical phenotype, confirming aggrecanopathy as the underlying cause of growth failure. Conclusions: These cases further delineate the phenotypic spectrum of ACAN-related short stature and underscore the diagnostic value of genetic testing in children with unexplained or idiopathic growth failure. Importantly, we expand the dysmorphological phenotype of aggrecanopathy by describing previously unreported facial features, which may facilitate earlier clinical recognition and diagnosis. The timely identification of pathogenic variants in the ACAN gene may have significant implications for patient management and long-term outcomes.

Despite its long-recognized effects in relieving pain, the neural substrates of auricular stimulation remain elusive. Here, we show that trans-auricular vagus nerve stimulation (taVNS), i.e., electrical stimulation of the auricular concha, effectively induces analgesia in a mouse model of neuropathic pain. Viral tracing, microendoscopic calcium imaging, and multi-electrode recordings reveal that auricular vagal signals travel to the jugular-nodose ganglia (JNG), which in turn connect to pro-opiomelanocortinergic neurons in nucleus tractus solitarius (NTS), subsequently activating glutamatergic neurons in ventrolateral periaqueductal gray (vlPAG). Optogenetic stimulation of central vagus terminals, JNG-derived auricular peripheral fibers, or vlPAG-projecting NTS neurons mimics taVNS-induced analgesia, whereas chemogenetic silencing of central vagus terminals or NTS neurons abolishes this effect. This study identifies an auricle-to-brain circuit underlying taVNS-driven analgesia in mice, with potential for facilitating taVNS optimization for pain management and other neurological conditions.

Mineralization of the para-aural soft-tissue region between the tympanic bulla, hyoid apparatus and nasopharynx in dogs has not been described in veterinary literature. The objective of the study was to determine the prevalence of para-aural mineralization on head computed tomography (CT), describe its morphological features, and assess associations with middle-ear disease, body weight, age, and breed. This retrospective case-control study of 1,833 canine head CTs (January 2012 - December 2024) identified para-aural mineralization in 15 dogs (0.8%) and affected cases were compared with 30 breed-matched controls. Affected dogs were predominantly male, median age 9.4 years and weight 27.3 kg, with lesions frequently bilateral, ventrolateral to the tympanic bulla, and having a median area 12.4 mm2 (median Hounsfield Units 424). All affected cases also showed external ear canal wall mineralization and 87% cf. 43% in the control cases had concurrent tympanic bulla disease (wsall thickening, lysis, and luminal soft tissue/fluid, or hyperostotic tympanic bone spicules) (p = 0.009), whereas age (p = 0.065) and weight (p = 0.709) did not differ significantly between the two groups. Dogs with para-aural mineral formations were more likely to have other soft tissue mineralization noted in the head CT. Cases with serial scans revealed coalescence of fragments, suggesting a dynamic calcification process. These CT findings indicate that para-aural mineralization is uncommon, but imaging findings could serve as a marker of occult chronic middle ear disease, rather than being associated with age or body weight.

Auricular rhabdomyosarcoma is an extremely rare malignancy in the pediatric population, and its management presents unique challenges due to both oncologic and reconstructive considerations. Chemotherapy remains the cornerstone of treatment, but surgical intervention is indicated when the tumor demonstrates limited response to induction therapy or when durable local control is required. We report the case of a 16-year-old boy with rhabdomyosarcoma originating in the auricle and extending into the external auditory canal (EAC). He underwent wide local excision of part of the auricle, lateral EAC, and superficial parotid gland after a limited response to induction chemotherapy. Immediate reconstruction of the EAC was performed using a tubularized anterolateral thigh (ALT) flap, with the epithelial surface oriented outward to preserve canal patency and auditory function. Despite the inherent thickness of the ALT flap, this method achieved favorable outcomes, including successful postoperative radiation therapy, preserved hearing, and negative surgical margins. The patient remained disease-free with preserved auditory function and only minimal canal narrowing at the 5-year follow-up visit. This case demonstrates that ALT flap tubularization is a viable reconstructive technique, even for complex pediatric sarcoma cases. It provides a balance between oncologic safety, functional preservation, and long-term durability.

A 15-month-old intact female rat was presented with worsening lethargy and dysorexia present for 1 wk and bruxism present for 3 d. The diet was fruits, vegetables, and granola. On presentation, the rat was mildly dehydrated and had marked incisor malocclusion with enamel hypoplasia. On oral examination, the left mandibular molars were not visible and the gum line was prominent. Black punctate enamel discoloration was observed multifocally on molars, but no mucosal lesions were observed. The incisors were trimmed and the rat was discharged with analgesics, supportive care, and dietary recommendations. The rat's condition continued to deteriorate and, 1 wk later, a left mandibular mass appeared that the owner perceived as painful. Computed tomography of the head showed lysis of the body of the left mandible, absence of left mandibular molar teeth, and abnormal soft-tissue attenuation in the left tympanic bulla. On the last visit (Day 31), purulent discharge was visible in the left external ear canal and along the left mandibular gingiva. Fine-needle aspiration and cytology of the mandibular mass suggested a keratinizing epithelial tumor of benign appearance. Euthanasia was elected, based on the poor prognosis. Histopathological examination revealed a well-differentiated oral squamous cell carcinoma of the left mandibular region with ipsilateral subacute purulent otitis media. Key clinical message: Squamous cell carcinoma should be included in the differential diagnosis of an infected, non-ulcerated oral mass in a rat.

Objective:To analyze the application experience and operation result of continuous irrigating mode of otoendoscopic surgery in patients with lateral semicircular canal fistula as a complication of cholesteatoma, so as to provide a basis for the feasibility and safety of the operation. Methods:A total of 45 patients diagnosed with middle ear cholesteatoma who underwent transcanal endoscopic surgery in our department between November 2022 and March 2025 were enrolled, among whom 13 presented with labyrinthine fistula. Mastoid opening and lesion removal were performed in continuous irrigating mode, patients with labyrinthine fistula underwent external semicircular canal fistula repair and tympanoplasty were completed at the same time, and outpatient re-examination was performed at 1 week, 3 weeks, 8 weeks and 12 weeks after surgery, of which endoscopic examination was performed at 3 weeks, 8 weeks and 12 weeks after surgery, and pure tone hearing threshold test was performed 6 months after surgery. Thereafter, regular re-examinations will be conducted every 3 to 6 months. The operation time, preoperative and postoperative vertigo symptoms, changes in bone conduction threshold of pure tone auditory threshold, the time of postoperative dry ear and surgical cavity epithelialization were analyzed. Results:A total of 13 patients were collected, all of whom had external semicircular canal fistulas, including 5 males and 8 females, aged 21 to 77 years, with a mean age of （47.62±15.40） years, with lesions located on the left side in 7 cases, 6 cases on the right side, 6 cases of type Ⅰ fistula and 7 cases of type Ⅱ fistula.The average operation time was（164.77±12.77） min, There was no statistically significant difference in the operation time compared with patients without labyrinth fistula（155.13±9.15） minutes（P=0.563）. 11 cases（84.62%） had dry ears 3 weeks after surgery, 9 cases（69.23%） reached cavity epithelialization at 8 weeks after surgery, and all cases reached epithelialization at 12 weeks after surgery. There was no statistically significant difference in the average bone conduction threshold before and after the operation（P=0.064）, and the average air-bone conduction difference was statistically significant（P=0.012）. One patient had vertigo symptoms after surgery, which was relieved 1 week after surgery, and the bone conduction hearing threshold of this patient did not change compared with that before surgery. Conclusion:①Continuous irrigating mode in otoendoscopic surgery provides a clear surgical field and allows for safe lesion removal, with operation times comparable to those in patients without labyrinthine fistula. ②No significant postoperative decline in bone conduction hearing thresholds was observed, while the air-bone gap was significantly improved. ③The low incidence of postoperative vertigo, along with shorter time to dry ear and cavity epithelialization, suggests that transcanal endoscopic surgery with continuous irrigation is a safe and effective approach for managing labyrinthine fistula.

Objective:External auditory canal cholesteatoma（EACC） is a common otological disease. Failure to provide timely and standardized treatment often leads to persistent inflammatory reactions and localized bone destruction, with potential involvement of adjacent structures such as the middle ear. To advance the standardization of EACC diagnosis and treatment, the Editorial Board of the Journal of Clinical Otorhinolaryngology Head and Neck Surgery in collaboration with the Otology Group of the Otorhinolaryngology Head and Neck Surgery Branch, Chinese Medical Doctor Association, developed this expert consensus. The consensus systematically elaborates on the definition, classification, etiology, clinical manifestations, and imaging evaluation strategies for EACC. It proposes a clinical staging system based on the extent of lesion involvement and clarifies the principles of treatment, which include complete lesion removal, repair or reconstruction of the external auditory canal structure, restoration of patency and drainage, and recovery of its self-cleaning function. In addition, a staged treatment approach-ranging from outpatient debridement to individualized surgery-is recommended. The goal of this consensus is to offer practical guidance for the standardized diagnosis, staging, and treatment of EACC.