[Effects and influencing factors of vestibular rehabilitation in 171 cases].

Objective: To explore the effect of vestibular rehabilitation and to identify factors that can affect rehabilitation outcomes. Methods: From December 2018 to October 2020, patients who underwent vestibular rehabilitation in the Eye, Ear, Nose and Throat Hospital of Fudan University were prospectively followed up. A battery of vestibular function examinations and psychological status evaluations were applied before and after rehabilitation initiation. The main outcomes were vertigo/dizziness and unsteadiness, measured by visual analogue scale (VAS); Secondary outcomes were daily activities and participation, assessed by vestibular activities and participation measure (VAP). Paired t-test was used to compare the effects before and after rehabilitation. Binary logistic regressions were applied to analyze the influencing factors of rehabilitation outcomes. Results: A total sample of 171 patients was followed up regularly with a median time of 11 months. Of the 171 patients evaluated, 72 were males and 99 were females; age ranged from 10 to 89 years old with a median age of 55 years old. At 6-month follow-up, the difference of VAS score of vertigo/dizziness and unsteadiness pre-post rehabilitation was 1.79±1.80 and 1.56±1.76, respectively; The difference of activity and participation domain of VAP score was 2.51±13 and 1.27±3.75, respectively. All differences pre-post rehabilitation exhibited statistically significant with P values<0.01. Regression analysis demonstrated that the length of symptom onset was a significant predictor of poor balance recovery (OR=6.52; 95%CI:2.10, 20.27). Visual dependence (OR=5.44; 95%CI: 1.38, 21.47) and suspectable anxiety (OR=6.45; 95%CI: 1.49, 28.30) were identified as risk factors for poor recovery of vertigo/dizziness. Conclusions: Vestibular rehabilitation effectively reduces dizziness, promotes balance, and improves the function of daily activities. Time from the onset, visual dependence and suspectable anxiety are the main factors hindering a desirable rehabilitation outcome.

[Effect of dynamic balance during the onset of benign paroxysmal positional vertigo on residual dizziness after successful repositioning: a multicenter prospective cohort study].

Objective: To explore the characteristics of dynamic balance during the onset of benign paroxysmal positional vertigo (BPPV) and its prediction of residual symptoms after successful repositioning. Methods: From January 2018 to August 2019, patients diagnosed with unilateral posterior semicircular canal or horizontal semicircular canal BPPV were consecutively enrolled from five otolaryngology clinics in Shanghai. The dynamic balance function was measured by sensory organization test (SOT) before repositioning maneuver, and the residual symptoms and its duration were followed up from one week to up to three months. Results: A total of 260 patients were recruited. After excluding 17 cases, 243 cases were successfully followed up including 89 males and 154 females, with an average age of (52.9±13.0) years. There were 175 cases of posterior semicircular BPPV, 61 cases of horizontal semicircular BPPV and 7 cases of canal conversion (from horizontal to posterior semicircular). Among 243 patients, 118 cases reported residual symptoms, with an incidence of 48.6%. The results of SOT showed that 58.0%(141/243) of the patients had abnormal vestibular input and 41.6%(101/243) were categorized as "near falls". With respect to the detailed residual symptoms, 47 cases (39.8%) reported unsteadiness or floating, 35 cases (29.7%) had fogginess/heaviness feeling, 22 cases (18.6%) had transient dizzy while head moving, and 15 cases (12.7%) reported that the symptom was too subtle to describe. Compared with the group without residual symptoms, the group with residual symptoms had more abnormal vestibular input(χ²=67.25, P<0.001) and near falls(χ²=74.78, P<0.001) as identified by SOT test. Cox proportional hazards regression failed to reveal any SOT results having significantly impact on the duration of residual symptoms [abnormal vestibular input (HR= 0.93, 95%CI: 0.48, 1.80), and near falls (HR= 0.90, 95%CI: 0.56, 1.46)]. Kaplan-Meier survival analysis showed that there was no significant difference in the duration of residual symptoms among patients with different SOT manifestations [Log rank (Mantel-Cox) test, P>0.05]. Conclusions: The impaired dynamic balance during the onset of BPPV is characterized by "abnormal vestibular input". The residual symptoms are mainly characterized by unsteadiness or floating feeling. The defect of dynamic balance function is a predictor of the residual symptoms after successful repositioning, but not for the duration of such symptoms.

[Intervention strategies for residual dizziness after successful repositioning maneuvers in benign paroxysmal positional vertigo: a single center randomized controlled trial].

Objective: To compare the effects of different intervention strategies for the management of residual dizziness following successful canalith repositioning procedure (CRP) in patients with benign paroxysmal positional vertigo (BPPV). Methods: A total of 129 BPPV patients with residual dizziness following successful CRP were recruited during January 2019 and July 2019. They were randomly assigned into three groups with 43 cases in each group: the vestibular rehabilitation group received rehabilitation training for four weeks; betahistine group was given orally 12 mg betahistine three times a day for four weeks; and the control group had no specific treatment. The primary outcomes were daily activities and social participation assessed by the Vestibular Activities and Participation measure (VAP). Secondary outcomes includedbalance function assessed by sensory organization test (SOT) and the duration of residual symptoms. Stata15.0 software was used for statistical analysis. Results: The scores of VAP in the three groups decreased over time, but a more significant decrease was found in vestibular rehabilitation group. Further paired comparison showed that the difference between the vestibular rehabilitation group and the control group was of statistical significance (B=-3.88, χ2=18.29, P<0.01), while the difference between the betahistine group and the control group was not statistically significant (B=-0.96, χ2=1.16, P=0.28). The balance function of the three groups showed a trend of recovery over time, with no significant differences between groups (χ2=1.37, df=2, P>0.05). The median duration of residual dizziness for both vestibular rehabilitation and betahistine groups was 14 days, while that of control group was 19 days, with no significant difference between three groups[Log-rank (Mantel-Cox) test; χ2=1.82, df=2, P=0.40]. Conclusion: Vestibular rehabilitation can significantly improve the daily activities and social participation function in BPPV patients with residual symptoms following successful CRP, but its effects on shortening the duration of residual symptoms and promoting the recovery of balance function remain uncertain.

[Value of shear-wave elastography of the liver and spleen for predicting the risk of esophageal - gastric varices and bleeding in patients with advanced schistosomiasis].

OBJECTIVE: To assess the value of shear-wave elastography (SWE) of the liver and spleen for predicting the risk of esophageal-gastric varices (EGV) and the bleeding from EGV (EGVB) in patients with advanced schistosomiasis. METHODS: The medical records of 90 patients with definitive diagnosis of advanced schistosomiasis in Wuxi People's Hospital Affiliated to Nanjing Medical University from January 2017 through January 2020 were retrospectively reviewed. The severity of EGV was graded in the 90 patients with advanced schistosomiasis using gastroscopic findings as a golden standard. Then, the subjects were assigned to the non-EGV and EGV groups, and the low- and high-risk EGVB groups according to the grading. The SWE elastic moduli of the liver and spleen were measured and compared between groups. In addition, the receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUC) was estimated to evaluate the diagnostic efficiency of the SWE elastic moduli of the liver and spleen for predicting the high risk of EGV and EGVB. RESULTS: The 90 patients with advanced schistosomiasis included 61 men and 29 women, and had a mean age of (74.3 ± 8.6) years (range, 62 to 83 years). If gastroscopic findings were employed as a golden standard, there were 32 cases with grade 0 (35.5%), 17 cases with grade 1 (18.9%), 15 cases with grade 2 (16.7%) and 26 cases with grade 3 EGV (28.9%). There were 32 cases in the non-EGV group (35.6%) and 58 cases in the EGV group (64.4%), and 41 cases in the high-risk EGV group (45.6%) and 49 cases in the low-risk EGV group (54.4%), respectively. The SWE elastic moduli of the liver and spleen were both significantly greater in the EGV group than in the non-EGV group (t = 5.73 and 7.26, both P values < 0.05). The SWE elastic moduli of the liver and spleen had AUCs of 0.70 and 0.75, optimal cut-off of 16.1 kPa and 22.6 kPa, sensitivities of 80.6% and 83.9% and specificities of 71.4% and 78.6% for the prediction of EGV, respectively. In addition, the SWE elastic moduli of the liver and spleen were significantly greater in the high-risk EGVB groups than in the low-risk EGVB group (t = 7.35 and 9.61, both P values < 0.05), and the SWE elastic moduli of the liver and spleen had AUCs of 0.68 and 0.71, optimal cut-off of 22.7 kPa and 33.8 kPa, sensitivities of 70.4% and 73.6% and specificities of 89.3% and 93.1% for the prediction of high-risk EGV, respectively. CONCLUSIONS: SWE is useful to predict the risk of EGV and EGVB in patients with advanced schistosomiasis.

[Clinical study of real-time shear wave elastography for diagnosis of severity of acute cholecystitis].

Objective: To assess the clinical value of real-time shear wave elastography (SWE) in distinguishing between mild and severe cholecystitis. Methods: A total of 176 patients with cholecystitis who meet the criteria of Tokyo Guideline in Wuxi People's Hospital of Nanjing Medical University from January 2017 to March 2018 were recruited, 95 male, 81 female, age range of 23-88 years, average age (48±16)years, and divided into severe (91 cases) and mild (85 cases) groups according to disease severity. All patients underwent routine ultrasound and SWE examination to assess gallbladder morphology, hepatic flow signals and liver cirrhosis adjacent to the gallbladder. Two sonographers with different diagnostic experience independently reviewed ultrasound images alone and in combination with SWE, respectively, and compared the diagnostic consistency of two sonographers in assessing severe cholecystitis. Results: The SWE value of liver in the severe group of cholecystitis was significantly higher than that of mild group (t=10.34, P=0.01). The area under the ROC curve of SWE value for diagnosing severe cholecystitis was 0.809 with the optimal cut-off value of 7.2 kPa. The sensitivity, specificity was 78.0% and 83.5%, respectively. In distinguishing between mild and severe cholecystitis, the diagnostic sensitivity (84.6%, 95.6%) was high and the specificity (49.4%, 35.3%) was low in diagnosing gallbladder edema and sludge.The diagnostic sensitivity (14.3%, 26.4%) was low and the specificity (100%, 95.3%) was high in diagnosing pericholecystic fluid and blood flow signal of the gallbladder wall.Two sonographers reviewed ultrasound images independently for diagnosing severe cholecystitis in good agreement (κ =0.75). Combining SWE to conventional ultrasound, the diagnostic consistency of the two sonographers in diagnosing server cholecystitis was excellent (κ=0.86), and the difference was statistically significant (P=0.02), the diagnostic efficacy of which was higher than that of conventional ultrasound alone. Conclusions: Compared with conventional ultrasound alone, combining with SWE can improve the diagnostic efficacy of distinguishing between mild and severe cholecystitis, and the clinical experience of sonographers has less influence on the diagnostic accuracy.

[Interpretation of updated version of BPPV clinical practice guideline: treatment and patient education].

In 2008, American Academy of Otorhinolaryngology Head and Neck Surgery(AAOHNSF) published the first clinical practice guideline for benign paroxysmal positional vertigo (BPPV), in which 13 key action statements for BPPV diagnosis, treatment, and patient education were proposed. The updated version of guideline was published in 2017. This article aimed at interpreting the updated guideline with particular focus on BPPV treatment and patient education.

[Interpretation of updated version of BPPV clinical practice guideline: diagnosis and examination].

In 2008, American Academy of Otolaryngology-Head and Neck Surgery Foundation（AAO-HNSF）published the first clinical practice guideline for Benign Paroxysmal Positional Vertigo (BPPV) based on evidence-based methodology. The primary purposes of this guideline were to improve quality of care and outcomes for BPPV by enhancing the accuracy and efficacy of diagnosis of BPPV, reduce the inappropriate use of vestibular suppressant, and decrease the inappropriate use of ancillary examinations. The guideline was updated in 2017. This paper aimed at interpreting the updated guideline with a focus on diagnosis and ancillary tests section. Changes from the prior guideline include removal of the "no recommendation" for audiometric; expansion of the recommendations with respect to radiographic and vestibular testing, and broadening out the overall framework of differential diagnosis regarding BPPV.

MicroRNA-206 functions as a tumor suppressor in colorectal cancer by targeting FMNL2.

BACKGROUND: Colorectal cancer (CRC) is one of the most common cancers in the world. MicroRNAs play important roles in the progression of CRC. This study aimed to investigate the role of miR-206 and its novel mechanism in the invasion and metastasis of CRC. METHODOLOGY: Real-time RT-PCR or Western blotting was used to detect the expressions of miR-206, FMNL2 and c-MET in CRC cell lines and tissues. Luciferase reporter assays were conducted to detect the associations between miR-206 and 3'UTRs of FMNL2 and c-MET. A series of loss-of-function and gain-of-function assays were performed to evaluate the effect of miR-206 on the proliferation, invasion and metastasis of CRC cells. RESULTS: miR-206 was significantly down-regulated in CRC tissues and correlated closely with differentiation, lymphatic metastasis and serosal invasion. miR-206 suppressed CRC cell proliferation by arresting CRC cells in the G1/G0 phase and accelerating apoptosis. miR-206 also inhibited cell invasion and lung metastasis in CRC cells. Mechanically, FMNL2 and c-MET were identified as direct targets of miR-206. And FMNL2 rescued the suppression of miR-206 in the proliferation and invasion of CRC cells. CONCLUSIONS: This study revealed functional and mechanistic links between miR-206 and oncogene FMNL2 and c-MET in the progression of CRC. miR-206 functioned as a tumor suppressor in the progression of CRC by targeting FMNL2 and c-MET. Restoration of miR-206 expression may represent a promising therapeutic approach for targeting malignant CRC.

Down-regulation of BTG3 promotes cell proliferation, migration and invasion and predicts survival in gastric cancer.

BACKGROUND: Gastric cancer (GC) is one of the most common malignancies in China. B-cell translocation gene 3 (BTG3) has been identified as a tumor suppressor in several tumors, but its role in GC remains unknown. This study aimed to detect the expression of BTG3 and its prognostic value in GC tissues and determine its function in the progression of GC. METHODOLOGY: The expression of BTG3 was detected in GC cell lines and tissues by real-time RT-PCR, Western blot or immunohistochemistry. A series of in vitro and in vivo assays were performed to evaluate the effect of BTG3 on proliferation, migration and invasion of GC cells. RESULTS: B-cell translocation gene 3 was obviously down-regulated in GC tissues. Its expression was positively correlated with distant metastasis (P < 0.05). Patients with lower BTG3 expression had shorter overall survival time (P = 0.015). BTG3 suppressed the proliferation of GC cells in vitro and in vivo. It also inhibited migration and invasion of GC cells in vitro. CONCLUSION: Down-regulation of BTG3 is closely associated with proliferation, migration and invasion in GC. It may be a novel prognostic biomarker for GC patients.

Effects of common dissolved anions on the reduction of para-chloronitrobenzene by zero-valent iron in groundwater.

Batch tests were conducted to evaluate the influences of several common dissolved anions in groundwater on the reduction of para-chloronitrobenzene (p-CNB) by zero-valent iron (ZVI). The results showed that p-CNB reduction was enhanced by both Cl(-) and SO(4)(2-). HCO(3)(-) could either improve or inhibit p-CNB reduction, depending on whether the mixing speed was intense enough to rapidly eliminate Fe-carbonate complex deposited on ZVI surface. Above a concentration of 100 mg L(-1), NO(3)(-) increased the p-CNB reduction rate. The reduction rate by ClO(4)(-) decreased because the ClO(4)(-) competed with p-CNB for electrons. The p-CNB reduction was inhibited by PO(4)(3-), SiO(3)(2-) and humic acid, in the order humic acid < PO(4)(3-) < SiO(3)(2-), since these ions could form inner-sphere complexes on iron surface. The reaction even ceased when the ion concentrations were greater than 4, 0.5, and 30 mg L(-1), respectively. The results indicated that common dissolved anions in groundwater should be taken into account when ZVI is applied for contaminated groundwater remediation.

Adsorption of phenol on inorganic-organic pillared montmorillonite in polluted water.

Both inorganic- and organic-pillared montmorillonites (PMts) were used to adsorb phenol to study suitable conditions for adsorption and adsorption isotherms. The adsorbing capacity of modified clays depends not only surface area, but mainly on micropore structure and surface components. After incandescing at 500 degrees C, the pillar structure and the basal interlayer spacing (1.83 nm) remained stable. Using modified PMt with surfactant can improve adsorbing capacity greatly. The PMt can be recycled, and it is a potential substance for adsorption of environmental pollutants.