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.

Objective: Comparing the benefit of Abidor, lopinavir/ritonavir and recombinant interferon α-2b triple combination antiviral therapy and lopinavir/ritonavir and interferon dual combination antiviral therapy to hospitalized novel coronavirus pneumonia 2019 in Zhejiang province. Methods: A multi-center prospective study was carried out to compare the effect of triple combination antiviral therapy with dual combination antiviral therapy in 15 medical institutions of Zhejiang Province. All patients were treated with recombinant interferon α-2b (5 million U, 2 times/d) aerosol inhalation. 196 patients were treated with abidol (200 mg, 3 times/d) + lopinavir / ritonavir (2 tablets, 1 time/12 h) as the triple combination antiviral treatment group. 41 patients were treated with lopinavir / ritonavir (2 tablets, 1 time/12 h) as the dual combination antiviral treatment group. The patients who received triple combination antiviral therapy were divided into three groups: within 48 hours, 3-5 days and > 5 days after the symptom onset. To explore the therapeutic effects of triple combination antiviral drugs and dual combination antiviral drugs, as well as triple combination antiviral drugs with different antiviral initiate time. SPSS17.0 software was used to analyze the data. Results: The time of virus nucleic acid turning negative was (12.2 ± 4.7) days in the triple combination antiviral drug group, which was shorter than that in the dual combination antiviral drug group [(15.0 ± 5.0) days] (t = 6.159, P < 0.01 ). The length of hospital stay [12 (9, 17) d] in the triple combination antiviral drug group was also shorter than that in the dual combination antiviral drug group [15 (10, 18) d] (H = 2.073, P < 0.05). Comparing the antiviral treatment which was started within 48 hours, 3-5 days and > 5 days after the symptom onset of triple combination antiviral drug group, the time from the symptom onset to the negative of viral shedding was 13 (10,16.8), 17 (13,22) and 21 (18-24) days respectively (Z = 32.983, P < 0.01), and the time from antiviral therapy to the negative of viral shedding was (11.8±3.9) , (13.5±5.1) and (11.2±4.3) d. The differences among the three groups were statistically significant (Z=32.983 and 6.722, P<0.01 or<0.05). Conclusions The triple combination antiviral therapy of Abidor, Lopinavir/Litonavir and recombinant interferon α-2b showed shorter viral shedding time and hospitalization time compared with the dual combination antiviral therapy. The earlier the time to initiate triple antiviral treatment, the shorter the time of virus shedding.

Objective:To compare the efficacy of the combination of abidol, lopinavir/ritonavir plus recombinant interferon α-2b (rIFNα-2b) and the combination of lopinavir/ritonavir plus rIFNα-2b for patients with COVID-19 in Zhejiang province.Methods:A multicenter prospective study was carried out to compare the efficacy of triple combination antiviral therapy and dual combination antiviral therapy in 15 medical institutions of Zhejiang province during January 22 to February 16, 2020. All patients were treated with rIFNα-2b (5 million U, 2 times/d) aerosol inhalation, in addition 196 patients were treated with abidol (200 mg, 3 times/d) + lopinavir/ritonavir (2 tablets, 1 time/12 h) (triple combination group) and 41 patients were treated with lopinavir/ritonavir (2 tablets, 1 time/12 h) (dual combination group). The patients who received triple combination antiviral therapy were further divided into three subgroups: <48 h, 3-5 d and >5 d according the time from the symptom onset to medication starting. The therapeutic efficacy was compared between triple combination group and dual combination group, and compared among 3 subgroups of patients receiving triple combination antiviral therapy. SPSS 17.0 software was used to analyze the data.Results:The virus nucleic acid-negative conversion time in respiratory tract specimens was (12.2±4.7) d in the triple combination group, which was shorter than that in the dual combination group [(15.0±5.0) d] ( t=6.159, P<0.01). The length of hospital stay in the triple combination group [12.0 (9.0, 17.0) d] was also shorter than that in the dual combination group [15.0 (10.0, 18.0) d] ( H=2.073, P<0.05). Compared with the antiviral treatment which was started within after the symptom onset of in the triple combination group, the time from the symptom onset to the viral negative conversion was 13.0 (10.0, 17.0), 17.0 (13.0, 22.0) and 21.0 (18.0, 24.0) d in subgroups of 48 h, 3-5 d and >5 d, respectively ( Z=32.983, P<0.01), while the time from antiviral therapy to viral negative conversion was (11.8±3.9), (13.5±5.1) and (11.2±4.3) d, respectively( Z=6.722, P<0.05). Conclusions:The triple combination antiviral therapy of abidol, lopinavir/litonavir and rIFNα-2b shows shorter viral shedding time and shorter hospitalization time, compared with the dual combination antiviral therapy; and the earlier starting triple combination antiviral therapy will result in better antiviral efficacy.

Objective To systematically evaluate the effectiveness and safety of interleukin-2 plus cisplatin for treating ma-lignant pleural effusion(MPE)to provide a basis for clinical treatment strategy.Methods CBM,CNKI,VIP,Wanfang,Pubmed, Embase,Cochrane library clinical trial registration database were systematically retrieved.The randomized controlled trial(RCT) quality assessment criteria of Cochrane collaboration network was adopted for including the study quality.The data were extracted by meta analysis.Results (1)Thirty-four RCT involving 2 037 MPE patients were included,the quality of included RCT was ordi-nary;(2)compared with simple cisplatin,the merged RR values and their 95%CI of meta-analysis for ORR,fever,were 1.45 (1.36-1.54),2.37 (1.53 -3.66),respectively,the differences between the two groups were statistically significant(P <0.05 ). The merged RR values and their 95%CI of meta-analysis for leukopenia,myelosuppression and thoracalgia were 0.81 (0.61 -1.07),0.83(0.62-1.11)and 1.04(0.84-1.29)respectively,the differences between two groups were not statistically significant (P >0.05).Conclusion This study indicates that IL-2 plus cisplatin can significantly improve the clinical curative effect in the pa-tients with MPE,but has the adverse reactions of fever,etc.and the quality of included RCT is general.

Objective To observe the effect of electroacupuncture on back three-acupoints ( namely bilateral Dazhu, Fengmen, Feishu) on the protein and mRNA expression of transforming growth factor-beta 1 (TGF-β1) and Smad3 in asthmatic rat airway remodeling model, and to explore its therapeutic efficacy and molecular mechanism. Methods Rat asthma model was established by inhalation of ovalbumin. After sensitization for 6 weeks, rats were killed. And then the airway morphological parameters of rats were measured by image analysis. The protein and mRNA expression of TGF-β1 and Smad3 in lung tissues were detected by immunohistochemistry and real-time quantitative polymerase chain reaction (qRT-PCR) respectively. Results Compared with the blank group, the standardized values of muscle cross-sectional area including airway smooth muscle area (WAm) /perimeter of the basement membrane (Pbm), and bronchial inner wall area (WAi)/Pbm were increased in the model group. The protein and mRNA expression levels of TGF-β1 and Smad3 were also increased in the model group. In electroacupuncture group, the above observation indexes were decreased, and the differences were statistically significant ( P<0.05 compared with the model group). Conclusion The experimental results indicated that back three-acupoint electroacupuncture has an effect on remodeling airway, and one of the mechanisms is probably associated with the regulation of TGF-β1/Smad3 signaling pathway.

OBJECTIVETo investigate the role ofCD4+CD25+ T regulatory (Treg) cells, T helper (Th)17cells and interleukin (IL)-6 in the progression of hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) and determine their value as prognostic markers.

METHODSThe Chinese National Knowledge Infrastructure (CNKI), WanFang, Chinese Scientific Journals (VIP), PubMed, Embase and Web of Science databases were searched for English language case-control studies on the relationship between regulatory T lymphocytes and ACLF.The quality of included studies was assessed using the Newcastle-Ottawa scale. The meta-analysis was designed according to the PICOS approach recommended by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. RevMan software, version 5.1, was used to perform the meta-analysis.

RESULTSNine case-cohort studies were selected for inclusion in the metaanalysis.The results of the meta-analyses showed that the level of CD4+CD25+ Treg cells was not significantly different between patients with HBV-related ACLF and patients with chronic hepatitis B (CHB) (mean difference (MD)=0.59, 95% confidence interval (CI)-1.68, 2.85, P=0.61) nor between patients with HBVrelated ACLF and healthy controls (MD=1.12, 95% CI:-1.42, 3.66, P=0.39). Thus, it appears that ACLF patients do not have a higher level of CD4+CD25+ Treg cells than CHB patients or healthy controls. However, the ACLF patients did appear to have a significantly higher level of Th17 cells than both the CHB patients (MD=1.73, 95% CI:0.21, 3.26, P=0.03) and the healthy controls (MD=1.62, 95% CI:(0.52, 2.72, P=0.004). In addition, the ACLF patients also had significantly higher level than both the CHB patients (MD=11.69, 95%CI:1.98, 21.40, P=0.02) and the healthy controls (MD=13.17, 95% CI:1.38, 24.95, P=0.03).

CONCLUSIONCD4+CD25+ Treg cells may be an important protective factor in the progression and prognosis of HBV-related ACLF, while Thl7 cells and IL-6 may be risk factors for further progression and worsened prognosis.

Acute-On-Chronic Liver Failure ; diagnosis ; immunology ; CD8-Positive T-Lymphocytes ; Case-Control Studies ; Disease Progression ; Hepatitis B virus ; Hepatitis B, Chronic ; complications ; Humans ; Interleukin-6 ; immunology ; Prognosis ; T-Lymphocytes, Regulatory ; immunology ; Th17 Cells ; immunology

Objective To investigate the effect of progesterone pretreatment of focal cerebral ischemic and reperfusion injury (fCIRI) and underlying molecular mechanisms.Methods A single intraperitoneal injection of progesterone (8 mg/kg) given 1 h,48 h and 96 h before fCIRI was established in male Sprague-Dawley rats.The number of survival of neurons in hippocampal CA1 region of the ischemiaside,as well as spatial memory function,was detected on days 3-8 after fCIRI.Extracellular-signalregulated kinase 1/2 phosphorylation (p-ERK1/2) and nuclear translocation of p-ERK1/2 in hippocampal CA1 region were examined using western blot.Results The number of survival of neuronal cells was significantly increased in ischemic groups treated with progesterone at 1 h and 48 h pre-fCIRI (164.3 ± 11.0,218.5 ± 9.1 and 142.7 ± 12.1,F =29.4,P ＜ 0.01) compared with fCIRI group treated with vehicle.Likewise,the escape-latency to reach the hidden-platform recorded in day 5 of Morris water maze test was reduced markedly in fCIRI-treatment groups compared with the vehicle group(10.3 ± 11.1,19.2 ±9.6 and 32.4 ± 14.3 ;F =35.8,P ＜0.01).The level of p-ERK1/2 was elevated notably during 24 h to 48 h postprogesterone by western blot,while restored to the baseline at 96 h post-progesterone.Improved nuclear translocation of p-ERK1/2 was observed from 2 h to 48 h post-progesterone.The progesterone receptor antagonist RU486 blocked the exaltation of either intracellular level or nuclear translocation of p-ERK1/2,which was induced by progesterone.Conclusions The pretreatment with progesterone exerts a neuroprotective effect against the ischemia-induced neuronal death and ameliorates the deficits in spatial memory through enhancing the activation of ERK1/2.The neuroprotection derived from pretreatment with progesterone achieves a time window of not less than 48 h,which is progesterone receptor-mediated ERK1/2 signaling pathway-dependent.

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 evaluate of the efficacy of transcranial electrical stimulation motor evoked potential (TES-MEP)in combination with cortical somatosensory evoked potential (CSEP) monitoring during the anterior or posterior approach spinal surgery for cervical spondylitie myelopathy (CSM).Methods TES-MEP on the bilateral anterior tibial muscle and flexor hallucal brevis and thenar muscles and CSEP on the bilateral posterior tibial nerve and ulnar nerve were observed simultaneously in 135 patients during spinal surgery.Intravenous anesthesia was employed in all the patients.The results of TES-MEP,CSEP and combined monitoring were analyzed statistically.Pre-oporative and post-operative motor and sensory functions of the spinal cord were compared. Result Success rate of TES-MEP,CSEP and the combined monitoring was 87.4%.97.8%and 100%,respectively.Out of 135 patients,nine patients (6.7%) were detected with the positive evoked potentials due to surgical operation.The sensitivity of TES-MEP and CSEP in assessing the spinal cord motor function was 100%and 83.3%,respectively,while that in assessing the spinal cord sensory function was 77.8%and 100%,respectively.The sensitivity and specificity of the combined monitoring was both 100%. Conclusion The successful detection rate and accuracy of the combined monitoring for spinal cord function are apparently higher than that of simple TES-MEP or CSEP.The causes for operative maneuvers evoking a positive evoked potential include complete anterior decompression of the spinal canal,intervertebral bone graft,laminoplasty for OPLL and hematoma compression caused by a failed drainage in a posterior-anterior approach surgery.

Objective To explore the histological changes of the wrist interosseous ligaments after radiofrequency electrothermal shrinkage. Methods Six frozen fresh male adult cadaver wrist ligaments were exploited for the research. The ligaments of the right wrists were treated with radiofrequency electrothermal shrinkage with Arthrocare system, while the ligaments of the left wrists were kept as the normal control. The bone-ligament-hone samples of all the scapholunate (SL) and lunotriquetral (LT) ligaments were prepared, sectioned and then stained with the regular HE staining, toluidine blue staining, Sirius-red staining and immunohistochemistry staining of collagen Ⅲ. The image analysis software was used to compare the staining results. Results The histological structures of SL dorsal ligaments (SL-d) and LT volar ligaments (LT-v) were very similar, and the structures of SL volar ligaments (SL-v) and LT dorsal ligaments (LT-d) were also very similar. The membrane parts of both SL and LT ligaments showed the fibrous cartilage structure. The histological structures of SL-d and LT-v were much less destroyed by the radiofrequency than those of SL-v and LT-d. After radiofrequency electrothermal shrinkage, only the distribution areas of collagen Ⅰ and collagen Ⅲ were significantly changed in the membrane parts of SL and LT ligaments. Conclusion Radiofrequency electrothermal shrinkage treatment can cause minor structural damage to the collagen-dominant ligaments such as SL-d and LT-v, while it can lead to quite severe structural damage to the ligaments containing collagen and lots of loose connective tissue, such as SL-v and LT-d.