Calorie restriction remodels gut microbiota and suppresses tumorigenesis of colorectal cancer in mice.

Colorectal cancer (CRC) is one of the most common cancers worldwide and the consumption of a high-calorie diet is one of its risk factors. Calorie restriction (CR) slows tumor growth in a variety of cancers, including colorectal cancer; however, the mechanism behind this remains unknown. In the present study, CR effectively reduced the tumor volume and weight in a xenograft BALB/c male nude mouse model. In addition, tumor immunohistochemistry revealed that the CR group had significantly higher expression of Bax (P<0.001) and significantly lower levels of Bcl2 (P<0.0001) and Ki67 (P<0.001) compared with control group. Furthermore, data from 16S ribosomal (r)RNA sequencing implied that CR was able to reprogram the microbiota structure, characterized by increased Lactobacillus constituent ratio (P<0.05), with amelioration of microbial dysbiosis caused by CRC. Further receiver operating characteristic curves demonstrated that the bacteria Bacteroides [area under the curve (AUC)=0.800], Lactobacillus (AUC=0.760) and Roseburia (AUC=0.720) served key roles in suppression of CRC in the mouse model. The functional prediction of intestinal flora indicated 'cyanoamino acid metabolism' (P<0.01), 'replication initiation protein REP (rolling circle plasmid replication)' (P<0.01), 'tRNA G10 N-methylase Trm11' (P<0.01) and 'uncharacterized protein with cyclophilin fold, contains DUF369 domain' (P<0.05) were downregulated in CR group. These findings implied that CR suppressed CRC in mice and altered the gut microbiota.

Preliminary Investigation and Imaging Analysis of Early Lung Cancer Screening Among Petroleum Workers in North China.

BACKGROUND: The detection rate of lung nodules has increased significantly among petroleum workers in North China since the low-dose CT (LDCT) screening has been widely carried out. What's more, the number of confirmed early lung cancers is increasing continuously. Therefore, a great deal of concern for the high risk of lung cancer has been shown among petroleum workers. PURPOSE: To improve the screening efficiency and maximize the benefits of the subjects, the current situation of LDCT lung cancer screening should be understood and the imaging characteristics of early lung cancer should be analyzed for petroleum workers in North China. MATERIALS AND METHODS: Firstly, the dynamic changes of LDCT early lung cancer screening for petroleum workers in North China were analyzed in recent years. Then, the survey data of 3121 petroleum workers was compared with that of 1868 non-petroleum workers, which was analyzed. Finally, 91 patients (129 nodular lung cancer) confirmed by pathology were retrospectively analyzed, and the data of which was compared with the clinical features obtained from survey data above. The imaging characteristics and related factors of different subtypes of lung adenocarcinoma were discussed and analyzed. RESULTS: Lung nodules were found in 810 cases (25.95%) out of 3121 petroleum workers; and the surgery was chosen by 42 patients, 38 of whom were confirmed as lung cancer. Compared with the data of screened petroleum workers, there were more older people and more females as well as a higher proportion of people with family malignancy history, and a lower proportion of smoking people in 91 patients with lung cancer. As the pathological grade of tumor nodules increased, the volume and diameter of nodules gradually increased, and the mean density, maximum density and standard deviation of density also increased (p < 0.001). The volume and diameter of nodules were positively correlated with ages (p < 0.05). CONCLUSION: The occurrence of lung adenocarcinoma is closely related to the family history of malignant tumors, and the constituent ratio of young women without a history of smoking increased significantly. At the same time, the quantitative information obtained by using CT images has important value in predicting its pathological subtypes.

Esophageal Functional Changes in Obstructive Sleep Apnea/Hypopnea Syndrome and Their Impact on Laryngopharyngeal Reflux Disease.

BACKGROUND: Obstructive sleep apnea/hypopnea syndrome (OSAHS) and laryngopharyngeal reflux (LPR) disease have a high comorbidity rate, but the potential causal relation between the two diseases remains unclear. Our objectives were to investigate the esophageal functional changes in OSAHS patients and determine whether OSAHS affects LPR by affecting esophageal functions. METHODS: Thirty-six OSAHS patients and 10 healthy controls underwent 24-h double-probed combined esophageal multichannel intraluminal impedance and pH monitoring simultaneously with polysomnography. High-resolution impedance manometry was applied to obtain a detailed evaluation of pharyngeal and esophageal motility. RESULTS: There were 13 OSAHS patients (36.1%) without LPR (OSAHS group) and 23 (63.9%) with both OSAHS and LPR (OSAHS and LPR group). Significant differences were found in the onset velocity of liquid swallows (OVL, P = 0.029) and the percent relaxation of the lower esophageal sphincter (LES) during viscous swallows (P = 0.049) between the OSAHS and control groups. The percent relaxation of LES during viscous swallows was found to be negatively correlated with upright distal acid percent time (P = 0.016, R = -0.507), and OVL was found to be negatively correlated with recumbent distal acid percent time (P = 0.006, R = -0.557) in the OSAHS and LPR group. CONCLUSIONS: OSAHS patients experience esophageal functional changes, and linear correlations were found between the changed esophageal functional parameters and reflux indicators, which might be the reason that LPR showed a high comorbidity with OSAHS and why the severity of the two diseases is correlated.

Inhomogeneous neuromuscular injury of the genioglossus muscle in subjects with obstructive sleep apnea.

PURPOSE: Muscle injury exists in the upper airway in subjects with obstructive sleep apnea (OSA). However, whether this injury is homogeneous remains unclear. The objective of this study was to measure neuromuscular changes in the anterior and posterior genioglossus muscle (GG) in subjects with OSA using motor unit potentials (MUPs). METHODS: Male subjects underwent diagnostic sleep studies to obtain apnea/hypopnea index (AHI) and lowest oxygen saturation (LSAT) data. MUPs of the anterior and posterior GG were recorded. Mean values and outliers of MUP parameters were analyzed. RESULTS: Seventeen subjects with severe OSA (AHI, 72.3 ± 16.7 events/h) and nine control subjects (AHI, 3.7 ± 0.4 events/h) were enrolled in this study. In the control group, the MUP values of amplitude, duration, area, area/amplitude, and size index did not differ significantly between the posterior and anterior GG. In the OSA group, these values were significantly higher in the posterior than anterior GG (amplitude: P = 0.011; duration: P = 0.007; area: P = 0.008; size index: P = 0.033). Posterior GG values were greater in the OSA group than in the control group, whereas anterior values were similar. A larger proportion of subjects with OSA had outlying values for the posterior GG than anterior GG (52.9 vs. 11.8%; P < 0.05). No significant correlation between MUP parameters and body mass index, AHI, or LSAT was observed in the OSA group. CONCLUSIONS: Chronic neuromuscular injury in subjects with OSA was more severe in the posterior than in the anterior GG.

Correlation of computed tomography angiography parameters and shock index to assess the transportation risk in aortic dissection patients.

BACKGROUND: Aortic dissection (AD) is a serious, life-threatening disease. It is currently crucial for AD patients to be transferred to a specialised hospital in a safe and timely manner. For this reason, the search for clinical and imaging changes related to transportation risk is becoming increasingly important. PURPOSE: The transportation risks of AD patients were assessed by studying the correlation between computed tomography angiography (CTA) parameters and shock index. MATERIALS AND METHODS: Thirty-six cases of AD confirmed with 64-slice volumetric CT (VCT) (18 cases of Stanford type A and 18 cases of type B) were divided into a high-risk group (14 cases, six Stanford type A and eight type B) and a low-risk group (22 cases, 12 Stanford type A and 10 type B) according to the modified Early Warning Score. The shock index (ratio of heart rate to systolic blood pressure) and measured CTA parameters were compared between the high-risk group and the low-risk group, and the correlation between the measured CTA parameters and shock index was analysed. RESULTS: The shock index and ratio of false/true lumen were compared between Stanford type A and type B, and no statistically significant differences were found. The shock index and ratio of false/true lumen were compared between the high-risk group and low-risk group, revealing a statistically significant difference (p < 0.05). Moreover, a significant linear correlation was found between the ratio of false/true lumen and the shock index (r = 0.691; p = 0.001). CONCLUSION: The higher the shock index and the ratio of false/true lumen are, the greater the transportation risk for AD patients. The shock index and the ratio of false/true lumen proved to be essential clinical and radiological indices for assessing the transportation risk of AD patients.

[Correlation between lung volume and the severity of obstructive sleep apnea hypopnea syndrome in obese patients].

OBJECTIVE: To examine the relationship between the severity of obstructive sleep apnea hypopnea syndrome (OSAHS), lung volume and obesity. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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.

[Application of pressure of end-tidal carbon dioxide concentration in polysomnography].

OBJECTIVE: The purpose of this study was to investigate the end-tidal carbon dioxide concentration (PETCO2) monitoring coupling in polysomnography for patients with obstructive sleep apnea hypopnea syndrome (OSAHS) during sleep. METHODS: PETCO2 was sampled through a Oral-Nasal Cannula and measured using micro-stream capnometer. Capnometer was calibrated according to the manufacturer instructions and integrated into the standard polysomnographic recordings. Thirty-eight consecutive patients underwent overnight polysomnography (PSG) were synchronously monitored PETCO2. All variables were recorded continuously and transferred to a computer for analysis. RESULTS: PETCO2 numeric values and waveform were displayed in real time on the PSG epoch. The mean PETCO2 of wake, non-rapid eye movement, rapid eye movement and TST(?) were negatively correlated with apnea-hypopnea index and arousal index (r were -0.458 ∼ -0.688, P < 0.01), were positively correlated with mean arterial oxygen saturation (SaO2) and lowest SaO2, (r were 0.604 ∼ 0.674, P < 0.01). CONCLUSIONS: The study provides preliminary data showing that PETCO2 potentially can be used in continuous monitoring of OSAHS patients. And PETCO2 can indicate the severity of OSAHS.

The preliminary exploration of 64-slice volume computed tomography in the accurate measurement of pleural effusion.

BACKGROUND: Using computed tomography (CT) to rapidly and accurately quantify pleural effusion volume benefits medical and scientific research. However, the precise volume of pleural effusions still involves many challenges and currently does not have a recognized accurate measuring. PURPOSE: To explore the feasibility of using 64-slice CT volume-rendering technology to accurately measure pleural fluid volume and to then analyze the correlation between the volume of the free pleural effusion and the different diameters of the pleural effusion. MATERIAL AND METHODS: The 64-slice CT volume-rendering technique was used to measure and analyze three parts. First, the fluid volume of a self-made thoracic model was measured and compared with the actual injected volume. Second, the pleural effusion volume was measured before and after pleural fluid drainage in 25 patients, and the volume reduction was compared with the actual volume of the liquid extract. Finally, the free pleural effusion volume was measured in 26 patients to analyze the correlation between it and the diameter of the effusion, which was then used to calculate the regression equation. RESULTS: After using the 64-slice CT volume-rendering technique to measure the fluid volume of the self-made thoracic model, the results were compared with the actual injection volume. No significant differences were found, P = 0.836. For the 25 patients with drained pleural effusions, the comparison of the reduction volume with the actual volume of the liquid extract revealed no significant differences, P = 0.989. The following linear regression equation was used to compare the pleural effusion volume (V) (measured by the CT volume-rendering technique) with the pleural effusion greatest depth (d): V = 158.16 × d - 116.01 (r = 0.91, P = 0.000). The following linear regression was used to compare the volume with the product of the pleural effusion diameters (l × h × d): V = 0.56 × (l × h × d) + 39.44 (r = 0.92, P = 0.000). CONCLUSION: The 64-slice CT volume-rendering technique can accurately measure the volume in pleural effusion patients, and a linear regression equation can be used to estimate the volume of the free pleural effusion.

Evaluation of neuromuscular activity in patients with obstructive sleep apnea using chin surface electromyography of polysomnography.

BACKGROUND: It is believed that defects in upper airway neuromuscular control play a role in sleep apnea pathogenesis. Currently, there is no simple and non-invasive method for evaluating neuromuscular activity for the purpose of screening in patients with obstructive sleep apnea. This study was designed to assess the validity of chin surface electromyography of routine polysomnography in evaluating the neuromuscular activity of obstructive sleep apnea subjects and probe the neuromuscular contribution in the pathogenesis of the condition. METHODS: The chin surface electromyography of routine polysomnography during normal breathing and obstructive apnea were quantified in 36 male patients with obstructive sleep apnea. The change of chin surface electromyography from normal breathing to obstructive apnea was expressed as the percent compensated electromyography value, where the percent compensated electromyography value = (normal breath surface electromyography - apnea surface electromyography)/normal breath surface electromyography, and the percent compensated electromyography values among subjects were compared. The relationship between sleep apnea related parameters and the percent compensated electromyography value was examined. RESULTS: The percent compensated electromyography value of the subjects varied from 1% to 90% and had a significant positive correlation with apnea hypopnea index (R(2) = 0.382, P < 0.001). CONCLUSIONS: Recording and analyzing chin surface electromyography by routine polysomnography is a valid way of screening the neuromuscular activity in patients with obstructive sleep apnea. The neuromuscular contribution is different among subjects with obstructive sleep apnea.

[Improving accumulation-mode fraction based on spectral aerosol optical depth in Beijing].

In the present study, the authors put forward a parameterization method of correcting fine-mode Angstrom index with aerosol optical depth and volume distribution of aerosol derived from AERONET in Beijing over 2011. The parameterization method is coupled with aerosol optical depth spectral deconvolution algorithm to improve the accuracy of accumulation-mode fraction. The errors of estimated AMF are derived from underestimate of fine-mode Angstrom index errors. We calculate and simulate the extreme values of fine-mode Angstrom index, getting constraint conditions, and then establish the extreme values correction method. Results from sensitivity test suggest that extreme values of fine-mode Angstrom index are constrained in the reasonable range. Finemode Angstrom index and AMF are sensitive to normalized volume distribution of aerosol, ranging from 0.662 to 2.849 and from 0.08 to 0.84 due to different distribution. Mean deviation of accumulation-mode fraction is reduced from 0.072 to 0.044, and the difference is 38.89%, especially in winter and summer. Improving computational accuracy of accumulation-mode fraction can enhance that of anthropogenic aerosol optical thickness, and it has important significance of anthropogenic aerosol direct radiation force estimation and environmental quality assessment.

[Correlation between obstructive sleep apnea hypopnea syndrome and gastroesophageal reflux disease].

OBJECTIVE: To discuss the occurrence correlation between obstructive sleep apnea hypopnea syndrome (OSAHS) and gastroesophageal reflux disease (GERD). METHODS: Forty-three patients suspected of laryngopharyngeal reflux disease underwent combined multichannel intraluminal impedance and esophageal manometry (MII-EM), twenty-four-hour esophageal and pharyngeal pH and impedance monitoring and PSG. Subjects were grouped according to the detections. The difference of the measurement between groups were Compared. The possible relationship between the two diseases was analyzed. RESULTS: Fourteen of all the subjects can be diagnosed to have GERD (32.6%). Twenty-six can be diagnosed to have OSAHS (60.5%). There were 10 patients had OSAHS and GERD simultaneously, which took over 38.5% of the OSAHS group, and 71.4% of the GERD group. BMI (P = 0.000) and lower esophageal sphincter (LES) residual pressure (P = 0.021) were significantly different among the four groups OSAHS, GERD, OSAHS and GERD, and control (non-OSAHS and non-GERD), but no linear relationship between LES residual pressure and prevalence or severity of the two diseases was found. In OSAHS group, AHI were positively correlated with the following indictors: the DeMeester score (r = 0.45), acid exposure of the distal esophagus (r = 0.491). There seems to be no Linear correlation among reflux indicators, sleep indicators, and esophageal functional indicators in GERD group. Linear correlation was not found among reflux indicators, sleep indicators, and esophageal functional indicators in OSAHS and GERD group (P > 0.05). CONCLUSIONS: The incidence and the severity of GERD and OSAHS were related to each other. Reflux events may aggravate OSAHS. The two diseases may have some relationship on the esophageal function, especially on the regulation of the LES pressure.

Pulse transit time for quantifying inspiratory effort in patients with obstructive sleep apnea.

OBJECTIVES: To investigate the feasibility of pulse transit time (PTT) as a quantitative measure of inspiratory effort in patients with obstructive sleep apnea (OSA). METHODS: Nineteen moderate to severe OSA patients were included to undergo overnight polysomnography simultaneously with esophageal pressure (P(es)) and PTT. The quantitative relationships between the size of P(es) variations (ΔP(es)) and PTT variations (ΔPTT) on a breath-by-breath basis in obstructive apneas were assessed. RESULTS: A total of 19,833 breaths from 6,087 obstructive apneas were analyzed. There were good correlations with r = 0.779 ± 0.095 (mean ± SD) between ΔP(es) and ΔPTT based on overnight sleep. The correlation coefficients for supine and lateral position were of the approximated magnitude (r = 0.783 ± 0.060 and 0.757 ± 0.106, respectively), whereas they were lower in rapid eye movement (REM) sleep (r = 0.564 ± 0.140) compared with non-rapid eye movement (NREM) sleep (r = 0.787 ± 0.071). In NREM sleep, the regression lines of ΔPTT against ΔP(es) were plotted with intercepts (5.1 ± 2.1 ms) and slopes (0.35 ± 0.08 ms·cm H(2)O(-1)). CONCLUSIONS: PTT showed good ability in detecting changes of inspiratory effort in overnight sleep and was proved to be a clinically useful method in quantifying increases in inspiratory effort in NREM sleep. Hence, PTT has prospects to become an alternative to P(es) in respiratory sleep studies.

CT virtual endoscopy of the ampulla of Vater: preliminary report.

AIM: To explore multi-slice spiral CT (MSCT) virtual endoscopy (CTVE) in the detection of Vater's ampulla lesions. METHODS: In addition to 30 healthy volunteers, 18 cases of common bile duct stones, and 7 cases of ampullary carcinoma were scanned with MSCT including virtual endoscopy (VE) reconstruction. Patterns of the duodenal papilla were then observed, and its size was measured. RESULTS: Reconstructed images of CTVE in the volunteers showed that the normal type of the duodenal papilla was nodular in 16 cases, V-shaped in 8 cases, and Y-shaped in 6 cases. Its mean diameter was 0.84 ± 0.17 cm in the healthy volunteers; in patients with common bile duct stones of nodular type, mean diameter was 1.72 ± 0.32 cm. In ampullary cancer patients with an irregular protruded type, its diameter was 2.30 ± 0.85 cm, Overall the mean differences between the groups were statistically significant (P < 0.001). CONCLUSION: CTVE is a convenience, no-wound, and precise clinical examination mode utilizing which the shape of duodenal papilla can be observed, and size of the latter can be measured.

[Value of pulse transit time in detecting respiratory drive].

OBJECTIVE: To assess the accuracy of pulse transit time (PTT) in classification of apnea events, and collect data for clinical application reference. METHODS: Thirty-two obstructive sleep apnea-hypopnea syndrome (OSAHS) patients included in the research had Polysomnography (PSG), and 10 305 apnea events were recorded. All the events were analyzed by PTT and esophageal pressure (Pes) respectively. The results were analyzed to assess the accuracy of PTT and compare the accuracy of pulse transit time between REM stage and NREM stage, and analyze the correlation between age, body mass index (BMI), apnea hypopnea index (AHI) and concordance rate in every patient. RESULTS: The total concordance rate between PTT and Pes in classification of apnea was 96.7% (9970/10305). The sensitivities of PTT in detecting central, mixed and obstructive apnea were 88.0%, 91.3% and 97.8% respectively and the specificities were 99.8%, 97.8% and 92.8% respectively. The false determinations of apnea events mainly concentrated on the false determinations between the obstructive and mixed apnea. There was no statistical significant between the accuracy of PTT in different sleep stages. There was a negative relationship between the age, BMI, Lowest SaO2, AHI and the concordance rate. CONCLUSIONS: There was good concordance between PTT and Pes in classification of apnea. PTT had very high sensitivity and specificity in detecting all kinds of apnea. This study showed that PTT can detect respiratory drive noninvasively with high accuracy.

[Relationship between vocal fold leukoplakia and gastropharyngeal reflux:analysis of 15 cases].

OBJECTIVE: To explore the possible relationship between vocal fold leukoplakia and gastropharyngeal reflux. METHODS: Fifteen patients with vocal fold leukoplakia confirmed by pathology, all males, aged (53 +/- 14) (20-88), underwent esophageal and laryngopharyngeal 24-hour pH monitoring before operation. The rate and characteristics of reflux were recorded. Semi-open-ended questionnaire was used to assess the symptoms. RESULTS: Nine of the 15 patients (60%) showed pathologic intra-esophageal reflux. The time of total acid reflux of the positive re intra-esophageal reflux group was 104.6 min +/- 42.1 min, significantly longer than that of the negative group [(10.9 min +/- 11.5 min), P = 0.001]. The frequencies of intra-esophageal acid reflux of the positive group was (30.1 +/- 16.2) times, significantly higher than that of the negative group [(4.8 +/- 3.4) times, P = 0.006]. The intra-esophageal acid reflux percentage of the positive group was 7.9% +/- 2.9%, significantly higher than that of the negative group [(1.0% +/- 0.6%), P = 0.01]. and the rate in esophageal pH <4 of total fraction time between reflux positive and negative patients (P < 0.01). The scores of heartburn and acid regurgitation of the positive group were significantly higher than those of the negative group (both P < 0.05). Two of 15 patients (13.3%) had pathologic laryngopharyngeal reflux. One patient also had obstructive sleep apnea hypopnea syndrome. CONCLUSION: The patients with vocal fold leukoplakia had more pathologic intra-esophageal reflux compared to the normal individuals. Reflux may be a risk factor of mucosa leukoplakia. Leukoplakia;

[Quantitative determination of soluble solid content in bayberry juice using near-infrared spectroscopy technique].

Near-infrared transmittance spectra of bayberry juice of different varieties in Zhejiang province were obtained and a quantitative analysis was carried out. Leverage value, studentized residue and sample's Mahalanobis distance were applied to detect the outlier sample, and different wave number ranges and resolutions were chosen for partial least squares (PLS) regression to abstract spectral information effectively. The best factor, resolution and optimum wave number range were determined. Analysis results show that one sample was an outlier and deleted, and the best model gave the relative high correlation coefficient of 0.957 85, RMSEC, RMSEP and RMSECV of 0.431, 0.925 and 1.07 degrees Brix, respectively, when the best wave number range was 4 000-12 267.46 cm(-1), and the best factor and resolution were 8 and 4 cm(-1), respectively. The results indicate that it is feasible to use NIR spectroscopy technique for quantitative analysis of bayberry juice soluble solid content.

[Preoperative overnight airway pressure measurement for predicting the outcome of revised uvulopalatopharyngoplasty].

OBJECTIVE: The distribution of upper airway obstruction sites can be identified quantitatively and dynamically with continuous airway pressure measurements in obstructive sleep apnea hypopnea syndrome ( OSAHS) patients. Its value as a clinical predictor for the outcome of revised uvulopalatopharyngoplasty was evaluated. METHODS: The upper airway obstruction sites (transpalatal level, tongue base or hypolarynx level) were determined preoperatively with overnight upper airway pressure monitoring and concurrent polysomnography (PSG). Of one's total amount of obstructive events, the proportion of apnea/hypopnea events located at Transpalatal level was quantified as contribution of transpalatal obstruction. Of all OSAHS patients, 26 males and 1 female underwent revised uvulopalatopharyngoplasty (2 had same stage transpalatal advancement pharyngoplasty) and had follow-up PSG 6. 33 +/- 0.84 months after surgery. The relationship of transpalatal obstruction proportion, age, tonsil size and body mass index (BMI) and the reduction in apnoea hypopnea index (AHI) was analyzed. RESULTS: The AHI (times/hr) of 27 subjects decreased from 63.9 +/- 20.7 to 28.4 +/- 25.4. The response rate was 51.9% (defined as AHI reduction over 50%). Correlation between the transpalatal obstruction proportion and the AHI reduction percentage was significant (r = 0.609), so was the degree of the tonsil size (r = 0.511). The proportion of tongue base level obstruction showed a negative correlation for the AHI reduction. Patients with oropharynx obstruction percentage > or = 70% had a success rate of 90% and all patients with oropharynx obstruction percentage <60% responded poorly to the operation. The regression model showed distribution of obstructive sites, along with tonsil size and other PSG parameters could predict 66.7% of the postoperative AHI of transpalatal level surgery (F = 6.701, P = 0.001) . CONCLUSIONS: Contribution of transpalatal level obstruction has significant predictive value to the outcome of transpalatal level surgery in OSAHS patients.

[Sites of obstruction in obstructive sleep apnea patients and their influencing factors: an overnight study].

OBJECTIVE: To understand how sleep stage and position influence the mechanisms for pharyngeal collapse in different levels of upper airway (UA), overnight state-related changes and postural variation in obstructive sites in obstructive sleep apnea hypopnea syndrome (OSAHS) patients were studied. METHODS: Fifty four OSAHS patients underwent overnight upper airway pressure monitoring during polysomnography. The lower limits of the UA obstruction were determined and their relationship with sleep stage, position, age, body mass index and apnea hypopnea index (AHI) were investigated. RESULTS: All 54 patients had oropharynx (14 837 of the 23 172 analyzed events) and tongue base obstruction (5605/23,172), 2532 events were located at the oropharynx with extension to tongue base. Twenty nine patients has hypopharynx obstruction (105/23 172). Of the total amount of apnea hypopnea, the portions of obstruction located at tongue base level increased (t = 8.790, P = 0.000) in rapid eye movement (REM) sleep while those located at oropharynx decreased (t = -6.846, P = 0.000). Indexes of the apnea hypopnea caused by tongue base obstruction raised (t = 6.189, P = 0.000). Although the overall AHI in supine position was higher than in lateral position (t = 4.000, P = 0.000), increases in indexes of both the apnea hypopnea caused by tongue base (supine, 17.1 +/- 13.8 vs. lateral, 13.9 +/- 14.6) and oropharynx obstruction (44.3 +/- 20.3 vs. 37.2 +/- 25.9) were without significance (P > 0.05). Distribution of obstructive site varied little with different position (P > 0.05). CONCLUSIONS: Upper airway obstruction involves more than one specific site of the upper airway and the oropharynx is the most common collapse site. Obstructive sites are likely to extend to lower levels during REM sleep. Sleep position has little effect on the distribution of obstructive site.

[Significance of apnea hypopnea time index in obstructive sleep apnea hypopnea syndrome patients and possible correlation between polysomnographic parameters and severity of the disease].

OBJECTIVE: To find out the polysomnography (PSG) indexes that reflex the degree of pathology of obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS: Six hundred and twenty-one male OSAHS patients, aged over 21, underwent measurement of weight, height, and neck circumference. Polysomnography was conducted to detect the apnea and hypopnea index (AHI), apnea and hypopnea time (AHT), and apnea and hypopnea time index (AHTI). A questionnaire survey based on Epworth sleep scaling (ESS) was conducted among 392 patients to assess the symptoms, such as excessive daytime sleepiness. 324 patients with an AHTI of 68.4 +/- 17.16 events/hour were regarded as severe group, and those with an AHTI >or= 7 events/hr were regarded as very severer group. The relationship among clinical characteristics and polysomnographic parameters were analyzed. RESULTS: The AHI, AHTI, and lowest SaO(2) of the patients were significantly correlated with the ESS7 scores, morning mouth dryness, daytime fatigue (all P < 0.01), and significantly correlated with sour regurgitation, and heartburn, (all P < 0.05). AHTI was significantly correlated (r = 0.317), morning mouth dryness (r = 0.239); and sour regurgitation, and heartburn (r = 0.137). AHT was significantly correlated (r = 0.344), morning mouth dryness (r = 0.261); and sour regurgitation, and heartburn (r = 0.138). Very significant differences existed in morning mouth dryness, sour regurgitation and heartburn, and ESS7 scores between the severe and very severe patients (all P < 0.01). CONCLUSION: Among the PSG indexes, AHTI is better associated with sleepiness and other clinical symptoms than AHI. In severe OSAHS patients, there are significant differences in their clinical symptoms between the AHI < 70 events/hr group and AHI >or= 70 events/hr group.

[Perioperative continuous positive airway pressure therapy for severe obstructive sleep apnea hypopnea syndrome patients].

OBJECTIVE: (1) To investigate the severe obstructive sleep apnea hypopnea syndrome (OSAHS) patients' perioperative variations of their polysomnographic indices, to discuss the necessity for their perioperative treatment; (2) To investigate the effects of continuous positive airway pressure (CPAP) on severe OSAHS patients during their perioperative period. METHODS: (1) 21 cases severe OSAHS patients were selected for at least 7 days preoperative CPAP therapy, and this group of patients were also given 3 continuous nights autotitrated CPAP (AutoSet) therapy postoperatively, i.e., the first 3 nights after operation. The 21 cases were remonitored with PSG during the second night after operation with their AutoSet ON. And all the 21 cases had revised uvulopalatopharygoplasty, in which the uvula is reserved completely. All patients apnea hypopnea index(AHI), lowest SaO2 (LSaO2), and sleep structure indices were calculated. (2) Another 24 cases of severe OSAHS patients without preoperative CPAP therapy or tracheotomy were selected as the control group, all patients received polysomnography (PSG) on the second night postoperatively. RESULTS: (1) 6 cases' condition of the control group got worse during the second night after operation, their LSaO2 are lower and their AHI got higher than pre-operation. For the another 18 cases, their condition got better than before operation. (2) 21 cases' AHI and LSaO2 are 61.1 +/- 9.9, 65.0% +/- 9.6% respectively before CPAP treatment, and the AHI and LSaO2 are 2.2 +/- 1.4, 94.5% +/- 2.9% during CPAP therapy. P < 0.001 (TTEST). All the 21 cases main symptoms disappeared after 1 week CPAP therapy. All 21 cases could tolerate AutoSet treatment well for the first 3 nights after operation. During the 2nd night with AutoSet therapy, the AHI and LSaO2 are 3.6 +/- 1.8 and 93.7% +/- 3.4% respectively. (3) For the 2nd night after operation, the CPAP and AutoSet treating group's AHI is lower than that of the control group, also the LSaO2 is higher, the deep and REM sleep stages are longer, and the S1, S2 sleep stages are shorter than that of the latter. CONCLUSION: For severe OSAHS patients, the postoperative condition has the possibility of getting worse. Perioperative CPAP therapy can have OSAHS patients severe condition alleviated, so the perioperative risks could be lowered; During the first 3 postoperative nights, AutoSet can be well tolerated by severe OSAHS patients.