Serum Estradiol Correlates With Benign Paroxysmal Positional Vertigo in Postmenopausal Women

BackgroundA high incidence of benign paroxysmal positional vertigo (BPPV) is reported in postmenopausal women, and the association between estradiol (E2) deficiency and the occurrence of BPPV was investigated.MethodsPostmenopausal women with and without BPPV were included from 2016 to 2019, and 1-year follow-up was performed. Serum otolin-1 and E2 levels were assayed before the canalith repositioning treatment. Bone mineral density (BMD) was measured with a dual-energy x-ray absorptiometry scan. Receiver operating characteristic analysis was performed to determine the occurrence of BPPV, and Pearson analysis was performed to indicate the correlation between E2, otolin-1, and BMD.ResultsEighty-six postmenopausal women with BPPV and 80 age-, demographics-, and clinical characteristics-matched normal postmenopausal women were enrolled. Decreased E2 levels, increased otolin-1 levels, and decreased BMD were observed in postmenopausal women with BPPV, and increased BMD and decreased otolin-1 levels were observed in patients with higher levels of serum E2. Receiver operating characteristic analysis revealed that E2, otolin-1, and BMD showed low sensitivity and moderate specificity to determine the occurrence of BPPV. On the other hand, a low correlation coefficient was found between E2 and otolin-1, or BMD. It is worth noting that low E2 levels were found in the relapsed patients with BPPV after a 1-year follow-up.ConclusionE2 deficiency is correlated with the occurrence of BPPV, which may be a potential risk biomarker for postmenopausal women.     

Impact of Postmaneuver Sleep Position on Recurrence of Benign Paroxysmal Positional Vertigo

Background

The necessity of postural restriction to patients suffering from benign paroxysmal positional vertigo is controversial.

Objective

To investigate the impact of the sleep position after the repositioning maneuver on BPPV recurrence.

Methods

150 unilateral BPPV patients who were treated by repositioning maneuver were distributed into two groups. The patients in group A were instructed to sleep in a semi-sitting position at an angle of approximately 30 degrees and refrain from sleeping on their BPPV affected side for one week. The patients in group B were told to sleep in any preferred position. The comparison of recurrence rates according to different actual sleep positions in one week and one month was performed.

Results

There was a statistically significant correlation between the sleeping side and the side affected by BPPV. Without instructions on postural restriction, most patients (82.9%, 73/88) avoided sleeping on their affected side. The patients sleeping on their affected side had a higher recurrence rate (35.3%) than ones sleeping in other positions in the first week after the repositioning maneuver (p<0.05, Chi-square test and Fisher''s exact test). The patients sleeping randomly in following 3 weeks had a lower recurrence rate than ones sleeping in other position (p<0.05, Fisher''s exact test).

Conclusions

BPPV patients had a poor compliance to postural instructions. The habitual sleep side was associated with the side affected by BPPV. The patients sleeping on their affected side had a higher recurrence rate than those sleeping in other positions in first week after the repositioning maneuver.     

Benign Paroxysmal Positional Vertigo after Dental Procedures: A Population-Based Case-Control Study

BackgroundBenign paroxysmal positional vertigo (BPPV), the most common type of vertigo in the general population, is thought to be caused by dislodgement of otoliths from otolithic organs into the semicircular canals. In most cases, however, the cause behind the otolith dislodgement is unknown. Dental procedures, one of the most common medical treatments, are considered to be a possible cause of BPPV, although this has yet to be proven. This study is the first nationwide population-based case-control study conducted to investigate the correlation between BPPV and dental manipulation.MethodsPatients diagnosed with BPPV between January 1, 2007 and December 31, 2012 were recruited from the National Health Insurance Research Database in Taiwan. We further identified those who had undergone dental procedures within 1 month and within 3 months before the first diagnosis date of BPPV. We also identified the comorbidities of the patients with BPPV, including head trauma, osteoporosis, migraine, hypertension, diabetes, hyperlipidemia and stroke. These variables were then compared to those in age- and gender-matched controls.ResultsIn total, 768 patients with BPPV and 1536 age- and gender-matched controls were recruited. In the BPPV group, 9.2% of the patients had undergone dental procedures within 1 month before the diagnosis of BPPV. In contrast, only 5.5% of the controls had undergone dental treatment within 1 month before the date at which they were identified (P = 0.001). After adjustments for demographic factors and comorbidities, recent exposure to dental procedures was positively associated with BPPV (adjusted odds ratio 1.77; 95% confidence interval 1.27–2.47). This association was still significant if we expanded the time period from 1 month to 3 months (adjusted odds ratio 1.77; 95% confidence interval 1.39–2.26).ConclusionsOur results demonstrated a correlation between dental procedures and BPPV. The specialists who treat patients with BPPV should consider dental procedures to be a risk factor, and dentists should recognize BPPV as a possible complication of dental treatment.     

Performance of DHI Score as a Predictor of Benign Paroxysmal Positional Vertigo in Geriatric Patients with Dizziness/Vertigo: A Cross-Sectional Study

Background

Dizziness/vertigo is one of the most common complaint and handicapping condition among patients aged 65 years and older (Geriatric patients). This study was conducted to assess the impact of dizziness/vertigo on the quality of life in the geriatric patients attending a geriatric outpatient clinic.

Settings and Design

A cross-sectional study was performed in a geriatric outpatient clinic of a rural teaching tertiary care hospital in central India.

Materials and Methods

In all consecutive geriatric patients with dizziness/vertigo attending geriatric outpatient clinic, DHI questionnaire was applied to assess the impact of dizziness/vertigo and dizziness associated handicap in the three areas of a patients’ life: physical, functional and emotional domain. Later, each patient was evaluated and underwent Dix-Hallpike maneuver by the physician who was blind of the DHI scoring of the patient.

Statistical Analysis Used

We compared means and proportions of variables across two categories of benign paroxysmal positional vertigo (BPPV) and non-BPPV. For these comparisons we used Student’s t-test to test for continuous variables, chi-square test for categorical variables and Fisher’s exact test in the case of small cell sizes (expected value<5).

Results

The magnitude of dizziness/vertigo was 3%. Of the 88 dizziness/vertigo patients, 19 (22%) and 69(78%) cases, respectively, were attributed to BPPV and non-BPPV group. The association of DHI score ≥50 with the BPPV was found to be statistically significant with x² value = 58.2 at P<0.01.

Conclusion

DHI Score is a useful tool for the prediction of benign paroxysmal positional vertigo. Correct diagnosis of BPPV is 16 times greater if the DHI Score is greater than or equal to 50. The physical, functional and emotional investigation of dizziness, through the DHI, has demonstrated to be a valuable and useful instrument in the clinical routine.     

改良Gufoni法应用于向地眼震型水平半规管良性阵发性位置性眩晕的临床研究

摘要 目的：比较分析向地眼震型水平半规管良性阵发性位置性眩晕（HC-BPPV）患者应用改良Gufoni法与传统Gufoni法的临床疗效。方法：将2017年1月1日至2021年6月30日收治的84例确诊的原发性向地眼震型水平规管良性阵发性位置性眩晕的患者随机分为改良组（42例）和对照组（40例）,改良组予以传统Gufoni法联合向健侧甩头复位,对照组予以传统Gufoni法复位,评定两组疗效（观察首次复位30 min、1 d后的疗效,若复位未成功,继续给予相同的手法复位,但复位次数不能超过3次,复位30分钟后对复位效果进行观察）;同时观察复位成功后的残留症状。结果：1.改良组的首次复位成功有38例（90.5%）高于对照组24例（57.2%）,两组差异有统计学意义（x²=12.07,P=0.001）。经过3次复位,改良组有41例（97.6%）复位成功,对照组复位成功的有36例（85.7%）,两组整体复位成功率比较差异有统计学意义（x²=3.896,P=0.048）。改良组复位成功所需循环次数少于传统组,两组差异有统计学意义（Z=2.071,P=0.047）。2.改良组复位成功后有残余症状的患者占比例为21.4%（9/42）,显著低于对照组42.9%（18/42）,2组患者之间的差别具有统计学意义（x²=4.421,P=0.035）。改良组的患者中同时出现2种残余症状的比例为4.8%（2/42）,低于传统组19.1%（8/42）,2组之间的差异有统计学意义（x²=4.086,P=0.043）。结论：改良Gufoni法较传统Gufoni法提高了首次复位、总复位成功率,减少了复位成功所需循环次数,而且减少了残留症状的发生率。     

Positional Information and Positional Signalling in Hydra

A model is proposed for regulation and regeneration of the headend of hydra in terms of positional information, which involvestwo gradients. One is a diffusible substance made at the headend, which may be regarded as a positional signal. The otheris a more stable cellular parameter which is the positionalvalue. The rule for head end formation is that the concentrationof the diffusible substance falls a threshold amount below thepositional value. This model, for which some computer simulationis provided, can account for head end formation in a wide varietyof grafts. Evidence for a diffusable signal is provided by experimentsin which the time/distance relationships for head inhibitionby a grafted head are determined. Changes in positional valueduring regulation have been assayed and are much slower awayfrom the boundary. Polarity is interpreted in terms of the interactionbetween the two gradients. The biochemical basis of the gradientsis not known, but an approach to the problem has been made bytreating hydra with a variety of chemical agents.     

Stereotypical Gender-Based Emotions Are Not Detectable in Dream Reports

This study reports on the number of feelings evoked in men and women by their dream characters as well as on the relative frequency of different kinds of feelings. Thirty-five subjects recorded 320 dreams over a two-week period, submitted dream reports and a dream log of all characters that appeared in their dreams as well as any feelings involving the characters. We found that feelings were pervasive in dreams and that they were evoked by over 80% of a subject's dream characters. Further, negative and positive emotions were balanced for both men and women. We found no significant differences in the number or in the profile of feelings in men and women's dreams. The reasons for this are discussed in terms of a continuity hypothesis across dream and wake states or, on the contrary, that feelings expressed in dreams may be independent of learned gender differences.     

Positional behavior in the Hominoidea

Quantitative studies on the positional behavior of members of the Hominoidea are compared in order (1) to identify consistencies across the superfamily, (2) to contrast ape positional behavior with that of Old World monkeys (forest-livingPapio anubis were chosen for study to reduce body size effects), and (3) to identify distinctive behaviors in each of the ape taxa. Differences in the way behaviors were sampled in the various studies necessitated considering posture and locomotion separately. Unimanual arm-hanging and vertical climbing were the most distinctive shared postural and locomotor modes among the apes (the gorilla excepted), constituting ≥5.0% and ≥4.9% of all behavior in each species. Arm-hanging and brachiation (sensu stricto) frequencies were the highest by far in hylobatids. Hand-foot hanging, bipedal posture, and clambering, an orthograde suspensory locomotion assisted by the hindlimbs, were more common in orangutans than in any other hominoid. Sitting and walking were observed in the highest frequencies in the African apes but were no more common than in the baboon. Relatively high frequencies of brachiation (sensu stricto) were reported for all apes except chimpanzees and gorillas. Brachiation and arm-hanging were kinematically different in apes and baboons, involving complete humeral abduction only in the former, whereas vertical climbing appeared to be kinematically similar in apes and baboons. It is concluded that the morphological specializations of the apes may be adaptations to (1) the unique physical demands of arm-hanging and (2) less kinematically distinct, but still quantitatively significant, frequencies of vertical climbing.     

Positional information in unicellular organisms

Two different and experimentally distinguishable developmental principles govern the organization of the cell surface of ciliated protozoa. One is structural guidance, defined as the positioning and orientation of new organelles under the localized influence of neighboring preformed organelles. This mechanism exerts short-range control over the orientation and number of the ciliary rows that extend longitudinally over the cell surface. The second principle is that of positional control, probably by gradient-fields, according to which local properties are defined by their geometrical relations to certain special regions (boundary zones). This principle must be invoked to explain the placement of organelle systems, such as buccal structures, groups of cirri, and contractile vacuole pores, that develop anew in each cell generation. A review of experimental studies on positioning of organelle systems in diverse ciliates reveals that the properties of these positional systems show remarkable similarities to “positional information” (Wolpert, 1969, 1971) as analyzed in multicellular organisms such as hydroids and insects. The similarities render plausible the possibility that positional information might be homologous in unicellular and multicellular systems. If this is so, then attributes of cellularity such as compartmentalization and localization of genomes may not be fundamental to the generation of positional information, nor perhaps even to the initial steps in the interpretation of this information.     

Positional Information,Positional Error,and Readout Precision in Morphogenesis: A Mathematical Framework

The concept of positional information is central to our understanding of how cells determine their location in a multicellular structure and thereby their developmental fates. Nevertheless, positional information has neither been defined mathematically nor quantified in a principled way. Here we provide an information-theoretic definition in the context of developmental gene expression patterns and examine the features of expression patterns that affect positional information quantitatively. We connect positional information with the concept of positional error and develop tools to directly measure information and error from experimental data. We illustrate our framework for the case of gap gene expression patterns in the early Drosophila embryo and show how information that is distributed among only four genes is sufficient to determine developmental fates with nearly single-cell resolution. Our approach can be generalized to a variety of different model systems; procedures and examples are discussed in detail.     

Positional information in cells and organisms

The processes of pattern formation are usually considered to be quite different in unicellular and multicellular organisms. The only unifying ideas have been very general, such as those concerning regional differences and organization along a polar axis. Concepts like induction, fields and gradients have generally been applied only to the development of multicellular organisms. Here, Joseph Frankel suggests that pattern formation by multicellular organisms evolved in their progenitors in response to multiplication of cytoplasmic structural units rather than of nuclei. Ciliates provide a living example of complex patterning in a compound uninucleate organism.