Objective:To analyze the correlation between drug-induced sleep endoscopy (DISE), results, polysomnography (PSG) indicators, and clinical parameters in patients with obstructive sleep apnea (OSA), and to establish and validate a predictive model for tongue base plane obstruction.Methods:This retrospective study analyzed 117 OSA patients diagnosed via PSG and treated at the Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, between October 2014 and March 2022. The cohort comprised of 114 males and 3 females, with an age range of 20 to 54 years (mean age 38.1±8.4 years). Data on DISE results, PSG results, and clinical indicators were collected for all 117 patients. Logistic regression analysis was performed to identify relevant indicators, and a predictive model for tongue base plane obstruction was constructed and internally validated using the R programming language.Results:Univariate logistic regression analysis identified four independent risk factors for predicting tongue root plane obstruction: tonsil grading, N2, N3, and rapid eye movement sleep(REM) stage [ OR:0.412(0.260~0.652),1.045(1.012~1.079),0.943(0.903~0.984),0.961(0.925~0.998), P <0.05]. Multivariate logistic regression analysis confirmed tonsil grading and N3 sleep stage (12.48±12.22%) as significant predictors. A nomogram model incorporating these factors demonstrated good predictive performance, with an area under curve(AUC) of 0.82 (95% CI: 0.548-1.000), an optimal cutoff of 0.519, a specificity of 80.0%, and a sensitivity of 86.7%. Internal validation of the model in the validation cohort yielded an AUC of 0.751 (95% CI: 0.625-0.876). Conclusions:Tongue base plane obstruction observed during DISE in OSA patients is associated with tonsil grading and N3 sleep stage duration. The predictive model developed for tongue base plane obstruction based on DISE demonstrates good efficacy, as evidenced by its internal validation.

[This corrects the article DOI: 10.1016/j.apsb.2022.08.024.].

In situ and real-time monitoring of responsive drug release is critical for the assessment of pharmacodynamics in chemotherapy. In this study, a novel pH-responsive nanosystem is proposed for real-time monitoring of drug release and chemo-phototherapy by surface-enhanced Raman spectroscopy (SERS). The Fe₃O₄@Au@Ag nanoparticles (NPs) deposited graphene oxide (GO) nanocomposites with a high SERS activity and stability are synthesized and labeled with a Raman reporter 4-mercaptophenylboronic acid (4-MPBA) to form SERS probes (GO-Fe₃O₄@Au@Ag-MPBA). Furthermore, doxorubicin (DOX) is attached to SERS probes through a pH-responsive linker boronic ester (GO-Fe₃O₄@Au@Ag-MPBA-DOX), accompanying the 4-MPBA signal change in SERS. After the entry into tumor, the breakage of boronic ester in the acidic environment gives rise to the release of DOX and the recovery of 4-MPBA SERS signal. Thus, the DOX dynamic release can be monitored by the real-time changes of 4-MPBA SERS spectra. Additionally, the strong T₂ magnetic resonance (MR) signal and NIR photothermal transduction efficiency of the nanocomposites make it available for MR imaging and photothermal therapy (PTT). Altogether, this GO-Fe₃O₄@Au@Ag-MPBA-DOX can simultaneously fulfill the synergistic combination of cancer cell targeting, pH-sensitive drug release, SERS-traceable detection and MR imaging, endowing it great potential for SERS/MR imaging-guided efficient chemo-phototherapy on cancer treatment.

Objective:To investigate the consistency of Velum, Oropharygneal, Tongue base, Epiglottis (VOTE) scores between two surgeons with similar clinical experience in obstructive sleep apnea hypopnea syndrome (OSAHS) patients with different degree of disease, and to analyze the influencing factors leading to the difference in score.Methods:This was a cross-sectional study. 64 preoperative drug-induced sleep endoscopy (DISE) videos of OSAHS patients during December 2014 to July 2018, from Nanfang Hospital, Southern Medical University were analyzed. The VOTE score was assessed single-blind by two similar experienced surgeons, and the Kappa value between the two scorers was calculated by the third researcher. According to the characteristics of the case, Fisher's exact test or chi-square test method was used to further explore the factors that influenced the consistency.Results:Sixty-four patients were divided into four groups according to the severity of the disease, including mild (7 cases), moderate (30 cases), severe(18 cases), and extremely severe (9 cases). The scores evaluated between two researchers were analysed for consistency. For mild patients, the two scorers were completely consistent in the configuration and degree of obstruction in the velum and epiglottis (Kappa=1). There was no agreement on whether obstruction or not, obstructed configuration, obstructed degree of the oropharynx and tongue base, and presence of velum and epiglottis obstruction. For moderate patients, the two scorers had a good consistency in the configuration and degree of the velum (0.61≤Kappa≤0.80), and there was no consistency in the evaluation of the degree of tongue base and epiglottis ( P>0.05). The consistency of the remaining obstructed conditions in the four planes was generally or moderate (0.21≤Kappa≤0.60). For patients with severe OSAHS, the two raters were completely consistent in the evaluation of palatopharyngeal and epiglottic planes for the presence of obstruction, but there was no consistency in the degree of obstruction. Although the degree of obstruction in the oropharyngeal plane can be assessed with good consistency, the consistency of whether the plane was blocked or not was generally not high. In the assessment of other obstructive conditions in the four planes of severe patients, the agreement between the two scorers was moderate or generally. For extremely severe patients, the two scorers were completely consistent in the evaluation of the velum obstruction, but there was no consistency in the degree of obstruction of the oropharynx and tongue base, and the obstruction configuration and degree of the epiglottis. The evaluation of other obstructed conditions in the four planes is good or moderate. Among the patients with severe OSAHS, the difference in the assessment of obstruction of the oropharynx was associated with tonsil size ( P<0.05). Conclusion:When physicians with similar clinical experience scored VOTE, the consistency of whether the velum and oropharyngeal planes are obstructed is related to the severity of the disease. Better consistency is observed among more severe OSAHS patients. The reason for the poor consistency of the oropharyngeal plane in severe OSAHS patients OSAHS is due to the difference of the tonsils size. For severe OSAHS patients with small tonsils, the assessment of whether the oropharynx is obstructed should be more cautious.

Objective: To investigate the risk factors of pneumonia in maintenance hemodialysis (MHD) patients. Methods: The clinical data of patients undergoing dialysis longer than three months at the Hemodialysis Center of West China Hospital of Sichuan University from July 2013 to July 2018 were retrospectively analyzed. The patients were divided into pneumonia group and non-pneumonia group. Follow-up time started from admission to the beginning of hemodialysis. All patients were followed until the patient died, or withdrawn from hemodialysis, or transferred to another center, or until the study deadline (April 2019). Baseline clinical data were compared between the two groups, and the differences in clinical data between the pneumonia group and the baseline were also analyzed. Risk factors for pneumonia in hemodialysis patients was analyzed by binary logistic regression. Kaplan-Meier curve was used to compare the survival prognosis of the two groups, and the Log-rank method was used for significant test. A multivariate Cox proportional hazard model was used to analyze risk factors for MHD patients' death. Results: (1) A total of 311 patients were enrolled in the study, in which 178 (57.2%) of the patients were male, and 75(24.1%) of the patients had pneumonia. Compared with non-pneumonia group, the pneumonia group patients were older (P=0.002), had higher level of white blood cells (P=0.001) and lower level of serum creatinine (P=0.003), albumin (P=0.001), and serum magnesium (P=0.039). There were also statistically significant differences between the two groups in the proportion of females and underlying diseases (all P<0.05). (2) The time of pneumonia occurred from the initial time of dialysis was (10.69±9.82) months. Compared with baseline values, decreased hemoglobin and albumin level were found (both P<0.01). (3) Logistic regression analysis showed male patients had lower risk of pneumonia than female patients (OR=0.438, 95% CI 0.242-0.795, P=0.007). For every 1 g/L increase in albumin, the risk of pneumonia was reduced by 6.4% (OR=0.936, 95% CI 0.885-0.991, P=0.022). Kaplan-Meier survival curve analysis showed that the difference in 5-year cumulative survival rate between pneumonia group and non-pneumonia group was statistically significant (60.6% vs 84.4%, χ²=16.647, P<0.001). (4) Multivariate Cox regression analysis showed that long dialysis time (HR=0.870, 95% CI 0.832-0.909, P<0.001) and high serum albumin level (HR=0.898, 95%CI 0.845-0.955, P=0.001) were protective factors in patients with MHD. Pneumonia (HR=3.008, 95% CI 1.423-6.359, P=0.004) was an independent risk factor for death in MHD patients. Conclusions Hemoglobin and albumin level are reduced in MHD patients with pneumonia. Low albumin level is a risk factor for pneumonia in patients. MHD patients with pneumonia have a lower survival time than those without pneumonia.

Objective To investigate the prevalence of nutritional risk,undernutrition and nutritional support among elderly inpatients with coronary heart disease in 11 tertiary A hospitals in China.Methods Records of elderly patients under the age of 90 with coronary heart disease were collected between March 2012 and May 2012 from 11 tertiary A hospitals in China following the direction of diagnosis related group of Beijing government.Results A total of 1 279 consecutive cases were recruited with the average age 74 years old (65-89).The total nutritional risk prevalence was 28.14％ (360/1 279).The prevalence of nutritional risk and nutritional risk score ≥ 5 increased with age.The prevalence of nutritional risk (12.88％ vs.30.08％ vs.42.28％) and nutritional risk scored ≥5 (10.86％ vs.18.61％ vs.27.78％)increased with age.Judging from BMI,most patients were overweight or obese (BMI ≥ 24 kg/m2),accounting for 53.0％ of the total,and prevalence of nutritional risk in this subgroup was 15.12％ (96/635).The prevalence of nutritional risk in patients with normal BMI was 34.24％.The prevalence of undernutrition defined as BMI＜ 18.5 kg/m2 was 4.25％ (51/1 279),among which patients with score ≥ 5 account for 64.7％ (33/51).The prevalence of undernutrition defined as nutritional impairment score =3 was 7.58％ (97/1 279).In patients with nutritional risk,57 were administrated nutrition support (16.6％);in patients without nutritional risk,21 received nutrition support,mostly parenteral nutrition (16 cases,76.2％).In patients with nutritional risk [(79.46± 7.19) years vs.(76.40± 6.16) years],there were statistically significant difference between those who received nutrition support and those who did not in terms of age and the ratio of patients with nutritional risk scored≥5 (35.1％ vs.17.1％) (P =0.001,P=0.002).Conclusions The prevalence of nutritional risk in patients with coronary heart disease was high.The prevalence of undernutrition was low.Prevalence of overweight and obese was high,but there was still nutritional risk in this group of patients.The patients who received nutrition support were older and had high nutritional impairment score,but the indication is not rationale.

Objective To investigate the value of aspartate aminotransferase-to-platelet ratio index (APRI) in judging the indication for antiviral therapy [liver inflammation grade (G) ≥2 or fibrosis stage (S) ≥2] in patients with chronic HBV infection and alanine aminotransferase (ALT) ＜ 2 × upper limit of normal (ULN).Methods A retrospective analysis was performed for the clinical data of 207 patients with chronic HBV infection and ALT ＜ 2 × ULN who were admitted to Nanyang Central Hospital from January 2015 to June 2017,and according to liver inflammation grade and fibrosis stage,these patients were divided into G ＜ 2 + S ＜ 2 group with 87 patients and G ≥2 or S ≥2 group with 120 patients.The results of liver biopsy and laboratory examination were recorded,and APRI was calculated.The Spearman correlation analysis was performed to investigate the correlation of APRI with liver inflammation grade and fibrosis stage.The area under the receiver operating characteristic curve (AUC) was used to investigate the value of ALT,aspartate aminotransferase (AST),platelet count (PLT),and APRI in judging the indication for antiviral therapy in patients with ALT ＜ 2 × ULN.The t-test or the Wilcoxon rank-sum test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups.Results APRI was positively correlated with liver inflammation grade and fibrosis stage (r =0.661 and 0.597,P ＜0.001).Among ALT,AST,PLT,and APRI,APRI had the highest value in judging the indication for antiviral therapy,with AUCs of 0.913 in the G≥2 or S≥2 group,0.882 in the G≥2 group,and 0.881 in the S≥2 group.APRI had an AUC of 0.913 (95％ confidence interval:0.871-0.954) in predicting the indication in the G ≥ 2 or S ≥2 group at the optimal cut-off value of 0.5324;when APRI was ≥0.5324,the patients had marked liver histological changes,i.e.,G≥2 or S≥2,which met the indication for antiviral therapy.APRI had a sensitivity of 87.50％,a specificity of 89.66％,a positive predictive value of 92.11％,and a negative predictive value of 83.87％.Conclusion For patients with chronic HBV infection and ALT ＜ 2 × ULN,APRI has a good value in evaluating liver pathological changes and judging the timing of antiviral therapy and can reduce the frequency of invasive assessment of histological changes via liver biopsy.

Objective: To discuss the relationship between lingual tonsil hypertrophy and laryngopharyngeal reflux. Methods: Ninety-two patients who received throat surgery in Nanfang Hospital between October 2015 and October 2016 were enrolled. Twenty-six healthy volunteers were recruited as normal controls. All participants were assessed with the reflux finding score(RFS) and the size of lingual tonsils were evaluated using a clinical grading system proposed by Friedman under electronic laryngoscope. The score of reflux symptom index(RSI), personal history and medical history were gathered. Biopsy specimens of lingual tonsils were taken from all participants for the immunohistochemical stain of pepsin.SPSS 19.0 software was used for statistical analysis. Results: There were 46.2% (12/26) pepsin-positive and 53.8% (14/26) pepsin-negative volunteers in normal controls. There were 87.0% (80/92) pepsin-positive and 13.0% (12/92) pepsin-negative patients in study group. The severity of lingual tonsil hypertrophy and expression intensity of pepsin in patients were significantly higher in volunteers (Z=-3.636, Z=-5.273, P<0.01). The severity of lingual tonsil hypertrophy was positively associated with the pepsin level in patients (r=0.556, P<0.01). The patients with pepsin-positive expression showed significant correlation between lingual tonsil hypertrophy and the positive rate of RSI and RFS (r=0.258, r=0.225, P<0.05). Analysis of correlated factors indicated that lingual tonsil hypertrophy was associated with smoking (χ²=8.502, P<0.05). Conclusions The expression of pepsin can be detected in lingual tonsil tissues. The lingual tonsil hypertrophy is closely related to laryngopharyngeal reflux.

Objective To investigate a reliable and easy assessment method for swallowing function by evaluating objectively the recovery process of swallowing function in patients six months after supracricoid partial laryngectomy.Methods The swallowing function of patients who underwent supracricoid partial laryngectomy was evaluated six months after operation in Nanfang Hospital of Southern Medical University between January 2013 and February 2014 with two methods,the modified barium swallow (MBS) and fiberoptic endoscopic evaluation of swallowing (FEES),combined with modified penetration aspiration scale (MPAS).Furthermore,the feasibility,reliability and accuracy of these two methods were compared.Results Eleven patients were enrolled.MPAS equals score 1 for solid food,semiliquid food,and liquid food was defined as a criteria of normal swallowing function.By MBS evaluation,the numbers of patients with normal swallowing function were two cases at day 16-30 postoperation,two cases at day 31-45 postoperation,five cases at day 46-90 postoperation,and six cases at day 91-180 postoperation,respectively.By FEES evaluation,the above numbers were three cases,four cases,six cases and eight cases,respectively.When the aspiration was minimal and ejected completely and MPAS was less than or equal to score 4 for solid food,semiliquid food,and liquid food,the gastric tube could be removed.According to this standard,the gastric tube was removed in all cases,and the mean time was (21.7 ± 9.8) days.A good correlation was obtained between these two methods when evaluating solid and semiliquid food,and the Kappa values were 0.802 and 0.844,respectively.However,a little agreement was obtained between these two methods when evaluating liquid food,and the Kappa value was 0.529.Conclusions Patients who underwent supracricoid partial laryngectomy could restore good swallowing function in six months after the operation.Both the MBS and FEES are valuable procedures for evaluating objectively the swallowing function in patients after supracricoid partial laryngectomy.The FEES is much better than MBS,because FEES is a simple operation performed alone by otolaryngologists with no radiation.

OBJECTIVE: To explore the ways of quantitative and objective evaluation for analyzing the multiple influence factors on middle ear function in the patients with primarily diagnosed NPC, and to analyze the influence factors of middle ear function in the patients with primarily diagnosed nasopharyngeal carcinoma (NPC). METHOD: Three hundred and twenty cases (320 ears) of primarily diagnosed NPC patients were examinated with electric otoscope, acoustic immittance measurement, pure tone audiometry, nasopharynx and middle ear CT or MRI scanning, eustachian tube function examination, and electronic nasopharyngoscope. A series of quantitative methods, as the influence factors including T stage, clinical stage, location, diffusion type and form of tumor, eustachian tube function, pharynx mouth shape, imaging extension (nasal, skull base, pharyngeal recess, parapharyngeal space, tensor veli palatini muscle, levator veli palatini and so on), were used to evaluate the middle ear function. SPSS 13.0 was used to anlyze the single and multiple factors in statistics. RESULT: T stage, clinical stage, location, diffusion type, and form of tumor, pharynx mouth shape, imaging extension (nasal, skull base, pharyngeal recess, parapharyngeal space, tensor veli palatini muscle, levator veli palatini) were the single influence factors on the function of middle ear in primarily diagnosed NPC patients. The gender, age, pathological types, N staging and M staging of NPC patients primarily diagnosed had no effect on middle ear function. The multple factors analysis showed that T stage, tumor location, the function of eustachian tube, tensor veli palatini muscle invasion, and skull base invasion were independent factor of affecting the middle ear function on primarily diagnosed NPC patients. CONCLUSION In this study, the influence factors of middle ear function with primarily diagnosed NPC were related to T stage, location of tumor, the function of eustachian tube, tensor veli palatini muscle invasion, skull base invasion, otitis media and quantitative criteria. The way of quantitative analysis could be used to evaluate objectively the middle ear function in patients with primarily diagnosed NPC.
Adult ; Aged ; Aged, 80 and over ; Carcinoma ; Ear, Middle ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; diagnosis ; physiopathology ; Young Adult