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Objective·To evaluate the quality of clinical practice guidelines of obstructive sleep apnea(OSA)published worldwide.Methods·The guidelines of OSA were retrieved in PubMed,Embase,China National Knowledge Infrastructure(CNKI),Wanfang Data,SinoMed,MedSci,The Cochrane Library,and the websites such as Medlive,U.S.Preventive Services Task Force(USPSTF),National Institute for Health and Care Excellence(NICE),New Zealand Guidelines Group(NZGG),Scottish Intercollegiate Guidelines Network(SIGN),and Guidelines International Network(GIN)from establishment to December 2022.Two reviewers screened the literature and extracted the main information independently,using the Appraisal of Guidelines for Research and Evaluation Ⅱ(AGREE Ⅱ)and Reporting Items for Practice Guidelines in Healthcare(RIGHT)to evaluate the quality of the included OSA guidelines.Subgroup analysis was performed according to the publication regions of guidelines.The inter-evaluator consistency test was also performed and the results were expressed as the intra-class correlation coefficient(ICC).All the included guidelines were read entirely and the clinical questions they raised were summarized.Results·A total of 35 OSA guidelines were included.The ICC value of 0.975 showed a good inter-evaluator agreement.The results of AGREE Ⅱ showed that the average score of all guidelines was(63.60±16.45)%,with a minimum of 23.40%and a maximum of 91.67%.In the six domains,the scores of"Rigor of development"[(56.07±25.89)%]and"Applicability"[(53.57±15.52)%]were relative low.The average reporting rate of RIGHT of all the included guidelines was(67.84±20.03)%,with a minimum of 14.29%and a maximum of 94.29%,and the three domains with the lowest reporting rates were"Review and quality assurance"[(31.40±45.51)%],"Funding and conflict of interest declaration and management"[(56.43±33.95)%]and"Other aspects"[(56.19±36.85)%].Subgroup analysis showed that guidelines in Asian had a lower score in"Rigor of development"and a lower overall score of AGREE Ⅱ than the guidelines in America and Europe(both P<0.05),and the reporting rates in the domains of"Evidence"and"Other information"of RIGHT of the Asian guidelines were also lower than those in the guidelines in America and Europe(P<0.05).These guidelines focused on 42 clinical questions which were classified to 3 aspects,i.e.screening and diagnosis,treatment and long-term management of OSA.Conclusion·The quality of current global OSA guidelines varies a lot,and they need to be strengthened in terms of rigor of development,applicability,review and quality assurance,funding and conflict of interest declaration and management,especially those in Asia.
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OBJECTIVE Aimed to analyze the demographic,anthropometric,severity,and common comorbidities of individuals with suspected obstructive sleep apnea(OSA)referred to the OSA diagnosis and treatment center of the Sixth People's Hospital affiliated with Shanghai Jiao Tong University School of Medicine from 2012 to 2021.METHODS Data of subjects with suspected OSA who underwent polysomnography(PSG)from January 2012 to December 2021 were collected.Subjects were categorized into five groups based on the PSG study date with a two-year interval.Clinical characteristics trends were compared across groups,focusing on the comparison between 2020-2021 and 2018-2019 to explore changes after COVID-19 epidemic.RESULTS 1.A total of 5870 subjects were included from 2012 to 2019[age(43.2±12.7)years,21.7％females].OSA prevalence was 84.8％.Over the two-year intervals,age,female proportion,OSA severity,and other indicators showed no significant changes.Body mass index(median 26.8kg/m2 to 26.0kg/m2)and overweight rates(78.1％to 73.4％)decreased yearly,as did the proportions of subjects who smoked(38.1％to 27.8％)and consumed alcohol(13.5％to 6.4％).The prevalence of hypertension increased yearly(40.3％to 51.8％),while awareness rates gradually decreased(70.3％to 59.4％).Diabetes prevalence remained relatively stable(9.4％to 9.7％),with increased awareness(49.5％to 66.2％).Dyslipidemia prevalence remained high(76.7％to 78.3％),with low awareness rates(20.8％to 28.7％).2.A total of 805 subjects were included from 2020 to 2021.Compared with 2018-2019,the proportion of females decreased(14.9％vs.22.0％),and OSA severity increased(apnea-hypopnea index 40.4 times/h vs.29.2 times/h).Prevalence rates of hypertension,diabetes,dyslipidemia(47.1％,6.9％,62.1％)and awareness rates(52.4％,57.7％,17.8％)were lower than those from 2018-2019.3.Compared with subjects with known their comorbidities,unknown subjects had significantly higher levels of systolic blood pressure(141 mmHg vs.134 mmHg),diastolic blood pressure(93 mmHg vs.85 mmHg),fasting blood glucose(7.87 mmol/L vs.6.07 mmol/L),and low-density lipoprotein(3.08 mmol/L vs.2.91 mmol/L)(P＜0.05).CONCLUSION From 2012 to 2021,individuals with suspected OSA referred for PSG test showed a tendency toward younger age,lower proportion of females,fewer comorbidities,but increased OSA severity.The awareness rate of comorbidities needs improvement,emphasizing the importance of a multidisciplinary approach to the diagnosis and treatment of OSA.
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OBJECTIVE To explore the application of the modified scalp coronal incision in the treatment of zygomatic and zygomatic arch fracture, and analyze its prognosis. METHODS A retrospective analysis of 236 cases with zygomatic and zygomatic arch fracture from 2008 to 2016 was performed. They were treated with zygomatic and zygomatic arch fracture open reduction and firm fixation by the modified scalp coronal incision and postoperative mouse rehabilitation. After 3-6 months, the infection of incision, facial paralysis, occlusal, degree of mouth opening, facial deformity and subjective satisfaction index were followed up. The prognosis and recovery were evaluated. RESULTS 1. All of the patients had no postoperative incision infection, subcutaneous hematoma, temporal region sag, bald, and permanent facial paralysis. They all got satisfied face recovery. 2. All patients with occlusal disorders and limited mouth opening obtained functional occlusal and ideal degrees of mouth opening. Satisfaction was 97％. CONCLUSION The modified coronal scalp incision in the reconstruction of 3 d structure of zygomatic and zygomatic arch, has the advantages of a clear operation field and accurateresetting, good restoration of face, concealed scar. It contributes to the protection of the facial nerve and vascular structureand reduces the incidence of surgical complications.
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Differentiated thyroid cancer is the most common malignant carcinoma in female population.Postoperative long-term thyroid-stimulating hormone(TSH) suppression therapy can reduce the risk of recurrence for differentiated thyroid cancer and control the progress of the disease, but it also induces simultaneously subclinical hypothyroidism and imposes negative effect on female. In addition to cardiovascular disease, TSH suppression therapy can lead to the alteration of sex hormone metabolism, menstrual disorder, poor influence on pregnancy and osteoporosis. This article reviews the recent studies on postoperative TSH suppression therapy in women with thyroid cancer.
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The etiology and pathogenesis of sleep obstructive apnea hypopnea syndrome (OSAHS) is not yet definitive, evidence shows that the dysfunction of pharyngeal nerve and the atonia of the muscle innervated by these nerve could play an important role in the progress of OSAHS. Dopamine is a neurotransmitter in the central nervous system which significantly affects the sleep-awake regulation. So far mounting evidence shows that dopamine has a potential role in the modulation of hypoglossal nucleus. The progress of dopamine in obstructive sleep apnea hypopnea syndrome is reviewed in this article.
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OBJECTIVE To discuss the clinical utility of the self-made curved laryngoscope.METHODS Clinical data of 198 patients with vocal cord polyps from September 2012 to October 2014 was analyzed retrospectively in which 99 cases were treated under the self-made curved larngoscopic surgeries (curved laryngoscope group) and 99 cases were treated by microlaryngoscopic surgeries (microlaryngoscope group).The duration of follow-up was 3 months in all patients.The clinical efficacy, times of inserting laryngoscope, glottic exposure and operation complications of two kinds of operations were observed and compared.RESULTS The total clinical efficacy in curved laryngoscope group showed no significant difference as compared with that in microlaryngoscope group. But for patients with difficult laryngeal exposure,the efficacy of curved laryngoscopic surgery was significantly better compared with that in the microlaryngoscopic surgery group. The results of times of inserting laryngoscope, glottic exposure and operation complications in the self-made curved larngoscope group were all better than those in microlaryngoscope group (P <0.05). CONCLUSION The operation under the self-made curved laryngoscope is a minimal invasive procedure to the laryngeal mucosa, with such more advantages like clear view of operation field and accurate management to the lesion tissue.Furthermore, the self-made curved laryngoscopic surgery is the first choice for the treatment of patients with difficult laryngeal exposure.
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In recent years, radiofrequency ablation technique is widely used in Otolaryngology Head and Neck Surgery clinical work, domestic scholars preliminary study the efficacy to early glottic cancer. The review will discuss the definition and the main treatment strategy of early glottic cancer, theory and history of radiofrequency ablation technique, vocal endoscopic surgical procedures and safety margin, Clinical observation of radiofrequency ablation technique to treat early glottic cancer.
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Humans , Catheter Ablation , Endoscopy , Glottis , Physiology , Laryngeal Neoplasms , General Surgery , Treatment OutcomeABSTRACT
OBJECTIVE@#To study the experience of clinical features and treatment of deep cervical necrotizing fasciitis.@*METHOD@#All 29 cases of cervical necrotizing fasciitis patients were diagnosed by CT, 12 cases underwent tracheostomies, lateral neck incisions and drainage operations, the other 17 patients underwent lateral neck incisions and drainage operations. Sequently washing, dressing changes and anti infection treatments were taken.@*RESULT@#Twenty-eight cases were cured, 1 cases died. During a follow-up of half a year,no relapse.@*CONCLUSION@#When patient was sufferd the cervical necrotizing fasciitis, surgical operation for exploration should be taken as soon as possible,and incision and drainage in the treatment of cervical abscess would obtain a satisfactory curative effect, which would prevent serious complications.
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Adult , Aged , Female , Humans , Male , Middle Aged , Fasciitis, Necrotizing , Diagnosis , General Surgery , NeckABSTRACT
Objective:To investigate lesion size caused by channel radiofrequency volumetric reduction of por-cine tongue base in vitro using the technique of three-dimensional reconstruction. And to evaluate safety about channel radiofrequency volumetric reduction of tongue base. Method: Eighteen fresh porcine tongues were randomly separated into six groups,and each group had three ones. The tongue bases were designed six points according to description of Powell. Tongues base were acted on 10 s and 6 level by Coblation radiofrequency system and were cut into serial freezing histological sections. These segments were sectioned at 20 μm on the injury lesion and stained with H & E. Collected 2D digital imagine of order histological sections, drawn and cut apart part of the le-sion of these sections. Images were procesed IPS and were taken three-dimensional reconstruction and statistics an-alyzes with SPSS10. 0. Result: The mean value of tongue base lesion volumes among points was (359. 5± 5. 6)mm~3 ,(364. 3±7. 0)mm~3 ,(363. 7±7. 2)mm~3, (354. 1±11. 8)mm~3, (349. 4±17. 2)mm~3 ,(353. 5±7. 9)mm~3 separately. Statistic analysis by one-way ANOVA showed that there was a insignificant difference between the groups(P>0. 05). Conclusion:These results demonstrated no significant effect lesion size in channel radiofrequency volumetric reduction in the different points of the tongue base. These data also indicated that coblation radiofre-quency system is a safe method for obstructive sleep apnea hypopnea syndrome.
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OBJECTIVE@#To compare the levels of the fasting blood glucose (FBG) and blood fat of the patients with obstructive sleep apnea hypopnea syndrome (OSAHS) before and after surgery, meanwhile to analyze the influence on blood glucose and blood fat after the changes of body mass index (BMI), apnea-hypopnea index (AHI) and lowest oxygen saturation (LSpO2).@*METHOD@#Thirty-one patients with severe OSAHS were performed Z-palatoplasty (ZPP) or ZPP combined with genioglossus advancement with hyoid suspension (GAHM). Cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL) and FBG were detected before and after surgery.@*RESULT@#Preoperative HDL was negatively related to BMI and AHI, but not LSpO2. After surgery the BMI, AHI, LSpO2, HDL and FBG were all improved. The change of HDL had correlation with the changes of BMI and AHI, and there was linear correlation with HDL and BMI (r= -0.36).@*CONCLUSION@#The surgery of ZPP and ZPP combined with GAHM can improve the AHI, LSpO2, BMI, the FBG and blood fat of the patients with OSAHS. Lose weight and rectifying sleep disordered breathing were important to improve glycolipid metabolism disorder of the patients with OSAHS.
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Adult , Female , Humans , Male , Middle Aged , Blood Glucose , Metabolism , Body Mass Index , Lipids , Blood , Obesity , Blood , General Surgery , Sleep Apnea, Obstructive , Blood , General SurgeryABSTRACT
OBJECTIVE@#To investigate lesion size caused by channel radiofrequency volumetric reduction of porcine tongue base in vitro using the technique of three-dimensional reconstruction. And to evaluate safety about channel radiofrequency volumetric reduction of tongue base.@*METHOD@#Eighteen fresh porcine tongues were randomly separated into six groups,and each group had three ones. The tongue bases were designed six points according to description of Powell. Tongues base were acted on 10 s and 6 level by Coblation radiofrequency system and were cut into serial freezing histological sections. These segments were sectioned at 20 microm on the injury lesion and stained with H & E. Collected 2D digital imagine of order histological sections, drawn and cut apart part of the lesion of these sections. Images were processed IPS and were taken three-dimensional reconstruction and statistics analyzes with SPSS10.0.@*RESULT@#The mean value of tongue base lesion volumes among points was (359.5 +/- 5.6) mm3, (364.3 +/- 7.0) mm, (363.7 +/- 7.2) mm3, (354.1 +/- 11.8) mm3, (349.4 +/- 17.2) mm3, (353.5 +/- 7.9) mm3 separately. Statistic analysis by one-way ANOVA showed that there was a insignificant difference between the groups (P>0.05).@*CONCLUSION@#These results demonstrated no significant effect lesion size in channel radiofrequency volumetric reduction in the different points of the tongue base. These data also indicated that coblation radiofrequency system is a safe method for obstructive sleep apnea hypopnea syndrome.
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Animals , Catheter Ablation , Methods , In Vitro Techniques , Sleep Apnea, Obstructive , General Surgery , Surgery, Computer-Assisted , Swine , Tongue , Wounds and Injuries , General Surgery , Treatment OutcomeABSTRACT
Objective To investigate the effect of estrogen on the pain score,c-Fos and substance P expressions in the dorsal horn of the spinal cord in the mice following formalin stimulation.Methods Fifteen C57/BL6 mice were randomized to 3 groups: control group(intact mice without estrogen treatment),OVX+V group(ovariectomized mice given vehicle) and OVX+E group(ovariectomized mice with subcutaneous injection of 2 ?g/d 17?-estradiol for 10 d).Pain score was used to assay the role of estrogen in affecting pain threshold in the mice following formalin injected into the right hind paw,and expressions of c-Fos and substance P in the dorsal horn of spinal cord(L3 to L5) in 2 h after injection of formalin was tested with immunohistochemisty to evaluate neuron activity and pain afferent fibers.Results Pain score was increased in ovariectomized mice following formalin stimulation,which was inhibited by estrogen especially in the early stage of secondary phase.The number of c-Fos-like immunoreactivity neuron(FLIN,P