Objective To improve the efficiency and accuracy of videonystagmography calibration test results while enabling effective recognition of saccadic undershoot waveform by developing a dual-stream architecture-based deep learning model. Methods A vestibular function calibration test recognition model with cross-modal feature fusion was constructed by integrating vision transformer (ViT) and a modified ConvNeXt convolutional network. The model utilized trajectory pictures and spatial distribution maps as inputs, employed a multi-task learning framework to classify calibration data, and to directly evaluate undershoot waveform. Results The model showed outstanding performance in assessing calibration compliance. The accuracy, sensitivity, specificity of the model in left side, middle, and right side were all greater than 90%, and AUC values were all greater than 0.99, with 97.66% of optimal accuracy (middle), 98.98% of optimal sensitivity (middle), 96.87% of optimal specificity (right side), and 0.997 of AUC (right side). The model also showed promising performance in undershoot waveform recognition with 87.50% of accuracy, 89.66% of sensitivity, 85.71% of specificity, 86.67% of F1 score, and 0.931 of AUC. Conclusions The proposed method not only significantly enhances the efficiency and accuracy of calibration test results, but also provides a novel solution for undershoot waveform recognition.

Objective To investigate the impact of vestibular dysfunction on various domains of cognitive function, providing a basis for developing comprehensive vestibular-cognitive intervention strategies. Methods A total of 33 patients with confirmed unilateral vestibular dysfunction treated at Eye & ENT Hospital, Fudan University between June 2024 and December 2024. Vestibular function was assessed using vestibular evoked myogenic potential (VEMP), caloric testing, video head impulse test (vHIT), and sensory organization test (SOT). Cognitive function was evaluated using mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), Stroop color-word test, trail making test (TMT), and auditory verbal learning test (AVLT). Subjective symptoms were assessed using dizziness handicap inventory (DHI). Results In the vestibular function assessment of patients, abnormalities in caloric testing, utricle VEMP and saccule VEMP results were most common, with rates of 87.9%, 57.6%, and 66.7%, respectively; SOT abnormality primarily characterized by impaired vestibular function (21.2%). Spearman correlation analysis showed age, years of education, hearing ability, and emotional state were associated with overall or specific domains of cognitive function in patients. Greater vestibular dysfunction severity was associated with longer TMT-A time (r＝0.443，P＝0.010), most severe damage of short-term (r＝－0.405，P＝0.019) and long-term delayed recalls (r＝－0.537，P＝0.001). Patients with 31-60 of DHI scores showed longer TMT-A time than patients with 0-30 of DHI scores (P＝0.033). Conclusions Patients with vestibular dysfunction exhibit significant impairment in low-frequency semicircular canal and utricle function, which affects attention allocation, information processing speed, and memory performance in cognitive tasks.

The incidence of otogenic vertigo accounts for approximately 70% of all vertigo, presenting a sensation of surrounding objects moving and balance disturbances, accompanied by nausea, vomiting, and emotional changes, severely affecting quality of life in patients. Neuroimaging techniques have been widely used to observe structural and functional changes in related brain regions, and provide new insights into the mechanisms of vertigo. This paper aims to review the recent neuroimaging advancements in the study of central nervous mechanisms of otogenic vertigo, offering a imaging evidence for further exploration of related neuropathological mechanisms of otogenic vertigo.

Pseudorabies virus(PRV)is the etiological agent of pseudorabies in pigs,which is char-acterized by dyspnea,reproductive disorders,and neurological diseases,and it spreads widely a-round the world.Since 2011,the newly emerged PRV variants have resulted in poor immunity pro-tection of traditional vaccine strains,and the original method of vaccine strain preparation is time-consuming and labor-intensive.Therefore,it is urgently needed to develop an efficient screening method of the vaccine strain at present.Using CRISPR/Cas9 gene editing technology in this study,two single guide RNAs(sgRNA)were designed targeting the virulence gene TK of PRV variant strain CH/JX/2016,and then the enhanced green fluorescent protein the reporter(EGFP)gene was inserted at the TK locus by a homologous repair plasmid.After multiple rounds of plaque puri-fication,the rPRV-ΔTK/EGFP strain was obtained.The results showed the cleavage efficiency of the two sgRNAs was extremely high.The preparation of rPRV-ΔTK/EGFP strain was succeed af-ter only three rounds of purification,and the EGFP expressed normally.The CRISPR/Cas9 system can edit the PRV gene simply,rapidly,and efficiently,and exhibits great potential in the construction of vaccine candidate strains.Meanwhile,the rescued rPRV-ΔTK/EGFP strain not only could be used as a tracer strain in PRV variant infection progresses,but also for subsequent antivi-ral drug screening.

The naissance of evidence-based medicine raises profound changes of medical practice mode all over the world. Evidence-based nursing follows the same methodology and principle with evidence-based medicine. This paper discussed how the evidence-based practice assisted development of nursing subject from three aspects including decision-making, thinking and culture. In decision-making, we should be based on the best research evidence, professional judgment and benefits of patients. In thinking, we should make clinical problems structured and scientific. In culture, we should evaluate evidences with critical eyes and establish transformative, enlightened, inclusive organization culture.

Swallowing function rehabilitation has great significance in improving life quality of patients partial laryngectomy. This paper summarized the main causes, methods of subjective and objective assessment as well as its advantages and disadvantages of patients with dysphagia after partial laryngectomy to set up measurement standard so as to provide a basis for rehabilitation nursing of impaired swallowing.

Objective To identity factors influencing willingness to participate in shoulder and neck rehabilitative exercise in laryngeal cancer patients after neck dissection surgery, and to provide reference for subject recruitment in research of similar kind. Methods Between December 2014 to December 2015, when study was conducted to subjects participating in shoulder and neck rehabilitative exercise in laryngeal cancer patients after neck dissection surgery, demographic and disease-related data of patients in two groups (those who were willing /unwilling to participate in the study) were retrospectively analyzed. Binary Logistic regression analysis was used to identify predictive factors influencing willingness to participate in shoulder and neck rehabilitative exercise in laryngeal cancer patients after neck dissection surgery. Results It was revealed by single factor analysis that differences of the following variables between the two groups were statistically significant: age (t=-3.12, P=0.001), whether living in solitude (χ2=4.55, P=0.030), whether currently employed (χ2=9.92, P=0.002), whether with other chronic diseases (χ2=7.91, P=0.004), and whether with radiotherapy after surgery (χ2=4.95, P=0.030); no statistical differences were found regarding tumor location, staging, or neck dissection method (P>0.05). Binary Logistic regression analysis indicated that age (OR=0.71, P=0.001), living alone (OR=0.76, P=0.005) and postoperative radiotherapy (OR=0.88, P=0.001) were predictors of patients' participation in shoulder and neck rehabilitation exercise. Conclusions Certain demographic factors may play a role in the patients' decision on whether or not to participate in shoulder and neck rehabilitation exercise. Senior patients and patients who live alone showa bigger tendency of refusing to attend the exercises. Also, postoperative radiotherapy reduces the patients' willingness in participating in shoulder and neck rehabilitation exercise.

Objective To evaluate the value of transpulmonary pressure (Ptp) guided optimal positive end-expiratory pressure (PEEP) selection in patients with early acute respiratory distress syndrome (ARDS).Methods A prospective randomized self-control study was conducted.ARDS patients in the early stage (onset ≤3 days) undergoing intubation and mechanical ventilation admitted to intensive care unit (ICU) of Jiangsu Provincial Subei People's Hospital from December 2013 to December 2015 were enrolled.The PEEP level was regulated to 30 cmH2O (1 cmH2O =0.098 kPa) after recruitment maneuver,and then it was gradually decreased to 0 with lowering by 3 cmH2O every 5 minutes.The optimal PEEP was titrated by Ptp,lowest dead space fraction (VD/VT),highest static lung compliance (Cst),and optimal oxygenation,respectively.Parameters of respiratory mechanics and gas exchange were observed.Results Totally 28 patients with ARDS (including 17 male and 11 female) were included with the average age of (45 ± 12) years old,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was 21 ± 9,oxygenation index (PaO2/FiO2) was (165 ± 76) mmHg (1 mmHg =0.133 kPa).① During decremental PEEP titration,Ptp was gradually decreased,and expiratory Ptp (Ptp-e) was more than zero [(1.3±0.3) cmH2O] when PEEP was (9.6 ± 2.3) cmH2O.Cst was initially improved until reaching a peak,and then deteriorated.Cst was highest [(50 ± 8) mL/cmH2O] when PEEP was (11.5 ± 2.4) cmH2O.PaO2/FiO2 reached the maximum [(312 ± 99) mmHg] at PEEP level of (18.0 ± 2.5) cmH2O.Compared with Ptp-e 3.00-5.99 cmH2O,PaO2/FiO2 was significantly decreased when Ptp-e became negative (all P ＜ 0.05).VD/VT was lowest (0.52 ±0.05) when PEEP was (10.1 ± 2.2) cmH2O.When compared with ventilation [inspiratory Ptp (Ptp-i) 0-2.99 cmH2O],it was significantly higher during high (Ptp-i ≥ 15 cmH2O,all P ＜ 0.05).② There were no statistically significant differences in the levels of optimal PEEP,Ptp-i and Ptp-e among Ptp,lowest VD/VT and highest Cst methods (all P ＞ 0.05),but they were significantly less than optimal oxygenation method (all P ＜ 0.05).Compared with baseline and the method of optimal oxygenation,Cst in other three PEEP titration methods including Ptp,lowest VD/VT and highest Cst was improved obviously (mL/cmH2O:46± 7,47±9,50± 8 vs.30± 8,35 ± 10,all P ＜ 0.05).PaO2/FiO2 (mmHg) in the method of Ptp and lowest VD/VT were higher than the baseline (252 ± 86,258 ± 72 vs.165 ± 76,both P ＜ 0.05),but significantly lower than that of optimal oxygenation method (312 ± 99,both P ＜ 0.05),and did not significantly differ from that of highest Cst (268± 85,both P ＞ 0.05).Compared with baseline and the method of optimal oxygenation,VD/Vr improved significantly in ventilated patients on PEEP targeting with Ptp and lowest VD/VT (0.53±0.05,0.52±0.05 vs.0.59±0.05,0.58±0.04,all P ＜ 0.05).Conclusion Titration the optimal PEEP level with the method of Ptp could promote collapse alveolar recruitment,improve oxygenation and lung compliance,decrease dead space ventilation,and will not cause alveolar excessive inflation in patients who undergoing mechanical ventilation with early ARDS.

Objective To explore the prognostic value of arterial blood lactate (Lac) levels and lactate clearance rate (LCR) in the patients with septic shock.Methods A retrospective study was conducted.Clinical data of 94 septic patients admitted in the Department of Critical Care Medicine in Subei People's Hospital from January 2011 to June 2014 were analyzed.The arterial blood Lac levels at the moment of diagnosis of septic shock (incipient value,0 hour) and early-stage after treatment (3,6 and 24 hours) were reviewed,and individual LCR was calculated at 3,6,24 hours for each patient.According to the outcome in intensive care unit (ICU),patients were divided into survival group (n =48) and death group (n =46).The Lac and LCR at different time points in two groups were analyzed,and the relationships between them and outcome were analyzed.The receiver-operating characteristic (ROC) curve was plotted to assess the value of Lac and LCR at different time points for predicting the outcome.Results Lac level after treatment in survival group was significantly lower than incipient value,but there was no obvious change in death group.Compared with death group,early Lac levels (mmol/L) in survival group were significantly reduced (0 hour:3.80 ± 2.14 vs.5.75±3.21,3 hours:2.05± 1.04 vs.5.03±2.53,6 hours:1.80±0.77 vs.4.40±2.02,24 hours:1.35±0.43 vs.4.90 ± 2.72,P ＜ 0.05 or P ＜ 0.01),the LCR was significantly increased [3 hours:50.00 (72.35)％ vs.13.51 (20.67)％,6 hours:41.43 (58.42)％ vs.22.00 (22.31)％,24 hours:58.73 (29.94)％ vs.18.92 (47.28)％,P ＜ 0.05 or P ＜ 0.01].The Lac levels at all time points were positively correlated with the outcome,and 6-hour and 24-hour LCR were negatively correlated with the outcome.According to the incipient Lac level,patients were divided into low Lac group (Lac ＜ 2 mmol/L),mild Lac group (Lac 2-3 mmol/L) and high Lac group (Lac ≥ 4 mmol/L).The mortality in low Lac group,mild Lac group,high Lac group was gradually increased [23.07％ (6/26),50.00％ (8/16),61.54％ (32/52),x2=10.270,P =0.006].ROC curves demonstrated that the area under ROC curve (AUC) of 24-hour Lac was the largest,0.944,and it was more sensitive and specific in the prognosis evaluation (100％ and 78.3％,respectively).According to the cut-off value of 24-hour Lac as 2.35 mmol/L,patients were divided into high Lac and low Lac groups,and mortality rate in high Lac group was significantly higher than that in low Lac group [100.0％ (36/36) vs.17.24％ (10/58),x2=30.441,P =0.000].The AUC of 24-hour LCR was the largest,0.865,and it was more sensitive and specific for the prognosis evaluation (83.3％ and 91.3％,respectively).According to the cut-off value of 24-hour LCR as 36.8％,patients were divided into high LCR group and low LCR group,and mortality rate in low LCR group was significantly higher than that in high LCR group [84.00％ (42/50) vs.9.09％ (4/44),x2=26.278,P =0.000].Conclusion Early high Lac in patients with septic shock prompts a poor prognosis,and 24-hour Lac levels and LCR are indicators of assessment of clinical therapeutic effect and prognosis of patients with septic shock.

Objective The purpose of this study was to acquire a deeper understanding for the short-term psychological experience after discharge for male patients after laryngectomy. Methods Phenomenological method and in-depth interviews were used. Eleven patients were recruited. The data were analyzed by Giorgi′s phenomenological procedures. Results After analyzing the data, five main themes were extracted: rejecting tracheal tube, desiring to speak early, sense of uncertainty about the future, emerging various negative emotions, heavy pressure caused by disease treatment, facing reality and living in the moment. Conclusions Patients with laryngectomy discharged in short term faced major problems, so clinical staff should give timely support and care to help them return to society in a better condition.