Objective To investigate the characteristics of heart rate variability(HRV)in obese patients with severe obstructive sleep apnea hypopnea syndrome(OSAHS).Methods We retrospectively analyzed 78 patients with severe OSAHS diagnosed by polysomnography(PSG)in The Second Affiliated Hospital of Xi'an Jiaotong University from April 2018 to May 2022.According to body mass index(BMI),the patients were divided into obese with severe OSAHS group(43 cases)and non-obese with severe OSAHS group(35 cases).All patients received 24-hour Holter monitoring while on polysomnography monitoring.The differences in HRV indexes between the groups and the correlation between HRV and clinical indicators were analyzed.Results In terms of basic data and PSG indexes,the analysis results showed that compared with those in the non-obese OSAHS group,weight,BMI,neck circumference,waist circumference,and AHI in obese with severe OSAHS group were significantly higher,while the standard deviation of the 24-hour normal R-R interval(SDNN),the standard deviation of the 5-minute mean(SDANN),the triangle index(TI),the heart rate deceleration force(DC),the standard deviation of the normal R-R interval(awake SDNN),and high frequency during sleep in the obese with severe OSAHS group were significantly lower(P＜0.05).The correlation results showed that among obese with severe OSAHS patients,root mean square of the difference of adjacent R-R interval(rMSSD)was negatively correlated with the course of hypertension;TI and DC were negatively correlated with AHI.After adjusting for neck circumference and waist circumference,the linear regression analysis showed that SDNN,SDANN,and rMSSD were correlated with systolic blood pressure(P＜0.05).Conclusion There is significant decrease in HRV index in obese patients with severe OSAHS,suggesting that deterioration of cardiac autonomic nervous regulation function may increase the risk of cardiovascular disease.

OBJECTIVE To analyze the narrow-band imaging(NBI)endoscopic characteristics of recurrent early glottic carcinoma patients after undergoing CO2 laser surgery with a suspend laryngoscopy.METHODS A retrospective study was conducted on patients with early-stage glottic carcinoma(Ⅰ-Ⅱ stage)who received CO2 laser surgery under supportive laryngoscopy at the Department of Otolaryngology Head and Neck Surgery,the Second Affiliated Hospital of Xi'an Jiao Tong University from January 2017 to December 2023.The medical history,treatment methods,laryngoscopy(including common white light endoscopy and NBI endoscopy),imaging examinations,and pathological results of patients with recurrent glottic carcinoma were collected at different time points including preoperation,postoperative 1 month,postoperative 3 months,and postoperative 6 months.The endoscopic characteristics of NBI in patients with recurrent glottic carcinoma were summarized.RESULTS First,among 18 patients with early-stage glottic cancer recurrence after CO2 laser,the diagnostic rate of NBI endoscopy for laryngeal cancer recurrence(88.89％,16/18)was significantly higher than that of common white light endoscopy(55.56％,10/18)(χ2=4.985,P=0.026).The intraepithelial papillary capillary loop(IPCL)was classified as a vertical vessel according to ELS in all relapsed patients.However,according to Ni classification,the IPCL of the 72.22％(13/18)were classified as type V,while the IPCL of 27.78％(5/18)showed suspicious abnormal neovascularization(punctate or dilated and curved).The proportion of patients with abnormal IPCL on the surgical surface at 1 month,3 months,and 6 months postoperatively was 0.00％,27.78％(5/18),and 61.11％(11/18),respectively,with statistically significant differences(χ2=16.164,P<0.001),which indicated that the longer the follow-up time for recurrent laryngeal cancer patients,the higher the proportion of patients with abnormal IPCL on the surface of the surgical area under NBI endoscopy.CONCLUSION For early glottic carcinoma after CO2 laser surgery with a suspend laryngoscopy,the appearance of suspicious new blood vessels with type Ⅴ IPCL and punctate or dilated curvature under NBI endoscopy may indicate early recurrence of laryngeal cancer.

OBJECTIVE To analyze the changes of temporary abnormal intraepithelial papillary capillary loop(IPCL)in the surgical area of early glottic laryngeal cancer after CO2 laser resection.METHODS A retrospective study was conducted on early-stage glottic carcinoma patients who visited the Department of Otolaryngology,Head and Neck Surgery at the Second Affiliated Hospital from January 2017 to November 2023.Patients who underwent CO2 laser surgery accepted electronic laryngoscopy examination at 1 month,3 months,and 6 months postoperatively(including white light endoscopy and narrowband imaging endoscopy(NBI),and their medical history,treatment methods,laryngoscopy images,imaging data,and pathological results before and after treatment were systematically collected.The changes in laryngoscopy characteristics at different follow-up times after surgery were analyzed.RESULTS This study included 55 patients with non recurrent early glottic carcinoma who underwent CO2 laser surgery.At 1 month,3 months,and 6 months after surgery,there were significant differences in the proportion of patients with pseudomembrane coverage(72.73%vs.25.45%vs.7.27%),granulation formation(60.00%vs.34.55%vs.1.82%),and abnormal IPCL(23.64%vs.7.27%vs.0.00%)on the surface of the surgical area(P<0.001),and abnormal IPCL(mainly type Va and Vb)can be observed under NBI endoscopy from 1 month to 3 months after surgery.Within 6 months after surgery,the pseudomembrane detachment,granulation regression,scar formation,and abnormal IPCL in the surgical area disappeared.CONCLUSION Early glottic carcinoma patients may experience temporary abnormal IPCL within 3 months after receiving CO2 laser resection,but the abnormal IPCL could disappear within 6 months after surgery for some patients.Therefore,close observation is necessary within 6 months after surgery and there is no need for urgent biopsy.

【Objective】 To construct a prediction model of severe obstructive sleep apnea (OSA) risk in the general population by using nomogram in order to explore the independent risk factors of severe OSA and guide the early diagnosis and treatment. 【Methods】 We retrospectively enrolled patients who had been diagnosed by polysomnography and divided them into training and validation sets at the ratio of 7∶3. Patients were divided into severe OSA group and non-severe OSA group according to apnea hypopnea index (AHI)>30. Variables entering the model were identified by least absolute shrinkage and selection operator regression model (Lasso), and logistic regression (LR) method. Then, multivariable logistic regression analysis was used to establish the nomogram, and the area under the receiver operating characteristic curve (AUC) was used to evaluate the discriminative properties of the nomogram model. Finally, we conducted decision curve analysis (DCA) of nomogram model, STOP-Bang questionnaire and Berlin questionnaire to assess clinical utility. 【Results】 Through single factor and multiple factor logistic regression analyses, the independent risk factors for severe OSA were screened out, including moderate and severe sleepiness, family history of hypertension, history of smoking, drinking, snoring, history of suffocation, sedentary lifestyle, male, age, body mass index (BMI), waist and neck circumference. Lasso logistic regression identified smoke, suffocation time, snoring time, waistline, Epworth sleepiness scale (ESS) and BMI as predictive factors for inclusion in the nomogram. The AUC of the model was 0.795 [95% confidence interval (CI): 0.769-0.820] . Hosmer-Lemeshow test indicated that the model was well calibrated (χ²=3.942, P=0.862). The DCA results on the visual basis confirmed that the nomogram had superior overall net benefits within a wide, practical threshold probability range which displayed the nomogram was higher than that of STOP-Bang questionnaire and Berlin questionnaire, which is clinically useful. The Clinical Impact Curve (CIC) analysis showed the clinical effectiveness of the prediction model when the threshold probability was greater than 82% of the predicted score probability value. The prediction model determined that the high-risk population with severe OSA was highly matched with the actual population with severe OSA, which confirmed the high clinical effectiveness of the prediction model. 【Conclusion】 The model performed better than STOP-Bang questionnaire and Berlin questionnaire in predicting severe OSA and can be applied to screening. And it can be helpful to the early diagnosis and treatment of OSA in order to reduce social burden.

Objective:To compare efficacy and erectile function outcome of Non-transecting Urethroplasty (NTU)with excision and primary anastomotic urethroplasty(EPA) in the management of bulbar urethral stricture.Method:A retrospective analysis of the case data of 73 patients with bulbar urethral stricture admitted to Shanghai Sixth People's Hospital from January 2016 to December 2019. The patients are 18 to 60 years old, because of the stenosis of the bulbous urethra, the length of the stenosis is less than 2 cm, and there is no history of urethral surgery, no multiple urethral stricture, and no obvious ED before surgery. According to the operation method, the patients were divided into 25 cases in NTU group and 48 cases in EPA group. The ages of the NTU group and the EPA group were (39.2±9.4) years and (42.1±9.3) years, respectively. The course of the disease was 6.0(3.0-14.0) months and 6.5(3.0-11.0) months, respectively, and the body mass index was (23.7±3.2) kg/m 2 and (24.5±2.7) kg/m 2, the preoperative maximum urine flow rate (Q max) was (8.7±4.3) ml/s and (7.9±4.6) ml/s, respectively, and the length of the stenosis was respectively (1.7±0.4) cm and (1.8±0.2) cm, the preoperative International Erectile Function Questionnaire (IIEF-5) was (20.9±1.9) points and (21.3±2.1) points, respectively, the difference was not statistically significant ( P>0.05). The etiology of NTU group and EPA group were 8 cases (32.0%) and 31 cases (64.6%) of trauma, 11 cases (44.0%) and 9 cases (18.8%) of iatrogenic injury, and 6 cases (24.0%) and 8 cases (16.7%), the difference was statistically significant ( P=0.023). All operations were performed by the same team of doctors. The urethral scar was assessed during the operation. If the scar tissue can be completely removed without breaking the urethra, NTU is performed. The distal end of the urethra is cut at the dorsal side of the narrow segment of the urethra, and the urethral scar is removed in a transverse wedge shape. The urethra is sutured; otherwise, EPA is performed, the urethra is completely cut off, the stricture of the urethra and surrounding scar tissue is completely removed, and the urethra end-to-end anastomosis is performed. Record the operation time and intraoperative bleeding. Difficulty urinating after surgery, urethral microscopy and urethral angiography showed that the urethral stricture at the surgical site was defined as a failure of the operation. The urinary catheter was removed 3 weeks after surgery, urine flow rate was measured at 3 weeks, 6 months, and 12 months after surgery, erectile function was evaluated 12 months after surgery, and urethral angiography was performed 1 to 2 years after surgery. Result:All 73 operations in this study were successfully completed. The operation time of NTU group and EPA group were (67.6±11.3) min and (62.7±10.1) min, respectively, and the difference was not statistically significant ( P=0.063); intraoperative blood loss was (71.6±16.2) ml and (86.0±20.8) ml, the difference was statistically significant ( P=0.004). The postoperative median follow-up time was 18.0 months (13-38 months). The surgical success rates of the NTU group and EPA group were 92.0%(23/25) and 93.8%(45/48), respectively. The Q max of the NTU group and the EPA group were (26.7±3.6) ml/s and (28.1±8.7) ml/s, (25.2±3.5) ml/s and (26.7±8.1) ml/s, (25.0±4.3) ml/s and (26.2±7.2) ml/s; the IIEF-5 scores were (21.8±1.6) and (20.6±2.9) points respectively at 12 months after operation, the difference was both No statistical significance ( P>0.05). There was a statistically significant difference in IIEF-5 between NTU group and preoperative ( P=0.023). Conclusion:NTU can achieve the same outcomes as EPA in the management of bulbar urethral stricture. More importantly, the continuance of bulbar urethra is attained and avoiding rupture of bulbar cavernous artery, so as to protect the blood supply of penile and erectile function. NTU is a minimally invasive, feasible surgical method, which is advised for the patients with shorter stricture segment and fewer fibrosis.

OBJECTIVE：To study the effects of chitosan graphene oxide car rier（CS-GO）loaded with oridonin （CS-GO- oridonin）on the proliferation and apoptosis of human lung cancer A 549 cells. METHODS ：Taking A 549 cells as objects ，the survival rate of cells were detected by CCK- 8 method after treated with different concentrations of CS-GO （3，6，12，24，48 μg/mL）and CS-GO-oridonin loaded with same mass of oridonin （3，6，12，24，48 μg/mL，by the weight of oridonin ，the same below）. IC 50 of CS-GO-oridonin was calculated. The cell morphology were observed by microscope after treated with CS-GO and CS-GO-oridonin（both 32 μg/mL）for 2，4，10，24 h. The uptake of CS-GO ，oridonin，CS-GO-orionin（all 32 μg/mL）by cells was observed with fluorescence labeling method. The apoptosis of cells and the content of ROS were observed by flow cytometry after treated with different concentrations of CS-GO （16，32，64 μg/mL）and CS-GO-oridonin （16，32，64 μg/mL）. The expression of anti-apoptosis related proteins （Mcl-1，Bax and Bak ）were detected by Western blot. RESULTS ：After treated with different concentrations of CS-GO ，the survival rate of cells was still above 90％ ；after treated with different concentrations of CS-GO-oridonin，the survival rate of cells showed a downward trend ，and was significantly lower than that of CS-GO group （P＜ 0.01）；IC50 of CS-GO-oridonin was 32.61 μg/mL. After CS-GO treatment，the cell morphology did not change significantly ；after CS-GO-oridonin treatment ，the cells shrunk and fell off in clusters ，and the suspended matter increased ；the fluorescence of oridonin and CS-GO-orionin taken up by cells was enhanced than CS-GO. Compared with blank group ，there was no significant change in the apoptosis rate ，the content of ROS and the expression of apoptosis-related protein in 16，32，64 μg/mL CS-GO groups（P＞0.05）；apoptosis rate ，the content of ROS ，the protein expression of Bax and Bak in 16，32，64 μg/mL CS- GO-oridonin groups were increased significantly ，while the protein expression of Mcl- 1 were decreased significantly. Above indexes were significantly high er or lower than the same concentration CS-GO group （P＜0.05）. CONCL USIONS：CS-GO dose not affect the proliferation and apoptosis of A 549 cells；CS-GO-oridonin has obvious inhibition and apoptosis promoting effect on cells ，which may be related to increasing ROS production and regulating the expression of apoptosis related proteins.

Objective:To investigate the multi-sites high frequency ultrasound features of rectus diastasis (RD) in early postpartum women and their relationships with different delivery modes.Methods:Total of 571 primiparas who gave birth in the Obstetrics and Gynecology Hospital Affiliated to Zhejiang University Medical College from March to May 2020 and underwent 6-week postpartum examination were chosen, they were divided into vaginal delivery group (336 cases) and the cesarean section group (235 cases). The inter-rectus distance(IRD) of five loci (umbilical on 4.5 cm, umbilical on 3 cm, umbilical edge, edge of umbilical, umbilical down 3 cm) at resting state and two loci (umbilical edge, edge of umbilical) at curling state as well as the rectus thickness on the right side of umbilical level were observed by high frequency ultrasound. The impacts of the two delivery modes on IRD at each site and the changes of IRD under the two conditions were analyzed. Spearman correlation analysis was used to evaluate the correlation between the thickness of rectus abdominis and IRD at each site.Results:The incidence of early postpartum RD was 79.7% (455/571), most of which occurring at 3 cm above the umbilicus and the umbilicus levels. At resting state, the IRDs at the 5 loci of vaginal delivery group were (1.62±0.79)cm, (2.03±0.84)cm, (2.65±0.94)cm, (2.09±0.93)cm, and 0.54(0.00, 1.13)cm respectively, while the IRDs at 5 loci of the cesarean section group were (1.75±0.85)cm, (2.26±0.99)cm, (2.99±1.14)cm, (2.57±1.21)cm, and 1.00(0.41, 1.59)cm, with statistical differences at all the levels between groups ( P<0.05). Under the curling state, the IRDs at the 2 loci of vaginal delivery group were (2.10±0.84)cm and (1.66±0.86)cm respectively, while the IRDs at the 2 loci of cesarean section group were (2.28±0.87)cm and (1.91±0.87)cm, with statistical differences between groups( P<0.05). The incidences of increased IRD when compared between resting and curling states at the upper and lower umbilicus in the vaginal delivery group were 16.1% and 26.5%, with 17.4% and 20.4% in the cesarean section group. At the resting state, there was a significant difference in the thickness of rectus abdominis between the vaginal delivery and cesarean section groups [(0.74±0.12)cm vs (0.67±0.12)cm, P<0.05]. At the curling state, the difference between two groups was statistically significant [(1.11±0.23)cm vs (0.99±0.22)cm, P<0.05]. The thickness of rectus abdominis was negatively correlated with IRD(all the 5 loci at resting state, rs=-0.116, -0.140, -0.185, -0.143, -0.144, all P<0.01; and the upper umbilical loci at curling state, rs=-0.091, P<0.05). There was no significant correlation between the thickness of rectus abdominis and IRD at the lower umbilical edge at the curling state ( P>0.05). Conclusions:High frequency ultrasound can evaluate the morphological characteristics of the abdominal rectus muscle in early postpartum stage. Compared with vaginal delivery, rectus abdominis thickness, the IRD is larger in cesarean section primiparas, but less affected by the curling state.

Duplex kidney and ureter abnormality are one of the most common malformation in urinary system,with most of patients present no apparent symptom,and only a few patients being complicated by ureter obstruction and serious hydronephrosis,which is difficult to differentiate with renal cyst.Therefore a case with duplex kidney and ureter abnormality was reported to provide information for clinical practice.

Objective:To study the clinical features, management methods, and survival of patients with urinary neuroendocrine carcinoma (NEC).Methods:A retrospective study of 22 patients with urinary NEC was performed from March 2008 to August 2019, including 21 male and 1 female. The average age was 68.2±9.9 years. Location of the lesion included left adrenal gland 1 case, right kidney 1 case, left ureter 1 case, bladder 9 cases and prostate 10 cases. 16 cases with bladder or prostate NECs had hematuria. Radiological feature was solid tumors with inhomogeneous enhancement and obvious local invasion. Clinical TNM stages included left adrenal NEC(T 2N 0M 0), right kidney(T 4N 1M 0), left ureter(T 3N 1M 0), bladder(2 cases with T 2N 0M 0, 2 with T 3N 0M 0, 3 with T 3N 1M 0, 1 with T 4N 2M 0 and 1 with T 4N 1M 1), prostate(2 cases with T 2N 0M 0, 2 with T 3N 0M 0, 1 with T 4N 0M 0, 2 with T 4N 0M 1 and 3 with T 4N 1M 1). Radical surgery was performed for 8 patients (5 with bladder NECs, 1 for renal, ureter and prostate NECs respectively). Tumor resection was performed for left adrenal NEC. 4 bladder NECs and 3 prostate NECs were managed with palliative resections and 4 prostate NECs with conservative treatment, 2 prostate NECs lost to follow up after needle biopsy. Results:Pathological results were as follows, 12 cases with primary SCNECs, 2 cases with NECs, 3 cases were bladder SCNECs combined with high grade urothelial carcinoma, 4 cases were prostate SCNECs combined with adenocarcinoma, 1 case was SCNEC combined with LCNEC. Pathological tests indicated that average Ki-67 was (60.9±16.0)%, synaptophysin(SYN)was positive in 20 cases, chromogranin A(CgA)in 10 cases and CD56 in 19 cases. The median following time was 15.5 months(8-108 months)of 20 patients, 16 were deceased, 3 were surviving with tumor and 1 with clinical cure. The 1-, 2- and 3-year overall survival rates between bladder NECs(66.7%, 22.2%, 11.1%)and NECs in other locations(90.9%, 63.6%, 42.4%) had statistical significance( P=0.038). Conclusions:Hematuria was the main symptom of bladder and prostate NEC. SCNEC is the most common pathological type, many were in advanced stage when diagnosed. Even though managed with radical surgery, most of cases had poor prognosis, overall survival rate of bladder NECs was lower than other locations. Radical surgery in early stage and multi-disciplinary therapy can improve the situation.

Objective To evaluate the clinical application value of a novel immobilization system in total marrow irradiation ( TMI) with MVCT image. Methods From 2016 to 2017, a retrospective analysis of the setup errors of 22 patients receiving TMI in two groups ( twelve patients were immobilized with the novel immobilization system in group 1, ten patients were immobilized with the combinatorial immobilization devices in group 2) was performed in this study on Zhongnan Hospital of Wuhan University. Two-sample t-test was used to analyze the differences of setup errors and the consistency of setup between two groups. Results In group 1, the setup errors on left-right, superior-inferior, anterior-posterior and rotation directions were ( 1.06±0.79) , ( 1.34±0.66) , ( 2.45±1.48) mm and ( 0.63°±0.65°) for the head and neck position, ( 1.58±1.13) , ( 2.38±1.99) , ( 2.05± 1.68) mm and ( 0.31°± 0.32°) for the chest position, ( 1.67± 1.24) , ( 3.88±2.20) , ( 1.96± 1.32) mm and ( 0.48°± 0.53°) for the pelvis position, and ( 0.95± 0.73) , ( 1.99± 1.35) , ( 3.66±2.13) mm and ( 0.24°±0.31°) for the lower limb, respectively. In group 2, the setup errors were ( 2.59±2.58) , ( 3.28±1.85) , ( 3.71±2.43) mm and ( 1.15°±1.18°) for the head and neck position, ( 4.38±3.69) , ( 5.64±3.78) , ( 2.72± 1.91) mm and ( 1.55°± 0.86°) for the chest position, ( 4.14± 2.97) , ( 6.97±3.68) , ( 2.21±2.26) mm and ( 1.23°±0.74°) for the pelvis position, ( 2.28± 1.15) , ( 5.97± 3.00) , ( 3.44±1.93) mm and ( 1.09°±0.94°) for the lower limb, respectively. The setup errors significantly differed between two groups on the left-right, superior-inferior and rotation directions for all positions ( all P<0.05) . The setup consistency significantly differed between two groups on the left-right, superior-inferior and rotation directions for the chest and pelvis positions ( all P<0.05) . Conclusion The novel immobilization system can significantly improve the setup accuracy and setup consistency, and enhance the precision of treatment for patients.