Objective:This study evaluates the agreement between a new low-load sleep monitoring system, QSA600, based on millimeter-wave radar technology, and polysomnography (PSG) in diagnosing obstructive sleep apnea (OSA).Methods:A total of 155 subjects were recruited for a parallel agreement study in the sleep laboratory of the Department of Otorhinolaryngology Head and Neck Surgery at Shanghai Sixth People′s Hospital from July to September 2023. The subjects underwent simultaneous monitoring with both PSG and the QSA600 system. One hundred and forty-five subjects consisting of 75 males and 70 females included in the final analysis, with an average age of (35.30±12.41) years, an average height of (168.23±8.08) cm, and an average weight of (68.28±13.74) kg. The subjects were divided into four groups based on the apnea-hypopnea index (AHI): <5.0 events/h (non-OSA group, 39 cases), ≥5.0-<15.0 events/h (mild OSA group, 47 cases), ≥15.0-<30.0 events/h (moderate OSA group, 25 cases), and≥30.0 events/h (severe OSA group, 34 cases). Intraclass correlation coefficients (ICC), Pearson correlation coefficients ( r), and Bland-Altman analysis were employed to assess the agreement between the two monitoring techniques regarding AHI and other parameters. Sensitivity and specificity of the QSA600 in diagnosing OSA were evaluated at different AHI thresholds. Statistical analyses were conducted using MATLAB R2022a. Results:Using AHI 5 events/h, 15 events/h and 30 events/h as thresholds, the sensitivity for diagnosing mild, moderate, and severe OSA was 88.68%, 89.83% and 97.06%, respectively. The specificity was 94.87%, 98.84% and 99.10%, respectively. The areas under the receiver operating characteristic (ROC) curve was 0.973 4, 0.990 9 and 0.999 5, respectively. The comparison of key indicators between QSA600 and PSG diagnostic results revealed:a Pearson correlation coefficient of 0.987 2( P<0.001) between the AHI measurement values. The mean difference between the Bland-Altman measurement values of the two was -1.43(95% CI:-8.74-5.88) events/h and the ICC between the two was 0.985 0(95% CI: 0.975 4-0.990 4). Conclusions:As a new low-load sleep monitoring system, QSA600 demonstrates high concordance with traditional PSG in diagnosing OSA and stratifying its severity, which has promising potential for clinical application. (Clinical trial registration number: NCT06038006)

Objective·To evaluate the quality of clinical practice guidelines of obstructive sleep apnea(OSA)published worldwide.Methods·The guidelines of OSA were retrieved in PubMed,Embase,China National Knowledge Infrastructure(CNKI),Wanfang Data,SinoMed,MedSci,The Cochrane Library,and the websites such as Medlive,U.S.Preventive Services Task Force(USPSTF),National Institute for Health and Care Excellence(NICE),New Zealand Guidelines Group(NZGG),Scottish Intercollegiate Guidelines Network(SIGN),and Guidelines International Network(GIN)from establishment to December 2022.Two reviewers screened the literature and extracted the main information independently,using the Appraisal of Guidelines for Research and Evaluation Ⅱ(AGREE Ⅱ)and Reporting Items for Practice Guidelines in Healthcare(RIGHT)to evaluate the quality of the included OSA guidelines.Subgroup analysis was performed according to the publication regions of guidelines.The inter-evaluator consistency test was also performed and the results were expressed as the intra-class correlation coefficient(ICC).All the included guidelines were read entirely and the clinical questions they raised were summarized.Results·A total of 35 OSA guidelines were included.The ICC value of 0.975 showed a good inter-evaluator agreement.The results of AGREE Ⅱ showed that the average score of all guidelines was(63.60±16.45)%,with a minimum of 23.40%and a maximum of 91.67%.In the six domains,the scores of"Rigor of development"[(56.07±25.89)%]and"Applicability"[(53.57±15.52)%]were relative low.The average reporting rate of RIGHT of all the included guidelines was(67.84±20.03)%,with a minimum of 14.29%and a maximum of 94.29%,and the three domains with the lowest reporting rates were"Review and quality assurance"[(31.40±45.51)%],"Funding and conflict of interest declaration and management"[(56.43±33.95)%]and"Other aspects"[(56.19±36.85)%].Subgroup analysis showed that guidelines in Asian had a lower score in"Rigor of development"and a lower overall score of AGREE Ⅱ than the guidelines in America and Europe(both P<0.05),and the reporting rates in the domains of"Evidence"and"Other information"of RIGHT of the Asian guidelines were also lower than those in the guidelines in America and Europe(P<0.05).These guidelines focused on 42 clinical questions which were classified to 3 aspects,i.e.screening and diagnosis,treatment and long-term management of OSA.Conclusion·The quality of current global OSA guidelines varies a lot,and they need to be strengthened in terms of rigor of development,applicability,review and quality assurance,funding and conflict of interest declaration and management,especially those in Asia.

Objective:To explore the causal relationship between vascular endothelial growth factor A (VEGF-A) and inflammatory bowel disease (IBD) using two-sample unidirectional Mendelian randomization (MR) analysis.Methods:Datasets based on genome-wide association studies (GWAS) of 91 inflammation-related proteins and GWAS datasets related to IBD were collected from the UK Biobank and the IEU OpenGWAS Project. With VEGF-A as the exposure factor, single nucleotide polymorphisms (SNP) associated with IBD were screened as genetic instrumental variables. The inverse variance weighted (IVW) approach served as the primary method in the two-sample unidirectional MR analysis was used to examine the potential causal link between VEGF-A and IBD. Cochran's Q test was utilized to detect potential heterogeneity, while the MR-PRESSO method and MR-Egger intercept test were employed to assess horizontal pleiotropy. A leave-one-out analysis was conducted to evaluate the sensitivity of the results. Results:GWAS data were sourced from the UK Biobank and the IEU OpenGWAS Project databases, including a total of 4 355 UC patients and 2 128 CD patients. The IVW results suggested that VEGF-A may play a protective role in the onset of UC after Bonferroni correction ( OR = 0.9993, 95% CI: 0.9985~0.99997, P = 0.0421; OR = 0.9991, 95% CI: 0.9984~0.9998, P = 0.0095), while no evidence of causal relationship with CD was found ( P = 0.5024, P = 0.3150). Subsequent meta-analysis of the MR results indicated that VEGF-A was a protective factor for UC ( OR = 0.9992, 95% CI: 0.9987~0.9997, P = 0.0011), while no causal association with CD was found ( OR = 1.0000, 95% CI: 0.9997~1.0004, P = 0.8352). The results of Cochran's Q test indicated no heterogeneity, the MR-Egger intercept suggested no horizontal pleiotropy, the MR-PRESSO outlier test detected no outliers, and the leave-one-out sensitivity analysis revealed no abnormal SNP, indicating that the causal inference from the Mendelian randomization analysis had a certain level of reliability. Conclusion:Mendelian randomization analysis indicates causal relationship between VEGF-A and reduced risk of UC, but no causal relationship is found between VEGF-A and CD.

Objective:To explore the causal relationship between vascular endothelial growth factor A (VEGF-A) and inflammatory bowel disease (IBD) using two-sample unidirectional Mendelian randomization (MR) analysis.Methods:Datasets based on genome-wide association studies (GWAS) of 91 inflammation-related proteins and GWAS datasets related to IBD were collected from the UK Biobank and the IEU OpenGWAS Project. With VEGF-A as the exposure factor, single nucleotide polymorphisms (SNP) associated with IBD were screened as genetic instrumental variables. The inverse variance weighted (IVW) approach served as the primary method in the two-sample unidirectional MR analysis was used to examine the potential causal link between VEGF-A and IBD. Cochran's Q test was utilized to detect potential heterogeneity, while the MR-PRESSO method and MR-Egger intercept test were employed to assess horizontal pleiotropy. A leave-one-out analysis was conducted to evaluate the sensitivity of the results. Results:GWAS data were sourced from the UK Biobank and the IEU OpenGWAS Project databases, including a total of 4 355 UC patients and 2 128 CD patients. The IVW results suggested that VEGF-A may play a protective role in the onset of UC after Bonferroni correction ( OR = 0.9993, 95% CI: 0.9985~0.99997, P = 0.0421; OR = 0.9991, 95% CI: 0.9984~0.9998, P = 0.0095), while no evidence of causal relationship with CD was found ( P = 0.5024, P = 0.3150). Subsequent meta-analysis of the MR results indicated that VEGF-A was a protective factor for UC ( OR = 0.9992, 95% CI: 0.9987~0.9997, P = 0.0011), while no causal association with CD was found ( OR = 1.0000, 95% CI: 0.9997~1.0004, P = 0.8352). The results of Cochran's Q test indicated no heterogeneity, the MR-Egger intercept suggested no horizontal pleiotropy, the MR-PRESSO outlier test detected no outliers, and the leave-one-out sensitivity analysis revealed no abnormal SNP, indicating that the causal inference from the Mendelian randomization analysis had a certain level of reliability. Conclusion:Mendelian randomization analysis indicates causal relationship between VEGF-A and reduced risk of UC, but no causal relationship is found between VEGF-A and CD.

Background:Ulcerative colitis(UC)is a chronic non-specific disease with potential for disability,and clinical treatment mainly relies on drugs.Currently,small molecule drugs(SMDs)have shown good application prospects.Aims:To evaluate the efficacy and safety of SMDs in the treatment of UC.Methods:Randomized controlled trials(RCTs)of SMDs in treatment of moderate-to-severe UC from CNKI,Wanfang Data,VIP,China Biomedical Literature Database,PubMed,Cochrane Library and Embase were searched from the establishment of the database to March 2024.References were screened and data extracted according to inclusion and exclusion criteria,and meta-analysis was performed using RevMan 5.3 software.Results:A total of 16 literatures involving 22 RCTs were finally included.Meta-analysis results suggested that SMDs had better efficacy indicators than placebo,such as clinical response rate(RR=1.86,95%CI:1.60-2.16,P<0.000 01),clinical remission rate(RR=3.01,95%CI:2.17-4.16,P<0.000 01),mucosal healing rate(RR=2.93,95%CI:2.27-3.79,P<0.000 01)and maintained response rate(RR=3.87,95%CI:3.11-4.81,P<0.000 01)were improved,and there was a statistical difference between them.And in terms of safety,SMDs compared to placebos,The incidence of adverse reactions(RR=1.02,95%CI:0.96-1.08,P=0.55),the incidence of serious adverse reactions(RR=0.77,95%CI:0.59-1.00,P=0.05),and the incidence of adverse reactions leading to drug withdrawal(RR=0.78,95%CI:0.59-1.02,P=0.07)were not statistically significant.Conclusions:SMDs are effective and safe in UC patients,which provides a new idea for the treatment of UC.

Background:Ulcerative colitis(UC)is a chronic non-specific disease with potential for disability,and clinical treatment mainly relies on drugs.Currently,small molecule drugs(SMDs)have shown good application prospects.Aims:To evaluate the efficacy and safety of SMDs in the treatment of UC.Methods:Randomized controlled trials(RCTs)of SMDs in treatment of moderate-to-severe UC from CNKI,Wanfang Data,VIP,China Biomedical Literature Database,PubMed,Cochrane Library and Embase were searched from the establishment of the database to March 2024.References were screened and data extracted according to inclusion and exclusion criteria,and meta-analysis was performed using RevMan 5.3 software.Results:A total of 16 literatures involving 22 RCTs were finally included.Meta-analysis results suggested that SMDs had better efficacy indicators than placebo,such as clinical response rate(RR=1.86,95%CI:1.60-2.16,P<0.000 01),clinical remission rate(RR=3.01,95%CI:2.17-4.16,P<0.000 01),mucosal healing rate(RR=2.93,95%CI:2.27-3.79,P<0.000 01)and maintained response rate(RR=3.87,95%CI:3.11-4.81,P<0.000 01)were improved,and there was a statistical difference between them.And in terms of safety,SMDs compared to placebos,The incidence of adverse reactions(RR=1.02,95%CI:0.96-1.08,P=0.55),the incidence of serious adverse reactions(RR=0.77,95%CI:0.59-1.00,P=0.05),and the incidence of adverse reactions leading to drug withdrawal(RR=0.78,95%CI:0.59-1.02,P=0.07)were not statistically significant.Conclusions:SMDs are effective and safe in UC patients,which provides a new idea for the treatment of UC.

Objective:To explore the effectiveness and safety of robot-aided percutaneous anterior column screw combined with posterior plate fixtation treatment for transverse acetabular fractures with posterior wall.Methods:A retrospective analysis was conducted on the data of 13 patients with transverse acetabular fractures and posterior wall fractures treated by robot-aided percutaneous anterior column screws combined with posterior plate in Tianjin Hospital from May 2016 to May 2021. There were 9 males and 4 females, aged 49.1±8.5 years (range, 25-65 years), 9 cases of vehicle accidents, 2 cases of falling injuries, 2 cases of impact injuries, 7 cases of combined posterior hip dislocations, and 1 case of sciatic nerve injury. Apply Kocher-Langenbeck approach for reduction and fixation of the posterior wall and the posterior column and indirect reduction of the anterior column. Use robot navigation for percutaneous anterior column screw fixation, and record the time of inserting anterior column screws, incision length, and complications. The quality of fracture reduction was evaluated using Matta imaging, and the degree of ectopic ossification was evaluated using Brooker classification. The Matta modified Postel Merle D'Aobigne score was used to evaluate the function at 3, 6 months after surgery and at the last follow-up.Results:All 13 patients successfully completed the surgery. The insertion time of the anterior column screw was 19.4±4.0 min (range, 17-23 min), and the incision length was 8.0±1.4 mm (range, 6-10 mm). Postoperative imaging examination showed that all anterior column screws were located within the bone canal, with a screw length of 108.3±11.2 mm (range, 90-130 mm), and no complications such as nerve or vascular injury or incision infection occurred. All 13 patients were followed up for a period of 12-36 months, with an average of 18.6 months; All fractures healed, with a healing time of 2-6 months, average 3.4 months. According to the Matta imaging evaluation method, 11 of 13 patients had anatomical reduction of fractures, and 2 were evaluated as incomplete reduction due to a 1-2 mm gap in the anterior column. The anatomical reduction rate was 84%. At postoperative 3, 6 months and the last follow-up, the modified Postel Merle D'Aobigne scores were 13.4±1.1, 15.8±1.5, and 17.0±1.7, respectively, with statistically significant differences ( F=7.78, P=0.007). The difference between the last follow-up and postoperative 3 months was statistically significant ( P=0.002), and there was no statistically significant difference compared to postoperative 6 months ( P=0.222). At the last follow-up, 8 cases were excellent, 4 cases were good, and 1 case was fair, with an excellent and good rate of 92%. There was no occurrence of ectopic ossification, traumatic arthritis, or necrosis of the femoral head. Conclusion:Robot-aided percutaneous anterior column screw combined with posterior plate treatment for transverse acetabular fractures with posterior wall is safe and effective, and is worthy of clinical promotion.

Background: Inflammatory bowel disease (IBD) is a chronic recurrent inflammatory disease of gastrointestinal tract including ulcerative colitis (UC) and Crohn's disease (CD). It is unclear whether there is a causal association between unsaturated fatty acids and IBD. Aims: A two⁃sample Mendelian randomization analysis was used to explore the causal association between unsaturated fatty acids and IBD. Methods: The data of the genome⁃wide association study (GWAS) of unsaturated fatty acids and IBD were obtained from web⁃based public databases. Two⁃sample Mendelian randomization analysis was performed by using inverse⁃variance weighted analysis, and weight median estimator and MR⁃Egger regression were conducted to validate the association of the causal effect. The causality of unsaturated fatty acids on the risk of IBD was evaluated by OR and 95% CI. Results: No direct causal association was found between ω⁃6 fatty acids and CD, and a direct causal association was found with UC. Inverse⁃variance weighted analysis showed a 16% increase in the risk of UC for each standard deviation increase in ω⁃6 fatty acid gene levels (OR=1.16, 95% CI: 1.00⁃1.36, P=0.04). However, no causal association was found between ω⁃3 fatty acids, monounsaturated fatty acids and IBD. Conclusions: ω⁃6 fatty acids may be only causally associated with UC, and no causal association is found between ω⁃3 fatty acids, monounsaturated fatty acids and IBD.

ObjectiveTo develop basic training courses for family doctor teams for people with disabilities. MethodsUtilizing the methods and theories of the World Health Organization (WHO) rehabilitation competency framework (RCF), and referring to the WHO universal health coverage global competency framework, the rehabilitation competency characteristics of family doctor teams for people with disabilities in community settings were analyzed, and a basic training course system for these teams based on the RCF was developed. Results and ConclusionBased on RCF, a competency framework for family doctor teams serving people with disabilities has been constructed. The objectives, content and training course system for basic rehabilitation training has been established.

OBJECTIVE Aimed to analyze the demographic,anthropometric,severity,and common comorbidities of individuals with suspected obstructive sleep apnea(OSA)referred to the OSA diagnosis and treatment center of the Sixth People's Hospital affiliated with Shanghai Jiao Tong University School of Medicine from 2012 to 2021.METHODS Data of subjects with suspected OSA who underwent polysomnography(PSG)from January 2012 to December 2021 were collected.Subjects were categorized into five groups based on the PSG study date with a two-year interval.Clinical characteristics trends were compared across groups,focusing on the comparison between 2020-2021 and 2018-2019 to explore changes after COVID-19 epidemic.RESULTS 1.A total of 5870 subjects were included from 2012 to 2019[age(43.2±12.7)years,21.7％females].OSA prevalence was 84.8％.Over the two-year intervals,age,female proportion,OSA severity,and other indicators showed no significant changes.Body mass index(median 26.8kg/m2 to 26.0kg/m2)and overweight rates(78.1％to 73.4％)decreased yearly,as did the proportions of subjects who smoked(38.1％to 27.8％)and consumed alcohol(13.5％to 6.4％).The prevalence of hypertension increased yearly(40.3％to 51.8％),while awareness rates gradually decreased(70.3％to 59.4％).Diabetes prevalence remained relatively stable(9.4％to 9.7％),with increased awareness(49.5％to 66.2％).Dyslipidemia prevalence remained high(76.7％to 78.3％),with low awareness rates(20.8％to 28.7％).2.A total of 805 subjects were included from 2020 to 2021.Compared with 2018-2019,the proportion of females decreased(14.9％vs.22.0％),and OSA severity increased(apnea-hypopnea index 40.4 times/h vs.29.2 times/h).Prevalence rates of hypertension,diabetes,dyslipidemia(47.1％,6.9％,62.1％)and awareness rates(52.4％,57.7％,17.8％)were lower than those from 2018-2019.3.Compared with subjects with known their comorbidities,unknown subjects had significantly higher levels of systolic blood pressure(141 mmHg vs.134 mmHg),diastolic blood pressure(93 mmHg vs.85 mmHg),fasting blood glucose(7.87 mmol/L vs.6.07 mmol/L),and low-density lipoprotein(3.08 mmol/L vs.2.91 mmol/L)(P＜0.05).CONCLUSION From 2012 to 2021,individuals with suspected OSA referred for PSG test showed a tendency toward younger age,lower proportion of females,fewer comorbidities,but increased OSA severity.The awareness rate of comorbidities needs improvement,emphasizing the importance of a multidisciplinary approach to the diagnosis and treatment of OSA.