Benign paroxysmal positional vertigo (BPPV) is a peripheral vestibular disorder characterized by brief episodes of vertigo triggered by changes in head position. Pachyman, a bioactive polysaccharide derived from the medicinal mushroom Poria cocos (also known as Fu Ling), exhibits diverse biological activities and shows promising applications in pharmaceutical development and functional foods. This study aimed to explore the therapeutic potential of pachyman in BPPV progression. Slc26a4 loop/loop mutant mice were used to simulate the BPPV progression in vivo . The mice were orally administered of pachyman, injected with TLR2 overexpression vector and BAY-11-7082. The air righting reflex accuracy, contact righting reflex evaluation, time of contact righting reflex, and the scores of head tilt and swimming behavior were recorded. In addition, the TLR2 expression and NF-κB pathway were detected by RT-qPCR and western blot assays. Pachyman treatment increased the accuracy rate of contact righting reflex, decreased the time of contact righting reflex and the scores of head tilt and swimming behavior. TLR2 was increased in the BPPV patients and Slc26a4 loop/loop mutant mice, while pachyman treatment decreased it. In addition, TLR2 overexpression reversed the role of pachyman in Slc26a4 loop/loop mutant mice. Furthermore, TLR2 overexpression activated NF-κB pathway. After BAY-11-7082 treatment, the role of TLR2 overexpression vector in pachyman-treated Slc26a4 loop/loop mutant mice was reversed. Pachyman relieved the BPPV-related vestibular deficits in Slc26a4 loop/loop mutant mice through inhibiting the TLR2-mediated NF-κB pathway.

The Peking Opera hat-wing technique is an intangible cultural heritage. This study adopted a single-subject case study design to characterize the movements of this technique, facilitating its intergenerational preservation and transmission. Biomechanical analysis was conducted to investigate the left-wing toss movement in the hat-wing technique, aiming to reveal the intrinsic biomechanical mechanism of the movement and provide a basis for its inheritance and training. An infrared motion capture system was used to collect kinematic parameters of the markers, and a three-dimensional force platform was employed to gather force data from the actor's left and right feet. Three sets of data-including Center of Pressure (COP) position, head movement parameters, and knee joint angles-were analyzed to elucidate the operating mechanism of the left-wing toss movement. Based on the results, the left-wing toss movement was theoretically segmented, and the initiation principle of the movement was determined. Additionally, factors influencing the sustained movement of the left-wing toss and those required to achieve a relatively static state at the end of the movement were identified. The primary hypothesis was that the phase relationship between the L3 Z-axis displacement-time (L3 Z-T) curve and the head tilt angle-time (α-T) curve can effectively distinguish the initiation, maintenance, and termination stages of the left-wing toss movement. Quantitative analysis of five repeated trials showed high movement repeatability, with a coefficient of variation (CV) < 15% for all key kinematic metrics. Among them, the phase difference (CV = 6.0%) and peak angular velocity (CV = 10.6%) exhibited excellent repeatability (CV < 11%), and other indicators also met the repeatability requirements for single-subject case studies (CV < 15%). During the initiation stage, the peak head tilt angle reached 6° ± 0.8°, and the peak angular velocity was 29.3°/s ± 3.1°/s. Throughout the movement, the COP excursion in the anterior-posterior direction was 4.2 ± 0.5cm, and the medial-lateral excursion was 2.1 ± 0.3cm. These findings provide a scientific foundation for the standardized training and intergenerational preservation of the Peking Opera hat-wing technique, highlighting the value of biomechanical analysis in traditional performing arts heritage.

A male combat veteran in his late 40s presented with debilitating chronic neck pain, involuntary cervical muscle spasms, rightward head tilt and headaches occurring more than 15 days per month after cumulative cervical trauma from blast exposures and over 350 parachute jumps. He was diagnosed with post-traumatic cervical dystonia and treated with onabotulinumtoxinA injections to the procerus, bilateral corrugator, frontalis, temporalis, occipitalis, cervical paraspinal and upper and lower trapezius muscles. Ninety days after the first injection cycle he reported 85%-90% improvement in pain, spasms and headache frequency, with sustained 90% improvement across treatments. He experienced over 100 fewer headache hours and seven fewer headache days per month compared with baseline. Mild symptom recurrence during the final week of his 90-day interval led to adjustment to a 12-week schedule, resulting in improved consistency of relief. Botulinum toxin type A therapy provided substantial and consistent improvement in this case of post-traumatic cervical dystonia.

Introduction Residual lower pole fragments are a common limitation of ureteroscopy, yet the optimal patient positioning to minimize stone migration remains undefined. This study aimed to evaluate the impact of Trendelenburg (HeadTilt) and lateral body roll (BodyTilt) on stone migration within the kidney using physics-based simulation. Methods Three-dimensional collecting system models were generated from delayed-phase CT urograms using RadiAnt™. These hollowed models and an open-source stone model were imported into NVIDIA Isaac Sim™ (physics-based simulator). Stones were placed in the upper pole and subjected to gravity and a random contact force directed toward renal pelvis to simulate stone migration during laser fragmentation. Five angles (0°, 5°, 10°, 15°, 20°) of HeadTilt and BodyTilt, independently and in combination, were tested with 100 simulations per configuration to evaluate lower pole migration. Stone migration between sides was compared with a Mann-Whitney U test. Two-way ANOVA assessed HeadTilt and BodyTilt effects, with paired t-tests and Pearson correlation quantifying their impact. Results From 20 CTs, 20 left and 18 right collecting systems were extracted. Average lower pole migration was 14.0 ± 5.5 (left) vs. 13.2 ± 5.4 (right), with no significant difference (U = 120,568, p = 0.056). Two-way ANOVA revealed significant effects of HeadTilt (F = 929.99, p < 0.0001) and BodyTilt (F = 513.42, p < 0.0001), without interaction (p = 0.37). Paired t-test showed no difference between tilt types (p = 0.056). Increased HeadTilt and BodyTilt correlated with reduced lower pole migration (r = -0.744 and -0.552, p < 0.0001). Conclusion Simulation findings suggest combined head and body tilt can reduce stone migration to the lower pole but challenge the convention of one ideal angle. These adjustments may improve stone clearance during ureteroscopy.

Carrying backpacks daily imposes a physical burden on school-aged children, raising increasing public concern. This study compared the physiological responses and head–neck posture of primary school students when carrying traditional versus modified bags. Thirty-two public primary school students aged 7–12 years participated. Physiological measures included heart rate (HR), oxygen saturation (SpO₂), blood pressure, and respiratory rate (RR). Head and neck tilt angles and forward head posture were assessed using photogrammetry and Kinovea software. Participants walked at a natural pace (1.1–1.3 m/s) along an 8-meter walkway for five minutes under five conditions: no bag, bilateral traditional bag, unilateral traditional bag, bilateral modified bag, and unilateral modified bag. Backpack design showed significant main effects on heart rate (p = 0.001, ηp² = 0.316), respiratory rate (p = 0.007, ηp² = 0.214), systolic blood pressure (p < 0.001, ηp² = 0.387), and diastolic blood pressure (p = 0.002, ηp² = 0.279), with higher values in the traditional condition (e.g., HR 95.94 ± 2.26 bpm; RR 31.59 ± 0.86 breaths/min; systolic 108.33 ± 1.30 mmHg; diastolic 78.05 ± 1.64 mmHg). Carrying method affected HR (p = 0.014, ηp² = 0.178), with higher values during unilateral use. No interaction effects were found for physiological variables (p > 0.05). SpO₂ remained stable (98.78–99.47%). For posture, significant effects of design were observed for neck tilt (p < 0.001, ηp² = 0.350), head tilt (p = 0.001, ηp² = 0.324), and forward head posture (p < 0.001, ηp² = 0.335). The traditional backpack produced smaller neck tilt (49.75° ± 1.05°) but greater head tilt (78.60° ± 1.56°) and forward head posture (8.68 ± 4.59 cm). Unilateral carrying increased head tilt (77.83° ± 1.56°, p = 0.021). Interaction effects were found for neck and head tilt (p < 0.05). The modified backpack reduces physiological strain and improves postural alignment, particularly under unilateral carrying, while bilateral use minimizes asymmetrical loading.

Inhalation therapy is the main pharmaceutical treatment for patients with chronic obstructive pulmonary disease (COPD), but the improper selection and incorrect use of inhalation devices are widespread. The digital therapy comprehensive management platform (DT-CMP) has the potential to change this situation. The inspiratory capacity and inhalation techniques of 64 COPD patients were evaluated and trained by a DT-CMP. Moreover, 60 patients newly diagnosed with COPD and required (pressurized metered dose inhalers) pMDIs were recruited to compare the correct usage rates of inhalation devices after training through self-study based on the instructions, video teaching, and DT-CMP. Additionally, two cases of using DT-CMP for inhalation device training were described. The data indicated that peak inspiratory flow (PIF) decreased with the increase of internal resistance of inhalers and positively correlated with maximum inspiratory pressure (MIP), but no significant correlation with forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1% prediction and FEV1/FVC. Usage errors rate of initial evaluation of DPIs was 50%, and decreased to 16.67% after training of DT-CMP. Among these patients, 50% had insufficient effective inspiratory time, and 16.67% had insufficient inspiratory flow rate. Usage errors rate of initial evaluation of pMDIs was 75%, and decreased to 10% after training. Among these patients, 25% had hand and mouth incoordination, 70% had insufficient effective inhalation time. We also found the most frequency errors were 'sit up/stand straight & tilt head', 'breath out completely before inhalation', 'hold breath (for at least 5s)', followed by 'hold breath' and 'hand and mouth incoordination'. And the incidence of errors in the digital therapy group was significantly lower than that in self-study group and video teaching group. The assessment of combination of checklist with DT-CMP is more comprehensive and effective than the checklist alone for evaluation and training of inspiratory capacity and inhalation techniques. DT-CMP is expected to become an important tool for assessment and training of inspiratory capacity and inhalation technique.

Aberrant three-dimensional estimates of head motion and orientation are generated by the brain when the vestibular periphery is damaged.

This study aimed to investigate the application of MIMICS software in measuring femoral neck fracture (FNF) parameters and its clinical significance. Computed tomography data from 72 patients with FNFs were used to reconstruct three-dimensional (3D) models using MIMICS. The FNFs were divided into valgus and bowing groups based on the coronal femoral head-neck angle. A simulated sphere identified the center of the femoral head, and a 3D coordinate system was established. Statistical analyses were performed. The valgus group showed more lateral x-axis and upward z-axis displacement (both p < 0.01). The medial x-axis and downward z-axis displacement distances were larger in the bowing group (both p < 0.01). Strong positive correlations were found between the horizontal head tilt angle and head spacing, spatial head-neck angle and y-axis displacement distance (all rs > 0.89, p < 0.01). MIMICS-based FNF parameter measurement accurately describes spatial characteristics post-fracture, providing guidance for FNF treatment and evaluation.

Otitis is a major disease impacting both pet guinea pigs and laboratory guinea pigs that are used as models in human otological studies. Medical records from two veterinary clinics were retrospectively reviewed to identify guinea pigs diagnosed with computed tomography (CT)-confirmed otitis between 2014 and 2023. The clinical signs, treatment and bacteria isolatedin these cases were noted, and predisposing factors were identified. Thirty-six guinea pigs out of the 1477 seen at the clinics during the study period had otitis, giving a prevalence of 2.4%. The majority (61%) of guinea pigs had non-specific clinical signs, with 12 (33%) having respiratory signs and nine (25%) having dental disease. Only 14 animals (39%) had vestibular signs. Females were less likely to have otitis than males (odds ratio: 0.2). No age predilection was identified (age range 5-60 months). Animals with vestibular signs or respiratory signs had 21.8 and 9.5 times higher odds of having otitis, respectively. Treatment was divided into medical management or surgery and antibiotic therapy. No difference in survival times was observed regarding treatment received. Limitations of the study include the small number of animals and lack of repeat CT. Veterinarians should remember that otitis is a common disease in guinea pigs of all ages, with males being slightly more predisposed than females. Affected animals can have non-specific clinical signs, such as respiratory or dental disease. Head tilt is the most common vestibular sign.

Facial emotion recognition is essential for building smarter human–computer interfaces. This project introduces FeelTrack, a real-time emotion detection system powered by a lightweight custom CNN. Unlike earlier methods that used handcrafted features like LBP and HOG, which struggled with poor lighting or head tilts, our approach leverages deep learning for better accuracy and adaptability. To reduce dataset bias, the training set mixes FER2013 with an additional collection of Indian facial images. The model was trained on 35,887 FER2013 images and 3,200 custom Indian facial images, evaluated using an 80–20 train-test split helping the model adapt better across different demographics.With preprocessing (grayscale conversion, resizing, normalization), dropout layers, and an optimized architecture, FeelTrack achieves ~80% accuracy while processing frames in under 100 ms on standard hardware i.e. no GPU required. Tested live via webcam, it reliably detects seven emotions: happy, sad, angry, surprise, fear, disgust, and neutral. Ideal for classroom engagement tracking, mental health monitoring, and interactive systems, FeelTrack proves that practical, accessible emotion AI is within reach using efficient deep learning.

Background: Congenital muscular torticollis (CMT) is usually managed conservatively during infancy, whereas surgical treatment is considered for persistent deformity in older children. However, evidence remains limited regarding the outcomes of distal resection combined with proximal release of the sternocleidomastoid muscle in children presenting beyond infancy. This study aimed to evaluate the functional and cosmetic outcomes of this combined approach in patients aged 3 years and older. Methods: This retrospective single-surgeon series included 37 patients with CMT aged 3 to 14 years who underwent distal resection combined with proximal release of the sternocleidomastoid muscle between 2002 and 2024. Preoperative and postoperative assessments were performed using the clinical outcome framework originally described by Lee et al., goniometric measurement of cervical rotation and lateral flexion, and clinical evaluation of head tilt, facial asymmetry, scar appearance, lateral band formation, and sternocleidomastoid V-column contour. Patients were also analyzed according to age at surgery, as 3–10 years and 11–14 years. Results: The mean age at surgery was 4.7 years, and the mean follow-up duration was 3.4 years. Significant postoperative improvement was observed in all major functional outcomes. Mean cervical rotation improved from 54.2 ± 8.6° to 87.9 ± 3.4°, and mean lateral flexion improved from 24.1 ± 6.8° to 44.5 ± 3.2° (both p < 0.001). Preoperative functional assessment scores averaged 6.8 ± 1.4, whereas postoperative total outcome scores averaged 14.2 ± 0.9. At final follow-up, no patient had residual head tilt. Mild residual facial asymmetry persisted in 3 patients (8.1%). Overall, postoperative outcomes were rated as excellent in 33 patients (89.2%) and good in 4 patients (10.8%). A slight partial loss of the sternocleidomastoid V-column contour was observed in 34 patients (91.9%), although this finding was not documented as a major cosmetic concern in the available clinical records. Hypertrophic scarring developed in 1 patient (2.7%). No lateral band formation, recurrence, revision surgery, infection, or hematoma was observed. Conclusions: Distal resection combined with proximal release provided favorable functional and cosmetic outcomes in children older than 3 years with CMT. The technique was associated with marked improvement in cervical motion, correction of head tilt, low complication rates, and a high proportion of excellent or good results.

Background and Aim: Patients with Chronic Otitis Media (COM) who undergo mastoidectomy sometimes experience imbalance, dizziness, and vertigo after the surgery. This study aimed to investigate the effects of mastoidectomy on the balance of patients with COM using standard and advanced balance tests. Methods: The study was conducted in 2024 in Imam Reza and Ghaem Hospital affiliated with Mashhad University of Medical Sciences, Mashhad, Iran. Forty patients scheduled for mastoidectomy were enrolled over a 12-month period using a census method. Patients underwent balance tests before and after surgery. These tests included the video Head Impulse Test (vHIT), Subjective Visual Vertical (SVV), and posturography. Results: Statistical analysis of the performance parameter under linear or sinusoidal plate movement conditions showed no significant difference before and after the surgery (p&gt;0.05). Statistical analysis of the gain in the six semicircular canals in the vHIT test also showed no significant difference before and after the surgery (p&gt;0.05). Similarly, statistical analysis of the deviation from the norm in the neutral position, –30° head tilt to the right, and –30° head tilt to the left showed no significant difference before and after the surgery (p&gt;0.05). Conclusion: The results of this study showed that mastoidectomy does not have a significant effect on balance tests, so performing it may not lead to severe balance disorders in patients with chronic otitis media who are candidates for mastoidectomy surgery.

Introduction: I-gel®, a second-generation supraglottic airway device with a soft, anatomically shaped cuff, which produces an airway seal without the need for air inflation. Distinctive features of the paediatric airway may interfere with ideal insertion of Supraglottic Airway Devices (SADs). Therefore, it is important to recognise the most effective technique for I-gel® placement in paediatric patients to minimise airway-related complications. Aim: To compare the triple airway manoeuvre and reverse insertion technique for I-gel® placement in paediatric patients under general anaesthesia. Materials and Methods: This single blinded, Randomised Controlled Trial (RCT) was conducted at Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana, India, over a period of 14 months from July 2023 to September 2024 in 100 paediatric patients (7-12 years), American Society of Anaesthesiologists-Physical Status (ASA-PS) grade I and II of either gender planned for elective surgery. Randomisation was performed into two groups using a computer-generated random number table, with 50 patients in each group. In Group R, I-gel® placement was done using the reverse insertion technique (n=50) and in Group TAM, I-gel® was placed using the triple airway manouvre, i.e. head tilt, jaw thrust, mouth open (n=50). Mean insertion time was measured as the primary outcome. Other parameters studied were the number of attempts, overall success rate, ease of I-gel® insertion, ease of nasogastric tube insertion and postoperative complications. Wilcoxon-Mann-Whitney U test, Chi-squared test, Fisher’sexact test were used to analyse data. A p-value &lt;0.05 was considered statistically significant. Results: The demographic profile of all 100 patients was comparable in both groups, based on age, gender, Body Mass Index (BMI) and ASA-PS classification. The mean±SD of insertion time in group R was 18.65±8.07 sec and in group TAM was 16.84±6.93 sec. The device was successfully placed on the first attempt in 90% of patients in group R compared with 84% in group TAM. The overall success rate was 100% in both groups. Conclusion: TAM and reverse insertion techniques of I-gel® placement were comparable clinically. The experience of the investigator with the technique should determine the choice of technique.

The objective of this study was to evaluate the mid- to long-term outcomes of surgical treatment for middle ear cholesteatoma in French bulldogs. A retrospective case series was conducted, reviewing medical records of 18 French bulldogs (20 ears) diagnosed with cholesteatoma and treated surgically from 2018 to 2023. Clinical presentation, imaging findings, surgical approach, histopathological and microbiological results, postoperative complications, and long-term outcomes, assessed through telephone follow-ups, were analyzed. The most common clinical signs were head tilt (80%) and facial nerve deficits (70%). Otitis media was present in all cases and magnetic resonance imaging (MRI) was the primary imaging modality for initial diagnosis (90%). All dogs underwent either subtotal or standard ear canal ablation-lateral bulla osteotomy (TECA-LBO). Staphylococcus pseudintermedius was the most frequently isolated pathogen in positive cultures (85%). Long-term follow-ups showed clinical improvement in all cases, with complete recovery in 40% and a recurrence in 10% of treated ears. These findings suggest that dogs undergoing surgical treatment for aural cholesteatoma experience long-term clinical improvement, although recurrence and persistent clinical signs remain possible.

The mammalian inner ear is traditionally divided into two systems: the peripheral vestibular system (for balance) and the cochlea (for hearing). This bipartite model has shaped our understanding of inner ear evolution, function, and pathology. However, it groups the semicircular ducts (which detect angular velocity) and otolithic organs (which detect linear acceleration, vibration, and head tilt) into a single peripheral vestibular system, overlooking key differences in their structure and function. Using advances in imaging technology, we investigate whether the otolithic system is evolutionarily and structurally distinct from the semicircular ducts, with a focus on primates. Specifically, we assess modularity and phylogenetic signal in the inner ear across 14 primate species using landmark-based 3D geometric morphometrics within a phylogenetic framework. Our results reveal previously unrecognized modularity in the primate peripheral vestibular system. The semicircular canals and otolithic organs show stronger integration within their own structures rather than with each other. Furthermore, these two systems show divergent evolutionary trajectories in both size and shape, particularly among hominoids. These findings challenge the traditional bipartite model of the inner ear. Instead, a tripartite framework comprising distinct cochlear, canalicular, and otolithic systems better reflects the structural, functional, and evolutionary complexity of the primate inner ear. This revised model reshapes perspectives on vestibular system organization and has implications for studies on balance, sensory adaptation, and inner ear disorders.

Background/Objectives: Cone beam computed tomography (CBCT) is vital in endodontics but suffers from beam-hardening artifacts caused by metallic restorations, which can obscure diagnostic details. This study evaluated a novel patient positioning protocol—a controlled head tilt—designed to mitigate these artifacts by moving contralateral metallic structures outside the primary X-ray path in small field of view (FoV) CBCTs. Methods: Using a skull phantom with metallic restorations CBCT scans were acquired in three positions: standard alignment, a 12° tilt toward the region of interest (ROI), and a 12° tilt to the opposite side. Fifty experienced dentists, blinded to the protocol, subjectively compared image quality and artifact severity between the tilted and reference images. Results: The tilt away from the ROI was rated as providing better image quality significantly more often than the tilt towards the side of the ROI (442 of 585 non-tied comparisons; p &lt; 0.001). A complementary rater-clustered GEE analysis adjusted for slide confirmed higher odds of “better” ratings under head tilt away from the ROI for image quality (OR = 4.16, 95% CI 3.12–5.56) and artefacts (OR = 2.87, 95% CI 1.93–4.26). An individual head tilt significantly improves subjective small-FoV CBCT image quality, most evidently in the longitudinal plane, by reducing artifact interference from contralateral metals, and should be considered a practical strategy for clinical use, and may serve as a practical chairside strategy, pending clinical validation.

Background Persistent postural–perceptual dizziness (PPPD) and motion sickness (MS) are associated with disturbances in spatial orientation related to altered multisensory integration. Impaired perception of upright orientation during head tilt may therefore occur in these conditions. Subjective visual vertical (SVV) and subjective visual horizontal (SVH) testing under head-tilted conditions provide quantitative measures of such perceptual errors. We hypothesized that headtilt–induced perceptual errors would be associated with PPPD and with susceptibility to clinically significant MS during non-driving tasks. Methods 80 participants were enrolled: 27 healthy controls, 36 individuals with high Motion Sickness Susceptibility Questionnaire scores who reported MS during real-world driving, and 17 patients with PPPD diagnosed according to the Bárány Society criteria. SVV and SVH were measured at ±30° and ±60° head-roll tilts in a virtual environment. Perceptual error was defined as the signed deviation from the true vertical or horizontal orientation. Diagnostic accuracy was assessed using receiver operating characteristic analysis. Results SVV and SVH errors under head-tilt conditions differed significantly between groups, with healthy controls showing contraversive deviations and both individuals with high-MS and patients with PPPD exhibiting ipsiversive deviations, particularly at ±60° roll tilts, whereas errors in the upright (0°) position were negligible. Several tilt conditions demonstrated excellent diagnostic accuracy (AUC ≥ 0.90). Real-world MS severity correlated with ipsiversive SVV errors but not with questionnaire-based susceptibility scores. Conclusions Based on the present findings, further methodological refinement may allow head-tilt SVV/SVH testing to serve as a rapid and sensitive tool for detecting perceptual alterations underlying functional dizziness, with translational potential for MS risk screening in future autonomous vehicle environments.

BackgroundMotion sickness (MS) occurs when the brain receives conflicting signals about body movement from the visual, vestibular, and proprioceptive systems. The otolith organs play a key role in perceiving verticality, and their function may be influenced by MS susceptibility.ObjectiveThis study aimed to investigate the effect of MS susceptibility on otolith-mediated verticality perception across different head positions.MethodsForty-seven participants were classified into two groups based on the Motion Sickness Susceptibility Questionnaire-Short Form (MSSQ-SF): an MS group (n = 24) and a control group (n = 23). All participants completed static Subjective Visual Vertical (SVV), dynamic Subjective Visual Vertical (DVV), and Rod-and-Frame Test (RFT) using a virtual reality system. Measurements were conducted in three head tilt (upright, 30° left, 30° right). The absolute deviation from true vertical was calculated for each test.ResultsWhile no significant differences were found in SVV performance between groups across head-tilt angles, the MS group exhibited significantly greater deviations in DVV at all positions and in RFT during 30° head tilts. Higher MSSQ scores correlated with greater deviations in DVV and RFT under tilt conditions.ConclusionsAlthough static verticality perception remains intact, individuals with MS exhibit greater deviations under dynamic and visually misleading conditions, suggesting subtle vestibular-perceptual deficits.

Purpose: To identify and report such rare entity and keep special concern to manage such case. Method: It is a prospective study. We hereby reviewed six cases of this rare entity selected from pediatric outpatient department of Ispahani Islamia Eye Institute &amp; hospital since January ’2019- December’2019. Selected patients underwent detailed history taking, cyclo refraction, slit lamp examination, orthoptic evaluation, fundoscopy and nystagmus evaluation. Result: Average age of presentation was 8+/-2 years. Aided visual acuity of two patients was (3/60-6/60), three (6/60-6/24), one (6/24-6/12). Four patients had positive family history of high myopia. On slit lamp examination revealed deep anterior chamber. One case showed normal fundus where remaining fives had characteristic myopic fundus. Four were associated with jerky nystagmus. Three of them had right beating and one left beating nystagmus. Head tilt was present in one patient. Ocular motility was free for two cases whereas restricted in variable degree in four cases may be due to herniation of progressive enlarging myopic globe supero temporally and retro equatorially through muscle cone. Conclusion: Understanding the different spectrum of presentation of high myopic patient facilitates early diagnosis, rehabilitation and management of such patient. J.Natl.Inst.Ophthalmol.2024;7(2): 71-75

Abstract The European standard EN 149:2001+A1:2009 specifies tests for filtering respiratory protective equipment (RPE). One of them is the total inward leakage (TIL) test designed to assess the fit of RPE and its performance in providing protection against harmful airborne particles and dust. The test is typically conducted using a sodium chloride aerosol with a mass median aerodynamic diameter of 0.6 µm. The objective of this study was to conduct TIL tests for the evaluation of the performance of high-quality filtering RPE against an aerosol containing reduced graphene oxide particles, considering the nanometric scale and varied shapes of these particles, and with particular attention to adequate fit. TIL was measured for four types of FFP2 respirators as well as four types of FFP3 respirators of various designs using a head-and-torso dummy that simulated a sequence of human movements consisting of head rotation (right-to-left), head tilt (up-and-down), and speech, followed by a rest period. TIL measurements followed a fit test performed using a PortaCount system (TSI, Inc., St. Paul, MN) and lasted 10 min in accordance with the exercise protocol specified in the standard EN 149. Analysis involved only particles no larger than 100 nm. The results showed that high-quality FFP3 respirators provide the highest level of protection, with an average TIL value of 0.75%. The study offers new insights into the appropriate fit and design of filtering facepiece respirators and contributes to minimizing the risk of leakage. It also demonstrates that the fit factor and filtering effectiveness influence measurements and TIL results for respirators challenged with a reduced graphene oxide aerosol. Graphical abstract