Comparison of the Application Value of Transthoracic Echocardiography in Diagnosing Patent Foramen Ovale Under Different States of Stimulation: A Retrospective Study.

OBJECTIVE: This study aims to evaluate the application value of contrast-enhanced transthoracic echocardiography (cTEE) in the diagnosis of patent foramen ovale (PFO) under different states of stimulation, with the goal of enhancing the accuracy and efficiency of PFO diagnosis. METHODS: This research consecutively enrolled patients suspected of having PFO from October 2022 to February 2024, presenting primary clinical symptoms such as unexplained syncope, headache, dizziness, and stroke. Patients underwent standard transthoracic echocardiography (TTE) and cTEE under three different states of stimulation (resting state, coughing, and Valsalva maneuver). Based on the presence of microbubbles in the left heart and their initial appearance time, patients were classified into PFO and control groups, with further diagnostic confirmation via transesophageal echocardiography (TEE) or foramen ovale closure procedures. RESULTS: The study results revealed significant differences between the PFO and control groups regarding age (p = 0.034) and headache symptoms (p = 0.001). In the PFO group, TTE showed a higher positivity rate both at rest and during coughing, highlighting the association between PFO and specific clinical symptoms. The number of microbubbles observed during TTE increased significantly under various stimulation states, particularly during the Valsalva maneuver (p < 0.05). This increase became more pronounced as the duration of the maneuver was extended, underscoring the differential response of PFO patients under varied physiological testing conditions, especially during prolonged Valsalva maneuvers. CONCLUSION: The study confirms the significant value of cTEE in diagnosing PFO under different stimulation states, particularly emphasizing the application of the Valsalva maneuver to significantly improve the sensitivity and specificity of PFO detection. Thus, incorporating cTEE examinations under various stimulation states holds significant clinical importance for enhancing the accuracy and efficiency of PFO diagnosis.

A rare case report of bilateral vestibulopathy due to otosyphilis.

RATIONALE: Bilateral vestibulopathy is an important cause of imbalance. There are multiple etiologies of bilateral vestibulopathy (BVP), but reports of BVP due to otosyphilis are rare. PATIENT CONCERNS: A 39-year-old male was referred to our medical center due to vertigo, persistent dizziness and gait disturbance for 2 months. DIAGNOSES: Bilateral vestibulopathy due to otosyphilis was considered in this case, as confirmed through analyses of vestibular function, laboratory tests, and penicillin treatment. INTERVENTIONS: The patient was was treated with a high dose of penicillin G (24 × 106 IU/d) for 14 days. OUTCOMES: The patient's symptoms had improved greatly following treatment, with dizziness and gait disturbance having completely resolved at 3 months following hospital discharge. LESSONS: Bilateral vestibulopathy should be considered when evaluating patients with acute or subacute persistent dizziness. Clinicians should also be aware of the potential for otosyphilis among patients who report BVP.

Validation of biomarkers and immunotherapy in head and neck squamous cell carcinoma using bioinformatics and Mendelian randomization.

BACKGROUND: To promote carcinogenesis through diverse molecular pathways involving dysregulation of gene expression and abnormalities. METHODS: We employed Mendelian randomization (MR) to uncover causal relationships between genetic factors and HNSCC. We used the Inverse Variance Weighted (IVW) method as the primary MR analysis, and validated the results through complementary approaches like MR-Egger regression, weighted median, and mode analyses. RESULTS: Our analysis identified 2210 genes that are differentially expressed in head and neck cancer (HNSCC) compared to normal tissues. Within the protein interaction network, the genes IL1B, CXCL8, CXCL1, and CCL2 stood out as central hubs. Further investigation revealed that these key genes are involved in important biological processes like skin development, wound healing, and fat metabolism. Notably, our Mendelian randomization analysis provided evidence for a causal relationship between the expression of the IL1B gene and the development of HNSCC. CONCLUSIONS: Our analysis identified 5 key genes - IL1B, CXCL8, CXCL1, CCL2, and IL1B - that show significant changes in expression in head and neck cancer. These genes could serve as important new biomarkers to help diagnose this disease and track how it progresses over time. Importantly, these genes are involved in regulating the immune system, suggesting that the body's immune response plays a critical role in head and neck cancer. This provides new avenues for future research to better understand the complex gene expression patterns underlying this type of cancer. Further investigation of these key genes and their regulatory networks could lead to important insights and potential new treatment approaches.

Molecular Mediators of Estrogen Reduction-induced Otolith Shedding.

OBJECTIVE: Previous study suggested that estradiol (E2) plays an important role in otolith shedding by regulating the expression of otoconin 90 (OC90). The purpose of this article is to provide further data on the effect and mechanism of E2 on the morphology of otolith. METHODS: The rats receiving bilateral ovariectomy (OVX) were used as animal models. Co-immunoprecipitation was used to observe the relationship between estrogen receptor (ER) and estrogen-related receptor α (ERRα). The morphology of otolith was observed under the scanning electron microscopy. Western blotting and qPCR were used for quantitative analysis of the roles of ER and ERRα in regulating OC90 expression. RESULTS: The looser otoliths were observed in rats receiving bilateral OVX, which could be reversed by supplementation with E2. The level of ERRα was decreased in bilateral OVX rats. ER and ERRα interacted with each other on the regulation of the expression of OC90. CONCLUSION: Our results suggest ER and ERRα are both important downstream receptors involved in regulating OC90 expression in utricles of rats, and ERRα probably functions by interacting with ER. This provides evidence for the mechanism of otolith shedding. And it may be significant for future studies of targeted prevention and therapies for benign paroxysmal positional vertigo.

Memantine ameliorates cognitive deficit in AD mice via enhancement of entorhinal-CA1 projection.

BACKGROUND: Memantine, a low- to moderate-affinity uncompetitive N-methyl-D-aspartate receptor antagonist, has been shown to improve cognitive functions in animal models of Alzheimer's disease (AD). Here we treated APP/PS1 AD mice with a therapeutic dose of memantine (20 mg/kg/day) and examined its underlying mechanisms in ameliorating cognitive defects. METHODS: Using behavioral, electrophysiological, optogenetic and morphology approaches to explore how memantine delay the pathogenesis of AD. RESULTS: Memantine significantly improved the acquisition in Morris water maze (MWM) in APP/PS1 mice without affecting the speed of swimming. Furthermore, memantine enhanced EC to CA1 synaptic neurotransmission and promoted dendritic spine regeneration of EC neurons that projected to CA1. CONCLUSIONS: Our study reveals the underlying mechanism of memantine in the treatment of AD mice.

Purkinje cells of vestibulocerebellum play an important role in acute vestibular migraine.

Both the central and peripheral vestibular systems contribute to the pathogenesis of vestibular migraine, although the mechanism of vestibular migraine remains unclear. To assess central and peripheral vestibular system damage in vestibular migraine and explore the underlying mechanism we performed vestibular function tests, including a caloric test, spontaneous, gaze-evoked nystagmus and saccadic, pursuit and optokinetic eye movements to evaluate the involvement of the central and/or peripheral vestibular system in subjects with acute vestibular migraine episodes. It was found that both peripheral and central vestibular systems were damaged in vestibular migraine patients with the number of subjects with central deficits significantly larger than those with peripheral deficits. The cerebellum, especially the vestibule cerebellum, is the most important part of the central vestibular system. Locculus and paraflocculus are essential structures of cerebellar circuitry controlling vestibular nuclei and oculomotor functions and are anatomically linked with the "migraine pathway". Purkinje cells are the only source of cerebellar output and it innervates inhibitory action. Therefore, we examined the effect of the electric stimulation on paraflocculus Purkinje cells by using a specific electrical stimulation of trigeminal ganglia to induce a migraine-like phenomenon in animal part. Moreover, electrophysiological recordings showed that parafloccular Purkinje cells of rats underwent electrical stimulation of trigeminal ganglia resulted in partial inhibition. It is suggested that Purkinje cells in the paraflocculus could be inhibited after the occurrence of migraine episode and this inhibition may be an important factor leading to vestibular migraine.

Estradiol deficiency is a risk factor for idiopathic benign paroxysmal positional vertigo in postmenopausal female patients.

OBJECTIVES/HYPOTHESIS: Although it is generally considered that benign paroxysmal positional vertigo (BPPV) is associated with changes in female sex hormone levels, no direct data have been reported until now. The purpose of this article was to provide direct data showing the distinct relationship between female sex hormone fluctuations and BPPV in postmenopausal female patients. STUDY DESIGN: Prospective analysis in humans and basic research in animals. METHODS: Blood samples were analyzed to determine the levels of estradiol, progesterone, follicle-stimulating hormone, and luteinizing hormone in 50- to 80-year-old postmenopausal female patients newly diagnosed with idiopathic BPPV based on history compatible with BPPV and positive provocative maneuvers. Animal models of bilateral ovariectomy and female sex hormone replacement therapy were used to further confirm the relationship between BPPV and female sex hormone levels by determining the expression levels of otoconin 90, the protein suggested as essential in the dislocation of otoconia. RESULTS: Statistically significant differences between the estradiol level of BPPV patients and the control group were found (P < .001). Moreover, in bilateral ovariectomy in rats, 17ß-estradiol replacement reversed the decrease of otoconin 90 levels. CONCLUSIONS: Our results suggest that estradiol deficiency may be an important risk factor for idiopathic benign paroxysmal positional vertigo in postmenopausal female patients. LEVEL OF EVIDENCE: NA. Laryngoscope, 128:948-953, 2018.

[Difference of cervical vestibular evoked myogenic potentials in different audition stage of Ménière disease].

OBJECTIVE: Our goal was to find whether inreversible function damage of saccule was exist and correlated in Meniere's patients with different audition. METHOD: Senenty-nine patients with unilateral Meniere's disease, who visited the Dizziness Diagnosis and Treatment Centre of the Second Military Medical University from January to July in 2015 were included. They were grouped as slightly audition damage group (41 cases), mildly-severely audition damage group(38 cases). Meanwhile 20 normal controls underwent the research. The cervical vestibular evoked myogenic potentials were conducted in symptom free period. RESULT: There was no significant difference of the C-VEMP inducing rate between slightly audition damage group and normal control group. While a statistically difference showed between mildly-severely audition damage group and normal control group or slightly audition damage group. P1, N1 latency had no statistically difference between three groups. The P1-N1 amplitude and asymmetric ratio had no difference between slightly audition damage group and normal control group, but had a statistically difference between mildly-severely audition damage group and slightly audition damage group, normal control group. CONCLUSION: The function of saccule in Meniere's patients decreased with the aggravation of audition damage.

Computed basis functions for finite element analysis based on tomographic data.

In bioelectromagnetics, the structures in which the electromagnetic field is to be computed are sometimes defined by a fine grid of voxels (3-D cells) whose tissue types are obtained by tomography. A novel finite element method is proposed for such cases. A simple, regular mesh of cube elements is constructed, each containing the same, integer number of voxels. There may be several different tissues present within an element, but this is accommodated by computing element basis functions that approximately respect the interface conditions between different tissues. Results are presented for a test model of 128 (3) voxels, consisting of nested dielectric cubes, driven by specified charges. The electrostatic potential computed with the new method agrees well with that of a conventional finite element code: the rms difference along the sample line is 1.5% of the highest voltage. Results are also presented for the potential due to a current dipole placed in a brain model of 181 × 217 × 181 voxels, derived from MRI data. The new method gives potentials that are different to those obtained by treating each voxel as an element by 1% of the peak voltage, yet the global finite element matrix has a dimension which is more than 50 times smaller.