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.

In order to further standardize the vaccination of kidney transplant candidates and recipients in China, the Branch of Organ Transplantation of Chinese Medical Association has organized experts in kidney transplantation and infectious diseases. Based on the "Vaccination of Solid Organ Transplant Candidates and Recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice", and in combination with the clinical reality of infectious diseases and vaccination after organ transplantation in China, as well as referring to relevant recommendations from home and abroad in recent years, these guidelines are formulated from aspects such as epidemiology, types of vaccines, vaccination principles, target population, and specific vaccine administration. The "Guidelines for Vaccination of Kidney Transplant Candidates and Recipients in China" aims to provide theoretical reference for medical workers in the field of kidney transplantation in China, regarding the vaccination of kidney transplant candidates and recipients. It is expected to better guide the vaccination of kidney transplant candidates and recipients, reduce the risk of postoperative infection, and improve survival outcomes.

Objective To understand the sleep status in patients with Parkinson's disease (PD), and to explore its relationship with dyskinesia and negative emotions. Methods A total of 308 patients with PD who met the inclusion and exclusion criteria in the hospital from September 2022 to May 2024 were selected as the research subjects. The scores of sleep status [Pittsburgh Sleep Quality Index (PSQI)], dyskinesia [Simplified Fugl-Meyer Motor Assessment (FMA)] and negative emotions [Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II)] were analyzed, and the PSQI score was compared among patients with different demographic characteristics. Pearson correlation analysis was performed to analyze the correlation of sleep with dyskinesia and negative emotions in patients with PD. Results The total score of PSQI scale was (6.16±0.97) points in 308 PD patients, of which 208 cases (67.53%) were complicated with sleep disorders. The proportions of female, 61-75 years old, technical secondary school or below, disease course of 4 years and above, Hoehn-Yahr stage IV and unmarried status in the sleep disorder group were higher than those in the non-sleep disorder group (P<0.05). Compared with the non-sleep disorder group, the FMA score in the sleep disorder group was lower (P<0.05) while the BAI score and BDI-II score were higher (P<0.05). Pearson correlation analysis revealed that PSQI was negatively correlated with FMA (r=-0.489, P<0.05), and was positively correlated with BAI and BDI-II (r=0.476, 0.502, P<0.05). Conclusion The incidence rate of sleep disorders in PD patients is high. PSQI is negatively correlated with FMA, and is positively correlated with BAI and BDI-II.

Objective To evaluate the radiation impact of a self-developed digital miniature CT on the human body and the environment under simulated scanning conditions, and verify its safety and regulatory compliance. Methods Under typical head scanning conditions with the digital miniature CT (70 kV/10 mA), the equivalent doses received at the body surface sites corresponding to the thyroid, breast, stomach, liver, kidney, and gonads of the phantom were measured without protection and with 0.5 mmPb equivalent protection using LiF (Mg, Cu, P) thermoluminescent dosimeters. The ambient dose equivalent rates at the bed level inside the CT room at different directions and distances from the scanning center were measured using a model AT1121 X/γ dosimeter. The equivalent doses of organs on both sides of the phantom and the ambient equivalent dose rates on the left and right sides of the longitudinal axis of the bed in the CT room were compared. The Mann-Whitney test was used at a significance level of P < 0.05. Results During a single scan of the head with the digital miniature CT, the equivalent doses at the body surface sites corresponding to the thyroid, breast, stomach, liver, kidney, and gonads without protection were 1.04, 0.95, 0.55, 0.57, 0.40, and 0.12 mSv, respectively, which were only 0.84% to 8.24% of the doses inside the irradiation field. With 0.5 mm Pb equivalent protection, the equivalent dose of the thyroid decreased from 8.24 mSv to 3.27 mSv with a reduction of 60.3%, and the doses of the other organs were reduced to 1.5-11.5 μSv with the maximum reduction of 14 times. In the longitudinal axis direction of the CT bed, the ambient dose equivalent rate at a distance of 2 m from the scanning center was reduced to 0.066 mSv/h, which was only 9.6% of the ambient equivalent dose rate at a distance of 50 cm from the scanning center. Conclusion The digital miniature CT has advantages in ensuring patient safety, optimizing imaging quality, and promoting technological development, demonstrating promising application potential. However, the radiation protection of personal and CT room should not be ignored.

As a serious cardiovascular disease, atherosclerosis (AS) causes chronic inflammation and oxidative stress in the body and poses a threat to human health. Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a member of the phospholipase A2 (PLA2) family, and its elevated levels have been shown to contribute to AS. Lp-PLA2 is closely related to a variety of lipoproteins, and its role in promoting inflammatory responses and oxidative stress in AS is mainly achieved by hydrolyzing oxidized phosphatidylcholine (oxPC) to produce lysophosphatidylcholine (lysoPC). Moreover, macrophage apoptosis within plaque is promoted by localized Lp-PLA2 which also promotes plaque instability. This paper reviews those researches of Chinese medicine in treating AS via reducing Lp-PLA2 levels to guide future experimental studies and clinical applications related to AS.
Humans ; 1-Alkyl-2-acetylglycerophosphocholine Esterase ; Medicine, Chinese Traditional ; Atherosclerosis/drug therapy* ; Lipoproteins ; Plaque, Atherosclerotic ; Biomarkers

To promote the development of extracellular vesicles of herbal medicine especially the establishment of standardization, led by the National Expert Committee on Research and Application of Chinese Herbal Vesicles, research experts in the field of herbal medicine and extracellular vesicles were invited nationwide with the support of the Expert Committee on Research and Application of Chinese Herbal Vesicles, Professional Committee on Extracellular Vesicle Research and Application, Chinese Society of Research Hospitals and the Guangdong Engineering Research Center of Chinese Herbal Vesicles. Based on the collation of relevant literature, we have adopted the Delphi method, the consensus meeting method combined with the nominal group method to form a discussion draft of "Consensus statement on research and application of Chinese herbal medicine derived extracellular vesicles-like particles (2023)". The first draft was discussed in online and offline meetings on October 12, 14, November 2, 2022 and April and May 2023 on the current status of research, nomenclature, isolation methods, quality standards and research applications of extracellular vesicles of Chinese herbal medicines, and 13 consensus opinions were finally formed. At the Third Academic Conference on Research and Application of Chinese Herbal Vesicles, held on May 26, 2023, Kewei Zhao, convenor of the consensus, presented and read the consensus to the experts of the Expert Committee on Research and Application of Chinese Herbal Vesicles. The consensus highlights the characteristics and advantages of Chinese medicine, inherits the essence, and keeps the righteousness and innovation, aiming to provide a reference for colleagues engaged in research and application of Chinese herbal vesicles at home and abroad, decode the mystery behind Chinese herbal vesicles together, establish a safe, effective and controllable accurate Chinese herbal vesicle prevention and treatment system, and build a bridge for Chinese medicine to the world.

Objective To evaluate the clinical effect of total optic nerve canal decompression in the treatment of traumatic optic neuropathy(TON)without photoreceptor.Methods The clinical data of 67 patients with no photoreceptor TON admitted to Department of Neurosurgery of the Shanghai Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine from January 2015 to December 2021 were selected for retrospective analysis,in which 37 cases in observation group received total optic nerve canal decompression surgery and 30 cases in control group received non-total optic nerve canal decompression surgery.Both groups received high-dose glucocorticoid therapy and oral administration of methylcobalamin before surgery.The visual acuity changes and complications after admission and treatment were examined and recorded in both groups.The effective rate,unblinding rate and complications after treatment were compared between the two groups.Results There were no statistically significant differences between observation group and control group in terms of age,gender,time from injury to surgery,preoperative GCS score,operative time,and intraoperative bleeding volume(P>0.05).After treatment,the effective rate of observation group was 54.1%and the unblinding rate was 35.1%,while the effective rate of control group was 46.7%and the unblinding rate was 33.3%;there was no statistically significant difference between the effective rate and unblinding rate of the two groups(P>0.05).No serious complications such as cerebrospinal fluid leakage,epilepsy,and intracranial infection occurred in both groups after surgery.In observation group,the effective rate after treatment was significantly lower in those with optic nerve canal fractures than that in those without optic nerve canal fractures(P<0.05);the effective rate was significantly higher in patients with injury-to-operation time≤7 d than that in patients with injury-to-operation time>7 d(P<0.05).Conclusion Total optic nerve canal decompression can improve the visual acuity of patients without photoreceptor TON and reduce the blinding rate,which is an effective surgical treatment method.

Objective:To investigate the application of phase angle by bioelectrical impedance in the assessment of malnutrition and its correlation with nutrtition status as measured by several different screening tools in patients on maintenance hemodialysis (MHD).Methods:This was a cross-sectional study, including 151 patients on MHD. Bioelectrical impedance analysis was used to detect body composition in hemodialysis patients. Nutritional Risk Screening 2002 (NRS 2002) scores, body mass index (BMI) and the Global Leadership Initiative on Malnutrition (GLIM) criteria were used to investigate the prevalence of malnutrition in MHD patients. The correlation between phase angle and nutrition-related indicators such as visceral fat area, body weight, skeletal muscle, and serum albumin in MHD patients was analyzed, and the consistency between phase angle and the three screening tools was examined.Results:In a total of 151 patients on MHD, the malnutrition prevalence as measured by BMI, NRS 2002 score and GLIM criteria was 9.27%, 27.81% and 54.97%, respectively. Phase angle in MHD patients was positively correlated with BMI( P<0.01), negatively correlated with impaired nutrition score of NRS 2002( P<0.01), and also associated with nutrition screening results as measured by GLIM criteria( P<0.001). Further study showed that phase angle was positively correlated with body weight, skeletal muscle and serum albumin( P<0.01), but negatively with visceral fat area and extracellular water/total body water( P<0.01). Conclusions:Malnutrition is highly prevalent in MHD patients. Phase angle showed good consistency with BMI, NRS 2002 and GLIM criteria in terms of malnutrition screening, implying the potential application in the assessment of malnutrition in MHD patients. However, the clinical relevance still needs corroboration with future large-scale researches.

Objective:To evaluate the effect of low-dose recombinant interleukin-2(rIL-2)therapy on immunocyte subsets and its side effects in children with solid tumor.Methods:A total of 22 children(11 males and 11 females)with solid tumor in our department from December 2012 to November 2017 were selected,with a median age of 9(3-16)years old when starting IL-2 therapy.ALL surgeries and chemotherapy of children had been completed before low-dose rIL-2 therapy,and 17 cases achieved complete remission(CR)and 5 cases achieved partial remission(PR).A low-dose rIL-2 therapy was given 1 month after chemotherapy for 1 year:4 × 105 IU/(m2·d),s.c.for every other day,3 times per week.The immunocyte subsets were detected every 3 months until the end of treatment,meanwhile,disease condition and therapy-related side effects were followed up.Results:After low-dose rIL-2 therapy in 22 children,the absolute values of CD3+T cells,CD3-CD56+natural killer cells,CD3+CD4+helper T cells(Th)and CD3+CD8+cytotoxic T cells were up-regulated remarkably,as well as Th/suppressor T cells(all P＜0.05).While,there were no significant differences in absolute value and proportion of CD4+CD25+CD127-Treg cells during therapy.Among the 17 children who achieved CR before rIL-2 therapy,14 cases continued to maintain CR after therapy,while 3 cases relapsed,and with 2 died after treatment abandonment.The 5 children who achieved PR before low-dose rIL-2 therapy were evaluated CR by PET/CT scan after treatment.In the early stage of low-dose rIL-2 therapy,1 child developed skin rashes at the injection sites,and 2 children ran a slight to mild transient fever.Their symptoms disappeared without any organ damage after symptomatic treatment.Conclusion:Low-dose rIL-2 therapy has good drug tolerance,and changes the distribution of anti-tumor immune-cell subgroup in peripheral blood of children with solid tumor remarkably without up-regulation of absolute value and ratio of Treg cells.

Objective To investigate the effect of circular RNA(circRNA)ACAP2 on myocardial injury in MI rats by regulating the miR-421/B cell translocation gene 2(BTG2)axis.Methods A rat MI model and an H9c2 myocardial cell model were constructed.A total of 80 rats were divided into sham operation group,MI group,small interfering RNA-negative control(si-NC)group,si-circACAP2 group,overexpression control(pcDNA3.1)group,pCDNA3.1-circACAP2 group,pCDNA3.1-circACAP2+mimic NC group,and pCDNA3.1-circACAP2+miR-421 mimic group,with 10 rats in each group.H9c2 cells were divided into hypoxia group,hypoxia+si-NC group,hypoxia+si-circACAP2 group,hypoxia+pcDNA3.1 group,hypoxia+pcDNA3.1 circACAP2 group,hypoxia+pcDNA3.1 circACAP2+mimic NC group,hypoxia+pcDNA3.1 circACAP2+miR-421 mimic group,and control group.LVEF,LVFS,myocardial infarction,pathological chan-ges of myocardial tissue,and circACAP2,miR-421 and BTG2 mRNA expression,LDH,CK-MB activity,H9c2 cardiomyocyte viability and apoptosis,BTG2 protein expression in myocardial tis-sue,and BTG2 protein expression in H9c2 cardiomyocytes were detected in each group.Results Compared with the sham operation group,higher mRNA levels of circACAP2(1.84±0.21 vs 1.00±0.10)and BTG2(1.68±0.17 vs 1.00±0.10),larger infarct size,stronger activities of CK-MB and LDH,while decreased expression of miR-421(0.49±0.05 vs 1.00±0.11)and LVFS and LVEF values were observed in the MI group(P＜0.05).Compared with the si-NC group,the si-circACAP2 group had alleviated myocardial injury,increased LVFS and LVEF values,and decreased infarct size and CK-MB and LDH activities(P＜0.05).Significantly increased cell via-bility,and reduced apoptotic rate and CK-MB and LDH activities were observed in the hypoxia+si-circACAP2 group than the hypoxia+si-NC group(P＜0.05).Compared with the pcDNA3.1 group,myocardial injury was aggravated,LVFS and LVEF were decreased,and infarct size and CK-MB and LDH activities were increased in the pcDNA3.1-circACAP2 group(P＜0.05);Com-pared with the hypoxia+pcDNA3.1 group,the hypoxia+PCDNA3.1-circACAP2 group signifi-cantly decreased cell viability,and enhanced apoptotic rate and CK-MB and LDH activities(P＜0.05).Conclusion circACAP2 is up-regulated in MI rats and H9c2 cells,and silencing circACAP2 may improve cardiac function,reduce myocardial injury,and increase cardiomyocyte viability by regulating miR-421/BTG2 axis.