Background: Dizziness, one of the most common neurologic symptoms, is difficult to assess objectively due to a lack of standardized stimulus materials and assessment scenarios. Nonstructural dizziness is often difficult to diagnose due to the lack of an objective diagnostic basis. Objective: In this study, we developed a standardized picture system to trigger dizziness and assess dizziness severity. Methods: First, we identified the pictures through documentaries and computer post-production to extract each picture's objective features and determined the most representative objective features affecting dizziness. The subjective features of each picture were scored by healthy participants. Then, we screened 100 pictures with an even distribution of dizziness scores and used them to assess dizziness severity and optimize the assessment model. Results: The results showed that standard deviation (std), blurriness (blur), frequency skewness of horizontal direction (skew_h), and frequency skewness of vertical direction (skew_v) were representative objective features of the dizziness pictures, of which skew_h and skew_v were negatively correlated with the degree of dizziness. The above 100 pictures were scored by patients with dizziness. The average deviation value of dizziness was positively correlated with the Visual Vertigo Analogue Scale (VVAS) scores (r = 0.267, p < 0.05). The Generalized Anxiety Disorder-7(GAD-7) scores optimized the assessment model and affected the relationship between the average deviation value of dizziness and the VVAS scores. Conclusions: This standardized dizziness picture system will help clinicians and researchers to consistently and accurately assess dizziness and assist in objective diagnosis. It also provides reliable experimental materials to study pathogenesis and interventions in dizziness, especially nonstructural dizziness.

This study aimed to assess the efficacy and safety of low-dose combinations (LDCs) of 3 or 4 blood-pressure (BP) lowering drugs in people with untreated hypertension. This was an updated systematic review and meta-analysis of randomised clinical trials comparing LDC to placebo, monotherapy and dual therapy in people on no background antihypertensive therapy. We identified 12 randomised clinical trials consisting of 4733 untreated patients (average age 55 ± 7 years with 57% women). Comparing LDC to placebo, the mean (95% CI) systolic blood pressure (SBP) difference was -13.1 (-17.6, -8.6, p < 0.001) mmHg and DBP difference was -6.3 (-9.3,-3.3, p < 0.001) mmHg at first follow-up (4-12 weeks). Compared to monotherapy, the mean difference in SBP was -3.4 (0.8, -7.6, p < 0.116) mmHg whilst mean difference in DBP was -1.4 (-5.8, 3.0 p < 0.001) mmHg. There was no significant difference in BP change between LDC and dual therapy. The proportion of patients reaching BP < 140/90 mmHg was significantly higher with LDC than placebo (RR 1.42, 95% CI, 1.62-3.62, p < 0,001) and monotherapy (RR 1.23, 1.08-1.39, p = 0.002) but not with dual therapy (RR 1.25, 0.97-1.60, p = 0.08). There was no difference in rates of treatment withdrawal or serious adverse events, but there was more dizziness reported with LDC vs control (RR 3.79, 95% CI 1.10-13.01, p = 0.03) and less headaches (RR 0.33, 95% CI, 0.14, 0.78, p = 0.001. Study heterogeneity was significant in all comparisons. LDCs of three of four BP lowering drugs appear to be highly effective and well tolerated in people on no background antihypertensives, highlighting the potential for LDCs as a first line agent in hypertension.

Dieulafoy's lesion and gastrointestinal stromal tumors (GISTs) are uncommon causes of upper gastrointestinal (GI) bleeding. We report a rare case of recurrent upper GI bleeding in a 71-year-old male who initially presented in 2017 with hematemesis, melena, and hemodynamic instability. Upper GI endoscopy identified a fundal Dieulafoy's lesion, which was successfully treated with endoscopic clipping. Seven years later, the patient re-presented with melena, fatigue, dizziness, and symptomatic anemia requiring blood transfusion. Repeat endoscopy demonstrated a 6-cm ulcerated submucosal mass in the gastric fundus. Endoscopic ultrasound showed a lesion arising from the fourth layer of the gastric wall, and fine-needle aspiration confirmed a low-grade mixed-type GIST. Computed tomography demonstrated a localized enhancing gastric mass without evidence of metastatic disease. Following multidisciplinary review, the patient underwent successful laparoscopic wedge resection. Histopathological examination confirmed a completely excised low-risk gastric GIST measuring 6.5 × 5.5 × 4.5 cm with a mitotic rate of 3 mitoses per 5 mm[2] and negative surgical margins. The postoperative course was uneventful. This case highlights the importance of reassessing patients with recurrent GI bleeding despite a previously identified bleeding source. The unusual temporal association between a Dieulafoy's lesion and a subsequently diagnosed gastric GIST in the same anatomical region underscores the need for continued diagnostic vigilance and multidisciplinary management in atypical presentations of upper GI bleeding.

Ozanimod and etrasimod are sphingosine-1-phosphate receptor modulators approved for ulcerative colitis treatment. Given their limited real-world safety data in this specific population, we conducted a disproportionality analysis using the Food and Drug Administration Adverse Event (AE) Reporting System database, aiming to explore their post-marketing safety profile. Original data were extracted from the aforementioned database. Three algorithms, namely reporting odds ratio, proportional reporting ratio, and Bayesian confidence propagation neural network, were employed to identify drug-related AE signals. We retrieved 1632 reports for ozanimod and 283 for etrasimod, with the most frequently reported age group being 50 to 59 years in both groups. At the system organ class level, signals for nervous system disorders, eye disorders, and cardiac disorders were detected for both drugs. At the preferred term level, 75 positive signals were identified for ozanimod and 24 for etrasimod. Common AEs for both drugs included drug ineffective, headache, dizziness, nausea, and blurred vision. Although most findings were consistent with the prescribing information, several unexpected AEs related to ozanimod merit special attention. The median onset time for ozanimod-related AEs was 17.5 days (interquartile range: 1.5-87.5 days). For etrasimod, the median onset time of AEs was 17.5 days (interquartile range: 2.75-69.25 days). We hope that these findings can provide comprehensive safety evidence for ozanimod and etrasimod, serving as a reference for clinicians in their individualized and safe application. However, due to the inherent limitations of the database, these findings still require further validation through prospective studies.