Volume 98 ·  Issue 47 ·  2018

Polysomnography is an examination technique that uses polysomnography to collect, record and analyze multiple sleep physiological parameters and pathological events continuously and simultaneously in sleep monitoring room. In recent years, the application of polysomnography technology in China is increasing day by day, and it has been carried out in different clinical departments of medical institutions at all levels, but its standardized application still faces challenges. In response to this, the Sleep Disorder Professional Committee of the Neurologist Branch of the Chinese Medical Association initiated and invited relevant experts together with the Sleep Disorder Professional Committee of the Chinese Sleep Research Association and the Sleep Disorder Group of the Neurology Branch of the Chinese Medical Association to launch the "Chinese Adult Polysomnography Technology Operation Specification and Clinical Application Expert Consensus"^[1]In order to further standardize the clinical application of polysomnography technology in China and promote the exchange and development of sleep medicine in China.

Talk to the patient and/or family members, inform them in detail about the necessity, expected efficacy, possible complications and risks during and after surgical procedures, obtain the consent of the patient (or) guardian, and sign the informed consent form for TACE treatment.

Qualitative diagnosis of intracranial lesions is the prerequisite for choosing treatment, and qualitative diagnosis mainly depends on pathological diagnosis, which is also the most direct and final diagnosis result. Although advanced imaging technology is of great significance in the diagnosis of intracranial lesions, there are still some lesions that cannot be diagnosed by imaging characteristics because of their atypical imaging manifestations, and pathological diagnosis can only be made by biopsy or surgery.

With the gradual improvement of the understanding of sleep diseases in modern medicine, sleep monitoring technology has been widely used in clinical departments such as neurology, respiratory department, otolaryngology department, stomatology department and psychiatry department. As an important tool in clinical and scientific research of sleep medicine, the value of polysomnography technology has been paid more and more attention. In order to further clarify the scope of clinical indications of polysomnography technology in China, standardize the operation process, and unify the diagnostic terminology and reporting form, the Sleep Disorder Professional Committee of Neurologist Branch of Chinese Medical Physicians Association initiated and together with the Sleep Disorder Professional Committee of China Sleep Research Association and the Sleep Disorder Group of Neurology Branch of Chinese Medical Association, invited relevant experts from the mainland and Hong Kong, China, to form the "Expert Committee on Operating Specifications and Clinical Application of Polysomnography Technology for Adults in China" for in-depth discussion. With appropriate reference to relevant foreign specifications, and on the basis of extensive solicitation of opinions, we jointly discussed and wrote the "Expert Consensus on Operating Specifications and Clinical Application of Polysomnography Technology for Adults in China".

Since 1992 Roviaro et al.^[1]It is reported that since the first complete laparoscopic anatomical lobectomy, video-assisted thoracoscopic surgery (VATS) has made a leap forward. The American Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD) shows that the percentage of anatomical lung resections (lobectomy and segmentectomy) in VATS increased from 8% in 2003 to 30% in 2013^[2]。 Due to the "minimally invasive" characteristics of VATS, the trauma of traditional thoracotomy is greatly reduced, such as mild postoperative pain degree and quick relief, little impact on shoulder joint function, better protection of lung function, reduction of postoperative trauma factors, better protection of immune function, obvious improvement of patients' postoperative quality of life and rapid recovery^{[3,4,5,6,7,8,9,10,11,12]}。 Previously, the application of VATS lobectomy in the treatment of lung cancer has been controversial, but under the premise of strictly mastering the indications, it still reflects the great advantage of minimally invasive and becomes one of the important means of diagnosis and treatment of lung cancer^[13]。 With the continuous development of minimally invasive surgical techniques and instruments, the accumulation of surgical experience and the emergence of reports of good long-term survival rate of surgical patients, the surgical mode of lung cancer began to change. In 2006, the guidelines for lung cancer treatment issued by the National Comprehensive Cancer Network (NCCN) in the United States began to propose that VATS lobectomy is a feasible option for resectable lung cancer, and preliminarily clarified the position of VATS in the surgical treatment of lung cancer; The latest NCCN guidelines in 2018 clearly state that VATS is the recommended surgical method for resectable lung cancer^[14]。 At present, VATS lobectomy has basically become mature and widely recognized, and its surgical technique is gradually refined and improved day by day.

To evaluate the patients with Cardiac amyloidosis (CA) and Hypertrophic cardiomyopathy (HCM) by using the strain indexes of three-dimensional speckle tracking imaging(3D-STI) technique, and to evaluate the prognosis.

A total of 32 patients with pathologically confirmed cardiac amyloidosis and 34 patients with hypertrophic cardiomyopathy and 16 normal controls were enrolled from the First Affiliated Hospital of Zhejiang University College of Medicine from June, 2013 to January, 2018.The color Doppler echocardiography and three-dimensional speckle tracking echocardiography were used to measure strain indexes of each group, and the Logistic regression equation was used to analyze the index differences.The cut-off values were analyzed using the Receiver Operating Characteristic (ROC), and Kaplan-Meier and Cox were used for survival regression analysis.

The globe radial strain (GRS) (16%±7% vs 23%±9%), left ventricular wall peak time difference (PSD) (52 ms±17 ms vs 77 ms±25 ms), Sokolow-Lyon index (20 mm±6 mm vs 34 mm±14 mm) were significantly different between cardiac amyloidosis group and hypertrophic cardiomyopathy group by 3D-STI, which had high sensitivity and specificity by Logistic regression analysis.The area under the ROC curve of GRS was 0.725, PSD was 0.812, Sokolow-Lyon index was 0.832.In addition, the area strain and atrial septal thickness were significant prognostic factors according to survival regression analysis.

For the differential diagnosis of cardiac amyloidosis with preserved LVEF, unlike echocardiographic parameters, the 3D-STI strain indicators could be used to differentiate cardiac amyloidosis from hypertrophic cardiomyopathy, reflecting obvious diagnostic advantages.When combined with area strain and atrial septal thickness, 3D-STI strain indicators could be used to predict the survival prognosis, which are important in clinical practice.

To assess the values of pelvic contrast enhanced magnetic resonance angiography (MRA) in detection of prostatic artery prior to prostatic arterial embolization(PAE).

This multicenter, prospective study from 5 hospitals in China consisted of 47 patients (mean age (69±16) years, range 56-83 years) who underwent PAE for benign prostatic hyperplasia (BPH) between January 2016 and April 2018, preprocedural prediction of prostatic arteries were determined using contrast enhanced MRA.CE-MRA findings were compared with subsequent intraprocedural digital subtraction angiography (DSA) or DSA combined with cone-beam computed tomography (CT) to assess the sensitivity and specificity with which contrast enhanced MRA predicted the number and origins of prostatic artery, also to assess the optimal oblique projection of PA.

In total, 47 patients (94 pelvic sides) with 97 PAs confirmed by DSA or DSA combined with cone-beam CT at the time of embolization, MR angiography successfully identified 88 PAs and their origins , the sensitivity and specificity was 90.7% (88/97) and 93.6% (88/94), respectively.MR angiography correctly determined the bilateral prostatic artery origins in 36 (76.6%) cases.According to the optimal oblique projection of PAs suggested by MR angiography, the origins and trajectory of PAs of all patients underwent PAE with the same oblique projection (20°-45°ipsilateral anterior oblique direction) were clearly displayed when performed the first arteriography.

Pelvic contrast enhanced MR angiography with high sensitivity and specificity in detection the origin, trajectory and number of PAs, and it could provide useful information regarding prostatic arteries before PAE.

To analyze the clinical efficacy and safety of ¹²⁵I radioactive seed implantation in the treatment of sub-capsular hepatocellular carcinoma (sub-HCC) with sequential radiofrequency ablation and transcatheter arterial chemoembolization (TACE).

The clinical data of 76 cases with advanced HCC with sub-capsular nodules including 68 males and 8 females, with an average age of (58±9) years, ranging from 33 to 78 years, enrolled in Lishui Central Hospital from January 2010 to December 2016 were collected.The average maximum diameter of tumor is (5.7±2.3) cm, ranging from 3.1 cm to 12.0 cm.The patients were divided into TACE+ RFA group and ¹²⁵I + TACE+ RFA group with 38 cases in each group.The overall survival (OS) and progression free survival(PFS) were calculated.The clinical efficiency and adverse events were evaluated.

The disease control rate were 84.2%(32/38) in ¹²⁵I + TACE+ RFA group and 63.2% (24/38) in TACE+ RFA group, χ ²=4.34, P= 0.04.The median PFS were 18 months in ¹²⁵I + TACE+ RFA group and 11 months in TACE+ RFA group, χ ²=4.84, P=0.03.The FPS cumulative rate in ¹²⁵I + TACE+ RFA group were higher than that in TACE+ RFA group at 6 months (94.7%±3.6% vs 81.3%±6.4%, Z=24.1>2.58,P=0.00), 1 year (89.2%±5.1% vs 40.7%±8.3%, Z=13.3>2.58,P=0.00) and 2 year (55.9%±8.6% vs 29.6%±8.2%, Z=7.2>2.58,P=0.00). The median OS were 42 months in ¹²⁵I + TACE+ RFA group and 30 months in TACE+ RFA group, χ ²=4.76, P=0.029.The survival cumulative rate in ¹²⁵I+ TACE+ RFA group were higher than that in TACE+ RFA group at 1 year (92.1%±4.4% vs 83.8%±6.1%, Z=23.5>2.58,P=0.00), 2 year (75.8%±7.0% vs 59.8%±8.4%, Z=12.43>2.58,P=0.00), 3 year (59.0%±8.2% vs 41.7%±8.9%, Z=8.3>2.58,P=0.00), 5 year (34.2%±8.2% vs 18.2%±8.1%, Z=5.5>2.58,P=0.00). In addition, there was no statistical difference in liver function and complications between TACE+ RFA group and ¹²⁵I+ TACE+ RFA group.

¹²⁵I radioactive seed implantation plus TACE combined with RFA treatment is an effective and safe treatment for sub-capsular hepatocellular carcinoma.

To evaluate the clinical efficacy of anterior decompression and stability reconstruction in patients with cervical hyperextension injury.

Postoperative data from 60 patients with cervical hyperextension injury between April 2009 and December 2016 were analyzed retrospectively; the patients included 50 males and 10 females, aged 21-87 years [average, (57±13) years]. All patients had various degrees of spinal cord injury, and were treated with anterior cervical decompression, fusion, and internal fixation.The preoperative and postoperative neurological function were compared to evaluate the clinical efficacy of the treatment.The t test was applied when preoperative and postoperative data were compared.

Of the 60 patients, 5 underwent anterior cervical discectomy and fusion, 26 underwent anterior cervical corpectomy and fusion, and 29 received treatment with the hybrid technique.The average follow-up was (5.1±2.1) years (range, 1.6-9.1 years). The American Spinal Injury Association (ASIA) scores, abbreviated injury scale (AIS grades), and Japanese Orthopedic Association Scores (JOA scores) at the 1 week post operation and final follow-up were significantly better than those obtained preoperatively (all P<0.01). The JOA scores before operation and at the final follow-up was 10(7, 11) and 16(14, 17), respectively.Based on the recovery rate of JOA scores, the rate of cure was 28.3% (17 cases), the rate of significant efficiency was 60.0% (36 cases), the rate of efficiency was 8.3% (5 cases), the rate of inefficiency was 3.3% (2 cases). Among the patients showing cure, 5 were satisfied with the life function, however, the extent of their injury was still of Grade D owing to the incomplete recovery of muscle force.Further, when the 60 patients were divided into A and B groups according to whether they had congenital spinal stenosis or not, respectively, and no significant difference was found in ASIA scores, AIS grades and JOA scores between the groups (allP<0.01).

Anterior cervical decompression, fusion and internal fixation is safe and effective for cervical hyperextension injury without continuous-type ossification of the posterior longitudinal ligament.

To study the relationship between the intracardiac echogenic foci and the abnormal chromosome and the changes of Cardiac function.

A total of 2645 cases with the gestational age between 14 to 22 weeks were tested in the department of gynecology and obstetrics of the Second Hospital of Jilin University from Jan.2016 to Dec.2017.Seventy-nine of them existed the intracardiac echogenic foci, and the patient′s imaging data in details were recorded.All of them have taken the non-invasive DNA examination.Fetal echocardiography was performed at 22-24 weeks.Karyotype analysis was performed using amniocentesis and umbilical cord blood puncture.Inducing labor was performed for fetuses that has been identified as a haploid or had a severely malformation during pregnancy.The other fetuses were followed up to the birth.Echocardiography was performed on neonates.

The detection rate of intracardiac echogenic focus was 3.0% in early pregnancy, 92% in the left ventricle, 4% in the right ventricle, and 4% in double ventricle.There were 5 cases of haploid fetus induced labor, 2 cases of induced labor due to fatal malformation.Fetal echocardiography revealed tricuspid regurgitation in 7 cases.One of them was induced labor in consideration of heart failure.

1.The risk of chromosomal abnormality in the fetus of isolated left intracardiac echogenic focus is lower.Non-invasive DNA examination has a high reliability that could be an important reference before an invasive antenatal diagnosis.2.A higher rate of fetal malformation will be found when the foci located in the right or double ventricle.3.The relationship between fetal intracardiac echogenic foci and fetal cardiac dysfunction needs to be further clarified.

To study the integrity of vestibular brain stem pathway and explore the diagnostic and clinical value of vestibular-evoked myogenic potentials (VEMPs) in central nervous system diseases through the establishment of detection method of VEMPs.

Seventy-two normal volunteers (included between April 2016 and July 2017) were divided into 6 groups according to different ages.All subjects were tested with short acoustic stimulation.The superior oblique, masseter and sternocleidomastoid muscles were recorded respectively, and the stable waveform was obtained: (1)the Opposite ocular potential (o- VEMP) N1 and P1; (2)the bilateral masseter potential (m-VEMP) P11; (3)the same side neck potential (c-VEMP) P13 and N23.The three detection methods were used to measure the latency period, the amplitude of the peak value, the ratio of the amplitude before and after the stimulus, and the logarithm value of the ratio.

The mean values of latency period of N1, P11 and P13 were 10.9-12.0 ms, 11.3-13.6 ms, 13.2-14.6 ms, among which the occurrence rates of o-vemp, m-vemp and c-vemp were respectively 97.2%, 98.5% and 95.4%.With the increase of age, the latency period of each wave was observed to be prolonged, with significant difference (P<0.05), while no significant difference in the gender and side of each wave (P> 0.05).

VEMPs are noninvasive measurement technology, stable and reliable, and can objectively evaluate the integrity of the vestibular brainstem pathway from three segment. This technology has broad application prospects in the central nervous system diseases, especially in neurodegenerative disease.

To observe the mid-term clinical outcome of total knee arthroplasty (TKA) with domestic A3 posterior stabilized prosthesis.

The clinical data of 342 patients (438 knees) who underwent primary TKA by the same surgeon from June 2012 to December 2013 in Peking University Third Hospital were retrospectively collected. The patients were divided into 2 groups according to the type of prosthesis: 107 patients (137 knees) with domestic A3 prosthesis, as domestic group; 235 patients (301 knees) with a kind of imported prosthesis, as the control group. In the end, 311 patients (390 knees) received complete follow-up.The postoperative knee maximum flexion angle, postoperative Hospital for Special Surgery Knee Score (HSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), postoperative coronal mechanical axis alignment and hospitalization costs were compared between the groups.Paired t-test was used to compare the preoperative and postoperative data in the same group, and independent sample t-test was used to compare the data between the two groups at the same time points.

The average follow-up time of all the patients was (5.6±1.1) years, and it was averaged for 64.8 months in the domestic group and 68.2 months in the control group.There was no significant difference in the HSS score and WOMAC score, the knee maximum flexion angle, and coronal mechanical axis alignment at the 3 months postoperatively and at the end of follow-up between the two groups (t=-0.890, -1.610, 1.740, 0.620, all P>0.05). In 2012, the average hospital cost was (24 879±1 627) yuan/knee in the domestic group and it was (49 611±1 589) yuan/knee in the control group (t=-48.902, P<0.01). In 2013, it was (38 393±2 773) yuan/knee in the domestic group, and was (55 931±3 533) yuan/knee in the control group (t=-14.795, P<0.01).

It indicates that the domestic A3 posterior stabilized prosthesis brings comparable mid-term results with the imported prothesis and it reduces medical costs remarkably.

To analyze the correlation and consistency of 2- and 24-hour endogenous creatinine clearance rate (Ccr) in patients in the intensive care unit (ICU).

It was a prospective bicentric observational study.According to the inclusion criteria, the patients were selected from the ICU of Fuxing Hospital Affiliate to Capital University of Medical Sciences and Chuiyangliu Hospital Affiliated to Tsinghua University from September 2015 to December 2016.After inclusion, the mixed urine sample was collected at 9-11 am, 9-11 pm and all day long (7 am-7 am, 24 hours). The urine volume was recorded and the urine creatinine was detected.The correlation and consistency analysis of Ccr were applied in the group of 9-11 am, 9-11 pm and 7 am-7 am.Clinical data including sex, age, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ), the use of diuretics, mean arterial pressure, blood glucose and body temperature were recorded for the analysis of the factors affecting correlation and consistency of Ccr between 2 h and 24 h.

A total of 158 cases were included, 82(51.9%) cases were males, the mean age was (76±13) years, the APACHE Ⅱ score was 19±8.And 83 patients (52.5%) were admitted to the ICU due to pulmonary disease.The average Ccr in the group of 24 h was (70±58) ml/min, the Ccr in 105 patients (66.5%) was less than 80 ml/min, it was less than 60 ml/min in 88 patients (55.7%) and was less than 30 ml/min in 33 patients (20.9%). The fasting serum creatinine level in the second day morning after admitted to ICU was 77.0(52.8, 122.2) μmol/L.The correlation analysis showed that the relative indices of R² between the 24hCcr and 2hCcr in the morning (9-11 am) and evening (9-11 pm) was 0.704 and 0.825, respectively, both P<0.01, and the bias was -2.3 and 0.3 ml/min.The patients were divided into group A (D-value≤20%) and B (D-value>20%) according to the Ccr D-value of the 24 h and the 2 h in morning.There were 72 patients (45.6%) in group A, and 86 patients (54.4%) in group B. The multiple Logistic regression analysis indicated that the factors affecting the correlation and consistency between 2hCcr and 24hCcr were body temperature, age and the D-value of serum creatinine, and the odd ratio (95%CI) was 1.844(1.112-3.059), 1.046(1.020-1.072), 1.038(1.003-1.074), respectively, all P<0.05.

There is significant correlation and consistency between 2hCcr and 24hCcr in ICU patients.And in most of the cases, the 24hCcr can be replaced by random 2hCcr, but the affecting factors of body temperature, age and the D-value of serum creatinine should be taken into account.

To evaluate the application of multivane technique at 3.0 T MRI in female pelvis examination in reducing artifacts and improving image quality.

A total of 49 female patients were collected between December 2016 and April 2018 from Zhongda Hospital Affiliated to Southeast University, which were examined with sagittal T₂-weighted TSE, T₂ weighted -MV and T₂ weighted-SShTSE with fat suppression on a 3.0 T scanner.Three radiologists assessed the images for the presence of artifacts and overall image quality using a five-point scale after Cronbach′s Alpha repeatability measurement of the three doctors.

The Cronbach′s Alpha of the three doctors was 0.950, 0.973, 0.985, respectively.Both MV and SShTSE groups got higher points than TSE group.In the level of anatomic detail, the differences was statistically significant(all P<0.05). Although there was no significant difference between MV and SShTSE group in the score of doctor 1 (P=0.126), but had significant differences in the score of doctor 2 (P=0.022)and doctor 3(P=0.005). In assessing the images for the presence of artifacts, both MV and SShTSE groups got higher points than TSE group, while SShTSE group got higher points than MV group, and the differences were statistically significant (all P<0.05). In assessing the overall image quality, both MV and SShTSE groups got higher points than TSE group, while MV group got higher points than SShTSE group, and the differences were statistically significant (allP<0.05).

Imagings of the anatomic detail are improved and the artifacts associated with bowel or respiratory motion are reduced with the MV technique.MV technique is important in providing an accurate diagnosis compared with TSE and SShTSE.

To explore the therapeutic effect of simple posterior reduction and decompression technique for different types of malformations in the craniocervical junction with atlantoaxial dislocation.

The clinical data of 34 cases of different malformations in the craniocervical junction who were treated by the simple posterior internal fixation and decompression surgery in the department of neurosurgery of the first affiliated hospital of Nanchang University from March 2014 to March 2017 were analyzed retrospectively.In 34 cases, including 26 cases of basilar invagination with atlantoaxial dislocation (19 cases with atlanto occipital fusion, 12 cases with Chiari malformation, 13 cases with syringomyelia), 8 cases of odontoid malformation with atlantoaxial dislocation (2 cases with Chiari malformation, 1 case with flat skull base, 1 case with malformation of atlas). All the cases were performed Dynamic position X-ray film, CT scan and Three-dimensional reconstruction, and craniocervical MRI scan before the operation.The enlarged decompression of the occipital foramen, the fixation and fusion of the occipitocervical were performed during the operation, and the patients with cerebellar tonsillar hernia were performed decompression of the occipital small bone window.

All patients were followed up after the operation.The symptoms were obviously improved in 29 cases (85.3%), stability and no change in 5 cases (14.7%) and none postoperative neurological deterioration cases.

The treatment of craniocervical junction malformation using simple posterior reduction and decompression technique is effective and has few complications, which can obviously improve the life quality of the patients.

Delirium is an acute fluctuating brain dysfunction caused by many reasons, mainly manifested as cognitive impairment, sleep-wake cycle disturbance, mood change and psychomotor abnormalities^[1]。 According to the alertness and psychomotor characteristics of patients, delirium is divided into three types: low-activity, high-activity and mixed^[2]。 Senile delirium is a cerebral organic syndrome caused by various diseases in the elderly, mostly caused by surgery, infection, cerebrovascular disease, metabolic disorders, ventilator application and intensive care unit (ICU) environment^[3,4]。 After delirium, the mortality, hospital stay and cost of patients increased significantly, which affected the long-term cognitive function and quality of life of patients^[4,5]。 At present, there are no effective and safe interventions in the prevention and treatment of delirium, mainly because the pathogenesis of delirium is not clear. Current studies suggest that some serological substances change during the development of delirium, which may be predictive factors and therapeutic targets of delirium. This article mainly summarizes the literature and discusses the serological markers that may change during the development of delirium, so as to provide clues for exploring the mechanism and diagnosis and treatment of delirium in the future.

prostacyclin (PGI₂) is an important metabolite formed by cyclooxygenase (COX) pathway of arachidonic acid, and is one of the members of the prostaglandin family that regulates the vascular system to make it in dynamic equilibrium. PGI₂Can act on platelet precursors, endothelial cells, vascular smooth muscle cells (VSMCs), and megakaryocytes, thereby exerting their role in dilating blood vessels, inhibiting platelet aggregation, and proliferation and differentiation of vascular smooth muscle cells^[1,2]。 Clinical PGI₂The analogues can activate downstream signaling pathways by interacting with type I prostaglan membrane receptors (IP) and peroxisome proliferator-activated receptors (PPARs), exert pharmacological effects such as anti-platelet and vasodilating, and then achieve the effects of improving ischemic symptoms, protecting damaged blood vessels, delaying the progression of atherosclerosis and reducing thrombosis^[3]。 The purpose of this article is to analyze the pharmacological mechanism of prostacyclin and its analogues and discuss its application in arterial occlusive diseases.