Surgical procedure and treatment results of pharyngoplasty CWICKs for obstructive sleep apnea

ObjectiveUvulopalatopharyngoplasty (UPPP) is performed as a surgical treatment at the oropharyngeal level for obstructive sleep apnea, but there are problems with variations in treatment effects and postoperative complications. Therefore, to improve those, we have devised and put into practice the so-called CWICKs, which is a modified version of barbed reposition pharyngoplasty as a surgical method. We outline the procedure of CWICKs and report the treatment results in comparison with the conventional UPPP.MethodsCWICKs are surgeries that use resorbable wound closure devices to pull the posterior palatal arch outward and elevate it anteriorly and superiorly to maintain an open upper airway during sleep at the soft palate level. We compared the therapeutic effects of 46 patients evaluated by polysomnography before and after surgery among CWICKs performed in our department between January 2015 and December 2019 and 91 patients who underwent UPPP in our department between January 2000 and December 2008.ResultsIn 46 patients who underwent CWICKs, significant improvement was observed before and after surgery using the apnea hypopnea index (AHI), obstructive apnea index (OAI), ration of each sleep stage, and SpO2 level > 90%. The improvement rate of AHI was 68.4%, and the surgical success rate was 58.7%. Postoperative patient satisfaction was also good, and significant improvement in subjective sleepiness (Epworth Sleepiness Scale) and subjective sleep quality (Pittsburgh Sleep Quality Index) was observed before and after surgery. No postoperative complications such as dysphagia or scar stenosis were observed in any of the patients in the CWICKs group. Compared with the 91 cases of UPPP, which is the conventional method, there was no significant difference in the improvement rate of AHI (p = 0.199), but the improvement rate of OAI had significantly improved (p = 0.013). Regarding the postoperative sleep stage, In the CWICKs group, a significant decrease in stage 1 and a significant increase in stage 2, stage 3, and stage rapid eye movement were observed, whereas in the UPPP group, no significant improvement in stage 3 was observed. Multivariate analysis of surgical success did not show an association with surgical methods (CWICKs or UPPP). On the other hand, an association was shown with age (<45), palatine tonsil size (≥3 / 5), high MPH (≥14 mm), and OAI rate (> 1/3).ConclusionThe treatment outcome of CWICKs was equal to or better than that of the conventional UPPP. Future follow-up is required for long-term prognosis, but no serious postoperative complications, such as dysphagia or scar stenosis, have been observed. CWICKs are considered to be minimally invasive, simple, and effective surgical procedures with few complications.     

双水平气道正压对OSAHS患者预后及血管内皮功能的影响

目的 分析双水平气道正压双水平气道正压通气(bi-level positive airway pressure,BiPAP)对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者血管内皮功能及预后的影响。 方法 将100例OSAHS患者纳入研究，随机分为观察及对照组，各50例。观察组行BiPAP ，对照组行常规治疗，比较两组多导睡眠监测(polysomnography，PSG)检查指标（低通气指数、呼吸暂停指数、呼吸暂停及低通气时间、90%以下血氧饱和度次数、90%以下血氧饱和度时间）、心肺功能［脑钠肽(brainnatriureticpeptide,BNP)、右心室Tei指数、左心室Tei指数、一秒用力呼气容积占用力肺活量的百分比(forced expiratory volume in one second/forced vital capacity，FEV1/FVC)、一秒用力呼气容积占预计值的百分比(FEV1占预计值%)］、血管内皮功能［内皮素1(endothelin-1,ET-1)、一氧化氮(nitric oxide,NO)、凝血酶Ⅲ(antithrombin Ⅲ,AT-Ⅲ)］及生活质量。 结果 观察组低通气指数、呼吸暂停指数、呼吸暂停及低通气时间、90%以下血氧饱和度次数及时间指标均显著低于对照组（P＜0.05）。观察组治疗后BNP以及Tei指数显著低于治疗前及对照组治疗后，FEV1/FVC、FEV1占预计值%显著高于治疗前及对照组治疗后(P＜0.05)。观察组治疗后ET-1、AT-Ⅲ低于治疗前及对照组治疗后，NO高于治疗前及对照组治疗后（P＜0.05）。观察组治疗后生活质量各项目评分高于对照组（P＜0.05）。 结论 BiPAP治疗能够改善OSAHS患者的预后情况及血管内皮功能，效果确切。     

A conceptual framework for treating jaw deformities in patients with abnormal condyles: preservation versus replacement of the glenoid fossa–disc–condyle–ramus

This article outlines a conceptual approach to the reconstruction of jaw deformities associated with abnormalities in the mandibular condyle. The authors describe a hierarchy of reconstruction, emphasizing use of the least invasive and progressing to the most complex and invasive techniques, depending on the nature and severity of the underlying deformity, prior operations, patient age, and stage of growth. Consider joint preservation orthognathic surgical correction, followed by biological techniques for replacement of the condyle, and avoid replacing a functional temporomandibular joint based only on radiographic remodeling and concerns about potential future flare-ups of disease based on anecdotal data.     

Endostar,an Antiangiogenesis Inhibitor,Combined With Chemoradiotherapy for Locally Advanced Cervical Cancer

This phase II randomized clinical trial aimed to assess the efficacy and toxicity of Endostar, an antiangiogenesis inhibitor, combined with concurrent chemoradiotherapy (CCRT) for locally advanced cervical cancer (LACC). Patients with LACC were randomly assigned to either CCRT plus Endostar (CCRT+E arm) or CCRT alone (CCRT arm). All patients received pelvic intensity-modulated radiation therapy (IMRT) and brachytherapy. Weekly cisplatin was administered concurrently with IMRT. Patients in the CCRT+E arm also received concurrent Endostar every 3 weeks for two cycles. The primary endpoint was progression-free survival (PFS) and acute toxicities. The exploratory endpoint was the impact of vascular endothelial growth factor receptor-2 (VEGFR2) expression on long-term survival. A total of 116 patients were enrolled. Patients in the CCRT+E arm and in the CCRT arm had similar acute and late toxicity profile. The 1- and 2-year PFS were 91.4% versus 82.1% and 80.8% versus 63.5% (p=0.091), respectively. The 1- and 2-year distance metastasis-free survival (DMFS) were 92.7% versus 81.1% and 86.0% versus 65.1% (p=0.031), respectively. Patients with positive VEGFR2 expression had significant longer PFS and overall survival (OS) compared with those with negative VEGFR2 expression. Patients in the CCRT+E arm had significantly longer PFS, OS, and DMFS than those in the CCRT arm when VEGFR2 expression was positive. In conclusion, CCRT plus Endostar significantly improved DMFS but not PFS over CCRT alone. The addition of Endostar could significantly improve survival for patients with positive VEGFR2 expression.     

Genomic epidemiological investigation of a Streptococcus suis outbreak in Guangxi,China, 2016

In June 2016, a Streptococcus suis outbreak occurred in Guangxi, China. We determined the genetic characteristics of six clinically isolated strains by serotyping, PCR, and whole-genome sequencing, performing genome epidemiology analysis on these and 961 public available S. suis genomes. We also classified the first sequence type ST665 human case. Sporadic and outbreak cases were distinguished by whole-genome sequencing and phylogenomics. This approach could help to prevent and control S. suis epidemics in Guangxi and the wider region.     

基于线粒体COⅠ基因的广西不同地区福寿螺遗传多态性分析

目的 通过对广西不同地区福寿螺的COⅠ基因进行分析,以了解广西福寿螺种群的遗传多态性。方法 从南宁市横县、桂林市全州县和荔浦县、贺州市富川县、百色市田林县和崇左市凭祥县共计6个县区采集福寿螺样本,提取DNA并进行COⅠ基因的PCR扩增及测序。运用MAGE 7.0将本研究获得的单倍型与GenBank中的福寿螺单倍型使用邻接法构建系统进化树,并计算个体间的遗传距离,分析其遗传多样性。结果 COⅠ基因长度为493 bp,从11个样本鉴定出2种单倍型：单倍型1（Haplotype 1）和单倍型2（Haplotype 2）。其中9个样本为Haplotype 1,分别来源于南宁市横县（2个）、贺州市富川县（1个）、桂林市荔浦县（1个）、百色市田林县（2个）、崇左市凭祥县（3个）,该单倍型与小管福寿螺遗传距离最近,为0.047;2个样本为Haplotype 2,分别源自为南宁市横县和桂林市全州,与孤岛福寿螺遗传距离最近,为0.062。根据上述条件所构建的进化树形成了7个分支,分别为P. canaliculata、P. camena、P. insularum、P. paludosa、P. diffusa、P. haustrum、和外群Pilaconica。Haplotype 1与来自美国夏威夷 （GenBank登录号 EU 523129）的P. canaliculata组成一个分支,Haplotype 2与来自巴西（GenBank登录号EF514942）的P. insularum组成一个分支,且置信值均在98%以上。结论 初步判断广西地区存在小管福寿螺与孤岛福寿螺两种类型的福寿螺,其种群内没有发现遗传分化。     

TACE 术前天冬氨酸氨基转移酶与淋巴细胞比值对原发性肝癌并门脉癌栓患者预后预测的价值

目的 探讨肝动脉化疗栓塞（transcatheter arterial chemoembolization，TACE）术前天冬氨酸氨基转移酶与淋巴细胞比值（aspartate aminotransferase to lymphocyte ratio index，ALRI）在原发性肝癌并门脉癌栓（primary liver cancer-portal vein tumor thrombosis，PLC-PVTT）患者预后预测中的价值。方法 选取2013年11月21日至2018年8月22日于广西医科大学附属肿瘤医院接受TACE治疗的175例PLC-PVTT患者为研究对象。采用时间依赖性ROC曲线确定ALRI的最佳临界值。采用Cox 回归模型分析总生存期（overall survival，OS）的独立预测因素，Kaplan-Meier法计算生存率。结果 ROC曲线显示，ALRI的最佳临界值为49.37，对应曲线下面积为0.71。Kaplan-Meier分析显示，ALRI>49.37的患者OS较ALRI≤49.37的患者短（P=0.003）。Cox 回归分析结果显示，ALRI>49.37、行1次以上TACE治疗、Child-Pugh分级B级、凝血酶原时间≥13 s是患者TACE术后OS的独立危险因素（均P＜0.05）。结论 TACE术前ALRI>49.37是PLC-PVTT患者OS的独立危险因素。