Pulsatile tinnitus is an uncommon symptom of the ear.Due to its complicated etiology,multiple sites and wide range of involvement,it often brings difficulties to the diagnosis and treatment.At present,the clini-cal dilemma is that there is still a lack of a complete etiological diagnosis system for pulsatile tinnitus at home and a-broad,and the etiology of most pulsatile tinnitus is difficult to determine,and the treatment is uncertain.In this re-view,the etiology of pulsatile tinnitus was classified and summarized from structural factors,metabolic factors and vascular factors,and the corresponding diagnosis and treatment strategies were briefly described.

Pulsatile tinnitus is an uncommon symptom of the ear.Due to its complicated etiology,multiple sites and wide range of involvement,it often brings difficulties to the diagnosis and treatment.At present,the clini-cal dilemma is that there is still a lack of a complete etiological diagnosis system for pulsatile tinnitus at home and a-broad,and the etiology of most pulsatile tinnitus is difficult to determine,and the treatment is uncertain.In this re-view,the etiology of pulsatile tinnitus was classified and summarized from structural factors,metabolic factors and vascular factors,and the corresponding diagnosis and treatment strategies were briefly described.

There is increasing evidence that the activation of glucagon-like peptide-1 receptor(GLP-1R)can be used as a therapeutic intervention for cognitive disorders.Here,we have screened GLP-1 R targeted com-pounds from Scutellaria baicalensis,which revealed baicalein is a potential GLP-1 R small-molecule agonist.Mitophagy,a selective autophagy pathway for mitochondrial quality control,plays a neuro-protective role in multiple cognitive impairment diseases.We noticed that Glp1r knock-out(KO)mice present cognitive impairment symptoms and appear worse in spatial learning memory and learning capacity in Morris water maze(MWM)test than their wide-type(WT)counterparts.Our mechanistic studies revealed that mitophagy is impaired in hippocampus tissue of diabetic mice and Glp1r KO mice.Finally,we verified that the cognitive improvement effects of baicalein on diabetic cognitive dysfunction occur through the enhancement of mitophagy in a GLP-1 R-dependent manner.Our findings shed light on the importance of GLP-1 R for cognitive function maintenance,and revealed the vital significance of GLP-1R for maintaining mitochondrial homeostasis.Furthermore,we identified the therapeutic potential of baicalein in the treatment of cognitive disorder associated with diabetes.

Objective:To observe the changes of follistatin-like protein 1 (FSTL1) in serum of patients with proliferative diabetic retinopathy (PDR).Methods:Twenty PDR patients confirmed by clinical examination and 20 normal people were included in the study. Human retinal vascular endothelial cells (HRCEC) were divided into HRCEC blank control group, 3 h hypoxia group, 6 h hypoxia group. Human umbilical vein endothelial cell (HUVEC) were divided into HUVEC blank control group, 3h hypoxia group, 6h hypoxia group. Real-time quantitative PCR (RT-PCR) and ELISA were used to determine the expression of FSTL1, TGF-β, VEGF, connective tissue growth factor (CTGF) mRNA and protein in peripheral blood and cells of all groups from all subjects.Results:The expressions of FSTL1, TGF-β1, CTGF, VEGF mRNA in blood samples of patients with PDR were 1.79±0.58, 0.97±0.21, 1.85±0.69 and 1.38±0.44. The expressions of FSTL1, TGF-β1 protein were 1.19±0.50, 0.71±0.24 ng/ml and 734.03±116.45, 649.36±44.23 ng/L. Compared with normal people, the differences were statistically significant ( tmRNA=0.90, 0.21, 2.85, 1.77; P=0.00, 0.00, 0.04, 0.02. tprotein=1.88, 7.68; P=0.00, 0.02). The cell viability of HRCEC cells in the 3 h hypoxia group and the 6 h hypoxia group were 0.66±0.05 and 0.64±0.04, respectively. Compared with the blank control group, the difference was statistically significant ( F=13.02, P=0.00). The cell viability of HUVEC cells in the 3 h hypoxia group and the 6 h hypoxia group were 0.63±0.06 and 0.68±0.06, respectively. Compared with the blank control group, the difference was statistically significant ( F=26.52, P=0.00). Comparison of FSTL1, TGF-β1, CTGF, and VEGF mRNA expression in HRCEC blank control group and 3 h hypoxia group, the differences were statistically significant ( F=14.75, 44.93, 85.54, 6.23; P=0.01, 0.00, 0.00, 0.03). Compared with the HRCEC blank control and 3 h hypoxia group, the expressions of FSTL1 and TGF-β1 protein were statistically significant ( P<0.05). There was a statistically significant difference in TGF-β1 protein expression in the hypoxic 6 h group ( P=0.03) and no significant difference in FSTL1 protein expression ( P=0.68). Comparison of FSTL1, TGF-β1, CTGF, and VEGF mRNA expression in HUVEC blank control group and 3h hypoxia group, the differences were statistically significant ( F=19.08, 25.12, 22.89, 13.07; P=0.00, 0.00, 0.00, 0.01). Immunofluorescence staining results showed that FSTL1, TGF-β1, CTGF, and VEGF proteins were positively expressed in cells in the 3h hypoxia and 6h hypoxia groups. Conclusion:The expression of FSTL1 gene and protein in serum of PDR patients was significantly higher than that of normal people.

Objective:To observe the changes in refractive status of eyes with idiopathic macular hole (IMH) after vitrectomy and phacoemulsification and IOL implantation (combined surgery).Methods:A retrospective clinical study. From January 2016 to June 2019, 51patients (56 eyes) of IMH who underwent combined surgery at the Tianjin Medical University Eye Hospital. were included in the study. Among them, there were 17 males and 34 females with the average age of 66.79±4.33 years. All the affected eyes underwent BCVA, retinoscopy and axial length (AL) measurement. The IOL power was calculated according to the SRK-T formula and the refractive power (predicted value) was predicted. The average BCVA of the affected eye was 0.20±0.13. The average anterior chamber depth was 2.89±0.28 mm. The average △corneal astigmatism was 0.73±0.43 D, the average AL was 22.92±0.70 mm, the average predicted refractive power was 0.10±0.66 D. All the affected eyes underwent standard transciliary flat part three-channel 25G combined surgery. Six months after the operation, the actual value (actual value) of the diopter after the operation was measured with the same equipment and method before the operation. Paired t test was used to compare the difference between the predicted value and the actual value. Results:Six months after the operation, the actual value of the refractive power was -0.19±0.64 D. Compared with the pre-operative refractive power, the difference was not statistically significant ( t=1.665, P=0.102). The difference between the actual value and the predicted value was -0.33± 0.81 D. Conclusions:The refractive status of the IMH eye undergoes myopia drift after combined surgery. The preoperative IOL power budget can be appropriately reserved for +0.3 D hyperopia.

Objective:To retrospectively analyze the epidemiological and clinical characteristics of novel coronavirus pneumonia (COVID-19), and to provide evidence for its further prevention and control.Methods:The epidemiological history, clinical symptoms, pulmonary CT changes, treatment plan (hormone intervention or not), and negative conversion time of nucleic acid were summarized and analyzed in 43 COVID-19 patients.Results:All the 43 patients had clear contact history, among which the number of patients transmitted from conference microphone was the largest (13 cases). There were 2 cases of critical disease, 4 cases of severe disease and 37 cases of common type. The main symptoms were fever (30 cases, 69.8%) and cough (40 cases, 72.1%). Lung CT mainly showed single or multiple ground glass shadows (40 cases), which were all absorbed by the treated lesions, among which 28 cases had a transient aggravation of the lesions during the treatment. All the 43 cases were treated with integrated traditional Chinese and western medicine, 2 cases in critical condition were treated with non-invasive ventilator, and 19 cases were treated with low-dose hormone. The average nucleic acid negative conversion time was 13.28 days, and the use of hormones had no significant effect on the negative conversion time ( P>0.05). Conclusions:COVID-19 of common type is the commonest. Early respiratory support therapy is recommended for critical cases. Hormone intervention makes no obvious influence on the negative conversion time of nucleic acid. Close contact in a closed environment greatly increases the risk of transmission.

Three patients (patient 1, a 48-years-old male; patient 2, a 65-years-old female; patient 3, a 58-years-old female) received clozapine for schizophrenia at daily doses of 200 mg, 175 mg, and 100 mg, respectively. Patient 1 developed venous thrombosis of lower limbs after 16 years of clozapine treatment, which was improved after thrombolytic therapy. Ten years later, the patient developed shortness of breath after activity and the symptom gradually worsened. Bilateral pulmonary embolism was diagnosed by computed tomographic pulmonary angiography (CTPA), and warfarin and rivaroxaban were given successively for anticoagulation. One year later, the patient developed cardiac insufficiency. The patient was diagnosed as having chronic thromboembolic pulmonary hypertension (pulmonary artery systolic pressure was 86 mmHg), chronic cor pulmonale, and cardiac insufficiency. Warfarin combined with cardiac glycosides, diuretics, and other symptomatic treatments were given. After 3 months of treatments, his dyspnea was markedly relieved and the pulmonary systolic pressure was reduced to 48 mmHg. Patient 2 developed pulmonary embolism after 5 years of clozapine treatment. After thrombolytic therapy, he was given oral warfarin and the drug was discontinued by himself 3 years later. Pulmonary embolism recurred 2 years after the drug withdrawal. Nadroparin calcium and warfarin anticoagulation was given successively and 3 months later, CTPA showed that pulmonary embolism basically disappeared. Patient 3 developed lower-extremity venous thrombosis after 2 years of clozapine treatment, and pulmonary embolism occurred 1 year later, which was improved after anticoagulation, diuretics, and other treatments. Three years later, the patient stopped warfarin by herself, and 10 months later, her pulmonary embolism recurred. Low-molecular-weight heparin sodium as bridge therapy to warfarin was given. Three months later, CTPA showed that pulmonary artery thrombosis basically disappeared.

Three patients (patient 1, a 48-years-old male; patient 2, a 65-years-old female; patient 3, a 58-years-old female) received clozapine for schizophrenia at daily doses of 200 mg, 175 mg, and 100 mg, respectively. Patient 1 developed venous thrombosis of lower limbs after 16 years of clozapine treatment, which was improved after thrombolytic therapy. Ten years later, the patient developed shortness of breath after activity and the symptom gradually worsened. Bilateral pulmonary embolism was diagnosed by computed tomographic pulmonary angiography (CTPA), and warfarin and rivaroxaban were given successively for anticoagulation. One year later, the patient developed cardiac insufficiency. The patient was diagnosed as having chronic thromboembolic pulmonary hypertension (pulmonary artery systolic pressure was 86 mmHg), chronic cor pulmonale, and cardiac insufficiency. Warfarin combined with cardiac glycosides, diuretics, and other symptomatic treatments were given. After 3 months of treatments, his dyspnea was markedly relieved and the pulmonary systolic pressure was reduced to 48 mmHg. Patient 2 developed pulmonary embolism after 5 years of clozapine treatment. After thrombolytic therapy, he was given oral warfarin and the drug was discontinued by himself 3 years later. Pulmonary embolism recurred 2 years after the drug withdrawal. Nadroparin calcium and warfarin anticoagulation was given successively and 3 months later, CTPA showed that pulmonary embolism basically disappeared. Patient 3 developed lower-extremity venous thrombosis after 2 years of clozapine treatment, and pulmonary embolism occurred 1 year later, which was improved after anticoagulation, diuretics, and other treatments. Three years later, the patient stopped warfarin by herself, and 10 months later, her pulmonary embolism recurred. Low-molecular-weight heparin sodium as bridge therapy to warfarin was given. Three months later, CTPA showed that pulmonary artery thrombosis basically disappeared.

Objective To investigate the auditory features in patients with severe obstructive sleep apnea hy-popnea syndrome(OSAHS) and the effects of continuous positive airway pressure (CPAP) on auditory functions . Methods Pure tone audiometry thresholds ,auditory brainstem responses (ABR) and distortion product otoacoustic emissions(DPOAE) were performed in three groups with 12 observed objects in each group ,which were the OS-AHS group(before and after treatment of CPAP) ,the simple snoring group and the normal control group .Results In the OSAHS group ,the high frequency auditory thresholds(at 8000 Hz) were greatly higher and the amplitudes of DPOAE reduced ;the detection rates of DPOAE were obviously declined .The peak latencies of Ⅰ ,Ⅲ and Ⅴ , and interpeak latencies of Ⅲ - Ⅴ andⅠ - Ⅴ were longer than those of in the other two groups .The differences were statistically significant(P<0 .05) .The differences of the interpeak latencies of Ⅰ - Ⅲ ,common pure tone au-ditory thresholds (125～4000 Hz) and the thresholds of Ⅴ -wave reaction in the OSAHS group did not change sig-nificantly compared with the other two groups(P>0 .05) .The amplitudes and the detection rates of DPOAEs (0 .5～8 kHz) increased after treatment with CPAP .The differences were statistically significant except the amplitudes of 500 ,750 and 1500 Hz (P<0 .05) .Pure tone audiometry and ABRs did not changed significantly after treatment with CPAP (P> 0 .05) .Conclusion The auditory functions of patients diagnosed with severe OSAHS were im-paired .Treatments with CPAP can partly improve the patients' auditory functions .

Objective To explore the diagnosis and treatment of empyema in children. Method The clinical data of empyema in 49 children were reviewed and analyzed. Results In the 49 cases (25 males and 24 females) aged 4.7±3.4 years, the common symptoms were fever, shortness of breath and coughing. There were 11 cases of positive blood culture, 17 cases of positive pleural fluid culture, 3 cases of positive blood and pleural fluid culture. Streptococcus pneumoniae was the most common pathogenic bacteria. All 49 patients were given systemic antibiotics and closed thoracic drainage. In addition, 26 cases were treated with urokinase and intrapleural fibrinolytic therapy and 6 cases were treated surgically. The prognosis was good and there was no death. Conclusion Pneumococcal infection is most common in children with empyema. Systemic antibiotics plus closed thoracic drainage and urokinase are effective, and some require surgical treatment.