睡眠呼吸障碍（sleep breathing disorders，SDB）是一种常见病、多发病，其主要类型是阻塞性睡眠呼吸暂停综合征（OSAS），特点是夜间睡眠过程中上气道完全或部分阻塞及呼吸中枢驱动降低导致呼吸暂停及低通气，产生慢性间歇性低氧、反复微觉醒、睡眠结构异常、自主神经功能紊乱等。OSAS近年已公认是一种全身性疾病，它可引起或加重许多疾病,美国心脏协会/美国心脏病学基金会（AHA/ACCF）联合发表了《睡眠呼吸暂停与心血管疾病的科学共识》。为了进一步认识两者之间的关系，提升OSAS及相关疾病防控水平，中华医学会呼吸病分会睡眠学组与心血管病学组就SDB与心血管疾病相关问题达成共识，为多学科联合防治SDB提供了科学依据。
Objective To systematically review the association between 14 bp insertion/ deletion polymorphism of HLA-G gene and preeclampsia (PE). Methods We electronically searched in the following databases: PubMed, Web of Science, EMbase, CBM, CNKI, WanFang Data, and VIP to collect all the case-control trials on the association between 14 bp insertion/ deletion polymorphism of HLA-G gene and PE. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Totally 10 studies were recruited. The results of meta-analysis showed that, the preeclampsia group was higher than the control group in the frequencies of HLA-G +14 bp haplotype in the fetus and fathers and the frequencies of HLA-G +14 bp/+14 bp genotype in fathers, but its frequencies of fetal HLA-G −14 bp haplotype was significantly lower. Their pooled OR and 95%CI were 1.42 (1.10 to 1.84), 1.54 (1.25 to 1.90), 2.00 (1.19 to 3.38), and 0.67 (0.54 to 0.82). Compared with the control group, in the preeclampsia group the frequencies of HLA-G +14 bp/+14 bp genotype in fetus were higher, while the frequencies of HLA-G −14 bp/−14 bp genotype were lower (OR=1.75, 95%CI 1.11 to 2.77; OR= 0.57, 95%CI 0.41 to 0.81). In the preeclampsia group, the frequencies of mother (+14 bp/−14 bp)/ fetal (+14 bp/+14 bp) were higher than the control group (OR= 3.77, 95%CI 1.40 to 10.11), while those of mother (−14 bp/−14 bp)/ fetal (−14 bp/−14 bp) and those of father (−14 bp/−14 bp)/fetal (−14 bp/−14 bp) were lower (OR=0.52, 95%IC 0.31 to 0.85; OR=0.33, 95%CI 0.15 to 0.75). Conclusion Paternal and fetal 14 bp insertion/ deletion polymorphism of HLA-G gene might be associated with preeclampsia. And maternal-fetal genotype compatibility analysis might provide new clues for the pathogenesis research and clinical diagnosis of preeclampsia.
Objective To evaluate the correlation between mycoplasma genitalium and HIV infection. Methods Databases including MEDLINE, ScienceDirect, EMbase, WanFang Data, and CNKI were searched from inception to March 2012, so as to identify the independent cohort studies, case-control studies and cross-sectional studies. Moreover, the references of relevant studies were also retrieved. According to the inclusion and exclusion criteria, the studies were screened, the data were extracted, and the methodological quality of the included studies was assessed. Then meta-analysis was performed using RevMan 4.2 and SAS 9.1.3 softwares. Results A total of 19 studies were included, including 3 430 HIV infected patients and 7 656 controlled participants. The results of meta-analyses showed that the HIV infection group was more likely to infect mycoplasma genitalium than the control group (OR=2.34, 95%CI 1.68 to 3.28, Plt;0.000 01). The same results were found in both subgroup and sensitivity analyses. Conclusion Mycoplasma genitaliuman infection is closely related to HIV infection. However, detailed pathogenesis is still unknown. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to prove the above.
Objective To investigate the prognostic factors related to long-term survival after gastrectomy. Methods A total of 351 patients with gastric cancer who underwent gastrectomy were successfully followed-up in our hospital had been selected from January 2004 to December 2009. The clinicopathological and follow-up data were studied by univariate and multivariate analysis. Results The age, location of tumors, T stage, N stage, TNM stage, and differentiation were related with postoperative survival of patients with gastric cancer by using univariate analysis（P＜0.05）. By using multivariate analysis, location of tumors, T stage, N stage, and chemotherapy were independent prognostic factors（P＜0.05）. Conclusions Location of tumors, depth of tumor invation, lymph node metastasis, and chem-otherapy were independent prognostic factors for gastric cancer patients who underwent gastrectomy. Chemotherapy after surgery could increase the survival rate of gastric cancer patients with lymph node metastasis or in TNM stage Ⅲ.
Objective To systematically review the influencing factors of mild cognitive impairment in type 2 diabetic patients. MethodsPubMed, Web of Science, EMbase, The Cochrane Library, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect studies on the influencing factors of mild cognitive impairment in patients with type 2 diabetes from inception to December 31, 2021. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of included studies; then, meta-analysis was performed by using RevMan 5.4 software and Stata 12.0 software. ResultsA total of 32 studies involving 7 519 subjects were included. The results of the meta-analysis showed that the main influencing factors of mild cognitive impairment in type 2 diabetic patients were age, duration of type 2 diabetes, educational level, cerebral infarction, hypertension, smoking, insulin resistance index, glycosylated hemoglobin, and homocysteine. ConclusionCurrent evidence shows that some factors such as age, duration, and educational level are the main influencing factors of mild cognitive impairment in type 2 diabetic patients. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusions.
Objective To investigate the clinical features, chest imaging manifestations, pathological changes, diagnosis and treatment of sarcoidosis with pleural effusion as the initial manifestation, and to analyze the possible causes of misdiagnosis, so as to help clinicians improve their understanding of sarcoidosis with pleural effusion as the initial manifestation, and reduce the rate of clinical misdiagnosis and missed diagnosis. Methods The general data, clinical manifestations, imaging examinations, pathological findings and outcomes of 4 patients with sarcoidosis with pleural effusion as the first manifestation admitted to Ningxia Medical University General Hospital from January 2019 to December 2020 were retrospectively analyzed. Results Out of these patients, 3 were female and 1 was male, with an average age of 50.3 years. The main clinical features were cough, expectoration, chest tightness, shortness of breath and other common respiratory symptoms. Chest CT indicated right pleural effusion. After admission, closed thoracic drainage, tracheoscopy, thoracoscopy, pleural biopsy and cervical lymph node biopsy were performed to obtain pathology. Combined with imaging and pathology, diagnosis was made. After hormone therapy, symptoms and imaging were improved. Conclusions Sarcoidity-related pleural effusion is relatively rare as the first episode, with no specific clinical symptoms and no specific physical and chemical properties of pleural effusion. Non-caseous granulomatous lesions can be found pathologically, and the diagnosis needs to rely on clinical, imaging and pathological comprehensive judgment.
Objective To identify micrometastasis in regional lymph nodes of gastric cancer by quantitative real-time reverse transcription-PCR (qRT-PCR) assay and to evaluate the clinical significance of micrometastasis. Methods To study 320 lymph nodes collected from January 2010 to June 2010， 281 of which were from 40 patients with gastric cancer who had undergone a standard gastrectomy with lymphadenectomy， and other 39 of which were from 10 patients with gastroduodenal ulcer. Made CEA， CK-19， and CK-20 as primers， and used qRT-PCR assay in addition to hematoxylin and eosin staining to detect the micrometastasis， and to analyze the clinicopathologic characteristics.Results Totally， micrometastasis were detected by qRT-PCR assay in 31 (15.34%，31/202) lymph nodes of 28 (70.00%， 28/40) patients. Thirty-nine lymph nodes from 10 patients with gastroduodenal ulcer were negative by qRT-PCR and HE staining. The degree of differentiation， depth of gastric mural invasion， and clinical stage had statistically significant correlation with the incidence of lymph node micrometastasis (P＜0.05). Conclusions qRT-PCR assay is a sensitive and specific method to detect lymph node micrometastasis in gastric cancer patients，and it has importantly clinical significance in evaluating clinical staging，prognosis and treatment prescription.
Objective To design a nucleic acid information early warning system and evaluate the effect of the application. Methods 60 nurses working in the clinical department of Zhongnan Hospital of Wuhan University from August to October 2021 were selected by convenient sampling method, and the included nurses were divided into experimental group and control group. The experimental group used the nucleic acid information early warning system, and the control group used the nucleic acid registration in a common way. Statistical duration of the nucleic acid information, nucleic acid leakage detection rate and nurses job satisfaction after application were compared between the two groups. Results After the application of nucleic acid information early warning system, compared with the control group, the statistical duration of the nucleic acid information in the experimental group was shortened [(2.0±0.4) vs. (3.8±0.7) min; t=25.827, P<0.001], nucleic acid leakage detection rate decreased [1.4% vs. 6.9%; P=0.019]. The job satisfaction of the experimental group was higher than that of the control group (P<0.001). Conclusions Applying the nucleic acid information early warning system could reduce statistical duration of the nucleic acid information, nucleic acid leakage detection rate and improve nurses job satisfaction and work experience. It will provide reference and basis for medical institutions to normalize the management of nucleic acid prevention and control in medical institutions.
Objective To explore the mid-term effectiveness of arthroscopic “mini incision” transtendon repair for partial articular-sided supraspinatus tendon avulsion (PASTA) lesion. Methods A clinical data of 39 patients with PASTA lesions, who underwent the arthroscopic “mini incision” transtendon repair and met the selected criteria between May 2017 and April 2021, was retrospectively analyzed. There were 13 males and 26 females, with an average age of 63.7 years (range, 43-76 years). Nine patients underwent trauma history, and no obvious inducement was found in the other 30 patients. The main clinical symptom was shoulder pain with positive hug resistance test. The interval from symptom onset to operation was 3-21 months (mean, 8.3 months). The visual analogue scale (VAS) score, University of California Los Angeles (UCLA) shoulder score, American Association of Shoulder and Elbow Surgeons (ASES) score and shoulder range of motion (ROM) of forward flexion, abduction, and external rotation were used to evaluate shoulder function. MRI was performed to assess the structural integrity and tension of reattached tendon. Patient satisfactions were calculated at last follow-up. Results All incisions healed by first intention with no complications such as incision infection or nerve injury. All patients were followed up 24-71 months (mean, 46.9 months). The VAS, UCLA, and ASES scores significantly improved at 24 months after operation when compared with preoperative ones (P<0.05). The ROMs of forward flexion and external rotation of the shoulder joint significantly increased at 3 and 24 months, and further increased at 24 months compared to 3 months, with significant differences (P<0.05). However, the ROM of abduction of the shoulder joint at 3 months did not significantly improve compared with that before operation (P>0.05), and it was significantly greater at 24 months than before operation and at 3 months after operation (P<0.05). At last follow-up, the patients were very satisfied with the effectiveness in 30 cases (76.9%), satisfied in 5 cases (12.8%), and dissatisfied in 4 cases (10.3%). At 6 months after operation, 31 patients underwent reviews of MRI scans, of which 28 patients possessed intact structural integrity, good tendon tension and tendon healing, and 3 patients underwent tendon re-tear. ConclusionArthroscopic “mini incision” transtendon repair in treatment of PASTA lesion could obtain satisfying mid-term effectiveness with low risk of tendon re-tear.
ObjectiveTo investigate the early effectiveness of arthroscopic repair of supraspinatus tendon tears with douple-pulley suture-bridge. Methods The clinical data of 38 patients with supraspinatus tendon tears who met the selection criteria between September 2020 and July 2022 were retrospectively analyzed, and all of them were treated with arthroscopic double-pulley suture-bridge technique. There were 15 males and 23 females, aged from 43 to 77 years, with an average of 61.5 years. There were 15 cases of left shoulder and 23 cases of right shoulder. Seven cases had a history of trauma, and the other 31 cases had no obvious inducement. The main clinical symptoms of the patient were pain in lifting the shoulder joint and hug resistance test (+). The time from onset of symptoms to admission ranged from 6 to 19 months, with an average of 10.3 months. Flexion, abduction, and external rotation of the shoulder were recorded before operation and at 3 and 12 months after operation. Pain and function of the shoulder were evaluated by visual analogue scale (VAS) score, University of California Los Angeles (UCLA) shoulder score, and American Society of Shoulder and Elbow Surgeons (ASES) score before operation and at 12 months after operation. Tendon healing, tendon continuity, and tension were evaluated by MRI at 3-6 months after operation, and patient’s satisfaction was evaluated at last follow-up. ResultsAll the incisions healed by first intention, and there was no complication such as incision infection or nerve injury. All patients were followed up 12-34 months, with an average of 23.3 months. VAS score, UCLA shoulder score, and ASES score at 12 months after operation were significantly better than those before operation (P<0.05). The external rotation range of shoulder joint significantly improved at 3 and 12 months after operation (P<0.05), and it further improved at 12 months after operation when compared with 3 months after operation (P<0.05). There was no significant difference in the range of flexion and abduction at 3 months after operation when compared with those before operation (P>0.05), but the range of flexion and abduction at 12 months after operation significantly improved when compared with those before operation and at 3 months after operation (P<0.05). MRI reexamination was performed in 28 patients at 3-6 months after operation. Among them, 25 patients had intact supraspinatus tendon structure, good tension, and tendon healing, and 3 patients had type 1 retear. The remaining 10 patients refused to undergo MRI reexamination because of the satisfactory effectiveness. At last follow-up, 29 patients (76.3%) were very satisfied with the results, 6 (15.7%) were satisfied, and 3 (7.8%) were not satisfied. ConclusionArthroscopic double-pulley suture-bridge technique can achieve the effect of suture bridge operation, reduce the cost of operation and the risk of type 2 retear, and the early effectiveness is satisfactory, but the shoulder joint movement is limited within 3 months after operation.