Objective:To investigate the effects of the Epley and Semont procedures with varying lateral angles of the head on posterior semicircular canal benign paroxysmal positional vertigo （PC-BPPV）. Methods:A total of 115 patients with unilateral PC-BPPV were randomly divided into five groups: Epley group, Semont group, Semont+10° group, Semont+20° group, and Semont+30° group, with 23 patients in each group. Corresponding reduction treatments were performed. Results:The total effective rates for the Epley group, Semont group, Semont+10° group, Semont+20° group, and Semont+30° group were 95.7% （22/23）, 4.3% （1/23）, 30.4% （7/23）, 52.2% （12/23）, and 87.0% （20/23） respectively. The inefficiencies were 4.3% （1/23）, 95.7% （22/23）, 69.6% （16/23）, 47.8% （11/23）, and 13.0% （3/23）. Statistically significant differences were observed in the total effective rates among the five groups （χ²=54.11, P<0.01）. The total effective rates in the Semont group, Semont+10° group, and Semont+20° group were significantly different from that of the Epley group （P<0.01）, while no statistically significant difference was found between the Semont+30° group and the Epley group （P= 0.608>0.012 5）. Conclusion:Among the four Semont methods with different lateral lying angles, the total effective rate of reduction treatment increased with the elevation of the lateral lying angle on the affected side. The efficacy of the Semont+30° group in treating PC-BPPV was not significantly different from the Epley group's reduction effect, which was markedly superior to that of the other four Semont methods at different angles. Therefore, the Semont+30° reduction technique is recommended for the treatment of PC-BPPV.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Benign Paroxysmal Positional Vertigo/therapy* ; Head ; Posture ; Semicircular Canals/physiopathology* ; Treatment Outcome

Objective:To more accurately evaluate the function of the otolith organ and its conduction pathway of pilots by collecting the vestibular evoked myogenic potentials (VEMPs) corrected by electromyogram (EMG) in healthy military pilots and comparing bilateral amplitude, amplitude asymmetry ratio and other relevant parameters with and without EMG rectification.Methods:One hundred (200 ears) healthy male active duty military pilots were selected as study subjects, with an average age of (26.86±6.54) years old. The cervical vestibular-evoked myogenic potential (cVEMP) and ocular vestibular-evoked myogenic potential (oVEMP) induced by air conduction acoustic stimulation were performed to the subjects in sitting position. Sound was delivered through inserted earphones, with the stimulus being tone burst at 97 dB nHL. The P1 latency, N1 latency, P1-N1 wave interval latency, and the P1-N1 amplitude and amplitude asymmetry ratio of VEMPs were recorded before and after the correction of EMG and those were compared and analyzed.Results:The evoked rate of VEMPs was 100%. The latency of P1 and N1, P1-N1 interval of cVEMP in these pilots were (15.58±1.29), (26.12±1.91), and (10.54±1.49) ms. The latency of N1 and P1, P1-N1 interval of oVEMP in these pilots were (11.96±0.92), (16.92±1.06), and (4.96±0.75) ms. The difference of VEMPs amplitude before and after EMG correction was statistically significant ( Z=-17.30, -17.30, both P<0.001). The difference of amplitude asymmetry ratio of cVEMP before and after correction was statistically significant ( Z=-2.91, P=0.004), but the difference of amplitude asymmetry ratio of oVEMP before and after correction was not statistically significant ( P>0.05). Conclusions:This research sets up the normal range of VEMPs corrected by EMG in military pilots and provides a more accurate reference for medical selection of flying cadets and functional evaluation of the otolith organ and its conduction pathway.

Objective To sinicize the long and short forms of the English version of the visually induced mo-tion sickness susceptibility questionnaire(VIMSSQ)and to test the validity and reliability of the Chinese version of the questionnaire among college students.Methods The Chinese version of the VIMSSQ was sinicized using Brislin's translation model,the translated scale was cross-culturally adapted through expert consultation.At last,the Chinese version of the questionnaire survey was conducted among 757 college students,and 80 college students were selected to fill out the simulator sickness questionnaire(SSQ)at the same time to do a correlation analysis in order to verify the predictive efficacy of the scale,and the reliability and validity results of the scale were analyzed to form the Chinese version of the VIMSSQ.Results The total Cronbach's alpha coefficient of the long form question-naire was 0.94,and the alpha coefficients of the five factors were 0.85,0.85,0.85,0.84,and 0.83 respectively.The total retest reliability was 0.79,and the retest reliabilities of the five factors were 0.73,0.77,0.76,0.66,and 0.62 respectively.The split-half reliability was 0.84.The total Cronbach's alpha coefficient of the short form ques-tionnaire was 0.83,and the retest reliability was 0.81,and the split-half reliability was 0.77.The item-level con-tent validity index(I-CVI)for the long and short forms and the average scale-level content validity(scale-level con-tent validity index/average,S-CVI/Ave)were both 1.VIMSSQ scores for both the long and short forms were sig-nificantly correlated with the SSQ,with r=0.76(P＜0.001)between the long form and the SSQ,and with r=0.77(P＜0.001)between the short form and the SSQ.Conclusion The Chinese version of the VIMSSQ has good reliability and validity among college students,and can be used as a measurement tool to evaluate college students'susceptibility to visually induced motion sickness.

Objective:To investigate the correlation factors of complete clinical response in idiopathic inflammatory myopathies(IIMs)patients receiving conventional treatment.Methods:Patients diagnosed with IIMs hospitalized in Peking University People's Hospital from January 2000 to June 2023 were in-cluded.The correlation factors of complete clinical response to conventional treatment were identified by analyzing the clinical characteristics,laboratory features,peripheral blood lymphocytes,immunological indicators,and therapeutic drugs.Results:Among the 635 patients included,518 patients finished the follow-up,with an average time of 36.8 months.The total complete clinical response rate of IIMs was 50.0％(259/518).The complete clinical response rate of dermatomyositis(DM),anti-synthetase syn-drome(ASS)and immune-mediated necrotizing myopathy(IMNM)were 53.5％,48.9％and 39.0％,respectively.Fever(P=0.002)and rapid progressive interstitial lung disease(RP-ILD)(P=0.014)were observed much more frequently in non-complete clinical response group than in complete clinical re-sponse group.The aspartate transaminase(AST),lactate dehydrogenase(LDH),D-dimer,erythrocyte sedimentation rate(ESR),C-reaction protein(CRP)and serum ferritin were significantly higher in non-complete clinical response group as compared with complete clinical response group.As for the treat-ment,the percentage of glucocorticoid received and intravenous immunoglobin(IVIG)were significantly higher in non-complete clinical response group than in complete clinical response group.Risk factor analysis showed that IMNM subtype(P=0.007),interstitial lung disease(ILD)(P=0.001),eleva-ted AST(P=0.012),elevated serum ferritin(P=0.016)and decreased count of CD4+T cells in peripheral blood(P=0.004)might be the risk factors for IIMs non-complete clinical response.Conclu-sion:The total complete clinical response rate of IIMs is low,especially for IMNM subtype.More effec-tive intervention should be administered to patients with ILD,elevated AST,elevated serum ferritin or decreased count of CD4+T cells at disease onset.

Objective:To more accurately evaluate the function of the otolith organ and its conduction pathway of pilots by collecting the vestibular evoked myogenic potentials (VEMPs) corrected by electromyogram (EMG) in healthy military pilots and comparing bilateral amplitude, amplitude asymmetry ratio and other relevant parameters with and without EMG rectification.Methods:One hundred (200 ears) healthy male active duty military pilots were selected as study subjects, with an average age of (26.86±6.54) years old. The cervical vestibular-evoked myogenic potential (cVEMP) and ocular vestibular-evoked myogenic potential (oVEMP) induced by air conduction acoustic stimulation were performed to the subjects in sitting position. Sound was delivered through inserted earphones, with the stimulus being tone burst at 97 dB nHL. The P1 latency, N1 latency, P1-N1 wave interval latency, and the P1-N1 amplitude and amplitude asymmetry ratio of VEMPs were recorded before and after the correction of EMG and those were compared and analyzed.Results:The evoked rate of VEMPs was 100%. The latency of P1 and N1, P1-N1 interval of cVEMP in these pilots were (15.58±1.29), (26.12±1.91), and (10.54±1.49) ms. The latency of N1 and P1, P1-N1 interval of oVEMP in these pilots were (11.96±0.92), (16.92±1.06), and (4.96±0.75) ms. The difference of VEMPs amplitude before and after EMG correction was statistically significant ( Z=-17.30, -17.30, both P<0.001). The difference of amplitude asymmetry ratio of cVEMP before and after correction was statistically significant ( Z=-2.91, P=0.004), but the difference of amplitude asymmetry ratio of oVEMP before and after correction was not statistically significant ( P>0.05). Conclusions:This research sets up the normal range of VEMPs corrected by EMG in military pilots and provides a more accurate reference for medical selection of flying cadets and functional evaluation of the otolith organ and its conduction pathway.

Objective:To investigate the role of conjunctival impression cytology in the diagnosis of Sj?gren's syndrome (SS) and the immunological factors influencing conjunctival lesions.Methods:A total of 57 patients complaining about dry eye were collected, including 38 patients with primary Sj?gren's syndrome (pSS) and 19 patients with non-SS. Conjunctival impression cytology tests were performed for all patients, and they were scored by the Nelson method. Thirty-one patients with SS underwent serological tests such as autoantibodies, immunoglobulins, and complement. The correlation between the relevant data was compared using the t test and the rank sum test. Results:The Nelson grade ≥2 is the positive cut-off value for the diagnosis of SS. The sensitivity was 68.4%, and the specificity was 89.5%, and the area under the receiver operating characteristic curve (ROC) was 0.767. In patients with SS, there was statistical correlation between the results of conjunctival impression cytology and antinuclear antibody (ANA) ( χ2=4.664, P=0.031), anti-SSA antibody ( χ2=8.58, P<0.01), anti-SSB antibody ( χ2=6.13, P=0.013), anti-SSA-52 antibody ( χ2=6.48, P=0.011), immunoglobulin (Ig)G ( t=-4.344, P<0.01) and rheumatoid factor (RF) ( U=25.0, P<0.01). Conclusion:Con-junctival impression cytology has certain value in the diagnosis of SS and can be used to evaluate conjunctival lesions in SS. Serum ANA, anti-SSA antibody, anti-SSB antibody, anti-SSA-52 antibody, IgG, and RF levels are significantly associated with the degree of conjunctival lesions, and can be considered as an indirect evidence of conjunctival involvement in SS.

Objective To compare the etiology of vertigo patients between flying personnel group and ordinary group and to provide evidence for the accurate diagnosis of vertigo or dizziness and the aeromedical assessment. Methods One thousand and sixteen ordinary vertigo patients,who were diagnosed by the Vertigo Center of Former Air Force General Hospital of PLA in the period from January 2017 to April 2018,were assigned to ordinary group.One hundred and fifty-three vertigo inpatients and outpatients of flying personnel,who were diagnosed by the hospital in the period from September 1984 to Augut 2018,were selected as flying personnel group.The etiological stratification analysis was conducted upon the gender and age in ordinary group.The disease spectrum was analyzed in flying personnel group.The etiological characteristics were compared between two groups. Results①In ordinary group,1 265 etiological factors were found in 1 016 vertigo patients (some of them had 2 or more etiologies).The top 7 etiological factors of the vertigo patients in ordinary group were benign paroxysmal positional vertigo (BPPV)that took 32.73 % (414/1 2 6 5 ),vestibular migraine (VM),31.46% (398/1 265 ),hypertension 12.96% (164/1 265 ),diabetes 4.03% (51/1 265 ), Meniere,s disease(MD)3.87%(49/1 265),vestibular neuritis(VN)3.87%(49/1 265),and cerebral infarction 3.24%(41/1 265).1.43%(1 7/1 265)cases were unable to categorize clearly.②The patients of ordinary group,aged from 8 to 89 yrs,were categorized to <21 yrs,21-40 yrs,41-60 yrs and >60 yrs subgroups.The top 4 etiological factors for <21 yrs group were VM (43.37%),BPPV (15.79%),VN(10.53%),and sudden deafness with vertigo(10.53%);for 21-40 yrs group were VM (46.86%),BPPV(29.7 1 %),VN (5 .86%),and hypertension (4.60%);for 41-60 yrs group were BPPV(35 .1 7%),VM(3 1 .54%),hypertension(12.30%),and MD(4.73%);and for >60 yrs group were BPPV (3 1 .28%),VM (20.5 9%),hypertension (20.05%),and cerebral infraction (6.68%). Detection rate of the top 7 etiological factors had significant difference in different age groups except VN and MD (χ2=1 3 .45-5 3 .1 6 ,P<0.0 1 ).③The etiological stratification by gender showed that the ratio of male to female was 1.00︰1.57.Detection rate of VM in female was higher than that in male. Detection rate of hypertension,MD and VN in male was higher than that in female,the difference was satistically significant (χ2=3.87-8.93,P<0.05).④In flying personnel group,184 etiological factors were found in 153 vertigo patients (some of them had 2 or more etiologies).Top 3 etiological factors were motion sickness(MS)that took 1 1 .41%(21/184),VN that took 10.32%(1 9/184)and MD that took 9.78% (18/184 ).The dizziness or vertigo with no accurate etiology took 57.61 % (106/184 ).⑤The BPPV and VM detection rate in flying personnel group were less than those in ordinary group (χ2=78.34,78.7 7 ,P<0.0 1 ).The dizziness or vertigo cases with no accurate etiology and MS,MD, VN and alternobaric vertigo cetection rate in flying personnel group were higher than those in ordinary group (χ2=6 .02-645 .5 9 ,P<0.05 ). Conclusions The causes of vertigo/dizziness are complex and diverse and patients may have more than one etiology.The etiological stratification analysis for patients is conducive to accurate diagnosis and treatment.Studying the difference of etiology between flying personnel and ordinary people will contribute to exploring the pathogenesis and prevention measures in flight environment and providing proof for aeromedical assessment.

Objective To compare the various parameters of vestibular autorotation test (VAT) between the Chinese military pilots and ordinary personnel. Methods Thirty-four pilots who had passed the physical examination,including the caloric test and video-head impulse test of vestibular functions,were selected as subj ects.They received vestibular autorotation test by VAT98-3 detector that manufactured by the WSR Company of United States.The frequencies,horizontal and vertical gains and phase shift of the vestibular ocular reflex (VOR)in VAT were analyzed and compared with the corresponding parameters of 100 ordinary personnel stored in the detector. Results By comparing the measured values of 34 military pilots with 100 ordinary personnel the significant differences were found on the horizontal gain at 2.0,2.3,4.7,5.1,5.5,5.9 Hz,the horizontal phase shift at 2.0,3.9,4.7,5.1 Hz,the vertical gain at 5.5,5.9 Hz and the vertical phase shift at 2.0,3.9, 5.1 Hz (t=2.106-18.647,P<0.05).The vertical phase shifts on the frequencies of 2.3,2.7,3.1, 3.5,4.3 Hz and the asymmetry showed insignificant difference as compared with the reference values of ordinary personnel. Conclusions The military pilots show higher gains on the 2.0 and 2 .3 Hz VAT than the ordinary personnel and the gain is close to 1 ,but on 4.7 ,5 .1 ,5 .5 ,and 5 .9 Hz.The differences should be considered in the evaluation of vestibular functions for military pilots.The aeromedical assessment should take the norm of military pilot as the reference.

Objective To obtain the detection method and reference constants of cervical vestibular evoked myogenic potential (cVEMP ) and ocular vestibular evoked myogenic potential (oVEMP)in military pilots and to provide reference basis for evaluating pilot,s otolith function in aeromedical assessment. Methods Thirty-three (6 6 ears )healthy male active duty fighter pilots were selected as study subj ects.They were between the age of 25 to 42 years old (30.3 ± 4.8 years). cVEMP and oVEMP were induced unilaterally by means of 500 Hz air-conducted tone burst stimulation.The VEMPs threshold of each ear was examined and the reference range of amplitude, latency and wave interval were calculated. Results The composite wave of cVEMP and oVEMP was observed in 33 pilots.The evoked rate was 100%.The latency of p13 and n23,p13-n23 interval,peak-to-peak p1 3-n2 3 amplitude and asymmetry ratio of cVEMP in these pilots were (1 3 .94 ± 1 .5 9 )ms, (20.95±1.59)ms,(7.01 ± 1.34)ms,(224.70 ±66.15)μV,(0.1 1±0.10).The amplitude had slight difference between the ears while the cVEMP p1 3 latency,n23 latency and wave interval showed very small difference between the ears.The latency of N1 and P1 ,N1-P1 interval,peak-to-peak N1-P1 amplitude and asymmetry ratio of oVEMP in the pilots was (1 1 .1 ± 0.9 9 )ms,(1 5 .41 ± 0.85 )ms, (4.31±0.84)ms,(2.23±0.59)μV,(0.10 ±0.08)respectively.The amplitude of oVEMP,latency of N1 ,latency and wave interval of P1 showed unobvious difference between left and right ears. Conclusions This study has established the conventional detection methods and constants of cVEMP and oVEMP of military pilots and these provide the obj ective reference to evaluate the functions of utricle and sacculus in aeromedical assessment.

Objective To compare the etiology of vertigo patients between flying personnel group and ordinary group and to provide evidence for the accurate diagnosis of vertigo or dizziness and the aeromedical assessment. Methods One thousand and sixteen ordinary vertigo patients,who were diagnosed by the Vertigo Center of Former Air Force General Hospital of PLA in the period from January 2017 to April 2018,were assigned to ordinary group.One hundred and fifty-three vertigo inpatients and outpatients of flying personnel,who were diagnosed by the hospital in the period from September 1984 to Augut 2018,were selected as flying personnel group.The etiological stratification analysis was conducted upon the gender and age in ordinary group.The disease spectrum was analyzed in flying personnel group.The etiological characteristics were compared between two groups. Results①In ordinary group,1 265 etiological factors were found in 1 016 vertigo patients (some of them had 2 or more etiologies).The top 7 etiological factors of the vertigo patients in ordinary group were benign paroxysmal positional vertigo (BPPV)that took 32.73 % (414/1 2 6 5 ),vestibular migraine (VM),31.46% (398/1 265 ),hypertension 12.96% (164/1 265 ),diabetes 4.03% (51/1 265 ), Meniere,s disease(MD)3.87%(49/1 265),vestibular neuritis(VN)3.87%(49/1 265),and cerebral infarction 3.24%(41/1 265).1.43%(1 7/1 265)cases were unable to categorize clearly.②The patients of ordinary group,aged from 8 to 89 yrs,were categorized to <21 yrs,21-40 yrs,41-60 yrs and >60 yrs subgroups.The top 4 etiological factors for <21 yrs group were VM (43.37%),BPPV (15.79%),VN(10.53%),and sudden deafness with vertigo(10.53%);for 21-40 yrs group were VM (46.86%),BPPV(29.7 1 %),VN (5 .86%),and hypertension (4.60%);for 41-60 yrs group were BPPV(35 .1 7%),VM(3 1 .54%),hypertension(12.30%),and MD(4.73%);and for >60 yrs group were BPPV (3 1 .28%),VM (20.5 9%),hypertension (20.05%),and cerebral infraction (6.68%). Detection rate of the top 7 etiological factors had significant difference in different age groups except VN and MD (χ2=1 3 .45-5 3 .1 6 ,P<0.0 1 ).③The etiological stratification by gender showed that the ratio of male to female was 1.00︰1.57.Detection rate of VM in female was higher than that in male. Detection rate of hypertension,MD and VN in male was higher than that in female,the difference was satistically significant (χ2=3.87-8.93,P<0.05).④In flying personnel group,184 etiological factors were found in 153 vertigo patients (some of them had 2 or more etiologies).Top 3 etiological factors were motion sickness(MS)that took 1 1 .41%(21/184),VN that took 10.32%(1 9/184)and MD that took 9.78% (18/184 ).The dizziness or vertigo with no accurate etiology took 57.61 % (106/184 ).⑤The BPPV and VM detection rate in flying personnel group were less than those in ordinary group (χ2=78.34,78.7 7 ,P<0.0 1 ).The dizziness or vertigo cases with no accurate etiology and MS,MD, VN and alternobaric vertigo cetection rate in flying personnel group were higher than those in ordinary group (χ2=6 .02-645 .5 9 ,P<0.05 ). Conclusions The causes of vertigo/dizziness are complex and diverse and patients may have more than one etiology.The etiological stratification analysis for patients is conducive to accurate diagnosis and treatment.Studying the difference of etiology between flying personnel and ordinary people will contribute to exploring the pathogenesis and prevention measures in flight environment and providing proof for aeromedical assessment.