The brain imaging studies of obstructive sleep apnea: evidence from resting-state EEG and fMRI / 生理学报

Obstructive sleep apnea (OSA) is a common clinic sleep disorder, and characterized by obstruction of upper airway during sleep, resulting in sleep fragmentation and intermittent hypoxemia. We reviewed the brain imaging studies in OSA patients compared with healthy subjects, including studies of functional magnetic resonance imaging (fMRI) and electroencephalography (EEG). The resting-state EEG studies showed increased power of δ and θ in the front and central regions of the cerebral cortex in OSA patients. While resting-state fMRI studies demonstrated altered large-scale networks in default-mode network (DMN), central executive network (CEN) and salience network (SN). Evidence from resting-state studies of both fMRI and EEG focused on the abnormal activity in prefrontal cortex (PFC), which is correlated with OSA severity. These findings suggested that the PFC may play a key role in the abnormal function of OSA patients. Finally, based on the perspectives of treatment effect, multimodal data acquisition, and comorbidities, we discussed the future research direction of the neuroimaging study of OSA.

Expression of HMGB1 in Spleen of Adult Patients with Chronic and Refractory Immune Thrombocytopenia and Its Significance / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To investigate the expression and clinical significance of high mobility group box 1(HMGB1) in spleen of adult patients with chronic and refractory immune thrombocytopenia(ITP).</p><p><b>METHODS</b>Twenty chronic and refactory ITP patients received splenectomy were enrolled in ITP group and 20 cases of traumatic spleen rupture were enrolled in control group. The splenectomy efficacy in ITP patients was analyzed retrospectively. The HMGB1 expression in spleen tissue was detected by immunohistochemistry, and the correlation between different expression levels of HMGB1 and splenectomy efficacy were analysed. Meanwhile, the protein expression levels of HMGB1 in peripheral blood serum and mononuclear cells(PBMNC) of 25 patients with chronic and refractory ITP were detected by ELISA and Western blot.</p><p><b>RESULTS</b>The median platelet count before splenectomy was 7.5 (0-20) ×10/L; all the patients showed that the initial response to splenectomy within the first month after operation was 100%, the median time of response was 1 day (1-6 days). The median peak platelet count post splenectomy was 448.5 (161-1272)×10/L. In the median time of 10(3-30) months, the platelets count in 8 patients was reduced to varying degrees. After a median follow-up of 69.5 months (22-195), complete response was found in 12 patients, 4 cases showed response and 4 did not. The HMGB1 expression positive rate in spleen of ITP patients was significantly higher than that in control group (85.0% vs 15.0%)(P<0.001). There were a negative correlation between the HMGB1 expression in ITP and therapeutic outcome after splenectomy (r=-0.791, P<0.01). In addition, HMGB1 expression levels in serum and PBMNC of the patients with chronic refractory ITP were also significantly higher than that in healthy controls (P<0.01).</p><p><b>CONCLUSION</b>The splenectomy has been found to be effective therapeutic method for patients with ITP, the HMGB1 highly express in the spleen of the patients with chronic refractory ITP, but negatively correlats with the therapeutic outcome after splenectomy.</p>

Measurement and comparison of retinal nerve fiber layer thickness in different stages of diabetic retinopathy patient with type 2 diabetes / 中华实验眼科杂志

Background Diabetic retinopathy (DR) is one of the leading causes that result in adult irreversible blindness in many countries.Recent researches suggest that neurodegeneration is an important component of DR.To realize the disease process of retinal neutron is very important for prevention and treatment on DR.Objective This study was to investigate the change of retinal nerve fiber layer thickness in patients with type 2 diabetes mellitus.Methods Ninety-six eyes of 48 patients with type 2 diabetes mellitus were enrolled in Peking Union Medical College Hospital.The patients were assigned into non-diabetic retinopathy (NDR) group,background diabetic retinopathy(BDR) group,proliferative diabetic retinopathy (PDR) group and panretinal photocoagulation (PRP) group based on the fundus finding and fundus fluorescein angiography(FFA),and 24 normal subjects with matched age were included as control group.RNFL thickness was measured by GDxVCC system,including temporal,superior,nasal,inferior,total,(TSNIT) average,superior average,inferior average,TSNIT standard deviation and nerve fiber indication.The datas of the RNFL thickness were analyzed and comparison among different groups by one-way analysis of variance and Student Newman Keuls test.Results The TSNIT averages of the NDR group,BDR group,PDR group and PRP group were(56.54±5.28),(56.92±6.49),(53.04±6.14) and(53.17±9.30) μm,respectively,while that of the control group was (59.04±4.37) μm.The TSNIT average,superior average,inferior average,TSNIT standard deviation of the PDR group and PRP group compared with control group were significantly decreased,and the nerve fiber indication of the PDR group and PRP group was significantly increased (P =0.002,0.000,0.002,0.000,0.001 ;P =0.002,0.000,0.001,0.000,0.000).Compared with the control group,the TSNIT average,superior average,inferior average,TSNIT standard deviation were insignificantly decreased,and the nerve fiber indication was insignificantly increased in the NDR group and BDR group (P =0.187,0.235,0.333,0.106,0.202 ;P=0.262,0.063,0.072,0.098,0.062).Conclusions The decline of the RNFL thickness appears prior to DR findings.The RNFL thinning of PDR and PRP patients suggests the degeneration of neurons and atrophy of axonal.The neurodegeneration is an important component of DR.

Complications and short-term outcomes of intraoperative electron radiotherapy (IOERT) in patients with periarticular soft-tissue sarcomas of the extremities / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the complications and short-term outcomes of patients receiving intraoperative electron radiotherapy (IOERT) for locally advanced and recurrent periarticular soft tissue sarcomas of the extremities.</p><p><b>METHODS</b>Twenty-one adult patients with locally advanced and/or recurrent periarticular soft tissue sarcomas of the extremities treated with IOERT were included in this study. Among them 14 patients had recurrent diseases after prior operation and 7 patients with locally advanced disease with primary treatment. The total dose of radiation ranged from 11 Gy to 21 Gy of 6 - 12 MeV beta ray given by intraoperative radiotherapy after complete tumor resection with negative margins. Five patients were given external beam radiotherapy (EBRT) with a total dose of 40 - 50 Gy, and 10 patients received chemotherapy.</p><p><b>RESULTS</b>The median follow-up time was 15 months. Five patients (23.8%) had tumor relapse, including one patients with local recurrence, one patient with regional recurrence, two patients with distant metastasis and one patient with local recurrence and distant metastasis. The actuarial local control rate at 1 year was 95.2% (20/21), and at 2 years was 90.5% (19/21). Acute skin toxicity (RTOG) within 3 months after surgery included grade I in 6 patients and grade II in 3 patients. Two year late skin toxicity (RTOG/EORTC) included grade I in 4 patients and grade II in 2 patients. Fibrosis included grade I in 3 patients and grade II in 3 patients. Six patients had joint dysfunction (3 patients with grade I and 3 with grade II) and 6 patients had healing problems. One patient got ipsilateral schiatic neuritis 9 months after IOERT. No adverse events occurred during surgery.</p><p><b>CONCLUSIONS</b>IOERT brings tolerable complications of acute and late toxicities and favorable local control rate. IOERT should be followed by postoperative radiotherapy or increase the intraoperative radiation dose for locally advanced and recurrent sarcomas to get a better local control. Otherwise, distant metastasis is one of the main reasons of treatment failure, so chemotherapy should be added to the treatment regimen.</p>

Relationship between cataract extraction with intraocular lens implantation surgery and age-related macula degeneration / 中国医学科学院学报

Cataract extraction with intraocular lens (IOL) implantation surgery may result in the remarked increase in the prevalence of age-related macular degeneration (AMD). Researches have shown that the postoperative retina is much more easily exposed to blue light, which can induce the retina to produce reactive oxygen species (ROS) and finally damage the retina. Therefore, cataract surgery should not be recommended at early stage; alternatively, to lower the incidence of AMD, blue-light filtering IOL may be implanted to avoid the ocular exposure to more blue light in the postoperative patients.

Myopic and retinopathy / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the incidence of myopic retinopathy and its risk factors.</p><p><b>METHODS</b>The fundus of 1449 patients (2879 eyes) with myopia were retrospectively examined. The clinical relationship between myopic retinopathy and diopter, age, and sex was analyzed.</p><p><b>RESULTS</b>Myopic retinopathy was detected in 413 eyes (14.35%). Posterior pole retinal lesions were detected in 22 eyes (0.76%). Peripheral retinal lesions were found in 396 eyes (13.75%). According to their diopters, the myopic patients were divided into four groups: low, medium, high and super high myopia The incidence of peripheral retinal lesions was 4.18%, 8.72%, 19.18%, and 37.44% in these four groups, which significantly different (chi2 = 178.594, P<0.001). By age these patients were divided into three groups: I group, age <25; II group, age 25-34; III group, age >34. The incidences of peripheral retinal lesions in these three groups were 8.11%, 15.34%, and 24.59%, which were significantly different (chi2 = 76.090, P<0.001). The incidence of retinal lesion in male and female was 9.32% and 16.07%, respectively, which was significantly different (chi2 = 24.886, P<0.001). Posteriorpole retinal lesions were only detected in the highly or super highly myopic patients, all of them were more than 25 years. The incidence of posteriorpole retinal lesions in the highly and super highly myopia group was 0.86% and 6.67% respectively, which was significantly different (chi2 = 31.898, P<0.001). The incidence of posteriorpole retinal lesions in group II and group III was 0.55% and 3.55% respectively, which was significantly different (chi2 = 22.523, P<0.001).</p><p><b>CONCLUSIONS</b>The prevalence of retinal lesions in myopic patients is higher than that of emmetropia. The incidence of peripheral retinal lesions increases in patients with deeper diopters. Posterior pole retinal lesions usually occur in the myopic patients whose age are more than 25 years and diopter more than - 6.00 D. Careful examination of fundus is essential for early detection and timely treatment.</p>