The video head impulse test (vHIT) is presently an essential part of the laboratory vestibular examination for patients with a suspected acute or chronic vestibular disorder. This chapter reviews its neurophysiology, interpretation, and clinical applications. A comparison with the caloric tests is included.

The Video Head Impulse Test (vHIT)

Meniere's disease (MD) represents one of the vertigo disorders characterized by triad symptoms (recurrent vertigo, fluctuating hearing loss, tinnitus or ear fullness). The diagnosis of MD relies on the accurate and detailed taking of medical history, and the differentiation between MD and vestibular migraine (VM) is of critical importance from the perspective of the treatment efficacy. VM is a highly prevalent vertigo condition and its typical symptoms (headache, vestibular symptoms, cochlear symptoms) mimic those of MD. Furthermore, the misdiagnosis in MD and VM could lead to VM patients mistakenly receiving the traumatic treatment protocol designed for MD, and sustaining unnecessary damage to the inner ear. Fortunately, thanks to the advances in examination technologies, the barriers to their differentiation are being gradually removed. These advances enhance the diagnostic accuracy of vertigo diseases, especially VM and MD. This review focused on the differentiation of VM and MD, with an attempt to synthesize existing data on the relevant battery of differentiation diagnosis (covering core symptoms, auxiliary tests [audiometry, vestibular tests, endolymphatic hydrops tests]) and longitudinal follow-up. Since the two illnesses are overlapped in all aspects, no single test is sufficiently specific on its own, however, patterns containing all or at least some features boost specificity. 

/pdf/vestibular-migraine-or-meniere-s-disease-a-diagnostic-2ulxq7c7.pdf

Vestibular migraine or Meniere's disease: a diagnostic dilemma

Background and aim Uncontrolled proliferation is the most prominent biological feature of tumors. In order to rapidly proliferate, tumor cells regulate their metabolic behavior by controlling the expression of metabolism-related genes (MRGs) to maximize the utilization of available nutrients. In this study, we aimed to construct prognosis models for colorectal adenocarcinoma (COAD) and rectum adenocarcinoma (READ) using MRGs to predict the prognoses of patients. Methods We first acquired the gene expression profiles of COAD and READ from the TCGA database, and then utilized univariate Cox analysis, Lasso regression, and multivariable Cox analysis to identify the MRGs for risk models. Results Eight genes (CPT1C, PLCB2, PLA2G2D, GAMT, ENPP2, PIP4K2B, GPX3, and GSR) in the colon cancer risk model and six genes (TDO2, PKLR, GAMT, EARS2, ACO1, and WAS) in the rectal cancer risk model were identified successfully. Multivariate Cox analysis indicated that these two models could accurately and independently predict overall survival (OS) for patients with COAD or READ. Furthermore, functional enrichment analysis was used to identify the metabolism pathway of MRGs in the risk models and analyzed these genes comprehensively. Then, we verified the prognosis model in independent COAD cohorts (GSE17538) and detected the correlations of the protein expression levels of GSR and ENPP2 with prognosis for COAD or READ. Conclusion In this study, 14 MRGs were identified as potential prognostic biomarkers and therapeutic targets for colorectal cancer.

Identification of Metabolic-Associated Genes for the Prediction of Colon and Rectal Adenocarcinoma.

Purpose Ample evidence has revealed that the lymphocyte-to-monocyte ratio (LMR), albumin-to-globulin ratio (AGR), and mean platelet volume (MPV) are cancer-related inflammatory markers. The present study aimed to combine these indicators to better assess the progression of colon cancer. Methods This retrospective study enrolled 251 patients with colon cancer, 171 patients with benign colon diseases, and 187 healthy control subjects. The receiver operating characteristic curve and area under the curve (AUC) were used to determine the diagnostic values of the selected inflammatory index. Results The levels of LMR, AGR, and MPV were decreased in the colon cancer group compared with the healthy control and benign colon disease groups. The LMR, AGR, and MPV were all correlated with tumor size. Moreover, LMR and AGR was associated with lymph node metastasis and clinical stage, AGR was related to distant metastasis. Both the LMR (P = .030) and AGR (P = .005) were negatively correlated with the concentration of carcinoembryonic antigen (CEA). The AUC value of MPV combined with CEA had a good diagnostic ability for distinguishing colon cancer cases (AUC = .950) and patients with benign colon diseases (AUC = .886) from controls. Meanwhile, the combination of LMR or AGR with CEA could enhance larger AUC (.746 for LMR + CEA, .737 for AGR + CEA) than CEA, LMR, or AGR alone in detecting colon cancer from benign colon diseases. Conclusions CEA combined with the LMR, AGR, or MPV may be used as better blood-based biomarkers in the progression of colon cancer patients.

https://journals.sagepub.com/doi/pdf/10.1177/10732748221091333

Predictive Values of the Selected Inflammatory Indexes in Colon Cancer

Introducao: A incidencia e as taxas de mortalidade por Câncer Colorretal (CCR) tem apresentado uma tendencia mundial de crescimento. Objetivo: Analisar a evolucao temporal e comparar as tendencias de taxa de mortalidade por CCR no estado de Sergipe e no Nordeste brasileiro, no periodo de 2008 a 2018. Metodos: Estudo documental, de obitos por CCR, no estado de Sergipe e na regiao Nordeste. Os dados foram coletados no Sistema de Informacao em Mortalidade, do Departamento de Informatica do Sistema Unico de Saude. A analise temporal foi realizada com aplicacao do modelo de regressao por pontos de inﬂexao Joinpoint Regression Analysis. Resultados: Os obitos por CCR em Sergipe e no Nordeste, foi predominante na regiao do colon, seguido pelo reto e juncao retossigmoide, prevaleceu nos idosos, com semelhanca entre os sexos, porem ligeiramente maior nas mulheres. As taxas de mortalidade permaneceram crescentes entre 2008 e 2018, tanto em Sergipe como no Nordeste do Brasil. Em Sergipe, destacaram-se os seguintes pontos de inflexao ( joinpoints ), um aumento da mortalidade de 8,6% ao ano em mulheres e de 5,3% ao ano em homens, enquanto o Nordeste apresentou uma taxa de crescimento de 6,6% ao ano, para ambos os sexos. Conclusao: Necessita-se do fortalecimento e ampliacao de medidas de promocao em saude com acoes preventivas, de diagnostico precoce e de tratamento do CCR focadas no rastreamento da populacao, principalmente a mais idosa. A realizacao e manutencao dessas acoes, a longo prazo, sao comprovadamente capazes de impactar, positivamente na reducao dos obitos por essa afeccao.

Evolução comparativa e temporal das tendências de mortalidade por Câncer Colorretal em Sergipe e Nordeste no período de 2008 a 2018 / Comparative and temporal evolution of Colorectal Cancer mortality trends in Sergipe and Northeast from 2008 to 2018

Purpose Compare and analyze the clinicopathological features and prognosis of 1315 patients with colorectal cancer located at different anatomical subsites. Methods A retrospective study was conducted to analyze the clinicopathological features and prognosis from 1315 patients with colorectal cancer who underwent surgery in the department of gastrointestinal surgery at the Second Affiliated Hospital of Dalian Medical University from January 2013 to January 2019. Among them, 287 patients were divided into the right-sided colon cancer (RCC) group; 329 patients were included into the left-sided colon cancer (LCC) group and the remaining 699 patients were assigned to the rectal cancer (RC) group. Clinicopathological features such as gender, age, pathological differentiation, neurovascular invasion, TNM stage, related tumor markers, maximum tumor diameter (MTD), median survival time and overall survival rate were extracted and analyzed. Results Patients in the RCC group had the oldest age of onset, highest positive rate of serum CA199 and greatest number of poorly differentiated adenocarcinomas among the three groups and significant statistical differences were found. The RC group had the highest positive rate of vascular invasion (42.9%) and the greatest number of patients in stage I and IV (19% and 3.9%, respectively). Besides, the number of patients with stage T1-T2 adenocarcinoma in RC group was also the highest among the three groups. There were no significant differences in gender, perineural invasion as well as serum levels of CEA, CA724 and CA242. The median survival time of RCC, LCC and RC were 72, 70 and 73 months, respectively, with significant inter-group differences (P = 0.049). Conclusion The age of onset of right-sided colon cancer is the oldest on average and poorly differentiated tumors accounted for the highest proportion. Besides, average maximum tumor diameter is the largest in right-sided colon cancer. In terms of median survival time, LCC is worse than RCC and RC. Colorectal cancer at different anatomical subsites has different epidemiological, clinicopathological features and prognosis. Fully understanding the clinicopathological features of colorectal cancer at different anatomical subsites is of certain guiding significance for the clinical diagnosis and treatment of colorectal cancer, and is conducive to individualized treatment and accurate treatment.

Analysis of clinicopathological features and prognosis of 1315 cases in colorectal cancer located at different anatomical subsites.

Background We retrospectively reviewed and consecutively collected the clinical data of distal gastric cancer patients who received surgical treatment, and we discuss the safety and feasibility of double layered end-to-end anastomosis with continuous manual suture to complete digestive tract reconstruction in totally laparoscopic distal gastrectomy. Methods We reviewed the clinical data of 41 patients with distal gastric cancer from the gastroenterology department of the Second Affiliated Hospital of Dalian Medical University, from September 2018 to August 2019, who underwent totally laparoscopic distal gastrectomy. During the operation, the method of double layered end-to-end anastomosis with continuous manual suture was used for Billroth type I anastomosis to complete digestive tract reconstruction. All patients have been given a follow-up visit and gastroscopy three months after the operation. The peri-operative clinical information and postoperative follow-up information were collected for analysis, and the clinical application value was evaluated. Results General information: male(n = 27), female(n = 14), age = 65.02(SD 9.94) years, and BMI = 23.52(SD 2.56) kg/m2, Tumor location: antrum(32,78.0%), angle (6,14.6%), and body (3,7.3%). Clinical stage: I (27, 65.9%), II (7, 17.1%), and III (7, 17.1%). Operative information: operation time = 154.51(SD 33.37) min, anastomosis time = 26.88(SD 5.11) min; intraoperative bleeding = 66.34(SD 48.81) ml; first postoperative ambulation Median = 1(IQR 0) d, first postoperative flatus Median = 3(IQR 2) d, first postoperative diet Median = 3(IQR 1) d, postoperative hospital stay Median = 7(IQR 2) d, and total hospitalization cost = 10,935.00(SD 2205.72)USD. Differentiation degree: high and high-moderate (3,7.32%), moderate and poor-moderate (24, 58.54%), poor differentiation (14, 34.15%), dissected lymph nodes Median = 31(IQR 17), and positive lymph nodes Median = 0(IQR 1). Pathological stage: IA (20, 48.78%), IB (3, 7.32%), IIA (4, 9.76%), IIB (5, 12.20%), IIIA (1, 2.44%), IIIB (3, 7.32%), and IIIC (5, 12.20%). Complications (n = 4): lung infection (1, 2.44%), anastomotic leakage (1, 2.44%), and gastroparesis (2, 4.88%). Conclusion It is safe and feasible in clinical treatment to apply the method of double layered end-to-end anastomosis with continuous manual suture to complete digestive tract reconstruction in totally laparoscopic distal gastrectomy.

/pdf/application-of-double-layered-end-to-end-anastomosis-with-4hf75rkfcy.pdf

Application of double layered end-to-end anastomosis with continuous manual suture for completing digestive tract reconstruction in totally laparoscopic distal gastrectomy.

Objective:To review the results of caloric test and the video head impulse test (vHIT) in a cohort of VM patients and assessed the value of each for predicting the prognosis in VM patients. Method:A retrospective analysis was performed on VM patients in our vertigo clinic, vestibular function were assessed by caloric test and vHIT at the initial visit and 6 months after treatment. Complete response (CR) was defined as no need for continued medication, uncomplete response (UR) as improved symptoms but need for continued medication, no symptomatic improvement. Result:At the initial evaluation, 15 of 75 (15.0%) exhibited abnormal caloric test results, 9 of 75 patients (12.0%) exhibited abnormal vHIT results. Six months later, 58 of 75 patients (77.3%) no longer required medication (CR), while 17 (22.7%）UR patients need for continued medication. The ratio of abnormal vHIT gain and abnormal caloric results were significantly different between group (CR) and group (UR) (P<0.05). Conclusion:Abnormal vHIT and caloric test results revealed semicircular canal dysfunction in VM patients, peripheral vestibular abnormalities are closely related to the development of vertigo in VM patients and predicted prolonged preventive medication and vestibular rehabilitation requirement.

[Vestibular function tests for vestibular migraine: clinical implication of video head impulse and caloric tests].

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Analysis of clinicopathological features and prognosis of 1315 cases in colorectal cancer located at different anatomical subsites.

Application of double layered end-to-end anastomosis with continuous manual suture for completing digestive tract reconstruction in totally laparoscopic distal gastrectomy.

[Vestibular function tests for vestibular migraine: clinical implication of video head impulse and caloric tests].