Video Head Impulse Test (vHIT): Value of Gain and Refixation Saccades in Unilateral Vestibular Neuritis

The aim of this study was to evaluate gain and refixation saccades (covert and overt) using a video head impulse test (vHIT) in the horizontal and vertical planes in patients after the onset of unilateral acute vestibular neuritis (AVN). Thirty-five patients were examined in the acute stage of AVN and at follow-up (range, 6–30 months); a control group of 32 healthy subjects also participated. At onset, the mean gain was significantly lower on the affected side in all of the semi-circular canal planes, mainly in the horizontal canal plane, and saccades (covert and overt) were more prevalent in the horizontal compared to the vertical canal planes. Multi-canal affection occurred more frequently (80% for gain, 71% for saccades) than isolated canal affection. At follow-up, which ranged from 6 to 30 months, the gain was recovered in all of the canals (anterior in 50%, horizontal in 42.8%, and posterior canal in 41.1% of cases), while covert and overt saccades were reduced in the horizontal and vertical planes. However, covert saccades were still recorded in a greater proportion (69%) than overt saccades (57%) in the horizontal plane and at a lower rate in the vertical planes. The compensatory mechanisms after AVN mainly involve the horizontal canal, as the refixation saccades—especially covert ones—were more frequently recorded in the horizontal than vertical canals

Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo. A Clinical Review

Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular dysfunctions encountered in clinical practice. Although the treatment of BPPV is relatively successful, many patients develop recurrence after treatment. Our purpose is to evaluate the mean recurrence rate and risk factors of BPPV after treatment. A review of the literature on the risk factors of BPPV recurrence was performed. A thorough search was conducted using electronic databases, namely Pubmed, CINAHL, Academic Search Complete and Scopus for studies published from 2000 to 2020. Thirty studies were included in this review with 13,358 participants. The recurrence rate of BPPV ranged from 13.7% to 48% for studies with follow-up <1 year, and from 13.3% to 65% for studies with follow-up ≥2 years. Pathophysiologic mechanisms and implication of each of the following risk factors in the recurrence of BPPV were described: advanced age, female gender, Meniere’s disease, trauma, osteopenia or osteoporosis, vitamin D deficiency, diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, migraine, bilateral/multicanal BPPV, cervical osteoarthrosis and sleep disorders. Patients with hyperlipidemia and hypertension had the highest recurrence rates of BPPV, 67.80% and 55.89%, respectively, indicating that vascular comorbidities increase the risk of BPPV recurrence. In addition, more than half of patients (53.48%) with diabetes mellitus and BPPV experienced recurrence of BPPV. Knowledge and awareness of risk factors for recurrence of BPPV are essential for the assessment and long-term prognosis of patients. Identification of these relapse risk factors may enhance the ability of clinicians to accurately counsel patients regarding BPPV and associated comorbidities

Correlations between clinicopathological variables and IGF1R-alpha cytoplasmic/membraneous immunohistochemical expression.

<p>Correlations between clinicopathological variables and IGF1R-alpha cytoplasmic/membraneous immunohistochemical expression.</p

REMARK Flow Chart.

<p>REMARK Flow Chart.</p

Clinicopathological characteristics.

<p>Clinicopathological characteristics.</p

Forest plot illustration of the multivariate analysis of predictors for DFS (Panel A) and OS (Panel B) in operable laryngeal cancer.

<p>Forest plot illustration of the multivariate analysis of predictors for DFS (Panel A) and OS (Panel B) in operable laryngeal cancer.</p

Kaplan- Meier Curves for overall survival (OS) and disease-free survival (DFS) according to IGF1R-alpha cytoplasm or membrane immunohistochemical expression (Median immunoreactive sore for IGF1R-alpha = 3).

<p>Kaplan- Meier Curves for overall survival (OS) and disease-free survival (DFS) according to IGF1R-alpha cytoplasm or membrane immunohistochemical expression (Median immunoreactive sore for IGF1R-alpha = 3).</p

Illustrative examples of immunohistochemical expression and immunoreactive score (IRS) evaluation on tissue-microarray cores.

<p>A. IGF1R-alpha strong membraneous staining in 100% of cancer cells (IRS = 9); B. IGF1R-beta strong cytoplasmic staining in 80% of cancer cells (IRS = 9); C. IGF2R strong cytoplasmic and membraneous staining in 80% of cancer cells (IRS = 9). All pictures: magnification X 40.</p

Kaplan- Meier Curves for disease-free survival (DFS) and overall survival (OS) according to the number of negative prognostic factors from the multivariate analysis (blue line: 1–2 factors; red line: 3 factors; green line: 4 or more factors).

<p>Kaplan- Meier Curves for disease-free survival (DFS) and overall survival (OS) according to the number of negative prognostic factors from the multivariate analysis (blue line: 1–2 factors; red line: 3 factors; green line: 4 or more factors).</p