Semont maneuver was performed in 97 patients with benign paroxysmal positional vertigo involving the posterior semicircular canal.Among 97 patients the Semont maneuver was successful in 69 cases and failed in 28 cases.There were three nystagmus patterns during the third position of the Semont maneuver:orthotropic nystagmus (n=45), no nystagmus (n=42) and reversed nystagmus (n=10);and the effective rates in three groups were 93%, 64% and 0%, respectively (P<0.05).The duration of latency period and nystagmus status in Dix-Hallpike test has no effect on repositioning efficacy ( P>0.05) .

Objective To analysis the clinical features of valproate (VPA)-induced encephalopathy in elderly people in order to improve our cognition toward it.Methods From March 2003 to March 2011,a total of 10 cases with VPA-induced encephalopathy were retrospectively reviewed and summarized.The data collected included clinical manifestations,biochemistry,EEG and therapeutic effects.Results In the 10 cases,8 were males and 2 females.The age ranged from 65-88 years old (mean age 75.4±10.3 years).7 subjects were on treatment with VPA alone,and the other 3 in combination with other anti-epileptic drugs.The serum VPA level in this study ranged from 62.1-122.7 μg/ml with mean of (92.3 ± 30.1) mg/L (normal range 50-100 mg/L).All subjects presented with confusion and cognitive impairment.The serum ammonia level in this study ranged from 56.7-225.1 μmol/L with mean of (101.4±55.2) μmol/L (normal range 11-32 μmol/L).All cases were with normal liver function.Electroencephalography was characterized by signs of severe encephalopathy with continuous generalized slowing,a predominance of θ and δ activity,occasional bursts of epileptiform discharges and triphasic waves.All cases were improved 3-21 days after VPA withdrawal.Conclusions VPA-induced encephalopathy that manifested in confusion and cognitive impairment is not uncommon in elderly patients and it has a good prognosis and the early withdrawal of VPA lads to improvement in almost all cases.

Objective To investigate the clinical and laboratory profiles of a patient with pustular psoriasis-like skin lesion and cerebral palsy due to biotinidase deficiency. Methods A 5 year and 4 month-old boy with biotinidase deficiency was confirmed by urinary organic acid analysis with gas chromatography/mass spectrometry (GC/MS)and biotinidase activity assay of peripheral blood. His clinical features, laboratory findings, treatment and outcome were studied. Results The boy showed difficulty in taking food after birth, gradually eczema and pustules appeared at the age of 2 months, and generalized erythema and intractable pustular psoriasis-like lesion at the age of 8 months. His intellectual development was normal with retardation of locomotor system. He had muscular dystonia at the age of 6 months. Physical examination showed generalized pustular psoriasis-like lesion, generalized paralysis, hypertonic contracture of extremities, sparseness of scalp hair and severe malnutrition. Routine laboratory tests showed a mild anemia, metabolic acidosis and elevation of plasma creatine phosphokinase. Increased excretion of urinary lactate, pyruvate, 3-OH-propionate, propionylglycine, and 3-methylcrontonylglycine were observed. Biotinidase activity of his peripheral blood was below 0.1 pmol/min/3mm (normal 6.3-9.3 pmol/min/3mm). Biotin (10 mg/day) supplementation led to a dramatic recovery of the skin lesion. After the treatment of rehabilitation, his muscle power was also improved gradually. Conclusions Dermatological and neurological manifestations are the main features of biotinidase deficiency. Early diagnosis and biotin administration can greatly improve the clinical symptoms. Generalized pustular psoriasis-like lesion and cerebral palsy of this boy have improved after the supplementation of biotin, but he may be remained wheelchair-dependent because of delayed diagnosis.

Objective: To investigate the clinical value of serum adiponectin in patients with preeclampsia and its relationship with insulin resistance. Methods: From May 2017 to May 2018, 80 cases of preeclampsia diagnosed and treated in obstetrics department of the Second People′s Hospital of Liaocheng were selected in the research.According to the severity of the disease, they were divided into severe preeclampsia group and mild preeclampsia group, with 40 cases in each group, and 40 healthy pregnant women in the same period were selected as the control group.The serum adiponectin level and insulin resistance index (HOMA-IR) were detected and compared among the groups, and the correlation between them was analyzed. Results: The serum adiponectin and HOMA-IR in the severe preeclampsia group were (5.08 ±1.13)mg/L, (3.08 ±1.54), respectively, which in the mild preeclampsia group were (6.55±1.46)mg/L, (2.62±1.34), respectively, which in the control group were (11.67±3.53)mg/L, (1.13±0.53), respectively.there were statistically significant difference among the three groups (all P<0.05). The serum adiponectin level in the severe preeclampsia group was lower than that in the mild preeclampsia group and control group(P<0.05), and the HOMA-IR in the severe preeclampsia group was higher than that in the mild preeclampsia group and control group (P<0.05). The serum adiponectin level in the mild preeclampsia group was lower than that in the control group, and the HOMA-IR was higher than that in the control group, the differences were statistically significant (all P<0.05). The serum adiponectin level of preeclampsia patients with insulin resistance was (4.89±1.25)mg/L, which was significantly lower than that of non-insulin resistance patients[(6.78±1.75)mg/L], and the difference was statistically significant (t=6.254, P<0.05). Pearson correlation analysis showed that serum adiponectin level was negatively correlated with HOMA-IR (r=-0.617, P<0.05). Conclusion The serum adiponectin level and insulin resistance index of preeclampsia patients are significantly decreased, and there is a significant negative correlation between them.

Objective　To detect the location of pathogens in myocardium using in situ RT-PCR technique in order to study the pathogenetic course of the myocardial lesion induced by CoxB3m virus infection in mice. Methods　(1) Thirty and fifty Balb/c mice were used respectively to establish the acute and chronic CoxB3m infected models, with another 25 healthy mice as the controls; (2) KS400 image analysis system (Germany) was used to measure the cardiac chamber area and the left ventricular wall thickness of the chronic infected mice and the controls; (3) CoxB3m virus in myocardial tissue was detected using in situ RT-PCR by direct incorporated technique which employed nucleotide labeling by anti-digoxin antibody and bonded with alkaline phosphatase (anti-dig-AKP method). Results　Picture analysis indicated that the left ventricular chamber area was enlarged and the left ventricular wall was thinner in the chronic repeated virus infected models than those of the controls. With in situ RT-PCR, positive signals for Coxsackie virus B3m RNA were detected not only in the myocardium of the acute Balb/c mice models but also in the myocardium of the chronic mice models. Conclusion　Coxsackie virus B3m is able to induce pathologic lesions by exhibiting positive CVB-RNA signals in both acute and chronic models in mice. In the chronic experimental models, the cardiac chamber is enlarged while the ventricular wall is thinned which demonstrates the association with persistent infection of Coxsackie virus B3m virus.

Objective To investigate the diagnostic value of lean test in Benign paroxysmal positional vertigo of posterior semicircular canal （PC-BPPV）. Methods We retrospectively included the clinical data of 220 patients with unilateral PC-BPPV who were admitted to the Department of Neurology，Jiaxing Second Hospital.All patients underwent lean test first，and then Dix-Hallpike test was performed to study the clinical characteristics of patients with vertigo induced by lean test. Results 133 （60.5%） patients induced PC-BPPV typical upbeat torsional nystagmus during the lean test. During the Dix-Hallpike test，the maximum slow phase angular velocity （SPV） of the induced upbeat nystagmus was higher than the SPV value induced by the lean test，and the latency and duration of the induced nystagmus were significantly different from the lean test （P 0.001）. Conclusion The lean test has a certain reference value for the diagnosis of PC-BPPV. It is effective for the diagnosis of PC-BPPV. The lean test induces a small nystagmus and mild autonomic symptoms compare to suspension position. In view of its simplicity，the lean test can be performed before the Dix-Hallpike operation.

Objective:To observe the effects of estradiol on expression of plasma membrane Ca 2+-ATPase isoform 2 in inner ear of rats. Methods:Twenty-five Three-months-old female Sprague-Dawley rats were randomly and equally divided into five groups by random number table mathod,with five rats in each group. Animals in Sham group were sham-operated while others were bilateral ovariactmized. One month after modeling, the OVX groups were supplemented with estradiol (E2 group), progesterone (P group), estradiol and progesterone (E2+P group)and vehicle sesame oil (Veh group), while the Sham operation group (Sham group) was supplemented with vehicle sesame oil.All rats were sacrificed and otocysts were obtained immediately. Enzyme-linked immunosorbent assay was used to detect the changes in serum estradiol and progesterone levels of each group of rats before operation, before treatment and before sacrifice. Western blot and quantitative real-time polymerase chain reaction were used to detect the expression of total PMCA2 protein and mRNA in the inner ear of each group.Results:There was no significant difference in serum estradiol and progesterone levels among the five groups before operated( P>0.05). Before treatment, the serum estradiol and progesterone levels of rats in each group were significantly lower than those in Sham group ( P<0.05). The serum estradiol level in E2 group and E2+P group was not significantly different from that in Sham group ( P>0.05), while the serum estradiol level in P group and Veh group was significantly different from that in Sham group ( P<0.05). The level of progesterone in P group and E2+P group was higher than that in Sham group ( P<0.05), while the level of progesterone in Veh group and E2 group was lower than that in Sham group ( P<0.05). Protein and mRNA expression of PMCA2 in P and Veh groups were significantly decreased compared with that of Sham group ( P<0.05) while the expression levels underwent no significantly change in E2 and E2+P groups ( P<0.05). Conclusion:The decrease of serum estradiol level can reduce the expression of otolith regulatory protein PMCA2 in rats, and then affect otolith metabolism, which may be an important link of estrogen affecting otolith metabolism.

Abstract OBJECTIVE To develop an ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method for determination of hynchophylline, isorhynchophylline, isocorynoxeine, corynoxeine, hirsutine and hirsuteine in Uncaria decoction, and investigate the effect of different storage conditions on the stability of active ingredients. METHODS An UHPLC-MS/MS method was established to investigate the effects of different storage temperature and time on the stability of six active components in Uncaria decoction. Separation was performed with a gradient mobile phase system of acetonitrile-0.1% formic water solution, the flow rate was 0.4 mL·min-1, the temperature of column was 30℃, the injection volume was 2 μL, the MS detection was dynamic multiple reaction monitoring mode. The effects of different storage temperature and time on the stability of six active components in Uncaria decoction was investigated. RESULTS Rhynchophylline, isorhynchophylline, corynoxeine, isocorynoxeine, hirsutine and hirsuteine were successfully separated using this method, with good linear relationship in the corresponding concentration range. The precision, repeatability, stability and recovery rate were good. The six alkaloids were basically stable within 14 d under low temperature storage, basically stable within 3 d under normal temperature storage, and not stable under high temperature storage. CONCLUSION The UHPLC-MS/MS method is stable, rapid and reproducible. It can be used to determine the contents of six effective components in Uncaria decoction. Cold storage is beneficial to the stability of Uncaria decoction.

Objective To explore the research hotspots and development trend on vascular dizziness/vertigo based on visual analysis. Methods The Web of Science Core Collection Database was searched for papers on vascular dizziness/vertigo from January 2008 to March 2023. The CiteSpace 6.2.R2 software was used for visual analysis of the literature. Results There were a total of 1298 papers，with an increasing number of published papers from January 2008 to March 2023. A total of 424 institutions from 83 countries/regions had published relevant papers. The United States ranked first in terms of the number of published papers（331 papers） and betweenness centrality（0.25）. Johns Hopkins University was the number one institution in terms of the number of published papers （56 papers），Newman-toker and David E were the most prolific authors. The most common keyword was ischemic stroke. According to keyword clustering，research in this field focused on early diagnosis of vascular dizziness/vertigo from risk factors and bedside examinations and infarction of the anterior inferior cerebellar artery supply area. In recent years，researchers had more interests in case reports，video electronystagmograms，and pathophysiological mechanisms in this field. Conclusion There are growing international studies on vascular dizziness/vertigo. Early diagnosis of vascular dizziness/vertigo through risk factors and bedside examinations in the emergency room is a research hotspot in this field. Researchers should focus on these topics in future studies.