Association between obstructive sleep apnea and vascular injury in hypertensive patients / 中华心血管病杂志

Objective: To investigate the relationship between obstructive sleep apnea (OSA), apnea hypopnea index (AHI) and vascular injury in hypertensive patients. Methods: This cross-sectional study enrolled patients admitted to the Hypertension Department of TEDA International Cardiovascular Hospital from April 2020 to April 2023, who finished portable sleep monitoring. Sleep monitoring indicators, flow-mediated vasodilation (FMD), carotid artery ultrasound, carotid intima-media thickness, cervical and femoral pulse wave conduction velocity (cfPWV), brachial and ankle pulse wave conduction velocity (baPWV) were analyzed. OSA was classified into mild (5 times/h≤AHI<15 times/h), moderate (15≤AHI<30 times/h), and severe (AHI≥30 times/h) based on AHI levels. FMD<6.0% was defined as vascular endothelial injury, and cfPWV>10 m/s and/or baPWV>18 m/s was defined as arterial stiffness. Multivariate logistic regression analysis was used to explore the correlation between AHI, OSA severity and vascular injury, and subgroup analysis was performed in young (age≤45 years) and middle-to-old patients (age>45 years). Sensitivity analysis was performed by excluding patients with diabetes, cerebrovascular disease and coronary heart disease. The correlation between AHI and vascular injury index was analyzed by restricted cubic spline. Results: A total of 555 adult hypertensive patients were included, the mean age was (39.7±9.2) years, 422 were males (76.0%), and the prevalence of OSA was 66.7% (370/555). Multivariate logistic regression analysis showed that moderate OSA (OR=2.83, P=0.019) and severe OSA (OR=3.40, P=0.016) were positively correlated with vascular endothelial injury after adjusting for age, sex, body mass index and mean arterial pressure. Subgroup analysis showed that log AHI (OR=1.99, P=0.035), moderate OSA (OR=4.83, P=0.010) and severe OSA (OR=4.64, P=0.015) were associated with vascular endothelial injury in young hypertensive patients. The results of sensitivity analysis were similar to the above results. The results of restricted cubic spline analysis showed that AHI was correlated with FMD (P=0.022), and the slope of the curve was the largest when AHI was between 0 and 10 times/h. There was no correlation between log AHI and OSA severity and carotid intima-media thickening and arterial stiffness (all P<0.05). Conclusions: OSA is associated with vascular endothelial injury in hypertensive patients, especially in young patients.

Association between obstructive sleep apnea and vascular injury in hypertensive patients / 中华心血管病杂志

Objective: To investigate the relationship between obstructive sleep apnea (OSA), apnea hypopnea index (AHI) and vascular injury in hypertensive patients. Methods: This cross-sectional study enrolled patients admitted to the Hypertension Department of TEDA International Cardiovascular Hospital from April 2020 to April 2023, who finished portable sleep monitoring. Sleep monitoring indicators, flow-mediated vasodilation (FMD), carotid artery ultrasound, carotid intima-media thickness, cervical and femoral pulse wave conduction velocity (cfPWV), brachial and ankle pulse wave conduction velocity (baPWV) were analyzed. OSA was classified into mild (5 times/h≤AHI<15 times/h), moderate (15≤AHI<30 times/h), and severe (AHI≥30 times/h) based on AHI levels. FMD<6.0% was defined as vascular endothelial injury, and cfPWV>10 m/s and/or baPWV>18 m/s was defined as arterial stiffness. Multivariate logistic regression analysis was used to explore the correlation between AHI, OSA severity and vascular injury, and subgroup analysis was performed in young (age≤45 years) and middle-to-old patients (age>45 years). Sensitivity analysis was performed by excluding patients with diabetes, cerebrovascular disease and coronary heart disease. The correlation between AHI and vascular injury index was analyzed by restricted cubic spline. Results: A total of 555 adult hypertensive patients were included, the mean age was (39.7±9.2) years, 422 were males (76.0%), and the prevalence of OSA was 66.7% (370/555). Multivariate logistic regression analysis showed that moderate OSA (OR=2.83, P=0.019) and severe OSA (OR=3.40, P=0.016) were positively correlated with vascular endothelial injury after adjusting for age, sex, body mass index and mean arterial pressure. Subgroup analysis showed that log AHI (OR=1.99, P=0.035), moderate OSA (OR=4.83, P=0.010) and severe OSA (OR=4.64, P=0.015) were associated with vascular endothelial injury in young hypertensive patients. The results of sensitivity analysis were similar to the above results. The results of restricted cubic spline analysis showed that AHI was correlated with FMD (P=0.022), and the slope of the curve was the largest when AHI was between 0 and 10 times/h. There was no correlation between log AHI and OSA severity and carotid intima-media thickening and arterial stiffness (all P<0.05). Conclusions: OSA is associated with vascular endothelial injury in hypertensive patients, especially in young patients.

Effects of bacterial lipopolysaccharide and normobaric hyperoxia on immature brain development of neonatal rat / 中华实用儿科临床杂志

Objective To investigate the effects of lipopolysaccharide (LPS) and / or normobaric hyperoxia on brain development of neonatal rat and the possible mechanisms.Methods One hundred and twenty postnatal day 2 (P2) SD rats were randomly assigned into 4 groups:air group,LPS group,hyperoxia group,LPS + hyperoxia group.General condition and body weight of the rats in each group were observed and recorded every day.The expression of active Caspase-3 and nuclear factor-κappaB P65 (NF-κB P65) in the brain were detected by immunohistochemistry staining on P7,and the level of IL-6 and 8-iso-PGF2α in the brain homogenate were measured by enzyme-linked immunosorbent assay(ELISA).The expression of myelin basic protein (MBP) in the brain was detected by immunohistochemistry staining on P12.Results The expressions of Caspase-3 and NF-κB P65 had the same trends:the number of positive cells from high to low was in LPS + hyperoxia group,LPS group/hyperoxia group,air group.There were significant differences between the first three groups and air group(all P ＜ 0.05).There were also significant differences between LPS + hyperoxia group and LPS group or hyperoxia group(all P ＜0.01).MBP in the brain had the completely reverse expression:from high to low order was in air group,hyperoxia group,LPS group,LPS + hyperoxia group.There were significant differences between the last three groups and air group (all P ＜ 0.05).There were also significant differences between LPS + hyperoxia group and LPS group or hyperoxia group(all P ＜0.01).The level of IL-6 in the brain from high to low order respectively was in LPS + hyperoxia group,LPS group,hyperoxia group,air group;and 8-iso-PGF2α was also in LPS + hyperoxia group,hyperoxia group,LPS group,air group,Significant differences were found among the four groups (all P ＜ 0.05).Conclusions Both postnatal infection and normobaric hyperoxia may induce premature rat brain injury,and increase the number of apoptosis cell and reduce the expression of MBP.The combination of infection and normobaric hyperoxia may aggravate the degree of brain damage of neonatal rat.NF-κB pathway mediated by Toll-like receptor may be involved in inflammation and oxidative stress,and may mediate Caspase-3 related apoptosis of nerve cell and white matter injury.

Risk factors of bronchopulmonary dysplasia in preterm infants with different severities / 中华实用儿科临床杂志

Objective To improve the prevention and treatment of bronchopulmonary dysplasia(BPD) in preterm infants,and the clinical risk factors of premature neonates with different severities of BPD were investigated.Methods A total of 139 cases among preterm infants who were admitted to NICU in the Third Affiliated Hospital of Zhengzhou University from Jan.2007 to Dec.2011 were analyzed retrospectively.The history of birth and mother pregnancy,clinical treatment,prognosis and complication of mild,moderate and severe BPD according to clinical diagnostic criteria were analyzed,respectively.Results Of the total 139 premature neonates,61 cases were diagnosed as mild BPD,48 cases as moderate BPD and 30 cases as severe BPD.No significant differences were found in gender,birth times,fertilization,delivery mode,the percentage of fetal distress and neonatal resuscitation,maternal age,the percentage of pregnancy-induced hypertension,the percentage of antenatal corticosteroids administration and postnatal pulmonary surfactant and combined with patent ducts arteries among the different groups(all P ＞ 0.05).With the increasing severity of BPD,the birth weight and gestational age were decreasing,the percentage of the infants with Apgar 1 minute score ≤7,premature rupture of membranes ≥ 8 hours,maternal perinatal infection,meconium-stained amniotic fluid were increasing(all P ＜ 0.05).And mechanical ventilation,the time of using oxygen,and the percentage of trachea cannula intubation ≥2 times,indwelling gastric tube and red blood cells transfusing,the positive rate of sputum cultures and the blood culture were also increased with the increasing severity of BPD(all P ＜ 0.05).Conclusions Preventing of preterm delivery,control and reduce antenatal and postnatal infection,shorten the duration of mechanical ventilation and usage of oxygen are key factors to reduce BPD and severities in neonatal infants.

Clinical analysis of organic acidemia in neonates from neonatal intensive care units / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the clinical features of organic acidemia in neonates admitted to the intensive care unit.</p><p><b>METHODS</b>The clinical features of neonates from 15 neonatal intensive care units of Henan Province, who were diagnosed with congenital organic acidemia by gaschromatography-mass spectrometry (GC-MS) between June 2008 and August 2011 were retrospectively reviewed.</p><p><b>RESULTS</b>Fifty neonates of 287 high risk neonates were confirmed as having or highly suspected to have inborn errors of metabolism. Of the 50 cases, 32 cases were diagnosed with organic acidemia disease, including 28 cases of methylmalonic acidemia, 2 cases of propionic acidemia, 1 case of maple syrup urine disease and 1 case of isovaleric acldemla. In most cases, disease onset occurred in the first week after birth in most of cases (75%). Neonates whose symptoms occurred immediately after or within a few hours of birth presented with serious conditions. Clinical manifestations were various and mainly related to neurologic, respiratory and gastrointestinal symptoms such as poor response, coma, drowsiness, abnormal muscle tone, convulsions, polypnea, dyspnea, milk refusal, diarrhea and jaundice. Initial symptoms were non-specific and included dyspnea, poor response, milk refusal, lethargy and seizures.</p><p><b>CONCLUSIONS</b>Methylmalonic acidemia is a common inherited metabolic disease in the neonatal period. Clinical manifestations of organic acid metabolism abnormalities in neonates are atypical and early onset is associated with more serious conditions.</p>

Risk factors for periventricular-intraventricular hemorrhage in premature infants treated with mechanical ventilation / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study risk factors for periventricular-intraventricular hemorrhage (PVH-IVH) in premature infants treated with mechanical ventilation.</p><p><b>METHODS</b>A total of 205 premature infants who were admitted to the neonatal intensive care unit (NICU) and treated with mechanical ventilation between January 2009 and December 2011 were enrolled. They were classified into PVH-IVH and non-PVH-IVH groups according to the results of head ultrasonography performed at 3 to 7 days after birth. Single factor and multivariate logistic regression analysis were used to identify risk factors for PVH-IVH.</p><p><b>RESULTS</b>Single factor analysis indicated 9 factors associated with the development of PVH-IVH, including a gestational age of <32 weeks, a birth weight of <1500 g, intrauterine distress, severe asphyxia, vaginal delivery, maternal perinatal infection, premature rupture of membranes (PROM) at ≥8 hours, mechanical ventilation duration of ≥7 days and ventilator-associated pneumonia (VAP) (P<0.05). Multivariate logistic regression analysis showed that a birth weight of <1500 g (OR=2.665), intrauterine distress (OR=2.177), severe asphyxia (OR=5.653), maternal perinatal infection (OR=4.365) and VAP (OR=2.299) were independent risk factors for the development of PVH-IVH (P<0.05).</p><p><b>CONCLUSIONS</b>Very low birth weight, intrauterine distress, severe asphyxia, maternal perinatal infection and VAP are closely associated with an increased risk of PVH-IVH in premature infants treated with mechanical ventilation. These clinical risk factors should be given more attention in the prevention of PVH-IVH.</p>

Perinatal conditions of preterm infants with different severities of respiratory distress syndrome / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To understand the risk factors for respiratory distress syndrome (RDS) by comparing the perinatal conditions of preterm infants with different severities of RDS.</p><p><b>METHODS</b>A total of 667 preterm infants with RDS were classified into 4 groups according to the chest X-ray severity: grade I (217 cases), grade II (225 cases), grade III (126 cases) and grade IV (99 cases). The perinatal conditions of the preterm infants were reviewed retrospectively.</p><p><b>RESULTS</b>There were no significant differences in the gender, the percentage of twins, the percentage of the younger one in twins, maternal age, the percentage of using antenatal corticosteroids, the percentage of premature rupture of membranes, the percentage of placental abruption, the delivery mode and the fertilization mode in preterm infants with different severities of RDS. With the increasing severity of RDS, the birth weight and the gestational age decreased, and the percentage of the infants with Apgar score ≤7 or maternal pregnancy-induced hypertension increased (P<0.05).</p><p><b>CONCLUSIONS</b>The severity of RDS is related to gestational age, birth weight and perinatal asphyxia in preterm infants.</p>