Sarcopenia as a Determinant of the Efficacy of Immune Checkpoint Inhibitors in Non-Small Cell Lung Cancer: A Meta-Analysis.

OBJECTIVE: The impact of pre-immunotherapy sarcopenia in patients with non-small cell lung cancer (NSCLC) receiving immune checkpoint inhibitors (ICIs) is elusive. We performed a meta-analysis to investigate the association between sarcopenia and clinical outcomes of ICIs. METHODS: PubMed, EMBASE, and the Cochrane Library were searched. RESULTS: Thirteen clinical trials were selected. The 1,2-year overall survival rate was lower in the sarcopenia group (odds ratio (OR) = 2.44, 95% confidence interval (CI), 1.78-3.35, P < 0.00001; OR = 1.60, 95% CI, 1.08-2.37, P = 0.02), with I2 = 34%, P = 0.15, and I2 = 41%, P = 0.12. The 1,2-year progression-free survival (PFS) was the same (OR = 3.43, 95% CI, 1.86-6.33, P < 0.0001; OR = 2.06, 95% CI, 1.19-3.58, P < 0.0001), with I2 = 31%, P = 0.17 and I2=31%, P = 0.17. Sarcopenia reduced the overall response rate (OR = 2.22, 95% CI, 1.01-4.84, P = 0.02), with I2= 56%, P = 0.02, and disease control rate (OR = 3.15, 95% CI, 2.10-4.72, P < 0.0001) with I2 = 33%, P = 0.18. CONCLUSION: Pre-immunotherapy sarcopenia was associated with poor clinical outcomes in patients with advanced NSCLC who received ICIs.

EEG Power Spectral Analysis of Abnormal Cortical Activations During REM/NREM Sleep in Obstructive Sleep Apnea.

Objective: To characterize electroencephalogram (EEG) power in different frequency bands during rapid eye movement (REM) sleep and non-rapid eye movement (NREM) sleep in patients with obstructive sleep apnea (OSA). Methods: Retrospective data on 151 patients were collected and divided into three groups: primary snoring group (AHI < 5/h), mild-moderate OSA group (6 ≤ AHI < 30/h), and severe OSA group (AHI ≥ 30/h). EEG recordings in the frontal, central, and occipital regions were extracted from both REM and NREM sleep, to compute the normalized spectral power densities in the delta, theta, alpha, sigma, beta, and gamma frequency bands, using Fast Fourier Transform. Correlations between the computed EEG power and PSG parameters were analyzed. Results: In NREM sleep, elevated normalized power spectral density (PSD) in the delta band was observed in the severe OSA group compared to the other two groups. In contrast, the PSD of the other frequency bands showed a corresponding decrease in the severe OSA group. In REM sleep, similar changes were observed in the frontal region. Delta band PSD was positively correlated with Apnea Hypopnea Index (AHI) (r = 0.33), longest time of apnea, oxygen desaturation index (ODI) (r = 0.34), percent sleep time below 90% SaO2 (T90%) (r = 0.30), Arousal Index (ArI) (r = 0.29), and negatively correlated with N3%, minimum oxygen saturation (minSaO2). Conclusion: Our findings provide neurophysiological evidence for pathological cortical activation during REM/NREM sleep, which may be associated with the arousals and cognitive impairments in OSA. The technique of power spectral analysis could prove a potentially useful tool in complementing traditional PSG parameters in assessing disease burden to guide therapeutic decisions.

Low Arousal Threshold: A Potential Bridge Between OSA and Periodic Limb Movements of Sleep.

OBJECTIVE: Periodic Limb Movements of Sleep (PLMS) is a poorly understood comorbidity with close association to Obstructive Sleep Apnea (OSA). The mechanistic link between the two is unclear. Recent studies on the latter have uncovered low respiratory arousal threshold as an important non-anatomical cause of the disorder. This study sought to investigate whether periodic limb movements are associated with the low respiratory arousal threshold (ArTH) in OSA. METHODS: Retrospective data on 720 OSA patients (mean age = 47.0) who underwent Polysomnography (PSG) were collected. Using PLMS diagnostic criteria of PLMS index ≥ 15, patients were divided into the OSA-PLMS group (n=95) and the OSA-only group (n=625). Binary logistic regression analysis was used to examine the correlation between PLMS and the presence of low ArTH, classified using a predicted tool (developed by Edward et al) requiring meeting at least two of the three criteria: apnea-hypopnea index (AHI) < 30/h, nadir oxygen saturation (SaO2) > 82.5%, and fraction of hypopneas > 58.3%. The resulting model was validated in the external MrOS database. RESULTS: The patients in the OSA-PLMS group tend to be older, with a higher prevalence of hypertension, diabetes, and stroke. PLMS was associated with age, diabetes, oxygen desaturation index, and low respiratory arousal threshold (OR=8.78 (4.73-16.30), p<0.001). When validated against the MrOS database, low ArTH remained a significant predictor of PLMS with an odds ratio of 1.33 (1.08-1.64, p = 0.009). CONCLUSION: This is the first study that demonstrated a strong correlation between PLMS and low respiratory arousal threshold. This suggests a possible mechanistic link between the physical manifestation of PLMS and the non-anatomical low arousal threshold phenotype in OSA.

Multidisciplinary team approach on a case of bronchopleural fistula after video-assisted thoracoscopic segmentectomy: a case report.

Bronchopleural fistula (BPF) is one of the most severe complications after lung surgery including pneumonectomy, lobectomy, and segmentectomy. BPF is dangerous and complicated. We reported a case of 41-year-old man who underwent a segmentectomy of the right lung through video-assisted thoracoscopy. The patient was diagnosed with BPFs by CT and the symptom of fever, cough with malodorous yellow phlegm. The patient underwent CT-guided thoracic catheter drainage treatment, as advised by a multidisciplinary team including experts from the thoracic surgery department, respiratory medicine department, and interventional department. Later, the patient underwent assisted postural drainage in combination with anti-infection treatment and nutritional support treatment. The patient recovered well. The patient's symptoms were completely relieved. The bronchial stump fistula healed, and the chest abscess disappeared.

Estimating Prevalence of Illicit Drug Use in Yunnan, China, 2011-15.

Background and Aims: Yunnan has been one of the provinces most afflicted by illicit drug use in China. However, there have been few systematic studies on the prevalence of illicit drug use in the area. Method: Using data on illicit drug users registered in the police system, this study aims to estimate the population size of illicit drug users and the annual prevalence of drug use in Yunnan from 2011 to 2015 using Zelterman's capture-recapture method. Results: In the 15-64 year-old population, the estimated prevalence rate of any illicit drug use was 0.81% (0.76-0.86%) in 2011 and 0.94% (0.90-0.98%) in 2014, representing a significant increase. The prevalence rate of heroin use decreased from 0.67% (0.63-0.73%) in 2011 to 0.57% (0.53-0.61%) in 2015, while the prevalence rate of methamphetamine use doubled from 0.20% (0.17-0.24%) in 2011 to 0.48% (0.46-0.50%) in 2015. The mean age of the 141,702 identified illicit drug users in Yunnan from 2011 to 2015 was 32.2 years, and the majority were male, low educated, and peasants; nearly half were single and ethnic minorities. The ratio of the number of identified illicit drug users to the number of hidden users increased from 1:12 in 2011 to 1:5 in 2015. Conclusion: The prevalence of illicit drug use in Yunnan has been increasing. Although the prevalence of heroin use decreased, methamphetamine use increased dramatically from 2011 to 2015. Preventive strategies that are more effective in reducing illicit drug use are urgently needed in Yunnan.

Influence of social network on drug use among clients of methadone maintenance treatment centers in Kunming, China.

AIMS: To examine drug use behavior of clients attending Methadone Maintenance Treatment (MMT) programs and its relationship with the clients' social network characteristics. DESIGN: Cross-sectional study. SETTING: Four MMT clinics in Kunming, Yunnan province, China. PARTICIPANTS: 324 consecutive MMT clients. MEASUREMENTS: A structured, self-completed questionnaire on background characteristics and existing social network. Current drug use was assessed by urine test for opiate metabolites. ANALYSIS: The association between client's social network characteristics and their own current drug use behavior is analysed using multiple logistic regression adjusting for socio-demographic characteristics. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) are obtained to give the strength of the associations. FINDINGS: MMT clients were more likely to concurrently use heroin while attending MMT if their social network had any of the following characteristics: more than half of the members were older than them (AOR = 1.03, 95% CI = 1.00,1.06), any member had a high level of influence on them (AOR = 6.47, 95% CI = 2.86,14.65) and any member joined them in using drugs (AOR = 1.94, 95% CI = 1.04,3.63). Having a social network member who could provide emotional support (AOR = 0.11, 95% CI = 0.03,0.35), having a spouse and/or child in their social network (AOR = 0.44, 95% CI = 0.24,0.81) and having a social network member with a high level of closeness (AOR = 0.28, 95% CI = 0.09,0.90) were associated with a decreased odds of heroin use. CONCLUSION: Social networks who could provide MMT clients with emotional support and a close relationship were significant factors for reducing the risk of concurrent drug use among clients attending MMT clinics in Kunming, China. Behavioral interventions should address the role of family and social network members in providing support to these clients.

Reliability and validity of the Treatment Outcome Profile among patients attending methadone maintenance treatment programs in Kunming, China.

BACKGROUND & OBJECTIVE: Substance misuse has been a major health and social issue worldwide and has become an important public health issue in China over the past two decades. Methadone maintenance treatment (MMT) has been proved worldwide by large bodies of research to be one of the most effective practices for illicit drug users. The Treatment Outcome Profile (TOP) was developed in 2007 by the UK National Treatment Agency (NTA). It has been proved to be a reliable instrument for outcome measure. This study aim to develop the Chinese version of the Treatment Outcome Profile (TOP), and to assess whether TOP is a reliable outcome measure that can be recommended for use in Chinese MMT program. METHODS: The Chinese version of TOP was translated and revised based on the English version of TOP. Psychometric properties of TOP were evaluated through face-to-face interviews in 197 patients who had been attending methadone maintenance treatment clinics in Kunming city, Yunnan Institute for Drug Abuse, for less than three months. Patients were interviewed by 3 trained interviewers. Reliability and validity of the instrument were analyzed by measures including test-retest and inter-rater reliability, concurrent validity and change sensitivity. Concurrent validity was assessed by comparing the scores from TOP with scores obtained from validated clinometric instruments. Self-reported opiate use was compared with results of urine analysis. Change sensitivity was judged by t-tests and chi-square tests. RESULTS & CONCLUSIONS: About 67% of the 197 interviewers were male and 33% were female. Test-retest reliability of TOP scores (after 10 days interval) were good (K=0.65 to 0.95), inter-rater correlations (ICC) ranged from 0.7 to 0.9, and the criterion validity ranged from 0.72 to 0.88. TOP covers a large scope of problems encountered by drug users needed for treatment. The Chinese version of TOP is a reliable and valid assessment tool.

Predictors of Poor Adherence to Methadone Maintenance Treatment in Yunnan Province, China.

BACKGROUND: China initiated the methadone maintenance treatment (MMT) program since 2004. The main challenge has been poor clinic adherence, which has a serious impact on treatment efficacy. OBJECTIVES: The aim of the study was to identify predictors of poor adherence to MMT in Yunnan Province, China. METHODS: We performed a case-control study of 764 patients, newly enrolled or re-enrolled on MMT programs, between January 1, 2007 and December 31, 2011. Information was obtained from clinic databases. RESULTS: The frequency of poor adherence was 561 (73.43%). Lower daily methadone dosage (<60 mg) was significantly associated with poor adherence (odds ratio 4.07; 95% confidence interval, 2.88-5.74; P value < 0.001). Younger age was also a significant predictor of poor adherence (odds ratio 1.04; 95% confidence interval, 1.01-1.05; P value < 0.01). CONCLUSIONS: Higher dosage of methadone is recommended as a way to improve treatment adherence.

Association of higher-risk alcohol consumption with injecting paraphernalia sharing behaviours in intravenous drug users.

BACKGROUND: Alcohol use is common among injecting drug users. The coexistence of alcohol consumption and injecting risk behaviour has the potential to increase harms among intravenous drug users (IDUs). OBJECTIVE: This study aimed to determine whether the level of alcohol use is a risk factor for injecting paraphernalia sharing behaviours. METHODS: A total of 637 treatment-seeking IDUs were assessed for injecting paraphernalia sharing behaviours and drinking risk level as defined by the National Institute for Health and Care Excellence (NICE). Multivariate analyses were performed to identify alcohol risk factors associated with injecting paraphernalia sharing behaviours. RESULTS: After adjusting for the effects of ethnicity, employment and drug used, the odds ratio of higher risk drinking for injecting paraphernalia sharing behaviours was 1.92 (95% CI 1.31-2.83). CONCLUSION: Higher-risk drinking in IDUs is associated with higher rates of injecting paraphernalia sharing behaviours. It is important to take alcohol use into account when evaluating these patients for treatment and designing intervention strategies.

Correlation of Epworth Sleepiness Scale with multiple sleep latency test and its diagnostic accuracy in assessing excessive daytime sleepiness in patients with obstructive sleep apnea hypopnea syndrome.

BACKGROUND: Excessive daytime sleepiness (EDS) is often associated with obstructive sleep apnea hypopnea syndrome (OSAHS) and contributes to a number of comorbidities in these patients. Therefore, early detection of EDS is critical in disease management. We examined the association between Epworth Sleepiness Scale (ESS) and multiple sleep latency test (MSLT) and diagnostic accuracy of ESS in assessing EDS in OSAHS patients. METHODS: The ESS, MSLT and overnight polysomnography were administered to 107 Chinese patients to assess EDS and its correlations with polysomnographic parameters. The diagnostic accuracy of ESS in classifying EDS (mean sleep latency (MSL) ≤ 10 minutes) was evaluated by calculating the area under ROC curve. RESULTS: As the severity of OSAHS increased, MSL decreased with increase in ESS score. Conversely, patients with worsening EDS (shorter MSL) were characterized by advanced nocturnal hypoxaemia and sleep disruption compared to those with normal MSL, suggesting EDS is associated with more severe OSAHS. There was a negative correlation between ESS score and MSL and both moderately correlated with some polysomnographic nocturnal hypoxaemic parameters. The area under ROC curve of ESS for identifying EDS was 0.80 (95% CI: 0.71 to 0.88) and ESS score ≥ 12 provided the best predictive value with a sensitivity of 80% and specificity of 69%. CONCLUSION: The ESS score moderately correlates with MSL and our ROC study supports ESS as a screening strategy for assessing EDS in OSAHS.

[Association between obesity and cognition impairment in patients with moderate-to-severe obstructive sleep apnea-hypopnea syndrome].

OBJECTIVE: To explore the association between obesity and cognition impairment in patients with moderate-to-severe obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: A total of 425 eligible patients with moderate-to-severe OSAHS were screened for this retrospective study at Sleep Center, Second Affiliated Hospital, Soochow University from January 2008 to January 2013. Based on body mass index (BMI), they were categorized into normal weight (18.5 ≤ BMI<24, n = 67), mild overweight (24 ≤ BMI<26, n = 100), severe overweight (26 ≤ BMI<28, n = 134) and obese (BMI ≥ 28, n = 124) groups. They were examined by overnight polysomnography (PSG). And cognitive functions were assessed by the Montreal Cognitive Assessment (MoCA) questionnaires. MoCA scores, clinical and polysomnographic variables were compared between the groups. And the correlations between MoCA scores and clinical and PSG parameters were further evaluated by stepwise multivariate regression. Two-way analysis of variance (two-way ANOVA) was performed to examine the effects of obesity and OSAHS on MoCA score. RESULTS: The scores of MoCA progressively decreased across the spectrum from mild overweight to obese groups. The highest BMI group (obese group) had the lowest MoCA score (25.45 ± 2.35 vs 26.26 ± 2.01, 26.29 ± 2.60, 26.05 ± 2.51, P = 0.030, 0.010, 0.048). The evaluations of MoCA subdomains further revealed selective reductions. Compare to normal weight group, the score of visuospatial and executive function, memory/delayed recall significant decreased in obese and severe overweight groups (visuospatial and executive function: 4.48 ± 0.63 vs 4.07 ± 0.94, 4.13 ± 1.04, P = 0.022, 0.048; memory/delayed recall: 3.54 ± 0.90 vs 2.77 ± 1.20, 2.87 ± 1.30, P = 0.001, 0.004). Stepwise multivariate regression analysis demonstrated that MoCA scores were correlated significantly with apnea-hypopnea index (AHI), BMI, age and years of education. Two-way ANOVA revealed that both obesity and OSAHS had independent effects on MoCA score (P = 0.004). The interactions between the effect of obesity and OSAHS on cognitive score were insignificant. It indicated that the effect of BMI on cognitive function did not change with AHI. CONCLUSIONS: In OSAHS patients, obesity aggravates cognitive impairment independently of AHI. And obesity is one of the most important influencing factors of cognitive function.

[Association between serum adipocyte fatty acid binding protein level and dyslipidemia in patients with obstructive sleep apnea syndrome].

OBJECTIVE: To explore the association between serum adipocyte fatty acid binding protein (A-FABP) levels and dyslipidemia in patients with obstructive sleep apnea syndromes (OSAS). METHODS: Eighty snoring patients were monitored by overnight polysomnography (PSG) in Second Affiliated Hospital of Soochow University from November 2010 to May 2011. There were 63 males and 17 females with a mean age of (48 ± 14) years (range: 22 - 77 years). Based on the results of apnea-hypopnea index (AHI), they were divided into 3 groups: primary snoring group (AHI < 5/h, n = 19), mild-moderate OSAS group (5/h ≤ AHI ≤ 40/h, n = 22) and severe OSAS group (AHI > 40/h, n = 39). The levels of A-FABP, total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were measured and compared between the primary snoring group and OSAS patients of different severities. And the correlations between serum A-FABP and plasma lipid as well as PSG parameters were further evaluated by partial correlation analysis. RESULTS: Compared with the primary snoring group ((15.7 ± 3.3) µg/L) and mild-moderate group ((17.3 ± 4.3) µg/L), there was a significant elevation of serum A-FABP level in the severe OSAS group ((20.4 ± 4.6) µg/L) (P = 0.001, P = 0.026). Additionally, after adjustment for body mass index and age, the serum A-FABP level showed significant positive correlations with TC, TG and LDL-C (r = 0.469, P = 0.000; r = 0.239, P = 0.035 and r = 0.366, P = 0.001). Serum A-FABP level was positively correlated with AHI and the time of oxygen saturation (SaO2) < 90% (r = 0.231, P = 0.042 and r = 0.226, P = 0.047). Nevertheless, the serum A-FABP level showed significant negative correlations with the lowest SaO2 and the mean SaO2 (r = -0.234, P = 0.039 and r = -0.270, P = 0.017). CONCLUSION: Dyslipidemia and elevated level of serum A-FABP are common in OSAS patients.

[Effect of chronic intermittent hypoxia on mitochondrial function of rat genioglossus cells and intervention role of adiponectin].

OBJECTIVE: To investigate the effect of chronic intermittent hypoxia (CIH) on mitochondrial function in genioglossus cells of rats and intervention role of adiponectin (Ad). METHODS: Thirty-nine healthy male Wistar rats were randomly divided into 3 groups, normal control (NC) group, CIH group and CIH + Ad group with 13 rats in each. Rats in NC group were kept breathing normal air, while rats in both CIH and CIH + Ad groups experienced the same CIH environment (CIH 8 h/day for successive 5 weeks). However, rats in CIH + Ad group was given intravenous Ad supplement at the dosage of 10 µg, twice a week for successive 5 weeks. At the end of experiment (day 35), the levels of plasma adiponectin, mitochondrial membrane potential activities of respiratory chain complexes I and IV in mitochondrion of genioglossus cells were compared among different groups. RESULTS: Serum Ad level was significantly lower in CIH group than that in NC group [(1108 ± 112) ng/ml vs (2241 ± 121) ng/ml, P < 0.01]. Serum Ad level in CIH + Ad group [(1889 ± 119) ng/ml] was significantly higher than that in NC group but lower than that in CIH group (all P < 0.01). Mitochondrial membrane potential was significantly lower in CIH group than that in NC group [(1.82 ± 0.11) vs (2.09 ± 0.14), P < 0.01]. Mitochondrial membrane potential in CIH + Ad group (1.98 ± 0.09) was higher than that in CIH group but lower than that in NC group (all P < 0.05). The concentrations of mitochondrial respiratory chain complexes I and IV in CIH group (35.68 ± 1.73) µmol×min(-1)×mg(-1) and (2.37 ± 0.11) nmol×min(-1)×mg(-1), respectively) were the lowest but became higher from CIH + Ad group [(37.18 ± 1.95) µmol×min(-1)×mg(-1) and (2.49 ± 0.09) nmol×min(-1)×mg(-1), respectively] to NC group (39.02 ± 1.38) µmol×min(-1)×mg(-1) and (2.81 ± 0.12) nmol×min(-1)×mg(-1), respectively), with a significant difference between NC and CIH groups (P < 0.01), between CIH + Ad and CIH groups (P < 0.05), as well as between CIH + Ad and NC groups (P < 0.05). CONCLUSION: CIH could lead to hypoadiponectinemia and impaired mitochondrial function in genioglossus cells of rats. Since such changes could be partially improved by supplement of adiponectin, it was suggested that hypoadiponectinemia might be involved in CIH-induced impairment of genioglossus energy metabolism.

Changes in genioglossus and their association with serum adiponectin levels in rats subjected to chronic intermittent hypoxia.

BACKGROUND: The genioglossus (GG) is involved in the maintenance of an open airway for effective breathing. Although the pathogenesis of obstructive sleep apnea hypopnea syndrome (OSAHS) was closely associated with GG dysfunction, its causes and possible treatment have not been elucidated. The aim of the study was to investigate the effects of chronic intermittent hypoxia (CIH) on serum adiponectin levels, electromyograph (EMG) activity and ultrastructure of GG, as well as the effect of an adiponectin supplement in anesthetized rats. METHODS: Forty-two healthy male Wistar rats were randomly divided into normal control (A), CIH (B) and adiponectin treatment (C) groups, 14 rats in each group. CIH was performed eight hours per day for five weeks in both groups B and C. Group C received transvenous injection of adiponectin at the dosage of 10 microg per injection, twice a week for five weeks. At the end of the 5th week the GG EMG voltage was measured and compared among the three groups. Transmission electron microscope was used to observe the ultrastructure of the GG. RESULTS: CIH caused significant hypoadiponectinemia, weakened activity of GG EMG at both baseline and hypoxia stimulation, and induced ultrastructural pathological changes, such as, myofibril discontinuities, lysis of myofilament, edema of mitochondria and disruption of cristae, vacuolus and lysis of some mitochondria. Venous supplement of adiponectin improved the above pathological changes resulting from CIH. CONCLUSION: CIH resulted in pathological changes in GG's EMG and ultrastructure, which could be improved by supplement of adiponectin and be associated with hypoadiponectinemia caused by CIH.

[Effect of chronic intermittent hypoxia on genioglossus and its intervention by adiponectin].

OBJECTIVE: To investigate the effects of chronic intermittent hypoxia (CIH) on electromyograph (EMG) and ultrastructure of genioglossus (GG) and the interventive effects with adiponectin supplement. METHODS: Forty-two healthy male Wistar rats were randomly divided into normal control (A), CIH (B) and adiponectin treatment (C) groups with 14 rats in each. CIH was performed 8 hours per day for 5 weeks in both group B and C. In group C, transvenous injection of adiponectin of 10 microg dosage each time, twice a week for 5 weeks. While in group A and B, transvenous injection of saline was performed twice a week for 5 weeks. At the beginning of 6th week the GG EMG voltages were measured before, during and following hypoxia stimulation by inserted bipolar needle electrodes and compared among three groups. Transmission electron microscope was used for observation of ultrastructure of GG. RESULTS: The serum adiponectin level in group B (1226.0 +/- 112.0) ng/ml (x(-) +/- s) was significantly lower than that in group A (2491.8 +/- 117.9) ng/ml, q = 38.2, P < 0.01), and adiponectin level in group C (1988.3 +/- 114.7) ng/ml was significantly higher than that in group B (q = 23.0, P < 0.01). Comparison of GG EMG activity showed that the baseline amplitude of GG EMG before hypoxia stimulation was significantly lower in group B than that in both group A and group C (all P < 0.01). At the 5th min of hypoxia stimulation the GG EMG activities were significantly enhanced among three groups (all P < 0.01). Such an enhancement was the most evident in group A but the least remarkable in group B, with a significant difference among three groups (q(ab) = 17.5; q(ac) = 8.9; q(bc) = 8.6, all P < 0.01). 15 min, 30 min and 45 min after hypoxia stimulation the amplitude of GG EMG remained at relative higher levels in group A and C, significantly higher than that in group B (all P < 0.01). CIH could cause significant ultrastructural pathological changes such as myofibril discontinuities, lysis of myofilament, edema of mitochondria and disruption of cristae, vacuoles and lysis of some mitochondria in group B. Venous supplement of adiponectin could improve pathological changes resulting from CIH. CONCLUSIONS: CIH could resulted in pathological changes in EMG and ultrastructure of GG, which might be associated with hypoadiponectinemia caused by CIH.