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.

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 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 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 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.