Objective To evaluate the effect of small-dose Lorazepam on residual dizziness in elderly patients with benign paroxysmal positional vertigo (BPPV) after successful particle repositioning maneuver (PRM).Methods A total of 268 patients aged 60 years and over, who were diagnosed as BPPV and underwent successful treatment of PRM, were randomly assigned to medication group and control group.The patients in the medication group were prescribed low-dose lorazepam for 1 week (0.25 mg/time, 3 times/d), whereas the patients in the control group were not prescribed any medication.Hamilton Anxiety Scale (HAMA) was employed to evaluate the anxiety status of patients before and after PRM, and the effect of small-dose lorazepam on residual dizziness was accessed by using the Dizziness Handicap Inventory (DHI) scale and the Activities-specific Balance Confidence (ABC) scale in elderly BPPV patients after PRM.Results No difference in HAMA scores was found between the two groups (t=-0.316, P=0.753) before PRM.The medication group (t=19.931, P=0.000) and the control group (t=26.930, P=0.000) showed a significant improvement in HAMA scores after PRM versus before PRM.However, HAMA scores after PRM was lower in the medication group than in the control group (t=14.967, P=0.000).The medication group had significant improvements after PRM versus before PRM in the following: DHI scores (t=43.661, P=0.000), functional (t=32.326, P=0.000981), emotional (t=31.981, P=0.000), physical (t=14.330, P=0.000) subscale scores, as well as in the ABC scores (t=-23.248, P=0.000).The improvements were also found in the control group in DHI scores (t=46.282, P=0.000), functional (t=32.117, P=0.000), emotional (t=34.563, P=0.000),physical (t=13.182, P=0.000) subscale scores, as well as in the ABC scores(t=-24.536, P=0.000)after PRM versus before PRM.However, after PRM the total DHI score, functional,emotional and physical subscale scores were lower in medication group than in control group (t=5.994, 3.206, 4.757 and 2.851, respectively, P=0.009, 0.002, 0.000 and 0.005).The ABC scores were higher in medication group than in control group (t=2.678, P=0.008) after PRM.Conclusions The elderly patients with BPPV are often accompanied by symptoms of anxiety.The small-dose Lorazepam can alleviate residual dizziness in elderly BPPV patients after successful PRM.

Objective To investigate the frequency of posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV) in each ear,and to explore the effect of sleep position in lateral-predominance of ear by PC-BPPV during sleep onset in elderly patients. Methods Totally 114 patients aged (67.4±7.5) years with unilateral PC BPPV confirmed by a positive Dix Hallpike test,were retrospectively reviewed.All patients included in the study were able to define a leteral predominant,favorate head-lying side (right,left or supine position) during sleep onset. Results The Dix Hallpike test was found to be positive on the right side in 72 patients and positive on the left side in 42 cases.During sleep onset,61 patients habitually laid their head on the right side,34 laid their head on the left,and the remaining 19 cases on the supine position.Among 114 cases with positive Dix Hallpike test,there were 78 cases with the same side between affected ear and sleep position (52 cases right,26 cases left),36 cases with different side (9 cases with right position and left positive Dix Hallpike test,8 cases left position and right positive Dix Hallpike test,19 cases slept in a supine position including 12 cases with right positive Dix Hallpike test and 7 cases with left positive).The association between affected ear and head-lying side during sleep onset was statistically significant (x2 =35.737,P＜0.01) and Pearson coefficient of continency was 0.4885. Conclusions Among the elderly,right-sided PC-BPPV is popular,and these patients favorite right head-lying position during sleep.There is association between the affected side by PC-BPPV and the head-lying side during sleep.

Objective To analyze the clinical and nursing care of peripartum reversible posterior leukoencephalopathy syndrome (RPLS).Methods Thirty five cases with peripartum RPLS were retrospectively reviewed.Results All patients developed acutely,22.9％ in the antepartum period and 77.1％ in the postpartum period.The major clinical characteristics were headache (65.7％),seizures(62.9％),visual disturbances (54.3％),altered mental status (22.9％).The most common abnormality on neuro-imaging was edema predominantly involving the cortex and subcortical white matter in the posterior portions of the cerebral hemispheres,including the occipital lobes (77.1％),parietal lobes (65.7％),temporal lobes (28.6％) and frontal lobe (20.0％).MR diffusion-weighted imaging and ADC mapping revealed vasogenic edema.The treatments included aggressive blood pressure control and anticonvulsants with special nursing care.The clinical symptoms and the lesions on neuroimaging improved or resolved within 1 day to 2 months.Conclusions The prognosis for peripartum RPLS is ensured as long as the diagnosis is made properly and reasonable application of care program.

Objective To analyze and study the connections between hypovolemia and lower extremity deep venous thrombosis (LDVT)in patients with cerebral infarction. Methods A total of 504 hospitalized patients with cerebral in-farction were selected. According to the comparison between infarction group and non-infarction group, ROC curves of urea nitrogen/creatinine ratio, plasma osmotic pressure, combined index of the two indices above and D-dimer were created, cut-off value of the indices above was calculated, and sensitivity and specificity were compared. Results Analysis on the results of ROC curves showed ROC area under the curve of urea nitrogen/creatinine ratio in the diag-nosis of LDVT in 10-14 days after admission was 0.788(95%CI 0.727-0.848),the optimal diagnostic cut-off point was 101.705, the sensitivity was 58%, and the specificity was 88.7%; ROC area under the curve of plasma osmotic pres-sure was 0.892 (95%CI 0.836-0.949), the optimal diagnostic cut-off point was 305.77 mmol/L, the sensitivity was 85.5%, and the specificity was 90.8%; ROC area under the curve of the combined index was 0.895 (95%CI 0.837-0.952); ROC area under the curve of D-dimer was 0.883(95%CI0.832-0.935), the optimal diagnostic cut-off point was 3.055 ug/L,the sensitivity was 85.5%, and the specificity was 82.1%. Conclusion Combined index of urea nitro-gen/creatinine ratio and plasma osmotic pressure in the diagnosis of LVDT is better than D-dimer, which is beneficial for early diagnosis.

Objective:To investigate the clinicopathological and genetic features of epithelioid and spindle cell rhabdomysarcoma with EWSR1-TFCP2 or FUS-TFCP2 fusion.Methods:The clinical, morphological and immunohistochemical features of 14 cases of epithelioid and spindle cell rhabdomysarcoma with EWSR1-TFCP2 or FUS-TFCP2 fusion diagnosed from January 2019 to December 2022 in the Department of Pathology, Foshan Traditional Chinese Medicine Hospital, Foshan, China were retrospectively analyzed. The cases were all subject to FISH or next generation sequencing for analysis of molecular genetic features. The literature was reviewed.Results:There were 5 males and 9 females, with the age at presentation ranging from 6 to 36 years (mean, 22 years). Tumors occurred in the head and neck (9 cases), pelvic region (2 cases), bladder (one case), right humerus (one case), and the abdominal wall, humerus and pubic at the same time (one case). Presenting symptoms varied by location but often included pain or discomfort. Most of the patients showed aggressive radiographic features with soft tissue extension. The tumors had a median size of 6.6 cm (range, 2-23 cm). The tumors were poorly defined and irregularly shaped. Microscopic examination showed diffuse proliferation of spindle or epithelioid cells. While morphologically high-grade tumors displayed obvious cytological atypia, a high mitotic count and tumor necrosis, low-grade tumors grew in sheets and fascicles composed of spindle, epithelioid cells with moderate or abundant amounts of eosinophilic cytoplasm, without pronounced cytological atypia. The tumor cells expressed Desmin, MyoD1, and Myogenin, as well as ALK, EMA, and CKpan. EWSR1/FUS-TFCP2 gene fusion was detected in 14 cases with next generation sequencing and confirmed by FISH. Six cases had EWSR1-TFCP2 fusions and 8 cases showed FUS-TFCP2 fusions. Follow-up information was available in 13 patients, ranged from 5 to 37 months. At the end of follow-up period, 7 patients died of the disease. Six patients were alive:two cases had local recurrences and metastases, two cases of recurrences, one case of metastasis and one case without recurrences and metastasis.Conclusions:Epithelioid and spindle cell rhabdomysarcomas with EWSR1-TFCP2 or FUS-TFCP2 fusion show a very aggressive clinical course, and more commonly occur in the head and neck. Their genetic hallmark is the presence of EWSR1/FUS-TFCP2 fusions. Familiarity with its clinicopathological characteristics is helpful in avoiding misdiagnoses.