Objective To study the impact of a subject's testing state on residual noise level and ABR wave V amplitude during non-sedated ABR testing using Kalman-weighted averaging(KWA).Methods Twenty-one adults(18～34 years old,42 ears)with normal hearing were enrolled for non-sedated ABR testing under three different states(lying,sitting,and writing)in a quiet room using a new Kalman-weighted averaging ABR system(vivosonic integrity system).The residual noise level and the amplitude of wave V for click ABR(cABR)of each subject were recorded.The traditional ABR test system(interacoustics,IA)was also used to record ABR with the residual noise level and the amplitude of wave V measured at the same time.Results ① There was no significant difference in am-plitude of wave V between traditional ABR and non-sedated ABR in three different testing states(P＞0.05).②The residual noise levels in the lying and sitting states of KWA ABR were lower than those of traditional ABR,but there was no statistically difference(P＜0.05).The residual noise level of the KWA ABR system in writing state was significantly higher than that of the other three conditions(P＜0.05).③ There was no significant difference between the left and right ears in the residual noise level and amplitude of wave V for non-sedated ABR in writing state(P＞0.05).Conclusion Compared with traditional ABR,the non-sedated KWA ABR system in uriting state was significantly higher than that of the other three conolitions.Haw ever,the residual noise level in lying and sit-ting states had no significant difference with conditional ABR,and different states of the subject had impact on the residual noise level in the ABR testing to sone extent.

Objective:To determine the expression of matrix metalloproteinase 13 (MMP13) in patients with psoriasis, and to evaluate the effect of tazarotene and narrow-band ultraviolet B (NB-UVB) on the expression of MMP13 in mice with psoriasis-like dermatitis.Methods:Lesional skin tissues and normal skin tissues were collected from 18 patients with psoriasis vulgaris and 10 healthy controls respectively, who were enrolled from General Hospital of Tianjin Medical University between May 2019 and August 2019, and serum samples were collected from all the subjects. A total of 25 specific pathogen-free (SPF) male BALB/c mice were randomly divided into control group, imiquimod group, imiquimod+NB-UVB group, imiquimod+tazarotene group and imiquimod+tazarotene+NB-UVB group. The control group received topical vaseline cream on the back once every morning; imiquimod group and imiquimod+NB-UVB group received imiquimod cream on the back once every morning; imiquimod+tazarotene group and imiquimod+tazarotene+NB-UVB group received imiquimod cream on the back once every morning, and tazarotene cream on the back once at night; imiquimod+NB-UVB group and imiquimod+tazarotene+NB-UVB group received NB-UVB irradiation on the back every other day at noon, with the dose being 300 mJ/cm 2 in the first session and increasing by 50 mJ/cm 2 in every session. The modeling lasted 7 days. After successful modeling, blood samples were obtained from the eyeballs of the mice, and skin tissues were resected from the back of the mice after being sacrificed by cervical dislocation on day 8. Changes in the epidermal thickness and pathological manifestations were observed by hematoxylin and eosin (HE) staining, protein expression of MMP13 in skin tissues was determined by immunohistochemical study, and the serum level of MMP13 was detected by enzyme-linked immunosorbent assay. Comparisons between 2 groups were performed by using two-independent-sample t test, comparisons among several groups by using one-way analysis of variance, multiple comparisons by using least significant difference- t test, and comparisons of enumeration data by using chi-square test. Results:The skin lesions of the patients with psoriasis were strongly positive for MMP13, and the MMP13 expression levels in the epidermis and serum (84.11±17.16, 13.29±3.95 μg/L, respectively) were significantly higher in the patients with psoriasis than in the healthy controls (11.98±4.08, 7.46±1.58 μg/L, respectively, both P< 0.01) . Compared with the control group (1.26±0.04 μm, 25.40±2.34, 185.76±7.22 μg/L, respectively) , a significant increase was observed in the epidermis thickness (7.93±0.59 μm, P< 0.01) , as well as MMP13 levels in the epidermis and serum in the imiquimod group (147.14±5.53, 215.98±15.17 μg/L, respectively, both P< 0.01) . Compared with the imiquimod group, the imiquimod+tazarotene group, imiquimod+NB-UVB group, and imiquimod+tazarotene+NB-UVB group all showed significantly decreased epidermal thickness (3.56±0.37 μm, 3.83±0.39 μm, 2.14±0.34 μm, respectively, all P< 0.05) , MMP13 levels in the epidermis (120.42±3.23, 91.08±0.46, 71.12±7.11, respectively, all P< 0.05) and serum (197.39±3.92 μg/L, 196.13±11.76 μg/L, 183.21±14.99 μg/L, respectively, all P< 0.05) . Conclusions:MMP13 protein expression markedly increased in the skin lesions and sera of patients with psoriasis, and decreased in skin lesions and sera of mice with psoriasis-like dermatitis after the treatment with tazarotene and NB-UVB. MMP13 may be involved in the development of psoriasis, and tazarotene and NB-UVB may inhibit the development of psoriasis by reducing the expression of MMP13.

Objective:To explore the possible pathogenesis of central paroxysmal positional vertigo (CPPV) by analyzing its clinical manifestations and characteristics.Methods:The clinical data of 3 patients with CPPV, including 1 male and 2 females, aged 36, 14 and 70 years old respectively, were collected from the Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from June 2014 to June 2018. The clinical symptoms, nystagmus, other central ocular motor abnormalities, MRI, PET-CT, and laboratory findings were analyzed retrospectively.Results:All patients showed transient vertigo and nystagmus induced by head changes relative to gravity, but the characteristics of nystagmus did not conform to the typical characteristics of nystagmus in benign paroxysmal positional vertigo. None of patients response to repositioning maneuvers, and all patients presented with the signs of abnormal visual oculomotor system or other symptoms of central system. MRI, PET-CT and blood biochemical tests confirmed that the causes of CPPV in the patients were chronic hemorrhage, inflammation and paraneoplastic cerebellar degeneration. Although the etiology of the three cases is different, the lesion site is involved in the central velocity storage mechanism.Conclusion:The damage of central velocity storage mechanism may lead to the damage of feedback rotation signal correction pathway, and CPPV appears when the head position changes relative to gravity.

OBJECTIVETo observe the effect difference between acupuncture of "five needles therapy" and conventional acupuncture for asthma of latent cold phlegm-fluid in the lung.

METHODSTwo hundred and ten cases were randomly assigned into an observation group and a control group, 105 cases in each one. Finally 7 cases were dropped out in the observation group; 6 cases in the control group. Feishu (BL 13), Dazhui (GV 14), Fengmen (BL 12) were used in the observation group; conventional acupuncture was used in the control group, and the main acupoints were Feishu (BL 13), Zhongfu (LU 1), Tiantu (CV 22), Danzhong (CV 17), Kongzui (LU 6), Dingchuan (EX-B 1), Fenglong (ST 40), Fengmen (BL 12), Taiyuan (LU 9). The needles were retained for 30 min each time, once a day for continuous 12 days. The scores of the individual symptoms and signs were observed before treatment and on the 3rd, 6th, 9th, 12th days, including pant, cough, cough up phlegm, fullness and oppression in the chest and diaphragm, wheezing rale and shortness of breath. The clinical effects were compared between the two groups.

RESULTSThe scores of six individual symptoms and signs on the 3rd, 6th, 9th, and 12th days in the two groups were lower than those before treatment (all<0.05), except the score of wheezing rale in the control group on the 3rd day (>0.05). The scores of pant, wheezing rale, cough on the 3rd, 6th, 9th, and 12th days in the observation group were lower than those in the control group (all<0.05), except the score of wheezing rale score on the 3rd day (>0.05). There were no significant difference between the two groups about the scores of cough up phlegm, fullness and oppression in the chest and diaphragm and shortness of breath on the 3rd, 6th, 9th, and 12th days (all>0.05), except the score of fullness and oppression in the chest and diaphragm in the observation group was lower than that in the control group on the 12th day (<0.05). 46 cases were clinical cured, 39 cases were markedly effective, 10 cases were effective and 3 cases were ineffective in the observation group with the total effective rate of 96.9%. 23 cases were clinical cured, 43 cases were markedly effective, 24 cases were effective and 9 cases were ineffective in the control group with the total effective rate of 90.9%. The difference was statistical (<0.05).

CONCLUSION"Five needles therapy" has significant therapeutic effect for asthma of latent cold phlegm-fluid in the lung, which is better than conventional acupuncture.

Objective To explore the improvement of cognitive impairment in patients with mild and moderate vascular cognitive impairment( VCI) treated with cerebralcare granule ( CG) and basic treat-ment.Methods From October in 2014 to December in 2016 year,143 cases of VCI patients were admitted from six hospitals in some areas of Hebei Province as the research objects,and divided into CG treatment group (experimental group,n=98) and conventional treatment group (control group,n=66).Three months and six months after treatment,the score of mental state examination ( MMSE) ,the Montreal cognitive assess-ment scale ( MoCA) and the daily living capacity scale( ADL) of the two groups were compared after 3 and 6 moths of treatment.Results ①The total score of MMSE in the experimental group was higher than that of the control group for six months after treatment, and the difference was statistically significant ( ( 23. 76 ± 4.02) vs (21.52±5.13),P<0.05).②Six months after treatment,the total score of MoCA ((21.06±4.66) vs (18.32±5.20)) and visual spatial/executive function((3.05±1.37) vs (2.42±1.66)),calculation force ((2.24±0.84) vs (1.83±1.05)) and orientation ability((5.20±1.12) vs (4.06±1.35)) scores in the ex-perimental group were significantly higher than those in the control group (P<0.05) .③Six months after treat-ment,the ADL score in the experimental group was lower than that before treatment,and the difference was statistically significant((24.96±8.74) vs (29.20±11.55),P<0.05);while there was no significant difference in the ADL score between the experimental group and the control group after 6 months (P>0.05).Conclusion CG can improve cognitive function in mild to moderate VCI patients,mainly in visual space/execution func-tion,calculation ability and orientation ability,and with the extension of treatment time,the curative effect is more obvious.

Objective: Dynamic visual acuity (DVA) is defined as the visual acuity when there are relative movements between subjects and visual targets. The purpose of this study was to discuss the correlation between bedside DVA test and other examinations of vestibular function, and to assess the value of DVA test for clinical diagnosis. Methods: Retrospective analysis of 323 cases with peripheral vestibular disorder, and analyzing the correlation between bedside DVA results and caloric test were performed. Results: Out of these 323 cases, 113 cases showed positive results of DVA.Among these 113 cases with positive DVA test, 109 cases were bilateral or unilateral vestibular function loss according to the results of caloric test or VEMP. The disease with the highest positive rate of DVA was bilateral vestibulopathy(BVP), followed by vestibular neuritis (VN) and profound sudden sensorineural hearing loss (pSSNHL). Conclusions Bedside DVA is effective to determine the cases with BVP and severe unilateral vestibular function loss.

The student problems existing in the practice and training course of acupuncture-moxibustion treatment include unsolid basic knowledge, inexperienced basic skills and poor comprehensive utilization ability. The writers proposed the effective countermeasures accordingly. Firstly, the students are required to go over the related knowledge in advance, targeting the weakness, and complement the basic knowledge. Secondly, the teachers provide the demonstration and guidance for the practice to improve the basic skills. Thirdly, the clinical simulation is adopted for the comprehensive training to enhance the comprehensive utilization ability. The countermeasures mentioned above improve effectively the basic skills and comprehensive ability in the students and lay the foundation for the future clinical work.

Objective To compare the results of TEOAE and DPOAE in the same population of normal newborns, to provide information on choosing appropriate screening tools.Methods A two-steps protocol was taken with the first screening during the first 48 to 72 hours of birth and rescreened from one to two months old if the newborns failed the first screening.For each step of screening, TEOAE and DPOAE were performed simultaneously using AccuScreen hearing screening instrument (Madsen-GN Otometrics, Taastrup, Denmark).A total of 1 062 normal newborns (F/M=508/554) delivered in Peking Union Medical College Hospital were enrolled in this research for the first screening.Infants who failed either TEOAE or DPOAE screening in the first screening were referred to a second screening.Among them, 135 performed both DPOAE and TEOAE in the second step.The newborns who failed the second screening would receive ABR when they were 3 months old.Results In the first screening,the failure rate for TEOAE was 11.0% (117/1 062) and 13.7% (145/1 062) for DPOAE.In the second screening step, the failure rates were 17.8% (24/135) and 20.7% (28/135) for TEOAE and DPOAE, respectively.Chi-square and Fisher's test showed that the failure rates of DPOAE were significant higher than TEOAE for both steps (P<0.001).The agreements between TEOAE and DPOAE were 96.0% and 95.6% for the first and second steps respectively, and the kappa values were 0.817 and 0.857.As to the average time taken to accomplish the screening for one ear, TEOAE was 24±25 s and DPOAE was 40±34 s during the first screening;in the rescreening, TEOAE was 52±41 s and DPOAE was 73±62 s.Paired-t tests showed that the differences between DPOAE and TEOAE testing time were statistically significant (P=0.000) in both screening steps.Finally, 7 newborns (10 ears) were diagnosed conductive hearing loss(except 1 ear was sensorineural hearing loss).Conclusion As a screening tool, TEOAE got lower refer rates and took less time than DPOAE implicating TEOAE a better screening tool for normal neonates.

Objective: The purpose of this study was to report two cases of light cupulopathy, and describe the characteristics of these cases and analysis the possible physiopathological mechanisms. Methods: The histories, clinical features, characteristics of nystagmus, and vestibular function, as well as audiologic results of the two patients with light cupula were analyzed. Results: The two patients showed persistent geotropic direction changing positional nystagmus(DCPN)in the supine head roll tests. The null plane was present when the head was turn slightly towards affected side. Canalith repositioning maneuver was not effective. A mild sensorineural hearing loss was found on the involved ear in one patient but not in the other. The vestibular functions of two patients were abnormal. Conclusions The characteristics of nystagmus with light cupulopathy are persistent geotropic DCPN with a null plane. The clinical features are similar with the horizontal semicircular canal canalolithasis. Canalith repositioning maneuver is not recommended for its ineffectiveness.

Objective: To evaluate the therapeutic efficacy of penciclovir combined with foscarnet sodium in the treatment of herpes zoster. Methods: The clinical datas of 135 herpes zoster patients from the ward of Department of Dermatology, Tianjin Medical University General Hospital were collected. Among them 64 patients received penciclovir and foscarnet sodium, and the remaining 71 patients only received penciclovir alone.Their general information, the time for vesicle stopped emerging, rash began to scab, pain to relief obviously, the adverse reaction and if they got the postherpetic neuralgia were recorded and included into statistical analysis. Results: The general information showed no significant differences between the 2 groups(all P>0.05). The time for vesicle stopped emerging, rash began to scab, pain to relief obviously in combination group was shorter than the penciclovir group (all P<0.001). The number of patients who developed postherpetic neuralgia of combination group was fewer than that of penciclovir group(P=0.013). There was no statistical significance between the 2 groups the adverse reaction(P=0.928). Conclusions The penciclovir and foscarnet sodium combination therapy showed rapid therapeutic effects on herpes zoster patients, the incidence of postherpetic neuralgia was low, and there was no more side effects than penciclovir alone therapy. The combined therapy may be a reliable way to treat herpes zoster.