Volume 100 ·  Issue 28 ·  2020

The novel coronavirus pneumonia (COVID-19) is a newly discovered class of infectious diseases that have spread globally. COVID-19 is caused by infection with SARS-CoV-2, which infects cells with angiotensin-converting enzyme II (ACE2) as a receptor. COVID-19 is dominated by respiratory lesions, and can involve multiple systems and organs such as kidneys, liver, heart, and blood. This disease is mainly transmitted through respiratory droplets and direct contact. Aerosol transmission is possible in a closed environment, and feces and urine may cause environmental pollution. Its incubation period is generally 1~14 days (mostly 3~7 days). This disease is generally susceptible in the population, and chronic kidney disease (CKD), especially dialysis patients, are also potentially susceptible populations. 16% ~20% of COVID-19 patients are clinically critically ill. Kidney involvement is often manifested as acute kidney injury (AKI) and proteinuria, and the occurrence of kidney injury has an important impact on the prognosis of COVID-19 patients^[1]。

To characterize electroencephalogram (EEG) power in different frequency bands, particularly in overnight distribution of slow wave activity (SWA) in patients with obstructive sleep apnea (OSA).

Seventy-seven subjects [31 males and 46 females, aged (55.3±5.2) years] with primary complaint of snoring from Sleep Medicine Center of West China Hospital were included in the study. All subjects underwent one night polysomnography (PSG). The subjects were divided into four groups based on the apnea hypopnea index (AHI): primary snoring (AHI<5 times/h), mild OSA (5 times/h ≤ AHI <15 times/h), moderate OSA (15 times/h ≤ AHI <30 times/h), and severe OSA (AHI ≥30 times/h). The absolute EEG power values across five frequency bands during overnight sleep, during non-rapid eye movement (NREM) and rapid eye movement (REM) sleep periods were initially compared across four groups. Afterwards, the relative SWA values over four NREM cycles during overnight records were compared across four groups, and the correlation between SWA and AHI, Epworth sleepiness scale (ESS) score was analyzed among all subjects.

For overnight analysis, SWA in the moderate and severe OSA groups was lower than that in the mild OSA and primary snoring groups during total sleep, NREM and REM periods[total sleep: (120.3±49.4), (125.6±65.5) vs (147.1±68.3), (163.1±66.7) μV ²; NREM period: (143.9±60.0), (146.6±77.1) vs (173.6±79.8), (193.7±82.4) μV ²; REM period: (39.9±14.7), (41.4±13.1) vs (48.4±20.8), (52.6±21.7) μV ²], but did not reach the significant level (all P>0.05). Four groups showed decreased patterns in relative SWA values from the first NREM cycle to the fourth NREM cycle. The relative SWA had significant difference among four NREM cycles in the primary snoring group, mild and moderate OSA groups (all P<0.001). In the severe OSA group, the relative SWA in four NREM cycles respectively was (156.5±0.5)%, (149.6±0.4)%, (135.1±0.4)%, (121.7±0.4)% (P=0.053). The relative SWA in the severe OSA group was higher than that in the mild OSA group in the fourth NREM cycle [(85.5±0.3)% vs (121.7±0.4)%] (P=0.004). SWA in 1^st NREM cycle was negatively correlated with ESS score (r=-0.239, P=0.043), no correlation was found between overnight SWA, SWA in NREM period, SWA in REM period, SWA in four NREM cycles and AHI (r=-0.095, -0.092, -0.174, -0.161, -0.089, -0.024, -0.115, all P>0.05).

The results suggest that SWA in OSA patients has internal stability and is related to daytime sleepiness. SWA is a potential predictor of daytime sleepiness in OSA patients. When SWA is used as a clinical indicator of sleep quality, attention should be paid to the dynamic analysis and its periodic changes.

To explore the clinical features of supine-related obstructive sleep apnea-hypopnea syndrome (OSAHS) and rapid-eye-movement (REM) related OSAHS.

General data and polysomnography (PSG) parameters of patients with mild to moderate OSAHS [5 times/h ≤ apnea hypopnea index (AHI) <30 times/h] who underwent polysomnographic sleep monitoring at the sleeping center of the Second Affiliated Hospital of Soochow University were collected from January 2016 to December 2018. The patients were divided into supine-related type and non-supine-related type based on the types of body positions; and were further divided into REM-related type and non-REM-related type according to sleep staging, so as to compare the differences in demographic parameters and polysomnographic characteristics among patients with different types of OSAHS, and explored corresponding clinical significance.

A total of 757 patients with mild to moderate OSAHS were recruited in the study, the average age was (46.7±13.4) years, 623 of which were male(82.3%). A total of 476 cases (62.9%) were supine-related, of which 213 cases (28.1%) were supine-predominant, and 263 cases (34.7%) were supine-isolated; 311 cases (41.1%) were REM-related, of which 212 cases (28.0%) were REM-predominant, 99 cases (13.1%) were REM-isolated, and 212 cases (28.0%) were supine-REM overlapped. There was no statistically significant difference in general information between supine-related and non-supine related OSAHS patients (P>0.05). Supine-related OSAHS patients′ complains of declined memory, apnea, oppressive wake, less than 90% of finger pulse blood oxygenation and respiratory-related micro-awakening indexes were higher than those of non-supine related patients (P<0.05). AHI and oxygen desaturation index (ODI) of supine-isolated patients were significantly lower than supine-predominant patients (P<0.05). Body mass index (BMI), the proportion of women, and proportion of complaints of dreaminess in REM-related patients were significantly higher than non-REM related OSAHS patients (P<0.05). However, their age, AHI, and ODI were lower than those in no-REM related patients (P<0.05). As shown in logistic regression model analysis, the risk of women with REM-related OSAHS was 2.055 times that of men (OR=2.055, 95%CI: 1.359, 3.109). For REM-isolated patients, the AHI and ODI were significantly lower than those of REM-predominant OSAHS patients (P<0.05), while the proportion of patients with complaints of difficulty sleeping and the score in accordance with item B of Pittsburgh Sleep Quality Index (PSQI) (time to fall asleep) was higher than that of REM-predominant patients (P<0.05). Among overlaped type patients, the proportion of women, BMI, and the proportion of patients with complaints of dreaminess and difficulty sleeping were higher than those of only supine-related OSAHS (P<0.05). And the proportion of declined memory loss was higher than that of only REM-related OSAHS patients (P<0.05).

Supine-related and REM-related OSAHS are common clinical phenotypes in patients with mild to moderate OSAHS. Our study figure out the clinical characteristics of each type, it is helpful for guiding individualized treatment.

To investigate the correlation between oxygen desaturation rate and daytime sleepiness in patients with severe obstructive sleep apnea syndrome (OSAS).

Between April 2018 and March 2019, patients with snoring were enrolled from the Department of Sleep Medicine Center, the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University. All subjects underwent polysomnography (PSG), and blood pressure was full-night monitored continuously and synchronized with PSG. Based on the PSG results and exclusion criteria, a total of 78 patients with severe OSAS were recruited and divided into two groups according to Epworth Sleepiness Scale (ESS): patients with excess daytime sleepiness (EDS group) (n=40, ESS>10 scores) and patients without EDS (non-EDS group) (n=38, ESS≤10 scores). Heart rate variability (HRV) was assessed in the frequency domains, the ratio of low to high frequency (LF/HF) was used to reflect sympathetic activity. Oxygen desaturation rate was expressed as the change in the percentage of pulse oxyhemoglobin saturation (SpO₂) per second during an obstructive apnea event. The PSG parameters were compared between the two groups. Multiple regression analyses were used to explore the relevant indicators for EDS in severe OSAS patients.

Compared to non-EDS group, the patients of EDS group were more likely to experience severe sleep breath disturbance [apnea-hypopnea index (AHI): (69±16) vs (60±16) events/h, P=0.010; respiratory event-related arousals (RERAs): (43±17) vs(30±14) events/h, P=0.001]. In addition, hypoxia exposure conditions in the EDS group were more severe than those in the non-EDS group, especially oxygen desaturation rate [(0.48±0.12)%/s vs (0.30±0.11)%/s, P<0.001]. The regression analysis showed that only the oxygen desaturation rate was correlated with the daytime sleepiness in patients with severe OSAS (β=0.615,P<0.001).

Oxygen desaturation rate, as a novel sleep monitoring parameter, may be one of the key factors associated with EDS in severe OSAS patients.

To evaluate the utility of a type Ⅲ portable monitor to diagnose obstructive sleep apnea (OSA) in adults with chronic obstructive pulmonary disease (COPD).

A total of 75 COPD patients with suspected OSA, who visited the Peking University International Hospital from September 2015 to November 2018, were recruited and performed home sleep apnea testing (HSAT) using type Ⅲ portable monitor at home followed by an polysomnography (PSG) and the same portable monitor test (PMT) in sleep laboratory. The success rates of HSAT by portable monitor were calculated; the agreement of apnea and hypopnea index (AHI) between HSAT and PSG as well as the PMT and PSG was analyzed by Bland-Altman plot, the sensitivity and specificity of portable monitor in the diagnosis of OSA in COPD patients were evaluated.

The success rates of HSAT was 88% (66/75). AHI [M (Q₁, Q₃)] was 16.25 (9.23, 30.68) and 17.95(8.63, 40.50) events/h on HSAT and PMT, respectively, both had no significant difference with AHI on PSG [18.25 (7.48, 44.65) events/h]. Bland-Altman analysis indicated that AHI on HSAT and PMT had high agreement with AHI derived from PSG (r=0.898, 0.966, both P<0.001). Using an AHI≥30 events/h to diagnose OSA, type Ⅲ portable monitor both at home and in sleep lab had diagnostic specificity over 95%.

Type Ⅲ portable monitor can be used either at home or in sleep lab to diagnose OSA in COPD patients.

To explore the predictive value of homocysteine (Hcy) and blood pressure fluctuation in patients with hypertension complicated with obstructive sleep apnea hypopnea syndrome (OSAHS).

Seven hundred and thirty-two patients with hypertension and OSAHS undergoing overnight full polysomnography (PSG) were included from Sleep Disorders Center at Affiliated Wujiang Hospital of Nantong University (the Ninth People′s Hospital of Suzhou) between January 2015 and December 2018. According to the monitoring results, they were divided into mild group (n=103), moderate group (n=150) and severe group (n=479) and they were compared with the snoring controls (n=55). The PSG variables were recorded and the blood pressure changes before and after sleep were analyzed. Serum Hcy of 40 patients with mild, moderate and severe OSAHS and 20 patients with snoring was measured by enzymatic cycling methods, and the relationships between Hcy and PSG results and blood pressure fluctuation were analyzed.

Post-sleep diastolic blood pressure (DBP) in the severe OSAHS group was higher than that in the mild, moderate OSAHS group and snoring control [(92.6±11.7) vs (88.5±8.1), (90.2±10.5), (86.2±11.0) mmHg (1 mmHg=0.133 kPa)], post-sleep pulse pressure (PP) in the severe OSAHS group was lower than that in the mild [(44.7±14.4) vs (48.9±14.8) mmHg] (allP<0.05). Post-sleep systolic blood pressure (SBP) in the moderate and severe OSAHS groups was higher than pre-sleep SBP [(134.9±15.9) vs (132.5±16.1), (137.2±16.6) vs (134.1±15.2) mmHg], and post-sleep PP was lower than pre-sleep PP[(44.7±12.7) vs (47.7±13.5), (44.7±14.4) vs (47.6±12.8) mmHg] (allP<0.05). Post-sleep DBP was higher than pre-sleep DBP [(86.3±8.4), (85.5±13.3), (86.5±11.5) mmHg] in the mild, moderate and severe OSAHS groups (P<0.05, separately). The concentrations of Hcy in the mild, moderate and severe groups were higher than those in the snoring controls [(25.8±10.9), (29.3±10.8), (34.0±11.4) vs (17.3±13.5) μmol/L] (all P<0.05) and there was a trend of increase with the aggravation of the disease. Correlation analysis indicated that serum Hcy positively correlated with the DBP difference before and after sleep (ΔDBP) (r=0.290, P=0.001) and negatively correlated with the lowest blood oxygen saturation (L-SaO₂) (r=-0.554, P<0.001). Receiver operating characteristic (ROC) curve showed that the cut-off value of Δ DBP (1 mmHg) for judgment of hypertension patients with OSAHS had a sensitivity of 70.8% and specificity of 70.0%. As a joint indicator with Hcy and ΔDBP, area under the ROC curve (AUC) was 0.813, sensitivity and specificity were 92.5% and 65.0% respectively.

Serum Hcy and DBP fluctuation before and after sleep may have good predictive value for hypertensive patients with OSAHS, which is especially suitable for primary medical institutions that cannot carry out PSG monitoring.

To analyze the clinical value of polyomavirus detection in the urine by metagenomic next generation sequencing (mNGS).

Urine specimens were collected from 33 patients diagnosed with urinary tract infection in Zhongshan Hospital of Fudan University from September 2018 to April 2020. The random amplification, DNA nanoball, BGI-500 sequencing platform, and Burrows-Wheeler Aligner algorithm were used for next generation sequencing and analysis of nucleic acid extracts from urine. The number of virus sequences in urine samples>100 was included in the study, and indexes of virus types, depth, coverage rate, abundance and reads number were observed. Viral load of polyomavirus DNA was determined using a TaqMan PCR strategy.

JC polyomavirus was detected in 30.3% (10/33) urine samples, with BK polyomavirus co-detected in one of them. All of the 10 patients were treated with antibiotics before, but only one with positive urine culture. The mean value of the depth, coverage rate, relative abundance and stringently mapped reads number (SMRN) were 35.9, 96.8%, 92.6% and 3 154, respectively. Further we verified the results with TaqMan real-time PCR, the viral DNA loads of the 10 patients were between 5.84×10³ to 6.55×10⁸ copies/ml, with mean value of 6.82×10⁷copies/ml, 9 (all were immunocompromised patients) of them were higher than 5×10⁴ copies/ml. The results were basically consistent with mNGS. There was a negative linear correlation between the RPM parameter (SMRN per M sequences) and the number of CD4⁺T cells (R²=0.84, P=0.004). In one case, after treatment with cidofovir, the hematuria and urine test indexes were improved, as well as the JC polyomavirus load tested by mNGS and RT-PCR.

The clinical significance of polyomavirus detection in urine remains elusive, but the possibility of infection should be considered in cases of immunocompromised hosts. The mNGS is of great value in the diagnosis of viral urinary tract infection. Cidofovir may be effective in the treatment of urinary tract polyomavirus infection.

To investigate the clinical manifestations, endoscopic features, potential risk factors for cancerization, surveillance and therapeutics of duodenal adenomas in familial adenomatous polyposis (FAP).

Forty-five cases with FAP at Peking Union Medical College Hospital were collected. The clinical data including clinical manifestations, endoscopic features, pathological results, surveillance, and therapies of the 45 patients were retrospectively analyzed.

Duodenal adenomas was present in 15 patients (33%, 8 males), with a mean age of (46.8±12.8) years, which was 9 years older than those without duodenal adenomas (P<0.001). No gender difference was found (P=0.904). The mean endoscopic follow-up time was (35.5±22.1) months. The Spigelman stage increased in 3 patients. The polyp size was greater than 20 mm in 5 patients and duodenal papilla was involved in 4 of them. Two of the 5 patients were diagnosed as ampullary carcinoma. Whipple′s procedure was performed in one of them and pylorus preserving pancreaticoduodenectomy (PPPD) was performed in the other. Endoscopic mucosal resection was performed in the rest of the patients who required intervention.

Duodenal adenomas are common in FAP. Upper gastrointestinal endoscopy is recommended in patients diagnosed with FAP. Combining with Spigelman scoring system, the location and the size of the polyp are risk factors associated with the development of duodenal carcinoma.

Transurethral ureteral stent placement and nephrostomy are two different methods of kidney urine drainage. This study aimed to compare the clinical effects of two different methods for the relief of severe hydronephrosis in infants.

Forty cases with severe hydronephrosis who were treated in Hebei Province Children′s Hospital from December 2014 to May 2018 were enrolled. Twenty cases were received transurethral ureteral stent placement (S group) and the other twenty cases were underwent nephrostomy (N group). The intraoperative conditions and postoperative recovery effects of the two groups were observed.

The preoperative renal pelvis anteroposterior diameter, renal cortical thickness, and postoperative six months renal cortical thickness had no significant differences between two groups (P>0.05). The mean operation time, average intraoperative blood loss, average hospital stay, and anteroposterior diameter of the renal pelvis at 3 months after operation were significantly different between two groups (P<0.05).

Both procedures are effective and feasible treatment options for relieving urinary tract obstruction. They can be used as a primary treatment for stage I treatment of severe hydronephrosis in infants. Transurethral ureteral stent placement is easy to operate, has less trauma, takes less time, recovers quickly after surgery, has no trauma on the body surface, is easy to care for, and has a chance to avoid the possibility of postoperative amputation and shaping surgery. It has more clinical application value.

To investigate the effects of inspiratory muscle training (IMT) combined with endurance training on cardiorespiratory endurance and peripheral muscle strength in patients with viral myocarditis and heart failure.

A total of 76 patients with viral myocarditis and heart failure admitted to our hospital were enrolled and randomly assigned by computer method, 38 in the rehabilitation group and 38 in the control group. Patients in the rehabilitation group were initially given IMT and endurance training and the control group had no special intervention except routine treatment. Patients in both groups were given PImax, left ventricular ejection fraction (LVEF), cardiopulmonary exercise (CPET) and Medical Research Council (MRC) 12 weeks after discharge to assess cardiopulmonary endurance and peripheral muscle strength.

After intervention, PImax in the rehabilitation group was higher than that in the control group and before intervention in the same group (P<0.001). LVEF in rehabilitation group was higher than that in control group (P<0.001). CPET: VO₂peak and VO₂at of the rehabilitation group were both higher than those of the control group, and the slope of CO₂ ventilation equivalent (VE/VCO₂ slope) of the rehabilitation group was lower than that of the control group with significant difference (P<0.05). MRC of the rehabilitation group was higher than that of the control group (P<0.001).

Reasonable IMT combined with endurance training cardiac rehabilitation program can improve cardiorespiratory endurance and peripheral muscle strength in patients with viral myocarditis and heart failure, and improve the quality of life and prognosis.

To investigate the status of dietary intake, nutrition and micro-inflammation among healthy residents in cities of Northern China, and explore the changes of nutritional status with age and its influencing factors.

From January to December 2014, a survey on dietary nutrient intake was conducted among residents ≥ 30 years old who were examined as basically healthy in three randomly selected cities of Northern China (Beijing, Dalian, Shenyang). Serum nutritional and microinflammatory indicators were measured by fasting blood sampling.

A total of 903 individuals met the eligibility criteria, and 420 individuals were male (46.5%). The age ranged from 30 to 95 (58±15) years old. Dietary survey results showed that the dietary intakes of sodium and fat in all age groups were significantly higher than the adequate intake (AI) values recommended by dietary reference intakes (DRIs) of Chinese residents in 2013, while the daily intakes of calcium and vitamin A in all age groups did not reach AI values and gradually decreased with increasing age. Other nutrients basically reached the recommended intake of DRIs. The nutritional serological indexes of the sampled population were within the normal range, but the levels of transferrin and albumin decreased with age (r=-0.321 and -0.236, both P<0.001). Fasting blood glucose, serum cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) increased with age (r=0.289, 0.477, 0.396 and 0.351, all P<0.001). The values of interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) were within the normal range and positively correlated with age (r=0.386, 0.444, both P<0.001). The results of regression analysis revealed that serum transferrin, prealbumin, albumin, fasting blood glucose, serum cholesterol, LDL and HDL were only related to age independently (allP<0.001).

The nutrient intakes of the healthy residents in cities of Northern China basically reached the recommended nutrient intakes, and the serological nutritional index and micro-inflammatory index of the healthy residents were within the normal range. However, there was no significant correlation between micro-inflammatory state and serum nutritional index.

The World Health Organization declared novel coronavirus pneumonia (COVID-19) a pandemic in 2020. Patients with metabolism-related fatty liver disease (MAFLD) often have other metabolic risk factors such as obesity and hypertension that may exacerbate COVID-19. To explore the association between MAFLD and COVID-19 severity, the study continuously enrolled 214 COVID-19 patients aged 18 to 75 years, and the diagnosis was confirmed by high-throughput sequencing of oropharyngeal swab specimens or real-time reverse transcription PCR. According to the international expert consensus on MAFLD in 2020, and the included patients were screened for fatty liver by abdominal CT to diagnose the presence or absence of MAFLD. The study finally included 66 patients with MAFLD who were divided into obese groups based on the presence or absence of obesity (n=45) versus non-obese group (n=21）。 The enrolled patients were divided into severe and non-severe groups according to China's "Novel Coronavirus Pneumonia Diagnosis and Treatment Plan (Trial 7th Edition)", and received standard treatment. The results showed that compared with the non-obese group, patients in the obese group had higher levels of aspartate aminotransferase, lower fasting blood glucose, low-density lipoprotein, lymphocyte counts, and more severe COVID-19 (37.5% vs 9.5%,P=0.021）。 The results of logistic regression analysis showed that among patients with MAFLD, obese people had an approximately 6-fold increased risk of severe COVID-19 compared with non-obese people (OR=5.77，95%CI：1.19~27.91，P =0.029）； Obesity remained independently associated with COVID-19 severity after adjusting for the confounders age, sex, smoking, diabetes, hypertension, and dyslipidemia (OR=6.32，95%CI：1.16~34.54，P=0.033）。