Objective To analyze the characteristics of nystagmus during the Dix-Hallpike and Roll tests in patients with benign paroxysmal positional vertigo (BPPV) using three-dimensional videonystagmography (3D-VNG), in order to to optimize diagnostic and therapeutic strategies of BPPV. Methods A retrospective analysis was conducted on 68 patients with posterior semicircular canal (PSC)-BPPV and 26 patients with horizontal semicircular canal (HSC)-BPPV. Nystagmus data obtained from 3D-VNG were reviewed for all patients, with a focus on the eye movement components during the Dix-Hallpike test in PSC-BPPV patients and the Roll test in HSC-BPPV patients. The direction and reversal rates of the vertical, horizontal, and torsional components were recorded and analyzed. Results All PSC-BPPV patients exhibited highly consistent three-dimensional nystagmus characteristics during the Dix-Hallpike test: vertical nystagmus was uniformly upward, torsional nystagmus was predominantly clockwise in left-side BPPV patients (17/23) and counterclockwise in right-side BPPV patients (44/45), while the horizontal component was mostly directed contralaterally (50/68); upon transitioning from the head-hanging to the sit-up position, vertical nystagmus components in all patients reversed, and torsional and horizontal nystagmus components reversed in approximately 50.0% or more patients. Among HSC-BPPV patients, right-side BPPV patients all showed right-beating (geotropic) horizontal nystagmus with predominantly upward vertical component (16/19), while most left-side BPPV patients showed left-beating horizontal nystagmus (6/7) with predominantly downward vertical component (6/7). During head rotation toward the healthy side, most (25/26) HSC-BPPV patients exhibited a reversal in the horizontal nystagmus direction, reduced intensity compared to the affected side, with a reversal in vertical components in 3 patients, and atypical torsional components. Conclusions 3D-VNG could precisely quantitative analyze three-dimensional features of nystagmus in BPPV patients, improve diagnostic accuracy in canal and side localization, particularly in PSC-BPPV patients.

OBJECTIVETo analyze the clinical features and genetic cause for a family affected with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).

METHODSClinical manifestations, neuroimaging, and genetic analysis were performed.

RESULTSThe main clinical features have included stroke, emotional disturbance and history of migraine without progressive memory impairment. A positive family history was confirmed. Cranial MRI has revealed multi-infarct lesions and white matter hyperintensity involving bilateral basal ganglia, subcortex and brain stem. All such features were in keeping with the diagnosis of CADASIL. A rare 2182C>T mutation in exon 14 of the NOTCH3 gene was identified in all available cases.

CONCLUSIONBoth clinical and molecular features suggested that the family has been affected with CADASIL.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Migraine Disorders ; genetics ; Receptor, Notch3 ; Receptors, Notch ; genetics

Objective To analysis the MRI features of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), to improve the understanding of MRI manifestations of this disease. Meth?ods The clinical manifestations, neuroimaging analysis and genetic analysis were performed in the CADASIL pedigree proband and his families. Results Five of six cases were confirmed with C2182T mutation on exon 14 of the NOTCH3, of which three cases were diagnosed by MRI. Brain MRI findings included bilateral symmetric distributed confluent lesions in the subcortical and periventricular white matter in the frontal lobe, hypointensity on T1WI and hyperintensity on both T2WI and T2 FLAIR imaging in four cases. The external capsule was involved in three cases, with hyperintensity on T2WI. Subcortical lacunar lesions (SLLs) were shown in three cases. Lacunar infarction in the basal ganglia and thalamus were presented in four cases. T2WI hyperintensity at the brain stem was found in two cases. Cerebral microbleeds were re?vealed in three cases. There was no O’Sullivan sign in all the six cases. Conclusions There is characteristic change of MRI in CADASIL patients, which may play a very important role in screening these cases.

Objective:To explore the clinical value of serum tumor markers ,which are carcino-embryonic antigen (CEA) ,car-bohydrate antigen 19-9 (CA19-9) ,carbohydrate antigen 72-4 (CA72-4) and cytokeratin 19 fragments (CYFRA21-1) ,in early diagnosis and treatment of laryngeal carcinoma .Methods :From January 2012 to June 2013 ,60 patients with laryngeal carcino-ma (case group) were selected ,and 60 corresponding participants in physical examination were also enrolled as healthy controls in this study .The serum contents of CEA ,CA19-9 ,CA72-4 and CYFRA21-1 were measured before and after operation in the two groups .The differences of sensitivity and specificity in detection of laryngeal carcinoma were compared between individual and combined detection of targeted indicators .Results:The serum levels of CEA ,CA19-9 ,CA72-4 and CYFRA21-1 were significantly higher in the study group than those in the control group (P<0 .01) .The serum levels of CEA ,CA19-9 ,CA72-4 and CYFRA21-1 of the study group were significantly higher in pre-operation than those in post-operation ,and the differ-ences were statistically significant (P<0 .01) ,among which CA19-9 showed the highest sensitivity (60 .00% ) ,while CA19-9 and CA72-4 showed the highest specificity (both were 100% ) .ROC curve analysis showed that the area under curve (AUC) of CA19-9 was 0 .987 ,which is significantly higher than those of CEA ,CA72-4 and CYFRA21-1 .The sensitivity of combined de-tection was significantly higher than individual test ,and the differences were statistically significant (P<0 .05) .Conclusions :Detection of serum CEA ,CA19-9 ,CA72-4 and CYFRA21-1 levels can be applied to early diagnosis of laryngeal carcinoma . Combined detection can significantly improve the sensitivity in diagnosis meanwhile maintain the superior specificity .

Objective To compare the clinical results of two different anterior cervical surgical treatment for multi-segmental cervical spondylotic myelopathy (≥3 segments).Methods Twenty-three patients with segmental cervical spondylotic myelopathy,10 cases were treated with anterior cervical discectomy and fusion (ACDF) as ACDF group,13 cases were treated with anterior cervical corpectomy and fusion (ACCF) as ACCF group.The operation time,operative blood loss,JOA scores,neurological improvement rate and the variable of the D value were compared.Results The operation time and operative blood loss in ACDF group was significantly lower than that in ACCF group [(130.0 ±31.5) min vs.(150.0 ±42.5) min,(150.0 ± 120.8) ml vs.(310.0 ± 320.8) ml,P ＜ 0.05].The variable of the D value in ACDF group was significantly higher than that in ACCF group [(3.1 ± 1.4) mm vs.(2.3 ± 0.9) mm,P ＜ 0.05].There was no statistically significant difference in JOA scores,neurological improvement rate between ACDF group and ACCF group.Two cases of cerebrospinal fluid leakage in ACDF group,the oppression and drainage recovery after treatment.One case of 14 d after fistula complications in ACCF group,after patching were cured; 2 cases of titanium mesh shift,follow the fusion.Conclusions Both methods attain good clinical results.ACDF combined with ACCF treatment of multi-segmental cervical spondylotic myelopathy,with shorter operation time,relatively less blood loss,and better restoration of cervical sagittal alignment.

Objective To optimize combined CT pulmonary angiography (CTPA) and renal venography (rCTV) and to evaluate its value for the detection of venous thromboembolism in patients with nephrotic syndrome (NS).Methods Ninety NS patients suspected of venous thromboembolism because of abnormal D-dimer value were included in this prospective study.The first 45 patients were defined as group 1 (protocol 1).These patients underwent CTPA,then rCTV 25 s after CTPA,last inferior vena cava scanning after another 25 s.The following 45 patients as group 2 (protocol 2).These patients underwent CTPA and then inferior vena cava scanning 50 s after CTPA,3 patients in group 2 were excluded because of unavailable CTPA or rCTV.Vessel enhancement of CTPA and rCTV,and radiation doses for two protocols were compared with independent sample student t test.Incidence and distribution of pulmonary embolism and renal vein thrombosis were recorded and compared by using Chi-square test.Results Enhancement values of pulmonary trunk for groups 1 and 2 were (335.5 ± 111.3) and (335.0 ± 76.0) HU,right renal vein were (142.7 ±33.3) and (140.7 ±25.9) HU,left renal vein were (141.6 ±26.4) and (138.8 ±33.6) HU respectively,without any statistical difference (t values were 0.026,0.322 and 0.452,P ＞0.05).Radiation dose to the patients receiving protocol 2 were lower than that of patients receiving protocol 1 [volume CT index,(19.7 ± 4.3) vs (13.6 ± 3.0) mGy; dose length product,(1019.9 ± 878.5) vs (532.0 ± 132.9) mGy · cm; both P ＜0.01].Of 87 NS patients,44 venous thromboembolism events were detected,resulting in the incidence of 50.6％ (44/87),including pulmonary embolism in 19 patients,renal vein thrombosis and pulmonary embolism in 17,renal vein thrombosis in 7,and inferior vena cava in one patient.The detection rate were 48.9％ (22/45) and 52.4％ (22/42),there was no significant difference (x2 =0.106,P =0.745).Conclusion Combined CTPA and rCTV with protocol 2 (CTPA and inferior vena cava phase scanning 50 s after CTPA) is suitable to clinical application and pulmonary embolism is the most common thromboembolism complication in NS patients.

Objective To observe effects of hydroxyethyl starch(130/0.4,voluven)on tissue perfusion and serum TNF-α,IL-6,IL-8 levels in patients with severe acute pancreatitis(SAP).Methods 60 SAP patients with non-operative treatment were randomly divided into voluven group and Ringer's solution group(n =30 per group).In addition to conventional drugs and treatment,of which voluven group daily 15ml/kg intravenously for 5 d;Ringer's solution group daily 20ml/kg intravenously for 5d.Hemodynamic parameters and tissue perfusion indicators were monitored,TN F-α,IL-6,IL-8 levels were examined after treatment 0,12,24,48,96 hours.Results Compared with Ringer solution group,Voluven group therapy high efficiency,faster raise MAP,ScvO2,Phi value,lower HR,Hct(t =2.785,3.126,4.132,3.168,2.218,all P ＜ 0.05).TNFα,IL-6 after 48h treatment,IL-8 after 96h treatment,both groups were significantly decreased,but the voluven group was significantly lower than Ringer's solution group(P ＜ 0.05).Conclusion Voluven could effectively and quickly maintain hemodynamic stability,improve the hemorheological and tissue perfusion,could be more conducive to improving the pancreatic microcirculation,thus inhibiting inflammatory cytokines TNF-α,IL-6,IL-8 release,and had favorable treatment effect on patients with SAP.

Objective To assess the feasibility of using biodegradable poly (lactic-co-glycolic acid) (PLGA) scaffold with controlled release of rhBMP-2 and its effect on the osteogenic activity of MSCs in vitro. Methods The PLGA scaffolds with rhBMP-2 sustained release system were made by combination of porogen-leaching and freeze-drying. The drug release kinetics was measured by enzyme-linked immunosorbent assay (ELISA) in vitro. MSCs were isolated from the bone marrow of human and cultured for 3 passages. Then, MSCs were seeded onto PLGA scaffolds. PLGA scaffolds without rhBMP-2 were used as experimental controls . Scanning electron microscopy(SEM) was used to observe the morphology of MSCs. The cell proliferation was determined by MTT assay. Results The rhBMP-2 was encapsulated into PLGA scaffolds and it was found to be continuously released from the scaffolds. The scaffolds have evident enhancing effect on ectopia osteogenesis. Conclusion PLGA scaffold containing rhBMP-2 is a new promising tissue engineering scaffold.

With the development of modem tumor diagnostic techniques and therapies, the survival rate of malignant tumor has been remarkably increased. With the increase in survival rate of cancer-beating patients, the chance of tumor metastasis is elevated. Minimally invasive treatment provides a new strategy to the therapy of spinal metastatic carcinoma. Its benefits include smaller surgical wound,, higher efficacy and fewer complications, and thus have a broad application prospects in the field of spinal metastatic tumors. In this article, a general re-view is given on minimally invasive treatments of spinal metastatic carcinoma, as well as the latest progress in the field. It was proposed that the united application of the treatment might be a promising hot spot of tumor therapy.

Objective To explore the clinical therapeutic effects in arterial interventional therapy in early osteosarcoma patients.Methods Thirty-eight early osteosarcoma patients received arterial chemoembolization therapies and performed operations.94.7% patients received limb salvage surgeries.Levels of alkaline phosphatase were tested in preoperative and postoperative phases.Results Levels of postoperativealkaline phosphatase[average(191.7±107.0)U/L]were significantly decreased compared with that before interventional therapy[average(1129.1±572.3)U/J.The survival rate in follow-up at 1,3 and 5 years Was97%,79%,50% respectively.The rate of recurrence and metastasis WAg 24%.Conclusions Arterialchemoembolization therapies in patients with early osteosarcoma could improve clinical symptoms effectively,enhance survival rate,relieve recurrence and metastasis,remain affected extremity.The clinical thempeutic effects of iodinated oil were the best among the three embolism materials.