Predictive values of the combination of Friedman stage and sleep oximetry done early after surgery in predicting the treatment outcomes of uvulopalatopharyngoplasty / 北京大学学报(医学版)

OBJECTIVE@#To explore the predictive values of the combination of preoperative data, including medical history and physical examination, and results of sleep oximetry performed early after the surgery (one week) in predicting the treatment outcomes of uvulopalatopharyngoplasty (UPPP) in adult patients with obstructive sleep apnea hypopnea syndrome (OSAHS).@*METHODS@#All the patients who were diagnosed with OSAHS, underwent UPPP treatment and had complete follow-up data in our institution between Jan 2013 and May 2016 were enrolled in our study. The pre-operative data of these patients, including age, physical examination, and polysomnography (PSG) data, were all exactly collected for analysis. All these patients had received the evaluation of subjective efficacy scale and the sleep oximetry test in early post-operative days (within one week). The long-term efficacy evaluations including PSG and subjective efficacy scale were all finished at least three months after the surgery.@*RESULTS@#In the research 61 patients were finally studied, including 25 responders (41.0%) and 36 non-responders (59.0%). Regression analysis revealed that the pre-operative Friedman stage and early post-operative oxygen desaturation index of ≥4% (ODI4) were found to be independently predictive parameters for the UPPP treatment outcomes (P<0.05). The ROC curve analysis was used to estimate the predictive values of ODI4 to the treatment outcomes, and it was calculated with an area under the curve of 0.822. Using the ODI4 of 15 as the cutoff value, the sensitivity and specificity of that calculated were up to 0.778 and 0.760 respectively. The response rate among the patients with an early post-operative ODI4 of <15 was 70.4%, which was significantly higher than that of the patients with an early post-operative ODI4 of ≥15, whose response rate was 17.6% (P<0.05). The similar results could also be obtained in the patients with pre-operative Friedman stage II (87.5% vs.25.0%) and Friedman stage III (33.3% vs. 6.7%).@*CONCLUSION@#The combination of early post UPPP operation oximetry parameters, especially ODI4, and pre-operative Friedman stage could be used in better evaluating the potential surgical outcomes of UPPP.

Immunization of BALB/c mice with Brucella abortus 2308DeltawbkA confers protection against wild-type infection

Brucellosis is a zoonotic disease that causes animal and human diseases. Vaccination is a major measure for prevention of brucellosis, but it is currently not possible to distinguish vaccinated animals from those that have been naturally infected. Therefore, in this study, we constructed the Brucella (B.) abortus 2380 wbkA mutant (2308DeltawbkA) and evaluated its virulence. The survival of 2308DeltawbkA was attenuated in murine macrophage (RAW 264.7) and BALB/c mice, and it induced high protective immunity in mice. The wbkA mutant elicited an anti-Brucella-specific immunoglobulin G response and induced the secretion of gamma interferon. Antibodies to 2308DeltawbkA could be detected in sera from mice, implying the potential for use of this protein as a diagnostic antigen. The WbkA antigen would allow serological differentiation between infected and vaccinated animals. These results suggest that 2308DeltawbkA is a potential attenuated vaccine against 16M. This vaccine will be further evaluated in sheep.

Upper airway changes in obstructive sleep apnea suffers after H-uvulopalatopharyngoplasty and H-uvulopalatopharyngoplasty combined with transpalatal advancement pharyngoplasty / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To compare the different postoperative changes of the pharynx in obstructive sleep apnea hypopnea syndrome (OSAHS) patients treated with H-uvulopalatopharyngoplasty (H-UPPP) combined with transpalatal advancement pharyngoplasty (PA) surgery or H-UPPP alone.</p><p><b>METHODS</b>The upper airway in 43 patients with OSAHS were scanned during the end of normal respiration before and after treatment. There were 17 patients undergoing H-UPPP alone, 26 patients undergoing H-UPPP combined with PA, with PSG before and after treatment. To compare the efficacy of H-UPPP with PA surgery or H-UPPP alone, upper airway characteristics were measured following each procedure in 43 patients using a quantitative 3-D CT. The 3-D CT measurement were made in lateral and anterior-posterior diameters, cross-section areas and volumes of retropalatal and retroglossal region. The changes in the structure of OSAHS patients treated with H-UPPP combined with PA surgery and H-UPPP alone were compared preoperatively and postoperatively, and the correction features that were presented in AHI and structural changes were analysed.</p><p><b>RESULTS</b>The difference between H-UPPP combined with PA (n = 26) and H-UPPP (n = 17) in the changes in apnea hypopnea index (AHI) were (67.5 ± 18.9, 38.7 ± 42.0, t = 2.84, P < 0.05), hard palate lengths were (4.50 ± 3.72) mm and (0.06 ± 0.22) mm (t = 5.55, P < 0.01); anteroposterior diameters of the hard palate level were (3.5 ± 4.3) mm and (-1.7 ± 4.4) mm (t = 3.90, P < 0.01); the minimum anteroposterior diameters of retropalatal were (1.2 ± 2.2) mm and (-1.2 ± 2.3) mm (t = -3.49, P < 0.01); the minimum lateral diameters of retroglossal area were (4.9 ± 9.6) mm and (13.1 ± 9.1) mm (t = 2.80, P < 0.01) preoperatively and postoperatively. The changes in the hard palate lengths were positively correlated to the change in AHI (r = 0.407, P < 0.01), also the change in anteroposterior diameter of the hard palate level (r = 0.351, P < 0.05), the minimum anteroposterior diameter of retropalatal area (r = 0.381, P < 0.01), and the minimum cross-section area of retropalatal (r = 0.312, P < 0.05).</p><p><b>CONCLUSIONS</b>H-UPPP combined with PA offers benefit over H-UPPP alone in OSAHS patients, which may be achieved by increased retropalatal airway size. Both the anteroposterior dimensions and the cross-area size are related with the efficacy of surgery.</p>

Correlation between lung volume and the severity of obstructive sleep apnea hypopnea syndrome in obese patients / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To examine the relationship between the severity of obstructive sleep apnea hypopnea syndrome (OSAHS), lung volume and obesity.</p><p><b>METHODS</b>The study included 60 adult male obese patients with OSAHS determined by overnight polysomnogram (PSG) using American Academy of Sleep Medicine-defined criteria. Lung volume measurements were made in maximum vital capacity (VCmax), forced vital capacity (FVC), maximum voluntary ventilation (MVV), functional residual capacity (FRC) and total lung capacity (TLC).</p><p><b>RESULTS</b>The aponea hypopnea index (AHI) were negatively correlated with FVC, MVV, VCmax (r were -0.533, -0.276 and -0.575, P < 0.01 or P < 0.05). But the lowest arterial oxygen saturation (LSaO2) and the mean arterial oxygen saturation (MSaO2) were positively correlated with FVC, MVV and VCmax (r were 0.299, 0.435, 0.412, and 0.344, 0.474, 0.457, P < 0.01 or P < 0.05). The body mass index (BMI) were positively correlated with AHI (r = 0.728, r(2) = 0.530, P < 0.01). The FVC, MVV, VCmax, LSaO2 and MSaO2 varied inversely with BMI. FRC and TLC had no relation with AHI, LSaO2, MSaO2 and BMI.</p><p><b>CONCLUSIONS</b>There are significant correlations among obesity, dynamic lung volume and OSAHS severity. This result suggests that changes in dynamic lung volume may play an important role in the pathogenesis of OSAHS in obese patients.</p>

Improved minimally invasive DHS internal fixation for old age patients with intertrochanteric fractures / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the improved minimally invasive DHS fixation for treatment of intertrochanteric fractures in aged and the influence on the lateral wall of the femoral.</p><p><b>METHODS</b>From January 2005 to December 2010,480 aged patients with intertrochanteric fractures were treated by modified minimally invasive DHS fixation. There were 21 males and 268 females,with an average age of 78.3 years old ranging from 60 to 103 years. Aaccording to the Evans type,there were 166 cases of type 1,212 of type II , 86 of type 111, 16 of type IV, among them 46 cases had the dangerous fractures of the lateral wall. The incision length,blood loss volume,time from extending surgical incision in the side panel to close and postoperative complications were observed and recorded. At 1 month, 3 and 6 months after operation,the patients were followed-up,the outcome were evaluated according to the imaging evaluation index and clinical effect assessment indexes.</p><p><b>RESULTS</b>The surgical incision length averaged (8.0+/-1.2) cm, peri-operative bleeding averaged (150.0+/-6.4) ml,time from extending the incision in the operation to close incision averaged (22.0+/-1.3) min, 1 case had postoperative rupture of the external wall, and 3 cases had tension screw cut out in the femoral head,4 cases had excessive shrink back. Postoperative 6 months basic daily living skills (BADL) averaged (14.8+/-1.1) scores, and the ability of walk averaged (6.40+/-0.34) scores.</p><p><b>CONCLUSION</b>Improved minimally invasive DHS fixation for treatment of intertrochanteric fractures in aged had advantages of small trauma surgery,short wound exposure time, less peri-operative bleeding and the integrity of the lateral wall after operation, the basic daily living skills and ability to walk has an ideal recovery activities, satisfied clinical curative effect.</p>

Evaluation of Watch PAT as a diagnosing test for patients with obstructive sleep apnea hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>This study aimed to test the accuracy of the watch peripheral arterial tone (Watch PAT) in diagnosing the obstructive sleep apnea hypopnea syndrome (OSAHS) and its influencing factors.</p><p><b>METHODS</b>Thirty five outpatients who had a chief complaining of sleep snoring were recruited to receive Watch PAT test and polysomnography (PSG) simultaneously. The results of PSG were manually analyzed by an experienced technician, while the results of Watch PAT were automatically analyzed by software.</p><p><b>RESULTS</b>There was a trend that the apnea hypopnea index (AHI) of PSG was significantly higher than that of Watch PAT (P = 0.06) in the 35 patients studied, however, these two variables were significantly correlated (P < 0.001), and the correlation coefficient was as high as 0.955. A linear regression analysis which used the AHI of Watch PAT to predict the AHI of PSG also concluded same result and the equation was AHI (PSG) = 0.944 + 1.030AHI (Watch PAT), P < 0.001. The analysis which used ROC curve to test the diagnostic efficiency of Watch PAT concluded that the area under the curve could reach to 0.953 (P < 0.001), and if an AHI (Watch PAT) threshold of ≥ 8.65 was used as the cut-off point in this study, the sensitivity and specificity could reach to 92.3% and 100.0%. The absolute values of the differences (AVD) between the AHI of Watch PAT and the AHI of PSG were also calculated as a criterion for grouping the 35 patients studied, then it could be found that there was a trend that the BMI of patients who had an AVD ≥ 5 were higher than that of patients who had an AVD < 5 (P = 0.077).</p><p><b>CONCLUSIONS</b>The Watch PAT is highly sensitive in the diagnosis of OSAHS, it can be used as a simple and reliable method for screening people with suspicious OSAHS. However, the accuracy of diagnosis may be relatively low in patients who have a great BMI.</p>

Safety, biodistribution, and dosimetry of myocardial imaging agent 99Tc(m)N-NOET in healthy volunteers / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study the safety, biodistribution, and dosimetry of myocardial perfusion imaging agent 99Tc(m)N-NOET in 10 healthy volunteers.</p><p><b>METHODS</b>744-792 MBq of 99Tc(m)N-NOET was injected to each volunteer. Safety parameters and adverse event was measured in 24 hours of injection. Biodistribution was studied by whole-body imaging 1, 30 minutes, 1, 2, 4, 8, and 24 hours after the injection of 99Tc(m)N-NOET. The estimation of dosimetry was based on the standard medical internal radiation dose method using MIRDOSE 3.0 analysis program. Myocardial single photon emission computed tomography (SPECT) imaging was performed at 1 and 4 hours after injection.</p><p><b>RESULTS</b>No undesirable effects were reported by the subject during 24 hours after injection of 99Tc(m)N-NOET. No clinically significant changes were found in vital signs (heart rate, blood pressure, and electrocardiogram). No biochemical aspects and serology changes were measured. The myocardial SPECT imaging was clear. Cardiac uptake of 99Tc(m)N-NOET was as high as 2.68% at 2 hours after injection. The heart to lung ratio was more than 1 from 30 minutes after injection, reaching a maximum of 1.91 +/- 0.53 at 2 hours after injection. Radiation dosimetry calculations indicated an effective absorbed dose of 1.28 x 10(-5) Sv/MBq. The dosimetry in each main organ is lower then 50 mGy given 740 MBq of 99Tc(m)N-NOET in once imaging.</p><p><b>CONCLUSIONS</b>99Tc(m)N-NOET exhibits high cardiac uptake and low estimated effective absorbed dose. It's a safe myocardial perfusion imaging agent.</p>

Diagnostic value of 99mTc-N-NOET myocardial perfusion imaging during exercise for coronary artery disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To assess the value of (99m)Tc-N-NOET ((99m)Tc-N-ethoxy-N-ethyl dithiocarbamato-nitrito) myocardial perfusion SPECT for the diagnosis of coronary artery disease.</p><p><b>METHODS</b>A total of 42 patients [mean age (54 +/- 9) years, 35 men] with suspected chest pain were included in this study. 740 MBq of (99m)Tc-N-NOET was injected intravenously during bicycle exercise when the heart rate attained reached more than 85% of the expected maximum, or in cases of angina pectoris, severe arrhythmias and ischemic ST segment changes. (99m)Tc-N-NOET 740 MBq, SPECT myocardial imaging acquisitions were obtained at 15 minutes and 2 hours after (99m)Tc-N-NOET injection. Coronary angiography was performed in all patients.</p><p><b>RESULTS</b>Coronary artery stenosis was detected in 26 patients and normal coronary angiography was shown in 16 patients. (99m)Tc-N-NOET myocardial perfusion imaging was abnormal in twenty-one patients out of the 26 patients with significant coronary artery stenosis (sensitivity, 81%); 14 out of 16 patients with normal angiography had a normal myocardial perfusion imaging (specificity, 88%). The positive predictive value, negative predictive value and predictive accuracy of (99m)Tc-N-NOET myocardial perfusion imaging for detection of CAD was 91%, 74% and 83%, respectively. The sensitivity of the imaging for detecting single vessel, double vessels and triple vessels disease were 60% (6/10), 86% (6/7) and 100% (9/9), respectively. There was mild (99m)Tc-N-NOET lung uptake in patients with coronary artery stenosis 15 minutes post (99m)Tc-N-NOET injection.</p><p><b>CONCLUSION</b>SPECT myocardial perfusion imaging with (99m)Tc-N-NOET supplied an important diagnostic tool for detecting coronary artery disease. Lung uptake with stress (99m)Tc-N-NOET might be related to coronary artery disease.</p>