Obstructive sleep apnea (OSA) has been definitively shown to be a risk factor for the development of cardiovascular disease and mortality. Recent reports have indicated that obstructive sleep apnea is associated with insulin resistance and impaired glucose metabolism, also have type 2 diabetes. The potential mechanisms leading to the development of type 2 diabetes in OSA patients are likely to be various. Reduced physical activity resulting from daytime somnolence, sympathetic nervous system activation, intermittent hypoxia, sleep fragmentation and sleep loss, dysregulation of the hypothalamic-pituitary axis, alteration in adipokine profiles, and activation of inflammatory pathways have been proposed. Based on the current evidence, clinicians should assess the risk of OSA in patients with type 2 diabetes and, conversely, consider that possibility of glucose intolerance in patients with OSA. Further large-scale and long-term follow-up studies in patient populations with selected by reliable but inexpensive diagnostic measures, controlled for potential confounder factor, are needed.
Adipokines ; Anoxia ; Axis, Cervical Vertebra ; Cardiovascular Diseases ; Glucose ; Glucose Intolerance ; Humans ; Insulin Resistance ; Motor Activity ; Risk Factors ; Sleep Apnea, Obstructive ; Sleep Deprivation ; Sympathetic Nervous System

Adolescent ; Adult ; Aged ; Electrodes ; Epistaxis ; surgery ; Female ; Hemostasis, Endoscopic ; methods ; Humans ; Male ; Middle Aged ; Young Adult

Objective To evaluate the effects of different sequences of intravenous administration on fentanyl-induced cough during induction of general anesthesia.Methods One hundred patients of both sexes,aged 18-70 yr,weighing 42-88 kg,of ASA physical status Ⅰ or Ⅱ,scheduled for elective surgery under general anesthesia,were equally randomized to 2 groups using a random number table:fentanyl-propofol group (group FP) and propofol-fentanyl group (group PF).In FP group,fentanyl 3 μg/kg was injected intravenously over 3 s,and then propofol 1.5 mg/kg was injected intravenously.In PF group,propofol 1.5 mg/kg was injected intravenously,and then fentanyl 3μg/kg was injected intravenously over 3 s.The development,intensity and onset time of cough were recorded within 1 min after fentanyl injection.Results Compared with FP group,the incidence of cough was significantly decreased,and no significant change was found in the intensity and onset time of cough in PF group.Conclusion Administration in the propofol-fentanyl sequence can reduce the development of fentanyl-induced cough as compared with that in the fentanyl-propofol sequence during induction of general anesthesia.

Mononuclear cells(MNCs) isolatedfrommammal'sbonemarrowandperipheral bloodbymeansof Ficoll density grandient centrifugation,which are composed of monocytes and lymphocytes,can differentiate into different progenitor cells with different functions in the development of atherosclerosis under different inducing conditions. This article described the induction conditions of MNCs,the identification methods of different progenitor cells,and the relationship between these progenitor cells and the development of atherosclerosis,thus provide a new idea for the prevention of the atherosclerosis.

Hip arthrograghy is a valuable procedure for visualization of the intrinsic obstructive factors impeding closed reduction and for critical assessment of quality of reduction in developmental dislocation of the hip. The authors have analyzed 25 cases of developmentally dislocated hips in 24 patients who have been followed up for more than 1 year postoperatively by roentgenographies and arthrographies. Among them 16 cases in 16 patients who had been treated by closed reduction according to acceptable quality of initial reduction were studied to estimate a value of arthrography and to evaluate an outcome of closed rediction performed on the base of an arthrographic finding. The following results were obtained. 1. The frequency of the common arthrographic observations were assessed. Medial dye columns identifying the depth of reduction were observed 25 cases(100%), configuration of osteocartilaginous structures in 24 cases(96.0%), limbus in 24 cases(96.0%), and ligamentum teres in 18cases(75.0%). 2. Good closed reduction classified according to Race and Herring on initial arthrography was associated with rapid improvement of acetabular angle and the CE angle and low incidence of avascular necrosis, compared with adequate or poor reduction. 3. In cases of initial good and adequate reductions, initial AP arthrograms showed some dye filling shadows owing to folding or redundancy of lax joint capsule of the dislocated hip after reduction just lateral to the limbus, of which finding decreased markedly on the second arthrograms. 4. The widths of medial dye column decreased with time during the first postoperative 7 weeks by an average of 0.5mm in cases with initial good quality of reduction, 3.5mm in adequate reductions and 0.5mm in poor reductions. 5. In cases with adequate closed reduction on initial arthrogram, but without substantial decrease in width of medial dye column on the second arthogram the outcome was poor. In those cases with decrease in width of medial dye column on the second arthrogram compared with initial arthogram, the shorter the period of immobilization in a plaster cast was, the worse eventual result was. 6. We think that hip arthography is a helpful procedure for visualization of obstacle obstructing closed reduction and for determination of treatment modality in developmental dislocation of the hip.
Acetabulum ; Arthrography ; Casts, Surgical ; Continental Population Groups ; Dislocations ; Hip ; Humans ; Immobilization ; Incidence ; Joint Capsule ; Necrosis ; Round Ligaments

No abstract available.
Nail-Patella Syndrome*

OBJECTIVES: Several studies suggest that nocturia may be related to obstructive sleep apnea syndrome (OSAS). The mechanism by which OSAS develops nocturia has not been determined. The present study aimed to determine the prevalence of nocturia among adults with OSAS and to identify factors that may be predictive in this regard. METHODS: Retrospective review of clinical and polysomnographic data obtained from patients evaluated at the sleep clinics of the St. Paul's Hospital between 2009 and 2012. The urinary symptoms were assessed on the basis of the International Prostate Symptom Score (IPSS). Pathologic nocturia was defined as two or more urination events per night. OSAS was defined as apnea-hypopnea index (AHI) > or =5. A multivariate analysis using logistic regression was performed to examine the relationship between polysomnographic variables and the presence of pathologic nocturia, while controlling for confounding factor. RESULTS: A total of 161 men >18 years of age (mean age 46.7+/-14.1), who had been referred to a sleep laboratory, were included in the present study. Among these, 27 patients with primary snoring and 134 patients with obstructive sleep apnea were confirmed by polysomnography. Nocturia was found in 53 patients with OSAS (39.6%) and 8 patients with primary snoring (29.6%). The AHI was higher in patients with nocturia than in those without nocturia (p=0.001). OSAS patients with nocturia had higher arousal index (p=0.044), and lower nadir oxyhemoglobin saturation (p=0.001). Multiple regression analysis showed that age (beta=0.227, p=0.003), and AHI (beta=0.258, p=0.001) were associated with nocturia, and that the presence of pathologic nocturia was predicted by age (OR 1.04 ; p=0.004) and AHI (OR 1.02 ; p=0.001). CONCLUSION: Nocturia is common among patients with OSAS. The strongest predictors of nocturia are age and AHI in patients with OSAS.
Adult ; Arousal ; Humans ; Logistic Models ; Male ; Multivariate Analysis ; Nocturia* ; Oxyhemoglobins ; Polysomnography ; Prevalence* ; Prostate ; Retrospective Studies ; Sleep Apnea, Obstructive* ; Snoring ; Urination

BACKGROUND: With the rapid growth of the elderly population, osteoporosis has become a major health problem worldwide. Although health knowledge and self-efficacy are important assets to facilitate healthy behaviors and disease prevention, such information as it relates to individuals and their bone health is limited. The purpose of this study was to assess the levels of knowledge, self-efficacy, and health behaviors on promoting bone health in middle-aged Korean women. METHODS: This is a cross-sectional survey study. A convenience sampling of middle-aged women (> or =40 years) was done at a community health center in Korea. Bone mineral density was measured by dual energy X-ray absorptiometry with the DEXXUM T. The level of knowledge was measured with the Knowledge of Osteoporosis Scale, and self-efficacy with the Osteoporosis Self-efficacy Scale. A questionnaire for bone health behaviors was developed for this study. Collected data were analyzed through descriptive methods, independent t-test, analysis of variance, and Pearson's correlation analysis. RESULTS: A total of 150 middle-aged women whose mean age was 59.8+/-11.5 years participated in the study. Most (74%) were menopausal. Less than one-quarter of participants (22.7%) had osteoporosis and less than half (42%) had osteopenia based on the T-score at the left femur neck site. Level of knowledge (mean score, 10.35) and self-efficacy (mean score, 47.67) ranged from low to moderate. Intake of calcium and vitamin D-rich foods was insufficient in our subjects. Bone health behaviors had significant positive relationships with knowledge (r=0.22, P=0.008) and self-efficacy (r=0.29, P<0.001) on promoting bone health. CONCLUSIONS: These results indicate that educational interventions are needed to enhance knowledge and confidence and to encourage middle-aged women to engage in bone health behaviors.
Absorptiometry, Photon ; Aged ; Bone Density ; Bone Diseases, Metabolic ; Calcium ; Community Health Centers ; Cross-Sectional Studies ; Female ; Femur Neck ; Health Behavior ; Humans ; Korea ; Middle Aged ; Osteoporosis ; Self Efficacy ; Vitamins

OBJECTIVETo explore the effects of nano-hydroxyapatite/polyamide 66 (n-HA/PA66) cage on recovering and maintaining lumbar curvature, lumbar heights and fusion rate when used in the transforaminal lumbar interbody fusion.

METHODSFrom February to July 2012, 50 patients with degenerative lumbar disease(lumbar disc herniation in 32 cases and lumbar spondylolisthesis in 18 cases) were treated with transforaminal lumbar interbody fusion using the n-HA/PA66 cage, and their preoperative and postoperative clinical outcomes were analyzed. The patients were followed up for 2, 4, 6 and 8 months after operation, during which the CR and CT film of lumbar vertebra were checked to get relative height of vertebral space, Taillard index,index of lumbar spinal curvature,angle of segmental and full lumbar lordosis. The data were analyzed respectively with pair t-test, analysis of variance or LSD-t-test.

RESULTSAll the patients were followed up, and the duraion ranged from 8 to 13 months, with a mean of 11.32 months. There were significant differences in relative height of vertebral space, Taillard index, index of lumbar spinal curvature, angle of segmental and full lumbar lordosis after surgery, but there were no significant differences in different periods after operation. The fusion time of lumbar ranged from 4 to 8 months.

CONCLUSIONThe n-HA/PA66 cage can recover and maintain lumbar normal stability with higher rate of fusion and less complications.

Adult ; Durapatite ; administration & dosage ; Female ; Humans ; Intervertebral Disc Displacement ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Nylons ; Spinal Fusion ; adverse effects ; instrumentation ; methods ; Spondylolisthesis ; surgery ; Tomography, X-Ray Computed

OBJECTIVETo analyze the reasons why anterior decompression and titanium mesh fusion for cervical spondylosis always show poor therapeutic effects, and to investigate the clinical effects of anterior revision surgery in these patients.

METHODSFrom January 2004 to December 2011, 16 patients underwent anterior decompression and titanium mesh fusion for cervical myelopathy were treated with anterior revision surgery. There were 7 males and 9 females with an average age of 61 years old (ranged from 46 to 75 years), including 11 cases with cervical spondylotic myelopathy, 2 cases with nerve root cervical spondylosis and 3 cases with mixed type cervical spondylosis. Average duration from the first operation to reoperation was 7 years(ranged from 4 to 12 years). In the first operation, titanium mesh segment located in C3-C5 (2 cases), C4-C6 (8 cases), C4-C7 (2 cases), C5-C7 (4 cases), and one of them, titanium mesh implantation in C4 and C5,6 intervertebral disk removal and cage fusion. After the first operation, symptom of 13 patients recurred after improvement or disappearance, 2 patients did not show obvious improvement, and 1 patient aggravated. Cervical spine radiography, CT scan and MRI were performed in all patients before re-operation. There were 12 patients with compression of the spinal cord or nerve root caused by degenerative changes in adjacent segments of fusion segments, 4 cases in upper segments, and 8 cases in lower segments; 3 patients with compression of the spinal cord or nerve root caused by vertebral posterior osteophyte of decompressed segments; 1 patient with compression of the spinal cord caused by incomplete anterior decompression. JOA, NDI and Odom classification were used to assess the clinical effects.

RESULTSAll anterior revision surgery were successful with a mean time of 110 min (80 to 150 min) and mean bleeding of 160 ml (30 to 200 ml). There was 30 ml clear drainage fluid in 1 patient suspected of cerebrospinal fluid leakage. But the 2nd day after operation, the tube was removed and the drainage opening was sutured, and the suture incision healed in grade A after 10 days. Other patients had no complications such as dysdipsia, hoarseness, and laryngeal edema, etc. All patients were followed up for 12 to 28 months with an average of 16 months. Two months after operation and at last follow-up, JOA scores and ODI index had obviously improved than preoperation (P < 0.01), and there was significant difference between postoperative 2 months and last follow-up (P < 0.01). At the final follow-up, improvement rate of JOA was (72.9 +/- 0.2)%. According to the standard of Odom, 12 cases got excellent results, 3 good, 1 fair.

CONCLUSIONAfter surgery of cervical decompression and bone graft fusion with titanium mesh, the patients need re-operation because of incomplete decompression, degenerative changes in adjacent segments or newly formed compression factors, and complications caused by implants. Anterior revision surgery can obtain good clinical effects.

Aged ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; methods ; Female ; Humans ; Male ; Middle Aged ; Reoperation ; Spinal Fusion ; methods ; Spondylosis ; surgery ; Surgical Mesh ; Titanium