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【Objective】 To construct a prediction model of severe obstructive sleep apnea (OSA) risk in the general population by using nomogram in order to explore the independent risk factors of severe OSA and guide the early diagnosis and treatment. 【Methods】 We retrospectively enrolled patients who had been diagnosed by polysomnography and divided them into training and validation sets at the ratio of 7∶3. Patients were divided into severe OSA group and non-severe OSA group according to apnea hypopnea index (AHI)>30. Variables entering the model were identified by least absolute shrinkage and selection operator regression model (Lasso), and logistic regression (LR) method. Then, multivariable logistic regression analysis was used to establish the nomogram, and the area under the receiver operating characteristic curve (AUC) was used to evaluate the discriminative properties of the nomogram model. Finally, we conducted decision curve analysis (DCA) of nomogram model, STOP-Bang questionnaire and Berlin questionnaire to assess clinical utility. 【Results】 Through single factor and multiple factor logistic regression analyses, the independent risk factors for severe OSA were screened out, including moderate and severe sleepiness, family history of hypertension, history of smoking, drinking, snoring, history of suffocation, sedentary lifestyle, male, age, body mass index (BMI), waist and neck circumference. Lasso logistic regression identified smoke, suffocation time, snoring time, waistline, Epworth sleepiness scale (ESS) and BMI as predictive factors for inclusion in the nomogram. The AUC of the model was 0.795 [95% confidence interval (CI): 0.769-0.820] . Hosmer-Lemeshow test indicated that the model was well calibrated (χ2=3.942, P=0.862). The DCA results on the visual basis confirmed that the nomogram had superior overall net benefits within a wide, practical threshold probability range which displayed the nomogram was higher than that of STOP-Bang questionnaire and Berlin questionnaire, which is clinically useful. The Clinical Impact Curve (CIC) analysis showed the clinical effectiveness of the prediction model when the threshold probability was greater than 82% of the predicted score probability value. The prediction model determined that the high-risk population with severe OSA was highly matched with the actual population with severe OSA, which confirmed the high clinical effectiveness of the prediction model. 【Conclusion】 The model performed better than STOP-Bang questionnaire and Berlin questionnaire in predicting severe OSA and can be applied to screening. And it can be helpful to the early diagnosis and treatment of OSA in order to reduce social burden.
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Objective:To analyze the correlation between obstructive sleep apnea (OSA) and attention deficit hyperactivity disorder (ADHD).Methods:The clinical Data, polysomnography (PSG) and cognitive function examination results of 112 OSA children admitted to Department of Otorhinolaryngology Head and Neck Surgery of the Second Affiliated Hospital of Xi′an Jiaotong University from January 2019 to June 2020 were retrospectively analyzed. According to the severity of OSA, the children were divided into mild, moderate and severe OSA groups, and the basic demographic characteristics, sleep parameters and ADHD occurrence were analyzed. According to the results of ADHD examination, the children were divided into ADHD group and non-ADHD group, and the basic demographic characteristics and sleep parameters were analyzed. Taking these parameters as independent variables, binary Logistic regression analysis was conducted to establish the model equation for predicting the risk of OSA associated ADHD among children.Results:Grouped by OSA severity, among the three groups, apnea-hypopnea index (AHI) [3.70 (2.84, 5.47) vs 8.59 (7.50, 9.54) vs 19.48 (15.83, 25.23)], obstructive apnea index (OAI) [1.31 (0.93, 1.82) vs 3.03 (1.54, 4.41) vs 11.69 (8.53, 15.42)], obstructive apnea-hypopnea index (OAHI) [2.82 (1.81, 3.64) vs 6.17 (5.58, 7.26) vs 15.68 (13.12, 21.25)], and respiratory event-related arousal index [0.50 (0.25, 1.05) vs 1.25 (0.70, 2.23) vs 2.40 (1.60, 4.70)] increased, minimum pulse oxygen saturation (SpO 2) [90.00 (88.00, 92.00) vs 87.00 (83.00, 90.25) vs 81.00 (76.00, 85.00)] decreased, the differences were statistically significant (all P<0.05). The non-rapid eye movement (NREM)1 period time ratio of the severe OSA group was significantly longer than that of the mild OSA group, while the average SpO 2 was significantly lower than that of the mild OSA group; the NREM3 period time ratio of the moderate and severe OSA group was significantly less than that of the mild OSA group; the arousal index of the severe OSA group was significantly greater than the mild or moderate OSA group. There were no statistically significant differences among the three groups in gender, age, body mass index, sleep efficiency, rapid eye movement (REM) period time ratio, and NREM2 period time ratio (all P>0.05). Mild OSA group had 10 cases of ADHD (17.54%), moderate OSA group had 7 cases (23.33%) of ADHD, severe OSA group had 9 cases of ADHD (36.00%), and the difference was not statistically significant. Grouped by ADHD examination, the AHI, OAI, OAHI, and NREM1 period time ratios of the ADHD group were significantly higher than those of the non-ADHD group, while the sleep efficiency, minimum SpO 2 and NREM3 period time ratio were significantly lower than those of the non-ADHD group. The Logistic regression analysis suggested that ADHD was correlated with sleep efficiency, minimum SpO 2, and NREM3 period time.The established Logistic regression equation was: X=15.670+0.061×(sleep efficiency)-0.212×(minimum SpO 2)-0.144×(NREM3 period time ratio), the sensitivity and specificity of the model prediction were 84.6% and 79.1% respectively when the area under the receiveroperating characteristic curves was 0.867. Conclusions:OSA and ADHD in children have a certain correlation. Sleep structure disturbance and intermittent hypoxia may be important reasons. The predictive model equations obtained by PSG in this study can be used to assess the risk of ADHD in children with OSA.
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A retrospective analysis of audiologic outcome and graft take rate on post-tympanoplasty with different middle ear mucosal conditions in wet ear. According to the characteristics of middle ear mucosal condition and residual eardrum, 80 cases with wet ear of chronic suppurative otitis media were divided into the hydrocele group, the swelling group and the granulation group. The factors in different groups, including gender, age, disease course, sides, size and location of perforations, destruction of ossicular chain and reconstruction methods were analyzed. Moreover, postoperative hearing improvement and graft take rate were compared among the three groups. There was no significant difference in gender, age, disease course, sides, size and location of perforations among the hydrocele group, the swelling group and the granulation group （>0.05）. Overall, the postoperative average Air-Bone Gaps（ABG） were reduced in all wet ear patients after surgery （0.05）. Wet ear is not an absolute contraindication of tympanoplasty for chronic suppurative otitis media. Whether there was effusion, swelling or granulomatous hyperplasia in the tympanoplasty, the patients'hearing improved significantly after tympanoplasty, and the healing rate of the tympanoplasty did not decrease. Further basic and clinical studies are needed to standardize the timing of wet ear surgery, clarify the operative contraindication and elucidate the pathophysiological mechanism of eardrum healing.
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Objective@#A retrospective analysis of audiologic outcome and graft take rate on post-tympanoplasty with different middle ear mucosal conditions in wet ear. @*Method@#According to the characteristics of middle ear mucosal condition and residual eardrum, 80 cases with wet ear of chronic suppurative otitis media were divided into the hydrocele group, the swelling group and the granulation group. The factors in different groups, including gender, age, disease course, sides, size and location of perforations, destruction of ossicular chain and reconstruction methods were analyzed. Moreover, postoperative hearing improvement and graft take rate were compared among the three groups. @*Result@#There was no significant difference in gender, age, disease course, sides, size and location of perforations among the hydrocele group, the swelling group and the granulation group （P>0.05）. Overall, the postoperative average Air-Bone Gaps（ABG） were reduced in all wet ear patients after surgery （P<0.01）. The ABG was decreased from （25.5 ± 10.8） dB to（15.4 ± 9.4） dB in the hydrocele group, and decreased from （27.6 ± 8.7） dB to （15.2 ± 9.6） dB in the swelling group, and from （29.5 ± 7.7） dB to （17.2 ± 17.2） dB in the granulation group. The graft take rates were 90.0% in totally. There were no significant difference in graft take rates among the three groups, and 84.6% in the hydrocele group, 93.3% in the swelling group and 100.0% in the swelling group（P>0.05）. @*Conclusion@#Wet ear is not an absolute contraindication of tympanoplasty for chronic suppurative otitis media. Whether there was effusion, swelling or granulomatous hyperplasia in the tympanoplasty, the patients'hearing improved significantly after tympanoplasty, and the healing rate of the tympanoplasty did not decrease. Further basic and clinical studies are needed to standardize the timing of wet ear surgery, clarify the operative contraindication and elucidate the pathophysiological mechanism of eardrum healing.
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Objective To investigate effects of different concentrations of dexmedetomidine on onset time and clinical time-effect of rocuronium in the processes of the total intravenous anesthesia.Methods Sixty patients with elective anesthesia breast modified radical mastectomy,aged 26 to 55 years,were randomly divided into four groups of 15 patients.Group A (control group):uniform within 10 min before induction of anesthesia saline infusion (NS ; 0.25 ml/kg) ; group B:dexmedetomidine given initial dose 0.3 μg/kg uniform within 10 min before induction of anesthesia infusion finished,anesthesia period 0.3 μg/(g · h) continuous infusion until the end of surgery; group C:dexmedetomidine given initial dose 0.6 μg/kg uniform within 10 min before anesthesia infusion finished,during anesthesia with continuous infusion 0.6 μg/'(kg · h) until the end of surgery ; and group D:dexmedetomidine given initial dose 1 μg/kg uniform within 10 min before anesthesia infusion finished,during anesthesia to 1 μg/(kg · h) continuous infusion to the end of surgery.Patients after the burglary were under multi-monitor vital signs monitoring blood pressure (BP),heart rate (HR),oxygen saturation (SPO2),electrocardiogram (ECG),and after intubation monitoring end-tidal carbon dioxide (EtCO2),recording time T0 and T25.Results No significant difference was found at the T0 time in each group.However,the T25 time (48 ± 6) min in group C and (51 ±6) min in group D was significant longer than that (40 ±6)min in group A (P ＜0.05).The mean artery pressure(MAP) of group C and D [(88.76 ± 7.06)mmHg,(87.89 ± 6.95)mmHg] were significantly lower than group A after dexmedetomidine infusion 5 min later(P ＜ 0.05); The HR of groups B and C [(60.80 ± 7.11)bpm,(63.31 ± 5.78)bpm] were significantly lower than group A before induction (P ＜ 0.05).The HR of group D was significantly lower than group A before induction and after infusion 5 and 30 min later[(66.40 ± 9.49) bpm,(60.52 ± 7.45) bpm,(61.32 ± 7.11) bpm,P ＜ 0.05].Conclusions Under the status of total intravenous anesthesia,different concentrations of dexmedetomidine did not affect the onset time of rocuronium,but dexmedetomidine given up to a certain concentration could enhance the clinical time-effect of rocuronium.
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OBJECTIVE@#To investigate the clinical and pathological manifestation, prognosis of unilateral allergic fungal sinusitis (AFS), and to analyze the characters and treatment paradigm of unilateral AFS.@*METHOD@#Clinical and pathological information of 10 cases of unilateral AFS were analyzed. Nasal endoscopy, skin prick test, and visual analogue score (VAS) of severity of illness were taken before surgery. Mucosa membrane and inspissated secretion obtained during endoscopic surgery were stained with hematoxylin-eosin and silver hexosamine. Regular clean of sinus and intranasal steroid spray were taken after surgery.@*RESULT@#Endoscopy showed that 5 cases had pale mucous membranes in the ipsilateral nasal cavity. Skin prick test was positive in all patients. Nasal CT scan demonstrated unilateral lesion in all 10 patients. In the involved sinus, all 10 patients had brown or yellow brown viscous secretion, which demonstrated eosinophilic amorphous mass with accumulation of eosinophils, Charcot-Leyden crystallization and fungal hyphae under microscope. The number of eosinophils in lamina propria of sinus mucosa membrane was 72 +/- 11/hpf. After follow-up for 16 to 26 months(mean 22 months), 9 cases were cured and 1 improved. The pre-operative VAS was 8.5 +/- 1.2, and the post-operative VAS was 1.1 +/- 1.0 (P < 0.01).@*CONCLUSION@#The systemic and local allergic reaction may co-exist in unilateral AFS, in which local hypersensitivity may be the dominant reaction. Endoscopic sinus surgery and intranasal steroid spray are effective in the treatment of unilateral AFS.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Mycoses , Diagnosis , Therapeutics , Rhinitis, Allergic , Rhinitis, Allergic, Perennial , Diagnosis , Microbiology , Therapeutics , Sinusitis , Diagnosis , Microbiology , TherapeuticsABSTRACT
Objective To evaluate the effectiveness of Inditherm warming system on prevention of intraoperative hypothermia in aged patients with transurethral resection of the prostate(TURP).Methods Fifty two aged patients with benign prostate hyperplasia(BPH) undergoing selective TURP were randomly divided into two groups:observation group(n =27) and control group(n =25).Patients in observation group received temperature prevention from hypothermia by using the patient warming system which temperature was set to 38-40 ℃.The control group were not provided with warming mattress and the ambient temperature of operation room was maintained at 21-23 ℃.The changes of the rectal temperature were continuously monitored during the operation and changes of vital signs,part of postoperative indicators were observed.Results The temperature of patients in both groups decreased after anesthesia.The decreasing degree of rectal temperature at 30,45,60,and 90 min after anesthesia and at the end of operation in observation group was less than those in control group[20min:(36.6±0.4)℃ vs(36.3±0.6)℃,t =2.1362;30 min:(36.4±0.5) ℃ vs(35.8±0.4) ℃,t =4.7536;45 min:(36.2±0.3)℃ vs(35.5±0.5)℃ ;t =6.1751;60 min:(36.1±0.4)℃ vs(35.3±0.4)℃,t =7.2057;90 min:(36.0±0.3)℃ vs(35.3±0.6)℃,t =5.3818;at the end of operation:(36.0±0.4)℃ vs(35.3±0.5) ℃,t =5.5948 ; P ＜ 0.05 or P ＜ 0.01].The occurrence rate of hypothermia(rectal temperature ＜36 ℃) after operation in observation group was lower than that in coutrol group[25.93％(7/27) vs 92.00％(23/25),x2=23.218,P ＜ 0.01];The occurrence rate of shiver was significantly lower in observation group than that in control group[14.81％(4/27) vs 64.00％(16/25),x2 =13.267,P ＜ 0.01].The VAS scores assessment of pain in the observation group was significantly less than that in the control group[(2.45±1.88)points vs(3.79±1.63) points,t =2.7362,P ＜ 0.01].The length of stay was shorten[(5.37±±2.31) d vs (7.13±3.06) d,t =2.3518,P ＜ 0.05]and the prognosis was better in observation group.Conclusion The patient warming mattress can effectively prevent the occurrence of hypothermia of aged patients undergoing TURP and reduce the occurrence of associated complication.
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Aim To determine what effects propofol exerts on apoptosis in hippocampal neurons caused by anoxia-reoxygenation.Methods Newborn SD rats(0.05).When pretreated with propofol,neurons proliferation increased and apoptosis decreased(P