Obstructive sleep apnea (OSA) is an increasingly widespread sleep-breathing disordered disease, and is an independent risk factor for many high-risk chronic diseases such as hypertension, coronary heart disease, stroke, arrhythmias and diabetes, which is potentially fatal. The key to the prevention and treatment of OSA is early diagnosis and treatment, so the assessment and diagnostic technologies of OSA have become a research hotspot. This paper reviews the research progresses of severity assessment parameters and diagnostic technologies of OSA, and discusses their future development trends. In terms of severity assessment parameters of OSA, apnea hypopnea index (AHI), as the gold standard, together with the percentage of duration of apnea hypopnea (AH%), lowest oxygen saturation (LSpO₂), heart rate variability (HRV), oxygen desaturation index (ODI) and the emerging biomarkers, constitute a multi-dimensional evaluation system. Specifically, the AHI, which measures the frequency of sleep respiratory events per hour, does not fully reflect the patients’ overall sleep quality or the extent of their daytime functional impairments. To address this limitation, the AH%, which measures the proportion of the entire sleep cycle affected by apneas and hypopneas, deepens our understanding of the impact on sleep quality. The LSpO₂ plays a critical role in highlighting the potential severe hypoxic episodes during sleep, while the HRV offers a different perspective by analyzing the fluctuations in heart rate thereby revealing the activity of the autonomic nervous system. The ODI provides a direct and objective measure of patients’ nocturnal oxygenation stability by calculating the number of desaturation events per hour, and the biomarkers offers novel insights into the diagnosis and management of OSA, and fosters the development of more precise and tailored OSA therapeutic strategies. In terms of diagnostic techniques of OSA, the standardized questionnaire and Epworth sleepiness scale (ESS) is a simple and effective method for preliminary screening of OSA, and the polysomnography (PSG) which is based on recording multiple physiological signals stands for gold standard, but it has limitations of complex operations, high costs and inconvenience. As a convenient alternative, the home sleep apnea testing (HSAT) allows patients to monitor their sleep with simplified equipment in the comfort of their own homes, and the cardiopulmonary coupling (CPC) offers a minimal version that simply analyzes the electrocardiogram (ECG) signals. As an emerging diagnostic technology of OSA, machine learning (ML) and artificial intelligence (AI) adeptly pinpoint respiratory incidents and expose delicate physiological changes, thus casting new light on the diagnostic approach to OSA. In addition, imaging examination utilizes detailed visual representations of the airway’s structure and assists in recognizing structural abnormalities that may result in obstructed airways, while sound monitoring technology records and analyzes snoring and breathing sounds to detect the condition subtly, and thus further expands our medical diagnostic toolkit. As for the future development directions, it can be predicted that interdisciplinary integrated researches, the construction of personalized diagnosis and treatment models, and the popularization of high-tech in clinical applications will become the development trends in the field of OSA evaluation and diagnosis.

Objective To compare the benefits and drawbacks of primary patch expansion versus pericardial tube right ventricular-pulmonary artery connection in patients diagnosed with pulmonary atresia with ventricular septal defect (PA/VSD). Methods A retrospective study was conducted on patients diagnosed with PA/VSD who underwent primary right ventricular-pulmonary artery connection surgery at our center between 2010 and 2020. Patients were categorized into two groups based on the type of right ventricular-pulmonary artery connection: a pericardial tube group and a patch expansion group. Clinical data and imaging findings were compared between the two groups. Results A total of 51 patients were included in the study, comprising 31 males and 20 females, with a median age of 12.57 (4.57, 49.67) months. The pericardial tube group included 19 patients with a median age of 17.17 (7.33, 49.67) months, while the patch expansion group consisted of 32 patients with a median age of 8.58 (3.57, 52.72) months. In both groups, the diameter of pulmonary artery, McGoon index, and Nakata index significantly increased after treatment (P<0.001). However, the pericardial tube group exhibited a longer extracorporeal circulation time (P<0.001). The reoperation rate was notably high, with 74.51% of patients requiring further surgical intervention, including 26 (81.25%) patients in the patch expansion group and 12 (63.16%) patients in the pericardial tube group. No statistical differences were observed in long-term cure rates or mortality between the two groups (P＞0.005). Conclusion In patients with PA/VSD, both patch expansion and pericardial tube right ventricular-pulmonary artery connection serve as effective initial palliative treatment strategies that promote pulmonary vessel development and provide a favorable foundation for subsequent radical operations. However, compared to the pericardial tube approach, the patch expansion technique is simpler to perform and preserves some intrinsic potential for pulmonary artery development, making it the preferred procedure.

Background Manganese is an essential trace element for the human body and maintains normal development of many organs including the brain. However, long-term exposure to a high manganese environment or excessive manganese intake will lead to manganese poisoning and result in neurological diseases, and currently no effective treatment plan is available. Objective To develop an animal model for subchronic manganese exposure and assess the impact of Dendrobium nobile Lindl. alkaloids (DNLA) on manganese associated behavioral and hippocampal effects in rats. Methods Fifty male SPF SD rats were randomly allocated into a control group (0.9% normal saline by intraperitoneal injection), two experimental groups [7.5 mg·kg⁻¹ (low) or 15 mg·kg⁻¹ (high) of MnCl₂·4H₂O by intraperitoneal injection], and two DNLA antagonistic groups [15 mg·kg⁻¹ MnCl₂·4H₂O by intraperitoneal injection then either 20 mg·kg⁻¹ (low) or 40 mg·kg⁻¹ (high) DNLA by oral administration]. All groups of rats were adminaistered 5 d per wek, once a day, for consecutive 13 weeks. Following modeling, neurobehavioral assessments were conducted using open field, Morris water maze, and Y maze. Inductively coupled plasma mass spectrometry (ICP-MS) was utilized to measure manganese levels in the blood and brain tissues of the rats, and hematoxylin-eosin (HE) staining was employed to examine neuronal morphological changes in the hippocampal tissues of the rats. Results The neurobehavioral tests revealed that the manganese-exposed rats exhibited decreased total movement distance, prolonged central zone dwelling time, and reduced motor activity in the open field test, indicating tendencies toward depression and anxiety (P<0.05). In the Y-maze test, the mean exploration distance in the novel arm, the number of entries into the novel arm, and the time spent in the novel arm of the managanses-exposed rats were all reduced, while the latency period increased, suggesting impaired spatial exploration and learning-memory functions (P<0.05). In the Morris water maze navigation test, the escape latency was significantly longer in the manganese-exposed rats compared to the control group, and the number of platform crossings decreased in the spatial probe test, indicating a significant decline in spatial learning and memory (P<0.05). The ICP-MS analysis showed elevated manganese concentrations in the blood and hippocampus of the exposed rats (P<0.05), and the histopathological observation revealed hippocampal damage. Following the DNLA intervention, the manganese-exposed rats showed increased total movement distance and reduced central zone dwelling time in the open field test (P<0.05). In the Y-maze test, the mean exploration distance in the novel arm, the number of entries into the novel arm, and the time spent in the novel arm increased, while the latency period decreased, suggesting alleviation of anxiety and improved exploratory behavior (P<0.05). In the Morris water maze test, the escape latency gradually shortened, and both the number of platform crossings and the percentage of time spent in the target quadrant increased, indicating improved spatial learning and memory (P<0.05). Additionally, the manganese levels in the blood and hippocampus decreased (P<0.05), and the hippocampal pathological changes were partially restored. Conclusion DNLA demonstrates the ability to counteract multiple neurotoxic effects following the elevation of manganese levels in the blood and hippocampal tissues of rats induced by subchronic manganese exposure. Specifically, DNLA is shown to ameliorate the behavioral alterations observed in rats after manganese exposure, and mitigate the hippocampal damage in manganese-exposed rats.

Objective To explore the severity of loneliness among the elderly in communities in Shanghai,and to identify factors associated with social and emotional loneliness respectively.Methods A cross-sectional study was conducted in older adults aged 65 years or above in Pudong New Area,Jing'an District and Huangpu District in Shanghai from Mar to Jun 2021.In Pudong New Area,multi-stage stratified random sampling was conducted based on the age and gender distribution of Shanghai,while in Huangpu District and Jing'an District convenience sampling was conducted.A total of 635 samples were included in the study.Loneliness was assessed using the De Jong Gierveld Loneliness Scale with social and emotional loneliness subscales.Logistic regression analyses were conducted to identify factors associated with social and emotional loneliness.Results Among the 635 participants,only 53 older adults(8.4%)were not lonely.Female(OR=0.46,95%CI:0.31-0.70),higher self-efficacy(OR=0.97,95%CI:0.94-1.00),more objective social support(OR=0.96,95%CI:0.93-0.99)were associated with less severe social loneliness.Meanwhile,higher level of education(secondary education,OR=0.56,95%CI:0.34-0.95;college or above,OR=0.30,95%CI:0.11-0.83)and higher self-efficacy(OR=0.96,95%CI:0.93-0.99)were associated with less severe emotional loneliness,while depression(OR=3.41,95%CI:1.76-6.60)and worse social capital(OR=2.02,95%CI:1.29-3.16)were associated with more severe emotional loneliness.Conclusion Up to 91.6%of the elderly in our study sample were moderately lonely or above.The factors associated with social loneliness include self-efficacy,gender and social support.The factors associated with emotional loneliness are self-efficacy,education level,depression,and social capital.

Depression is a common disease that affects human mental health in today’s society. The establishment of animal model of depression is of great significance to the study of depression. In recent years, people’s research on depression has gradually increased, and the modeling methods of depression animals have been gradually enriched. Due to the reasons of operation and cost, the modeling of depression in rodents is more common and mature. At present, the main animal models of depression include stress model, drug model, surgical model and genetic model. Each model has its own advantages and disadvantages. Appropriate methods can be selected according to the research purpose, so as to conduct in-depth research on depression. Recent studies have found that some brain signal pathways have become new targets for the treatment of depression. These signal pathways are closely related to depression, and the drugs acting on these targets have significant curative effects. Therefore, this paper reviewed the research progress of animal models and signal pathways of depression in recent years, so as to provide a theoretical basis for the study of the pathogenesis of depression.

Objective: To construct an evaluation index system of oral health literacy for children's parents, so as to provide an index system for the evaluation of oral health literacy for children's parents in China. Methods: The evaluation index system of oral health literacy for children's parents was designed based on literature review and semi-structured interview. Experts from oral prevention and pediatric oral medicine were invited to participate in two-round Delphi consultations. The indicators were scored and screened according to the importance, and the weight determined using analytic hierarchy process. The effectiveness of the consultation was evaluated by positive coefficient, authority coefficient and coordination coefficient. Results: Twenty-four experts participated in the consultation, including 6 males and 18 females. There were 21 experts with a master degree, 3 experts with a doctor degree, and 20 experts with vice senior professional titles and above. The recovery rates of the two rounds of consultations were 96.00% and 100.00%, the authority coefficients were 0.866 and 0.917, the Kendall's coefficient of concordance were 0.120 and 0.156 (both P<0.05), and the coefficient of variation was 0.15-0.38 and 0.03-0.17, respectively. The final evaluation index system included 3 primary indicators, 11 secondary indicators and 40 tertiary indicators. The primary indicators were basic knowledge and concepts related to oral health, promoting lifestyle and behaviors related to oral health, and maintaining basic skills related to oral health. Conclusion The evaluation index system of oral health literacy for children's parents has been established in this study and needs to be further applied and evaluated.

Objective To compare the ultrasound signs of symptomatic joint lesions in rheumatoid arthritis (RA) and gouty arthritis (GA), musculoskeletal ultrasound (MSUS) was utilized.Methods A retrospective analysis was performed for 85 hospitalized patients with RA and 55 hospitalized patients with GA in the same period, and the differences in general data, diseased joints and ultrasound signs between the two groups were compared.Re-sults The gender, age and diseased joints of the two groups were statistically significant (all P<0.05).The de-tection rate of knee joint lesions was the highest;the RA group had high sensitivity, high specificity of meniscal in-jury, and high diagnostic efficiency of bone erosion, while the diagnostic performance of the three combined ultra-sound signs of punctate strong echo, double track sign and tophi in the GA group was higher than that of any indi-vidual diagnosis, and the sensitivity and specificity were also higher.The course of disease in the RA group was positively correlated with bone erosion (P<0.05) , and the course in the GA group was positively correlated with tophi (P<0.05).Conclusion The ultrasound signs of RA and GA are different, and MSUS has good value in the diagnosis and differential diagnosis of the two.

177Lu-prostate specific membrane antigen(PSMA)radio-ligand therapy has been approved abroad for advanced prostate cancer and has been in several clinical trials in China.Based on domestic clinical practice and experimental data and referred to international experience and viewpoints,the expert group forms a consensus on the clinical application of 177Lu-PSMA radio-ligand therapy in prostate cancer to guide clinical practice.

Objective:To combine and improve two kinds of classical transvaginal cervical cerclage,and to provide a new reference for the clinical treatment of patients with cervical insufficiency(CIC).Methods:Retro-spective analysis was performed on the clinical data of 117 patients who underwent transvaginal cervical cerclage due to CIC from January 1,2018 to August 31,2023 in the Second Affiliated Hospital of Kunming Medical Univer-sity.According to different surgical methods,the patients were divided into the modified cerclage group(40 ca-ses),the McDonald cerclage group(40 cases)and the Shirodkar cerclage group(37 cases).Intraoperative and postoperative conditions and pregnancy outcomes were compared.Univariate and multivariate Logistic regression analysis was performed to analyze the related factors of preterm birth after modified cervical cerclage and the oth-er two groups of classical cervical cerclage.Results:①Compared with the McDonald cerclage group,the modified cerclage group had longer effective cervical length,longer delivery and gestational weeks,higher term delivery rate,and shorter post-operative contraction inhibitor time,with statistical significance(P＜0.05).Compared with the Shirodkar cerclage group,the operation time of patients in the modified cerclage was significantly shortened,the amount of intraoperative blood loss was reduced,the use time of postoperative contraction inhibitors was shortened,and the rate of postoperative wire-cutting was decreased,with statistical significance(P＜0.05).②Multivariate Logistic regression analysis of preterm birth showed that the longer the length of the cervix and the later gestational age when the modified cervical cerclage was performed with reference to McDonald's cerclage,the longer the length of the cervix after surgery,the later the gestational age when the suture was removed.The risk of preterm birth was reduced(OR＜1,P＜0.05),while preoperative BMI≥24 kg/m2 was associated with an increased risk of preterm birth(OR＞1,P＜0.05).Using Shirodkar's cerclage as reference,the risk of preterm delivery was consistent between the two types of cervix(P＞0.05).Longer cervical length and later gestational age after suture removal reduced the risk of preterm delivery(OR＜1,P＜0.05).Conclusions:The modified transvaginal cervical cerclage is simple and safe in clinical application,it has certain advantages in improving ad-verse pregnancy outcomes of pregnant women,which provides a new reference for the treatment of pregnant women with CIC.Due to the small number of cases included in the study,comprehensive evaluation by clinicians is still needed for clinical application.

Objective:To combine and improve two kinds of classical transvaginal cervical cerclage,and to provide a new reference for the clinical treatment of patients with cervical insufficiency(CIC).Methods:Retro-spective analysis was performed on the clinical data of 117 patients who underwent transvaginal cervical cerclage due to CIC from January 1,2018 to August 31,2023 in the Second Affiliated Hospital of Kunming Medical Univer-sity.According to different surgical methods,the patients were divided into the modified cerclage group(40 ca-ses),the McDonald cerclage group(40 cases)and the Shirodkar cerclage group(37 cases).Intraoperative and postoperative conditions and pregnancy outcomes were compared.Univariate and multivariate Logistic regression analysis was performed to analyze the related factors of preterm birth after modified cervical cerclage and the oth-er two groups of classical cervical cerclage.Results:①Compared with the McDonald cerclage group,the modified cerclage group had longer effective cervical length,longer delivery and gestational weeks,higher term delivery rate,and shorter post-operative contraction inhibitor time,with statistical significance(P＜0.05).Compared with the Shirodkar cerclage group,the operation time of patients in the modified cerclage was significantly shortened,the amount of intraoperative blood loss was reduced,the use time of postoperative contraction inhibitors was shortened,and the rate of postoperative wire-cutting was decreased,with statistical significance(P＜0.05).②Multivariate Logistic regression analysis of preterm birth showed that the longer the length of the cervix and the later gestational age when the modified cervical cerclage was performed with reference to McDonald's cerclage,the longer the length of the cervix after surgery,the later the gestational age when the suture was removed.The risk of preterm birth was reduced(OR＜1,P＜0.05),while preoperative BMI≥24 kg/m2 was associated with an increased risk of preterm birth(OR＞1,P＜0.05).Using Shirodkar's cerclage as reference,the risk of preterm delivery was consistent between the two types of cervix(P＞0.05).Longer cervical length and later gestational age after suture removal reduced the risk of preterm delivery(OR＜1,P＜0.05).Conclusions:The modified transvaginal cervical cerclage is simple and safe in clinical application,it has certain advantages in improving ad-verse pregnancy outcomes of pregnant women,which provides a new reference for the treatment of pregnant women with CIC.Due to the small number of cases included in the study,comprehensive evaluation by clinicians is still needed for clinical application.