Isolated Bilateral Macrostomia.

Macrostomia (Tessier's 7 cleft) is a rare congenital lip deformity. Macrostomia can occur unilateral or bilateral, isolated or associated with other syndromes. Isolated bilateral macrostomia is exceedingly rare with only a few cases reported to date. The authors report 6 cases of isolated bilateral macrostomia surgically repaired in 4-layered approaches. The traditional method was improved and the result obtained was satisfactory after longest follow-up of 3 years. The technique is easy to imitate, simple in design, aesthetically and functionally corrects the deformity.

[Preparation technology of total coumarins from Laportea bulbifera].

OBJECTIVE: To investigate the preparation process of total coumarins from Laportea bulbifera. METHODS: The optimum condition for the extraction of total coumarins was studied using the orthogonal test, and the extracts was purled with different kinds of macroporous resins. The content of total coumarins was detected by ultraviolet spectrophotometry. RESULTS: The optimum extraction process was as follows: three-time circumfluence with 4 times volume of 75% ethanol for 1.5 h each time. HPD300 macroporous resin was the optimum one for the separation and purification of total coumarins. The extraction condition was loading 30 mL of 0.4 g/mL the crude drug, flowing at 2BV/h, then edulcorating with 4 times volume of distilled water and eluting with the same volume of 75% ethanol. The yield rate was more than 52%. CONCLUSION: This method is suitable for the preparation of total coumarins in Laportea bulbifera, and the process is stable and repeatable.

Arg-liposome-amplified colorimetric immunoassay for selective and sensitive detection of cystatin C to predict acute kidney injury.

Cystatin C (Cys C) has been considered as a novel biomarker of kidney disease, which is thought to be a better indicator of glomerular filtration rate than creatinine (Scr) in the prediction of acute kidney injury (AKI). Hence, there is strong need to develop a precise, rapid and simple detection method for Cys C. Here we reported a Arg-liposome-amplified colorimetric immunoassay for the detection of Cys C to predict AKI. Cys C antibodies are conjugated on the surface of magnetic beads (MBs) and arginine (Arg)-loaded liposomes to form Ab1-MBs and Ab2-Arg-liposomes, respectively. When Ab1-MBs captured Cys C, Ab2-Arg-liposomes are added and incubated to form the immuno-sandwich complex. After magnetic separation, the surfactant Triton ×100 is added to damage the liposomes, leading to the release of Arg which can induce the gold nanoparticles aggregation. Therefore, the discoloration can be used for visual and quantitative detection of Cys C. Notably, the method has a linear relation in the range of 10-100 µg/L for Cys C with a limit of detection 4.32 µg/L, which is lower than some of the previous reports. In addition, the AKI mice serum samples were tested by the developed method, which were in good agreement with ELISA results. More intriguingly, the results of cisplatin induced acute kidney injury in mice showed that the method could be used to evaluate the protective effect of astragalus membranaceus (AM) on AKI by detecting Cys C in serum, providing a new strategy for screening renal protective drugs. Accordingly, a rapid and highly sensitive Cys C detection system was established with great potential for clinical diagnostics.

A dual-responsive biosensor for blood lead detection.

Simple and accurate detection of trace heavy metals in blood is very important. A novel dual-responsive electrochemical/fluorescent biosensor based on magnetic hyperbranched polyamide with heparin modification (MHPAM-H) for blood lead detection has been successfully developed. Upon conjugated with blood lead ions, dual-biosensor could not only display electrochemical signal but also fluorescence signal owing to the enriched amino groups, cavity structure, and good fluorescence properties of HPAM. Blood biocompatibility, construction of the dual-responsive biosensor, electrochemical/fluorescent detection of lead ions in water phase and blood condition, selectivity and stability of the dual-responsive biosensor were investigated in detail. The proposed dual-responsive biosensor displays good linear relationship (1.5 pM- 4.8 × 103 pM for electrochemical detection and 0.5 pM-4.8 × 103 pM for fluorescent detection) with low detection limit (4.4 pM for electrochemical detection and 1.0 pM for fluorescent detection) for blood lead, providing potential application for blood lead detection in the future.

[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.

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.

[Combination of transpalatal advancement pharyngoplasty and uvulopalatopharyngoplasty for obstructive sleep apnea].

OBJECTIVE: Investigate the response of the patients with obstructive sleep apnea hypopnea syndrome (OSAHS) patients to combination of transpalatal advancement pharyngoplasty and uvulopalatopharyngoplasty. METHODS: Thirty two patients with OSAHS, age ranged from 27 to 54, mean value (x +/- s) 39.1 +/- 7.8, male, body mass index (BMI) ranged from 22.9 to 36. 7 kg/m2, mean value (29.0 +/- 3.6) kg/m2, preoperative apnea and hypopnea index (AHI) was 11.7/h to 113.7/h, mean value (61.8 +/- 21.9)/h, the lowest blood oxygen saturation was 0.10 to 0.85, mean value 0.64 +/- 0. 13. With preoperative endoscopic technique, bony nasopharynx cavity narrowing were present, 14 patients had concomitant tonge-base obstruction. Cephalometric result, SNA ranged from 72.9 degrees to 87.0 degrees, mean value (80.7 +/- 4.1) degrees; SNB 69.50 to 85.0 degrees, mean value (76.8 +/- 4.5) degrees; PAS 0.5 cm to 2.1 cm, mean value (1.2 +/- 0.5) cm; MP-H: ranged from 1.2 cm to 3.5 cm, mean value (2.2 +/- 0.7) cm; PNS ranged from 2.4 cm to 3.5 cm, mean value (2.8 +/- 0.4) cm. All the patients had H-UPPP and concomitant transpalatal advancement pharyngoplasty. Fourteen patients with tonge-base obstruction had chin advancement. Results Six months after the operations, the patients were evaluated the response to the operations using Epworth sleep scale, OSAHS filtration questionnaire scale and polysomnography (PSG). There were 27 patients with the decrease percent of AHI reaching or more than 25% and 22 patients with the decrease percent of AHI reaching or more than 50% including 8 patients with AHI less than 5. The other 5 patients were ineffective. After operation, the Epworth sleep scale decreased from (9.2 +/- 4.5) to (4.7 +/- 2. 8) and OSAHS filtration questionnaire scale decreased form (56.0 +/- 15.3) to (17.5 +/- 11.5). Both of the differences were obvious (P < 0.01). CONCLUSIONS: Combination of transpalatal advancement pharyngoplasty and H-UPPP can improve the efficacity and in some patients with pure retropalatal airway narrowing, the cure rate can be improved.

[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.