Objective:The variability of the apnea-hypopnea index（AHI） measured in the first and second halves of the night is significant in patients with obstructive sleep apnea hypopnea syndrome（OSAHS）. This variation may be related to fluid redistribution caused by the supine position during sleep. Methods:Eighty-nine adult subjects were enrolled. Circumferences（neck, chest, waist, and calf） were measured before sleep onset and upon awakening. Polysomnography（PSG） was performed, and the night was divided into two halves based on the midpoint of total sleep time to calculate AHI for each half. The correlation between changes in AHI and changes in circumferences was analyzed. Results:Twenty simple snorers and sixty-nine OSAHS patients were included, with a median AHI of 22.6（11.8, 47.3） events/hour. Compared to pre-sleep measurements, there was no significant change in neck circumference upon awakening in the control group（P=0.073）, while reductions were observed in the other three measurements（P=0.006, P=0.038, P<0.001）. In the OSAHS group, neck circumference increased（P<0.001）, and reductions were noted in the other three measurements（P<0.001 for all）, with the most significant change observed in calf circumference 40.0（37.1, 42.0） cm to 38.0（35.8, 40.5） cm. Compared to the first half of the night, total AHI, supine AHI, and NREM AHI significantly decreased in the second half（P=0.010, P=0.031, P=0.001）, while no significant changes were observed in lateral AHI and REM AHI（P=0.988, P=0.530）. Further analysis revealed a significant relationship between increased chest circumference and decreases in NREM AHI, supine AHI, and supine NREM AHI（P=0.036, P=0.072, P=0.034）, as well as between decreased lateral position AHI and increased waist circumference（P=0.048）. Additionally, this study found a negative correlation between changes in calf circumference and changes in AHI（R=-0.24, P=0.048）, while neck circumference changes positively correlated with changes in AHI（R=0.26, P=0.03）. Conclusion:In OSAHS patients during the second half of sleep compared to before sleeping, chest circumference, waist circumference, and calf circumference decrease while neck circumference increases; total AHI, supine position AHI, and NREM period AHI decrease; increases in chest circumference are associated with decreases in NREM period AHI, supine position AHI, supine position NREM period AHI. There is nocturnal variability in AHI among OSAHS patients that may be associated with fluid shifts during sleep.
Humans ; Sleep Apnea, Obstructive/physiopathology* ; Male ; Female ; Polysomnography ; Fluid Shifts/physiology* ; Adult ; Middle Aged ; Neck ; Severity of Illness Index ; Sleep/physiology* ; Snoring/physiopathology*

Background::Psychological stress has been reported to be a potential risk factor for hypertension among females, but it remains unclear whether spousal chronic stress levels alter the risk of hypertension among women. We examined the associations between stress within the family and hypertension among married women.Methods::Reproductive-aged women who were planning for pregnancy and their husbands were recruited from the National Free Pre-pregnancy Checkup Projects (NFPCP) across 31 provinces in China in 2016 and 2017. Perceived stress of wives or husbands was measured with a 5-point Likert-type scale, and assessed from three domains: work/life-related stress, economic stress, and overall stress. Multivariable-adjusted logistic regression models were used to assess the associations between stress status and the prevalence of hypertension.Results::Of 10,027,644 couples, 261,098 (2.60%) women had hypertension. The results showed that higher stress levels among themselves or their husbands were associated with a higher prevalence of hypertension in women ( Pfor trend <0.001). Compared with non-stressed participants, female participants with the highest stress themselves were at a greater risk of hypertension, with adjusted odds ratio (OR) of 1.31 (95% confidence interval [CI]: 1.25-1.37); and compared with participants whose husbands had no stress, those whose husbands had the highest stress level were at a higher risk of hypertension with adjusted OR of 1.24 (95% CI: 1.20-1.29). Moreover, compared with non-stressed status for both couples, only-wife-stressed, only-husband-stressed, and both-stressed couples were found to be significantly associated with increased risks of wives’ hypertension, with adjusted ORs of 1.28 (95% CI: 1.25-1.31), 1.19 (95% CI: 1.17-1.21), and 1.28 (95% CI: 1.26-1.31), respectively. Conclusion::Moderate to severe stress in both spouses might be associated with female hypertension prevalence, which highlights the importance of paying attention to the psychological stresses of couples within the family.

Epigenomic imbalance drives abnormal transcriptional processes,promoting the onset and progression of cancer.Although defective gene regulation generally affects carcinogenesis and tumor suppression networks,tumor immunogenicity and immune cells involved in antitumor responses may also be affected by epigenomic changes,which may have significant implications for the development and application of epigenetic therapy,cancer immunotherapy,and their combinations.Herein,we focus on the impact of epigenetic regulation on tumor immune cell function and the role of key abnormal epigenetic processes,DNA methylation,histone post-translational modification,and chromatin structure in tumor immunogenicity,and introduce these epigenetic research methods.We emphasize the value of small-molecule inhibitors of epigenetic modulators in enhancing antitumor immune responses and discuss the challenges of developing treatment plans that combine epigenetic therapy and immuno-therapy through the complex interaction between cancer epigenetics and cancer immunology.

Hemophilic arthritis(HA),caused by recurrent bleeding,can seriously affect patient quality of life and consumes extensive social and medical resources.There is thus a need to establish an animal model of HA for research;however,this is limited by ethical requirements.Here we review the recent literature and summarize research progress into animal models of HA at home and abroad,from the aspects of species selection,modeling method,histopathology,and imaging evaluation method.Species selection includes rodents such as mice,New Zealand rabbits,beagles,miniature pigs,and crab-eating macaques.Modeling method comprise gene knockout trauma models,gene knockout spontaneous models,and injection models.Among these,the gene knockout spontaneous model closely mimics the pathological process of spontaneous bleeding and concurrent arthritis in human HA,making it more relevant to human HA.However,due to high modeling costs,phenotypic instability,and low survival rates,this model is not the preferred choice for animal experimental studies.In contrast,gene knockout trauma models exhibit characteristics such as short modeling time,strong stability,and high success rates,thus being widely utilized in animal experimental research.Evaluation of HA models involves various imaging method including MRI,micro-CT,MSKUS/PD,in addition to various gross scoring method.By reviewing the progress of HA model research,more experimental evidence is provided for investigating the pathogenesis and validating the efficacy of HA treatments,thereby compensating for the lack of clinical data,particularly in the field of traditional Chinese medicine therapy.

Background The high-pressure and high-risk nature of the police profession may consume individual resources and lead to job burnout. Objective To understand the current situation of police job burnout, and test potential mediating role of psychological empowerment between social support and job burnout. Methods From May to October 2020, a questionnaire survey was conducted among police officers in cities A and B of Sichuan Province by convenience sampling. The Perceived Social Support Scale, Psychological Empowerment Scale, and Maslach Burnout Inventory-General Survey were used to evaluate social support, psychological empowerment, and job burnout respectively. Mediation effect of psychological empowerment on the relationship between social support and job burnout was tested using bias-corrected bootstrap method. Results Of the 483 questionnaires recovered, there were 461 valid questionnaires (95.44%). The M (P₂₅, P₇₅) scores of social support, psychological empowerment, and job burnout were 5.00 (3.50, 5.83), 3.25 (2.00, 4.25), and 3.61 (2.43, 3.88), respectively. The positive rate of job burnout was 93.92% (433/461), of which 42.51% (196/461) and 51.41% (237/461) of the participants were at mild to moderate and severe levels of job burnout respectively. The results of Spearman correlation analysis showed that social support and psychological empowerment were negatively correlated with job burnout (r=−0.265, −0.328, P<0.01), and social support was positively corrected with psychological empowerment (r=0.390, P<0.01). The Bootstrap test results showed that social support negatively affected job burnout (β=−0.193, P<0.001) and positively affected psychological empowerment (β=0.330, P<0.001). Psychological empowerment negatively affected job burnout (β=−0.212, P<0.001) and played a partial mediating role in the relationship between social support and job burnout, and the effect value was −0.070 (95%CI: −0.097, −0.047) that accounted for 36.27% of the total effect. Conclusion Job burnout is prevalent among the police officers. Social support has a negative effect on job burnout, and psychological empowerment plays a partial mediating role between social support and job burnout.

Objective:To investigate whether stress hyperglycemia (SH) is an independent risk factor for the occurrence and mortality of sepsis-associated encephalopathy (SAE).Methods:From August 2016 to October 2021, sepsis patients admitted to the ICU of Guangdong Provincial People's Hospital were selected as the study subjects. According to whether they developed to SH (RBG>11.1 mmol/L) within 7 days of enrollment, the pat ients were divided into the SH group and the non-SH group for analysis. Logistic regression was used to analyze whether SH was an independent risk factor for SAE occurrence, and ROC curve was used to analyze the predictive value of SH to SAE. Kaplan-Meier curve was used to compare the 90-day survival of SAE patients with or without SH. Cox regression analysis was used to analyze the risk factors of 28-day and 90-day death in SAE patients.Results:A total of 183 sepsis patients were included, including 62 patients in the SH group and 121 in the non-SH group. Logistic regression analysis demonstrated that SH was an independent risk factor for SAE ( OR=4.452, 95% CI: 2.021-9.808, P <0.001). ROC curve demonstrated that SH could accurately predict SAE (AUC=0.831; Sensitivity=78.4%; Specificity=76.8%; and Yoden index=0.553). Kaplan-Meier curve demonstrated that the 90-day survival of SAE patients with SH significantly declined (log-rank test: P<0.01). Cox regression analysis suggested that SH was a risk factor for death at day 28 and day 90 in SAE patients (28 d, HR=2.272, 95% CI: 1.212-4.260, P=0.010; 90 d, HR=2.456, 95% CI: 1.400-4.306, P<0.01). Conclusions:SH is an independent risk factor for SAE and can predict SAE occurrence. SH significantly reduces 90-day survival and increase mortality at 28 and 90 days in SAE patients.

Objective:To compare the efficacy of different volume of ropivacaine for subomohyiod anterior suprascapular nerve block (aSSNB) in the patients undergoing arthroscopic shoulder surgery with general anesthesia.Methods:One hundred and thirty-five patients of either sex, aged 18-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, scheduled for elective arthroscopic shoulder surgery, were divided into 3 groups ( n=45 each) using a random number table method: 0.5% ropivacaine 5 ml group (L group), 10 ml group (M group), and 15 ml group (H group). Before induction, aSSNB was performed with 0.5% ropivacaine 5, 10 and 15 ml in L, M and H groups, respectively.Diaphragmatic excursion, occurrence and degree of diaphragmatic paralysis, decrease in SpO 2, dyspnea and Horner syndrome were recorded at 30 min after injection.The intraoperative consumption of remifentanil and cardiovascular events were recorded.The extubation time, length of post-anesthesia care unit stay, and duration of sensory block were recorded.Quality of Recovery-15 scale score and score for patient′s satisfaction with analgesia were recorded.The first pressing time of analgesic pump, effective pressing frequency of analgesic pump, requirement for rescue analgesia, nausea, vomiting and nerve block-related complications within 24 h after surgery were recorded. Results:Compared with group L, the incidence of diaphragmatic paralysis was significantly increased, the degree of diaphragmatic paralysis was aggravated, the first pressing time of analgesic pump and duration of sensory block were prolonged, the effective pressing times of analgesic pump was reduced, and the requirement for rescue analgesia was decreased in M and H groups, and the decrease in SpO 2 was significantly increased, and the introperative consumption of remifentanil was decreased in group H ( P<0.05). Compared with group M, the decrease in SpO 2 and incidence of diaphragmatic paralysis were significantly increased, the degree of diaphragmatic paralysis was aggravated, the first pressing time of analgesic pump and duration of sensory block were prolonged ( P<0.05), and no significant change was found in the introperative consumption of remifentanil, the effective pressing times of analgesic pump or requirement for rescue analgesia in group H ( P>0.05). There was no significant difference in the incidence of cardiovascular events, score for patient′s satisfaction with analgesia, incidence of dyspnea and extubation time, length of post-anesthesia care unit stay, Quality of Recovery-15 sacle score, and the incidence of nausea and vomiting among three groups ( P>0.05). There were no Horner syndrome and nerve block-related complications in the three groups. Conclusions:Subomohyoid aSSNB with 0.5% ropivacaine hydrochloride 10 ml provides optimal efficacy when used for subomohyiod anterior suprascapular nerve block in patients undergoing arthroscopic shoulder surgery with general anesthesia.

Objective:To investigate the diagnostic and early-warning value of laboratory test indicators for sepsis-induced myocardial injury (SIMD).Methods:The clinical data of 183 patients with sepsis admitted to the Department of Emergency and Critical Care Medicine of Guangdong Provincial People's Hospital from August 2016 to October 2020 were collected. The patient's age, gender, past medical history, vital signs and pathogen culture results were extracted. Cardiac function, blood routine, liver function, renal function, inflammatory factors, coagulation function, APACHE Ⅱ and SOFA scores were recorded at enrollment and 72 h after admission. SIMD was defined as cTnT ≥300 pg/mL and NT-proBNP ≥1243 pg/mL twice in 72 h intervals between enrolled cases, and the early-warning factors of patients with SIMD were analyzed. The differences in various indicators between the two groups were compared, and Logistic regression analysis was used to explore the diagnostic efficacy of cTnT and NT-proBNP combined for SIMD, and the correlation between PCT/PLT ratio and the occurrence of SIMD.Results:Among 250 patients, 67 patients were excluded for lack of the main indicators, and 183 patients (including 62 patients with history of cardiac disease) were enrolled finally. Among 183 patients with sepsis, 105 patients (57.38%) with cTNT ≥300 pg/mL and NT-proBNP ≥1 243 pg/mL, were diagnosed as myocardial injury; after excluding 62 patients with history of cardiac disease, 59 patients (48.76%) with cTNT ≥300 pg/mL and NT-proBNP ≥1 243 pg/mL were diagnosed as myocardial injury. Logistic regression analysis showed that increased PCT/PLT ratio ( OR=1.585, 95% CI: 1.124-2.237, P=0.009) was an independent risk factor for early-warning of SIMD. The PCT/PLT ratio ( OR= 1.850, 95% CI: 1.103-3.102, P=0.020) could stably predict the occurrence of SIMD in patients without previous history of heart disease. ROC curve analysis showed that PCT/PLT ratio could effectively predict the occurrence of SIMD (AUC=0.693, 95% CI: 0.617-0.769, P<0.001), the optimal cut-off value was 0.177 (sensitivity: 65.7%, specificity: 66.7%). The PCT/PLT ratio was still effective in predicting the occurrence of SIMD after excluding patients with previous history of heart disease (AUC=0.733, 95% CI: 0.643-0.823, P<0.001), and the optimal cut-off value was 0.429 (sensitivity: 55.9%, specificity: 83.9%). Conclusions:The combination of cTnT and NT-proBNP has certain diagnostic value for SIMD, and the PCT/PLT ratio could warn the occurrence of SIMD.

In the past 30 years, laparoscopic hepatectomy has developed rapidly, which multi-dimensionally promoted the innovation of hepatectomy technology and strategy. This is mainly attributed to the key factors such as the improvement of domestic and foreign scholars′ under-standing of liver anatomy, the conversion and application of laparotomy technology, the expansion of laparoscopic vision and the feedback in surgery related fields. The authors summarize the enlighten-ment, development, promotion and sublimation of laparoscopic hepatectomy, and discuss the classi-fication and evolution of the surgical approach of laparoscopic hepatectomy.

Objective:To compare the effects of five different types of videolaryngoscopes in patients with a simulated difficult airway.Methods:575 patients who needed endotracheal intubation in Nanjing Hospital Affiliated to Nanjing Medical University from May 2021 to September 2021 were randomly divided into 5 groups [UE videolaryngoscope group (U group), GlideScope videolaryngoscope group (G group), C-MAC videolaryngoscope group (C group), Airtraq videolaryngoscope group (A group) and A. P.advance videolaryngoscope group (AP group)], with 115 patients in each group. They all wore cervical collar to simulate difficult airway. The main observation index was the success rate of first endotracheal intubation. Secondary observation indicators included overall success rate, laryngoscope exposure field, intubation time, operator′s subjective score, cause of failure, adverse events, and complications of intubation.Results:The patients′ mouth opening degree was reduced from (46±6)mm to (24±4)mm ( P<0.05) after wearing the cervical collar; The success rate of the first endotracheal intubation were 96%(UE), 92%(C-MAC), 86%(GlideScope), 85%(Airtraq), and 60%(AP.Advance) respectively, with statistically significant difference ( P<0.05); Compared with AP group and G group, the incidence of soft tissue injury or bleeding in U group and C group were lower ( P<0.05); There were significant difference in the overall success rate of videolaryngoscopes, laryngoscope visual field exposure, intubation time, the subjective score of the operator and adverse events ( P<0.05); There was no significant difference in the complications of intubation among the groups ( P>0.05). Conclusions:Among 575 patients with a simulated difficult airway with limited neck mobility and limited mouth opening, there were significant differences in the use of five videolaryngoscopes. Among them, UE video laryngoscope had the highest first intubation success rate and lowest tissue trauma rate, C-MAC video laryngoscope, GlideScope video laryngoscope and Airtraq video laryngoscope followed in performance, while A. P.Advance video laryngoscope performed the worst.