At present, there is no effective drug treatment for obstructive sleep apnea hypopnea syndrome (OSAHS). It is usually treated by mechanical ventilation through a ventilator. In this paper, a non-invasive bi-level breathing therapy system suitable for home scenarios is developed. The system supports single-level and bi-level positive airway pressure therapies, and introduces the function of inspiratory synchronous trigger based on flow monitoring to enhance the synchrony of patient-ventilator synchronization. The test results show that the performance indicators of the system meet expectations. Each ventilation mode can operate normally and can meet the requirements for the use of home non-invasive ventilators.
Humans ; Sleep Apnea, Obstructive/therapy* ; Equipment Design ; Noninvasive Ventilation/instrumentation* ; Respiration, Artificial

OBJECTIVE To evaluate the cost-utility of ciclesonide （CIC） versus budesonide （BUD） for the maintenance treatment of mild to moderate bronchial asthma. METHODS From the perspective of Chinese health service system， a Markov model was established based on the data from a clinical trial in China and some literature. The cycle length was 1 week， the time horizon was 60 years. A discount rate of 5% per year was applied. Cost-utility analysis was performed on therapeutic scheme of CIC and BUD using three times of China’s per capita gross domestic product （GDP） in 2023 as the threshold of willing-to-pay （WTP）. One-way sensitivity analysis， probabilistic sensitivity analysis and scenario analysis were applied to test the uncertainty of basic analysis. RESULTS Compared with BUD scheme， the incremental cost of the CIC scheme was 9 401.67 yuan， and the incremental quality-adjusted life years（QALYs） were 0.001 3； incremental cost-effectiveness ratio （ICER） was 6 928 868.26 yuan/QALY， far beyond the threshold of WTP 268 074 yuan/QALY. One-way sensitivity analysis showed that the usage， dosage and unit price of CIC and BUD were parameters that had a significant impact on ICER； probabilistic sensitivity analysis showed that the basic analysis results were relatively robust； scenario analysis showed that， when the price of CIC reduced to 159.95 yuan/branch， the probability of CIC scheme having economics was similar to that of BUD scheme. CONCLUSIONS At the current price， CIC is not economical compared with BUD for the maintenance treatment of mild to moderate asthma， using three times of China’s GDP in 2023 as the threshold of WTP.

OBJECTIVE To evaluate the cost-utility of ciclesonide （CIC） versus budesonide （BUD） for the maintenance treatment of mild to moderate bronchial asthma. METHODS From the perspective of Chinese health service system， a Markov model was established based on the data from a clinical trial in China and some literature. The cycle length was 1 week， the time horizon was 60 years. A discount rate of 5% per year was applied. Cost-utility analysis was performed on therapeutic scheme of CIC and BUD using three times of China’s per capita gross domestic product （GDP） in 2023 as the threshold of willing-to-pay （WTP）. One-way sensitivity analysis， probabilistic sensitivity analysis and scenario analysis were applied to test the uncertainty of basic analysis. RESULTS Compared with BUD scheme， the incremental cost of the CIC scheme was 9 401.67 yuan， and the incremental quality-adjusted life years（QALYs） were 0.001 3； incremental cost-effectiveness ratio （ICER） was 6 928 868.26 yuan/QALY， far beyond the threshold of WTP 268 074 yuan/QALY. One-way sensitivity analysis showed that the usage， dosage and unit price of CIC and BUD were parameters that had a significant impact on ICER； probabilistic sensitivity analysis showed that the basic analysis results were relatively robust； scenario analysis showed that， when the price of CIC reduced to 159.95 yuan/branch， the probability of CIC scheme having economics was similar to that of BUD scheme. CONCLUSIONS At the current price， CIC is not economical compared with BUD for the maintenance treatment of mild to moderate asthma， using three times of China’s GDP in 2023 as the threshold of WTP.

Objective:To evaluate the clinical effect of orbital fat releasing and repositioning through supra-suborbicularis oculi fat (SOOF) in lower eyelid blepharoplasty.Methods:The authors retrospectively analyzed the clinical data of patients who received lower eyelid blepharoplasty in the Department of Plastic Surgery, Beijing Tsinghua Changgung Hospital from January 2017 to January 2023. Lower eyelid blepharoplasty with orbital fat releasing and repositioning through supra-SOOF was performed. The tear trough ligament and orbicularis retaining ligament were released between the orbicularis oculi muscle and SOOF via skin approach. Orbital septal fat was released to this space, lateral fat flap was fixed to the SOOF capsule, medial fat flap was fixed to the superficial fascia of the levator labii superioris muscle, orbital septum was repositioned, and lateral canthus was suspended. After the operation, lower eyelid morphology and complications were evaluated.Results:A total of 58 patients were enrolled, including 8 males and 50 females with the age of (49.8 ± 10.4) years (32 to 70 years). All patients had obvious lower eyelid bags on both sides, combining the tear trough deformity and (or) palabromalar groove. Fifty-seven patients were followed up for (29.1 ± 16.9) months (6-67 months). All patients were satisfied with the operation. The appearance of lower eyelid was greatly improved, with elimination of fat prominence and tear trough deformity. Mild lower eyelid ectropion was observed two cases 1 week after the operation, and were relieved by moderate massage 2 weeks postoperatively. In one case, mild lower eyelid retraction was observed 1 month postoperatively, with no complaint of discomfort or further treatments. Bulbar conjunctival hemorrhage occurred in 1 case and recovered without further interventions.Conclusion:Lower eyelid blepharoplasty with orbital fat releasing and reposting through supra-SOOF can effectively release the tear trough ligament and the orbicularis retaining ligament, with stronger fat fixation and less surgical difficulty. After the operation, eyelid contour was flat and tight with fewer complications and higher patient satisfaction.

A wireless wearable sleep monitoring system based on EEG signals is developed.The collected EEG signals are wirelessly sent to the PC or mobile phone Bluetooth APP for real-time display.The system is small in size,low in power consumption,and light in weight.It can be worn on the patient's forehead and is comfortable.It can be applied to home sleep monitoring scenarios and has good application value.The key performance indicators of the system are compared with the industry-related medical device measurement standards,and the measurement results are better than the special standards.

Objective To understand the molecular characteristics of rifampicin rpoB gene mutation site in patients with rifampin-resistant pulmonary tuberculosis (RR-TB) complicated with diabetes mellitus, and to explore whether the combination of diabetes mellitus affects rifampicin resistance-related gene mutation, providing data support for prevention and treatment of tuberculosis complicated with diabetes comorbidity. Methods A total of 170 patients with rifampicin-resistant pulmonary tuberculosis diagnosed by mycobacterium culture in sputum or alveolar lavage fluid and drug sensitivity test at the Second Affiliated Hospital of Hainan Medical University from 2022 to 2023 were selected. According to whether they were comorbid with diabetes, patients were divided into two groups: rifampicin-resistant tuberculosis without diabetes group (RR-TB; n=102) and rifampicin-resistant tuberculosis with diabetes group (RR-TB+DM; n=68). Rifampicin rpoB gene loci were detected in sputum or alveolar lavage fluid samples from all patients by microarray method, and the mutation characteristics of rifampicin resistance loci in the two groups were analyzed to explore the differences of drug resistance loci. Results The proportion of rifampicin resistance was higher in males, retreatment, smear positive and 40 to <60years old, but there was no statistically significant difference between the two groups (P>0.05); the proportion of patients aged 20 to <40 years in RR-TB+DM group (11.8%, 8/68) was significantly lower than that in the RR-TB+DM group (24.5%, 25/102) (χ2=4.237, P<0.05); the main mutation sites of the rpoB gene in both groups were 531, 526 and 511, but the mutation frequency of the sites was slightly different. The most common mutation sites in RR-TB+DM group were 531 (57.4%, 39/68), 526 (19.1%, 13/68), and 511 (8.9%, 6/68), whereas in the RR-TB group, they were 531 (51.9%, 53/102), 526 (18.6%, 19/102), and 511 (14.8%, 15/102), but there was no significant difference between the two groups (P>0.05). The mutation of 531 was mainly TCG→TTG. The 526 had four mutation types, with CAC→TAC being the main mutation type. The main mutation type of 526 in the RR-TB group was CAC→GAC, while there was no CAC→GAC mutation at 526 in the RR-TB+DM group, and the difference between the two groups was statistically significant (P<0.05). The 511 mutation was mainly CTG→CCG, but there was no significant difference between the two groups (P>0.05). Conclusions The mutation rate of RpoB 526CAC→GAC and the proportion of rifampin resistance in patients aged 20 to <40 years are significantly lower in pulmonary tuberculosis with diabetes than in simple pulmonary tuberculosis, suggesting that diabetes may affect the gene mutation at this site.

Objective:To analyze the clinical and genetic characteristics of a family of cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL) caused by a new locus of HTRA1 mutation. Methods:The medical history and clinical data of a patient with CARASIL were collected, and genetic test was performed on some family members to observe the HTRA1 mutation. Results:The proband presented with cognitive impairment, suspicious lumbar lesions, and alopecia. Cranial imaging revealed extensive blank brain lesions and multiple microbleeding foci. The mother of the proband had psychiatric symptoms and stroke once, and the sixth younger sister had history of dementia and hypertension. Genetic test revealed that the proband and his two sons carried HTRA1 heterogenic mutation c.888C>G (p.I296M), and the two sons had alopecia. Conclusion:The c.888C>G(p.I296M) may be a new pathogenic mutation site of CARASIL.

Objective:To evaluate the clinical effect of orbital fat releasing and repositioning through supra-suborbicularis oculi fat (SOOF) in lower eyelid blepharoplasty.Methods:The authors retrospectively analyzed the clinical data of patients who received lower eyelid blepharoplasty in the Department of Plastic Surgery, Beijing Tsinghua Changgung Hospital from January 2017 to January 2023. Lower eyelid blepharoplasty with orbital fat releasing and repositioning through supra-SOOF was performed. The tear trough ligament and orbicularis retaining ligament were released between the orbicularis oculi muscle and SOOF via skin approach. Orbital septal fat was released to this space, lateral fat flap was fixed to the SOOF capsule, medial fat flap was fixed to the superficial fascia of the levator labii superioris muscle, orbital septum was repositioned, and lateral canthus was suspended. After the operation, lower eyelid morphology and complications were evaluated.Results:A total of 58 patients were enrolled, including 8 males and 50 females with the age of (49.8 ± 10.4) years (32 to 70 years). All patients had obvious lower eyelid bags on both sides, combining the tear trough deformity and (or) palabromalar groove. Fifty-seven patients were followed up for (29.1 ± 16.9) months (6-67 months). All patients were satisfied with the operation. The appearance of lower eyelid was greatly improved, with elimination of fat prominence and tear trough deformity. Mild lower eyelid ectropion was observed two cases 1 week after the operation, and were relieved by moderate massage 2 weeks postoperatively. In one case, mild lower eyelid retraction was observed 1 month postoperatively, with no complaint of discomfort or further treatments. Bulbar conjunctival hemorrhage occurred in 1 case and recovered without further interventions.Conclusion:Lower eyelid blepharoplasty with orbital fat releasing and reposting through supra-SOOF can effectively release the tear trough ligament and the orbicularis retaining ligament, with stronger fat fixation and less surgical difficulty. After the operation, eyelid contour was flat and tight with fewer complications and higher patient satisfaction.

Objective To investigate the current status of liver and gallbladder diseases and analyze the influencing factors of fatty liver based on the ultrasound examination results of officers and soldiers on a certain island.Methods The data of physical examination from 377 officers and soldiers on a certain island in 2021 were retrospectively analyzed.Age,gender,living habits,abdominal ultrasound results,and liver function test results were collected,and the incidence of liver and gallbladder diseases were investigated.Univariate and multivariate logistic regression analyses were used to screen the influencing factors of fatty liver disease.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of influencing factors for fatty liver disease.Results A total of 103 officers and soldiers were diagnosed with liver and gallbladder diseases.The top three were fatty liver(63.11%,65/103),gallbladder polyps(19.42%,20/103),and liver hemangioma(8.74%,9/103),accounting for 91.27%(94/103)of the subjects with liver and gallbladder diseases and 24.93%(94/377)of all the subjects undergoing physical examination.There were significant differences in the age,body mass index(BMI),the habit of mid night snacks,liver function indexes(alanine aminotransferase[ALT],aspartate aminotransferase[AST],total bilirubin[T-Bil],direct bilirubin[D-Bil],gamma-glutamyltransferase[γ-GT]),glucose(Glu),and triglyceride(TG)between the officers and soldiers with fatty liver(65 cases)and without fatty liver(312 cases)(all P<0.01).Multivariate logistic regression analysis showed that ALT,Glu,TG,BMI and the habit of midnight snacks were independent influencing factors of fatty liver(all P<0.05).The area under the ROC curve values of ALT,Glu,TG,BMI,the habit of midnight snacks and their combination in prediction of fatty liver were 0.776,0.621,0.764,0.828,0.637 and 0.866,respectively.Conclusion There is a high prevalence of fatty liver in officers and soldiers on a certain island(17.24%,65/377).ALT,Glu,TG,BMI and the habit of midnight snack can be used as a combined diagnostic model of fatty liver.The diet,exercise and training methods should be systematically and comprehensively managed to control related risk factors.Risk factor intervention and treatment should be carried out for high-risk population to effectively improve the physical and mental health of officers and soldiers on the island.

To explore the pathogenesis and treatment of recurrent granulomatous mastitis based on "deficiency， toxin and blood stasis". It is believed that the main pathogenesis of recurrent granulomatous mastitis is spleen and stomach deficiency due to chronic illness， and at the same time， the persistent or intermittent presence of various causes makes the residual toxin unclear， which leads to the stagnation of local meridians and collaterals in the breast， accumulation of lumps， and then suppuration. Deficiency of qi and blood in zang-fu organs is the main cause of this disease， and residual toxin is the key factor of this disease. The treatment should focus on promoting therapy， promoting with dispersing， expelling with supplementing， supplementing with warming and dredging， dissolving toxins and releasing stasis， and the prescription is based on modified Tuoli Xiaodu Powder （托里消毒散） or self-prescribed Jiangru No.2 Formula （浆乳2号方）. Overall， the treatment should combine deficiency， toxin and blood stasis with different syndrome differentiation and treatment， reinforce healthy qi and express toxin， and activate blood circulation and dredge collaterals with flexibly modification， to promote disease healing.