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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 Toexplorethecorrelationanalysisofmammographyandclinicalcharacteristicsassociatedwiththerecurrence ofearlystageoftripleGnegativebreastcancer(TNBC).Methods Thedataofmammographyandclinicalcharacteristicsof231TNBC patientsfromJanuary2009to October2017 wereretrospectivelyanalyzed,andthenthedifferencesofmammographyandclinical characteristicswerecomparedbetweenthepatientswithrecurrence(n＝64)andthosewithoutrecurrence(n＝167).Results Compared withthepatientswithoutrecurrence,thepresenceoffamilyhistoryinpatientswithrecurrencewashigherthanthosewithoutrecurrence (12.5%vs3.6%,P＜0.05).Thehistologicalgradesofthepatientswithrecurrenceweremainlyshowedasgrade2(6.3%)and3(93.7%), andthehistologicalgradeinpatientswithrecurrencewashigherthanthosewithoutrecurrence(P＜0.05).Themammographicfindingsin TNBCshowedthatthepatientswithrecurrenceweremorelikelytohavedensebreasttissue(84.4%),axillarylymphnodesinvasion (53.1%)andlowercalcification(12.5%)(P＜0.05).Multivariatelogisticregressionanalysisshowedthatthefamilyhistoryofbreast cancer(P＝0.01,OR＝2.54),histologicalgradeof2(P＝0.01,OR＝2.23)and3(P＜0.001,OR＝3.79),mammographicdensity breasttissue(P＝0.02,OR＝2.32),calcification(P＝0.02,OR＝0.45),andaxillarylymphnodesinvasion(P＝0.03,OR＝1.75)were statisticallysignificancewithTNBCrecurrence.Conclusion Thefamilyhistory,histologicalgrade,thepresenceofdensebreasttissue andaxillarylymphnodesinvasionsatmammographywereassociatedwiththeincreasedriskofrecurrenceinTNBC,whilethepresenceof calcificationwasrelatedtothelowerriskofrecurrenceinTNBC.
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Objective: To explore the clinical efficacy of ultrasound-guided local injection in treatment of rheumatoid arthritis (RA) patients with hand and wrist tenosynovitis. Methods: Totally 62 RA patients with hand and wrist tenosynovitis were randomly divided into ultrasound-guided injection (USGI) group (n=37) and conventional blind injection (CBI) group (n=25) and underwent USGI or CBI of betamethasone and lidocaine mixture, respectively. The ratio of adverse effect during the therapeutic process was compared between the two groups. Before treatment and 2, 4 and 12 weeks after treatment, the pain visual analogue scale (VAS), disease activity score in 28 joints (DAS28), gray scale ultrasound (GSUS) and power Doppler ultrasound (PDUS) scores, as well as therapeutic efficiency were compared between the two groups. Results: The ratio of adverse effect of USGI group was 2.70% (1/37), lower than that of CBI group (5/20, 20.00%; P=0.03). VAS and DAS28 scores of USGI group 4 and 12 weeks after treatment were lower than those in CBI group (all P<0.01). PDUS scores of USGI group 2, 4 and 12 weeks after treatment were lower than those in CBI group (all P<0.01), respectively, while GSUS score of USGI group was lower than that of CBI group 12 weeks after treatment (P<0.01). The efficiency of USGI group 4 and 12 weeks after treatment was higher than that in CBI group (both P<0.05). Conclusion: Ultrasound-guided local injection is safe and efficient in treatment of RA patients with hand and wrist tenosynovitis.
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Objective The aim of this study was to explore the value of ultrasound in the diagnosis of Lemmel syndrome. Methods Ultrasound images of 36 patients with Lemmel syndrome confirmed by ERCP or surgery were retrospectively analyzed, and the image′s feature of ultrasound was explored. Results The ultrasound feature of Lemmel syndrome was showed as cystic protuberance from lesser curvature of duodenum, and three types of ultrasound characteristics were found: hyperechogenicity of gas, solid-cystic echogenicity full filled with fluid and inhomogeneous echogenicity full filled with food residue. The presence of hyperechogenicity (24 cases), solid-cystic echogenicity (8 cases), inhomogeneous echogenicity (4 cases) were found in 36 patients with periampullary diverticulum, and the biggest diameter of periampullary diverticulum was 6 to 32 mm. All of the patients (36 cases) were with mechanical obstruction in the common bile duct, and 12 patients were found mild dilatation of the pancreatic duct. Conclusion Higher clinical application value of ultrasound has been found when ultrasound is used in the diagnosis of Lemmel syndrome.
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Objective To discuss the application of cystic cavity flushing technique in percutaneous ethanol sclerotherapy for the thyroid colloid cysts.Methods A total of 49 patients with thyroid colloid cysts were randomly divided into the study group (n=33) and the control group (n=16).Patients in the study group received cystic cavity flushing treatment by using saline together with α-chymotrypsin,which was followed by percutaneous ethanol injection (PEI).Patients in the control group underwent simple aspiration of cyst fluid followed by PEI.The residual cystic volume,the effective rate and the untoward effects were calculated at one,3 and 6 months after the treatment,and the results were compared between the two groups.Results Striking difference in the changes of postoperative residual cystic volume existed between the study group and the control group.The effective rate of PEI in the study group was 93.9％,which was obviously better than 68.8％ in the control group,the difference between the two groups was statistically significant (P＜0.05).No untoward effect was observed during the performance of aspiration of cyst fluid and flushing of cystic cavity.Nevertheless,bad side effect occurred in PEI procedure in both the study group (6.1％) and the control group (8.3％),but the difference was not statistically significant (P=0.75).Conclusion For the treatment of thyroid colloid cysts,the use of aspiration of cyst fluid together with cystic cavity flushing technique by using saline combined with α-chymotrypsin is safe and reliable,it can improve the curative effect of subsequent PEI.