Objective:To analyze and summarize the characteristics and rules of upper airway computerized tomography (CT) in obstructive sleep apnea (OSA) patients with epiglottic collapse.Methods:As a cross-sectional study, OSA patients (all were male, aged 18 to 60) who received Han-uvulopalatopharyngoplasty (H-UPPP) surgery at Second Affiliated Hospital of Zhejiang University School of Medicine from April 2023 to February 2024 were continuously selected. All patients underwent physical examination, polysomnography (PSG) and three-dimensional CT plain scan of upper airway before surgery. Preoperative drug-induced sleep endoscopy (DISE) was performed on the day of surgery. According to the findings of DISE, all patients were divided into two groups: epiglottic collapse group and non-epiglottic collapse group. The relevant data were collected, and the measured data included epiglottic length, epiglottic width, epiglottic curvature, epiglottic angle, distance between epiglottis and posterior pharyngeal wall, distance between epiglottis and tongue base, angle between epiglottis and tongue base, the lymph tissue classification of the tongue base, airway length, mandibular - hyoid bone distance, soft palate length and soft palate - hard palate Angle. Statistical analysis was performed using SPSS 25.0.Results:There were a total of 104 patients with OSA, consisting of 27 patients with epiglottic collapse and 77 patients with non-epiglottic collapse. In this study, the incidence of epiglottic collapse was 25.96%. There were no significant differences in apnea hyponea index (AHI), minimum blood oxygen saturation and the time ratio of blood oxygen saturation below 90% (TS90) between the two groups (all P>0.05). Compared with the non-epiglottic collapse group, the epiglottic length [(19.77±2.42)mm vs. (18.54±2.62)mm, t=2.162, P=0.033] and the lymph tissue classification of the tongue base [4(1,4) vs.2(1,3), Z=-2.968, P=0.003] in the epiglottic collapse group increased. Distance between epiglottis and tongue base reduced [2.70(0,5.88) mm vs. 5.45(2.15,6.98)mm, Z=-2.385, P=0.017]. According to Logistic regression analysis, epiglottic collapse and epiglottic width ( OR: 1.201; 95% CI: 1.009-1.430, P=0.039) were positively correlated, epiglottic curvature ( OR: 0.979; 95% CI: 0.961-0.998, P=0.030) was negatively correlated, and with the grade of lymph tissue of tongue root ( OR: 1.936; 95% CI: 1.294-2.896, P=0.001) was positively correlated. Conclusion:CT examination in awake OSA patients with epiglottic collapse can reveal its characteristic indicators. The wider the epiglottic width, the smaller the epiglottic curvature, and the larger the lymph tissue grade of the base of tongue were effective predictors of epiglottic collapse.

Objective:To analyze and summarize the characteristics and rules of upper airway computerized tomography (CT) in obstructive sleep apnea (OSA) patients with epiglottic collapse.Methods:As a cross-sectional study, OSA patients (all were male, aged 18 to 60) who received Han-uvulopalatopharyngoplasty (H-UPPP) surgery at Second Affiliated Hospital of Zhejiang University School of Medicine from April 2023 to February 2024 were continuously selected. All patients underwent physical examination, polysomnography (PSG) and three-dimensional CT plain scan of upper airway before surgery. Preoperative drug-induced sleep endoscopy (DISE) was performed on the day of surgery. According to the findings of DISE, all patients were divided into two groups: epiglottic collapse group and non-epiglottic collapse group. The relevant data were collected, and the measured data included epiglottic length, epiglottic width, epiglottic curvature, epiglottic angle, distance between epiglottis and posterior pharyngeal wall, distance between epiglottis and tongue base, angle between epiglottis and tongue base, the lymph tissue classification of the tongue base, airway length, mandibular - hyoid bone distance, soft palate length and soft palate - hard palate Angle. Statistical analysis was performed using SPSS 25.0.Results:There were a total of 104 patients with OSA, consisting of 27 patients with epiglottic collapse and 77 patients with non-epiglottic collapse. In this study, the incidence of epiglottic collapse was 25.96%. There were no significant differences in apnea hyponea index (AHI), minimum blood oxygen saturation and the time ratio of blood oxygen saturation below 90% (TS90) between the two groups (all P>0.05). Compared with the non-epiglottic collapse group, the epiglottic length [(19.77±2.42)mm vs. (18.54±2.62)mm, t=2.162, P=0.033] and the lymph tissue classification of the tongue base [4(1,4) vs.2(1,3), Z=-2.968, P=0.003] in the epiglottic collapse group increased. Distance between epiglottis and tongue base reduced [2.70(0,5.88) mm vs. 5.45(2.15,6.98)mm, Z=-2.385, P=0.017]. According to Logistic regression analysis, epiglottic collapse and epiglottic width ( OR: 1.201; 95% CI: 1.009-1.430, P=0.039) were positively correlated, epiglottic curvature ( OR: 0.979; 95% CI: 0.961-0.998, P=0.030) was negatively correlated, and with the grade of lymph tissue of tongue root ( OR: 1.936; 95% CI: 1.294-2.896, P=0.001) was positively correlated. Conclusion:CT examination in awake OSA patients with epiglottic collapse can reveal its characteristic indicators. The wider the epiglottic width, the smaller the epiglottic curvature, and the larger the lymph tissue grade of the base of tongue were effective predictors of epiglottic collapse.

Objective To explore the changes of serum thyroid peroxidase antibody (TPOAb), thyroglobulin (Tg), and anti-thyroglobulin antibody (Tg-Ab) in patients with gestational thyroid dysfunction and their relationship with pregnancy outcomes. Methods The clinical data were collected from 98 patients with gestational thyroid dysfunction in Nanchong Mental and Physical Hospital between January 2020 and December 2022. According to disease types, patients were divided into hyperthyroidism group (n=50) and hypothyroidism group (n=48). A total of 100 pregnant women with normal thyroid function during the same period were enrolled as the healthy group. The levels of serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroid hormone (FT4), TPOAb, Tg and Tg-Ab, and maternal and neonatal outcomes were compared among the three groups. According to maternal and neonatal outcomes, patients with gestational thyroid dysfunction were divided into normal pregnancy group (n=68) and adverse pregnancy group (n=30), and levels of serum TPOAb, Tg and Tg-Ab were compared between the two groups. Results Compared with the healthy group, level of serum TSH was decreased in the hyperthyroidism group (P<0.05), while levels of serum FT3, FT4, Tg, Tg-Ab and TPOAb were increased (P<0.05). Compared with the healthy group, levels of serum FT3 and FT4 were decreased in the hypothyroidism group (P<0.05), while levels of serum TSH, TPOAb, Tg and Tg-Ab were increased (P<0.05). The level of serum TSH in the hyperthyroidism group was lower than that in the hypothyroidism group (P<0.05), while levels of serum FT3, FT4, Tg, Tg-Ab and TPOAb were higher than those in the hypothyroidism group (P<0.05). There was no significant difference in the overall incidence of adverse pregnancy outcomes between the hyperthyroidism group and the hypothyroidism group (34.00% vs 27.08%, P>0.05), but the overall adverse pregnancy outcome rate in the two groups was higher than that in the healthy group (9.00%, P<0.05). The levels of serum TSH, TPOAb and Tg-Ab in adverse pregnancy group were higher than those in normal pregnancy group (P<0.05). Conclusion The levels of serum TPOAb, Tg and Tg-Ab are abnormally increased in patients with gestational thyroid dysfunction, which are all related to adverse pregnancy outcomes. Clinical attention should be paid to and early intervention should be taken.

Objective:To investigate the characteristics of distribution and drug resistance of urinary bacteria in the mid-stream urine of patients with infectious stones.Methods:The retrospective study analyzed the clinical data of 254 patients with infectious stones in the First Affiliated Hospital of Guangzhou Medical University from September 2016 to September 2018. All patients were treated with PCNL. Overall, there were 101 male and 153 female patients, with the mean age of(51.5±12.3) years, and the mean stone burden of 1443.5(660.8, 2837.5) mm2. There were 58 (22.8%) patients with hypertension, 17(6.7%) patients with diabetes and 195(76.8%)with hydronephrosis. The mid-stream urine samples were obtained for bacterial culture and susceptibility test, and the results of urine culture and antimicrobial susceptibility were recorded and analyzed.Results:Of 254 patients involved in this study, 89(35.0%) were positive and 165 (65.0%) were negative for urinary bacterial culture of the mid-stream. The proportion of patients with positive urine bacterial culture of the mid-stream who had positive urine leucocytes, positive urine nitrite and postoperative pyrexia were 86.5%(77/89), 64.0%(57/89), 25.8%(23/89), respectively, which was higher than that of patients with negative urine bacterial culture of the mid-stream [50.3%(83/165), 14.5%(24/165), 14.5%(24/165), P<0.05]. Four teen kinds of bacteria were detected from the mid-stream urine, and the three bacteria with the highest detection rate in turn were Escherichia coli of 38.2%(34/89), Proteus mirabilis of 15.7%(14/89), and Pseudomonas aeruginosa of 11.2%(10/89). The results of this study showed that three common bacteria had high resistance to drug including Cefazolin, Cefuroxime, Cefuroxime ester, Ampicillin and Co-trimoxazole (all resistance rate>40%). The resistance rates of Escherichia coli and Pseudomonas aeruginosa to Ciprofloxacin and Levofloxacin were higher than or equal to 40%. The resistance rates of Escherichia coli and Proteus mirabilis to meropenem, imipenem, ertapenem, piperacillin/tazobactam and amikacin were all lower than 10%. In addition, the resistance rates of Escherichia coli to nitrofurantoin and tigecycline and Proteus mirabilis to tobramycin, aztreonam and cefoxitin were all less than 10%. The resistance rates of Pseudomonas aeruginosa to ceftazidime, cefepime, gentamicin and aztreonam were less than 10%. Conclusions:The highest detection rate of urinary bacteria in culture of the mid-stream with infectious stones are Escherichia coli, Proteus mirabilis and Pseudomonas aeruginosa, all of which showed high resistance to Ampicillin, Cotrimoxazole, and some cephalosporins. Escherichia coli and Pseudomonas aeruginosa showe high resistance to Ciprofloxacin and Levofloxacin, and all of the three bacteria have low resistance rates to some β-Lactamase inhibitor complex and carbapenems, suggesting a reference for clinical empirical medical treatment.

Objective:To compare the effects of rosuvastatin and atorvastatin on coronary artery bypass grafting (CABG) on the incidence of acute kidney injury (AKI), and assess the independent risk factors of AKI.Methods:We retrospectively collected 550 patients aged 18 years or older who underwent CABG from May 2014 to May 2020. They were divided into the rosuvastatin group ( n=322), atorvastatin group ( n=125) and non statins group ( n=103) according to whether rosuvastatin or atorvastatin was routinely used before operation. Demographic data, clinical data before and after CABG and laboratory results were collected. Blood urea nitrogen (BUN), serum creatinine (Scr), creatinine clearance rate (Ccr) and incidence of postoperative AKI were compared among the three groups. Univariate analysis and binary logistic regression analysis were used to investigate the effect of statins on AKI in patients undergoing CABG. Results:Compared with preoperation, BUN showed no significant change ( P>0.05), while Scr was increased and Ccr was decreased significantly (both P<0.01); BUN in the rosuvastatin group was decreased significantly ( P<0.01), whereas Scr and Ccr had no significant change ( P>0.05); Scr in the atorvastatin group was increased significantly ( P<0.01), but there was no significant difference in BUN and Ccr ( P>0.05). BUN and Scr in the non statins group were increased significantly (both P<0.01), while Ccr was decreased significantly ( P<0.01). After operation, BUN and Scr in the rosuvastatin group and atorvastatin group were significantly lower than those in the non statins group (all P<0.01); Ccr was significantly higher than that in the non statins group ( P<0.01). BUN and Scr were not significantly different between the rosuvastatin and atorvastatin groups ( P>0.05), but Ccr was significantly higher than that in the atorvastatin group ( P< 0.05). There were significant differences in BUN, Scr and Ccr among the three groups ( χ2=48.925, 22.677 and 34.426, all P<0.01). The incidence of AKI among 550 patients was 15.1% (83/550), of which 9.6% (31/322) in the rosuvastatin group, 16.0% (20/125) in the atorvastatin group and 31.1% (32/103) in the non statins group. The incidence of AKI in the rosuvastatin and atorvastatin groups was significantly lower than that in the non statins group ( χ2=28.412, 7.282, P<0.01). Multivariate regression analysis showed that hypertension ( OR=3.555, 95% CI: 1.959-6.451, P<0.01), NHYAⅢ/Ⅳ ( OR=2.438, 95% CI: 1.187-5.008, P=0.015), and increased serum creatinine level ( OR=1.018, 95% CI: 1.003-1.032, P=0.016), and intraoperative cardiopulmonary bypass ( OR=2.936, 95% CI: 1.454-5.927, P=0.003) were independent risk factors for AKI after CABG, while preoperative conventional statin therapy ( OR=0.490, 95% CI: 0.247-0.974, P=0.042) and increased serum albumin level ( OR=0.920, 95% CI: 0.856-0.990, P=0.026) were protective factors for AKI after CABG. Conclusions:The incidence of AKI after CABG is common. Rosuvastatin or atorvastatin and increased preoperative serum albumin level can protect renal function and reduce the incidence of AKI, which are the protective factors of AKI after CABG. The hypertension, NHYAⅢ/Ⅳ, increased preoperative serum creatinine level and cardiopulmonary bypass are the independent risk factors of AKI after CABG.

Objective To explore the predictive value of INR in early stage of warfarin therapy (early INR)for anticoagulation intensity after 7 days of treatment. Methods The medical records of patients hospitalized in the Department of Cardiology,Linyi People′s Hospital,Shandong University from January 2012 to May 2015 were collected,who received warfarin anticoagulation therapy and underwent INR tests in the morning after 3 or 7 days of medication. The early INR meant INR after 3 days of warfarin treatment. According to INR after 7 days of warfarin treatment,the patients were divided into 2 groups, anticoagulation up to standard(INR 2. 0﹣3. 0)group and over﹣anticoagulation(INR﹥3. 0)group. The best critical value of early INR for predicting INR after 7 days of warfarin treatment was obtained by plotting ROC curve. The risk of over﹣anticoagulation after 7 days of warfarin treatment was compared in patients with early INR ≥critical value and﹤critical value. Univariate analysis was used to compare the clinical characteristics in the 2 groups. The indexes with P ﹤0. 100 were used as covariate and multivariate logistic regression analysis was performed. The odds ratio( OR)and its 95% confidence interval( CI)was calculated and independent risk factors of INR ﹥3. 0 after warfarin treatment were screened. Results A total of 75 patients with atrial fibrillation were enrolled in the study,including 38 males and 37 females,aged(64 ± 9),42 patients in the anticoagulation up to standard group and 33 patients in the over﹣anticoagulation group. There were significant differences in body weight,INR after 3 days of medication,and the number of patients with hypoproteinemia between the 2 groups(all P﹤0. 05),but no significant differences in other indicators (all P﹥0. 05). The results of ROC curve showed that the best critical value of anticoagulation intensity predicted by early INR was 1. 67,the area under the curve was 0. 915[95% CI:0. 828﹣0. 967],and the sensitivity and specificity were 0. 95 and 0. 82,respectively. The risk of over﹣anticoagulation in patients with 7 days of warfarin treatment in the group with early INR ≥1. 67 was significantly higher than that in the group with early INR ﹤1. 67[90. 0%(27/30)vs. 13. 3%(6/45),χ2 ＝39. 883,OR＝58. 50,95% CI:13. 45﹣254. 48,P﹤0. 001]. Multivariate logistic regression analysis showed that early INR≥1. 67 was an independent risk factor for over﹣anticoagulation after 7 days of treatment( OR＝48. 719,95% CI:10. 891﹣217. 940,P﹤0. 001). Conclusions The early INR can predict anticoagulation intensity after 7 days of treatment. Early INR≥1. 67 is an independent risk factor for over﹣anticoagulation after 7 days of warfarin treatment.

Objective To explore the predictive value of INR in early stage of warfarin therapy (early INR)for anticoagulation intensity after 7 days of treatment. Methods The medical records of patients hospitalized in the Department of Cardiology,Linyi People′s Hospital,Shandong University from January 2012 to May 2015 were collected,who received warfarin anticoagulation therapy and underwent INR tests in the morning after 3 or 7 days of medication. The early INR meant INR after 3 days of warfarin treatment. According to INR after 7 days of warfarin treatment,the patients were divided into 2 groups, anticoagulation up to standard(INR 2. 0﹣3. 0)group and over﹣anticoagulation(INR﹥3. 0)group. The best critical value of early INR for predicting INR after 7 days of warfarin treatment was obtained by plotting ROC curve. The risk of over﹣anticoagulation after 7 days of warfarin treatment was compared in patients with early INR ≥critical value and﹤critical value. Univariate analysis was used to compare the clinical characteristics in the 2 groups. The indexes with P ﹤0. 100 were used as covariate and multivariate logistic regression analysis was performed. The odds ratio( OR)and its 95% confidence interval( CI)was calculated and independent risk factors of INR ﹥3. 0 after warfarin treatment were screened. Results A total of 75 patients with atrial fibrillation were enrolled in the study,including 38 males and 37 females,aged(64 ± 9),42 patients in the anticoagulation up to standard group and 33 patients in the over﹣anticoagulation group. There were significant differences in body weight,INR after 3 days of medication,and the number of patients with hypoproteinemia between the 2 groups(all P﹤0. 05),but no significant differences in other indicators (all P﹥0. 05). The results of ROC curve showed that the best critical value of anticoagulation intensity predicted by early INR was 1. 67,the area under the curve was 0. 915[95% CI:0. 828﹣0. 967],and the sensitivity and specificity were 0. 95 and 0. 82,respectively. The risk of over﹣anticoagulation in patients with 7 days of warfarin treatment in the group with early INR ≥1. 67 was significantly higher than that in the group with early INR ﹤1. 67[90. 0%(27/30)vs. 13. 3%(6/45),χ2 ＝39. 883,OR＝58. 50,95% CI:13. 45﹣254. 48,P﹤0. 001]. Multivariate logistic regression analysis showed that early INR≥1. 67 was an independent risk factor for over﹣anticoagulation after 7 days of treatment( OR＝48. 719,95% CI:10. 891﹣217. 940,P﹤0. 001). Conclusions The early INR can predict anticoagulation intensity after 7 days of treatment. Early INR≥1. 67 is an independent risk factor for over﹣anticoagulation after 7 days of warfarin treatment.

Objective To evaluate the effectiveness of anticoagulation management by physician-clinical pharmacist team for patients with valvular atrial fibrillation. Methods One hundred and seventy two patients with valvular atrial fibrillation received warfarin therapy for anticoagulation during hospitalization in Linyi People′s Hospital from January 2014 to December 2016, the patients continued to receive warfarin therapy for>6 months after discharge. The patients were randomly assigned in two groups:the anticoagulation management was given by physician-clinical pharmacist team in 87 cases (trial group), while the dosage of wargarin was adjusted in outpatient department by physicians alone in 85 cases (control group). The goal attainment rate of international normalized ratio (INR), the proportion of patients with a stable warfarin dose, knowledge of anticoagulants, belief of medication, medication compliance were compared between two groups. Results There were no significant differences in age, sex, body weight, smoking and drinking habits, valvular disease type, comorbidities; and the initial INR, knowledge of anticoagulants, belief of medication and medication compliance at admission between two groups (all P>0.05). The goal attainment rate of INR (52.17％vs. 41.02％,χ2=8.178, P=0.004), the proportion of patients with a stable dose of warfarin (74.71％ vs. 56.47％,χ2=6.349, P=0.012), the knowledge of anticoagulants (11.03 ± 2.25 vs. 10.08 ± 1.86, t=3.018, P=0.003), the belief of medication[(12.23 ± 2.07) vs. (11.67 ± 1.48), t=2.042, P=0.043], and the medication compliance[(7.36 ± 0.89) vs. (7.04 ± 1.10), t=2.1128, P=0.036] in the trial group were significantly higher than those in control group. Conclusion Anticoagulation management by physician - clinical pharmacist team can improve the management level of anticoagulation and the knowledge of anticoagulans, enhance the medication belief, improve the goal attainment rate of INR and the compliance rate of medication in patients with valvular atrial fibrillation.

Objective To investigate the prevention of acute kidney injury (AKI) by earlier application of rosuvastatin in patients after coronary artery bypass grafting (CABG).Methods A total of 200 patients with CABG were enrolled from May 2013 to April 2017.According to whether rosuvastatin were used routinely before operation or not,all patients were divided into the trial group (n =136) and the control group (n =64).Demographics,and clinical data were collected before and after CABG.The renal function markers including blood urea nitrogen (BUN),serum creatinine (sCr),endogenous creatinine clearance rate (GFR),emergence of AKI of two groups were documented and compared.Enumeration data were analyzed with x2 test,measurement data were analyzed with t test,and P ＜ 0.05 was considered to be significant.Results There were no differences in sCr (t =-1.156,P ＞ 0.05) but differences in BUN and eGFR (t =-2.915,3.690,respectively,P ＜ 0.05) before operation between two groups.After operation,the BUN was decreased (t =2.486,P ＜ 0.05) compared with that of pre-operation in the trial group,but there were no significant difference in sCr and eGFR (t =-1.877,-0.752,respectively,P ＞0.05).The BUN and sCr were increased (t =-3.792,-5.027,respectively,P ＜ 0.05) after operation compared with that of pre-operation in the control group,while the eGFR was decreased (t =5.540,P ＜0.05).Compared with the control group,BUN,sCr and the incidence of AKI were significantly decreased in the trial group (t/x2 =5.759,4.196,15.506,respectively,P ＜0.05),while the eGFR was increased (t =-6.215,P ＜ 0.05).Conclusions Earlier application of rosuvastatin before CABG can effectively protect renal function and reduce the incidence of AKI.

OBJECTIVE:To evaluate the effects of clinical pharmacists participating in clinical pathway management for chron-ic heart failure(CHF). METHODS:A total of 107 CHF adult inpatients in Linyi People's Hospital during Jan. 2014-Oct. 2015 were divided into control group(56 cases,3 withdrawal,53 in total)and trial group(58 cases,4 withdrawal,54 in total)accord-ing to random number table. Control group received routine clinical pathway management method of CHF;trial group received clin-ical pathway management with the participation of clinical pharmacists. Clinical efficacy,the utilization of heart failure drugs,eco-nomic indexes,medication compliance after discharge,re-hospitalization rate due to heart failure were compared between 2 groups. RESULTS:Total response rate of trial group was significantly higher than control group,with statistical significance(P<0.05). The utilization rate of ACEI/ARB,β-receptor blocker,target dose rate of ACEI/ARB in trial group were significantly higher than control group,with statistical significance(P<0.05);target dose rate of β-receptor blocker was higher than control group,without statistical significance(P>0.05). Hospitalization time,drug cost,total hospitalization cost and drug ratio of trial group were short-er or lower than control group,without statistical significance(P>0.05). One month after discharge,the proportion of medication compliance in trial group was significantly higher than control group,with statistical significance(P<0.05);re-hospitalization rate was lower than control group,without statistical significance(P>0.05). Three months after discharge,the proportion of medica-tion compliance in trial group was higher than control group,while re-hospitalization rate was lower than control group,with statis-tical significance(P<0.05). CONCIUSIONS:The participation of clinical pharmacists in clinical pathway management of CHF can significantly improve the utilization rate of recommended drugs by guideline,clinical efficacy and medication compliance,and reduce re-hospitalization rate.