Investigation of cognitive needs of medical staffs for the Horizon Scanning System in public hospitals in eastern and western provinces / 中国卫生政策研究

Objective: To understand the cognition and needs of medical personnel for the Horizon Scanning System(HSS)for emerging health technology based on the survey conducted in two provinces(municipalities)in some general public hospitals in eastern and western China,to provide a reference for establishing a proper,new HSS for emerging health technology in China.Methods:A total of 10 general public hospitals in Shanghai and Gansu were selected by convenience sampling method.The self-designed anonymous questionnaire survey was conducted on medi-cal staff.Results:There were 837 respondents,59.95%of which considered it of great necessity to establish a HSS for emerging health technology in China and 91.53%of which would use this system.The most expected functions of the HSS were identifying innovations in the field of health technology,and providing reference for decision-making of the introduction/distribution/use of the technology.The most expected feature of the HSS was involving clinicians and technical experts,and maintaining independence and justice.Conclusions:Medical personnel had a great demand for the HSS.The HSS was expected to identify new technologies efficiently and timely,and provide relevant information for decision makers.

Effects and relationship of intermittent hypoxia on serum lipid levels, hepatic low-density lipoprotein receptor-related protein 1, and hypoxia-inducible factor 1α.

OBJECTIVE: This study investigated the influence of intermittent hypoxia on serum lipid level, hepatic low-density lipoprotein receptor-related protein (LRP)1, and hepatic hypoxia-inducible factor (HIF)-1α and the underlying mechanisms of action. METHODS: Male Sprague Dawley rats were subjected to different levels of hypoxia. After 1-4 weeks hypoxemia, routine blood tests were performed and the levels of LRP1 and HIF-1α in liver were examined. Intermittent hypoxia (IH) was induced in HepG2 cells with or without HIF-1α inhibitor YC-1 pretreatment, and the levels of LRP1 and HIF-1α in cells were examined. RESULTS: IH caused elevated serum triglyceride, cholesterol, low-density lipoprotein, and high-density lipoprotein in rats. IH caused elevated hepatic levels of LRP1 and HIF-1α. After pretreatment with YC-1, HIF-1α protein expression decreased but mRNA expression did not change in HepG2 cells. CONCLUSIONS: IH caused dyslipidemia and elevated LRP1 and HIF-1α. Elevated LRP1 expression was caused by HIF-1α.

Osthole suppresses migration and invasion of A549 human lung cancer cells through inhibition of matrix metalloproteinase-2 and matrix metallopeptidase-9 in vitro.

Osthole, a natural compound, may be extracted from Cnidium monnieri and other medicinal plants. Previous studies have shown that osthole has anticancer effects in various human cancer cell lines. There is, however, no available information concerning the effects of osthole on the migration and invasion of human lung cancer cells. In the current study, we used Transwell assays to demonstrate that osthole inhibited the migration and invasion of A549 human lung cancer cells. Western blot analysis revealed that osthole reduced the levels of matrix metalloproteinase-2 (MMP-2) and matrix metallopeptidase-9 (MMP-9) in the A549 human lung cancer cells. Our findings indicate that osthole may have a novel function as an inhibitor of the metastasis of human lung cancer.

Elevated nocturnal and morning blood pressure in patients with obstructive sleep apnea syndrome.

BACKGROUND: The nocturnal nondipping and elevated morning blood pressure (BP) in patients with obstructive sleep apnea syndrome (OSAS) have not yet been well investigated in Chinese patients. This study aimed to describe the BP profile, and to elucidate the relationships between daytime BP and nighttime BP, and between evening BP and morning BP in patients with OSAS. METHODS: Twenty teaching hospital sleep centers in China were organized by the Chinese Medical Association to participate in this study and 2297 patients were recruited between January 2004 and April 2006. BP assessments were made at four time points (daytime, evening, nighttime and morning) and polysomnography (PSG) was performed and subjects were classified into four groups by their apnea-hypopnea index (AHI): control, n = 213 with AHI < 5; mild, n = 420 with AHI ≥ 5 and < 15; moderate, n = 460 with AHI ≥ 15 and < 30; and severe, n = 1204 with AHI ≥ 30. SPSS 11.5 software package was used for statistical analysis and figure drawing. RESULTS: All the average daytime, nighttime, evening and morning BPs were positively correlated with AHI and negatively correlated with nadir nocturnal oxygen saturation. The ratios of nighttime/daytime and morning/evening average BP were positively correlated with AHI. The ratio of nighttime/daytime systolic BP became a "reversed BP dipping" pattern until the classification reached severe, while the ratio of nighttime/daytime diastolic BP became reversed at moderate. Similarly, the ratio of morning/evening diastolic BP becomes reversed even at mild. CONCLUSIONS: OSAS may result in higher BP levels at all four time points. The ratios of nighttime/daytime and morning/evening BP increase with increased AHI. The increasing of diastolic BP, which is inclined to rise more quickly, is not parallel with increasing systolic BP.

[Retrospective analysis of related factors for patients with weaning difficulties in medical intensive care unit].

OBJECTIVE: To explore the related factors of difficult-to-wean patients in medical intensive care unit (MICU). METHODS: A retrospective analysis was performed for 112 patients placed on mechanical ventilation. There were 63 males and 49 females with a mean age of (58 ± 26) years. Their primary diseases included acute exacerbation of chronic obstructive pulmonary disease (AECOPD) (n = 27), pneumonia (n = 20), asthma (n = 12) and neuromuscular diseases (n = 8). Basic admission profiles, underlying diseases, accompanying diseases and pre-weaning changes in physiological indicators were recorded. They were divided into 2 groups: successfully-weaned group and different-to-wean group. Logistic regression analysis was used to analyze the risk factors correlated with the difficult withdrawal of mechanical ventilation. RESULTS: There were 27 (24.1%) difficult-to-wean patients on mechanical ventilation in MICU. Some underlying diseases had statistical significance in both groups, including AECOPD (χ(2) = 6.238, P = 0.028), idiopathic pulmonary fibrosis (χ(2) = 5.232, P = 0.025) and neuromuscular disease (χ(2) = 14.635, P = 0.007). The ratios of difficult-to-wean patients were 9/27, 2/6 and 6/8 respectively. There was statistical significance of pre-admission and pre-weaning oxygenation index between two groups (t = 2.183, 2.162, P < 0.05). Zubrod score at pre-weaning was also significantly different between two groups (t = 9.037, P < 0.05). Logistic regression indicated that the patients with severe heart failure (OR = 5.781), psychological disorders (OR = 4.654), obstructive sleep apnea (OR = 4.012), AECOPD (OR = 3.617) and neuromuscular diseases (OR = 2.885) were more vulnerable to weaning difficulties. CONCLUSION: The major risk factors of difficult-to-wean patients in MICU include severe heart failure, psychological diseases, obstructive sleep apnea, neuromuscular disease and AECOPD. And oxygenation and self-care capability may also affect weaning significantly.

Relationship of daytime blood pressure and severity of obstructive sleep apnea among Chinese: a multi-center investigation in China.

BACKGROUND: Epidemiologic studies have shown an independent and definite association between obstructive sleep apnea (OSA) and hypertension. This study aimed to define the association between daytime blood pressure and severity of OSA in Chinese population in mainland of China. METHODS: Twenty university hospital sleep centers in mainland of China were invited by the Chinese Medical Association (CMA) to participate in this epidemiologic study and 2297 consecutive patients (aged 18 - 85 years; 1981 males and 316 females) referred to these twenty sleep centers for evaluation of OSA between January 2004 and April 2006 were prospectively enrolled. Nocturnal polysomnography was performed in each patient, and disease severity was assessed based on the apneahypopnea index (AHI). These patients were classfied into four groups: nonapneic control (control, n = 257) with AHI < or = 5 episodes/hour; mild sleep apnea (mild, n = 402) with AHI > 5 and < or = 15 episodes/hour; moderate sleep apnea (moderate, n = 460) with AHI > 15 and < or = 30 episodes/hour and severe sleep apnea (severe, n = 1178) with AHI > 30 episodes/hour. Daytime blood pressure measurements were performed under standardized conditions in each patient at 10 a.m. in office on the day of referring to sleep centers for getting average value. All the patients were requested to quit medications related to blood pressure for three days before the day of assessing. RESULTS: Both daytime systolic blood pressure and diastolic blood pressure values were significantly related to AHI positively (r = 0.201 and 0.276, respectively; both P values < 0.001) and to nadir nocturnal oxygen saturation negatively (r = -0.215 and -0.277, respectively; both P values < 0.001), which were the parameters of OSA severity. In two special designed mean plots, means of daytime systolic and diastolic blood pressure increased gradually with increasing AHI. Beyond AHI of 61 - 65, this increasing trend reached a plateau. CONCLUSIONS: The results showed that OSA severity was associated with daytime blood pressure until AHI of 61 - 65, providing evidence for early OSA management, especially in OSA patients with concomitant hypertension.

[The analysis of risk factors correlated to pulmonary hypertension in obstructive sleep apnea syndrome patients during awake state].

OBJECTIVE: To investigate the development of pulmonary hypertension in obstructive sleep apnea syndrome (OSAS) patients and to analyze the correlated factors. METHODS: Pulmonary arterial pressure was monitored by right cardiac catheterization in 15 OSAS patients, and simultaneously polysomnography was performed. Blood gas analysis and lung function were also measured. RESULTS: Pulmonary arterial pressure at awake state was correlated positively to mean maximal pulmonary pressure during sleep, body mass index (BMI) and hemoglobin (Hb), but negatively to PaO2, the percent predicted forced vital capacity (FVC% pred). Compared with OSAS patients without pulmonary hypertension, the BMI, PaCO2, and Hb of OSAS patients with pulmonary hypertension increased significantly, while FVC% pred and PaO2 decreased. Stepwise linear regression indicated that pulmonary arterial pressure at awake state was closely correlated with mean maximal pressure during sleep (beta = 0.35, standard error 0.10, R(2) = 0.89, P = 0.006) and PaCO2 (beta = 0.72, standard error 0.27, R(2) = 0.94, P = 0.022), and mean maximal pulmonary arterial pressure during sleep was closely correlated to PaCO2, BMI, PaO2 and the ratio of arterial pressure and oxygen concentration during rapid eye movement sleep (RDeltaPAP/DeltaSpO2). The regression equation was y' = -152.70 + 1.92 PaCO2 + 1.37 BMI + 0.67 PaO2 + 16.29 RDeltaPAP/DeltaSpO2. CONCLUSION: Pulmonary arterial pressure increasing in OSAS patients is induced mainly by hypercapnia and hypoxia at day time, and related to forced ventilation capacity, BMI and the ratio of pulmonary arterial pressure and oxygen concentration variation during rapid eye movement sleep. There was no obvious relation between pulmonary arterial pressure and apnea index.

[Regulation of hypothalamus-pituitary-adrenal axis and growth hormone axis in obstructive sleep apnea-hypopnea syndrome patients].

OBJECTIVE: To explore the regulation of hypothalamus-pituitary-adrenal (HPA) axis and growth hormone (GH) axis in obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: OSAHS patients (OSAHS group) and subjects with obesity alone (control group) were monitored by polysomnography (PSG). The corticotropin-releasing hormone (CRH), growth hormone releasing hormone (GHRH), corticotropin (ACTH), cortisol and growth hormone levels in plasma were measured by enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay before and after sleep. Their correlation were analyzed. RESULTS: The CRH concentration [(1.66 +/- 0.34), (4.96 +/- 0.98) mmol/L before and after sleep] and cortisol content [(152.93 +/- 136.15), (445.53 +/- 123.09) microg/L before and after sleep] in the OSAHS group were significantly higher than those of the control group [CRH was (0.67 +/- 0.42), (2.27 +/- 1.10) mmol/L, cortisol concentration was (68.94 +/- 20.13), (146.05 +/- 30.48) microg/L, before and after sleep, respectively, all P < 0.01]; GHRH significantly decreased in the OSAHS group [(1.42 +/- 0.07), (1.01 +/- 0.05) mmol/L before and after sleep] compared with the control group [(1.99 +/- 0.34), (1.58 +/- 0.15) mmol/L, respectively; all P < 0.01]; but there was no difference in growth hormone. The ratio of the variation of CRH, GHRH level (DeltaCRH/DeltaGHRH) was significantly higher in the OSAHS group (285.02 +/- 143.32) than that in the control group (71.15 +/- 15.37, P < 0.01). The bivariate correlation analysis of the OSAHS group indicated that DeltaCRH/DeltaGHRH was correlated positively with average awake duration (r = 0.882), but negatively with average blood oxygen concentration (r = -0.696). The average blood oxygen concentration was negatively correlated with average awake duration (r = -0.729). CONCLUSIONS: There are abnormal changes of HPA axis and GH axis in OSAHS patients, and the feedback regulation is disordered. These abnormalities are related to sleep structure variation and hypoxia during sleep.

[Endothelium-dependent vasodilation in patients with obstructive sleep apnea-hypopnea syndrome].

OBJECTIVE: To evaluate the endothelial function in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) by measuring the brachial artery diameter during reactive hyperemia. METHODS: Thirty patients with OSAHS (8 with mild and 22 with moderate/severe OSAHS) and 10 control subjects were studied. Brachial artery diameter was measured with Doppler ultrasound under baseline conditions, during reactive hyperemia (an endothelium-dependent dilatation) and after sublingual administration of nitroglycerin (an endothelium-independent vasodilator). The dilative rate of brachial artery in different conditions was calculated to evaluate the endothelial function. RESULTS: The dilative rate of brachial artery in the control group, the mild OSAHS group and the moderate/severe OSAHS group were (15.2 +/- 2.6)%, (14.3 +/- 3.2)% and (9.8 +/- 4.9)%, respectively. There was a significant decrease of endothelium-dependent flow-mediated dilation in the moderate/severe OSAHS group compared to the control group and the mild OSAHS group. No significant difference in endothelium-independent vasodilator after sublingual administration of nitroglycerin was found among the three groups. CONCLUSION: Patients with moderate/severe OSAHS have impaired endothelium-dependent vasodilatation, and OSAHS itself maybe a risk factor for endothelial dysfunction.

[The effect of chronic intermittent hypoxia to hypothalamus-pituitary-adrenal axis and growth hormone level in rats during sleep].

AIM: To research the effect of intermittent hypoxia during sleep on hypothalamus-pituitary-adrenal (HPA) axis and growth hormone (GH) level. METHODS: Rats were respectively exposed to intermittent hypoxia, room air and continuous hypoxia, after 1 day, 3 days, 7 days and 30 days, mRNA levels of corticotropin-releasing hormone (CRH) and growth hormone releasing hormone (GHRH) in hypothalamus of rats were detected using RT-PCR, and the levels of CRH, GHRH, corticotropin(ACTH), cortex ketone, and growth hormone in plasma were measured. RESULTS: After 30 days, the CRH mRNA levels in rats hypothalamus which exposed to intermittent hypoxia were increased significantly than those exposed to continuous hypoxia as well as normal control but GHRH decreased, there was no difference between continuous hypoxia and normal control. After 1 day, 3 days, and 7 days, there was no difference between continuous hypoxia and intermittent hypoxia. After 30 days, the plasmic level of CRH,ACTH and cortex ketone increased, GHRH decreased and GH had no obvious change. CONCLUSION: The rats' HPA axis level increases and GHRH restrained with chronic intermittent hypoxia during sleep, feedback regulation disorders.