[Validation of prognostic value of pathological staging in pathological stage â lung adenocarcinoma].

Objectives: To examine the prognostic significance of WHO classification of lung adenocarcinoma in 2021 in patients with stage Ⅰ pulmonary adenocarcinoma. Methods: The clinical data of 829 patients who underwent surgery from January 2015 to September 2016 at Department of Thoracic Surgery, Zhongshan Hospital of Fudan University and had a postoperative pathologically confirmed diagnosis of stage Ⅰ lung adenocarcinoma were analyzed retrospectively. There were 389 males and 440 females, aged (60±11) years (range: 32 to 90 years), including 570 cases with solid nodules, 259 cases with ground-glass nodule. The survival curve was plotted using the Kaplan-Meier method and compared by the Log-rank test. The Cox proportional hazards regression model was used to identify prognosis factors on overall survival (OS), and recurrence-free survival (RFS). Results: Among the 829 patients, 470 cases were acinar predominant type, 165 cases were papillary predominant type, 90 cases were lepidic predominant type, 62 cases were solid predominant type, and 42 cases were micropapillary type. Compared with the solid nodule group, the proportion of patients with lepidic predominant type was higher in the ground glass nodule group (20.5%(53/259) vs. 6.5%(37/570), χ²=35.922, P<0.01), while the proportion of micropapillary (1.2%(3/259) vs. 6.8%(39/570), χ²=11.961, P<0.01) and solid predominant type (1.5%(4/259) vs. 10.2%(58/570), χ²=19.172, P<0.01) was lower. Survival analysis of 829 patients showed that patients with the lepidic predominant had the best prognosis, those with acinar and papillary predominant were worse, and patients with solid and micropapillary predominant had the worst prognosis (all P<0.01). The independent prognosis factors associated with postoperative recurrence were T2 stage (HR=1.631, 95%CI: 1.030 to 2.583, P=0.037), pathologic subtype (P=0.036), presence of a micropapillary component (HR=1.764, 95%CI: 1.143 to 2.722, P=0.010), and solid nodule in CT picture (HR=18.690, 95%CI: 7.587 to 46.043, P<0.01). Subgroup analysis showed that in both solid and ground-glass nodules, the presence of a solid-type component was a prognosis factor for overall survival, and the presence of a micropapillary component was a prognosis factor for recurrence-free survival. Conclusions: The presence of micropapillary and solid component, in addition to histological subtype, are prognosis factors for patients with stage Ⅰ lung adenocarcinoma. For patients with stage Ⅰ lung adenocarcinoma, the combination of pathological subtype and T-stage is more valuable and reliable for prognosis.

[Tap-hammer elicited vestibular-evoked myogenic potentials system: its design and preliminary application].

Objective: The aim of this study was to design and perform "Tap-hammer"system that can be used to elicit vestibular evoked myogenic potentials (VEMP) in normal adults and to report the preliminary results of this system. Methods: A triggered Tap-hammer was designed, made and connected with an electric recording system, to form as a system for Tap-VEMP recording. Twenty healthy adult volunteers (7 males and 13 females, aged 20 to 37 years, 40 ears in total) were recruited for air-conducted sound VEMP (ACS-VEMP) and Tap-VEMP examinations. Waveforms and parameters of both VEMPs were recorded and analyzed. SPSS 22.0 software was used for statistical analysis. Results: The response rates of ACS-, Tap-ocular VEMP (oVEMP) and ACS-, Tap-cervical VEMP (cVEMP) were both 100% (40/40). The mean±SD n1 latency, p1 latency, n1-p1 interval, amplitude, and asymmetry ratio (AR%) of Tap-oVEMP were (9.80±2.51)ms, (13.90±3.26)ms, (4.09±1.43)ms, (16.43±9.61)µV, (22.68±17.35)% respectively. The mean±SD p1 latency, n1 latency, p1-n1 interval, amplitude, and asymmetry ratio (AR%) of Tap-cVEMP were (13.26±2.07)ms, (21.84±2.89)ms, (8.58±2.10)ms, (457.65±274.94)µV, (20.42±13.46)% respectively. Both n1 latency and p1 latency of Tap-VEMPs were shorter than those in ACS-VEMPs (P<0.05). No statistical difference could be found between the two stimulation methods in the parameters of n1-p1 interval, amplitude, and asymmetry ratio(P>0.05). Conclusion: The Tap-hammer system can elicit VEMP responses in healthy young people. This system can be used as an alternative stimulation method for bone conduction VEMP.

Clinical significance of tumor mutation burden and DNA damage repair in advanced stage non-small cell lung cancer patients.

OBJECTIVE: This study aimed to investigate the impact of tumor mutational burden (TMB) and DNA damage repair (DDR) gene alteration on overall survival (OS) in advanced non-small cell lung cancer (NSCLC) patients. PATIENTS AND METHODS: A DNA library of cancer cells from 67 NSCLC patients in stages III-IV was constructed for next-generation sequencing (NGS). Geneseeq422 probes were used for hybridization enrichment. The target-enriched library was sequenced on HiSeqNGS platforms, and we analyzed the relevant signaling pathways. Then, we correlated the OS of the patients with TMB and DDR mutations. RESULTS: Many significant alterations were found, including in the EGFR, p53, KRAS, RB1, ERBB2, NF1, DNMT3A, ALK, MYC, PIK3CA, ROS1, BRAF, ARID1A, PTEN, CDKN2A, and FGF19 genes. We also identified many mutations in the genes relevant to the DDR pathway. Interestingly, we found that the TMB of patients with DDR gene mutations was dramatically higher than that in the DDR wild-type (WT). Univariable analysis showed that DNMT3A, RB1, DDR pathway-related gene mutations, and TMB were critical factors for the effects on OS. Multivariable analysis confirmed that DNMT3A and mutations in the DDR pathway-related genes were important for predicting OS. CONCLUSIONS: Multiple mutations in the genes of the DDR pathway caused higher TMB levels, which resulted in longer OS. By contrast, OS was significantly longer in patients with non-DNMT3A mutations than in those with DNMT3A variants. DNMT3A alteration in NSCLC patients led to poor outcomes.

[Transbronchial lung cryobiopsy in diffuse lung disease: a pathological analysis of 173 cases].

Objective: To evaluate the value of transbronchial lung cryobiopsy (TBCB) in pathological diagnosis for diffuse lung disease. Methods: The clinicopathological data of 173 patients from the first affiliated hospital of Guangzhou medical university between Jaunary 2017 and June 2019 with transbronchial lung cryobiopsy of diffuse lung disease were retrospectively analyzed and summarized with review. Among 173 cases, TBCB and conventional transbronchial lung biopsy (TBLB) were performed in 54 patients. The size of biopsy samples and diagnostic yield were compared. Results: Among 173 cases, the diagnostic yield was 85.54% (148/173) , 160 (92.49%) cases provided definite diagnosis and valuable pathological results, according to age, sex, occupation, past history, contact history, smoking history, laboratory serology and imaging findings. Among 160 cases, there were 72 cases of known etiology (45.00%), 27 cases of idiopathic interstitial pneumonia (16.88%), 7 cases of granulomatous lesions (4.38%) and 54 cases of other types (33.75%). With TBCB and TBLB in 54 patients, the specimens sizes of TBCB and TBLB were (3.3±1.3) mm(2) and (1.0±0.3) mm(2) respectively (t'=12.67 P<0.01) . The diagnostic yields of TBCB and TBLB were 81.48% (44/54) and 42.59% (23/54) respectively (χ(2)=17.33, P<0.01) . The diagnostic yields of TBCB and TBLB for interstitial lung diseases were 48.15% (26/54) and 5.56% (3/54) respectively (χ(2)=24.94, P<0.01) . However, the diagnostic yields of TBCB and TBLB for the other diffuse lung disease except interstitial lung diseases were 33.33% (18/54) and 37.04% (20/54) respectively, with no significant difference (χ(2)=0.1624, P=0.687). Conclusion: Compared with TBLB, TBCB has obvious advantages and application value in the diagnosis of diffuse pulmonary diseases, especially interstitial pulmonary diseases.

Long-term comparison study of philtral ridge morphology with two different techniques of philtral reconstruction.

Cleft lip and/or cleft palate are the most common congenital craniofacial anomalies. Philtral ridge morphology is an important aesthetic component of unilateral cleft lip (UCL) repair. To this end, we have developed two techniques of philtral ridge reconstruction: (1) asymmetric mattress muscle sutures, and (2) overlapping mattress muscle sutures. The objective of this retrospective cohort study was to compare their outcomes in UCL repairs. Group I patients (n=30) underwent UCL repair before August 2003, including philtral ridge reconstruction by asymmetric mattress muscle sutures. Group II patients (n=30) underwent UCL repair after August 2003, including philtral ridge reconstruction by overlapping mattress muscle sutures. Philtral morphology was evaluated by ultrasonographic and three-dimensional photographic measurements, examining cleft side philtral projection and philtral ridge symmetry. These demonstrated that group II patients had better philtral column symmetry and projection on the cleft side when compared to group I. Overlapping mattress muscle sutures produced better philtral morphology in UCL repairs than asymmetric mattress muscle sutures.

[Evaluation of vestibular evoked myogenic potential, caloric test and cochlear electrogram in the diagnosis of Meniere's disease].

Objective:The aim of this study is to evaluate the diagnostic value of vestibular-evoked myogenic potential （cVEMP and oVEMP）, caloric test, and cochlear electrogram （EcochG） in patients with Meniere's disease （MD） and non-Meniere's disease. Method:Sixty-four patients （64 ears） with Unilateral Meniere's disease were enrolled in the study group （MD group）, and 127 cases（254 ears） of non-Meniere's disease patients as non-MD group, including vertigo migraine in 40 cases, benign paroxysmal positional vertigo in 48 cases, benign recurrent vertigo in 13 cases, vestibular paroxysmia in 3 cases, vestibular neuritis in 5 cases and other undiagnosed vertigo in 18 cases. Both group undertake cVEMP, oVEMP, caloric test and ECochG. Use Medcale software to draw ROC curve of ECochG and calculate the area under curve（AUC）, Jordan index and optimal diagnostic cut-off points. Make the cut-off point as the point of -SP/AP, then evaluate the sensitivity, specificity, positive predictive value（PPV）, negative predictive value（NPV） and diagnostic accuracy of cVEMP, oVEMP, caloric test and ECochG in MD group and non-MD group. Result:The AUC of ECochG ROC curve was 0.74, the Jordan index was 0.47 and the cut-off point was 0.4. The sensitivity and specificity of cVEMP（62% and 68%）, oVEMP（61% and 53%） and caloric test（53% and 57%） were all below ECochG（65% and 78%）. The positive predictive value and of ECochG was the highest（61.9%）, the negative predictive value of cVEMP was highest（87.5%）. The diagnostic accuracy of ECochG was highest（74%）, followed with cVEMP（67%）, oVEMP（55%） and caloric test（56%）. Conclusion:Compared with the vestibular function tests, the sensitivity, specificity, diagnostic accuracy and NPV were all higher in ECochG, and the diagnostic benefit can be maximized when -SP/AP value>0.4. So the value of single vestibular function examination in the diagnosis of Meniere's disease is limited. The diagnosis of MD still requires a comprehensive evaluation in combination with medical history, audiological tests and vestibular function examinations.

[Preliminary observation of galvanic vestibular stimulation-vestibular evoked myogenic potentials in healthy young people].

Objective: To introduce the method of galvanic vestibular stimulation-vestibular evoked myogenic potentials (GVS-VEMP) as well as to observe and analyze the parameters and elicited rate of GVS-cVEMP and GVS-oVEMP in healthy young people in China. Methods: Twenty six normal young subjects were recruited for conventional examinations of GVS-VEMP. The subjects were 21-37 years old, average age was (25.8±3.7) years old, including 13 males and 13 females. The galvanic stimulation intensity of 3 mA/1 ms was used to evoke cVEMP and oVEMP on the sternocleidomastoid and inferior extraocular muscles respectively, and the intensity of stimulus was decreased until the response disappeared, the threshold, latency, amplitude, interval phase and interaural amplitude ratio(IAR) were calculated. SPSS18.0 software was used for statistical analysis. Results: All subjects were elicited normal GVS-cVEMP and GVS-oVEMP under 3 mA/1 ms, the elicited rate was 100%. The threshold of GVS-cVEMP was (1.18±0.47) mA, p1 latency was (10.43±1.54) ms, n1 latency was (17.91±1.20) ms, the amplitude was (102.47±56.77) uV and IAR was (0.26±0.20). The threshold of GVS-oVEMP was (1.12±0.50) mA, n1 latency was (8.46±1.05) ms, p1 latency was (11.83±1.27) ms, the amplitude was (9.12±6.82) uV and IAR was (0.25±0.20). In terms of gender and lateral comparison, only the GVS-oVEMP amplitude was higher for male than for female, which had significant statistical difference (P<0.05), and there was no statistical difference in the other parameters between GVS-cVEMP and GVS-oVEMP. Conclusion: GVS-cVEMP and GVS-oVEMP could be elicited in healthy youth population, and the parameters could provide reference for subsequent vestibular function evaluation.

[Functional vestibulo-ocular reflex test].

Summary In recent years, the diagnosis and treatment of vertigo and balance disorders have become a hot topic of multidisciplinary attention. The evaluation method of vestibular function has also been improved, providing important evidence for the diagnosis and differential diagnosis of vertigo related diseases. Vestibular rehabilitation is one of the important methods for the treatment of vertigo diseases. Assessing vestibular rehabilitation status in these patients is also the key for guiding treatment. The assessment of vestibulo-ocular reflex (VOR) function is an important part of vestibular functional testing. Currently, the dynamic visual acuity test (DVAT), gaze stabilization test (GST), and head impulse test (HIT) can be used to evaluate the VOR function. Based on these tests, a method of vestibular function testing has emerged internationally: functional head impulse test (fHIT). The article based on the review of relevant literatures and the principle of VOR detection and HIT detection to introduce the test methods and results interpretation of fHIT, DVAT and GST to provide reference for clinical diagnosis and treatment.

[Clinical diagnosis and treatment of eosinophilic otitis media].

Objective: Eosinophilic otitis media(EOM) is a rare,refractory otitis media.This article summarizes the clinical manifestations and diagnosis and treatment experience of EOM. Method: Retrospective analysis of 3 cases of EOM patients with medical history, clinical manifestations, and related auxiliary examinations.Discuss the EOM clinical features,diagnosis and treatment in conjunction with the literature. Result: The clinical features of 3 patients with EOM were summarized as: a large amount of yellowish white secretions or polyps formation, obvious itching symptoms; polyp biopsy showed a large amount of eosinophil infiltration;topical use of hormone-containing ear drops treatment is effective.Conclusion: EOM is a new type of chronic otitis media.It has characteristic clinical manifestations,a comprehensive treatment based on glucocorticoids should be given..

[Suppression head impulse paradigm in healthy adult population: the values and features of the parameters].

Objective: To observe the parameters of the results of suppression head impulse paradigm (SHIMP) in healthy adults, and to provide reference for evaluating vestibular oculomotor reflex function in patients with peripheral vertigo. Methods: Fifty healthy adults, 22 males and 28 females, aged from 23-65 years, with an average age of (38.5±11.6) years, were recruited from January to March 2018. Parameters provided by the video head pulse software included the gains, the latency and the peak velocity of saccades, and comparison was made with head impulse paradigm (HIMP). Results: All subjects were elicited anti-compensatory saccades in SHIMP. The normal values of left and right gains were 1.02 and 1.10 in HIMP, and 0.93 and 1.01 in SHIMP respectively. The left and right saccades latency were (201.1± 50.8)ms and (187.0± 42.9)ms, and the peak saccadic velocity were (302.7±58.5)°/s and (291.5±46.5)°/s in SHIMP; there were small but significant difference between two sides about gains in HIMP and SHIMP, as well as latency in SHIMP(P<0.05); there were small but significant difference between HIMP and SHIMP about gains in ipsilateral(P<0.01); there were no significant difference between two sides about peak saccadic velocity in SHIMP(P>0.05). Conclusions: SHIMP can be used for the examination of vestibular oculomotor reflex function in adult population. It is easy to be operated and is convenient for clinical application. Combined with head pulse test, the function of the semicircular canal can be evaluated together.

[Establishment of experimental method for bone-conducted vibration elicited vestibular-evoked myogenic potentials in healthy guinea pigs].

Objective: To estabilsh animal methods of bone-conducted vibration elicited cervical vestibular-evoked myogenic potentials (BCV-cVEMP) and ocular vestibular-evoked myogenic potentials (BCV-oVEMP) in healthy guinea pigs. Methods: Eleven healthy (250-350 g) and awake guinea pigs were selected and undertake conventional BCV-cVEMP and BCV-oVEMP examination in prone position. Parameters of waveforms were cauculated. Results: The BCV-cVEMP and BCV-oVEMP both could be elicited in 100% (22/22) in guinea pigs respectively, threshold was (85.5±10.8)dB SPL and (90.7±10.6)dB SPL for cVEMP and oVEMP; n1 latency was (4.5±1.3)ms and (4.3±1.5)ms for cVEMP and oVEMP; p1 latency was (5.8±1.4)ms and (5.6±1.7)ms respectively; n1-p1 interwave latency was (1.2±0.4)ms for cVEMP and (1.4±0.6)ms for oVEMP, amplitude was (21.5±17.3)µV and (24.0±16.3)µV respectively. Conclusion: Both BCV-cVEMP and BCV-oVEMP can be successfully elicited in healthy guinea pigs.

[The application value of suppression head impulse paradigm in vestibular neuritis].

Objective:To study the parameters of the suppression head impulse paradigm of vestibular neuritis and explore the application value of suppression head impulse paradigm in vestibular neuritis.Method:Twenty patients with vestibular neuritis in our outpatient clinic were selected. The HIMP and SHIMP gain of unilateral vestibular neuritis patients were detected by video pulse detector.Result:All patients with HIMP examination in the affected side can elicit compensatory saccade, the healthy side with no compensatory saccade; SHIMP examination in the healthy side can elicit anti-compensatory saccade, the affected side without compensatory saccade or weak saccades. The HIMP gain of affected side and healthy side of patients with vestibular neuritis were 0.56±0.15 and 0.99±0.13 respectively, and the SHIMP gain of affected side and healthy side of patients with vestibular neuritis were 0.45±0.13 and 0.9±0.13 respectively. The gain of the affected side and the healthy side of HIMP was larger than those of SHIMP, and the difference was statistically significant (P<0.05).The differences of HIMP and SHIMP gain between the affected side and the healthy side were statistically significant (P<0.01).Conclusion:Video head impulse test combined with suppression head impulse paradigm can evaluate vestibular function injury and residual retention in vestibular neuritis, and can also dynamically monitor vestibular compensation in patients.

[Vestibular-evoked myogenic potentials in healthy guinea pigs].

Objective:To establish detection methods of air-conducted sound elicited vestibular-evoked myogenic potentials (ACS-VEMPs) in guinea pigs, including cervical vstibular-evoked myogenic potential (cVEMP) and ocular vestibular evoked myogenic potential (oVEMP). Method:Eleven healthy (250-350 g) guinea pigs (22 ears) were selected and underwent conventional ACS-cVEMP and ACS-oVEMP examinations. Parameters of waveforms were recorded. Result:The ACS-cVEMP and ACS-oVEMP could be elicited in 77.27% and 59.09% guinea pigs,respectively；threshold was (107.1±14.6)dB SPL and (115.5±15.6)dB SPL for ACS-cVEMP and ACS-oVEMP；n1,p1 latency for cVEMP was (7.4±1.5)ms and (9.3±1.6)ms，(6.4±1.4)ms and (8.1±1.8)ms for oVEMP；amlipude was (15.4±8.6)µV and (11.4±6.0)µV for cVEMP and oVEMP respectively. No statistical difference could be found in above parameters between ACS-cVEMP and ACS-oVEMP (P>0.05). Conclusion:Both ACS-cVEMP and ACS-oVEMP could be elicited in guinea pigs.

[The experimental study on endoplasmic reticulum stress-participated outer hair cell apoptosis in cadherin 23 gene mutant mice].

Objective: To test the mechanism and upstream pathway of outer hair cell apoptosis in Cadherin 23 (Cdh23) gene mutant mice. Method: The mutant Cdh23(erl/erl)(erl) mice were collected as the study group, while the C57BL/6J (B6) mice were chosen as the control group. A total of 70 mice per group were used in this study. The study group and control group underwent auditory-evoked brainstem response (ABR) tests at the same age. The terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay was performed to detect outer hair cell(OHC) apoptosis. The qRT-PCR was conducted to test the expression of ER stress markers immunoglobulin-binding protein (BiP) and C/EBP homologous protein (CHOP) mRNA. The expression and location of BiP and CHOP protein in OHC were detected by immunostaining. The expression of BiP protein in cochleae was identified by Western blot. The expression and location of CDH23 protein in OHC were discovered by immunostaining. Results: The ABR thresholds in erl mice were significantly higher than those in B6 mice at the age of 1 and 3 months (both P<0.05). The surface preparation with TUNEL staining confirmed OHC apoptosis in erl mouse cochleae which showed a higher TUNEL positive cell ratio than B6 mouse(t=11.291, P<0.01). The ER stress marker Bip and Chop mRNA were upregulated in the erl mouse inner ear, when compared with those in the B6 mouse(both P<0.05). The BiP protein extracted from the erl mouse cochleae was significantly higher than that of B6 mouse measured by Western blot (t=3.66, P=0.02). Immunostaining showed that BiP and CHOP were highly detected in the OHC in erl mouse cochleae, and was mainly detected in the perinuclear region of OHC. However, a bare BiP and CHOP signal were shown in B6 mouse cochleae. The CDH23 protein was specifically localized at the top of the OHC in B6 mice, indicating the localization of the tip links in hair bundle stereocilia. On the contrary, the CDH23(erl) protein was found to be localized from the top to the nuclei of the OHC in erl mice. Portions of the CDH23(erl) proteins failed to reach the top of the hair bundles and remained in the OHC cytoplasm. Conclusion: As the downstream response of the Cdh23 gene mutation, portions of the mutant CDH23(erl) protein was accumulated in ER lumen resulting in the increase of ER loading and ultimately triggered ER stress and hair cell apoptosis in erl mouse cochleae.

[A retrospective study of the inducing factors and clinical characteristics of patients hospitalized for asthma exacerbation in China in 2013-2014].

Objective: To study the inducing factors and clinical characteristics of patients hospitalized for asthma exacerbation in China. Methods: Patients hospitalized for asthma exacerbation at 29 hospitals in China were retrospectively recruited during 2013-2014. Results: Clinical data of 3 240 asthmatic patients were collected and analyzed including 1 369(42.3%) males and 1 871(57.7%) females. The patients hospitalized for asthma exacerbation counted for 2.95% (6 375/215 955) of all patients hospitalized during the same period. The leading six inducing factors, in sequence, were acute upper respiratory tract infection [42.3%(1 370/3 240)], changes of weather [22.8%(738/3 240)], noxious gas [(4.3%(140/3 240), allergy challenges [3.5%(115/3 240)], strenuous exercise [1.8%(57/3 240)], and air pollution [1.5%(49/3 240)]. In older patients, more exacerbations were induced by weather changes, yet less sensitive to allergy challenges. As to middle-aged patients, they were less sensitive to upper respiratory tract infections, however the difference was not statistically significant (P>0.05). In winter more asthma patients were induced by upper respiratory tract infections, while in autumn more patients were induced by weather changes, strenuous exercise and air pollution. In spring and summer more patients were induced by allergy challenges, but the differences failed to achieve statistical significance (P>0.05). In northern cities more patients were induced by upper respiratory infections, whereas in southern cities more by noxious gases. Allergy challenges and air pollution tended to affect more patients in northern cities, but the difference was of no significance (P>0.05). The differences of inducing factors among patients of different gender, with or without a smoking history, and with different exacerbation severity didn't show any statistical significance. The patients with severe and life-threatening exacerbations counted for 20.1% (652/3 240). The percentage of patients older than 60 years was higher in patients with severe or life-threatening exacerbations than in whose with mild or moderate exacerbations, so did the percentage of male patients, of patients with disease duration longer than 10 years, with smoking history, and with a history of hospitalization or emergency department visits due to asthma exacerbation during the last year. Conclusion: The acute upper respiratory tract infection ranks top among all the inducing factors. Senility, male gender, long duration of disease, smoking history, and a history of frequent hospital visits might be the risk factors for severe or life-threatening asthma exacerbations.

[Pilot study on the functional evaluation of vestibular otolith-organ pathway in the stage of patients with Meniere disease].

Objective: To observe the features of air-conducted sound elicited ocular vestibular-evoked myogenic potential(ACS-oVEMP) and cervical vestibular-evoked myogenic potential(ACS-cVEMP) in patients with Meniere disease (MD). To analyze the relationship between air-conducted sound elicited vestibular-evoked myogenic potentials (ACS-VEMP) responses and clinical stages of disease, as well as its clinical application of cervical and ocular vestibular evoked myogenic potentials in MD. Method: Fifty six patients with MD and 50 normal subjects (100 ears) were recruited for conventional cVEMP and oVEMP examinations. Grades of vestibular function were also collected for patients with MD. The relationship between VEMPs abnormity, grades of vestibular function and clinical stages of MD were analyzed. Results: The abnormal rates of cVEMP and oVEMP in MD patients were 57.1% (32/56) and 64.3% (36/56), which were significantly higher than those in normal subjects respectively (χ2=22.286, P=0.000; χ2=15.217, P=0.000). The abnormal rates of cVEMP and oVEMP in MD patients of stage Ⅰ to stage Ⅳ were 20.0% (1/5) and 40.0% (2/5), 50.0% (9/18) and 50.0% (9/18), 59.3% (16/27) and 70.4% (19/27), and 100.0% (6/6) and 100.0% (6/6) respectively. There was a significant difference in cVEMP abnormity between four stages of MD patients (P=0.046). Significant correlation was found between clinical stages and the grades of vestibular dysfunction (rs=0.417, P=0.001). Conclusions: Dysfunction of vestibular otolithic organs and their input pathways in patients with MD can be detected by cVEMP and oVEMP tests. The abnormal rates of VEMP could show an gradually increasing trend with the development of MD stages. And the extent of vestibular lesions could be detected by cVEMP and oVEMP tests, which may provide a reference for clinical staging of MD.

[A case report: Ramsay Hunt syndrome with throat as starting place merger ipsilateral cranial nerver involvement].

The clinical data of a case of Ramsay Hunt syndrome concurrent with ipsilateral Ⅴ, Ⅶ, Ⅷ, Ⅸ, Ⅹ, Ⅺ cranial nerves paralysis with throat as starting place was retrospectively analyzed, and the relevant literatures were also reviewed. The case is rare, so the relevant clinical reports are less. It is important to take the objective data as well as subjective symptoms of the patients into consideration to make a definite diagnosis, so that we can treat it as soon as possible to achieve better curative effect.

[Advance in research of delayed endolymphatic hydrops].

Delayed endolymphatic hydrops (DEH) is a disease entity first described by Kamei and named by Schuknecht, defined as profound sensorineural deafness at early stage and after several years started to appear clinical feature of endolymphatic hydrops such as vertigo, aural fullness like Meniere's disease or fluctuating hearing loss in the contralateral ear . DEH can be classified into ipsilateral type, contralateral type and bilateral type. Although DEH has low incident rate, there are many kinds of etiology and audiology and vestibular tests. Up to now, a lot of literatures about etiology, diagnose, clinical manifestation, relevant examination and therapy of DEH were published abroad. In this review, we will make a summary of research status of DEH.

[Effect of BCYRN1 on proliferation and migration of airway smooth muscle cells in rat model of asthma].

Objective: To detect the effect of brain cytoplasmic RNA 1 (BCYRN1) on the proliferation and migration of airway smooth muscle cells (ASMCs) in rat model of asthma. Methods: Male SD rats were randomly divided into control group and asthma group (n=10 each). The ovalbumin (OVA) model was constructed in asthma group. Real time-qPCR was performed to detect the level of BCYRN1 in the ASMCs separated from the airway tissue of these rats. Then 2-(4-iodophenyl)-3-(4-nitrophenyl)-5-(2, 4-disulfophenyl)-2H-tetrazolium (WST-1) assay, roche real-time cell analyzer assay and Transwell cell migration assay were performed to detect the viability/proliferation and migration of ASMCs which were transfected with Ad-BCYRN1.Platelet-derived growth factor (PDGF)-BB was used to treat ASMCs to induce proliferation and migration, and the level of BCYRN1 was examined.The viability/proliferation and migration of ASMCs treated with PDGF-BB and transfected with si-BCYRN1 were detected. Inspiratory resistance and expiratory resistance were measured in rats with BCYRN1 knockdown.Briefly, rats were randomly divided into four groups: control (group A), sensitization + Ad-GFP (group B), sensitization + AdSM22α-siBCYRN1 (group C), control + Ad-SM22α-siBCYRN1 (group D) (n=10 each). The corresponding adenovirus vectors were sent to lung of group B, group C and group D through nasal spray. The OVA model was constructed in group B and group C. The rats in group A and group D were treated with saline.After 24 h of the last treatment with OVA or saline, rats of each group were given tracheal intubation, connected with breathing machine. Rats were injected with methacholine to measure the inspiratory resistance and expiratory resistance. Results: The level of BCYRN1 in ASMCs separated from rats in asthma group and in ASMCs treated with PDGF-BB was 3.60±0.45 and 3.53±0.35, respectively, significantly higher than those of the corresponding control (both P<0.01). Ad-BCYRN1 significantly increased the expression of BCYRN1 in ASMCs. The cell viability and proliferation rates of ASMCs transfected with Ad-BCYRN1 increased 1.75-and 1.47-fold compared to those of the control group, respectively (P<0.01); mobility increased 2.42-fold compared to that of the control group (all P<0.01). BCYRN1 knockdown reversed the increasing proliferation and migration of ASMCs induced by PDGF-BB. The cell proliferation rate and cell migration number in the PDGF-BB treatment group were (4.87±0.21)% and 80.00±5.00, respectively, which were significant higher than those in the si-BCYRN1 transfected group ((3.63±0.21)% and 25.33±2.52, all P<0.01). BCYRN1 knockdown reduced the inspiratory resistance and expiratory resistance in sensitization + Ad-SM22α-siBCYRN1 group. When the concentration of acetylcholine reached 1 mg/kg, the inspiratory resistance in the group A, group B, group C, and group D were 8.27±0.21, 25.40±0.56, 12.07±0.67 and 8.40±0.46 cmH2O·s·ml-1, and expiratory resistance were 13.30±0.56, 38.37±1.33, 16.40±0.56 and 13.40±0.46 cmH2O·s·ml-1, respectively (all P<0.01). Conclusion: Overexpression of BCYRN1 promotes the proliferation and migration of ASMCs in rat model of asthma.