目的：探討高血壓合并阻塞性睡眠呼吸暫停綜合征（OSAS）患者血漿5-羥色胺（5-HT）水平的變化。方法：應用放射免疫法測定45例高血壓合并阻塞性睡眠呼吸暫停綜合征患者血清5-HT濃度。結果：高血壓合并阻塞性睡眠呼吸暫停綜合癥患者與單純高血壓不合并OSAS的患者相比，血壓控制較差，而血漿5-HT水平明顯增高（P＜0.05），輕、中、重度阻塞性睡眠呼吸暫停綜合征患者血漿5-HT水平之間相比較有差異（P＜0.05）。結論：5-HT水平可能與血壓控制和阻塞性睡眠呼吸暫停綜合征的發病有關。
Objective To discuss the screening and diagnostic value of nocturnal oximetry saturation monitoring combined with clinical score (CS) for patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods A total of 106 snorers were recruited in the analysis whose general information and medical history were collected respectively. All patients received polysomnography (PSG) and oximeter monitoring. The patients were divided into a non-OSAHS group and an OSAHS group according to apnea hypopnea index (AHI). A correlation analysis was made between PSG-AHI and oximeter-ODI to analyze the diagnostic sensitivity and specificity of different ODI combined with CS for OSAHS. Results The AHI, ODI, CS for the non-OSAHS group were 1.8±1.4 times/h, 2.6±3.5 times/h and 1.0±0.8; while for the OSAHS group they were correspondingly 37.3±23.9 times/h, 31.0±24.1 times/h, 2.6±1.1. There was a significant correlation between ODI and AHI (r=0.943, P<0.01). The sensitivity and specificity of ODI≥5 times/h combined with CS≥2 for diagnosis of OSAHS were 91.7% and 94.1% respectively, which had the value of preliminary screening. The sensitivity and specificity of ODI≥10 times/h combined with CS≥2 for diagnosis of OSAHS were 77.8% and 100.0% respectively, which would not result in misdiagnose for severe patients with AHI >30 times/h, so it could be an index of severe OSAHS screening. Conclusion Nocturnal oxyhemoglobin saturation monitoring combined with clinical score is of significant value for initial diagnosis of OSAHS.
Objective To discuss the effectiveness of atlantoaxial joint release through anterior retrophayngeal approach and staged posterior reduction fixation and fusion for irreducible atlantoaxial dislocation (IAAD). Methods Fifteen patients with IAAD (9 males, 6 females), aged 14-53 years (mean, 31.4 years) were included in the study. The disease duration was 3 months to 17 years (mean, 5.7 years). IAAD was attributed to trauma in 13 cases, and 2 cases were caused by congenital odontoid disconnection. Preoperative imaging examination showed atlantoaxial dislocation and could not be reset automatically in functional position. The preoperative visual analogue scale (VAS) score was 3-7 (mean, 4.1), and the preoperative Japanese Orthopaedic Association (JOA) score was 10-17 (mean, 13.8). All patients received atlantoaxial joint release through anterior retrophayngeal approach and staged posterior fixation and fusion. Results Anatomical reduction was achieved in all 15 patients, and the alignment of atlantoaxial joints was restored. After operation, the neck pain and neurological symptom were partially or fully improved in all patients, without deterioration of neurological function. One patient developed pharyngeal discomfort and cough after one-stage operation, 4 patients developed pharyngeal discomfort and foreign body sensation after operation, and 2 patients developed pin-path lipstick swelling during skull traction. All patients were cured by symptomatic treatment. No pulmonary infection, pressure ulcers, venous thrombosis, and incision infection was found during the treatment. All 15 patients were followed up 24-36 months, with an average of 28.6 months. Bony fusion was achieved in all patients, and the fusion time was 3-5 months, with an average of 3.6 months. At last follow-up, the VAS score was 0-2 (mean, 0.5) and the JOA score was 13-17 (mean, 15.9). There was no dislocation, recurrence, or other abnormal sign in the cervical X-ray films and three-dimensional CT. Conclusion Anatomical reduction can be achieved by atlantoaxial joint release through anterior retrophayngeal approach and staged posterior fixation and fusion for treating IAAD. It is an optional procedure for IAAD.
Objective To prospectively verify the accuracy and reliability of the diagnostic model of obstructive sleep apnea (OSA), including the probability model and disease severity model, and to explore a simple and cost-effective method for screening of OSA. Methods A total of 996 patients who underwent polysomnography in Zigong Fourth People’s Hospital(590 cases) and West China Hospital of Sichuan University(406 cases) were consecutively and prospectively included as the research subjects. Firstly, the OSA diagnostic model was used for the diagnostic test; then polysomnography was performed; Finally, taking polysomnography as the gold standard, the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and area under the ROC curve of OSA diagnostic model were calculated, and the reliability analysis of the model’s results was carried out. Results The sensitivity, specificity and accuracy of the OSA diagnostic model were 76.38%(595/779), 83.41%(181/217) and 77.91%(776/996) respectively, the positive predictive value is 94.29%, negative predictive value is 45.49%, positive likelihood ratio is 4.604, negative likelihood ratio is 0.283; and the area under the ROC curve was 0.866. The reliability analysis of OSA diagnostic model showed that there was no significant difference in the bias comparison of AHI; the intra-class correlation coefficient(ICC) between AHI in the OSA diagnostic model and AHI in polysomnography was 0.659, with a relatively strong consistency degree; the intra-class correlation coefficient between the lowest SpO2 in the OSA diagnostic model and the lowest SpO2 in polysomnography was 0.563, with a moderate consistency degree. Conclusions The OSA diagnostic model can better predict the probability of illness and assess the severity of the disease, which is helpful for the early detection, diagnosis and treatment of OSA. The OSA diagnostic model is suitable for popularization and application in primary hospitals and when polysomnography is not available in time.
Object ive To summa r i z e the advanc ement of cytoske l e ton and axon outgrowth of neuron. Methods The recent l iterature concerning cytoskeleton and axon outgrowth of neuron was reviewed and summarized. Results The actin filaments and microtubules in neuron were highly polarized and dynamic structures confined to the ti ps of axons and the reci procal interactions between these two major cytoskeletal polymers was also dynamic. Attractive or a repulsive cue whose final common path of action was the growth cone cytoskeleton mediated the growth of axons of neuron by intracellular signaling cascades. Regulating the actin filament and microtubule dynamics as well as their interactions in growth cones played a key role in neurite outgrowth and axon guidance. Rho-GTPases and glycogen synthase kinase 3β (GSK-3β), the two major intracellular signal ing pathways had emerged in recent years as candidates for regulating the dynamics of actin filaments and microtubules. Conclusion The axon outgrowth and guidance depend on well-coordinated cytoskeletal and reciprocal interaction dynamics which also mediate axon regeneration after spinal cord injury. Regulating activity of Rho-GTPases and GSK- 3β simultaneously may acts as key role to regulate the dynamics of cytoskeletal and to determine axon outgrowth.
ObjectiveTo compare the effect of percutaneous kyphoplasty (PKP) with different phases bone cement for treatment of osteoporotic vertebral compression fracture (OVCF).MethodsThe clinical data of 219 OVCF patients who treated with PKP and met the selection criteria between June 2016 and May 2018 were retrospectively analyzed. According to the different time of intraoperative injection of bone cement, they were divided into observation group [116 cases, intraoperative injection of polymethyl methacrylate (PMMA) bone cement in low-viscosity wet-sand phase)] and control group (103 cases, intraoperative injection of PMMA bone cement in low-viscosity wire-drawing phase). There was no significance in general date of gender, age, disease duration, body mass index, bone mineral density T value, fracture vertebral body, preoperative fracture severity of the responsible vertebral body, anterior height ratio of the responsible vertebral body, preoperative pain visual analogue scale (VAS) score, and Oswestry disability index (ODI) between the two groups (P>0.05). The VAS score and ODI score were used to evaluate the improvement of patients’ symptoms at immediate, 2 days, 3 months after operation and at last follow-up. At 1 day, 3 months after operation, and at last follow-up, X-ray film and CT of spine were reexamined to observe the distribution of bone cement in the vertebral body, bone cement leakage, and other complications. During the follow-up, the refracture rate of the responsible vertebral body and the fracture rate of the adjacent vertebral body were recorded.ResultsThe injection amount of bone cement in the observation group and control group were (4.53±0.45) mL and (4.49±0.57) mL, respectively, showing no significant difference between the two groups (t=1.018, P=0.310). Patients in both groups were followed up 6-18 months (mean, 13.3 months). There were 95 cases (81.9%) and 72 cases (69.9%) of the bone cement distribution range more than 49% of the cross-sectional area of the vertebral body in the observation group and the control group, respectively, showing significant difference in the incidence between the two groups (χ2=4.334, P=0.037). The VAS score and ODI score of the postoperative time points were significantly improved compared with those before operation (P<0.05), and there were significant differences among the postoperative time points (P<0.05). The VAS score and ODI score of the observation group were significantly better than those of the control group (P<0.05) at immediate, 2 days, and 3 months after operation, and there was no significant difference between the two groups at last follow-up (P>0.05). At 1 day after operation, the cement leakage occurred in 18 cases of the observation group (8 cases of venous leakage, 6 cases of paravertebral leakage, 4 cases of intradiscal leakage) and in 22 cases of the control group (9 cases of venous leakage, 8 cases of paravertebral leakage, 5 cases of intradiscal leakage). There was no significant difference between the two groups (P>0.05). During the follow-up, 5 cases (4.3%) in the observation group, 12 cases (11.7%) in the control group had responsible vertebral refracture, and 6 cases (5.2%) in the observation group and 14 cases (13.6%) in the control group had adjacent vertebral fracture, the differences were significant (χ2=4.105, P=0.043; χ2=4.661, P=0.031).ConclusionBone cement injection with wet-sand phase in PKP is beneficial for the bone cement evenly distributed, strengthening the responsible vertebral, relieving the short-term pain after operation, decreasing the rate of responsible vertebral refracture and adjacent vertebral fracture without increasing the incidence of relevant complications and can enhance the effectiveness.
Objective To investigate the differences in biological features between male and female patients with obstructive sleep apnea-hypopnea syndrome( OSAHS) . Methods 192 cases of patients with snoring were analyzed in the Sleep Medicine Center of West ChinaHospital fromSeptember 2004 to February 2005. The standard sleep disorder questionnaires, neck circumference, hight, weight, and all night polysomnography ( PSG) were evaluated. The clinical features of the male and female patients with OSAHS were compared. Results 170 cases of patients met the criteria of OSAHS for the apnea-hypopnea index ( AHI) more than 5 times per hour. Male gender accounted for 90% of the total patients ( male vs. female 153 vs. 17, 9∶1) . The age of male patients with OSAHS was younger than that of female ( 45. 7 ±11. 4 yearsvs. 58. 0 ±6. 1 years, P = 0. 000) . Parameters including neck circumference ( 37. 6 ±3. 2 cm vs. 35. 6 ±3. 2 cm, P =0. 000) , waist/hip rate ( 0. 94 ±0. 04 vs. 0. 9 ±0. 06, P = 0. 000) , AHI ( 36. 4 ±25. 7 vs.21. 4 ±17. 4, P =0. 004) , oxygen desaturation index ( 34. 5 ±27. 4 vs. 22. 2 ±20. 8, P =0. 035) , the number of smoking ( 52. 9% vs. 5. 9% , P = 0. 000) and drinking ( 46. 4% vs. 5. 9% , P = 0. 001) were different among the male and female patients with OSAHS. On the other hand, the morning headache ( 70. 6% vs.26. 1%, P = 0. 005) , mouth dry( 76. 5% vs. 47. 7% , P = 0. 025) , bad temper ( 52. 9% vs. 19. 0% , P =0. 004) , and hypertension ( 52. 9% vs. 20. 9% , P =0. 007) were more common in the female patients with OSAHS. Conclusion There are significant differences between male and female patients with OSAHS in prevalence, age, symptoms, and severity of the disease.
目的 探討軀體感覺誘發電位（SEP）在頸脊髓損傷術前、術中監測的意義。 方法 納入2010年1月－2012年4月治療的241例頸脊髓損傷患者，術前按美國脊柱脊髓損傷協會（ASIA）評分并分級，確定損傷平面。術前與術中SEP監測，分析不同損傷分級以及不同損傷平面術前的波幅及潛伏期的差異，術中SEP監測以波幅下降＞50%和或潛伏期延長＞10%為預警標準。 結果 各損傷分級組術前SEP監測：A級組SEP波消失，呈一直線，而B、C、D、E級組均測出SEP波形，根據是否可測出SEP波形，可將A級與B、C、D、E及組區別。B、C、D級組之間波幅和潛伏期均無統計學意義（P＞0.05）。E級組較B、C、D級組波幅增高、潛伏期縮短，差異有統計學意義（P＜0.05）；不完全性頸脊髓損傷組內不同損傷平面組之間波幅和潛伏期差異均無統計學意義（P＞0.05）。術中SEP對脊髓功能損傷監測的靈敏度83.3%、特異度98.7%。其中術中：SEP陽性8例，真陽性5例，4例術者處理后波幅及潛伏期回復至正常范圍，術后無新的神經功能損傷，另1例術者采取各種處理后波幅及潛伏期無恢復，術后神經功能損傷較術前加重；假陽性3例，1例麻醉師給予升高血壓后波形恢復至正常，另2例經麻醉師調整麻醉深度后波形恢復正常，此3例術后無新的神經功能損傷。SEP陰性233例，真陰性232例，術后無新的神經功能損傷；假陰性1例，患者術中、術后波形未見異常，術后運動功能損傷程度較術前加重。 結論 ① SEP能準確評估完全性和不完性頸脊髓損傷，但對不完全性頸脊髓損傷的損傷程度不能作出準確評估、也不能區分頸脊髓損傷的損傷平面；② 術中SEP監測能較好地反映頸脊髓功能完整性，對減少頸脊髓損傷術中發生醫源性頸脊髓損傷風險具有重要意義。