[Sleep quality and sleep disturbances in Chinese pregnant women: a multicenter cross-sectional study].

Objective: This study aims to investigate the sleep quality of pregnant women in Xuhui District, Shanghai, and the related factors of sleep disturbances during pregnancy. Methods: From February 2019 to February 2021, we used online integrated sleep questionnaire (including PSQI, BQ, ESS, AIS) in Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, The International Peace Maternity and Child Health Hospitals of China Welfare Institution, and Shanghai Eighth People's Hospital, to investigate the sleep quality across pregnancy. We also collected maternal physical examination results, childbearing history, sociodemographic, and other clinical data. The prevalences and related factors of various sleep disturbances in pregnant women were analyzed, including insufficient/excessive nighttime sleep, low sleep efficiency, difficulty falling asleep, poor sleep quality, insomnia, daytime sleepiness, and high risk of sleep-disordered breathing (SDB). Results: This study includes 1 898 cases in the first trimester (T1), 3 099 cases in the second trimester (T2), and 1 539 cases in the third trimester (T3). Poor sleep quality (38.6%), daytime sleepiness (mild 41.9%, moderate 17.7%, severe 2.1%), and suspicious insomnia (32.3%) are most prevalent among women in T1 (P<0.01). In comparison, short sleep time (2.7%), long sleep time (8.6%), difficulty falling asleep (12.2%), poor sleep efficiency (35.4%), very poor sleep quality (6.7%), clinical insomnia (21.8%), and high-risk SDB (6.4%) are most prevalent among women in T3 (P<0.05). During pregnancy, late gestation (OR=1.016, 95%CI: 1.006-1.025) and multiple induced/drug abortions (OR=1.329, 95%CI: 1.043-1.692) are risk factors for poor sleep quality (PSQI>5), while multiple full-term deliveries (OR=0.800, 95%CI: 0.675-0.949) is its protective factor. Advanced maternal age (OR=0.976, 95%CI: 0.956-0.997), multiple full-term deliveries (OR=0.808, 95%CI: 0.680-0.959), late gestation (OR=0.983, 95%CI: 0.974-0.992) and hypertension (OR=0.572, 95%CI: 0.401-0.814) are protective factors for daytime sleepiness (ESS>6). The high-risk pregnancy category (OR=9.312, 95%CI: 1.156-74.978) is a risk factor for insomnia (AIS≥4), while multiple full-term deliveries (OR=0.815, 95%CI: 0.691-0.961) is its protective factor. High BMI (OR=1.334, 95%CI: 1.270-1.402) and hypertension (OR=4.427, 95%CI: 2.539-7.719) are risk factors for high-risk SDB in pregnant women. Conclusions: The prevalences of various sleep disturbances are high throughout pregnancy. Noticeably, symptoms of maternal SDB develop along with pregnancy. Different types of sleep disturbances are associated with different factors. Women of high-risk pregnancy category, in late gestation, with high BMI, hypertension, a history of induced/drug abortion, or without a history of full-term delivery can be at high risk of sleep disturbances during pregnancy.

[Efficacy of Han-uvulopalatopharyngoplasty (HUPPP) combined with radiofrequency ablation of tongue base or HUPPP with traction of tongue base on moderate to severe patients with obstructive sleep apnea hypopnea syndrome (OSAHS):a multicenter randomized controlled trial].

Objective: To compare the therapeutic efficacy of Han-uvulopalatopharyngoplasty (HUPPP) combined with radiofrequency ablation of tongue base or HUPPP with traction of tongue base on moderate to severe patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: This is a multicenter randomized controlled trial. From March 2017 to July 2019, moderate to severe OSAHS patients from three clinical center in Shanghai who were intolerant to continuous positive airway pressure (CPAP) and with velopharyngeal and glossopharyngeal plane obstruction were enrolled in this study. According to the surgical type, they were 1∶1 randomized to HUPPP plus radiofrequency ablation of tongue base group (Ablation group) or HUPPP plus traction of tongue base group (Traction group). All patients completed over-night standard Polysomnography (PSG), upper-airway assessment (Friedman classification, Müller test, CT and cephalometric examination), preoperative routine examination, Epworth Sleepiness Scale (ESS) and Quebec sleep questionnaire (QSQ). Six to 12 months after operation, all the above-mentioned examinations were repeatedly performed. Changes of aforementioned variables before and after operation were assessed. Results: A total of 43 patients with moderate to severe OSAHS were enrolled in this study. One patient lost to follow-up, the remaining 21 were allocated to Ablation group and 21 were allocated to Traction group. The total therapeutic efficacy of all patients was 69.05% (61.90% in Ablation group and 76.19% in Traction group), but there was no statistical significance between the two groups (P= 0.317). The value of sleep scale score (ESS and QSQ), objective sleep variables (apnea-hypopnea index, oxygen saturation, percentage of time with blood oxygen less than 90% in total sleep time, oxygen desaturation index and micro-arousals) and upper airway cross-sectional area (palatopharyngeal and retrolingual area) of the two groups were improved (P<0.05), but the differences between the two groups were not statistically significant (P>0.05). Conclusion: For moderate to severe OSAHS who had glossopharyngeal plane obstruction, both HUPPP plus radiofrequency ablation of tongue base or HUPPP plus traction of tongue base are effective treatment for OSAHS, and the curative effect is similar. The choice of surgical type could be selected according to patient's or surgical conditions.

[Obstructive sleep apnea and metabolic syndrome: an association study based on a large sample clinical database].

Objective: To investigate the prevalence and associated risk factors of metabolic syndrome (MS) in patients with obstructive sleep apnea (OSA). Methods: From July 2007 to June 2017, a total of 8 155 adult subjects, including 6 484 males and 1 671 females, aged 18-90 (43.13±12.28), body mass index 14.61~59.56 (25.59±3.98) kg/m2,who were admitted to the Department of Otorhinolaryngology head and Neck surgery of The Sixth People's Hospital affiliated to Shanghai Jiao Tong University, were retrospectively analyzed. All patients underwent polysomnography and biochemical tests. Subjects were divided into four groups (non-OSA, mild OSA, moderate OSA, and severe OSA) according to OSA severity. The prevalence of MS was expressed as percentage, and the correlation between OSA and MS and its characteristic pathophysiological indicators was evaluated by logistic regression model after adjusting for factors such as gender, age, BMI, neck circumference, hip circumference, smoking and alcohol consumption, and was expressed by odds ratio (OR). SPSS 25.0 software was used for statistical analysis. Results: The overall prevalence of MS was 43.6%, and that of non-/mild/moderate/severe OSA group was 18.6%, 30.4%, 43.8%, 57.1%.Logistic regression showed that patients with mild/moderate/severe OSA had an increased risk of MS compared with non-OSA patients, with adjusted OR values and confidence intervals of 1.27 (1.05-1.54), 1.84 (1.53-2.22), and 2.08 (1.76-2.46), respectively (P<0.01).In addition, indicators of OSA anoxic burden [oxygen drop index(Toxygen=7.1), minimum blood oxygen(Tminimum=56.3), blood oxygen saturation below 90% cumulative time ratio (TCT90=10.6) ]were closely associated with MS disease(P<0.01), but sleep fragmentation index (arousals index) was not significantly associated with MS disease. Conclusion: The risk of MS gradually increases with the severity of OSA, and the indicators reflecting OSA hypoxia burden are closely related to MS disease.

[Free-hand technique of S(2) alar iliac screw placement for sacropelvic fusion in lumbar degenerative scoliosis].

Objective: To evaluate the feasibility of placement of S(2) alar iliac screw (S(2)AI) using free-hand technique for sacrapelvic fusion in lumbar degenerative scoliosis. Methods: Eighteen patients with Lumbar Degenerative Scoliosis treated by S(2)AI screw fixation at Department of Orthopedics, General Hospital of Southern Theater Command of People's Liberation Army and Department of Orthopedics, 89th hospital of People's Liberation Army from August 2014 to October 2018 were analyzed retrospectively. There were 5 males and 13 females, aged 63.2 years old (range:55 to 71 years old).Parameters of spine including: Cobb Angle, C(7) plumb line -center sacral vertical line (C(7)PL-CSVL), lumbar lordosis(LL), sagittal vertical axis(SVA), pelvic incidence(PI), pelvic tilt(PT), sacral slope (SS) and pI-LL were measured on the whole spine X-ray before operation and at final follow-up. Pelvic CT scan was performed postoperatively to assess the accuracy of S(2)AI placement. Oswestry disability Index (ODI) was also recorded. The data were compared by paired t test or Wilcoxon tests. Results: All patients were followed up for 23.7 months (range: 12~62 months).At the last follow up, Cobb Angle decreased from (32.28±4.97) °preoperative to (6.56±3.20) ° (t=41.142, P<0.01) and C(7)PL-CSVL deceased from (1.11±2.07) cm preoperative to (0.18±1.08) cm (t=41.142, P=0.06) .LL improved from (-22.39±13.07) °preoperative to (-36.39±4.29) ° (t=4.470, P<0.01) , PI-LL decreased from (26.83±14.83)°preoperative to (13.72±8.3)° (t=4.396, P<0.01) , PT decreased from (27.94±4.26) °to (23.39±6.08) ° (t=2.680, P=0.02) , and SS increased from (22.22±6.36) °to (26.28±7.24) ° (t=-2.178, P=0.04) .SVA decreased from (6.54±4.51) cm preoperative to (2.62±1.29) cm (t=3.052, P=0.01) .ODI decreased from 0.58(0.40) (M(Q(R))) to 0.18 (0.15) (Z=-4.567, P<0.01) .No complications such as nerve and blood vessel injury occurred during the operation. A total of 32 S(2)AI screws were placed, 3 screws were placed with mild to moderate cortical breaches, 2 were perforated the pelvis ventrally, 1 was perforated posteriorly, with no clinically notable neurovascular or visceral complications. Eight patients finished the SRS-22 questionnaire, with mean score of 4.4 in terms of satisfaction with management. Conclusions: Free-hand technique of S(2)AI screw placement for sacrapelvic fusion in degenerative lumbar scoliosis is safe and feasible.S(2)AI fixation in DLS can provide great correction of deformity, maintain the stability of lumbo-pelvic area and improve the clinical symptoms.

The expression of overexpressed PTEN enhanced IR-induced apoptosis of myocardial cells.

Since this article has been suspected of research misconduct and the corresponding authors did not respond to our request to prove originality of data and figures, "The expression of overexpressed PTEN enhanced IR-induced apoptosis of myocardial cells, by Y.-B. Zhu, N. Ding, H.-L. Yi, Z.-Q. Li, published in Eur Rev Med Pharmacol Sci 2019; 23 (10): 4406-4413-DOI: 10.26355/eurrev_201905_17948-PMID: 31173315" has been withdrawn. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/17948.

The association between vitamin D receptor gene polymorphism and susceptibility to hypertension: a meta-analysis.

OBJECTIVE: Current studies reporting the association between VDR polymorphisms and susceptibility to hypertension are controversial. This meta-analysis aims to obtain a precise correlation estimate between VDR polymorphisms and susceptibility to hypertension. MATERIALS AND METHODS: Relevant studies were searched in PubMed, Web of Science, CNRI, Wanfang, and VIP using the keywords as "Vitamin D receptor, hypertension", "Vitamin D receptor polymorphism, hypertension", and "VDR, hypertension". ORs and corresponding 95%CI of eligible studies were calculated using RevMan5.3 and STATA12.0. RESULTS: Seven independent studies reporting the association between VDR gene polymorphisms and hypertension were enrolled. VDR rs1544410 (BsmI) was associated with susceptibility to hypertension. The frequency of VDR BsmI AA genotype decreased in hypertension patients compared with healthy controls. The population carrying VDR BsmI AA genotype had lower susceptibility to hypertension relative to those carrying GA or GG genotype (OR = 0.69, 95% CI = 0.54-0.89, p = 0.005). Meanwhile, the frequency of A allele was higher in the case group than that of control group (OR = 0.83, 95% CI = 0.69-0.99, p = 0.04). No significant correlation was found between VDR FokI or VDR ApaI with susceptibility to hypertension. CONCLUSIONS: VDR BsmI gene polymorphism is closely related to the susceptibility to hypertension.

[Relationship between smoking and the severity of OSA].

Objective:To explore the relationship between smoking and the severity of OSA. Method:There were 719 patients included in the study, who were accompanied by snoring, daytime sleepiness and other symptoms. Laboratory-based polysomnographic variables （including AHI, oxygen desaturation index and microarousal index, etc.）, and anthropometric measurements （including weight, neck circumference, waist circumference, hip circumference etc.） were collected for all participants. The severity of OSA was determined by AHI. No OSA was defined as AHI<5, mild OSA as AHI of 5 to 15，moderate OSA as AHI of >15 to 30, and severe OSA as AHI of >30. Smoking severity was determined by the smoking index （SI）. Light smoke was defined as SI<200, moderate smoke was as SI 200 to 400, and severe smoke as SI>400. Result:There were 138 cases of non-OSA and 581 cases of OSA. There were 381 non-smokers, 279 smokers and 59 quit smokers. The smoking rate of OSA group was significantly higher than that of non-OSA group （41.5% vs. 27.5%,P<0.01）. After excluding 59 quit smokers, the remaining 660 subjects were divided into four groups according to the severity of smoking, then each group was further divided into four groups according to OSA severity. Unadjusted analysis showed that OSA severity positively correlated with smoking severity （r=0.203,P<0.01）. The positive correlation remained significant after further adjustment for age, BMI and waist-hip ratio. In addition, logistic regression analysis showed that compared to non-smokers, the odd ratios for OSA in moderate smokers were 1.72 （95%CI 1.08-2.75） and in severe smokers were 2.68 （95%CI 1.61-4.46）, after adjustment for age, BMI and waist-hip ratio. Conclusion:The severity of smoking significantly correlated with the severity of OSA. There was increased risk of OSA in patients with severe smoke. The correlation was independent of some confounders such as age and obesity.

[Clinical characteristics and management of cervical necrotizing fasciitis].

Objective:To investigate the clinical characteristics and treatment of cervical necrotizing fasciitis. Method:Clinical data of 61 patients were analyzed retrospectively. All patients were underwent surgical debridement and treated with broad-spectrum antibiotics after diagnose. Result:Complications occurred in 14 patients. Fifty-nine patients were cured while 2 patients died. After 3 months or more follow-up, 3 patients accompanied with sequelae of vocal hoarseness, and no patient recurred or died. Conclusion:Early surgical debridement and the use of antibiotics should be taken as soon as possible after diagnosis of cervical necrotizing fasciitis, as well as control of comorbidities and systemic support treatment in order to prevent complications and deaths.

The expression of overexpressed PTEN enhanced IR-induced apoptosis of myocardial cells.

OBJECTIVE: Myocardial cell apoptosis is an important pathologic basis of ischemia-reperfusion injury (I/R). PI3K/Akt signaling pathway involves in cell growth, survival, and apoptosis regulation, thus playing an important role in the protection of I/R injury. PTEN is a negative regulatory factor of PI3K/Akt signaling pathway. This study established rat I/R injury model after AMI and myocardial cell I/R injury model to explore the regulatory role of PTEN-PI3K/Akt signaling pathway in myocardial I/R injury in vivo and in vitro. MATERIALS AND METHODS: Rat myocardial I/R injury model was established. PTEN and p-Akt expressions in myocardial tissue were compared. H9C2 cells were incubated in I/R condition for 12 h, followed by reoxygenation for 12 h. H9C2 cells were divided into three groups, including I/R+pSicoR-Blank, I/R+pSicoR-PTEN, and I/R+pSicoR-PTEN+VO-Ohpic. PTEN, p-Akt, Bcl-2, and Bax expressions were detected. Cell apoptosis was measured by flow cytometry. RESULTS: PTEN expression significantly increased, while p-Akt level markedly declined in myocardial tissue in I/R group compared with Sham group. Temporary PTEN downregulation and p-Akt elevation appeared at 2 h after I/R. I/R treatment markedly enhanced PTEN and Bax expressions, increased cell apoptosis, and reduced p-Akt and Bcl-2 levels. PTEN overexpression significantly enhanced Bax expression and cell apoptosis, while declined p-Akt and Bcl-2 in H9C2 after I/R. PTEN inhibited by VO-Ohpic markedly downregulated p-Akt and Bcl-2 expressions, whereas reduced Bax level and cell apoptosis. CONCLUSIONS: The overexpression of PTEN aggravated myocardial cell apoptosis after I/R. The blockage of PTEN enhanced PI3K/Akt signaling pathway and attenuated cell apoptosis induced by I/R.

[Preliminary study on the relationship between OSA and renal function].

Objective:To explore the relationship between obstructive sleep apnea(OSA) and renal function. Method:We collected the clinical data of 487 patients who underwent sleep monitoring in our hospital from January 2013 to December 2017 and excluded history of chronic heart disease, acute and chronic glomerulonephritis, and pyelonephritis. Among the 487 patients, 54 were in nonOSA control group and 433 were in OSA group, including 64 patients with mild OSA, 77 patients with moderate OSA, 108 patients with severe OSA, and 188 patients with extremly severe OSA. The eGFR was calculated using an equation combined serum creatinine and cystatin C. Then propensity score matching(PSM) was used to reduce differences in confounders among groups. The differences of creatinine, cystatin and eGFR between the control group and different degrees of OSA were compared, and the relationship between OSA severity and renal dysfunction was analyzed.Result:There was no statistically significant difference in creatinine between the OSA group and the control group. Serum cystatin C levels in the moderate OSA group and the extremly severe OSA group were higher compared with the control group(0.90±0.18)mg/L, (0.82±0.21) mg/L,P=0.026;(0.92±0.22) mg/L,(0.82±0.21) mg/L,P=0.006,there was no statistically significant difference in cystatin C level of mild OSA group or severe OSA group compared with the control group.The eGFR levels in the moderate OSA group and extremly severe OSA group were lower than that in the control group, 100.64±16.09, 108.57±19.31,P=0.012; 102.03±18.39, 108.57±19.31, P=0.024.After matching with the PSM, the serum cystatin C levels in the moderate OSA group and in the extremely severe OSA group were higher compared with the control group, (0.91±0.19) mg/L,P=0.028;(0.91±0.23) mg/L,P=0.031;(0.82±0.21) mg/L, but only in moderate OSA group, eGFR was lower than the control group,100.86±17.31,108.57±19.31,P<0.05. Conclusion: The renal function of OSA patients has different degrees of impairment. Renal function impairment and the severity of OSA do not show a single linear relationship.

[Advances in the application of cloud platform in diagnosis and treatment of OSA].

Obstructive sleep apnea(OSA) has been a major public health problem due to a surge in the number of patients with OSA, which can create a heavy socio-economic burden. How to effectively carry out mass screening and prevention is an important link in China's health management and chronic disease prevention.The development of cloud computing and Internet of things technology has brought new directions and new solutions.For the sake of diagnosis and treatment of disease involving multiple disciplines, cross cooperation problems, we can use the Internet of things, a cloud platform and the database as the core architecture to establish the network which contains family-primary hospitals-tertiary hospitals-specialized subject and sleep medicine laboratory.With the help of handsets, we are able to realize the effectiveness and convenience of remote cooperation and eventually form the cloud platform diagnosis and treatment system of sleep-related breathing disease based on the large sample data.

[Advances in postoperative thyroid-stimulating hormone suppression therapy in females with thyroid cancer].

Differentiated thyroid cancer is the most common malignant carcinoma in female population.Postoperative long-term thyroid-stimulating hormone(TSH) suppression therapy can reduce the risk of recurrence for differentiated thyroid cancer and control the progress of the disease, but it also induces simultaneously subclinical hypothyroidism and imposes negative effect on female. In addition to cardiovascular disease, TSH suppression therapy can lead to the alteration of sex hormone metabolism, menstrual disorder, poor influence on pregnancy and osteoporosis. This article reviews the recent studies on postoperative TSH suppression therapy in women with thyroid cancer.

[Progress of dopamine in obstructive sleep apnea hypopnea syndrome].

The etiology and pathogenesis of sleep obstructive apnea hypopnea syndrome (OSAHS) is not yet definitive, evidence shows that the dysfunction of pharyngeal nerve and the atonia of the muscle innervated by these nerve could play an important role in the progress of OSAHS. Dopamine is a neurotransmitter in the central nervous system which significantly affects the sleep-awake regulation. So far mounting evidence shows that dopamine has a potential role in the modulation of hypoglossal nucleus. The progress of dopamine in obstructive sleep apnea hypopnea syndrome is reviewed in this article.

[Advances of the treatments for thyroid carcinoma patients with laryngotracheal invasion].

Thyroid carcinoma is one of the most common cancer in the head and neck and its incidence shows an increasing tendency. Due to the special anatomical location of thyroid carcinoma, patients will have a bad prognosis outcome when cancer invades larynx and trachea. Surgical treatment is still a preferred therapy for thyroid carcinoma with laryngotracheal invasion, because it has the advantages such as high survival rate, low recurrence rate, relieving of airway obstruction, improving of postoperative quality of life. Other therapies including radiotherapy, chemotherapy, 131I and molecular targeted therapy can also be used for treatments of thyroid carcinoma. This article reviews the current treatments for thyroid carcinoma with laryngotracheal invasion.

The microRNA-29 plays a central role in osteosarcoma pathogenesis and progression.

Osteosarcoma is the most common type of bone cancer, with a peak incidence in the early childhood. The relationship between microRNAs (miRNAs) and cancer development attracted more and more attention over the last few years. Members of the miRNA-29 family, including miRNA-29a, miRNA-29b, and miRNA-29c were shown to participate in the development of rhabdomyosarcoma and hepatocarcinogenesis. Here, it has been demonstrated miRNA-29a and miRNA-29b expression levels to be downregulated in most of the osteosarcoma tissues (23 from 30). Besides, miRNA-29a displayed ability to induce apoptosis in both U2OS and SAOS-2 osteoblastic cells. While miRNA-29 members induced apoptosis through p53 gene activation, the effect of miRNA-29a on osteoblastic cells was independent on p53 expression level. Moreover, Bcl-2 and Mcl-1 were earlier demonstrated to be the direct targets of miRNA-29 in many types of cancer tissues and cancers. In both U2OS and SAOS-2 osteoblastic cell types, overexpression of miRNA-29a also downregulated Bcl-2 and Mcl-1, while silencing of miRNA-29a increased their expression. In addition, enhanced expression of miRNA-29a increased the expression of two tumor suppressor genes, E2F1 and E2F3. In summary, data obtained highlight the role of miRNA-29a in the regulation of osteoblastic cell apoptosis by silencing Bcl-2 and Mcl-1 and inducing E2F1 and E2F3 expression.

Changes in facial appearance after maxillomandibular advancement for severe obstructive sleep apnoea hypopnoea syndrome in Chinese patients: a subjective and objective evaluation.

This study evaluates the outcome and change in facial appearance after maxillomandibular advancement (MMA) in Chinese adults with severe obstructive sleep apnoea hypopnoea syndrome (OSAHS). Twelve patients underwent MMA with adjunctive procedures for severe OSAHS. All underwent physical examination, Epworth Sleepiness Scale evaluation, cephalometry, polysomnography, and facial photographic assessment before and 6 months after MMA. The aesthetic plane (relationship of nose, lips, and chin) was used to judge soft tissue facial profile change after MMA. Postoperative cephalometric data were compared with normal occlusive standards and aesthetic norms. Pre- and postoperative aesthetic appearance was evaluated by 100 lay people using a 10-point visual analogue scale. The maxillomandibular complex (MMC) was advanced 5-10 mm (mean 7.4 mm). The success rate was 83%. All patients were satisfied with the functional and aesthetic results. Postoperative SNA, SNB, and posterior airway space increased and mandibular plane-to-hyoid distance decreased significantly in all patients. The lower lip was closer to EP than the preoperative and normal occlusive standard. In 11 of 12 patients, the lay aesthetic scores were significantly higher postoperatively. MMA is effective for Chinese adults with severe OSAHS. In most patients, facial appearance was more attractive after MMC advancement of 5-10 mm.