不同程度鼾症患者睡眠结构及醒觉指数分析

目的:分析不同程度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者和单纯鼾症患者的多道睡眠图(PSG)的特点.方法:应用60道PSG监测仪对65例睡眠打鼾成人行整夜睡眠监测,并按照呼吸暂停低通气指数(AHI)将患者分为单纯鼾症组(Ⅰ组)、轻度OSAHS组(Ⅱ组)、中度OSAHS组(Ⅲ组)和重度OSAHS组(Ⅳ组),并比较各组间的PSG检测结果.结果:与单纯鼾症组相比,重度OSAHS组的非快速眼动睡眠(NREM)Ⅰ期所占的百分比增加(P＜0.001),快速眼动睡眠期(REM)所占的百分比减少(P＜0.05);四组鼾症患者的总醒觉指数(ArI)和伴有呼吸紊乱的觉醒指数均增加,自发性觉醒指数均减小;但各组间存在明显差异.NREMⅡ期所占的百分比、NREMⅢ Ⅳ期所占的百分比、睡眠效率等在四个鼾症患者组间比较无明显差异.结论:鼾症患者中睡眠结构紊乱及睡眠片段化与AHI的大小有关.     

Epworth嗜睡量表在阻塞性睡眠呼吸暂停低通气综合症诊断中的应用

目的 探讨Epwoyth嗜睡量表对阻塞性睡眠呼吸暂停低通气综合症（OSAHS）临床诊断意义。方法 对83例鼾症、279例OSAHS患者（轻度65例、中度97例、重度117例）分别进行Epworth问卷调查并判断嗜睡评分（EP），然后行多导睡眠监测（PSG）。依据PSG检查将EP与相关资料做统计学分析。结果 鼾症、OSAHS患者EP评分与睡眠呼吸暂停-低通气指数（AHI）、夜间睡眠呼吸紊乱时间（T）呈明显正相关；EP与最低氧饱和度（SaO2）呈负相关。即OSAHS病情越重，EP评分越高。诊断符合率分别为：鼾症90．36％（75／83），轻度OSAHS92．3％（60／65），中度0SAHS91．75％（89／97），重度OSAHS92．3％（108／117）。结论 EP评分基本与病情相符，诊断符合率较高。可以用Epworth嗜睡量表作为临床OSAHS患者的初筛检查，尤其是在基层医院。     

成年阻塞性睡眠呼吸暂停患者多导睡眠图及临床特征分析性差异

目的:分析成年男性阻塞性睡眠呼吸暂停(OSA)患者多导睡眠图及临床特征,明确年龄对OSA严重程度的影响。方法:回顾性研究包括836名成年男性OSA患者,按年龄分为三组:青年组312人(平均年龄37.07岁),中年组359人(平均年龄52.14岁),老年组165人(平均年龄69.43岁)。分析其多导睡眠图和临床特征,并进行相关性分析。结果:中年组和老年组呼吸暂停低通气指数(AHI)、阻塞性呼吸暂停指数(OAI)、AHI-NREM和AHI-REM均无显著统计学意义(P>0.05),但均低于青年组(P<0.01);中年组和老年组的最低血氧饱和度(SaO2)均高于青年组;中枢性呼吸暂停指数(CAI)随年龄增长而升高(P<0.05)。在睡眠结构方面,老年组总睡眠时间、非快速眼动(NREM)睡眠时间和快速眼动期(REM)睡眠时间均缩短,睡眠效率亦低于青年组(P<0.01),但睡眠潜伏期和入睡后觉醒时间(WASO)明显延长(P<0.01)。年龄与以下各项均呈现显著的相关性:AHI(P<0.01),OAI(P<0.01),CAI(P<0.01),最低SaO2(P<0.01)。多重回归分析表明年龄作为独立变量分别与AHI,OAI,CAI具有相关性。结论:在成年OSA患者中,年龄与OSA严重程度具有显著的相关性,表现为OSA随年龄增长而降低。本研究为研究年龄与OSA严重程度的关系提供了新的证据。     

阻塞性睡眠呼吸暂停综合征病情严重程度的预测因素

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)患者病情危险程度与临床特征的关系.方法对66例习惯性打鼾者,行多导睡眠呼吸仪监测和鼾声测定,分为单纯打鼾(SS)组和OSAS组,同时测量颈围和体重指数.结果 OSAS组患者颈围、体重指数、鼾声均较单纯打鼾组明显增高.体重指数与呼吸紊乱指数(AHI)呈正相关;颈围与鼾声大小呈正相关.结论 OSAS患者的AHI随体重的变化而变化,体重越重、病情越重;颈围、鼾声大小是判断OSAS易患的指标.     

阻塞性睡眠呼吸暂停综合征病情严重程度的预测因素

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)患者病情危险程度与临床特征的关系．方法对66例习惯性打鼾者，行多导睡眠呼吸仪监测和鼾声测定，分为单纯打鼾(SS)组和OSAS组，同时测量颈围和体重指数．结果OSAS组患者颈围、体重指数、鼾声均较单纯打鼾组明显增高．体重指数与呼吸紊乱指数(AHI)呈正相关；颈围与鼾声大小呈正相关．结论OSAS患者的AHI随体重的变化而变化，体重越重、病情越重；颈围、鼾声大小是判断OSAS易患的指标．     

阻塞性睡眠呼吸暂停低通气综合征患者生活质量及影响因素的调查

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者生活质量状况及其影响因素.方法:对149例睡眠时打鼾者行多导睡眠图检查,并进行一般情况调查及Calgary生活质量指数、Epwoah嗜睡量表、Beck抑郁问卷测评.根据呼吸暂停低通气指数(AHI)将其分为对照组(AHI＜5)35例,OSAHS组(AHI≥5)114例.结果:OSAHS组和对照组的生活质量各指标之间存在差异,OSAHS患者的生活质量总分与AHI、最低氧饱和度无相关,与平均氧饱和度、抑郁、嗜睡量表得分相关.多元逐步回归分析显示抑郁和嗜睡症状是OSAHS患者生活质量的独立预测因素.结论:OSAHS患者的生活质量下降,并与抑郁情绪和嗜睡症状有关.     

睡眠呼吸暂停分析系统

本文介绍了一种用于监测睡眠呼吸疾患的计算机自动分析系统的工作原理和软硬件设计。该系统实时显示、记录存储人体9种不同生理信号,自动分析报告睡眠、呼吸和血氧饱和度的动态变化。临床应用证明该系统可为临床诊断失眠、鼾症和睡眠呼吸暂停等睡眠障碍提供可靠的客观依据,与传统的记录多导睡眠图的方法相比,具有节省人力、时间和记录纸的优点。     

血清同型半胱氨酸水平在阻塞性睡眠呼吸暂停低通气综合征和冠心病患者中的变化及其作用

目的:观察血清同型半胱氨酸(Hcy)水平在阻塞性睡眠呼吸暂停低通气综合征(OSHAS)及冠心病(CHD)患者中的变化和作用。方法:收集临床确诊CHD、OSAHS、CHD+OSAHS患者各30例,分别为CHD组、OSAHS组和CHD+OSAHS组。平行检测各组血清Hcy水平及睡眠呼吸监测指标:呼吸暂停低通气指数(AHI)、夜间最低血氧饱和度(SaO2)及平均SaO2,比较各组Hcy水平的差异以及Hcy水平与睡眠呼吸监测指标的相关性。并与30例体检健康者(健康对照组)对比分析。结果:(1)血清Hcy水平:三病例组明显高于健康对照组(P0.01),CHD+OSAHS组明显高于CHD组和OSAHS组(P0.01),CHD组与OSAHS组比较,差异无统计学意义(P0.05)。(2)病例组血清Hcy水平与AHI呈正相关(r=0.64,P0.01),与夜间平均SaO2和夜间最低SaO2均呈负相关(r分别为-0.64、-0.65,P0.01)。结论:血清Hcy水平升高与OSAHS患者SaO2减低有关,可能有利于CHD的发生与发展。     

基于LSTM-CNN的睡眠呼吸暂停与低通气事件实时检测算法研究

睡眠呼吸暂停与低通气综合征(SAHS)严重影响睡眠质量, 是一种潜在的致死性呼吸疾病。为了兼顾对睡眠呼吸暂停与低通气(AH)事件检测的准确率与时间分辨率, 提出一种长短时记忆-卷积神经网络(LSTM-CNN)方法, 实现对AH事件的精准预测;同时基于事件检测结果, 提出一种呼吸紊乱指数(AHI)估计方法, 进而实现对SAHS严重程度的定量评估。选取美国国家心肺血液研究所睡眠健康数据库中54名受试者的腹部位移信号对LSTM-CNN算法进行测试。对于处理得到的超过90万数据片段, 正确率、敏感度、特异度分别为88.6%、88.2%、88.7%;54名被试的AHI预测结果与多导睡眠图(PSG)标注结果相比, 皮尔逊相关指数达到0.98;观察SAHS严重程度诊断结果, kappa系数达到0.95。结果表明, 所提出的方法不仅可以实现对AH事件的高精度检测, 而且可以对AHI指数与SAHS严重程度做出准确估计, 有望用于PSG检测之前SAHS的初步诊断以及成为家用SAHS长期监护工具。     

伴有阻塞性睡眠呼吸暂停低通气综合征的糖尿病患者的临床特点分析

目的：探讨伴有阻塞性睡眠呼吸低通气暂停综合征的糖尿病患者的临床特点,以提高DM与OSAHS两病关系的认识。方法对在2009年1月~2012年12月资料完整的糖尿病患者进行多导睡眠监测,筛选出符合标准的130例患者。根据呼吸暂停低通气指数(AHI)将DM患者分为OSAHS组患者67例;非OSAHS组患者63例。检测血脂、糖代谢等指标并计算胰岛素抵抗指数,比较两组参数的差异。结果OSAHS组的DM患者在体质量指数(BMI)、睡眠呼吸暂停低通气指数(AHI)、最低脉搏容积血氧饱和度(LSpO2)、血清甘油三酯(TG)、糖化血红蛋白(HbA1c)、空腹胰岛素水平(FIns)、胰岛素抵抗指数(HOMA-IR)等参数均高于未伴有OSAHS的DM患者,差异有统计学意义(P<0.05)。 OSAHS组患者血清FIns及HOMA-IR与LSpO2和AHI均存在相关性。OSAHS组高血压和冠心病并发症明显高于非OSAHS组。结论伴有OSAHS的DM患者由于慢性间歇性低氧与IR相关,发生高血压、冠心病的可能性增大,医务工作者应该提高糖尿病患者人群OSAHS的识别。     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.     

Der Einfluß von Nahrungsmitteln und Rauchen auf die klinisch-chemische Diagnostik von Phäochromozytom,Neuroblastom und Karzinoid-Syndrom

Zusammenfassung Der Einfluß von verschiedenen Nahrungsmitteln auf Methoden zur Bestimmung von Adrenalin (AD), Noradrenalin (NA), Vanillinmandelsäure (VMS), Metanephrinen (MN), Homovanillinsäure (HVS) und 5-Hydroxyindolessigsäure (5-HIE) im 24 h-Harn zur Diagnose des Phäochromozytoms bzw. Karzinoid-Syndroms wurde untersucht. Die in die Untersuchung einbezogenen Nahrungsmittel waren: Tee, Kaffee, Mandeln, Ananas, Käse, Walnüsse, Vanillepudding, Bananen, Tomaten und Milchschokolade. Außerdem wurde der Einfluß des Zigarettenrauchens auf die Bestimmung von AD, NA, VMS und MN untersucht.Walnüsse führten zu einer starken Erhöhung der 5-HIE-Ausscheidung. Bananen erhöhten die Ausscheidung von AD, NA, VMS, MN und 5-HIE. Kaffee und Ananas bewirkten eine geringe Zunahme der MN-Werte. Rauchen von 20–30 Zigaretten/Tag beeinflußte keine der vier Variablen.Wenn die beschriebenen Methoden benutzt werden, sollte lediglich auf den Verzehr von Bananen und Walnüssen vor und während der Harnsammelperioden verzichtet werden, da die oberen Normgrenzen im Harn überschritten werden könnten. Ein Verzicht auf Kaffee und Ananas in normalen Mengen ist nicht erforderlich. Es besteht kein Anlaß, weiterhin die bisherigen umfangreichen Restriktionen der übrigen Nahrungsmittel beizubehalten.