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]To explore the micro-ecological mechanism of soil amendment combined with Trichoderma solution in resolving the replant obstacles of Atractylodes macrocephala through studying their effects on the microbial community structure in the rhizosphere soil.[Methods]In pot experiment and field experiment,different soil amendments and Trichoderma inoculants were applied to Atractylodes macrocephala,the survival rate,physiochemical properties of soil and microbial community were detected,as well as analysis of the microenvironmental changes in the rhizosphere.[Results]The number of leaves and survival rate were significantly increased after the application of lime(mainly composed of calcium oxide)and mixed bacterial solution;the activity of soil-urease(S-UE),soil-phosphatase(S-NP),solid-β-glucosidase(S-β-GC),soil-catalase(S-CAT)in the rhizosphere were also increased,indicating that the replant obstacle was alleviated.Meanwhile,the rhizosphere bacteria and fungi were the highest.The sequencing results showed that the bacteria in the rhizosphere soil after the application of lime and mixed bacterial solution were mainly composed of Gemmatimonadetes,Verrucomicrobia,Firmicutes,Actinobacteria,while the fungi were mainly composed of Ascomycetes,Mortierella,Basidiomycetes and Chytridiomycota,after the application of lime and mixed bacterial solution,the proportion of Fusarium decreased,and the proportion of Penicillium increased.[Conclusion]The combination of lime as a soil amendment and Trichoderma can effectively improve the replant disorder of Atractylodes macrocephala and promote the growth of Atractylodes macrocephala,which may be by improving the structure of the microbial communities in the rhizosphere,increasing the abundance of biocontrol bacteria and reducing the abundance of pathogenic bacteria.

Objective:To analyze the fail mode of neoadjuvant therapy combined with surgery for locally advanced esophageal squamous cell carcinoma (ESCC) after long-term follow-up.Methods:Clinical data of consecutive 238 patients with locally advanced resectable ESCC who underwent neoadjuvant therapy combined with surgery in Zhejiang Cancer Hospital from September 2012 to October 2019 were retrospectively analyzed. The failure mode in the whole cohort was analyzed after long-term follow-up. The overall survival (OS) and disease free survival (DFS) rates were analyzed by Kaplan-Meier method. Survival differences were determined by log-rank test.Results:The pathological complete response (pCR) rate was 42.0% in 238 patients. After a median follow-up of 46.1 months, tumor progression occurred in 96 patients (40.3%), including 25 patients (10.5%) with local recurrence, 61 patients (25.6%) with distant metastases, and 10 patients (4.2%) with simultaneous local recurrence and distant metastases. The median OS and DFS were 64.7 months and 49.9 months. And the 3-, 5-, and 7-year OS and DFS rates were 70.0%, 52.8%, 36.4% and 63.5%, 42.5%, and 30.0%, respectively. The 3-, 5-, and 7-year locoregional recurrence-free survival rates and distant metastasis-free survival rates were 86.0%, 71.4%, 61.2% and 70.6%, 55.9%, 43.0%. Compared with non-pCR patients, the overall progression rate and distant metastasis rate of pCR patients were lower (26.0% vs. 50.7%, 16.0% vs. 32.6%, both P<0.05). And the 3-, 5-, and 7-year OS (83.0% vs. 60.2%, 69.7% vs. 41.7%, 50.4% vs. 27.7%, all P<0.001) and DFS rates (80.4% vs. 51.4%, 63.9% vs. 31.2%, 45.9% vs. 20.3%, all P<0.001) were significantly better in pCR patients. Conclusions:Distant metastasis is the main failure mode of patients with locally advanced ESCC after neoadjuvant therapy. Patients with postoperative pCR can achieve better long-term survival.

Objective:To analyze the failure patterns and survival after stereotactic body radiotherapy (SBRT) in patients with T 1-2N 0M 0 non-small cell lung carcinoma (NSCLC). Methods:Clinical data of early-stage NSCLC patients who received SBRT at Zhejiang Cancer Hospital from January 2012 to September 2018 were retrospectively analyzed. The primary observed endpoint was the pattern of disease progression, which was divided into intra-field recurrence, regional lymph node recurrence and distant metastasis. Overall survival (OS) and progression-free survival (PFS) were calculated by Kaplan-Meier method. Univariate analysis was conducted by log-rank test, and multivariate analysis was performed by Cox's model.Results:A total of 147 patients with 156 lesions were included. The median follow-up time was 44.0 months (16.5-95.5 months). A total of 57 patients (38.8%) progressed: 14 patients (24.5%) had recurrence with the 1-, 3-, and 5-year local recurrence rates of 2.0%, 10.9%, and 14.3%, respectively; 36 patients (63.2%) had Distant metastasis with the 1-, 3- and 5-year distant metastasis rates of 12.2%, 22.4% and 28.6%, respectively; and 7 patients (12.3%) had recurrence complicated with distant metastasis. The 3-, 5- and 7-year OS rates were 80.5%, 64.2% and 49.9% for all patients, respectively. The median OS was 78.4 months. The 3-, 5- and 7-year PFS rates were 64.8%,49.5% and 41.5%, with a median PFS of 57.9 months (95% CI: 42.3-73.5 months). Univariate and multivariate analyses showed that biologically equivalent dose and age were the factors affecting the efficacy of SBRT (both P<0.05). Conclusion:Distant metastasis is the main failure pattern in patients with T 1-2N 0M 0 NSCLC after SBRT. High-risk population should be selected for further systematic treatment to improve the efficacy.

Objective:To compare the efficacy of stereotactic body radiotherapy(SBRT) and surgery in treating intrapulmonary recurrence of non-small cell lung cancer (NSCLC) after radical surgery.Methods:A retrospective analysis was conducted on NSCLC patients, who underwent radical surgery at the Cancer Hospital Affiliated to University of Chinese Academy of Sciences from November 2012 to December 2018 and then received SBRT or secondary surgery because of postoperative intrapulmonary recurrence. The survival rates of these patients were calculated using the Kaplan-Meier method. The comparison between the two groups was made using the Log-rank method, and the univariate and multivariate analysis was made using the Cox regression method.Results:Among 62 eligible patients, 33 received SBRT and 29 received secondary surgery, and they were divided into the SBRT group and the surgery group accordingly. For the SBRT and surgery groups, the median follow-up time was 45.8 months and 37.4 months, the 3-year locoregional control rate (LRCR) 79.8% and 90.2%, respectively ( P > 0.05), the progression-free-survival (PFS) 58.5% and 42.3%, respectively ( P >0.05), and the overall survival (OS) 78.0% and 85.5%, respectively ( P >0.05). The multivariate analysis suggested that treatment method, Charlson comorbidity index (CCI), and adjuvant drug therapy were independent prognostic factors for PFS ( P = 0.027, 0.013, 0.001). Conclusions:The efficacy of SBRT and surgery is comparable for patients with intrapulmonary recurrence of NSCLC after radical surgery.

Objective    To investigate the feasibility and safety of non-intubation anesthesia in thoracic surgery. Methods    From September 2017 to December 2019, 296 patients were operated at department of thoracic surgery in our hospital. There were 167 males and 129 females with an average age of 50.69±12.95 years, ranging from 16 to 76 years. The patients were divided into two groups according to whether they were intubated: 150 patients were in a non-intubation group, including 83 males and 67 females with an average age of 49.91±13.59 years, ranging from 16 to 76 years, and 146 patients were in an intubation group including 84 males and 62 females with an average age of 51.49±12.26 years, ranging from 16 to 74 years. Intraoperative data, postoperative recovery, inflammatory response of the two groups were compared. Results    There was no statistical difference between the two groups in operation time, blood loss, the lowest oxygen saturation or other indicators (P>0.05). But the highest partial pressure of carbon dioxide of the non-intubation group was higher than that of the intubation group (P=0.012). The non-intubation group was superior to the intubation group in postoperative recovery and inflammatory response (P<0.05). Conclusion    The non-intubation anesthesia is safe and maneuverable in thoracic surgery, and it has some advantages in accelerating postoperative rehabilitation.

OBJECTIVES: Patients with classical type 1 diabetes mellitus (T1DM) require lifelong dependence on exogenous insulin therapy due to pancreatic beta-cell destruction and absolute insulin deficiency. T1DM accounts for about 90% of children with diabetes in China, with a rapid increase in incidence and a younger-age trend. Epidemiological studies have shown that the overall glycated haemoglobin (HbA1c) and compliance rate are low in Chinese children with T1DM. Optimal glucose control is the key for diabetes treatment, and maintaining blood glucose within the target range can prevent or delay chronic vascular complications in patients with T1DM. Therefore, this study aims to investigate the glycemic control of children with T1DM from Hunan and Henan Province with flash glucose monitoring system (FGMS), and to explore factors associated with glycemic variability. METHODS: A total of 215 children with T1DM under 14 years old were enrolled continuously in 16 hospitals from August 2017 to August 2020. All subjects wore a FGMS device to collect glucose data. Correlation of HbA1c, duration of diabetes, or glucose scan rates with glycemic variability was analyzed. Glucose variability was compared according to the duration of diabetes, HbA1c, glucose scan rates and insulin schema. RESULTS: HbA1c and duration of diabetes were positively correlated with mean blood glucose, standard deviation of glucose, mean amplitude of glucose excursions (MAGE), and coefficient of variation (CV) of glucose (all P<0.01). The glucose scan rates during FGMS wearing was significantly positively correlated with time in range (TIR) (P=0.001) and negatively correlated with MAGE and mean duration of hypoglycemia (all P<0.01). Children with duration ≤1 year had lower time below range (TBR) and MAGE when compared with those with duration >1 year (all P<0.05). TIR and TBR in patients with HbA1c ≤7.5% were higher (TIR: 65% vs 45%, TBR: 5% vs 4%, P<0.05), MAGE was lower (7.0 mmol/L vs 9.4 mmol/L, P<0.001) than those in HbA1c >7.5% group. Compared to the multiple daily insulin injections group, TIR was higher (60% vs 52%, P=0.006), MAGE was lower (P=0.006) in the continuous subcutaneous insulin infusion group. HbA1c was lower in the high scan rates (≥14 times/d) group (7.4% vs 8.0%, P=0.046), TIR was significantly higher (58% vs 47%, P<0.001), and MAGE was lower (P<0.001) than those in the low scan rate (<14 times/d) group. CONCLUSIONS The overall glycemic control of T1DM patients under 14 years old in Hunan and Henan Province is under a high risk of hypoglycemia and great glycemic variability. Shorter duration of diabetes, targeted HbA1c, higher glucose scan rates, and CSII are associated with less glycemic variability.
Adolescent ; Blood Glucose ; Blood Glucose Self-Monitoring ; Child ; Diabetes Mellitus, Type 1/drug therapy* ; Glucose ; Glycated Hemoglobin A/analysis* ; Humans ; Hypoglycemia/prevention & control* ; Hypoglycemic Agents/therapeutic use* ; Insulin/therapeutic use*

Objective:To evaluate the 5-year survival outcome of patients with unresectable locally advanced non-small cell lung cancer (NSCLC) treated with Endostar in combination with platinum-based concurrent chemoradiotherapy.Methods:From March 2009 to June 2015, 115 patients with the unresectable locally advanced NSCLC from two prospective studies[Clinical trials 2009-2012(ClinicalTrials.gov NCT01894) and 2012-2015(ClinicalTrials.gov, NCT01733589)] were treated with Endostar in combination with platinum-based concurrent chemoradiotherapy. A total dose of 60-66 Gy was delivered in 30-33 fractions. Endostar was given 1 week prior to the beginning of radiotherapy, and repeated fortnightly during the concurrent chemoradiotherapy. After long-term follow up, survival outcome was evaluated in 104 patients treated with radiation dose of ≥60 Gy. Kaplan-Meier method was used for survival analysis. Univariate survival analysis was performed using the log-rank test.Results:Of 104 eligible patients, 60.6% of them had squamous carcinoma and 65.4% were classified in stage Ⅲ B. All the patients received ≥2 cycles of Endostar and 93.3% of them received 4 cycles of Endostar. The median follow-up time was 68.3 months. The median overall survival (OS) and median progression-free survival (PFS) were 31.3 and 13.9 months, respectively. The 3-year and 5-year OS were 45.6% and 35.7%, respectively. The 3-year and 5-year PFS were 27.1% and 24.9%, respectively. Univariate analysis indicated that sex, ECOG, pathological type, clinical stage, radiotherapy technique, chemotherapy regimen, chemotherapy cycle and cycle of Endostar use were not associated with OS. Late radiation injury occurred in 14.4% of patients, and no grade 4-5 late injury was observed. Conclusion:Patients with unresectable locally advanced NSCLC treated with Endostar fortnightly in combination with platinum-based concurrent chemoradiotherapy achieve better OS than historical data with tolerable toxicities.

Objective:To investigate the clinical efficacy of integrated steel plate system combined with Kirschner wire internal fixation in the treatment of Lisfranc injury.Methods:Data of 30 cases with Lisfranc injury who were admitted from January 2010 to December 2018, including 22 males and 8 females were retrospectively analyzed. The age ranged from 22 to 58 years, with an average age of 44.5 years. All of them were closed injuries, including 8 cases involving metatarsal tarsal base fracture, and 2 cases with compression fracture of dice. Classification of Lisfranc joint injury: 6 cases of injury of the inner column alone, 10 cases of injury of the inner column and the middle column, 4 cases of injury of the middle column and the outer column, 10 cases of injury of the three columns. Cause of injury: traffic injury in 12 cases, machine injury in 10 cases, fall injury in 8 cases. The time from injury to operation was 2-7 d, with an average of 5 d. After the improvement of soft tissue conditions, all patients were treated with open reduction and internal fixation using integrated plate system combined with Kirschner wire, followed up by regular post-operative imaging examination, and the therapeutic effect was evaluated by the American Association of Foot and Ankle Surgery (AOFAS) midfoot score.Results:Thirty patients were followed up for 12-30 months (mean 24 months), during which no soft tissue complications such as wound infection and skin necrosis were observed. Average postoperative healing was observed at 12 weeks (10-16 weeks) for them who combined with fracture. At the latest follow-up, the AOFAS midfoot score was 65-95 points (mean 85 points). The midfoot function scores of the 30 patients were: excellent in 15 cases, good in 10, fair in 3, poor in 2. The excellent and good rate was 83.3% (25/30). One patient showed low toxicity and red skin 8 months after the operation. The integrated steel plate system was removed and the skin healed smoothly after the operation. One year after surgery, 10 patients requested removal of the internal fixation. None of the patients had the complication of plate, screw and Kirschner wire fracture. Two patients with three-column injury developed traumatic arthritis and walking pain 12 and 18 months after surgery, respectively, and then underwent metatarsal tarsal joint fusion. The postoperative pain disappeared.Conclusion:The integrated steel plate system combined with Kirschner wire internal fixation for the treatment of Lisfranc injury is simple, can avoid joint redislocation and articular cartilage reinjury, is a safe and effective method for the treatment of Lisfranc injury.

Objective:To explore the repair of fingertip defects with transplantation of different types of free perforator flaps pedicled with the superficial palmar branch of radial artery (SPBRA).Methods:A retrospective analysis was carried out of the clinical data of 46 fingers from 38 cases [28 males and 10 females, aged 17-54 years with a mean age at (38.5±15.5) years] with tissue defects of fingertips that were repaired with free perforator flaps based on SPBRA, between January, 2013 and December, 2018. The soft tissue defects were 1.5 cm ×3.5 cm to 2.5 cm×5.5 cm. Among them, 8 cases were repaired with bilateral free SPBRA perforator flaps. Thirteen flaps carried long palmar tendon. Thirty flaps carried radial nerve and the other 16 flaps without. The size of flaps was 1.6 cm×4.0 cm- 2.8 cm×6.0 cm. Donor sites were all closed directly. Monthly postoperative follow-up was conducted. All the evalua- tion indexes of flap were measured and recorded. Instructed patients to do wrist and finger joint exercises.Results:All 46 flaps survived. No vascular crisis happened and all skin grafts survived in donor sites. There was 0.5 cm×0.3 cm of distal flap necrosis in 1 case and healed by dress changing. Thirty-eight cases had followed-up for 6 to 24 months. The flaps were soft and elastic, and colours were near to normal. There was no bulkiness. Sensory function re- covered well and TPD was 5.0-8.5 mm. The function and appearance of the finger were good. According to the Oper- ative Hand Surgery Function Evaluation of Flap after 6 months, the result was excellent in 42 cases, good in 3 cases, fair in 1 case, with 97.83% of excellent and good rate.Conclusion:Using different types of free tissue perforator flap based on SPBRA can repair fingertip defect, and reconstruct the defect of digital artery, nerve or tendon in one stage. The operation was simple and easy to do, and can achieved good results with high survival rates and good function recovery.