Volume 96  ·  Issue 13  ·  2016

With the rising trend of hypertensive patients in China every year, the incidence of aortic dissection, aortic aneurysm and other diseases caused by this is also increasing year by year. In addition, the incidence of connective tissue diseases such as Marfan syndrome in China is much higher than that in western countries, and the number of aortic diseases caused by this is also higher. Aortic disease is a group of serious life-threatening diseases. Because of its urgency, complexity and danger, the surgical treatment is not only technically difficult, but also has a high mortality and disability rate. The risk assessment before surgery seriously affects the surgical decision-making, survival and prognosis of patients.

CNS-related complications have always accompanied the development of cardiovascular surgery. The complications of the central nervous system mainly include brain complications and spinal cord complications, while the complications of the central nervous system in traditional cardiac surgery are mainly brain, while the complications of the spinal cord in macrovascular surgery, especially those involving the descending arch and thoracic aorta, are much higher than those in traditional cardiovascular surgery. The main complications related to spinal cord injury are paraplegia or lower limb paresis. The incidence of this complication in thoracotomy is 2.7% ~33%^[1,2,3]In the recent development of endovascular thoracic aorta repair (TEVAR), although it is less invasive than traditional surgery, the incidence of spinal cord injury also reaches 3% ~6%^[4,5,6]。 Once these complications occur, they will increase the mortality rate of patients or decrease the quality of life, causing a great economic burden on society and families.

From the perspective of discipline development, neuroscience is one of the important frontier fields in life science, which is highly valued by governments and society. Although the development of neuroscience has achieved brilliant achievements driven by science and technology, as President Barack Obama said, "People can identify galaxies and magnetic fields tens of thousands of light years away from the Earth, and can study particles smaller than atoms. However, with current technological capabilities, people still can't fully and profoundly reveal the mystery of their own brain." Neuroscience is a great challenge for contemporary natural science. The progress of science and technology, the cross-penetration and collaboration of multiple fields and disciplines are undoubtedly the key to tackle this challenge.

To study the risk factors of severe postoperative hypoxemia after surgery for Standford type A aortic dissection and establish a prediction model.

Data of 411 consecutive patients from January 2014 to April 2015, who underwent surgery for Standford type A aortic dissection in the department of cardiovascular surgery of Beijing Anzhen Hospital, were retrospectively analyzed. All the cases were divided into two groups according to the appearance of severe postoperative hypoxemia. All the data about potential risk factors was put into the database and analyzed by logistic regression. The prediction model was then established upon acquired independent risk factors. Discrimination and calibration of the prediction model were assessed with ROC curve and Hosmer and Lemeshow goodness of fit test.

The perioperative in-hospital mortality was 6.57%(27/411). Severe postoperative hypoxemia (PaO₂/FiO₂≤100 mmHg) happened in 69 cases within 48 hours after procedures, with an incidence rate of 17.1%. The logistic regression demonstrated that body mass index (BMI), age, preoperative serum myoglobin, preoperative serum creatinine, preoperative serumalanine aminotransferase, the time of cardiopulmonary bypass, re-exploration within 48 hours after procedures were the independent risk factors for severe postoperative hypoxemia. The prediction model was then established based on these independent risk factors. The area under ROC curve of the model was 0.785, and the P value in Hosmer and Lemeshow goodness of fit test was 0.625.

The logsitic model built in this study succeeded to predict the incidence of severe postoperative hypoxemia after surgery for Standford type A aortic dissection, and it could meet the doctors' requirement with its excellent discrimination and calibration.

To evaluate the application value of evoked potentials (EP) monitoring in patients undergoing aorta-iliac bypass for total thoracoabdominal aorta aneurysm repair (tTAAAR).

A prospective study, with a total of 31 patients undergoing tTAAAR and intraoperative EP monitoring from June 2014 to April 2015 was carried out. The results of intraoperative evoked potentials, clinical outcomes and follow-up data of patients were collected for further evaluation.

The EP wave disappeared [motor evoked potentials for (55.6±18.1) min, somatosensory evoked potentials for (50.3±18.7) min] after proximal descending aorta being clamped, and gradually recovered after the segment arteries of spine cord were reconstructed. The EP wave was restored to normal level at the end of operation in all the cases. The somatosensory evoked potentials remained unchanged in 2 cases (false negative). One case died after operation. No spinal cord injury occurred. The median follow-up after operation was 10 months (5-14 months). There was no delayed neurological deficit.

EP provided an on-line monitoring of the condition of spinal cord function, which become an intraoperative protocol to avoid the irreversible injury of spinal cord.

To evaluate the safety and efficacy of cut-and-sew Cox-Maze (CM) Ⅲ procedure for patients with atrial fibrillation associated with rheumatic mitral valve disease.

Patients received mitral valve replacement and CM procedure between January 2007 and July 2015, were 1∶1 matched and assigned to CM Ⅳ group (undergoing surgical ablation) and CM Ⅲ group (undergoing cut-and-sew CM Ⅲ). Safety indices, mortality rate, complications and recovery rate of sinus rhythm were compared between the two groups.

Mean extracorporeal circulation time was (154±22) min in the CM Ⅲ group and (136±21) min in the CM Ⅳ group (P<0.001), and aortic clamp time was (85±9) min in the CM Ⅲ group and (74±12) min in the CM Ⅳ group (P<0.001). One patient (1.18%) in the CM Ⅲ group died of multi-organ failure 4 day after left ventricular rupture being sucessfully repaired, and 2 patients died (2.35%) in the CM Ⅳ group ( 1 due to left ventricular rupture and 1 due to low cardiac output syndrome). There was no significant difference in mortality between the two groups. Temporary pacemaker were applied for 76 cases (89.41%) in the CM Ⅲ and 70 cases (82.35%) in the CM Ⅳ group, without a statistical difference (P=0.186). There were also no statistical difference between the two groups in intraoperative urinary volume, postoperative drainage of fluid volume, hemoglobinuria, ventilator time, ICU time, hospital stay and the incidence of the complications (all P>0.05). Sinus rhythm recovery rate was 62.35 % in the CM Ⅲ group and 57.65 % in the CM Ⅳ group, without a statistical difference (P=0.531) at the operation day, but at discharge a statistical difference was found (97.62% in the CM Ⅲ group vs 81.93% in the CM Ⅳ group, P<0.001). All patients were followed up for three months, and no deaths occurred. Sinus rhythm recovery rate was 96.43 % in the CM Ⅲ group and 86.75% in the CM Ⅳ group, with a statistical difference (P=0.024).

The cut-and-sew Cox-Maze Ⅲ procedure is a safe and effective method for patients with atrial fibrillation associated with rheumatic mitral valve disease.

To investigate the prevalence and influencing factors of visual hallucinations in patients with Parkinson's disease(PD), and to analyze the relationship between visual hallucinations and sleep disorders.

We recruited 187 patients with PD(H-Y Ⅰ-Ⅲ) from outpatient department in Beijing Hospital. The patients were investigated for general information and the use of medicine. The patients were divided into visual hallucination(VH) group and non-hallucination(non-VH) group. A comparison study was conducted between two groups. We investigated the sleep disorders of PD patients according to Non Motor Symptom Quest(NMSquest) and Parkinson's disease sleep scale(PDSS). Logistic stepwise multiple regression procedures were used to determine the best predictive model of visual hallucinations in patients with PD.

(1) 42 cases(22.5%) of PD patients were accompanied by visual hallucinations; (2) the VH group and non-VH group had no difference in age, sex, duration of illness, the scores of Minimum Mental State Examination(MMSE) and levodopa equivalent doses (LED). The scores of Unified Parkinson's Disease Rating Scale(UPDRS) Ⅰ, the Hamilton Rating Scale for Anxiety(HAMA) and the Hamilton Rating Scale for Depression(HAMD) in VH group were significantly higher than those in non-VH group[3.5(2, 5) vs 2 (1, 3); 10(6.75, 15) vs 8(5, 11); 11(7.75, 17) vs 9(5, 13);P<0.05]; (3) the incidences of vivid dreams and REM sleep behavior disorder(RBD) in VH group were significantly higher than those in non-VH group(61.9% vs 40.7%, 71.4% vs 47.6%,P<0.05). There were no significant differences in incidences of excessive daytime sleepiness and restless legs between two groups(P>0.05). The score of PDSS in VH group was significantly lower than that in non-VH group[111(92.75, 128.25) vs 123(109, 135),P<0.05]; (4) the Logistic stepwise multiple regression revealed that vivid dreams(P=0.045) and the score of PDSS(P=0.006) were the independent influencing factors for VH in PD patients.

The incidence of VH in PD with H-Y staging Ⅰ-Ⅱ is 22.5%. The presence of vivid dreams and severe sleep disorder are independently associated with VH in PD.

To identify the sensitive scales and the early change of nerve conduction for chronic oxaliplatin-induced peripheral neuropathy (OXLIPN), and to investigate correlation between the symptoms of acute OXLIPN and chronic OXLIPN.

Between December 2014 and August 2015, 16 colorectal cancer patients confirmed by pathology, from department of Oncology, Chinese PLA General Hospital, scheduled to receive XELOX, completed the acute neurotoxic symptoms questionnaire at the end of 1 cycles and the scales of TNSc and NCI-CTC at the baseline and the end of 4 cycles. Nerve conduction studies (bilateral peroneal nerves and sural nerves) were performed in 11 patients at the baseline and the end of 4 cycles.

After chemotherapy, TNSc increased 1-9 points for all cases, while NCI-CTC increased 1 point for only 9 cases, the remaining 7 cases had the same NCI-CTC score before and after chemotherapy, where TNSc increased 1-6 points. Left sural nerve a-SNAP (amplitude of sensory nerve action potential) was (15.3±5.8)μV before chemotherapy and(12.3±5.0)μV after chemotherapy. Right sural nerve a-SNAP was (17.4±8.6)μV before chemotherapy and (13.3±6.7)μV after chemotherapy. After chemotherapy, these datum were significantly reduced for left peroneal nerve distal and proximal a-CMAP (amplitude of compound muscle action potential), bilateral sural nerve a-SNAP and left sural nerve SCV (sensory conduction velocity) (P<0.05). After chemotherapy, TNSc was correlated significantly with the acute neurotoxic symptoms questionnaire (Spearmanr=0.698, P=0.003).

TNSc is more sensitive to the severity and changes in chronic OXLIPN than NCI-CTC. Sural nerve a-SNAP has a higher sensitivity for the early changes of nerve conduction studies in chronic OXLIPN. Patients who have more symptoms of acute OXLIPN are those who eventually develop more severe chronic OXLIPN.

To explore the effect of icariin on the proteomic expression profile of bone microvascular endothelial cells of human femoral head against steroids-induced lesion using protein chip system in vitro.

Bone microvascular endothelial cells (BMECs) in cancellous bone of femoral head were isolated and harvested in vitro.The model of BMECs injury induced by glucocorticoid and icariin preconditioning was established. The apoptosis of BMECs were detected with terminal-deoxynucleoitidyl transferase mediated nick end labeling (TUNEL)methods. The proteomic expression profile of BMECs in each group were detected by protein chip system.

The apoptosis rates of hydrocortisone groups (46.9%±5.8%, 78.0%±8.5%) were significantly higher than that of normal group(4.8%±1.3%), meanwhile the apoptosis rate of icariin+ hydrocortisone groups(15.2%±7.7%, 44.6%±5.3%)significantly decreased compared with hydrocortisone group (P<0.001). The results of protein chip showed that the expression of granulocyte colony-stimulating factor (G-CSF) in the hydrocortisone group decreased compared with the control group, meanwhile the expression of IL-4 increased. The expression of G-CSF in the icariin+ hydrocortisone groups increased compared with the hydrocortisone group, meanwhile the expression of IL-4 decreased.No appreciable change was found in the expression of apoptotic factors.

The therapy effect of icariin for steroid-induced necrosis of femoral head might be related with the protective action to BMECs and the moderating effect of promoting the proteins expression of pro-angiogenesis factor and inhibiting expression of inflammatory factor.

To explore the relevant factors associated with the surgical efficacy and prognosis of seizures in patients with low-grade glioma (LGG).

The clinical cases of seizures in patients with LGG admitted to our department were retrospectively collected from January 2010 to December 2014. A total of 45 cases were studied to analyze the relevant factors associated with the surgical efficacy and prognosis.

During a follow-up period of 1 to 5 years after surgery, Engel classⅠ to Ⅱ were achieved in 36 patients (80%) and Engel class Ⅲ to Ⅳ in 9 cases (20%). The preoperative epilepsy frequency and the use of intraoperative electrocardiograph (ECoG) were correlated with the surgical efficacy and prognosis (P<0.05). The other factors, such as age, gender, duration of epilepsy, and tumor characteristics, had no significant statistical difference.

The surgical efficacy of seizures in patients with LGG is favorable. Our results suggest that preoperative epilepsy frequency and intraoperative ECoG are important factors for surgical efficacy and prognosis. Consequently, based on gross total resection for seizures in patients with LGG, epileptogenic zones should be considered and dealt with by use of ECoG.

To provide evidence for establishing standardized treatment strategy of severe anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in China, by demonstrating the clinical characteristics and comparing the treatment strategy with that adopted in foreign countries.

A total of 35 hospitalized cases who met the diagnostic criteria for severe anti-NMDAR encephalitis were retrospectively analyzed. Demographic data, clinical history, past medical history, laboratory tests, imaging studies, treatment and the follow-up information were recorded using unified forms.

Mental and behavioral abnormalities, seizures and consciousness disturbance occurred in all cases; involuntary movements, speech disorders, memory loss, central hypoventilation and autonomic dysfunction happened in 45%-65% of cases. Sixteen patients (45.71%) required mechanical ventilation. Modified Rankin score (mRS ) arranged 4-5 (mean mRS 4.86). The percentage of patients with elevated intracranial pressure, white blood cell and protein in cerebrospinal fluid were 42.86%, 60.00%, and 14.29%, respectively. Abnormal findings in brain magnetic resonance imaging scan happened in 31.43% cases, located in frontal lobe, temporal lobe, insular lobe, hippocampus, cingulate gyrus, corpus callosum, brain stem, and cerebellum. All cases received intravenous immunoglobulin, for one to maximum seven cycles, with an average of three cycles. 91.43% of cases received glucocorticoid therapy, including 54.29% of cases received high-dose methylprednisolone. Two patients (5.71%) received plasma exchange. Five patients(14.29%) received second-line therapy including rituximab for 4 patients and intravenous cyclophosphamide (CTX) for one. Fifteen patients(42.86%) received long-term immunosuppression therapy. All cases acquired improvement after immunotherapy and were transferred out from ICU, the median ICU time was 46 days and median hospitalized duration was 72 days. The mRS were 5 for 2 cases, 1-4 for the rest patients, and no patient died during hospitalization. During a median follow-up period of 17.6 months, 30 of 35 patients (85.71%) achieved complete recovery or a good outcome (mRS 0-2). Eleven patients (31.43%) relapsed. One patient(2.90%) died 2 years after discharge.

Intravenous immunoglobulin combined with high-dose methylprednisolone therapy is effective for severe anti-NMDAR encephalitis. Retrial of the first-line immunotherapy is an option for initially unresponsive cases.

To observe the diagnostic efficiency of gemstone spectral CT imaging in diagnosis of solitary pulmonary nodule (SPN).

A total of 114 patients with SPN proved by pathology (from the First Affiliated Hospital of Zhengzhou University and 13 cooperative hospitals) underwent spectral CT from July 2014 to July 2015.All the patients were divided into malignant group(63 cases), inflammatory group(32 cases) and tuberculosis group(19 cases) .Iodine concentration(IC), normalized iodine concentration(NIC) and slope rate of spectral curve(40-80 keV) in both arterial and venous phase were measured and calculated.The one-way ANOVA and LSD were used to analyze parameters among 3 groups.ROC curves were taken to calculate the diagnostic efficiency and the diagnostic sensitivity and specificity .

IC, NIC and slope rate of spectral curve had statistically significant differences in both phases (all P<0.05). The malignant group was the highest, and the tuberculosis group was the lowest(allP<0.05). When NIC(venous phase)>0.31, NIC>0.28, NIC>0.21, the sensitivity of diagnosing malignant and inflammatory SPN, malignant and tuberculosis SPN, inflammatory and tuberculosis SPN were respectively 81.0%, 85.7%, 84.4%, and the specificity of them were 71.9%, 94.7%, 84.2%, respectively.

Spectral CT imaging is helpful to diagnosis of SPN, and venous phase NIC can get high sensitivity and specificity for qualitative diagnosis of SPN.

To explore the effect of chronic subdural hematoma external drainage surgery using self-made "H shaped" flush type single-tube double-lumen drainage tube.

There were 56 cases chosen from the First Affiliated Hospital of Bengbu Medical College between Jan 2013 and Aug 2015. These patients with unilateral chronic subdural hematoma requiring surgery to place drilling external drainage catheter were randomly divided into group A (21 cases, using self-made single-tube double lumen "H shaped" drainage tube) and group B (35 cases, traditional silicone drainage tube), then the residual liquid volume after drainage on the first day, the days that the tube stay in body and the residual fluid volume after removing the tube were compared between the two groups.

The residual liquid volume after drainage on the first day in group A was (23±15)ml, in group B was (31±15)ml. The days that the tube stay in body in group A was (2.7±1.0)d, in group B was (3.3±1.1)d, the two groups had statistical differences (P<0.05). The residual fluid volume after removing the tube in group A was (13±7) ml, in group B was (16±8)ml, but the data in these two groups had no significantly statistical differences (P>0.05).

The effect of self-made "H shaped" flush type single-tube double-lumen drainage tube in the drainage of chronic subdural hematoma drainage is good, with short tube stay in the body; therefore, it is a safe and effective way to treat chronic subdural hematoma, and is worthy of clinical application.

To explore the therapeutic potential of transplantation of adipose derived mesenchymal stem cells (ADMSCs) in rats osteoarthritis caused by anterior cruciate ligament transection.

Rats peritoneal adipose tissues were used to extract ADMSCs.Cell morphological appearance was documented and flow cytometric cell cycle was used to identify ADMSCs. Anterior cruciate ligament transection was used to induce knee osteoarthritis in rats. ADMSCs were injected into the knee cavities. Knee joint pathology was performed to observe the treatment effects. QRT-PCR and Western blot were used to identify the targets of ADMSCs.

ADMSCs were successfully extracted, separated, cultured and identified. Two and eight weeks after ADMSCs transplantation, pathology showed significantly attenuation of arthritis including osteophyte and synovitis, reflecting in significantly improvement of both osteophyte and synovitis grading compared to the controls. QRT-PCR and Western blot revealed that collagen Ⅱ expression was significantly up-regulated after ADMSCs transplantation compared to the controls.MMP-13, but not other MMP-1, MMP-3 or MMP-9 was reduced when ADMSCs were co-cultured with primary chondrocytes. DDR-2 expression in chondrocyte was heavily up-regulated when stimulated by TNF-αin vitro. However, ADMSCs could reverse the effect when co-cultured with chondrocyte, implying that ADMSCs may suppress the expression of DDR-2. IL-1β suppressed the cartilage differentiation of ADMSCs, and Actinomycin D (DDR-2 inhibitor) could reverse the effect.

ADMSCs can attenuate osteoarthritis induced by anterior cruciate ligament transection in rats by suppressing the expression of MMP-13, and the upstream target spot may be DDR-2.

To investigate the effect of hepcidin downregulation on the osteogenesis metabolism and involved mechanism based on the construction of hepcidin green fluorescent protein (GFP) in the transgenic zebrafish.

The eggs of zebrafish were transfected by hepcidin GFP plasmid by microinjection in half an hour after fertilization. The expression of hepcidin in the zebrafish was checked every 6 hours for 120 hours.Iron staining change was done in the larvae of zebrafish transfected by ATG morpholine and GFP plasmid compared with wild type in 4 days in the same conditions.Alizarin red staining of bone and cartilage was performed in 9 days and the expression of bone metabolic cDNA differences was analysed with real-time PCR on 4th day.

Hepcidin expressed begin on 72 hours and strongest in 96 hours on GFP transgenic zebrafish.Iron staining was significantly darker than the GFP-control type on 4th day. Alizarin red staining became shallow and ribs and caudal fin did not change furthermore in zebrafish transfected by ATG morpholine. PCR related metabolic gene expression was expressed down in zebrafish transfected by ATG morpholine.

Hepcidin expressed strongest on GFP transgenic zebrafish on 96 hours. The inhibition of hepcidin caused iron accumulation and lowered the osteogenesis led to retardation and reduction of bone in zebrafish.

Comparative study of delivery mode and perinatal outcomes in women with premature rupture of membranes at term compared to those with intact membranes.

A cross sectional survey of all deliveries in 39 hospitals in 3 geographic regions of mainland China from January 1 to December 31, 2011 was carried out to investigate the demographic data and delivery outcomes.

In our analysis of 103 124 pregnancies, 14 073(13.6%) were complicated by premature rupture of membranes. Compared to those with intact membrane, the risks of postpartum hemorrhage, maternal complications and neonatal complications were increased significantly for women with premature rupture of membranes at term, especially the prevalence of neonatal respiratory distress syndrome(NRDS) and meconium aspiration syndrome. The risk of low Apgar (<7) at 1 minute was decreased for women with premature rupture of membranes at term.

The adverse perinatal outcomes are slightly higher in women with term premature rupture of membranes than those with intact membrane.

A 33-year-old female, G₁P₀The main reason was "menopause for 61 days, vaginal bleeding for 22 days, lower abdominal pain for 3 days, and syncope for one admission". The patient underwent ovulation induction artificial insemination in a hospital 47 days ago, and postoperative B-ultrasound showed that 3 eggs were discharged. The patient had a small amount of vaginal bleeding without obvious trigger 22 days ago, and B-ultrasound showed that fetal sac was visible in the uterus (Figure 1，Figure 2), blood human chorionic gonadotropin (HCG) 4 475 U/L, given intramuscular progesterone 20 mg for abortion protection. B-ultrasound was re-examined in the external hospital 9 days ago, which indicated that the embryo was stopped. Uterine curettage was performed in the external hospital 7 days ago, and villus tissue was seen during the operation. Postoperative review B-ultrasound: the endometrium was clear, and no abnormal mass was found in the left adnexal area (Figure 3，Figure 4)。 The patient experienced continuous aggravation of left lower abdominal pain without trigger 3 days ago, accompanied by anal distension, and fainting when going to the toilet. Emergency admission with blood pressure 100/70 mmHg (1 mmHg =0.133 kPa) and pulse 98 beats/min. Emergency blood HCG 756.51 U/L, hemoglobin 99 g/L; Hematocrit 30%. Emergency B-ultrasound showed that 5.5 cm heterogeneous mass could be seen in the left adnexal area, 1.7 cm diameter without echo could be detected in the center, and 0.7 cm diameter fetal bud-like structure could be seen inside, without obvious fetal heart beat; A 3.6 cm liquid dark area was visible in the left lower abdomen (Figure 5，Figure 6)。 0.8 ml of dark red non-coagulant blood was extracted from the posterior fornix puncture. Considering intraabdominal hemorrhage, ectopic pregnancy is highly likely. Urgent laparoscopic exploration. Intraoperative detection: the ampulla of the left fallopian tube was enlarged to form a 6.0 cm ×2.0 cm mass, and a blood clot was seen at the umbrella end, with active bleeding. When the mass was incised, aggravated tissue and blood clot were seen, which resembled villi, and the size of both ovaries was normal. Non-coagulation and blood clots in the pelvic cavity 1 600 ml. Postoperative pathology confirmed that the villus structure could be seen in the samples submitted for examination. The patient recovered well after postoperative follow-up.

Acute respiratory distress syndrome (ARDS) is a common clinical critical disease that seriously threatens the life of patients. It is urgent to explore the early and effective treatment of ARDS. The basic pathological damage of ARDS is the extensive damage of lung parenchyma cells, especially lung microvascular endothelial cells and alveolar epithelial cells^[1]But the self-repair ability of injured lung tissue is limited^[2]。 The methods to promote the early and effective repair of pulmonary microvascular endothelial cells and alveolar epithelial cells, and to realize the effective reconstruction of alveolar structure are the key and difficult points of current research. Exogenous mesenchymal stem cell (MSC) transplantation provides a new possible therapeutic approach for the repair of ARDS injured cells, but an important factor for the success of MSC transplantation is whether MSC can be homed in the corresponding tissues at the later stage of transplantation.

Sphingolipid is the main component of eukaryotic cell membrane. Ceramide-1-phosphate, sphingosine and sphingosine 1-phosphate (S1P) are important metabolites of sphingolipid. They are widely involved in and regulate many biological processes such as cell proliferation and apoptosis, cell migration, angiogenesis, immune response and inflammation. Recent studies have found that sphingolipid metabolites are involved in the development of rheumatoid arthritis (RA), inflammatory bowel disease, dermatomyositis and subacute cutaneous lupus erythematosus, and their signaling pathways may be potential targets for the treatment of autoimmune diseases^[1], suggesting the importance of focusing on the role of these metabolites in autoimmune diseases. The research progress of S1P in RA is summarized as follows.

obstructive sleep apnea syndrome (OSAS) is a clinical syndrome characterized by hypopnea and apnea caused by repeated partial or complete collapse of the respiratory tract during sleep, resulting in multiple system organ dysfunction, including hypertension, pulmonary hypertension, cardiovascular disease, glucose intolerance, sexual dysfunction, gastroesophageal reflux, and a series of neuropsychiatric^[1]and cerebrovascular diseases. Polysomnogram (PSG) surveillance is currently the best means to diagnose this disease. OSAS is characterized by repeated hypopnea and apnea during sleep, resulting in disordered sleep structure, increased nocturnal awakening times and micro-awakening index, and hypoxemia and hypercapnia. In recent years, the cognitive dysfunction caused by OSAS has been widely concerned by scholars at home and abroad^{[2,3,4,5,6,7,8]}The most common manifestations are executive function, learning and memory, and delayed recall function. This article reviews the research progress on the characteristics, mechanism, clinical evaluation and treatment of cognitive dysfunction in OSAS patients, so as to provide help for early clinical prevention and treatment.