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This paper introduces professor SUN Shen-tian's clinical thoughts and his characteristics of acupuncture techniques for the treatment of depression based on "psychosomatic medicine". Professor SUN, the master of traditional Chinese medicine, believes that depression refers to comorbidity of "heart mind" and "body", resulting from the "body-mind" disharmony, specially dominated by the emotional disorder. This disease is located in the brain, with the injury of mind and closely related to the heart and liver dysfunction. In pathogenesis, the dysfunction of brain mind and the unhealthy conditions of body and mind are involved. The treatment should focus on "regulating the mind, improving the intelligence, co-modulating the abdominal and brain functions and treating the physical and mental disorders". Baihui (GV 20), Ningshen (Extra) and emotional area on the head are selected as the main points to benefit the intelligence and calming down the mind; the abdominal region 1 and region 8 of "Sun's abdominal acupuncture" are used as the main points of the abdomen to regulate the brain functions. The point prescription is modified according to the symptoms and etiologies. The repeated transcranial acupuncture stimulation and electroacupuncture at low frequency (2 Hz) are crucial to the therapeutic effect. Reliving anxious emotions is specially considered before acupuncture, and the mind is protected and deqi is consolidated during acupuncture.
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Humans , Depression/therapy , Acupuncture Points , Acupuncture Therapy/methods , Medicine, Chinese Traditional , AcupunctureABSTRACT
Objective:To investigate the value of bone marrow plasma cell morphology in the diagnosis and prognosis of plasma cell myeloma (PCM).Method:Observational study.Collect the bone marrow morphology image reports and corresponding monoclonal protein (M protein) identification results of 1071 patients [629 males and 442 females, Median age 62 (29, 93) years] diagnosed with PCM in the outpatient and inpatient departments of Beijing Chaoyang Hospital affiliated to Capital Medical University from January 1, 2017 to February 28, 2022. Combined with Durie‐Salmon(DS) and International Staging System (ISS) of 427 patients diagnosed with PCM and overall survival time (OS) of 436, summarize the relevant plasma cell morphological characteristics. Statistical methods include chi-square test, Kruskal-Walls test, Spearman correlation analysis and Kaplan-Meier survival analysis.Result:The bone marrow morphology reports showed that the typical morphological features of peripheral blood in 573 patients with PCM included plasma cells (40.84%), immature granulocytes (30.89%), rouleaux formation in erythrocytes (68.94%) and nucleated red blood cells (8.55%). The types of bone marrow plasma cells in 1 071 patients diagnosed with PCM included 372 (34.73%) plasmablasts, 674 (62.93%)immature plasma cells, and 25 (2.34%) mature plasma cells. There is a significant positive correlation between the number of bone marrow plasma cells (proportion of nuclear cells) and the concentration of IgG and IgA type, from M protein identification( r=0.55, r=0.60, P<0.01). The proportions of M protein types in 1 071 patients with PCM from high to low were IgG (45.75%), IgA (23.53%), light chain (19.61%), IgD (4.76%), non-secretory (4.3%), biclonal (1.78%), IgE (0.19%), IgM (0.08%). The typical characteristics of the bone marrow plasma cells in various M protein types included clustered distribution, different cell body sizes, inclusions in the cytoplasm, binuclear, polynuclear, and abnormal nuclear. The proportion of plasmablasts in DSⅢ stage was 44.81% (164/366), higher than 21.57% (11/51) in DSⅡstage, and the difference was statistically significant(χ 2=10.2, P<0.05). There was a significant positive correlation between the number of bone marrow plasma cells and DS and ISS stages( r=0. 0.23, r=0.30, P<0.01). The median OS of the PCM patients in the plasmablasts group was significantly shorter than that in the immature plasma cells group [56.0 (23.0, 101.8) months vs 75.9(31.6, 121.5) months, HR=1.42,95% CI 1.05-1.91, P=0.02]. The median OS of the PCM patients in the group of tumor plasma cells burden≥37.5% was shorter than that of the tumor plasma cells burden<37.5% [75.9 (21.4, 122.6)months vs 81.3 (36.6, 108) months, HR=1.54,95% CI 1.14-2.07, P<0.05]. Conclusion:The morphology and tumor burden of bone marrow plasma cells provide an important basis for the diagnosis of PCM and can be used as a prognostic indicator for patients with PCM.
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Objective:To investigate the prevalence and risk factors of depression in patients with acute ST-segment elevation myocardial infarction(STEMI) after percutaneous coronary intervention(PCI).Methods:From January 2019 to December 2019, 205 patients with STEMI who underwent PCI were selected randomly in Department of Cardiology of Heilongjiang Provincial Hospital.And 200 health examined people from our hospital at the same time were selected as health control group.The Zung self-rating depression scale(SDS) was used to score the depression in STEMI patients one week after PCI.The social demographic data were investigated, including age, gender, education status, place of residence, medical payments, monthly income, marital status, smoking history, drinking history, diabetic history, cardiovascular and cerebrovascular diseases history.The clinical indicators were measured, including height, weight, waist circumference(WC), hip circumference(HC), body mass index(BMI), waist-hip rate(WHR), fasting plasma glucose(FPG), fasting serum insulin(FINS), homeostasis model assessment-insulin resistance index(HOMA-IR), serum total cholesterol(TC), total triglyceride(TG), low density lipoprotein-C(LDL-C), high density lipoprotein-C, (HDL-C), systolic blood pressure(SBP) and diastolic blood pressure(DBP).Results:The prevalence of depression in the STEMI group was obviously higher than that in the control group(17.07% vs.9.50%, χ 2=5.025, P=0.025). There was statistically significant difference in the severity of depression between the two groups(χ 2=8.360, P=0.039). Multivariate Logistic regression analysis showed that the risk factors for depression in order of OR values were FPG, gender(female), age(65 or old), BMI, monthly income(<5 000 RMB), HOMA-IR, self-paying for medical services ( OR=1.894, 1.812, 1.545, 1.428, 1.335, 1.285, 1.202). Conclusion:The prevalence of depression in STEMI patients after PCI is increased.The risk factors for depression include female, old age, obesity, low income, insulin resistance and self-paying for medical services.
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Objective@#To investigate the etiology, clinical and pathological characteristics of laryngeal leukoplakia and the predictive risk factors of recurrence and malignant transformation.@*Methods@#Clinical data of 263 patients with laryngeal leukoplakia between January 2000 and December 2015 were analyzed retrospectively.@*Results@#The pathological diagnoses included squamous epithelial hyperplasia (54.4%), mild dysplasia (17.9%), moderate dysplasia (12.2%), severe dysplasia and carcinoma in situ (12.5%), and invasive carcinoma (3.0%). Age and the extent of lesion were statistically different among different pathological groups (P<0.05). Gender, smoking and alcohol consumption did not show statistical differences among different pathological groups (P>0.05). Follow-up of 215 patients, excluding 6 cases of invasive carcinoma. The recurrence rate was 20.6%(43/209), and the malignant transformation rate was 5.3%(11/209). Multivariate analysis showed that pathological classification of moderate to severe dysplasia was the independent risk factor for recurrence and malignant transformation of laryngeal leukoplakia (P<0.05). In patients with severe dysplasia and carcinoma in situ, the recurrence proportion of conservative treatment, vocal cords (partial) resection and radiotherapy were 8/10, 0/10 and 2/11 respectively.@*Conclusions@#Laryngeal leukoplakia occurs frequently in elderly men with long-term smoking history. Pathological diagnoses are different. The grade of dysplasia is the predictive risk factor for the recurrence and malignant transformation of laryngeal leukoplakia. More aggressive treatment and closer follow-up should be warranted for patients with moderate dysplasia, severe dysplasia and carcinoma in situ.
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Objective To investigate the effect of trimetazidine on oxidative stress and morphological structure of cardiomyocytes in dogs with heart failure. Methods A model of heart failure was established by rapid pacing, and 15 dogs were randomly divided into 3 groups: sham operation group, model group, trimetazidine group [ intragastric administration trimetazidine 5 mg/( kg·d) ] for 6 weeks. At the end of the experiment, the left ventricular myocar-dium was removed and the malondialdehyde ( MDA) was determined by thiobarbital method. The superoxide dis-mutase ( SOD) was determined by xanthine oxidase method, and the pyruvate was determined by RT-PCR, then the pathomorphology and myocardial ultrastructure was observed. Results The activity of SOD was increased but the expression of MDA were decreased in the myocardium of tramadiazine group. The expression of pyruvate dehy-drogenase ( PDH) mRNA was up-regulated after treated weith trimetazidine, which was higher than that in model group(P＜0.05). The degree of myocardial injury in tramadamide group was lower than that in model group veri-fied by light microscope and electron microscope detection ( P＜0.05) . Conclusion Tramadiazine can improve oxidative stress in cardiomyocytes of heart failure dogs. The mechanism may be related to the reduction of nicotin-amide adenine dinucleotide ( NADH) production, indirectly improving the expression of PDH mRNA, improving glucose oxidation, inhibiting lipid peroxidation, improving myocardial energy metabolism.
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Objective@#To explore the safety and validity of endoscopic cricopharyngeal myotomy in patients with cricopharyngeal achalasia.@*Methods@#A total of 19 patients with cricopharyngeal achalasia suffered from sustained dysphagia were enrolled in this study. The patients were divided into transcervical cricopharyngeal myotomy(CPM) group and endoscopic CPM (ECPM) group. Swallowing function and complications were evaluated.SPSS7.0 software was used to analyze the data.@*Results@#The swallowing function improved significantly in seven patients in ECPM group, and 9 patients improved in CPM group.The video fluoroscopic swallowing study(VFSS)-swallowing score, VFSS-aspiration score and drinking test score were (3.1±1.1), (3.4±0.8) and (2.0±0.6)in post-ECPM, (3.4±1.4), (3.0±0.9) and (2.2±0.6)in post-CPM. No statistical difference was found in validity between CPM group and ECPM group(t=-0.435, t=1.086, t=-0.607, P>0.05). No statistical difference was observed on the occurrence of complication between two groups. Only one patient had subcutaneous emphysema after operation in ECPM.@*Conclusions@#New surgical instruments and endoscopic surgical technique were safe and effective for cricopharyngeal achalasia. Because these instruments are cheaper, laryngeal endoscopic cricopharyngeal myotomy is easier to be popularized more easily than microscopic laser assistted CPM.
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Objective@#To introduce the method of transoral coblation-assisted endoscopic minimally invasive surgery for superficial tongue base tumour.@*Methods@#A total of 15 patients treated with transoral coblation-assisted endoscopic minimally invasive surgery from Mar. 2006 to Aug. 2016 were retrospectively reviewed. There were 9 patients with malignant tumors, 6 patients with benign neoplasms. Adjuvant postoperative radiation therapy was applied in three cases of squamous cell carcinoma, neck was performed in four cases of cancer. One case of non-Hodgkin lymphoma received postoperative chemotherapy.@*Results@#One case with ectopic thyroid gland was treated by subtotal resection and one case with squamous cell carcinoma changed into open surgery because of major lingual artery bleeding. The En bloc resection under edoscope was achieved in 92.86%(13/14)of patients. Fifteen cases of neoplasms were followed-up for 8-50 months(median 20 months), one patient with Cowden syndrome was lost to follow-up because of appendical carcinoid combined pulmonary metastasis, one patient with non-Hodgkin lymphoma died of recurrence in other head neck areas 2 years after chemotherapy.@*Conclusion@#Transoral coblation-assisted endoscopic surgery can successfully treat for the patients with superficial tongue base tumours.
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Objective@#To explore the feasibility and effectiveness of transoral surgery (TOS) for the treatment of hypopharyngeal carcinoma by means of the radiofrequency coblation(RFC).@*Methods@#Twenty-two patients with hypopharyngeal carcinoma who were treated with TOS using RFC during the years of 2010-2016 were enrolled. Among these patients, 15 suffered from pyriform sinus carcinoma, 4 suffered from postcricoid carcinoma, and 3 suffered from posterior hypopharyngeal wall carcinoma. According to the AJCC 2002 guideline, the tumor stages were T1N0M0 for 3 patients, T2N0M0 for 9 patients, T1N1M0 for 1 patient, T1N2M0 for 1 patient, T2N1M0 for 4 patients, and T2N2M0 for 4 patients respectively. All patients with N+ underwent concurrent neck dissection; 2 patients underwent concurrent prophylactic tracheotomy; 17 underwent post-operative radiotherapy for 50-66 Gy. The follow-up time was 6-72 months with a median 35 months.Two patients were lost to follow-up.@*Results@#All patients except 2 underwent the TOS successfully, while the two patients were treated with open approach surgery due to unsure safe margin. Most patients returned to oral feeding within one week. Among the 18 patients with complete follow up data, 3 had the local recurrence of the tumor (16.7%) and one died due to local recurrence, multiple primary esophageal carcinoma, and distant metastasis 4 years after surgery (5.6%). According to the Kaplan-Meier method, the 5-years local control rate and survival rate were 57.8% and 67.5% respectively. All patients had no disorders in speech, swallowing and respiration during the follow up.@*Conclusions@#The RFC can be applied in TOS for the treatments of hypopharyngeal carcinoma with high cutting efficiency and better control of intraoperative hemorrhage, which is useful in lowering the operation difficulty. The oncologic results are comparable to the open surgery with satisfactory postoperative organ function preservation.
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Objective To observe the Leu72Met single nucleotide polymorphism (SNP)of ghrelin gene and the relationship with essential hypertension (EH).Methods Polymerase chain reaction -restriction fragment length polymorphism (PCR -RFLP)was used to detect the Leu72Met SNP of ghrelin gene in 210 EH patients and 220 healthy controls.The plasma ghrelin was detected by radioimmunoassay method collected from all subjects. Results There were three types of polymorphism of ghrelin gene at the base site Leu72Met.There were significant differences in the genotypes (CC,CA,AA)and alleles (C,A)between the EH patients and the controls (χ2 =6.054,P =0.048;χ2 =5.866,P =0.015).In EH group,the plasma ghrelin level in subjects who were homozygous CC without mutant was not only significantly lower than those who were heterozygous CA,but also lower than those who were nucleotide homozygous mutant AA (t =-8.738,P =0.000;t =-5.103,P =0.000).The patients with CC genotype had higher SBP (t =4.298,P =0.000;t =2.236,P =0.019)and lower HDL -C (t =-11.682,P =0.000;t =-7.872,P =0.000).The patients with A allele had lower plasma ghrelin (t =-16.264,P =0.000), HDL -C (t =-15.332,P =0.000)and higher SBP(t =3.800,P =0.000),DBP(t =11.895,P =0.000),and LDL -C (t =38.401,P =0.000).Conclusion The Leu72Met SNP of ghrelin gene is significantly related to the susceptibility of EH.Base mutation C to A reduced the incidence of EH.The Leu72Met polymorphism of ghrelin gene is related to the plasma ghrelin,blood pressure and blood lipid metabolism.Base mutation C to A elevated plasma ghrelin,and lowered blood pressure and blood lipid.
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<p><b>OBJECTIVE</b>To explore the methods and results of surgical management for refractory dysphagia and aspiration.</p><p><b>METHODS</b>The clinical data of 24 refractory dysphagia and aspiration patients who accepted surgical management were retrospectively analysed.</p><p><b>RESULTS</b>Twenty-four refractory dysphagia and aspiration patients accepted 26 operations between 2001 and 2014. Of the 26 operations, 17 were cricopharyngeal myectomy (CPM), 6 were scarectomy, 3 were laryngeal-tracheal separation. No severe complications occurred. Assessments of dysphagia were completed in 18 operations before and after operation. Aspiration scores of videofluoroscopic swallowing study (VFSS) were 4.50 [4.00;7.00] vs 2.00 [1.00; 3.25], P = 0.000; swallow dysfunction scroes of VFSS were 5.00 [4.00; 12.00] vs 1.00 [1.50; 10.00], P = 0.001; aspiration scores of fibroptic endoscopic evaluation of swallowing (FEES) were 4.00 [5.00; 7.00] vs 2.00 [1.75; 3.00], P = 0.000. But the surgical results for post radiotherapy dysphagia were not successful (n = 5): aspiration scores of VFSS were 7.00 [6.50; 8.00] vs 6.00 [2.00; 7.50], P = 0.109;swallow dysfunction scroes of VFSS were 12.00 [10.50; 12.00] vs 12.00 [7.50; 12.00], P = 0.180;aspiration scores of FEES were 7.00 [6.50; 8.00] vs 6.00 [2.00; 7.50], P = 0.109.</p><p><b>CONCLUSION</b>Surgical management was effective for refractory dysphagia and aspiration, but the surgical indication selection should be strict.</p>
Subject(s)
Humans , Deglutition Disorders , General Surgery , Endoscopy , Fluoroscopy , Larynx , Larynx, Artificial , Retrospective Studies , TracheaABSTRACT
Objective To evaluate the sterilization effect of Er:Yag laser irradiation combined with 2%chlorhexidine gel on single tube premolar enterococcus faecalis infection model.Methods After disinfection test was performed without molars bacterial infection,200 single rooted premolar root canal were selected.10μL enterococcus faecalis( ATCC 29212) bacterium suspension were inoculated into single intratracheal with high pressure sterilization and and then were cultured for 2 weeks.200 infected premolar model were divided into four groups:control group (n=50),A group (n=50),B group (n=50) and C group (n=50).The control group did not receive any disinfec-tion treatment,group A received Er:Yag laser irradiation and 2%chlorhexidine gel disinfection,B group received only Er:Yag laser irradiation,the C group received only 2% chlorhexidine gel disinfection.After disinfection,premolars were put into 10mL sterile water,mixed thoroughly,and then 1mL liquid were taken and diluted by10 times.Then the 200μL dilutions lipuid were coated on BHI agar plate,and plate could be selected for counting colony count.Results The average number of colonies was(127 ±12) in the control group,average number of group A(10 ±3) and which was lower than that group C (48 ±6)(t=12.005,P=0.000) and group C (43 ±5) (t=19.277,P=0.000). There were only 2 cases,which had obvious ablation phenomena in group A.Conclusion Disinfection effect of Er:Yag laser irradiation combined with 2%chlorhexidine gel is better than that of Er:Yag laser irradiation or 2% chlo-rhexidine gel disinfection.The incidence rate of the ablation phenomenon was low.
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<p><b>OBJECTIVE</b>To investigate the clinical value of localization of upper airway obstructive site with the method of combination of nasopharyngeal airway and polysomnography (PSG).</p><p><b>METHODS</b>Forty-seven patients diagnosed as obstructive sleep apnea hypopnea syndrome (OSAHS) by PSG were enrolled. Each patient was examined by Somte PSG for the first night, underwent repeated PSG examination with the nasopharyngeal airway in place for the second night and received airway continuous pressure measurements (ApneaGraph) examination for the third night. The standard of treatment success was defined as apnea-hypopnea index (AHI) less than 20/h and a reduction of 50% or more. The patients were divided into success group and failure group. The PSG indices and ApneaGraph data of the two groups were compared. Correlations between AHI with nasopharyngeal airway in place by PSG and lower AHI and constituent ratio of lower obstruction by ApneaGraph were calculated. SPSS 17.0 software was used to analyze the data.</p><p><b>RESULTS</b>Forty-two patients completal three-night examination. With the nasopharyngeal airway in place, AHI, the lowest oxyhemoglobin saturation (LSaO2), average oxyhemoglobin saturation, percent of sleep time with oxyhemoglobin saturation <0.90 (SaO2 < 0.90T%) were improved obviously (P < 0.001). Twenty-nine patients (69.0%) achieved treatment success. There were statistical differences (t = 2.670, P = 0.011; Z = -3.252, P = 0.001 and t = -4.556, P < 0.001) of LSaO2 by PSG, lower AHI and constituent ratio of lower obstruction by ApneaGraph compared success group with failure group. The correlations between AHI with nasopharyngeal airway in place by PSG and lower AHI and constituent ratio of lower obstruction by ApneaGraph were 0.616 (P < 0.001) and 0.526 (P < 0.001).</p><p><b>CONCLUSION</b>The method of combination of nasopharyngeal airway with PSG is a reliable method of localization of upper airway obstructive site and can be used as a simple means to find out if there's any retroglossal obstruction.</p>
Subject(s)
Humans , Airway Obstruction , Diagnosis , Nasopharynx , Polysomnography , Research , Sleep , Sleep Apnea, Obstructive , Diagnosis , Treatment OutcomeABSTRACT
BACKGROUND: The participation of laboratories in external quality assessment (EQA) programs is required for the quality assurance of nucleic acid amplification of Chlamydia trachomatis. This study aimed to construct a new quality control (QC) material applicated in EQA of C. trachomatis PCR. METHODS: A QC material-HTB-SiHa cells transfected with a recombinant plasmid containing the cryptic plasmid sequence-was constructed for C. trachomatis PCR detection, and four different panels, each consisting of 4 positive samples with serial dilution of the constructed QC material and 1 negative sample, were distributed by the National Center for Clinical Laboratories among four groups of 275, 268, 317, and 304 participants across China from 2011 through 2012. A total of eight commercial kits were used for C. trachomatis PCR detection in participants. RESULTS: Nine laboratories reported false-positive results (0.9%). As the series dilution increased, the correct reporting of the data sets decreased; the lowest correct rate was 96.3% in the weakest positive samples (104 copies/mL). Eight laboratories reported false-positive results, and 42 laboratories reported false-negative results in the EQA detection of C. trachomatis. No significant differences were observed in the detection of the constructed C. trachomatis positive samples (97.9%, 98.5%, 100%, 98.5%; P=0.36) and negative samples (100%, 99.0%, 100%, 99.0%; P=0.764) using four commercial kits commonly used in China. CONCLUSIONS: The results of the EQA study indicated that the constructed material provides a noninfectious, stable control material with sufficient volume for PCR detection of C. trachomatis.
Subject(s)
Humans , Cell Line , Chlamydia Infections/diagnosis , Chlamydia trachomatis/genetics , DNA, Bacterial/analysis , False Negative Reactions , Laboratories/standards , Plasmids/genetics , Polymerase Chain Reaction/standards , Quality Control , Reagent Kits, DiagnosticABSTRACT
Deer velvet antler is the only mammal organ which can continuous regenerate. Currently, international scholars are interested in antler that is defined as a perfect regeneration model of neuro, blood vessel, connective tissue, cartilage, and bones. In 1986, we started to study the separation of active protein and peptide of fresh velvet antler using classic biochemical methods. After entering the 21st century, we further investigated the differentiation of antler proteome from different growth periods using advance differential proteomics approach, and unveiled the correlation between the proteome difference and life cycle. The international antler research has entered the stage of molecular biology, and will no doubt have a profound impact on the modern biomedical fields, such as regenerative medicine, organ degeneration and dysplasia, trauma medicine and anti-inflammatory treatment, growth factor research, as well as creation of new medical thinking.
Subject(s)
Animals , Humans , Antlers , Chemistry , Deer , Medicine, Chinese Traditional , Peptides , Pharmacology , Regenerative MedicineABSTRACT
OBJECTIVE@#To investigate the relevance and clinical value of synchronous monitoring with Apnea Graph (AG) and micro movement sensitive mattress sleep monitoring system (MSMSMS) for the patient with obstructive sleep apnea-hypopnea syndrome before surgery.@*METHOD@#One hundred and fifteen patients diagnosed as OSAHS by PSG were synchronous examined by two methods: MSMSMS and AG with continuous upper airway pressure recording at night in Peking Union Medical College Hospital. The apnoeic and oxygen desaturation events during sleep determined by the two methods were compared. The correlation between MSMSMS and AG were analyzed.@*RESULT@#According to the OSAHS severity grading: the mild, moderate and severe were 6, 16, 93 for AG and 8, 26, 81 for MSMSMS respectively, and the hypoxemia severity grading:the mild, moderate, severe were 14, 70, 27 for AG and 6, 72, 37 for MSMSMS respectively. There were no statistically difference in the severity grading of OSAHS and hypoxemia during sleep determined by AG and MSMSMS. According to the parameters of the two methods, the AHI are (51.5 +/- 21.2) times/h (x +/- s, similarly hereinafter) and (48.1 +/- 24.2) times/h, r = 0.947; the LSaO2 are 0.736 +/- 0.110 and 0.710 +/- 0.108, r = 0.935; the correlation coefficient (r) of apnea index and obstructive apnea and hypopnea index were 0.856 and 0.841, P < 0.01 respectively, the data monitored by the two methods is positively correlated.@*CONCLUSION@#There is no significant difference in determining the severity of OS AHS between the AG and MSMSMS. The two methods had good correlation in respiratory disturbance index and oxygen decline index, and revealed well-prospects of preoperative assessment in patients with OSAHS.
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Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Polysomnography , Methods , Sleep Apnea, ObstructiveABSTRACT
<p><b>OBJECTIVE</b>To explore the assessment methods of dysphagia.</p><p><b>METHODS</b>The data of 37 patients with dysphagia were retrospectively analyzed. These patients took the Kubota drinking test, Tengdao's evaluation, videofluoroscopic swallowing study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES).</p><p><b>RESULTS</b>Fourteen out of thirty-seventh patients showed abnormal results during Kubota drinking test. Tengdao's evaluation results showed that 29/37 patients were abnormal. There 27/37 and 33/37 patients showed abnormalities in positive-aspiration score and swallow dysfunction score of VFSS. The number of abnormal patients in aspiration score of FEES was 19/21. The Kappa values were 0.137, 0.416 between Kubota drinking test. Tengdao's evaluation and VFSS. The FEES was measured against the VFSS for sensibility, specificity, positive predictive value, and negative predictive value, the values were 88.9%, 66.7%, 94.1% and 50.0%.</p><p><b>CONCLUSIONS</b>Kubota drinking test and Tengdao's evaluation can be applied for screening purpose and evaluating result after treatment; VFSS and FEES can be used as more accurate assessments, they can study the dysphagia's character, position and severity. The combination of a variety of dysphagia evaluation methods is the most important basis for diagnosis and treatment of deglutition disorders.</p>
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Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Deglutition , Deglutition Disorders , Diagnosis , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To develop a simplified Chinese version of the 32-item Quebec sleep questionnaire (QSQ) and to examine the reliability and validity.</p><p><b>METHODS</b>A cross-sectional sample of 141 patients [22 simple snorers and 119 obstructive sleep apnea hypopnea syndrome (OSAHS)] and a longitudinal sample of 55 patients [35 in uvulopalatopharyngoplasty (UPPP) group and 20 in control group] completed the simplified Chinese version of QSQ for assessment of its feasibility, reliability, validity and responsiveness.</p><p><b>RESULTS</b>QSQ had good feasibility. All internal consistency coefficients exceeded 0.65. Intraclass correlation coefficients of five domains for test-retest reliability ranged from 0.82 - 0.91. There were significant differences in four domains (daytime sleepiness, diurnal symptoms, nocturnal symptoms and social interactions) among patients with different severity of apnea hypopnea index (AHI) and lowest saturation of arterial oxygen (LSaO2, P < 0.01 or < 0.05). Correlations between QSQ scores and five domains and Epworth sleepiness scale (ESS) were statistically significant (P < 0.01). Correlations between QSQ scores and three domains (daytime sleepiness, nocturnal symptoms and social interactions) and polysomnography (PSG) indices (AHI and LSaO2) were statistically significant (P < 0.05). There were significant differences in scores of five domains of patients between at baseline and after UPPP. There were significant differences in change scores of five domains between patients who were treated and those who were not.</p><p><b>CONCLUSION</b>The simplified Chinese version of QSQ offers good reliability, validity and responsiveness and can be used as a OSAHS-specific instrument to assess impact of illness and treatment effectiveness in OSAHS patients.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Asian People , Language , Quality of Life , Quebec , Reproducibility of Results , Sleep , Sleep Apnea, Obstructive , Surveys and QuestionnairesABSTRACT
<p><b>OBJECTIVE</b>To evaluate the clinical value of localization of upper airway obstructive site with pressure measurements and Friedman staging system in preoperative upper airway reconstructive surgery for obstructive sleep apnea-hypopnea syndrome (OSAHS), and to evaluate the value of Friedman staging system in predicting the upper airway obstructive site.</p><p><b>METHODS</b>One hundred and three patients with snoring, daytime sleepiness diagnosed as OSAHS by polysomnography were first classified using Friedman staging system, and then examined using whole night recording, including airway continuous pressure measurements (Apnea Graph, AG). AG transducer catheter containing two pressure and two temperature sensors used for obstruction site determination and detection of apnea events during sleep. Obstructive sites were divided into upper (retropalatal region) or lower level (retroglossal region). Using constituent ratio to reflect the obstructive proportion of different levels so as to find the correlation between Friedman staging system and localization of upper airway obstructive site with pressure measurements performed during sleep, and to evaluate the clinical value of Friedman staging system in predicting the severity of OSAHS.</p><p><b>RESULTS</b>There was statistically significant difference in the constituent ratio of retroglossal obstruction determined by AG, according to Friedman staging system, Friedman tongue position (FTP) and tonsil size grading (F = 13.876, 7.655, 10.207 respectively, P < 0.05). The constituent ratio of retroglossal obstruction between stage IV and I, II, III (P < 0.01) was significantly different. With the increasing of Friedman staging, the constituent ratio of retroglossal obstruction had the tendency of increasing. The constituent ratio of retroglossal obstruction between FTP grade 2 and grade 3, grade 4 (P < 0.05) was significantly different. With the increasing of FTP grading, the constituent ratio of retroglossal obstruction had the tendency of increasing. The constituent ratio of retroglossal obstruction between the Friedman tonsil size grade 4 and grade 1, grade 3 (P < 0.01), grade 2 (P < 0.05) was significantly different.</p><p><b>CONCLUSIONS</b>Friedman staging system, in particular the FTP grading, had a correlation with upper airway pressure measurements (AG) in determination of the lower level of upper airway obstructive site, especially the retroglossal region, which could predict the main localization of upper airway obstructive site identified by upper airway pressure measurements during the sleep.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Airway Obstruction , Classification , Diagnosis , Manometry , Sleep Apnea, Obstructive , Diagnosis , Snoring , Transducers, PressureABSTRACT
OBJECTIVE@#To determine whether there was agreement between the short daytime ApneaGraph (dAG) and nocturnal ApneaGraph (nAG) in diagnosing sleep respiratory events initially and identifying the site of obstruction in airway.@*METHOD@#Twenty four patients diagnosed OSAHS by PSG were enrolled. The apnea-hypopnea index (AHI), apnea index (AI), obstructive apnea-hypopnea index (OAHI), central apnea hypopnea index (CAHI), mixed apnea index (MAHI), lowest oxygen saturation (LSaO2) and the proportion of upper/lower obstruction (UPPER, LOWER) of patients were measured using both dAG and nAG.@*RESULT@#There were no significant differences between nAG and dAG for the following parameters: AHI, AI, CAHI, MAHI, OAHI, the proportion of upper/lower obstruction, or LSaO2 (P>0.05). There were significant positive correlations between nAG and dAG with regard to AHI, AI, MAHI, OAHI, the proportion of upper/lower obstruction , LSaO2 except CAHI.@*CONCLUSION@#The dAG has similar results with nAG in early diagnosis of sleep respiratory events and identifying the level of airway obstruction. The time-saving dAG is of considerable referential importance in diagnosis of sleep respiratory events and analysing the level of airway obstruction.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Airway Obstruction , Exercise Test , Methods , Polysomnography , Methods , Sleep , Sleep Apnea, Obstructive , DiagnosisABSTRACT
Objective: To study whether interleukin (IL)-18 is involved in the activation of monocytes through direct contact with T cells and the related intracellular mechanism. Methods: T cells and monocytes were isolated and purified from the peripheral blood of healthy donors by magnetic beads. Phytohemagglutinin (PHA) pre-stimulated T cells were fixed by 1% paraformaldehyde and were then co-cultured with monocytes at a T cell: monocyte ratio of 4:1. TNF-α and IL-18 levels in the supernatants were assayed by ELISA. Expression of IL-18 receptor α chain (IL-18Rα) on the surface of monocytes was analyzed by flow cytometry. Results: Monocytes activated by PHA-stimulated T cells produced significantly more TNF-α than by unstimulated T cells; non-cultured T cells or monocytes hardly produced any TNF-α. Upon direct cellular contact, PHA prestimulated T cells also up-regulated IL-18Rα expression on the surface of monocytes and induced IL-18 production in monocytes, which could be suppressed by nuclear factor (NF)-κB inhibitor (N-acetyl-L-cysteine, NAC) or phosphatidyl-inositol (PT) 3 kinase inhibitor (LY294002), but not by mitogen activated protein kinase (MAPK) inhibitor (SB203580). Neutralizing anti-IL-18 monoclonal antibody dose-dependently inhibited the production of TNF-α by monocyte-stimulated T cells. IL-18 failed to induce TNF-α production by cultured monocytes alone, while dose-dependently enhanced TNF-α production in monocyte-stimulated T cells, which could be inhibited by NAC or LY294002, but not by SB203580. Conclusion: By direct cellular contact T cells can stimulate monocytes to produce TNF-α and IL-18, up-regulate IL-18 receptor expression in monocytes, and activate intracellular NF-κB and PI3 kinase pathways. IL-18 can enhance T cell ability to stimulate TNF-α production by monocytes, which is dependent on the activation of NF-κB and PI3 kinase pathways.