Inflammation Triggers Chondrocyte Ferroptosis in TMJOA via HIF-1α/TFRC

Inflammation and loss of articular cartilage are considered the major cause of temporomandibular joint osteoarthritis (TMJOA), a painful condition of the temporomandibular joint (TMJ). To determine the cause of TMJ osteoarthritis in these patients, synovial fluid of TMJOA patients was compared prior to and after hyaluronic lavage, revealing substantially elevated levels of interleukin (IL) 1β, reactive oxidative stress (ROS), and an overload of Fe3+ and Fe2+ prior to lavage, indicative of ferroptosis as a mode of chondrocyte cell death. To ask whether prolonged inflammatory conditions resulted in ferroptosis-like transformation in vitro, we subjected TMJ chondrocytes to IL-1β treatment, resulting in a shift in messenger RNA sequencing gene ontologies related to iron homeostasis and oxidative stress-related cell death. Exposure to rat unilateral anterior crossbite conditions resulted in reduced COL2A1 expression, fewer chondrocytes, glutathione peroxidase 4 (GPX4) downregulation, and 4-hydroxynonenal (4-HNE) upregulation, an effect that was reversed after intra-articular injections of the ferroptosis inhibitor ferrostatin 1 (Fer-1). Our study demonstrated that ferroptosis conditions affected mitochondrial structure and function, while the inhibitor Fer-1 restored mitochondrial structure and the inhibition of hypoxia-inducible factor 1α (HIF-1α) or the transferrin receptor 1 (TFRC) rescued IL-1β-induced loss of mitochondrial membrane potential. Inhibition of HIF-1α downregulated IL-1β-induced TFRC expression, while inhibition of TFRC did not downregulate IL-1β-induced HIF-1α expression in chondrocytes. Moreover, inhibition of HIF-1α or TFRC downregulated the IL-1β-induced MMP13 expression in chondrocytes, while inhibition of HIF-1α or TFRC rescued IL-1β-inhibited COL2A1 expression in chondrocytes. Furthermore, upregulation of TFRC promoted Fe2+ entry into chondrocytes, inducing the Fenton reaction and lipid peroxidation, which in turn caused ferroptosis, a disruption in chondrocyte functions, and an exacerbation of condylar cartilage degeneration. Together, these findings illustrate the far-reaching effects of chondrocyte ferroptosis in TMJOA as a mechanism causing chondrocyte death through iron overload, oxidative stress, and articular cartilage degeneration and a potential major cause of TMJOA.

[Techniques for quantifying endotypes of obstructive sleep apnea]

Obstructive sleep apnea (OSA) is the frequent occurrence of apnea and/or hypopnea during sleep, leading to intermittent hypoxia, hypercapnia, and disruption of sleep architecture, further resulting in multisystem damage. The pathophysiological mechanisms include abnormal anatomical structure, low arousal threshold, high loop gain, and poor muscle reactivity, etc. As there are individual differences in the underlying mechanisms of OSA (i.e. endotypes), the effectiveness of treatment and prognosis may also vary according to these characteristics. Understanding the endotype of OSA is critical to understanding which patients are most likely to benefit from non-invasive ventilation therapy. Quantification of endotypes is central to the precision treatment of OSA and may provide the basis for accurate clinical treatment of OSA based on endotypes.

Evolving information complexity of coarsening materials microstructures

The temporal evolution of microstructural features in metals and ceramics has been the subject of intense investigation over many years because deviations from normal grain growth behavior are ubiquitous and strongly dictate observed mechanical and magnetic properties. To distinguish among different grain growth scenarios, we examine the time evolution of the information content of both synthetic and experimental coarsening microstructures as quantified by both a computable information density (CID) and a spectral entropy along with selected metrics and measures of shared information and interaction strength. In these approaches, microstructural evolution is described in terms of two time series representations, namely: (1) strings and their compressed counterparts that reflect the information contained in the configuration of a system over time, and (2) the spectra of graph Laplacians that embody the information contained in a coarsening grain network. These approaches permit one to characterize dynamically evolving microstructures and to identify correlation times associated with different coarsening scenarios. Moreover, as the information content of a system is a proxy for the entropy, a thermodynamic description of grain growth is also described.

[Prediction models for respiratory event types in OSA patients based on hypoxic parameters]

Objective: To analyze the hypoxic parameters in patients with obstructive sleep apnea (OSA), to explore the difference and association between different types of respiratory events and to construct predictive models for respiratory event types. Methods: Fifty patients [including 41 males and 9 females with age 18-74(45.72±13.39) years ] with OSA diagnosed by polysomnography (PSG) were selected for retrospective analysis, and all respiratory events with pulse oximetry (SpO2) desaturation in the recorded overnight data were divided into hypopnea group (Hyp, 3 316), obstructive apnea group (OA, 5 552), central apnea group (CA, 1 088) and mixed apnea group (MA, 1 369) according to the type of events, and all event records were exported separately from the PSG software as comma-separated variable (.csv) files, which were imported and analyzed using the in-house built Matlab software. A total of 13 hypoxic parameter differences were compared among the four groups, including minimum oxygen saturation of events (e-minSpO2), the depth of desaturation (ΔSpO2), the duration of desaturation and resaturation (DSpO2), the duration of desaturation (d.DSpO2), duration of resaturation (r.DSpO2), duration of SpO2<90% (T90), duration of SpO2<90% during desaturation (d.T90), duration of SpO2<90% during resaturation (r.T90), area under the curve of SpO2<90% (ST90), area under the curve of SpO2<90% during desaturation (d.ST90), area under the curve of SpO2<90% during resaturation (r.ST90), oxygen desaturation rate (ODR) and oxygen resaturation rate (ORR). Hyp model (H), OA model (O), CA model (C) and MA model (M) were constructed respectively; group differences for the different hypoxia parameters were assessed using single factor analysis and Kruskal-Wallis H test. For different categories of respiratory events, binary logistic regression was used to identify the variables included in the regression model. Receiver operating characteristic (ROC) curves were generated to assess and compare the sensitivity, specificity, positive predictive value and negative predictive value of the four models, thereby gauging the predictive precision of each model. Results: ΔSpO2, ODR, ORR, T90, d.T90, r.T90, ST90, d.ST90 and r.ST90 for each type of respiratory events showed MA>OA>CA>Hyp, and e-minSpO2 showed MA Collapse

Key Words Collapse

MESH Headings

• Male
• Female
• Humans
• Adolescent
• Young Adult
• Adult
• Middle Aged
• Aged
• Retrospective Studies
• Oxygen
• Oximetry
• Hypoxia
• Sleep Apnea, Obstructive/diagnosis

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[Relationship between respiratory event-related arousal and increased pulse rate in patients with obstructive sleep apnea]

Objective: To investigate the relationship between respiratory event-related arousal and increased pulse rate in patients with obstructive sleep apnea (OSA), and to evaluate whether elevated pulse rate can be used as a surrogate marker of arousal. Methods: A total of 80 patients [40 males and 40 females, age range (18-63 years), mean age (37±13) years] who attended the Sleep Center of the Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital for polysomnography (PSG) from January 2021 to August 2022 were enrolled. Stable PSG recordings of non-rapid eye movement (NREM) sleep to compare the mean pulse rate (PR), the lowest PR 10 seconds before the onset of arousal, and the highest PR within 10 seconds after the end of arousal associated with each respiratory event. At the same time, the correlation between the arousal index and the pulse rate increase index (PRRI), as well as ΔPR₁ (highest PR-lowest PR) and ΔPR₂ (highest PR-mean PR), respectively, with the duration of respiratory events, the duration of arousal, the magnitude of pulse oximetry (SpO₂) decline, and the lowest SpO₂ was analyzed. Among the 53 patients, 10 events without arousal and 10 events with arousal (matched for the magnitude of SpO₂ decline) were selected for NREM in each of the 53 patients, and ΔPR before and after termination of respiratory events in the two groups was compared. In addition, 50 patients were simultaneously subjected to portable sleep monitoring (PM) and divided into non-severe OSA group (n=22) and severe OSA group (n=28), and ΔPR≥3 times,≥6 times,≥9 times, and≥12 times after respiratory events were used as surrogate markers of arousal, and ΔPR was scored manually and integrated into the respiratory event index (REI) of PM. Then, we compared the agreement between REI calculated from the four PR cut-off points and the apnea-hypopnea index (AHI_PSG) calculated by the gold standard PSG. Results: ΔPR₁ [(13±7)times/min] and ΔPR₂ [(11±6)times/min] were significantly higher in patients with severe OSA than in patients with non-OSA,mild and moderate OSA. The arousal index was positively correlated with the four PRRIs (r 0.968, 0.886, 0.773, 0.687, P<0.001, respectively), and the highest PR [(77±12) times/min] within 10 s after the end of arousal was significantly higher than the lowest PR [(65±10) times/min, t=113.24, P<0.001] and the mean PR [(67±11) times/min, t=103.02, P<0.001]. ΔPR₁ and ΔPR₂ were moderately correlated with the decrease in SpO₂ (r=0.490, 0.469, P<0.001). After matching the magnitude of SpO₂ decline, the ΔPR[(9±6)/min] before and after the termination of respiratory events with arousal was significantly higher than that of respiratory events without arousal [(6±5)/min, t=7.72, P<0.001]. The differences between REI+PRRI₃ and REI+PRRI₆ and AHI_PSG in the non-severe OSA group were not statistically significant (P values 0.055 and 0.442, respectively), and REI+PRRI₆ and AHI_PSG showed good agreement (the mean difference was 0.7 times/h, 95%CI 8.3-7.0 times/h). The four indicators of PM in the severe OSA group were statistically different from AHI_PSG (all P<0.05), and the agreement was poor. Conclusions: Respiratory event-related arousal in OSA patients is independently associated with increased PR, and frequent arousal may lead to increased frequency of PR fluctuations, and elevated PR may be used as a surrogate marker of arousal, especially in patients with non-severe OSA, where elevated PR≥6 times significantly improves the diagnostic agreement between PM and PSG.

[Research progress of acetaldehyde dehydrogenase 2 in liver diseases]

Acetaldehyde dehydrogenase 2 (ALDH2) is an important kind of aldehyde dehydrogenase in mitochondria, which has the function of eliminating acetaldehyde and other toxic aldehydes substances. Furthermore, it is abundant in liver and is closely related to the occurrence and development of a variety of liver diseases. ALDH2 genetic polymorphisms plays an important role in the occurrence of a variety of liver diseases in the human population.This paper mainly reviews the research progress of ALDH2 in liver diseases in recent years, with a view to provide theoretical basis for clinical prevention and treatment.

[Effect of peritoneum reconstruction on postoperative complications after laparoscopic low anterior resection for rectal cancer]

Objective: To determine the effect of peritoneum reconstruction on postoperative complications after laparoscopic low anterior resection (LAR) for rectal cancer. Methods: Retrospective cohort study and propensity score matching were conducted. Case inclusion criteria: (1) pathologically confirmed rectal adenocarcinoma; (2) 18 to 80 years; (3) patients with middle to low rectal cancer undergoing laparoscopic LAR; (4) patients staging cT1-4aN0-2M0 or ycT1-4aN0-2M0 after neoadjuvant therapy; (5) the distance of 4-10 cm from tumor low margin to anal verge. Exclusion criteria: (1) abdominal surgery history (except appendicitis, cholecystitis, ectopic pregnancy); (2) anastomosis above the peritoneal reflection; (3) tumor distant metastasis or clinical staging of T4b during surgery; (4) conversion to open surgery; (5) severe incapacitating disease (American Society of Anesthesiologists classification IV or V, ASA). A total of 666 patients with middle to low rectal cancer undergoing laparoscopic LAR in The First Affiliated Hospital of Army Medical University from January 2017 to June 2020 were enrolled. There were 473 males and 193 females with the median age of 59 (18-80) years. Laparoscopic LAR with peritoneum reconstruction was performed in 188 cases (PR group), and laparoscopic LAR without peritoneum reconstruction was performed in 478 cases (NPR group). After 1:1 propensity score matching according to 1:1 based on age, gender, body mass index, TNM staging, ASA classification, intraoperative blood loss, distance from tumor low margin to anal edge, 153 cases were included in each group. Postoperative complications were classified according to Clavien-Dindo classification. Anastomotic leakage was defined and graded according to the International Study Group of Rectal Cancer (ISGRC) criteria. Results: After propensity score matching, there were no significant differences in baseline demographic characteristics between the 2 groups (all P>0.05), indicating that these two groups were comparable. (1) Operative conditions: All the patients in both groups completed operation successfully. Compared with the NPR group, the PR group had longer operation time [(181.3±60.3) minutes vs. (168.9±51.5) minutes, t=2.185, P=0.029], shorter postoperative median hospital stay [8 (7, 10) days vs. 9 (7, 11) days, Z=-2.282, P=0.022], and the differences were statistically significant (P<0.05). (2) Postoperative complications: The overall morbidity of postoperative complication in PR group and NPR group was 20.3% (31/153) and 24.2% (37/153) respectively, and the incidence of anastomotic leakage was 9.8% (15/153) and 11.1%(17/153) respectively, whose differences were not statistically significant (both P>0.05). Compared with NPR group, PR group had lower morbidity of grade III to IV complications [3.9% (6/153) vs. 11.1% (17/153), χ(2)=5.688, P=0.017] and lower secondary operation rate [1.3% (2/153) vs. 5.9% (9/153), χ(2)=4.621, P=0.032], the differences were statistically significant (both P<0.05). Though PR group had lower incidence of grade C anastomoic leakage [1.3% (2/153) vs. 3.9% (6/153), χ(2)=2.054, P=0.152], but the differences were not statistically significant. (3) Postoperative inflammation: The difference of the procalcitonin level of both PR and NPR groups at postoperative 1-d, 3-d, and 5-d was statistically significant (F=5.222, P=0.010) in time-dependent manner, while the difference was not significant in the interaction effect (P>0.05). No statistically significant differences in the C-reactive protein level between two groups at postoperative 1-d, 3-d, and 5-d were found (all P>0.05). Conclusion: Peritoneum reconstruction in laparoscopic LAR can decrease the morbidity of postoperative complication of grade III to IV and the reoperation rate, and plays an important role in controlling the inflammatory reaction, which has great clinical value.

[Value of night pulse oximetry monitoring in obstructive sleep apnea hypopnea syndrome prediction and classification]

Objective: To explore the value of night pulse oximetry monitoring in the prediction and classification of obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: From January 2018 to December 2019, 580 snoring patients admitted to the Sleep Center of Tianjin Medical University General Hospital were analyzed retrospectively. There were 418 males and 162 females, aging 13-85(49±14) years. All subjects underwent polysomnography, and the apnea hypopnea index (AHI)was 0-101.4(43.06±27.47) times/hour. There were 52 cases in the non-OSAHS group (AHI<5 times/h), 69 cases in the mild OSAHS group (5 times/h<AHI≤15 times/h), 98 cases in the moderate OSAHS group (15 times/h<AHI≤30 times/h), and 361 cases in the severe OSAHS group (30 times/h<AHI).Correlation analysis was performed between indicators extracted from SpO₂ signal and AHI, and 11 blood oxygen indicators related to AHI were selected (3% oxygen reduction recovery index, the area of SpO₂ under the 90% curve, average lowest SpO₂, lowest SpO₂, the average SpO₂, the percentage of time SpO₂ under 95%, 90%, 85%, 80%, 75%, 70%). Finally, gender, age and body mass index (BMI) were added. We ysed multiple linear regression (MLR) method to achieve AHI prediction, and back propagation neural network (BPNN) multi-classification method to achieve OSAHS severity classification. Statistical analysis was performed based on SPSS 25.0. The measurement data were analyzed using Pearson correlation test. Results: The MLR method achieved high prediction performance, with a prediction correlation coefficient r=0.901 (P<0.05) and a goodness of fit r² = 0.848 (P<0.05).The specificity and negative prediction rate of BPNN method classification results were both around 90%, and the sensitivity and positive prediction rates were also high. Among them, the sensitivity of the non-OSAHS group (AHI<5 times/h) was 88.46%±4.50%, and the sensitivity of the severe OSAHS group (AHI>30 times/h) was 94.74%±0.76%. Conclusion: Based on the signals recorded by the SpO₂ monitor, the methods of using MLR model for AHI prediction and using BPNN model for multi-classification may have higher value for the prediction and classification of OSAHS.

Obstructive sleep apnea and respiratory center regulation abnormality

PURPOSE

Obstructive sleep apnea (OSA) is a complex disease in which phenotypic analysis and understanding pathological mechanisms facilitate personalized treatment and outcomes. However, the pathophysiology responsible for this robust observation is incompletely understood. The objective of the present work was to review how respiratory center regulation varies during sleep and wakeness in patients with OSA.

DATA SOURCES

We searched for relevant articles up to December 31, 2019 in PubMed database.

METHODS

This review examines the current literature on the characteristics of respiratory center regulation during wakefulness and sleep in OSA, detection method, and phenotypic treatment for respiratory center regulation.

RESULTS

Mechanisms for ventilatory control system instability leading to OSA include different sleep stages in chemoresponsiveness to hypoxia and hypercapnia and different chemosensitivity at different time. One can potentially stabilize the breathing center in sleep-related breathing disorders by identifying one or more of these pathophysiological mechanisms.

CONCLUSIONS

Advancing mechanism research in OSA will guide symptom research and provide alternate and novel opportunities for effective treatment for patients with OSA.

Slow-wave sleep is associated with incident hypertension in patients with obstructive sleep apnea: a cross-sectional study

OBJECTIVE

This study aimed to examine the association between slow-wave sleep ([SWS] N3 stage) and the risk of hypertension in patients with obstructive sleep apnea (OSA) or primary snorers.

METHODS

A retrospective cross-sectional study of 1145 participants who were evaluated for suspected OSA at our Sleep Medical Center were included. Among these participants, 1022 had OSA and 123 were primary snorers. Logistic regression modeling was performed to evaluate the association between the prevalence of hypertension and combined OSA and SWS based on polysomnographic measurements.

RESULTS

Patients with OSA in the lowest SWS quartile (quartile 1,  < 2.0%) showed a two-fold increased risk of hypertension after adjustment for confounding factors compared with primary snorers (odds ratio, 2.13 [95% confidence interval 1.54-2.06]). In logistic analysis stratified according to SWS quartiles, there was no significant difference in the risk of hypertension between patients with OSA and primary snorers in quartile 1. However, in the highest quartile (quartile 4), SWS was significantly associated with incident hypertension in patients with OSA rather than primary snorers.

CONCLUSION

SWS is associated with prevalent hypertension in patients with OSA. Notably, a low proportion of SWS confers a stronger association with incident hypertension than OSA.

[Study on the characteristics of major birth defects in 1.69 million cases of fetus in Guangxi Zhuang Autonomous Region]

Objective: Tracking the information on 1.69 million fetal cases across Guangxi Zhuang Autonomous Region (Guangxi) so as to study the occurrences of total and major birth defects in order to evaluate the ability on related prevention and control programs in Guangxi. Methods: Using the self-developed "Gui Women's System" to establish a database of 1.69 million fetal cases in Guangxi and to analyze the distribution of time, space and population, as well as the outcomes of pregnancy, using the big data. Results: During the 29 months of observation, the overall live birth rate was 99.25%, with stillbirth rate during pregnancy as 0.44%, stillbirth rate during birth as 0.02%, and the 0-6 days mortality rate as 0.14%. The total detection rate on birth defects was 197.63/10 000; the incidence rate was 103.04/10 000, the birth rate was 102.55/10 000. The overall discovery rate of major birth defects was 48.33/10 000, with the incidence rate as 783 000, the birth rate as 0.58/10 000. The discovery rates of major birth defects in 14 cities were between 35 and 68/10 000, and the birth rate dropped significantly to less than 1.00 in 10 000. Nationalities showed that the number of pregnant women with birth defects more than 50 000 would include Hui (9.68/10 000), Yao (9.57/10 000), and Jing (9.37/10 000). With the increasing age of gestation, number of birth defects, incidence of major birth defects also increased. Ninety-five percent of the major birth defects were found within <28 weeks and with the top 5 kinds of major birth defects as complicated congenital heart disease (9.11/10 000), alpha thalassemia (8.36/10 000), and 21-trisomy syndrome (7.85/10 000), beta thalassemia (5.32/10 000) and fetal edema syndrome (4.92/10 000). The top 5 major birth defects appeared as complicated congenital heart disease (9.11/10 000), alpha thalassemia (8.36/10 000), and 21-trisomy syndrome (7.85/10 000), beta thalassemia (5.32/10 000) and fetal edema syndrome (4.92/10 000). Conclusion: Programs leading to increase the rate on discovery of major birth defects were fundamental in effectively reducing the major birth defects.

[Clinical characteristics in patients with hypervirulent Klebsiella pneumoniae infection and its capsular serotypes and multilocus sequence typing]

Objective: To describe the clinical characteristics of hypervirulent Klebsiella pneumoniae (hvKP) infection. To analyze the antibiotic susceptibility of hvKP to provide the empiric antibiotic options. To investigate capsule serotype and sequence type (ST) of hvKP and their correlation with clinical profiles. Methods: hvKP was defined as bacteria isolated from patients with community-acquired pyogenic liver abscess (CA-PLA) with co-infection sites outside liver or a bloodstream infection in a host without underlying biliary tract diseases. Patients with CA-PLA hospitalized in the First Hospital of China Medical University were retrospectively analyzed from January 2011 to December 2017. Antibiotic susceptibility was detected by automatic bacterial identification and antibiotic susceptibility analysis system in vitro. Polymerase chain reaction method and gene sequencing were used to detect the main capsule serotype and ST. Results: A total of 140 cases with hvKP infection were enrolled. The co-infections outside liver abscess included 98 bloodstream infections, 53 pneumonia, 11 perianal abscess, 10 urinary system infections, 3 subphrenic abscess, 3 endophthalmitis, 2 spleen abscess, and other miscellaneous infections including 1 peritonitis, 1 skin and soft tissue infection, 1 myelitis, 1 colitis, 1 psoas major abscess and 1 myocardial abscess. Among the 140 cases, 106 presented with single co-infection site, 32 with 2 sites, and 2 with 3 sites. HvKP manifested high antibiotic susceptibility up to 80% for most commonly used antibiotics. Capsule serotyping of 43 revived isolates indicated that K1 serotype accounted for 53.49% (23/43), K2 34.88 (15/43), K54 2.33% (1/43), K57 2.33% (1/43), and other serotypes 6.98%(3/43). There was no significant distribution among K1, K2, K54 and K57 of hvKP capsule serotypes in patients with or without diabetes mellitus (P>0.05). Multilocus sequence typing (MLST) suggested that ST23 and ST65 were predominant accounting for 39.53% (17/43) and 25.58% (11/43) respectively. No serotype or ST predominance was seen in any of the clinical infections. Conclusion: HvKP is related to a wide spectrum of infectious diseases, including multiple extrahepatic sites and bloodstream infections besides CA-PLA with high antibiotic susceptibility. K1 and K2 are the predominant capsule serotypes, and ST 23 and ST65 are the predominant sequence types.

[Distribution of electroencephalograph power density in patients with severe obstructive sleep apnea during different sleep stages]

Objective: To investigate the variation of electroencephalograph(EEG) power density during different sleep stages in OSA for understanding of the mechanisms underlying the brain dysfunction in OSA as well as its earlier diagnosis and treatment. Methods: Sixteen-channel EEGs from OSA patients and normal controls in stage wake, sleep stage 1, sleep stage 2, sleep stage 3 and rapid eye movement stage were analyzed by time-frequency analysis method. The EEG power density in different frequency bands (including δ, θ, α, σ, β and γ) was respectively compared between the 2 groups. The correlation between the variation in the EEG power and primary indices of polysomnography was further analyzed. Results: The EEG power density in δ band in stage wake [OSA: (0.82±0.13) μV(2)/Hz, Control: (0.66±0.02) μV(2)/Hz, t=4.309, P<0.05], stage 1 [OSA: (1.28±0.07) μV(2)/Hz, Control: (0.92±0.04) μV(2)/Hz, t=-3.369, P<0.05] and stage 3 [OSA: (2.74±0.22) μV(2)/Hz, Control: (2.04±0.07) μV(2)/Hz, t=-2.669, P<0.05] was significantly higher in OSA, compared with that in the control. Statistical analysis showed that the EEG power density was significantly higher in frontal and central regions in stage wake [frontal: OSA: (0.90±0.02) μV(2)/Hz, Control: (0.66±0.02) μV(2)/Hz, t=8.539, P<0.01; central: OSA: (1.15±0.06) μV(2)/Hz, Control: (0.72±0.02) μV(2)/Hz, t=6.669, P<0.01] and stage 1 [frontal: OSA: (1.23±0.03) μV(2)/Hz, Control: (0.99±0.03) μV(2)/Hz, t=5.983, P<0.01; central: OSA: (1.52±0.05) μV(2)/Hz, Control: (1.14±0.04) μV(2)/Hz, t=5.714, P<0.01], as well as central region in stage 3 [OSA: (3.24±0.17) μV(2)/Hz, Control: (2.71±0.08) μV(2)/Hz, t=2.707, P<0.05]. The correlation analysis showed that the power density in central region in stage 1 and stage 3 was positively correlated with arousal index (r=0.877 in stage 1, 0.656 in stage 3), implying that sleep fragmentation was closely related to the variation of EEG power density during nocturnal sleep in OSA. Conclusions: The feature stages for OSA are stage wake, stage 1 and stage 3. The EEG power density in OSA (δ band) was significantly higher than that in the control. The EEG power density in OSA and the control shows differences in frontal and central regions in stage wake and stage 1, as well as in central region in stage 3. The results indicate that low-frequency EEG power density giving priority to frontal area and central area has improved in severe OSA, which may be related to the neurologic deficits in corresponding brain areas.

[Interleukin-17 expression and clinical significance in the lung tissue of patients with stable chronic obstructive pulmonary disease]

OBJECTIVE

To observe the interleukin-17 (IL-17) expression in lung tussiue of patients with stable chronic obstructive pulmonary disease (COPD) and investigate the clinical significance.

METHODS

A total of 50 patients receiving lung resections in General Hospital, Tianjin Medical University for lung cancer from October 2010 to October 2011 were included and divided into non-smoking COPD group (NS group), smoking non-COPD group (S group), smoking COPD group (COPD group) according to smoking status and 2013 COPD diagnosis standard. The expression of IL-17 was detected by immumohistochemical staining. The volume of IL-17 in the airway and lung parenchyma was calculated by immumohistochemical staining scores which was product of dyeing cells positive rate and intensity. Pearson correlation analysis was used to analyze the relationships between expression of IL-17 in the airway and lung parenchyma and forced expiratory volume in 1 second/predicted value (FEV1%pred), carbon monoxide diffusion amount accounting for the percentage of the expected value (DLCO%pred), COPD assessment test (CAT) score, body mass index (BMI).

RESULTS

The expressions of IL-17 in airway and lung parenchyma in S group (5.6±3.1, 6.4±2.5) were higher than those in NS group (1.6±1.4, 1.4±1.2) (both P<0.05), while expressions in COPD group (7.3±2.5, 7.8±2.1) were further higher than S group (both P<0.05). In the S group and COPD group, the expressions of IL-17 in the airway and lung parenchyma were positively correlated with smoking (r=0.453, P=0.007 and r=0.573, P<0.001); In the COPD group, the expressions of IL-17 in the airway and lung parenchyma were negatively correlated with FEV1%pred (r=-0.729, P=0.001 and r=-0.489, P=0.039), negatively related with DLCO%pred (r=-0.493, P=0.038 and r=-0.520, P=0.027), positively correlated with COPD CAT score (r=0.730, P=0.001 and r=0.644, P=0.004) and negatively related with BMI (r=-0.653, P=0.003 and r=-0.485, P=0.041).

CONCLUSION

Smoking increases inflammation of lung tissue, increases IL-17 expression in airway and lung parenchyma; the expression of IL-17 is closely related to the severity of disease, the quality of life and prognosis in COPD patients.

[Changes on patterns of sleep duration: findings from China Health and Nutrition Survey in population in 9 provinces]

Objective: To understand the changes on patterns of sleep duration of the China Health and Nutrition Survey (CHNS) cohort in 9 provinces from 2004 to 2011. Methods: Four rounds of CHNS data were used. Urban/rural, age and gender specific insufficient sleeping rates and excessive sleeping rates were analyzed. Results: In 2004, 2006, 2009 and 2011, a total of 274, 281, 329 and 304 children aged 3-5 years; 874, 806, 768 and 742 children aged 6-12 years; 789, 529, 426 and 367 children aged 13-17 years; 9 568, 9 530, 9 942 and 9 609 adults aged ≥18 years were surveyed respectively. The lowest insufficient sleeping rate was 53.9% (200/371) in 3-17 years old children in rural area in 2006, the highest insufficient sleeping rate was 77.2% (44/57) in 3-5 years old children in urban area in 2004. The insufficient sleeping rate increased in rural 3-5 years old children from 2004 to 2011. For the adults aged ≥18 years, the insufficient sleeping rate ranged from 4.2% (82/1 954) in females aged 18-44 years in 2004 and 2009 to 20.8% (211/1 015) in urban residents aged > 60 years in 2011. The insufficient sleeping rate in age-groups 44-59 years and ≥60 years increased in both males and females and in both urban area and rural area from 2004 to 2011. The gender specific excessive sleeping rate in 3-17 years old children was very low in both urban area and rural area and no difference was found in different rounds of survey. The excessive sleeping rate in adults ranged from 18.4% (569/3 093) in urban population in 2011 to 32.5% (1 617/4 969) in females in 2004. The excessive sleeping rate of adult decreased from 2004 to 2011. Conclusion: We should pay attention to the fact that the insufficient sleeping rate in adolescents is high and in increase in rural 3-5 years old children and adults aged ≥45 years.

A novel enzyme-assisted ultrasonic approach for highly efficient extraction of resveratrol from Polygonum cuspidatum

Resveratrol is a promising multi-biofunctional phytochemical, which is abundant in Polygonum cuspidatum. Several methods for resveratrol extraction have been reported, while they often take a long extraction time accompanying with poor extraction yield. In this study, a novel enzyme-assisted ultrasonic approach for highly efficient extraction of resveratrol from P. cuspidatum was developed. According to results, the resveratrol yield significantly increased after glycosidases (Pectinex® or Viscozyme®) were applied in the process of extraction, and better extraction efficacy was found in the Pectinex®-assisted extraction compared to Viscozyme®-assisted extraction. Following, a 5-level-4-factor central composite rotatable design with response surface methodology (RSM) and artificial neural network (ANN) was selected to model and optimize the Pectinex®-assisted ultrasonic extraction. Based on the coefficient of determination (R(2)) calculated from the design data, ANN model displayed much more accurate in data fitting as compared to RSM model. The optimum conditions for the extraction determined by ANN model were substrate concentration of 5%, acoustic power of 150W, pH of 5.4, temperature of 55°C, the ratio of enzyme to substrate of 3950 polygalacturonase units (PGNU)/g of P. cuspidatum, and reaction time of 5h, which can lead to a significantly high resveratrol yield of 11.88mg/g.

Formoterol as reliever medication in asthma: a post-hoc analysis of the subgroup of the RELIEF study in East Asia

Background

As-needed formoterol can effectively relieve asthma symptoms. Since budesonide/formoterol is available as maintenance and reliever therapy in Asia, formoterol is now being used as-needed, but always with concomitant inhaled corticosteroids. The objective of this analysis was to assess the safety and efficacy of formoterol therapy in patients in East Asia (China, Indonesia, Korea, the Philippines and Singapore) with asthma.

Methods

Post-hoc analyses of data from the East Asian population of the RELIEF (REal LIfe EFfectiveness of Oxis® Turbuhaler® as-needed in asthmatic patients; study identification code: SD-037-0699) study were performed.

Results

This sub-group comprised 2834 randomised patients (formoterol n = 1418; salbutamol n = 1416) with mean age 35 years; 50.7 % were male. 2678 patients completed the study. There was no significant difference in the total number of adverse events (AEs) reported in the formoterol and salbutamol groups (21.3 % vs 20.9 % of patients; p = 0.813), nor in the total number of serious AEs and/or discontinuations due to AEs (4.6 % vs 5.5 %, respectively; p = 0.323). Compared with salbutamol, formoterol was associated with a significantly longer time to first exacerbation (hazard ratio 0.86; p = 0.023) and a 14 % reduction in the risk of any exacerbation (p < 0.05). Relative to salbutamol, mean adjusted reliever medication use throughout the study was significantly lower in the formoterol group (p = 0.017) and the risk of increased asthma medication use was 20 % lower with formoterol (p = 0.005).

Conclusions

Among patients with asthma in East Asia, as-needed formoterol and salbutamol had similar safety profiles but, compared with salbutamol, formoterol reduced the risk of exacerbations, increased the time to first exacerbation and reduced the need for reliever medication.

Electronic supplementary material

The online version of this article (doi:10.1186/s12890-015-0166-0) contains supplementary material, which is available to authorized users.

Hippocampal mitogen-activated protein kinase activation is associated with intermittent hypoxia in a rat model of obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS), characterized by intermittent hypoxia/re-oxygenation, may impair the cerebral system. Although mitogen-activated protein kinase (MAPK) signaling was observed to have a key role in hypoxia-induced brain injury, the intracellular events and their underlying mechanisms for intermittent hypoxia/re-oxygenation-associated damage to hippocamal MAPKs, including extracellular signal-regulated kinase (ERK)1/2, P38MAPK and c-Jun N-terminal kinase (JNK) remain to be elucidated and require further investigation. A total of five rats in each sub-group were exposed to intermittent hypoxia or continued hypoxia for 2, 4, 6 or 8 weeks. Histological, immunohistochemical and biological analyses were performed to assess nerve cell injury in the hippocampus. Surviving CA1 pyramidal cells were identified by hematoxylin and eosin staining. The levels of phosphorylated ERK1/2, P38MAPK and JNK were detected by western blotting. B-cell lymphoma 2 (Bcl-2) and Bcl-2-associated X protein (Bax) in neural cells were examined by immunohistochemistry. The malondialdehyde (MDA) contents and superoxide dismutase (SOD) activities were measured by thiobarbituric acid and xanthine oxidation methods, respectively. Under continued hypoxia, the levels of phospho-ERK1/2 peaked at the fourth week and then declined, whereas phospho-P38MAPK and JNK were detected only in the late stages. By contrast, under intermittent hypoxia, ERK1/2, P38MAPK and JNK were activated at all time-points assessed (2, 4, 6 and 8 weeks). The levels of phospho-ERK1/2, P38MAPK and JNK were all higher in the intermittent hypoxia groups than those in the corresponding continued hypoxia groups. Bcl-2 was mainly increased and reached the highest level at six weeks in the continued hypoxia group. Of note, Bcl-2 rapidly increased to the peak level at four weeks, followed by a decrease to the lowest level at the eighth week in the intermittent hypoxia group. Bax was generally increased at the late stages under continued hypoxia, but increased at all time-points under the intermittent hypoxia conditions. The two types of hypoxia induced an increase in the MDA content, but a decrease in SOD activity. Marked changes in these two parameters coupled with markedly reduced surviving cells in the hippocampus in a time-dependent manner were observed in the intermittent hypoxia group in comparison with the continued hypoxia group. OSAS-induced intermittent hypoxia markedly activated the MAPK signaling pathways, which were triggered by oxidative stress, leading to abnormal expression of downstream Bcl-2 and Bax, and a severe loss of neural cells in the hippocampus.

Cheyne-Stokes respiration during sleep: mechanisms and potential interventions

Cheyne-Stokes respiration is characterized by a typical waxing and waning pattern in breathing amplitude, interspersed with central apnoeas or hypopnoeas. This article reviews current knowledge regarding Cheyne-Stokes respiration with a particular emphasis on the mechanisms and latest methods of intervention.

Noninvasive ventilation with complex critical care ventilator in the treatment of acute exacerbation of chronic obstructive pulmonary disease

OBJECTIVE

To compare the clinical effect of noninvasive positive-pressure ventilation (NIPPV), delivered via critical care ventilator or miniventilator, in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

METHODS

Prospective comparison study. Patients with AECOPD underwent NIPPV via: miniventilator with BiLevel positive airway pressure (BiPAP; Group A); critical care ventilator with pressure support ventilation and positive end expiratory pressure (PSV + PEEP; Group B); critical care ventilator with pressure-synchronized intermittent mandatory ventilation (P-SIMV)+PSV + PEEP (Group C). Physiological parameters were recorded before, during and after ventilation.

RESULTS

Patients in Group C (n = 21) showed significantly better improvements in physiological parameters (compared with pretreatment values) than those in Group B (n = 20) or Group A (n = 22).

CONCLUSION

NIPPV delivered via critical care ventilator has a better treatment effect than miniventilator NIPPV in patients with AECOPD. The use of P-SIMV + PSV + PEEP mode provides a significantly better treatment effect than PSV + PEEP alone.

Prognostic value of oxygen consumption and ventilatory equivalent slope in female candidates referred for heart transplantation--experience of a single Asian center

BACKGROUND

Ventilatory equivalent (ventilation/CO2 production, VE/VCO2) slope has been suggested to be a much more accurate predicator than peak oxygen consumption (VO2) during exercise for prognosis in patients with heart failure. However, patients tested were predominately male.

METHODS

To investigate whether peak VO2 and VE/VCO2 slope predict the prognosis of female patients with heart failure, we retrospectively collected data of 39 female candidates referred for heart transplantation (HTx) from 2004 to 2011. Both peak VO2 and VE/VCO2 slope were obtained from the results of an exercise pulmonary function test. The outcome was death or mechanical devices implantation or HTx. Logistic regression was used for data analysis.

RESULTS

Mean age and heart failure survival score were 55.8 ± 13.7 years and 7.3 ± 0.7, respectively. Each increment of VE/VCO2 slope decreased 2-year event-free rate (odds ratio [OR] = 0.88, 95% confidence interval [CI] = 0.79 to 0.98) in the female group. The predictions of VE/VCO2 slope for 1-year event-free survival did not reach statistical significance (OR = 0.92, 95% CI = 0.84 to 1.00). On the other hand, peak VO2 was not a strong predictor for 1- and 2-year event-free survival (OR = 1.22 and 1.16, 95% CI = 0.96 to 1.55 and 0.94 to 1.44, respectively).

CONCLUSIONS

Impairment in exercise ventilation holds a clinical and long-term prognostic impact in female patients with heart failure. The role of peak VO2 during exercise in prognostic prediction among the cohort should be further investigated.

A study of noninvasive positive-pressure mechanical ventilation in the treatment of acute lung injury with a complex critical care ventilator

OBJECTIVE

To test the hypothesis that there would be better clinical outcomes following the treatment of patients with acute lung injury (ALI) using noninvasive positive-pressure mechanical ventilation (NIPPV) delivered via a complex critical care ventilator compared with a conventional mini-ventilator.

METHODS

Patients with ALI who required NIPPV were prospectively enrolled and randomly divided between three intervention groups: group A was ventilated using a mini-ventilator; groups B and C were ventilated using a complex critical care ventilator using different settings. Clinical parameters were recorded before and after 8 h of mechanical ventilation.

RESULTS

A total of 51 patients with ALI were enrolled in the study. Clinical parameters in groups B and C underwent greater improvements than those in group A. Group C demonstrated the lowest treatment failure rate (23.5%). Failure rates were highest in group A (58.8%).

CONCLUSION

The findings of this present study suggest that there were more satisfactory clinical outcomes following the treatment of patients with ALI when NIPPV was delivered using a complex critical care ventilator compared with a conventional mini-ventilator.

Optimized ultrasound-assisted extraction of phenolic compounds from Polygonum cuspidatum

In this study the phenolic compounds piceid, resveratrol and emodin were extracted from P. cuspidatum roots using ultrasound-assisted extraction. Multiple response surface methodology was used to optimize the extraction conditions of these phenolic compounds. A three-factor and three-level Box-Behnken experimental design was employed to evaluate the effects of the operation parameters, including extraction temperature (30-70 °C), ethanol concentration (40%-80%), and ultrasonic power (90-150 W), on the extraction yields of piceid, resveratrol, and emodin. The statistical models built from multiple response surface methodology were developed for the estimation of the extraction yields of multi-phenolic components. Based on the model, the extraction yields of piceid, resveratrol, and emodin can be improved by controlling the extraction parameters. Under the optimum conditions, the extraction yields of piceid, resveratrol and emodin were 10.77 mg/g, 3.82 mg/g and 11.72 mg/g, respectively.

Predictors of long-term adherence to continuous positive airway pressure therapy in patients with obstructive sleep apnea and cardiovascular disease in the SAVE study

STUDY OBJECTIVES

To determine the clinical variables that best predict long- term continuous positive airway pressure (CPAP) adherence among patients with cardiovascular disease who have obstructive sleep apnea (OSA).

DESIGN

12-mo prospective within-trial observational study.

SETTING

Centers in China, Australia, and New Zealand participating in the Sleep Apnea cardioVascular Endpoints (SAVE) study.

PATIENTS

There were 275 patients age 45-70 y with cardiovascular disease (i.e., previously documented transient ischemic attack, stroke, or coronary artery disease) and OSA (4% oxygen desaturation index (ODI) > 12) who were randomized into the CPAP arm of the SAVE trial prior to July 1, 2010.

METHODS

Age, sex, country of residence, type of cardiovascular disease, baseline ODI, severity of sleepiness, and Hospital Anxiety and Depression Scale (HADS) scores plus CPAP side effects and adherence at 1 mo were entered in univariate analyses in an attempt to identify factors predictive of CPAP adherence at 12 mo. Variables with P < 0.2 were then included in a multivariate analysis using a linear mixed model with sites as a random effect and 12-mo CPAP use as the dependent outcome variable.

MEASUREMENTS AND RESULTS

CPAP adherence at 1, 6, and 12 mo was (mean ± standard deviation) 4.4 ± 2.0, 3.8 ± 2.3, and 3.3 ± 2.4 h/night, respectively. CPAP use at 1 mo (effect estimate ± standard error, 0.65 ± 0.07 per h increase, P < 0.001) and side effects at 1 mo (-0.24 ± 0.092 per additional side effect, P = 0.009) were the only independent predictors of 12- mo CPAP adherence.

CONCLUSION

Continuous positive airway pressure use in patients with coexisting cardiovascular disease and moderate to severe obstructive sleep apnea decreases significantly over 12 months. This decline can be predicted by early patient experiences with continuous positive airway pressure (i.e., adherence and side effects at 1 month), raising the possibility that intensive early interventions could improve long-term continuous positive airway pressure compliance in this patient population.

CLINICAL TRIALS REGISTER

Clinical Trials, http://www.clinicaltrials.gov, NCT00738179.

Ultrasonic-assisted extraction of the botanical dietary supplement resveratrol and other constituents of Polygonum cuspidatum

The roots of Polygonum cuspidatum produce several phenolic compounds, including trans-resveratrol (1), trans-piceid (2), and emodin (3), and are a commercial source of the botanical dietary supplement 1. Ultrasonic-assisted extraction technology and conventional shaking extraction procedures were compared for the extraction of 1-3 from P. cuspidatum roots, using 50% ethanol as a food grade solvent. These compounds were extracted successfully, and their mass transfer coefficients were calculated by fitting the experimental results to a model derived from Fick's second law. The results indicated that ultrasonic-assisted extraction had higher mass transfer efficacies and extraction yields for 1-3 as compared with conventional shaking extraction. Under the extraction conditions used (extraction temperature 50 °C; ultrasonic power 150 W), yields of 3.5, 9.2, and 7.8 mg/g were obtained for 1-3, respectively.

Cytopathology of chick renal epithelial cells experimentally infected with avian infectious bronchitis virus

The renal ducto-tubular epithelial cells of chicks infected with the MA-87 strain of avian infectious bronchitis virus (IBV) were examined ultrastructurally. Infected epithelial cells containing IBV particles were more numerous in the collecting ducts, collecting tubules, distal convoluted tubules and Henle's loops than in the proximal convoluted tubules. Virus particles invaded host cells through endocytotic vesicles. Cytopathologic changes in the infected epithelial cells were manifested by a variety of organlle alterations including swelling of mitochondria, dilation of Golgi vesicles and an increase in the amount of rough endoplasmic reticulum (RER). Virus particles were produced by budding into RER and, rarely, toward the perinuclear space. As virus replication progressed, virus particles were enclosed mainly in the dilated RER, cytoplasmic vesicles or virus-containing electron-dense bodies. Virus particles were also found in vesicles of Golgi complex, the dilated perinuclear space, in some autophagic vacuoles or free in the cytoplasm. Virus particles were released by exocytosis through cytoplasmic vesicles, or appeared to be discharged through disrupted cell membranes. It was concluded that epithelial cells of lower nephron and ducts are the primary target cells in IBV-infected kidneys.

Meiotic studies on a Brassica campestris-alboglabra monosomic addition line and derived B. campestris primary trisomics

Diakinesis chromosomes were studied in pollen mother cells of Brassica campestris (2n = 20, genome AA), B. alboglabra (2n = 18, genome CC), a B. campestris-alboglabra monosomic addition line (AA + 1 chromosome from the C genome), and four derived B. campestris primary trisomics. The nucleolar chromosomes of B. campestris were distinguishable by their morphology at diakinesis. The alien C-genome chromosome in the addition line paired preferentially with the nucleolar chromosome of the A genome. Very rarely, it paired with another pair of the A genome. Thus, it was concluded that the alien C-genome chromosome of the addition line is primarily homoeologous to the nucleolar chromosome and secondarily to another chromosome of the A genome. Three of the four derived B. campestris trisomic plants were identified as B campestris nucleolar trisomics. Trisomy in the fourth plant involved another chromosome. The cytological mechanism underlying the origin of trisomics in the addition line and chromosome homoeology relationships between B. campestris and B. alboglabra are envisaged.

Histopathology and immunohistochemistry of renal lesions due to avian infectious bronchitis virus in chicks uninoculated and previously inoculated with highly virulent infectious bursal disease virus

A nephropathogenic strain of infectious bronchitis virus (IBV) was inoculated intra-tracheally into 14-day-old specific-pathogen-free chicks or ones previously inoculated with highly virulent infectious bursal disease virus (IBDV) at 7 days of age. The renal lesions were examined histopathologically and immunohistochemi-cally at intervals up to 30 days post-inoculation. The mortality was 20% in the IBDV + IBV-inoculated group, but not in the IBV-inoculated one. Swollen and pale kidneys due to IBV infection were more severe and of longer duration in dually infected chicks. At the early stage of infection, the histopathological changes in the kidneys were similar in both groups, but the ducto-tubular damage was more severe in the dually infected chicks. At the late stage of infection, the renal lesions were characterized by chronic interstitial nephritis with formation of lymphoplasmacytic nodules in IBV-inoculated chicks and by chronic active nephritis which consisted of tubular degeneration, lymphoid cell reaction and interstitial fibrosis in IBDV + IBV-inoculated ones. More IBV antigen-positive cells persisted longer in the kidneys of dually infected chicks than in those of IBV-inoculated ones.

Mitotic karyotypes of Brassica campestris and Brassica alboglabra and identification of the B. alboglabra chromosome in an addition line

A Brassica campestris-alboglabra monosomic addition line (genome: AA + one chromosome from the C genome, 2n = 21) harbours the Brassica alboglabra (CC, 2n = 18) chromosome with the gene for erucic acid. In order to identify this chromosome, we have studied the mitotic prometaphase chromosomes of Brassica campestris (AA, 2n = 20), B. alboglabra, and the monosomic addition line. More pronounced differential staining and size differences of chromosomes were observed in B. campestris than in B. alboglabra. The karyotype of B. campestris was composed of four median (m), four submedian (sm), and two subterminal (st) chromosome pairs, while that of B. alboglabra was composed of three m, four sm, and two st chromosome pairs, provided that the length of the satellite was excluded when determining the arm ratio of the nucleolar chromosome. The alien chromosome from the C genome in the addition line was easily identified in the background B. campestris genome by its large size, its submedian centromere, and its differential staining pattern. When compared with the karyotype of B. alboglabra, the alien chromosome from the C genome in the monosomic addition line was revealed to be chromosome 4.

Comparison of heat stability of goat milk subjected to ultra-high temperature and in-container sterilization

Goat milk with and without stabilizing salt was subjected to in-container and UHT sterilization. Heat stability was assessed by measuring the amount of sediment in the milk. Without stabilizing salts, goat milk usually produced less sediment when subjected to in-container sterilization compared with UHT processing. Addition of stabilizing salts up to 12.8mM resulted in a progressive increase in sediment for in-container sterilization. In contrast, adding stabilizing salts at 6.4mM initially reduced sediment formation in UHT-treated milk but addition of stabilizing salts at 12.8mM increased sediment formation. Adding stabilizing salts to goat milk increased pH, decreased ionic calcium, and increased ethanol stability. Adding up to 2mM calcium chloride increased sediment formation more after UHT treatment than after in-container sterilization. These results suggest that no single mechanism or set of reactions causes milk to produce sediment during heating and that the favored pathway is different for UHT and in-container sterilization processes. Poor heat stability could be induced both by increasing ionic calcium and by decreasing it. Ethanol stability is not a good indicator of heat stability for in-container sterilization, but it may be for UHT sterilization, if milk does not enter the region of poor heat stability found at low concentrations of ionic calcium.

Elevated nocturnal and morning blood pressure in patients with obstructive sleep apnea syndrome

BACKGROUND

The nocturnal nondipping and elevated morning blood pressure (BP) in patients with obstructive sleep apnea syndrome (OSAS) have not yet been well investigated in Chinese patients. This study aimed to describe the BP profile, and to elucidate the relationships between daytime BP and nighttime BP, and between evening BP and morning BP in patients with OSAS.

METHODS

Twenty teaching hospital sleep centers in China were organized by the Chinese Medical Association to participate in this study and 2297 patients were recruited between January 2004 and April 2006. BP assessments were made at four time points (daytime, evening, nighttime and morning) and polysomnography (PSG) was performed and subjects were classified into four groups by their apnea-hypopnea index (AHI): control, n = 213 with AHI < 5; mild, n = 420 with AHI ≥ 5 and < 15; moderate, n = 460 with AHI ≥ 15 and < 30; and severe, n = 1204 with AHI ≥ 30. SPSS 11.5 software package was used for statistical analysis and figure drawing.

RESULTS

All the average daytime, nighttime, evening and morning BPs were positively correlated with AHI and negatively correlated with nadir nocturnal oxygen saturation. The ratios of nighttime/daytime and morning/evening average BP were positively correlated with AHI. The ratio of nighttime/daytime systolic BP became a "reversed BP dipping" pattern until the classification reached severe, while the ratio of nighttime/daytime diastolic BP became reversed at moderate. Similarly, the ratio of morning/evening diastolic BP becomes reversed even at mild.

CONCLUSIONS

OSAS may result in higher BP levels at all four time points. The ratios of nighttime/daytime and morning/evening BP increase with increased AHI. The increasing of diastolic BP, which is inclined to rise more quickly, is not parallel with increasing systolic BP.

[Effect of different intermittent hypoxia patterns on interleukin-6 and interleukin-8 levels of human umbilical vein endothelial cells]

OBJECTIVE

To investigate the effect of different patterns of intermittent hypoxia on the levels of interleukin-6 (IL-6) and interleukin-8 (IL-8) of vascular endothelial cell.

METHODS

The human umbilical vein endothelial cells of the line ECV304 were used to set up the cells model. The experiment cell strains contained one control group and eight experimental groups, 1 constance normoxia group (control group), 3 different intermittent hypoxia (IH) degree groups (10% O₂ group, 1.5% O₂ group, 0.5% O₂ group with 12 times/h), 4 different IH frequency groups (40 times/h, 20 times/h, 12 times/h, 9 times/h and 6 times/h with 0.5%O2). The specimen were put into a program-controlled gas delivery system with different level and frequency of IH respectively. Then enzyme linked immunosorbent assay (ELISA) was used to examine the levels of IL-6 and IL-8.

RESULTS

Higher level of IL-6 and IL-8 were found in 3 different IH degree groups than in control group (F were 1961.100 and 103.855 respectively, P all < 0.001). The level of IL-6 and IL-8 was gradually increased with the decreasing of IH degree. The difference of IL-6 and IL-8 levels between each two different groups in IH degree was significant (P all < 0.05). The level of IL-6 and IL-8 groups was significantly different in severe IH exposure (F were 544.396 and 149.328 respectively, P all < 0.001 in both groups). There was a trend as the IH frequency decreased, the level of IL-6 and IL-8 was tenderly increased in 20/hour group (P < 0.05), highest in 12/hour group (P < 0.05), decreased in 9/hour group (P < 0.05), and decreased further in 6/hour group (P < 0.05) in severe IH expose. There was statistical significance between each two different frequency IH groups (P < 0.05).

CONCLUSIONS

Intermittent hypoxia caused significant inflammatory reaction in vascular endothelial cells. The secreted level of IL-6 and IL-8 depended on the degree of hypoxia. There was a trend as the level of IH frequency decreased, the level of IL-6 and IL-8 gradually increased at first, and then decreased in the same way.

Clinical evaluation of oral levofloxacin 500 mg once-daily dosage for treatment of lower respiratory tract infections and urinary tract infections: a prospective multicenter study in China

Levofloxacin (LVFX), a fluoroquinolone agent, has a broad spectrum that covers Gram-positive and -negative bacteria and atypical pathogens. It demonstrates good clinical efficacy in the treatment of various infections, including lower respiratory tract infections (LRTIs) and urinary tract infections (UTIs). To evaluate the efficacy and safety of oral LVFX 500 mg once daily, a large open-label clinical trial was conducted in 1266 patients (899 with LRTIs and 367 with UTIs) at 32 centers in China. In the per-protocol population, the clinical efficacy rate (cure or improvement) at 7 to 14 days after the end of treatment was 96.4% (666/691) for LRTIs and 95.7% (267/279) for UTIs. In 53 patients diagnosed with atypical pneumonia the treatment was effective. The bacteriological efficacy rate was 96.6% (256/265) for LRTIs and 93.3% (126/135) for UTIs. The eradication rate of the causative pathogens was 100% (33/33) for Haemophilus influenzae and 96.0% (24/25) for Streptococcus pneumoniae in LRTIs, and 94.1% (80/85) for Escherichia coli in UTIs. The overall efficacy rates were 89.3% (617/691) for LRTIs and 87.8% (245/279) for UTIs. The incidence of drug-related adverse events (ADRs) was 17.3% (215/1245), and the incidence of drug-related laboratory abnormalities was 15.7% (191/1213). Common ADRs were dizziness, nausea, and insomnia. Common laboratory abnormalities included "WBC decreased", "alanine aminotransferase (ALT) increased", "aspartate aminotransferase (AST) increased", and "lactate dehydrogenase (LDH) increased". All of these events were mentioned in the package inserts of fluoroquinolones including LVFX, and most events were mild and transient. Thirty-four patients (2.7%) were withdrawn from the study because of the ADRs. No new ADRs were found. This study concluded that the dosage regimen of LVFX 500 mg once daily was effective and tolerable for the treatment of LRTIs and UTIs.

[The quality of life of patients with chronic obstructive pulmonary disease and correlated factors]

OBJECTIVE

To evaluate the quality of life (QOL) of patients with chronic obstructive pulmonary disease (COPD) and correlated factors.

METHODS

Data of 20 245 patients with COPD were collected from the cross-sectional survey of COPD, which was conducted between 2002 and 2004 in urban and rural areas of Beijing, Shanghai, Guangdong, Liaoning, Tianjin, Chongqing and Shanxi for residents aged over 40 years old. The recruited populations were interviewed with questionnaire and tested for spirometry. The quality of life was assessed with 12-item short-form health survey questionnaire (SF-12). Those with less than 70% of post-bronchodilator FEV(1)/FVC were identified as having COPD. The differences between groups in SF-12 scores converted by rank were compared using general linear model. Stepwise multiple linear regressions were conducted to study the main determinants of QOL.

RESULTS

Compared to subjects without COPD, those with COPD had impaired QOL (56 +/- 7 vs. 57 +/- 6 in mental component scores, F = 4.442, P < 0.05; 46 +/- 9 vs. 50 +/- 6 in physical component scores, F = 453.960, P < 0.05). Among COPD patients, the mental component score was associated with scores of dyspnea, BMI, comorbidities, sex and living areas, while the physical component score was associated with scores of dyspnea, severity of COPD, comorbidities, exposure to dusts/gases/fumes, sex, age, educational level and previous diagnosis of respiratory diseases (all P < 0.05).

CONCLUSIONS

The QOL in patients with COPD was impaired and associated with scores of dyspnea, severity of COPD, comorbidities and BMI. Improvement of dyspnea, nutritional support, prevention of comorbidities and keeping away from risk factors may improve the QOL in COPD patients.

Histopathology and immunohistochemistry of renal lesions due to infectious bronchitis virus in chicks

Two-day-old specific-pathogen-free chicks were inoculated intranasally with the MA-87 strain of infectious bronchitis virus, and trachea and kidney lesions studied histologically and immunohistochemically. Lesions and viral antigen were first detected in the trachea; severe damage was then observed in the kidney. Viral antigen appeared prior to the development of renal lesions and was detected in the cytoplasm of epithelial cells by 4 days post-inoculation (p.i.). The epithelial cells of the collecting ducts, collecting tubules and distal convoluted tubules were first affected, followed by involvement of Henle's loops, whereas the proximal convoluted tubules were only minimally affected. Antigen-positive cells of ducts and tubules were degenerated and desquamated. The severe epithelial cell damage resulted in infiltration of heterophils and macrophages in the interstitium, ducts and tubules. The detection of viral antigen was consistent with the distribution of histological lesions at 6 to 8 days p.i. At a later stage, antigen-positive cells disappeared and repair of epithelial cells was seen, accompanied by interstitial lymphoplasmacytic infiltration and lymphoid nodular formation.

Effect of carbocisteine on acute exacerbation of chronic obstructive pulmonary disease (PEACE Study): a randomised placebo-controlled study

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is characterised by airflow limitation, and has many components including mucus hypersecretion, oxidative stress, and airway inflammation. We aimed to assess whether carbocisteine, a mucolytic agent with anti-inflammatory and antioxidation activities, could reduce the yearly exacerbation rate in patients with COPD.

METHODS

We did a randomised, double-blind, placebo-controlled study of 709 patients from 22 centres in China. Participants were eligible if they were diagnosed as having COPD with a postbronchodilator forced expiratory volume in 1 s (FEV(1)) to forced vital capacity (FVC) ratio (FEV(1)/FVC) of less than 0.7 and an FEV(1) between 25% and 79% of the predicted value, were aged between 40 and 80 years, had a history of at least two COPD exacerbations within the previous 2 years, and had remained clinically stable for over 4 weeks before the study. Patients were randomly assigned to receive 1500 mg carbocisteine or placebo per day for a year. The primary endpoint was exacerbation rate over 1 year, and analysis was by intention to treat. This trial is registered with the Japan Clinical Trials Registry (http://umin.ac.jp/ctr/index/htm) number UMIN-CRT C000000233.

FINDINGS

354 patients were assigned to the carbocisteine group and 355 to the placebo group. Numbers of exacerbations per patient per year declined significantly in the carbocisteine group compared with the placebo group (1.01 [SE 0.06] vs 1.35 [SE 0.06]), risk ratio 0.75 (95% CI 0.62-0.92, p=0.004). Non-significant interactions were found between the preventive effects and COPD severity, smoking, as well as concomitant use of inhaled corticosteroids. Carbocisteine was well tolerated.

INTERPRETATION

Mucolytics, such as carbocisteine, should be recognised as a worthwhile treatment for prevention of exacerbations in Chinese patients with COPD.

The genetic basis of flowering time and photoperiod sensitivity in rapeseed (Brassica napus L.)

The objective of this study was to dissect the genetic control of days to flowering (DTF) and photoperiod sensitivity (PS) into the various components including the main-effect quantitative trait loci (QTLs), epistatic QTLs and QTL-by-environment interactions (QEs). Doubled haploid (DH) fines were produced from an F1 between two spring Brassica napus cultivars Hyola 401 and Q2. DTF of the DH lines and parents were investigated in two locations, one location with a short and the other with a long photoperiod regime over two years. PS was calculated by the delay in DTF under long day as compared to that under short day. A genetic linkage map was constructed that comprised 248 marker loci including SSR, SRAP and AFLP markers. Further QTL analysis resolved the genetic components of flowering time and PS into the main-effect QTLs, epistatic QTLs and QEs. A total of 7 main-effect QTLs and 11 digenic interactions involving 21 loci located on 13 out of the 19 linkage groups were detected for the two traits. 3 main-effect QTLs and 4 pairs of epistatic QTLs were involved in QEs conferring DTF. One QTL on linkage group (LG) 18 was revealed to simultaneously affect DTF and PS and explain for the highest percentage of the phenotypic variation. The implications of the results for B. napus breeding have been discussed.