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Dizziness or vertigo is a common clinical symptom, and its underlying etiology is complex. Many clinicians are confused about its diagnosis and treatment. This article presents a case about chronic vestibular syndrome. And case appreciation and academic discussion are conducted by well-known domestic neurologists and otologists, so as to provide a good thinking model and basic ideas for the diagnosis and treatment of dizziness or vertigo, hoping to further improve the diagnosis and treatment level among clinicians.
Sujet(s)
Humains , Sensation vertigineuse/thérapie , Vertige/étiologie , Maladies vestibulaires/complications , OtorhinolaryngologistesRÉSUMÉ
To provide anatomy information for harvesting the posterior tibial artery cutaneous branches-chain flaps. Methods The research was performed from January, 2017 to January, 2018. Anatomic ob-servation on 10 legs from fresh human cadaver were performed. The location of cutaneous branches of the posterior tibial artery was observed and its diameter and length was measured. Five legs were prepared to investigate the cuta-neous branches of posterior tibial artery.The anastomosis of cutaneous branches of posterior tibial artery was observed by PVA-bismuth oxide perfusion for molybdenum target X-ray arteriography in 5 perfused legs. The cutaneous branches with diameter over 0.2 mm in 10 legs of latex perfusion microdissection were included in the statistical analysis.The data were clustered and analyzed to find the location of distant and near cutaneous branches, which was called the gathering point of cutaneous branch vascular plexus. Secondly, the measured data of distal and near seg-ments containing cutaneous branches were compared by t-test.Then the distribution of cutaneous branches of posteri-or tibial artery on the tibiofibular side was compared by Chi-square test.It was considered to be significant if P value was under 0.05. Results ①There were 4.3 cutaneous branches raised from the posterior tibial artery.There was no significant difference on the tibial and ribula side distribution of the cutaneous branches from the posterior tibial artery (P＞0.05).②The distal cutaneous branch clusters was located at about 1/5 of the distal leg and there were 3.6 cutaneous branches raised from the posterior tibial artery. While the proximal clusters was located at 1/3 of the proximal leg and there were 0.7 cutaneous branches raised from the posterior tibial artery.There were no significant differences in the di-ameters (P=0.28) and pedicle length (P=0.14) between distal and proximal cutaneous branches. ③There were the large cutaneous perforators (≥1.0) mm from the posterior tibial artery at (6.37±1.22) cm proximal to the medial malleolus.The diameter and pedicle length of the distal perforators were (1.11±0.09) mm and (6.53±1.51) mm respectively.④The vas-cular chains parallel to the posterior tibial artery were formed via anastomosis of the adjacent cutaneous perforators. Conclusion The cutaneous expenditure of posterior tibial artery is constant, with a certain pedicle length and diameter. There are 2 relatively dense vascular plexus of cutaneous branches. The proximal and distal vascular flaps can be de-signed with these 2 vascular dense points as rotation points.
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The mechanisms of radiation-induced brain injury ( RBI) remain unclear. Currently a number of studies suggest that inflammatory response may play an important role in RBI. The production of reactive oxygen species, the release of inflammatory mediators, the interactions between neurons, glial cells, and pericytes, and the recruitment of peripheral leukocytes all contribute to the development of radiation-induced brain injury. This article reviews the research progress of the inflammatory response mechanism of radiation-induced brain injury.
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Objective To investigate the effect of bevacizumab (BVZ) on cerebral vessel and blood brain barrier changes in whole-brain irradiation mice.Methods Seventy-five male mice aged 6-7 weeks were randomly divided into normal control group,BVZ group and radiation group (n=25).Mice firom normal control group were without whole-brain irradiation or drug administration.Mice from BVZ group and radiation group were accepted fractionated cranial irradiation at a total dose of 30 Gy by X-ray.Mice from BVZ group and radiation group were intraperitoneally injected with 10 mg/kg BVZ solution or equivalent normal saline (10 weeks continuously) at the beginning of the first X-ray whole-brain irradiation.Eleven weeks after the first irradiation,HE staining was used to observe cerebrovascular pathological changes;Western blotting was used to test vascular endothelial growth factor (VEGF) protein expression;Evan Blue (EB) staining was used to assess the blood-brain barrier damage,and immunofluorescence staining was used to test the yon willebrand factor (vWF) and tight junction protein-1 (ZO-1) expressions.Results The VEGF protein expression level and brain tissue EB content ([9.66±0.73] μg/mL) in the normal control group were significantly increased as compared with those in the radiation group and BVZ group ([16.90±2.15] μg/mL and [12.29±0.96] μg/mL,P＜0.05),but ZO-1/vWF ratio (0.92±0.08) in normal control group was significantly decreased as compared with that in the radiation group and BVZ group (0.46±0.18 and 0.75±0.11,P＜0.05).As compared with the radiation group,BVZ group had significantly reduced VEGF protein expression and EB level in the brain tissues,and had significantly increased ZO-1/vWF ratio (P＜0.05).Conclusion BVZ decreases the quantity of VEGF in brain tissues and alleviates the continuous damage of the brain vessels and blood brain barrier in whole-brain irradiation mice.
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OBJECTIVE:To investigate therapeutic efficacy and safety of Acetic acid goserelin sustained-release implants (AGRI) in the treatment of ovary endometrium cyst (OEC) recurrence after laparoscopic enuleation of ovarian cyst. METHODS:Totally of 60 patients with OEC recurrence after laparoscopic enuleation of ovarian cyst in Zhangjiagang First People's Hospital dur-ing Jan. 2013-Jan. 2015 were divided into control group and observation group according to random number table,with 30 cases in each group. Both groups were given Mifepristone tablets orally 25 mg,qd. Control group was given Gestrinone capsules orally 2.5 mg,twice a week. Observation group was given AGRI subcutaneously 3.6 mg,once a month. Both groups were treated for consec-utive 6 months. Clinical efficacies of 2 groups were observed as well as the levels of serum follicle stimulating hormone(FSH),lu-teinizing hormone(LH)and estradiol(E2),VAS scores of dysmenorrheal and chronic pelvic pain before treatment,3,6 months af-ter treatment. The occurrence of ADR and the prognosis of 12-month follow-up were observed in 2 groups. RESULTS:Total re-sponse rate of observation group was 86.67%,which was significantly higher than 70.00%of control group,with statistical signifi-cance(P0.05);after 6 months of treatment,the levels of FSH,LH and E2 in 2 groups were decreased significantly,and the observation group was significantly lower than the control group,with statistical significance(P0.05). The recovery rate of men-struation in observation group was 86.67%,the rate of dominant follicle formation was 60.00% and pregnancy rate was 53.33%, which were significantly higher than 46.67%,46.67% and 33.33% of control group,with statistical significance(P<0.05). CON-CLUSIONS:AGRI shows significant therapeutic efficacy for OEC recurrence after laparoscopic enuleation of ovarian cyst,can ef-fectively relieve dysmenorrhea and chronic pelvic pain,increase the rate of pregnancy. There is still recurrent cases after drug with-drawal. The incidence of ADR is high,but the symptoms are mild.
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Objective To evaluate functional activity of the subcortical nuclei in Wilson's disease (WD) using resting state functional MRI (rs-fMRI),and to evaluate damage to the functional conjunction in the extracorticospinal tract in WD patients.Methods Twenty-two patients with WD (between January 2015 and January 2016),including 18 with cerebral type and 4 with hepatic type,and 20 age-matched healthy controls were enrolled.Neurological symptoms were scored using the modified Young Scale.Patients with cerebral type WD were divided into 4 subgroups.All study subjects underwent rs-fMRI of the brain.The values of amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (REHO) in the thalamus,caudate nucleus,putamen and globus pallidus were determined.The relationships between rsfMRI metrics and clinical status were evaluated.Results ALFF values were lower in the caudate nucleus,putamen and right thalamus of WD patients than in controls (t =-3.07,-3.00,-3.12,-2.46,-2.20;P =0.005,0.006,0.004,0.020,0.036),while REHO values were lower in the left caudate nucleus and left thalamus of WD patients (t =-2.38,-2.16;P =0.025,0.040).In the caudate nucleus (P =0.032,0.029,0.023),thalamus (P =0.022,0.041,0.035) ALFF values were lower in group 4 than in other groups.REHO values of the putamen (P =0.040,0.017,0.040) and thalamus (P =0.024,0.029 7,0.041) were higher in group 4 than in other groups.ALFF values in the caudate nucleus (t =-0.29,P=0.037),and thalamus (t =-1.77,P =0.042) were lower,and REHO values in the caudate nncleus (t =-1.46,P =0.040) were lower,in patients of cerebral type than in hepatic type patients.Conclusions The damage to the functional activity of the subcortical nuclei may occur in the WD patients.The functional activity of nuclei may be different between hepatic and cerebral type patients.Damage to the activity of neurons in the putamen and thalamus may correlate with psychiatric symptoms in WD patients.
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A new method for chiral separation and purity inspection of landiolol hydrochloride and its stereoisomers was developed by ultra-performance convergence chromatography ( UPC2 ) . The mobile phase was the mixture of supercritical CO2 and methanol/n-butyl alcohol/acetonitrile (1:1:1, V/V) plus 0. 5%NH3?H2O. The separation was carried out on the Daicel CHIRALPAK? IF column (150 mm × 4. 6 mm, 3 μm) with a flow rate of 2. 8 mL/min at 50℃ using 223 nm as detection wavelength. Under the optimized experimental conditions, for R,R-stereoisomer, R,S-stereoisomer and S,R-stereoisomer, the detection limits (LOD, S/N=3) were 0. 3, 0. 4 and 0. 3 mg/L, the linear ranges were 2-300 mg/L, 5-300 mg/L and 2-300 mg/L, the recoveries of spike samples were 103. 4%±2. 5%, 91. 8%±2. 5% and 101. 7%±1. 5%, and the injection repeatabilities were 0. 06%, 0. 09% and 0. 08% (n=6), respectively. The experimental results demonstrate that the UPC2-based method can be used for the analysis and determination of landiolol hydrochloride and its stereoisomers.
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BACKGROUND:Synthetic patch as an important substitute to pelvic tissue can replace damaged pelvic fascia tissue, and has been widely used in the pelvic floor reconstruction. OBJECTIVE:To observe the efficacy and complications of pelvic floor reconstruction with mesh, and to explore its safety and effectiveness. METHODS: Forty-five pelvic organ prolapse female patients were divided into two groups according to patient’s wilingness: experimental group, pelvic floor reconstruction with mesh (n=25); control group, transvaginal hysterectomy combined with vaginal wal repair (n=20). Perioperative conditions were recorded, and uterine prolapse staging, complications, pelvic floor function, pelvic discomfort, as wel as an objective cure rate were evaluated in the two groups during the folow-up. RESULTS AND CONCLUSION:Compared with the control group, the experimental group was characterized as shorter operative time, less amount of bleeding, milder infections, and faster recovery (AlP < 0.05). At 6 months of folow-up, the score on uterine prolapse staging was higher in the experimental group than the control group; at 12 months, the scores on pelvic floor function and pelvic discomfort as wel as the incidence of complications were significantly lower in the experimental group (P < 0.05), but the objective cure rate was higher compared with the control group (P < 0.05). These findings suggest that pelvic floor reconstruction with mesh for pelvic organ prolapsed can reduce the operative time and blood loss and promote postoperative recovery. Meanwhile, it can significantly improve pelvic floor function, pelvic discomfort, postoperative complications, the rate of exposure, and the objective cure rate, which is safe and effective during the short-term folow-up.
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Objective To investigate the possible presence of radiation brain injury (RBI) in vascular injury and blood-brain barrier (BBB) damage.Methods Seventy 8 weeks old male BALB/C mice were randomly divided into irradiation group and control group;mice in the two groups received whole-brain exposure with a single dose of 10 Gy irradiation or sham irradiation.Tissue samples were taken 1,7,30,90 and 180 days after irradiation (7 mice in each time point per group);HE staining was used to observe the microvascular morphology and density changes;immune-fluorescence staining was used to visualize the differential expressions of factor Ⅷ related antigen (vWF) and zonulaoccludens-1 (ZO-1).Results Micro-vascular disorders began to appear from the first day of irradiation,deteriorating with time extension gradually.After the X-ray irradiation exposure,the protein expressions of vWF and ZO-1 in the irradiation group were significantly decreased as compared with those in the control group 1,7,30,90 and 180 days after irradiation (vWF:23.17±2.93 vs 15.80±2.39,21.25±2.33 vs 11.60±2.3,19.78±2.16 vs 8.20±1.64,17.21±3.31 vs 6.00±2.12 and 16.98±1.92 vs 3.80±2.59;ZO1:26.17±3.31 vs 15.40±1.82,23.20±2.93 vs 12.00±1.58,20.88±2.20 vs 9.10±2.55,18.32±1.87 vs 6.20±1.92 and 17.50±1.91 vs 2.40±1.52,P＜0.05);besides,the decreased expression ofvWF and ZO-1 in the irradiation group showed a time-depended manner,with significant differences between each two time points (P＜0.05).Conclusion X-rays may induce persistent micro-vascular injury and destroyed BBB tight junctions,which may be closely related to the occurrence and development of RBI.
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Investigation of simvastatin and its related substances was carried out using a reversed phase ultra performance liquid chromatography/tandem mass spectrometry method. The identification of impurities in simvastatin was performed with a triple-quadrupole mass spectrometer, with an electrospray ionization (ESI) source in the negative/positive ion mode. A total of 12 compounds were characterized in commercial samples, among which 2 impurities had never been reported. All the impurities were deduced based on the MS fragment pathways of simvastatin and the biosynthetic pathway of lovastatin. This work provides very useful information for quality control of simvastatin.
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This paper is to report the polymorphism of raw materials of clopidogrel bisulfate at home and abroad. By the analysis of Fourier transform infrared spectroscopy (FTIR) and powder X-ray diffraction (p-XRD), samples are roughly classified into two groups, except one patent material. And the differential scanning calorimeter (DSC) examination showed more detailed information for these materials. The results of the study could provide comprehensive basis for the quality evaluation of clopidogrel bisulfate.
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Objective To investigate the prevalence and risk factors of intracranial vertebrobasilar artery stenosis. Methods By cluster sampling, adult Han people were recruited from residential communities. Medical history was documented and body height, body weight, waist circumference, hip circumference and blood pressure were measured. Venous blood samples were collected to determine serum fasting glucose, total cholesterol and triglycerides concentrations. Intracranial vertebrobasilar artery stenosis was diagnosed with transcranial Doppler. The SPSS 11.0 software package was used for data analysis. Results Among 1035 people conforming to the inclusion criteria, intracranial vertebrobasilar artery stenosis was found in 58 (5.6%), 17 with left VA stenosis, 23 with right VA stenosis and 30 with BA stenosis.Univariate analysis showed that subjects with diabetes mellitus had a significantly higher prevalence ( 10. 3% ) of intracranial vertebrobasilar artery stenosis (χ2 = 6. 221, P = 0. 013 ) and the mean systolic blood pressure (( 131.1 ± 25.5) mm Hg, 1 mm Hg = 0. 133 kPa) in the subjects with stenosis was significantly higher than those without (3.2%, ( 124. 1 ± 21.6) mm Hg) (t = 2. 228, P = 0. 026). Logistic regression indicated that diabetes mellitus and systolic blood pressure were independent risk factors for intracranial vertebrobasilar artery stenosis ( diabetes mellitus: OR = 3. 305, P = 0. 023; elevated systolic blood pressure 1 mm Hg: OR = 1. 012, P =0. 047). Conclusions This study demonstrated a considerably high prevalence of intracranial vertebrobasilar artery stenosis in a southern Chinese population. Diabetes mellitus and systolic blood pressure play potent roles in intracranial vertebrobasilar artery stenosis.
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Angiotensin-converting enzyme (ACE) gene is one of major candidate genes with genetic susceptibility to stroke. However, its correlation with stroke remains controversial. The relationship between gene polymorphism and stroke also cannot be determined. A specific branch in the ACE phylogenic tree may replace the insertion/deletion polymorphic site as a risk marker of stroke for association study.
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Objective The study the formative causes of low dense area in lung on CT images during expiration.Methods This group included 15 young volunteers,mean age was 22 years.Thin sections of spiral CT at right middle hilum were scanned at suspended deep inspiration and deep expiration on both supine and prone positions.The density and area of lobes on matching structural images in the middle hilum at deep inhalation and exhalation were measured on the supine and prone.The increasing rate in area and absolute increasing value in attenuation as full inhalation comparing to full exhalation were calculated.Results Changes of distention and density in the same section of the right lower lobe on dependent position were greater than that on nondependent one.Correlation between distention and density of the lobes was high(P
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AIM: To explore clinical significance of the serum changes of neuron-specific enolase (NSE)and S-100 ? protein (S-100 ?) during acute cerebral infarction. METHODS: 59 acute cerebral infarction patients were classified as total anterior circulation infarcts (TACI), partial anterior circulation infarcts (PACI), lacunar infarcts (LACI) and posterior circulation infarcts (POCI). Their serum NSE and S-100 ? concentrations were determinated by enzyme linked immunosorbent assay (ELISA) during stroke onset 6 d, and compared with 32 controls. RESULTS: The every time point serum NSE concentration of TACI was higher than controls (P
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AIM: To observe the activity and distribution of astrocytes and glial fibrillary acid protein(GFAP) after middle cerebral artery occlusion (MCAO). METHODS: The rat MCAO model was made by two-kidney, tow clip renovascular hypertensive rat stroke prone(RHRSP). Rats were killed and brain samples were collected at the end of 1,3,6 and 9 weeks after MCAO, respectively. The ultrastructure of astrocytes was determined at broder of infarct (A area); distant of infarct (B area) and opposite of hemisphere (C area) by electron microscope. The number and optical density of GFAP-positive cells were also observed. RESULTS: The astrocyte proliferation distributed in the whole brain after MCAO. The highest numbers of GFAP-positive cells were observed at A area, then B area. The lowest numbers of GFAP positive cells were found in C area. The time course of GFAP-positive cell change was that the highest number was observed at 1 week after MCAO, then decreased by time from 3, 6 weeks to 9 weeks. The optical density of GFAP-positive cells showed the same patterns. CONCLUSION: The correlation between astrocyte proliferation and tissue damage after MCAO can be estimated by GFAP expression. The astrocyte proliferation plays an important role in healing process after MCAO.