Volume 95  ·  Issue 42  ·  2015

Good sleep is very important to restore physical strength, relieve fatigue, maintain abundant energy, promote early recovery of diseases and enhance the ability of body to resist diseases. However, due to the special environment such as hypoxia, cold and dryness, people living in the plateau, especially newcomers, will have different degrees of sleep breathing disorders, such as frequent awakening, sleep hypopnea, periodic breathing and apnea. Because of plateau hypoxia causes respiratory disturbances, thus causing further hypoxia. Severe hypoxia will damage brain function, which is manifested as weakness in the morning, headache in the morning, dizziness, memory loss, slow response, abnormal behavior and sexual dysfunction.

Sleep disorders of breathing (SDB) related diseases have gained more and more attention, among which obstructive sleep apnea hypopnea syndrome (OSAHS) is the most common, with a prevalence of 2% to 4% in middle-aged people^[1]。 Although great progress has been made in the pathogenesis and epidemiological investigation of OSAHS and other diseases, there are few studies on the sleep health status of the bedmate of SDB patients. In 1987, Cartwright and Knight^[2]It is mentioned for the first time that the bedmate of SDB patients actually also has sleep quality problems. Subsequent studies mentioned that OSAHS couples have poor sleep quality, marital relationship and personal relationship, and even make marriage a burden for some couples with OSAHS^[3,4]。 However, given the insufficient attention paid to SDB disease itself at that time, the problem of sleep quality for bedmates was naturally ignored. Until 2003, Ashtyani and Hutter^[5]Explicitly suggest that sleep health problems in bedmates are one of the collateral harms caused by SDB. With the in-depth discussion of this issue, it gradually aroused people's attention to this part of the population. In the past 10 years, the research on the sleep problem of the bedmate of SDB patients has involved many aspects of clinical, psychological and social psychology, but all of them are small-scale clinical observation data. In order to further understand the severity of collateral injury of SDB to patients' bedmate and its impact on society, it is expounded as follows in combination with relevant research at home and abroad.

To evaluate the clinical utility of four questionnaires of Berlin, STOP, STOP-Bang(SBQ) and Epworth Sleepiness Scale(ESS) in the screening of patients with obstructive sleep apnea(OSA).

A total of 350 consecutive patients(302 males and 48 females, 19-86 years old, average(42.9±11.0) years old) with suspected OSA who underwent an overnight polysomnography(PSG) were recruited into this study. Four questionnaires of Berlin, STOP, SBQ and ESS were completed. Based on the severity of OSA which was determined by apnea-hypopnea index(AHI), the patients were classified into four groups of primary snoring(<5 events/h), mild(5-<15 events/h), moderate(15-<30 events/h) and severe OSA(≥30 events/h). Sensitivity, specificity, positive predictive values, negative predictive values and the area under the receiver operating characteristics curve of four questionnaires were calculated.

Using mild-moderate-severe(≥5 events/h), moderate-severe(≥15 events/h), and severe(≥30 events/h) OSA as cutoffs, SBQ had the highest sensitivity(94%, 94% and 95%, respectively). Berlin Questionnaire had the largest area under the receiver operating characteristics curve(0.784, 0.732, and 0.771, respectively). ESS had the lowest sensitivity(43%, 45% and 48%, respectively).

Compared to the PSG, SBQ questionnaire has the highest sensitivity, but lower specificity; in contrast, Berlin questionnaire may have better accuracy.

To explore the value of actigraphy and oximetry for diagnosing sleep apnea-hypopnea syndrome(SAHS).

Suspected SAHS subjects were enrolled from sleep center of Peking University People's Hospital between December 2013 and September 2014. Light-out and light-on were simultaneously recorded for polysomnography(PSG), actigraphy and oximetry. Actigraphy was used to correct total sleep time(TST) for oximetry. Oxygen desaturation index(ODI₄), namely the times of pulse oxygen saturation(SpO₂) drop≥4% per hour, was detected by oximetry. ODI_A was used instead of ODI₄ with TST corrected by actigraphy. Receiver operating characteristic(ROC) curve was used for evaluating the value of ODI₄ and ODI_A for diagnosing SAHS and cut-off value was calculated. Paired t-test or signed rank t-test was used for data acquired using actigraphy or oximetry compared with data acquired by PSG. Sensitivity and specificity were calculated using fourfold table. Disease severity of SAHS was classified by apnea-hypopnea index(AHI) detected by PSG. If AHI<5/h, SAHS was not considered. 5-<15/h was classified as mild, 15-<30/h was classified as moderate and AHI≥30/h was classified as severe.

Among 213 SAHS subjects, 38 of them were normal, 34 of them were mild, 51 were moderate and 90 were severe. Compared with PSG, actigraphy can correctly estimate TST in non-SAHS(P=0.408) and mild SAHS groups(P=0.949); while in moderate and severe SAHS groups, TSTs detected by actigraphy were shorter than TSTs acquired by PSG((405±51) vs(419±40) min and(399±62) vs(422±60) min)(both P<0.05). Area under ROC curve(AUC) of ODI₄ for diagnosing SAHS was 0.956 using a cut-off value of 5; the AUC of ODI_A for diagnosing SAHS was 0.951 with a cut-off value of 5 as well. The sensitivity of ODI₄ for mild, moderate and severe SAHS was 80.6%, 66.7% and 58.9% respectively, all with a specificity of 100%. After adjusting TST with actigraphy, the sensitivity of ODI_A for mild, moderate and severe SAHS was 84.0%, 73.8 % and 68.9%, with specificity of 94.7%, 100% and 99.2% respectively.

Actigraphy can correctly estimate TST in non-SAHS and mild SAHS groups. ODI₄ can be used for diagnosing SAHS. After correcting TST by actigraphy, the sensitivity of ODI_A is higher.

To compare young males' sleep quality and structure between native Tibetans and longtime Han residents.

A total of 14 male Tibetans and 11 male Hans at an altitude of 3 780 m were enrolled in this study. Tibetans were native highlanders with a mean age of(32.0±9.1) years.Han subjects were born and living in high altitude with a mean age of(36.6±7.6) years.All subjects were monitored by Polysomnography(PSG), and the differences of sleep structure and quality between the two groups were compared according to the international standard.

The sleep efficiency(93.1%±3.9% vs 85.7%±4.2%) and nocturnal oxygen saturation(SpO₂)(89.4%±2.0% vs 84.6%±4.3%) in Tibetans was significantly higher than those in Hans(both P<0.05). The number of awakening((1.9±0.8) vs(4.1±1.3)/h) and micro-awakening((23.4±5.8) vs(28.7±4.1)/h), the oxygen reduction index((11.7±4.8) vs(16.3±7.5)/h), apnea hypoventilation index(AHI)((5.8±2.3) vs(9.6±4.2)/h) and average heart rate((66.9±8.3) vs(79.9±6.7)/min) of Tibetans were significantly lower than Hans(allP<0.05). Tibetans had longer slow wave sleep(20.1%±7.2% vs 8.8%±3.3%) and the Hans had longer stage 2 of non-rapid eye movement(NREM)(31.1%±11.9% vs 18.4%±6.7%) and shallow sleep(76.1±11.7 vs 70.8±11.2)(allP<0.05).

Tibetans have better sleep quality and higher sleep efficiency than Han residents at high altitude.

To evaluate the relationship of visceral adiposity index(VAI) with serum aminotransferase levels and incidence of nonalcoholic fatty liver disease(NAFLD) in patients with sleep apnea(SA).

Between January 2011 and December 2014, participants who were referred from Fujian Provincial Sleep-disordered Breathing(SDB) Clinic Center with repeated snoring or a clinical suspicion of SDB were recruited. All individuals underwent polysomnography(PSG) testing and an abdominal ultrasonography scan during this period. They were classified into four groups by apnea-hypopnea index(AHI), non-SA group, mild, moderate and severe group(AHI<5/h, 5-<15/h, 15-<30/h, ≥30/h, respectively). The differences in SA-related parameters, serum aminotransferase and VAI were tested, and the correlations of VAI with indices of PSG and serum aminotransferase were analyzed using Spearman coefficient. Receiver operating characteristic(ROC) curve was conducted to obtain a cut-off value of VAI for predicting NAFLD. Afterwards, logistic regression was performed to analyze VAI's predictive ability regarding incidence of NAFLD in SDB patients.

A total of 152 participants including 110 males and 42 females were analyzed, with mean age(51.1±11.3) years. There were 20 subjects in non-SA group, 31 in mild, 39 in moderate and 62 in severe group, with 92 NAFLD patients and 60 controls. No differences in sex, age, alkaline phosphatase were observed among groups according to AHI. However, body mass index, waist circumference, AHI, lowest oxygen saturation, oxygen desaturation index(ODI), VAI, alanine aminotransferase(ALT), aspartate aminotransferase, gamma glutamyltransferase(GGT) and incidence of NAFLD were significantly different among groups. Significant positive relations were observed between VAI and AHI(β=0.222,P=0.006), ODI(β=0.216,P=0.008), ALT(β=0.237,P=0.003), GGT(β=0.238,P=0.003). As shown in ROC curve, the cut-off point of VAI for predicting NAFLD was 1.59 in all individuals. SDB patients with VAI≥1.59 tended to have significantly greater risk in incidence of NAFLD(OR=4.550, P<0.001).

VAI was closely associated with increased serum aminotransferase levels and incidence of NAFLD.

To explore the relationships between pathogenic gene mutations and extra-gonadal manifestations in male patients with congenital hypogonadotropic hypogonadism(CHH).

A total of 15 genes were screened in 259 CHH patients by massively parallel DNA sequencing. The identified pathogenic mutations were confirmed by Sanger polymerase chain reaction(PCR). The extra-gonadal features in all patients were recorded.

Gene mutations were detected in 83(32.0%) patients, which included FGFR1(n=20), PROKR2(n=19), CHD7(n=16), KAL1(n=14) and other genes(n=14), such as PROK2, FGF8, GNRHR, KISS1R, NELF and WDR11. Patients with KAL1 mutation displayed CHH related family history(n=5) and obesity(n=3). Patients with FGFR1 mutation presented with short stature(n=3), testicular hydrocele(n=2), lip-palate cleft(n=2) and dental dysplasia(n=1). Patients without detectable mutations may also exhibit obesity, mental retardation and short stature.

CHH patients may present with extra-gonadal manifestations, including anosmia, obesity, dental dysplasia, short stature and mental retardation. An obscure relationships could be found between the clinical features and different gene mutations, but it is difficult to speculate the types of pathogenic gene mutations according to these extra-gonadal manifestations.

To investigate whether the variations of genes encoding pro-inflammatory cytokines is associated with longevity in Uyghurs in Xinjiang.

A total of 240 individuals aged ≥90 years from Xinjiang Uyghur Autonomous Region were enrolled between 1999 and 2012 as the longevity group, 92 unrelated individuals from the same area who died naturally at the age of 59-73 in the same period were selected as the control group. Seven single nucleotide polymorphisms(SNPs) of 4 genes(tumor necrosis factor(TNF)-α(rs1800629), IL-6(rs1800796, rs10499563), C-reactive protein(CRP)(rs2808630, rs1205) and IL-1β(rs1143623, rs16944)) were genotyped. Logistic regression was applied to assess the association between each individual SNP and longevity in case-control analyses.

The distribution of C allele of rs1800796 in the longevity group(0.298) was lower than that in the control group(0.435) with statistical significance(P=0.001). The distributions of the other 6 genetic variations between the longevity group and the control group showed no statistically significant differences(all P>0.05). CT genotype of rs1800796 was positively associated with longevity(P_add=0.002, OR=1.983, 95%CI: 1.296-3.023), while no significant association was noted between other genotypes and longevity.

SNP of rs1800796 of IL-6 gene may be significantly associated with longevity in Uyghurs in Xinjiang. CT genotype of rs1800796 is significantly associated with longevity. C allele of rs1800796 may be a negative factor for longevity.

To investigate the therapeutic effect of pulsatile GnRH(gonadorelin) pump on female patients with idiopathic hypogonadotropic hypogonadism(IHH).

In this retrospective study, five female IHH patients were recruited. Patients were treated with pulsatile gonadorelin(10 μg per 90 min) via a pump for at least 12 weeks. Serum gonadotropins and sex steroid levels were measured, and menses were recorded.

After one-week treatment, luteinizing hormone(LH) level increased from(2.2±2.0) U/L to(5.4±2.5) U/L(P=0.028), follicle-stimulating hormone(FSH) level increased from(3.7±2.7) U/L to(6.3±1.0) U/L(P=0.162), and estradiol(E₂) level increased from(58±13) pmol/L to(260±97) pmol/L(P=0.011). Menstrual bleeding was observed in 4 patients after starting treatment for 35-55 days and two natural pregnancies were reported. No menstrual bleeding was reported in another patient. The frequency of pulsatile GnRH had to be adjusted according to endogenous GnRH secretion during the follicular phase of normal women and regular menses were induced.

Pulsatile GnRH is effective in treating female IHH. A constant frequency of pulsatile GnRH is suitable for most of IHH patients. However, for those who failed to produce regular menses, adjusting pulsatile frequency to imitate the physiological rhythm of GnRH may be an alternative option.

To explore the significance of serum bone metabolic markers in the diagnosis and monitoring of multiple myeloma bone disease(MBD).

Thirty-six newly diagnosed multiple myeloma(MM) patients who were treated in Department of Hematology, Tianjin Medical University General Hospital from January 2013 to December 2014 were collected. Bone morbidity was graded into two stages according to the radiographic evaluation of the skeleton: stage A(n=12) included patients with no lytic lesions or with osteoporosis alone; stage B(n=24) included patients with osteolytic lesions and/or a pathological fracture. All the patients achieved partial or complete remission after treated with bortezomib + dexamethasone + zoledronic acid regimen. A total of 25 aged- and gender-matched healthy individuals were enrolled in this study as controls. The levels of serum tartrate-resistant acid phosphatase isoform 5b(TRACP-5b), carboxy-terminal cross-linking telopeptide of type Ⅰ collagen(CTX), osteocalcin(OCN), and procollagen Ⅰ amino-terminal propeptide(PINP) were investigated by ELISA and electrochemiluminescence immunoassay(ECLIA). The differences of these bone metabolic markers before and after treatment, and at different stages of bone disease were observed.

The value of TRACP-5b in the newly diagnosed MM was significantly higher than that in the healthy controls and after treatment(median 4.16 vs 2.63 U/L, P=0.014; 4.16 vs 2.61 U/L, P=0.037). Serum level of CTX in the newly diagnosed MM patients was significantly decreased after treatment(median: 0.26 vs 1.05 μg/L, P=0.003). The ratio of CTX/OCN and CTX/PINP decreased after treatment, but there were no significant differences(both P>0.05). The pretreatment level of serum TRACP-5b in stage B patients was higher than that of the healthy controls(median: 4.20 vs 2.63 U/L,P=0.015). The levels of serum CTX in stage A and stage B patients were both higher than that of the healthy controls(median: 1.16 vs 0.48 μg/L, P=0.002; 0.88 vs 0.48 μg/L, P=0.040). The levels of serum OCN and PINP were higher in stage A patients compared with stage B patients, but there were no significant differences(both P>0.05). The ratio of CTX/OCN and CTX/PINP of stage A and stage B patients all increased compared with those of the healthy controls, but there were no significant differences(allP>0.05).

Bone damage of MM patients is improved after effective treatment, but bone imbalance still exists, indicating that the treatment of MBD is a long process. Abnormal serum levels of TRACP-5b and CTX are found before positive X-ray findings in MBD, suggesting that these biochemical markers could be used as indices for early diagnosis of MBD.

To compare the effect of propofol and sevoflurane on perioperative immunity and surgical outcomes in patients undergoing laparoscopic radical resection of colorectal cancer.

During September 2012 to April 2014 in Sir Run Run Shaw Hospital, thirty patients scheduled for laparoscopic colorectal cancer radical resection were randomly assigned into two groups: propofol TCI anesthesia and sevoflurane inhale anesthesia. Venous blood was taken before induction, on finishing the surgery and 24 h after surgery for lymphocyte subtype study by flow cytometry. Postoperative outcomes including intestinal obstruction, urine retention, anastomotic fistula and incision healing, antibiotic using time, hospital-stay time were compared.

In the sevoflurane group, the percentage of CD3⁺, CD4⁺ and CD19⁺ subtype were increased immediately after surgery((64.0±13.5)%,(37.5±11.8)%,(12.3±4.5)%) comparing to preoperative level((59.0±12.0)%,(33.0±8.3)%,(9.9±4.3)%)(t= 3.423, 2.543, 2.768 respectively, all P<0.05), while NK cell percentage was significantly decreased((22.9±13.2)% vs(30.7±11.9)%)(t=-3.444, P<0.01). The changes of CD3⁺, CD19⁺ and NK cell remained significant at 24 h((63.5±9.3)%,(13.0±4.0)%,(22.5±7.2)%)(t=2.961, 3.502, -4.621 respectively, all P<0.05). In the propofol group, the levels of CD3⁺, CD4⁺, CD19⁺ and CD4⁺ /CD8⁺ ratio were significantly increased after surgery((69.4±9.7)%,(43.2±9.2)%,(15.2±7.4)%, 1.9±0.9) comparing to the preoperative levels((61.9±13.6)%,(34.6±8.9)%,(10.4±4.5)%, 1.5±0.7)(t= 4.732, 6.132, 3.688, 4.640 respectively, all P<0.01), and NK cell was significantly decreased((14.7±10.2)% vs(27.2±14.3)%)(t=-4.935, P<0.01). These changes were similar to that of the sevoflurane group. At 24 h in the propofol group, comparing with those after surgery, CD3⁺, CD4⁺ and CD4⁺ /CD8⁺ ratio were significantly decreased((63.6±12.3)%,(36.0±8.7)%, 1.5±0.6)(t=-2.879, -3.682, -3.340 respectively, all P<0.05), and returned to baseline when comparing to the preoperative level(t= 0.858, 0.758, -0.074 respectively, all P>0.05). NK cell began to recover at 24 h((22.2±12.6)%) comparing to the postoperative level(t= 2.941, P<0.05), but was still lower than the baseline(t=-2.249, P<0.05). Also, for all the above data, there were no difference between the two groups at any points(allP>0.05). There were no difference in hospital-stay time, antibiotic using time, the time to anal exhaust or defecate, postoperative fever, incision infection, neither other complications such as intestinal obstruction, urine retention, anastomotic fistula or intraperitoneal infection(allP>0.05). The incision infection rate was 0 in the propofol group while 14.3% in the sevoflurane group, which was quite clinically obvious though not statistically significant.

Propofol may have less or shorter impact on immunity. However, whether anesthesia with propofol could be superior to that with sevoflurane for patients' immune function is still undetermined and needs further study.

To improve understanding of the clinical and histopathological features of early stage dermatofibrosarcoma protuberans(DFSP).

The clinical data and histopathological findings of 14 cases of early stage DFSP diagnosed in Institute of Dermatology, Chinese Academy of Medical Sciences from 2008 to 2014 were retrospectively analyzed.

The patients were mostly young people. The average age of onset was 21 years old. The progress was slow. The initial main manifestations were well-circumscribed atrophic erythema or sclerotic plaque, and subcutaneous nodules appeared gradually based on the erythema. Histopathology showed a small number of tumor cells in the upper dermis, aligned parallel to the epidermis with wavy arrangement, while the tumor cells exhibited typical DFSP changes in the lower dermis and the subcutaneous fat. The tumor cells expressed vimentin and CD34, but not S100 and CD68.

Because the clinical and histological features are atypical, the early stage of DFSP is easily misdiagnosed as various benign diseases. Repeated biopsy and combining clinical features with pathological findings are helpful for diagnosis.

To analyze the relationship between proportion of mitochondrial DNA 4 977 bp deletion(ΔmtDNA⁴⁹⁷⁷) or copy number in blood and the clinical complexity to find the pathogenesis of mitochondrial disease.

A total of 160 patients with mitochondrial disease and 101 healthy controls of Peking University First Hospital from December 2003 to December 2013 were collected in this study. Their peripheral blood showed no hot-point mutation which detected by polymerase chain reaction-restriction fragment length polymorphism. All the patients were divided into younger group(age<10y) and elder group(10y≤age<20y). The incidence of ΔmtDNA⁴⁹⁷⁷ was detected by real-time quantitative PCR. Internal gene was used to calculate the number of mitochondrial DNA in each cell. Statistical analysis were carried out by the independent t-test, one-way ANOVA and Spearman's bivariate correlation analysis.

ΔmtDNA⁴⁹⁷⁷ proportion in the younger group was(2.66±0.63)% and in the elder group was(3.09±0.74)%, both of them were higher than that of healthy control group with the same age(the younger group: t=8.57, P<0.01; the elder group:t=4.38, P<0.01); ΔmtDNA⁴⁹⁷⁷ copy number per cell in the younger group was(2.79±0.50)copy and in the elder group was(2.97±0.48)copy, both of them were higher than that of healthy control group with the same age(the younger group: t=4.50, P<0.01; the elder group:t=-3.67, P<0.01). The ΔmtDNA⁴⁹⁷⁷ proportion was positively correlated with the complexity of the mitochondrial disease(the younger group: r=0.519, P<0.01; the elder group:r=0.772, P<0.01). The ΔmtDNA⁴⁹⁷⁷ copy number per cell was positively correlated with the complexity of the mitochondrial disease(the younger group: r=0.389, P<0.01; the elder group:r=0.607, P<0.05). However, the total mtDNA copy number per cell was negatively correlated with the complexity of the mitochondrial disease(the younger group:r=-0.260, P<0.01; the elder group:r=-0.430, P<0.05).

The proportion or copy number of ΔmtDNA ⁴⁹⁷⁷ or total mtDNA copy number in blood are correlated with the complexity of mitochondrial diseases, especially the proportion of ΔmtDNA ⁴⁹⁷⁷.

To evaluate the effectiveness and safety of Ligation of the Intersphincteric Fistula Tract Plus Bioprosthetic Anal Fistula Plug(LIFT-plug) in the treatment of chronic anal fistula.

A total of 239 patients(199 males, 40 females) with chronic anal fistula were recruited from 5 hospitals between March 2011 and April 2013. These patients were randomly assigned to the experimental group(n=119) treated with LIFT-plug or the control group(n=120) treated with LIFT. The follow-up period was 180 days. The collected data included healing rate, the median healing time, the recurrence rate, the Visual Analogue Scale(VAS), the incontinence rate, and the safety indicators associated with the anal fistula plug.

The healing rate of the experimental group was better than the control group(96.5% vs 83.7%, P<0.05). The median healing time of the experimental group was 22 days and the latter was 30 days(P<0.05). By the end of the follow-up period, there was no recurrence found in the two groups. The VAS and the incontinence rate had no statistically significant difference between the two groups. There were no adverse events associated with the anal fistula plug in the experimental group.

LIFT-plug is simple, less invasive, and with shorter healing time and more satisfactory healing rate in treating chronic anal fistula compared with LIFT.

To assess the prevalence of male urinary tract infection(UTI) after invasive urodynamic studies and to determinate the risk factors by evaluating the clinical characteristics and urodynamic parameters of patients.

Six hundred and seventy-one consecutive men were recruited. All patients accepted urine routine tests and(or)urine culture three times. The first culture and routine tests were carried out in the 2 to 4 weeks before urodynamic studies by using clean-catch midstream urine(MSU) or catheter urine specimen. The second urine routine test was carried out at the start of examinations and the last urine culture were carried out in 48-72 hours after the investigations. Male patients with negative results(leucocytes <15 cells/ul and <10 ⁵ colony-forming units per milliliter [cfu/ml]) in 1^st and 2^nd time received a standard urodynamic investigation. The investigations of the remaining patients were postponed until the urinary tract infection had been treated.

The prevalence of urinary tract infection before urodynamic investigation(with positive results in 1^st and 2^nd urine test) was 7.3%, and the prevalence after the investigation in patients without UTI before examination was 10.3%. Bladder outlet obstruction(BOO), age≥65 years, and diabetes were the risk factors for UTI after urodynamic investigation. The most common uropathogens in the urinary tract infections after the urodynamic investigation were Escherichia coli(53.1%, 34/64) and Enterococcus faecalis(17.2%, 11/64).

Despite a stringent standard operation protocol, the prevalence of UTI in male patients caused by urodynamic examination is about 10%. For the high-risk patients with BOO, older age, and diabetes, prophylactic antibiotic treatment before or after procedure may be necessary.

To introduce the methods and techniques of treatment of renal pedicle vessels during retroperitoneal laparoscopic nephrectomy.

Retroperitoneal laparoscopic nephrectomies were performed in 580 cases in our hospital from March 2004 to May 2014. Different measures were adopted to seek and manage bilateral renal pedicle vessels. The operative time, intraoperative blood loss, duration of postoperative drainage, and postoperative hospital stay were analyzed retrospectively.

12 cases were converted to open surgery due to severe bleeding of renal pedicle vessels. Mean operative time was(100.5±24.8) min, mean intraoperative blood loss was(90.4±26.5) ml, duration of postoperative drainage was(3.6±1.2) d, and mean postoperative hospital stay were(7.4±2.8) d.

Different managing for bilateral renal pedicle vessels will help to decrease operative time and improve the safety of the surgery.

To screen the repetitive extragenic palindromic sequences with activation of toll-like receptor 9(TLR9) activity from Brucella melitensis DNA, providing new ideas and new targets for prevention and treatment of brucellosis.

Bioinformatics methods were used to detect repetitive extragenic palindromic(REP) sequences from Brucella melitensis DNA. The studied REPs were selected and synthesized. RAW264.7 was cultured and transfected with REPs mediated by lipofectamine 3000. Additionally, TLR9-siRNA was used to downregulate TLR9 expression. The content of interferon-α(IFN-α) in the supernatant was then measured by ELISA.

A total of 2 200 REP sequences in Brucella melitensis DNA were identified. Twelve REP sequences were synthesized for further detecting of the TLR9 agonistic activity. IFN-α expression in RAW264.7 treated with M2, M3, M4, M5, M6, M7, M9, M12 were(26.944 ± 1.868),(46.461 ± 2.562),(34.980 ± 2.055),(43.016 ± 2.162),(62.533 ± 4.031),(67.125 ± 5.069),(18.908 ± 1.633),(39.572 ± 2.465) pg/ml respectively, which significantly increased when compared with the negative control group [(12.594 ± 1.338) pg/ml,t=10.817, 20.295, 15.812, 20.724, 20.365, 18.016, 5.180, 16.660, all P<0.05]. Additionally, TLR9-siRNA can significantly decrease the levels of IFN-α in RAW264.7 treated with M6.

REP sequences presented in Brucella melitensis DNA are able to induce IFN-α expression through TLR9, which can be helpful for the understanding of pathogenesis and immunity ofBrucella melitensis.

Ventricular hemorrhage (IVH) is a common critical and severe disease in neurosurgery. It is mostly caused by cerebral parenchymal hemorrhage breaking into the ventricle, and a few are primary intraventricular choroid plexus hemorrhage^[1]Acute obstructive hydrocephalus caused by obstruction of ventricular cast cerebrospinal fluid circulation pathway after hemorrhage, resulting in cerebral hernia. At present, external ventricular drainage (EVD) is used for ventricular hemorrhage and acute hydrocephalus caused by various causes, but its complications include intracranial infection, cerebrospinal fluid leakage, tube blockage and the need to replace or replace external drainage after infection. Once infected, the mortality and disability rate are extremely high. According to the literature, the infection rate after EVD is 0~45%^[2]。 The purpose of this study was to analyze the factors associated with intracranial infection after ventricular hemorrhage with external ventricular drainage, so as to reduce the rate of intracranial infection after EVD.

A 14-year-old male was admitted to hospital on November 15, 2014 due to "mixed phenotype acute leukemia for more than 6 months, haploid hematopoietic stem cell transplantation for more than 3 months, abdominal pain, nausea, vomiting and constipation for 2 days". Physical examination: clear consciousness, poor spirit, no yellowing staining, rash, bleeding spots and ecchymosis on the skin and mucous membranes, no obvious swelling of superficial lymph nodes, no obvious abnormalities in the heart and lungs, soft abdomen, no obvious tenderness, rebound pain, no tenderness, percussion pain in the limbs and spine, and no edema in the limbs. After admission, blood routine, urine and feces routine and liver and kidney function tests were performed, and no obvious abnormalities were found. Blood calcium was 3.89 mmol/L, and abdominal color Doppler ultrasound showed no obvious abnormality. Bone marrow puncture: 3.6% problasts, 97% short tandem repeat (STR), CMV-DNA and Epstein-Barr virus-DNA (EBV-DNA) negative, parathyroid hormone (PTH) decreased: 100 ng/L, interleukin (IL) 1, IL-6, and tumor necrosis factor α (TNF-α) were normal. Skeletal emission single photon computed tomography (ECT) showed no significant bone damage. The blood calcium decreased to normal after 2 days of treatment with diuresis, hydration, pamidronate disodium and salmon calcitonin, and hypercalcemia recurred after 10 days; After another treatment of calcification and other treatments, and re-examination of bone marrow showed that prooblasts accounted for 12.8%, and reserved hematopoietic stem cells were retransfused, and bone marrow was re-examined 10 days later. Because the patient's family members did not agree to further immunotyping and other examinations, only morphological re-examination showed recurrence (35.2% of prooblasts). After 1 course of chemotherapy with Hyper-CVAD regimen (cyclophosphamide, vindecine, doxorubicin, dexamethasone), 6% of the protoplasts were re-examined, and the condition improved and the protoplasts were discharged.

A 51-year-old female suffered from uniform swelling of the index finger of her right hand (Figure 1), severe pain during extension and flexion for more than 20 days, and went to our hospital on January 22, 2015. The patient was usually in good health and had no history of hypertension, heart disease, diabetes, immune diseases and other diseases, nor a history of hormone use. He had a history of stabbing in the distal section of his right index finger in mid-September 2014. Laboratory test: Blood routine showed white blood cells 7.9×10⁹/L, neutrophils 0.62, lymphocytes 0.31; The X-ray film of the right index finger showed no obvious bone destruction; B-ultrasound of the right index finger showed thickening of flexor tendon tendon sheath, suggesting flexor tendon tenosynovitis. On January 23rd, the patient brought the examination results to the hand and foot surgery department of a tertiary hospital in Hebei Province. According to the clinical manifestations and examination results, the patients were treated with "tenosynovitis of flexor tendon of right index finger", followed by 1 ml of compound betamethasone injection +1 ml of 2% lidocaine for local closure. The swelling and pain began to decrease 4~5 h after treatment, significantly decreased after 24 h, and disappeared after 3 d, and the function was completely recovered. On January 31st, the proximal interphalangeal joint of the distal segment of the right index finger appeared redness, swelling, high skin temperature, and slightly limited activity, but the pain was not obvious. Then he went to our hospital again, and the blood routine showed that white blood cells were 10.6×10⁹/L, neutrophils 0.64, lymphocytes 0.29; C-reactive protein (CRP)<3.36 mg/L; erythrocyte sedimentation rate 2 mm/1 h; B-ultrasound of the right index finger showed a small amount of local hypoechoic, and the tendon sheath of the flexor tendon was slightly thickened, suggesting that the inflammatory focus abscess may be flexor tendon tenosynovitis. Following the intravenous infusion of penicillin 4 million U +100 ml of normal saline, twice/d for 5 days, it was ineffective, and the swollen area felt a fluid wave sensation, which spread to the proximal and distal interphalangeal joints of the middle segment of the index finger (Figure 2)。 On February 4 and February 6, respectively, we punctured under sterile conditions, and took blood pus samples and sent them to the microbiology room of our hospital for bacterial culture. Both cultures suspected "Nocardia" infection. Minocycline 100 mg was administered orally twice a day since February 8. At the same time, topical disinfection with 3% iodine tincture, once/d, for more than 15 minutes each time, then deiodination with ethanol, and finally application of vitamin E skin care oil. After taking medication and local disinfection for 3 days, the skin temperature returned to normal, the redness and swelling were significantly reduced on the 10th day, and it was basically cured on the 20th day. After stopping taking medication and local disinfection, it was cured on March 10th. There was no recurrence after nearly 3 months of follow-up.

Vascular access is the "lifeline" of maintenance hemodialysis patients. The quality of vascular access largely determines the quality of life and even the life span of hemodialysis patients. Autologous arteriovenous fistula is recognized as the best vascular access^[1]。 After the establishment of autologous arteriovenous fistula, the structural adaptive changes of blood vessels due to the changes of intra-luminal pressure and flow are called vascular remolding. The state of vascular remolding directly determines the outcome of arteriovenous fistula. The ideal result of vascular remolding is that the fistula matures, while abnormal or poor vascular remolding will cause the maturation obstacle or even occlusion of the fistula. Vascular remodeling throughout the maturation, use and complication of arteriovenous fistula^[2,3,4,5,6]。 Hemodynamic changes are the initial factor of vascular remodeling, and shear stress is recognized as the most important hemodynamic factor^[2,3,4,5]。 The research on shear force has been started since the 1970s, but the research on the relationship between shear force and arteriovenous fistula vascular remodeling and related complications is still in its infancy. The blood flow pattern of arteriovenous fistula is different from any other blood flow pattern in physiological state, and its hemodynamics has its own characteristics. Therefore, the shear force related to arteriovenous fistula also has its own uniqueness. Fully understanding the characteristics of shear force in arteriovenous fistula can help to understand the mechanism of vascular remodeling, maturation and complication of fistula.

cell free DNA refers to a fragment of free DNA located in the peripheral environment, which can be in physiological or pathological conditions^[1]Released into blood, cerebrospinal fluid, urine, sputum, or feces^[2]About 160-180 bp, is the product of DNA degradation of target cells^[3]。 As a class of cfDNA, circulating tumor DNA (ctDNA) derived from tumor cells can indirectly reflect the relevant characteristics of tumor disease. Therefore, non-invasive detection of this class of free nucleic acids is also considered to be an effective "liquid biopsy" technique^[1,2,3,4]。

Sequelae of polio (PPS) refers to a series of new or slowly developing syndromes in polio survivors after a stable period of about 20 to 30 years, which are mainly manifested by fatigue, fatigue, muscle and joint pain, and decreased tolerance to cold^[1,2]。 In patients with PPS, there will be different degrees of sleep apnea (SDB), including obstructive sleep apnea syndrome, central sleep apnea syndrome, mixed sleep apnea syndrome and sleep hypopnea syndrome^[3]。 Although there are many reports of SDB caused by other neuromuscular diseases, there is still little attention to SDB related to PPS, probably because of the following reasons: (1) SDB in PPS patients occurs later (mostly after middle age), and it is a slow course, which is easily overlooked; (2) For a long time, the concept of PPS has not been comprehensively understood, and more attention has been paid to the surgical correction of young patients' physical disabilities, but the breathing, especially sleep breathing, of the elderly is neglected. At present, most of the millions of polio survivors in China are in the high incidence period of PPS. Strengthening the understanding of SDB in PPS patients is the key to ensure timely diagnosis and treatment, improve the quality of life and reduce complications^[3]。 The mechanisms, clinical manifestations, related tests and interventions of SDB in patients with polio are reviewed below.