The accuracy and influencing factors of sleep staging based on single-channel EEG via a deep neural network / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate theaccuracy of artificial intelligence sleep staging model in patients with habitual snoring and obstructive sleep apnea hypopnea syndrome (OSAHS) based on single-channel EEG collected from different locations of the head. Methods: The clinical data of 114 adults with habitual snoring and OSAHS who visited to the Sleep Medicine Center of Beijing Tongren Hospital from September 2020 to March of 2021 were analyzed retrospectively, including 93 males and 21 females, aging from 20 to 64 years old. Eighty-five adults with OSAHS and 29 subjects with habitual snoring were included. Sleep staging analysis was performed on the single lead EEG signals of different locations (FP2-M1, C4-M1, F3-M2, ROG-M1, O1-M2) using the deep learning segmentation model trained by previous data. Manual scoring results were used as the gold standard to analyze the consistency rate of results and the influence of different categories of disease. Results: EEG data in 124 747 30-second epochs were taken as the testing dataset. The model accuracy of distinguishing wake/sleep was 92.3%,92.6%,93.5%,89.2% and 83.0% respectively,based on EEG channel Fp2-M1, C4-M1, F3-M2, REOG-M1 or O1-M2. The mode accuracy of distinguishing wake/REM/NREM and wake/REM/N1-2/SWS , was 84.7% and 80.1% respectively based on channel Fp2-M1, which located in forehead skin. The AHI calculated based on total sleep time derived from the model and gold standard were 13.6[4.30,42.5] and 14.2[4.8,42.7], respectively (Z=-2.477, P=0.013), and the kappa coefficient was 0.977. Conclusions: The autonomic sleep staging via a deep neural network model based on forehead single-channel EEG (Fp2-M1) has a good consistency in the identification sleep stage in a population with habitual snoring and OSAHS with different categories. The AHI calculated based on this model has high consistency with manual scoring.

Changes of intraocular pressure and choroidal thickness in patients with chronic renal failure after hemodialysis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the changes of intraocular pressure and choroidal thickness after hemodialysis in patients with chronic renal failure, and to explore the impact of hemodialysis on blood supply. <p>METHODS: Totally 55 patients(110 eyes)with chronic renal failure who had been treated for a long time in our hospital were selected to test plasma osmotic pressure. Before and after hemodialysis 5min, hemodialysis venous blood was collected, and plasma osmotic pressure was measured. Before hemodialysis 1h and after hemodialysis 1h, intraocular pressure was measured; intraocular pressure and choroidal thickness were compared before and after hemodialysis measured by enhanced depth imaging technique of optical coherence tomography(OCT). <p>RESULTS: After hemodialysis plasma osmotic pressure reduced, and the difference was statistically significant(<i>t</i>=12.73, <i>P</i><0.01); and intraocular pressure increased after hemodialysis and the difference was statistically significant(<i>t</i>=2.07, <i>P</i><0.05). The choroid thickness was thinner after hemodialysis, and the differences before and after hemodialysis at every measurement points(under central fovea, nasal, temporal, superior and inferior 1 and 3mm from the central fovea)were statistically significant(<i>P</i><0.05). <p>CONCLUSION: After hemodialysis ocular pressure increased and the choroid thickness became thinner in chronic renal failure patients, which might affect the ocular blood flow state. It is suggested that the osmotic pressure gradient should be adjusted in hemodialysis patients and eye test and treatment must be given in necessity.

Mean Corpuscular Volume Can Be A Predictor for Therapeutic Response of Patients with Chronic Myeloid Leukemia / 中国实验血液学杂志

<p><b>OBJECTIVE</b>The past studies found that the treatment of chronic myeloid leukemia (CML) with imatinib can induce the macrocytic anemia, moreover the incidence of anemia increases along with enhancement of imatinib concentration. This study was aimed to evaluate the potential relation of erythrocyte mean corpuscular volume (MCV) increase after the treatment with tyrosine kinase inhibitors (TKI) with the therapeutic response in patients with CML-chronic phase (CML-CP).</p><p><b>METHODS</b>The clinical and hematologic data including MCV, molecular and cytogenetic response of 119 patients with CML-CP were collected after treatment with TKIs, and the relation of MCV changes after treatment with the clinical characteristics and therapeutic efficacy for patients with CML-CP was analyzed.</p><p><b>RESULTS</b>The MCV in patients treated with TKIs for 12 months significantly increased as compared with that at initial diagnosis (P<0.05). The proportion of patients with increased MCV in group of complete cytogenetic response (CCyR) was significantly higher than that in group of non-CCyR (P<0.05). As compared with decreased MCV group, the patients in increased MCV group much more easily achieved CCyR after treatment for 6, 12 months (P<0.05, P<0.05) respectively, furthermore, much more easily maintained MMR (P<0.05).</p><p><b>CONCLUSION</b>The MCV as a parameter which is easily acquired may be a new marker for prodecting the therapeutic response of patients treated with TKIs.</p>

Effects of Altered Intra-abdominal Pressure on the Upper Airway Collapsibility in a Porcine Model / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Obstructive sleep apnea is strongly associated with obesity, particularly abdominal obesity common in centrally obese males. Previous studies have demonstrated that intra-abdominal pressure (IAP) is increased in morbid obesity, and tracheal traction forces may influence pharyngeal airway collapsibility. This study aimed to investigate that whether IAP plays a role in the mechanism of upper airway (UA) collapsibility via IAP-related caudal tracheal traction.</p><p><b>METHODS</b>An abdominal wall lifting (AWL) system and graded CO2pneumoperitoneum pressure was applied to four supine, anesthetized Guizhou miniature pigs and its effects on tracheal displacement (TD) and airflow dynamics of UA were studied. Individual run data in 3 min obtained before and after AWL and obtained before and after graded pneumoperitoneum pressure were analyzed. Differences between baseline and AWL/graded pneumoperitoneum pressure data of each pig were examined using a Student's t-test or analysis of variance.</p><p><b>RESULTS</b>Application of AWL resulted in decreased IAP and significant caudal TD. The average displacement amplitude was 0.44 mm (P < 0.001). There were three subjects showed increased tidal volume (TV) (P < 0.01) and peak inspiratory airflow (P < 0.01); however, the change of flow limitation inspiratory UA resistance (Rua) was not significant. Experimental increased IAP by pneumoperitoneum resulted in significant cranial TD. The average displacement amplitude was 1.07 mm (P < 0.001) when IAP was 25 cmH2O compared to baseline. There were three subjects showed reduced Rua while the TV increased (P < 0.01). There was one subject had decreased TV and elevated Rua (P < 0.001).</p><p><b>CONCLUSIONS</b>Decreased IAP significantly increased caudal TD, and elevated IAP significantly increased cranial TD. However, the mechanism of UA collapsibility appears primarily mediated by changes in lung volume rather than tracheal traction effect. TV plays an independent role in the mechanism of UA collapsibility.</p>

Evaluation of neuromuscular activity in patients with obstructive sleep apnea using chin surface electromyography of polysomnography / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>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.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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).</p><p><b>CONCLUSIONS</b>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.</p>

Lignans from Machilus robusta / 中国中药杂志

Eighteen lignans were isolated from an ethanol extract of Machilus robusta by a combination of various chromatographic techniques including column chromatography over silica gel, Sephadex LH-20 and reversed-phase HPLC. Their structures were identified by spectroscopic data analysis as isolariciresinol-9'-O-beta-D-xylopyranoside (1), (+)-5'-methoxy-isolariciresinol-9'-O-beta-D-xylopyranoside(2), lyoniresinol-9'-O-beta-D-xylopyranoside(3), (+)-(8S, 8'S) -4, 4'-dihydroxy-3, 3', 5, 5'-tetramethoxylignan-9, 9'-diol 9-O-beta-D-xylopyranoside (ssioriside, 4), lyoniresinol (5), meso-dihydroguaiaretic acid (6), (+)-(8S, 8'R)-3', 4, 4'-trihydroxy-3'-methoxylignan (7), (8S, 8'R)-4'-hydroxy-3, 3', 4-trimethoxylignan (meso-monomethyl dihydroguaiaretic acid, 8), (+)-guaiacin (9), isoguaiacin (10), (-)-(7'R, 8R, 8'R)-4, 4'-dihydroxy-3, 3', 5-trimethoxy-2, 7'-cyclolignan (11), henricine B (12), (-)-(7S, 7'S, 8R, 8'R)-4, 4'-dihydroxy-3, 3', 5, 5'-tetramethoxy-7, 7'-epoxylignan-9, 9'-dio] (7S, 7'S, 8R, 8'R-icariol A2, 13), (+)-(7R, 8R, 7'E)-4-hydroxy-3, 5'-dimethoxy-7, 4'-epoxy-8, 3'-neolignan-7'-ene (licarin A, 14), nectandrin B (15), machilin-I (16), (-)-pinoresinol (17), and (-)-syringaresinol (18). All compounds were isolated from this plant for the first time. In the preliminary assay, compound 17 showed inhibitory activity against NO secretion of mouse peritoneal macrophages with an inhibition rate of 72.2% at 10 micromol x L(-1).

Overnight hemoglobin-oxygen saturation monitoring the first day following revised uvulopalatopharyngoplasty in patients with obstructive sleep apnea hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the characteristics of overnight arterial oxygen saturation (SaO2) the first day after upper airway reconstruction surgery in patients with obstructive sleep apnea hypopnea syndrome (OSAHS).</p><p><b>METHODS</b>One hundred and thirteen subjects with OSAHS underwent revised uvulopalatopharyngoplasty (H-UPPP), among them, 46 subjects underwent same phase transpalatal pharyngoplasty under general anesthesia. After transferred to general ward from intensive care unit the first day after operation they received an overnight hemoglobin-oxygen saturation monitoring.</p><p><b>RESULTS</b>Twelve subjects (10.2%) had lower lowest SaO2 than preoperative value. ≥ 0.03 oxygen desaturation index (ODI3) decreased in an median of 36.9 [16.9; 52.2] events/hour compared with preoperative values (Z = -9.221, P < 0.001). One subjects (0.8%) had increased ODI3. No hemorrhages, cardiovascular complications or airway obstruction occurred. The subjects with any two of the following conditions (n = 51) had lower average SaO2, lowest SaO2 and higher ODI3 than the others (n = 62, Z were -3.084, -4.083 and -4.593, P < 0.001). The three subjects were: (1) BMI ≥ 27.0 kg/m(2); (2) Lowest SaO2 < 0.600; (3) AHI ≥ 60.0 events/h.</p><p><b>CONCLUSIONS</b>Some OSAHS patients had a decreased LSaO2 than preoperative values the first day after operation. As part of a patient safety initiative, SaO2 monitoring for those who have high risk for hypoxemia is necessary.</p>

Gene therapy based on inducible IL-12 gene in a mouse model of orthotopically transplanted H22 hepatoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the antitumor efficiency of IL-12 gene induced by RU486 regulatory system in a mouse model of orthotopically transplanted hepatoma.</p><p><b>METHODS</b>The orthotopic hepatoma model was prepared by inoculation of H22 hepatoma cells into the mouse liver. Murine interleukin-12 (IL-12) expressing plasmid pRS22 containing RU486 regulatory system was injected into mice by a hydrodynamic injection 3 days after H22 cells inoculation. Three days after hydrodynamic injection, the mice were induced with RU486 (250 µg/kg) consecutive intraperitoneal administration for 6 days. Blood samples were taken at 10 h after the first and third induction for the determination of IL-12, IFN-γ and NO. Five mice were sacrificed at 2 days after the treatment with RU486. The tumor size was measured. HE and immunohistochemical stainings were applied to evaluate the proliferative activity and angiogenesis in the tumors. The other 7 mice were kept to monitor their survival.</p><p><b>RESULTS</b>In mice receiving saline plus RU486, pRS-LacZ plus RU486, or pRS22 plus sesame oil, the liver tumors were big in size: (409.90 ± 137.03) mm(3), (271.80 ± 182.63) mm(3) and (251.00 ± 76.55) mm(3), respectively. Strong PCNA positive expression [(82.10 ± 4.62)%, (83.45 ± 2.34)% and (77.46 ± 2.99)%] and extensive microvessel density (74.58 ± 18.47, 63.60 ± 13.36 and 53.52 ± 11.74 per 400 × field), respectively, in these tumor tissues were observed after immunohistochemical staining. The survival period was shorter in these mice. In contrast, in mice treated with pRS22 plus RU486, the tumor was smaller in size. Extensive necrosis, weak PCNA proliferative activity (50.67 ± 8.09)%, and a marked paucity of microvessel density (25.38 ± 10.87) were seen. The survival of mice was obviously prolonged. Compared with the 3 control groups, a significant elevation of serum IL-12, IFN-γ and NO levels were detected in the mice treated with pRS22 plus RU486.</p><p><b>CONCLUSION</b>Expression of IL-12 gene can be effectively controlled by a RU486 regulatory system. The inducible IL-12 can delay the growth of orthotopically transplanted hepatoma and prolong the survival of mice.</p>

Evaluation of retropalatal mechanical loads in patients with obstructive sleep apnea / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the mechanical load of retropalatal airway in obstructive sleep apnea patients, and to investigate the contributions of pharyngeal anatomy to upper airway collapsibility.</p><p><b>METHODS</b>Static mechanical load of transpalatal pharynx was determined by opening pressure (Popen) of the segment during general anesthesia in 30 patients and 14 controls. Size of pharynx was measured while intraluminal pressure was controlled at 3-20 cm H2O (1 cm H2O = 0.09806 kPa) and the minimal intraluminal pressure that needed to compensate for the mechanical load of a retropalatal segment was determined.</p><p><b>RESULTS</b>Pharyngeal cavity collapse at the level of the hard palate was observed in only one of the 30 subjects (3.3%), and in none of the 14 controls. At tongue base level, 23 subjects had a Popen > 0 cm H2O (76.7%) while in 7 of the controls (50.0%) had a Popen > 0 cm H2O. And at the level of the uvual and soft palate, pharyngeal collapses was observed in all subjects except in 9 of the controls (64.3%). The median of Popen was 8.3 [5.9;11.5] cm H2O in the patients group and was 2.7 [-3.9;6.0] cm H2O in the control group. Differences of Popen were significant between patients and controls (U = 58.500, P = 0.000). The correlation between Popen and AHI was also significant at 0.05 level (r = 0.377, P = 0.044).</p><p><b>CONCLUSIONS</b>Patients with sleep apnea have more collapsible passive upper airway than controls. Retropalatal and retroglossal airway are the most collapsible segments and positive pressures are needed to compensate for the mechanical loads.</p>

Value of pulse transit time in detecting respiratory drive / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To assess the accuracy of pulse transit time (PTT) in classification of apnea events, and collect data for clinical application reference.</p><p><b>METHODS</b>Thirty-two obstructive sleep apnea-hypopnea syndrome (OSAHS) patients included in the research had Polysomnography (PSG), and 10 305 apnea events were recorded. All the events were analyzed by PTT and esophageal pressure (Pes) respectively. The results were analyzed to assess the accuracy of PTT and compare the accuracy of pulse transit time between REM stage and NREM stage, and analyze the correlation between age, body mass index (BMI), apnea hypopnea index (AHI) and concordance rate in every patient.</p><p><b>RESULTS</b>The total concordance rate between PTT and Pes in classification of apnea was 96.7% (9970/10305). The sensitivities of PTT in detecting central, mixed and obstructive apnea were 88.0%, 91.3% and 97.8% respectively and the specificities were 99.8%, 97.8% and 92.8% respectively. The false determinations of apnea events mainly concentrated on the false determinations between the obstructive and mixed apnea. There was no statistical significant between the accuracy of PTT in different sleep stages. There was a negative relationship between the age, BMI, Lowest SaO2, AHI and the concordance rate.</p><p><b>CONCLUSIONS</b>There was good concordance between PTT and Pes in classification of apnea. PTT had very high sensitivity and specificity in detecting all kinds of apnea. This study showed that PTT can detect respiratory drive noninvasively with high accuracy.</p>

Sites of obstruction in obstructive sleep apnea patients and their influencing factors: an overnight study / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To understand how sleep stage and position influence the mechanisms for pharyngeal collapse in different levels of upper airway (UA), overnight state-related changes and postural variation in obstructive sites in obstructive sleep apnea hypopnea syndrome (OSAHS) patients were studied.</p><p><b>METHODS</b>Fifty four OSAHS patients underwent overnight upper airway pressure monitoring during polysomnography. The lower limits of the UA obstruction were determined and their relationship with sleep stage, position, age, body mass index and apnea hypopnea index (AHI) were investigated.</p><p><b>RESULTS</b>All 54 patients had oropharynx (14 837 of the 23 172 analyzed events) and tongue base obstruction (5605/23,172), 2532 events were located at the oropharynx with extension to tongue base. Twenty nine patients has hypopharynx obstruction (105/23 172). Of the total amount of apnea hypopnea, the portions of obstruction located at tongue base level increased (t = 8.790, P = 0.000) in rapid eye movement (REM) sleep while those located at oropharynx decreased (t = -6.846, P = 0.000). Indexes of the apnea hypopnea caused by tongue base obstruction raised (t = 6.189, P = 0.000). Although the overall AHI in supine position was higher than in lateral position (t = 4.000, P = 0.000), increases in indexes of both the apnea hypopnea caused by tongue base (supine, 17.1 +/- 13.8 vs. lateral, 13.9 +/- 14.6) and oropharynx obstruction (44.3 +/- 20.3 vs. 37.2 +/- 25.9) were without significance (P > 0.05). Distribution of obstructive site varied little with different position (P > 0.05).</p><p><b>CONCLUSIONS</b>Upper airway obstruction involves more than one specific site of the upper airway and the oropharynx is the most common collapse site. Obstructive sites are likely to extend to lower levels during REM sleep. Sleep position has little effect on the distribution of obstructive site.</p>

Preoperative overnight airway pressure measurement for predicting the outcome of revised uvulopalatopharyngoplasty / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>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.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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) .</p><p><b>CONCLUSIONS</b>Contribution of transpalatal level obstruction has significant predictive value to the outcome of transpalatal level surgery in OSAHS patients.</p>

Study of the Growth Rate and Comparative Analysis of Esterase Isoenzyme from Two Isolates of Polyporus umbellatus / 微生物学通报

Comparative analysis of characteristic of species and esterase-isoenzyme of isolates of Polyporus umbel-latus from different regions were processed. The results indicated that isolates of Jizhaoling ( Z) and Zhushiling (ZJ) have significant differences in characteristic, and enzymatic band types of the two species also have significant differences. The homology at genetics between the two isolates is 0% , and consanguinity between the two i-solates is the farthest.