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Background: Obstructive sleep apnea hypopnea syndrome (OSAHS) is a disease with high morbidity and is associated with adverse health outcomes. Screening potential severe OSAHS patients will improve the quality of patient management and prognosis, while the accuracy and feasibility of existing screening tools are not so satisfactory. The purpose of this study is to develop and validate a well-feasible clinical predictive model for screening potential severe OSAHS patients. Methods: We performed a retrospective cohort study including 1,920 adults with overnight polysomnography among which 979 cases were diagnosed with severe OSAHS. Based on demography, symptoms, and hematological data, a multivariate logistic regression model was constructed and cross-validated and then a nomogram was developed to identify severe OSAHS. Moreover, we compared the performance of our model with two most commonly used screening tools, Epworth sleepiness scale (ESS) and Stop-Bang Questionnaire (SBQ), among patients who completed the questionnaires.Results: Severe OSAHS was associated with male, BMI≥ 27 kg/m2, high blood pressure, choke, sleepiness, apnea, white blood cell count ≥ 9.5×109/L, hemoglobin ≥ 175g/L, triglycerides ≥ 1.7 mmol/L. The AUC of the final model was 0.75 (95% CI: 0.67-0.82), with sensitivity and specificity under the optimal threshold selected by maximizing Youden Index of 71% and 68%. Among patients having the information of ESS or SBQ, the AUC of our model was statistically significantly greater than that of ESS (0.74 vs 0.58, P=0.006) and not less than that of SBQ (0.78 vs 0.66, P=0.073). Conclusion: Based on common clinical examination on admission, we develop a novel model and a nomogram for identifying severe OSAHS from inpatient with suspected OSAHS, which provides physicians with a visual and easy-to-use tool for screening severe OSAHS.

In recent years, the incidence of oropharyngeal carcinoma (OPC) is increasing, while the better prognosis of patients with Human papillomavirus (HPV) positive oropharyngeal carcinoma has been confirmed in a number of studies. There are a variety of detection methods for HPV-associated oropharyngeal carcinoma. Including P16 immunohistochemistry, Polymerase Chain Reaction (PCR) or In situ hybridization (ISH) detection of HPV DNA, HPV RNA, Revers transcriptase Polymerase Chain Reaction (RT PCR) was used to detect HPV RNA. The better prognosis of patients with HPV-positive oropharyngeal carcinoma has led to the emergence of a large number of degraded treatment trials. The traditional P16 test has certain limitations in the diagnosis of patients with HPV-positive oropharyngeal carcinoma. It is necessary to combine with other detection methods to accurately screen out patients with HPV-positive oropharyngeal carcinoma and better apply to degraded therapy. In this article, we will briefly introduce the trend of HPV-associated oropharyngeal carcinoma, the detection methods and the new progress of degraded treatment trials.

Based on the expert consensus on parenteral and enteral nutrition support for geriatric patients in China in 2013, domestic multidisciplinary experts were gathered to summarize the new evidence in the field of elderly nutritional support at home and abroad. The 2013 consensus was comprehensively updated and upgraded to a guideline by referring to the World Health Organization (WHO) guidelines for the Grading of Recommendations Assessment, Development, and Evaluation system for grading evidence. These guidelines were divided into two parts: general conditions and common diseases. After discussion by all members of the academic group and consultation with relevant experts, 60 recommendations were ultimately established as standardized nutritional support in the field of geriatrics in China.

We conducted a case-control study to assess the relation- ship between rs35767, rs2288377, and rs5742612 insulin-like growth factor-1 (IGF-1) and osteoporosis risk in a Chinese female population. The genotypes of rs35767, rs2288377, and rs5742612 of IGF-1 were determined by polymerase chain reaction-restriction fragment length polymorphism. Patients with osteoporosis were more likely to have drinking and smoking habits and have lower bone mineral density in the L 2 -L 4 vertebrae, femoral neck, and total hip. According to conditional regression analysis, individuals carrying the TT genotype of rs35767 had an increased risk of osteoporosis, with an adjusted odds ratio (95% confidence interval) of 2.29 (1.35-4.97). In conclusion, our results sug - gest that the TT genotype of IGF-I rs35767 was associated with an in- creased risk of osteoporosis, suggesting that this polymorphism can be used as a predictive factor for osteoporosis risk.

The present study investigated the recovery and intrathecal administration of human umbilical cord‑derived mesenchymal stem cells (HUC‑MSCs) by lumbar puncture and analyzed the technical difficulties and short and long‑term effects of UC‑MSC transplantation in various neurological conditions. In total, 100 patients who underwent subarachnoid placement of UC‑MSCs between December 2006 and May 2010 were included in the present study. The present study evaluated the number of attempts, localization of subarachnoid space and postprocedural complications. The Hauser Ambulation Index was employed for functional assessment. Clinical symptoms, the associated biochemical index and photographic examinations were observed regularly. HUC‑MSCs were transplanted into mice as well as patients in order to determine the underlying therapeutic mechanisms. Technical difficulties were encountered in 31 patients (31%) in the form of general anesthesia supplementation and difficulty localizing lumbar space. Side effects were observed in 22 (22%) patients, which resolved with symptomatic treatment within 48 h. On follow‑up one year later, functional indices improved in 47 (47%) patients. Transplantation of HUC‑MSCs inhibited apoptosis and the protein expression of c-Jun N-terminal kinase and p38 as well as triggered the phosphorylation of P‑42/44 extracellular-signal-regulated kinase. In conclusion, intrathecal administration of UC‑MSCs is safe and effective with no long‑term adverse effects in neurological disorders. HUC‑MSCs may achieve these effects via the mitogen‑activated protein kinase pathway. The results suggest that there is a promise of restoration of lost tissue and improvement of function in patients with profound neurological defects. These data support expanded double blind, placebo‑controlled studies for this treatment modality.

The aim of this study was to clone, express the gene of Hgp44 in adhesin domains of gingipains from Porphyromonas gingivalis and purify the protein. Furthermore, the effect of Hgp44 from P. gingivalis on inducing HUVECs to secrete IL-6 and IL-8 was evaluated. The Hgp44 gene fragment was amplified by polymerase chain reaction, and then inserted into the cloning vector pMD18-T and linked with a prokaryotic expression vector pET22b to construct the recombinant expression plasmid pET22b-Hgp44. Fusion protein expression was induced by IPTG, and it was purified by immobilized metal-chelating affinity chromatography (IMAC) using an Ni(2+) matrix column. HUVECs were cultured in vitro and different concentrations of Hgp44 were added to confluent HUVEC monolayers and incubated for 2, 8 and 24 h. We extracted the supernatants and then used ELISA kits to test the changes in IL-6 and IL-8 levels. Finally, a 1100-bp fragment was successfully amplified, and the expression of the fusion protein was examined by SDS-PAGE and Western blot analysis, and the data showed that the protein was 44 kDa in size and expressed mostly in the form of inclusion bodies. The purification of the fusion protein was achieved using Ni(2+) affinity chromatography. About 3.5 mg/L fusion protein was obtained. Hgp44 could induce HUVECs to secrete IL-6 and IL-8 levels, which were remarkably increased. In a word, Hgp44 was successfully expressed in a prokaryotic expression system and purified by IMAC using the Ni(2+) matrix column. The effect of Hgp44 in inducing HUVECs to secrete IL-6 and IL-8 was demonstrated.

The aim of current study is to investigate the molecular mechanism that caloric restriction (CR) suppresses endothelial cells senescence. Human aortic endothelial cells (HAECs) were divided into 5 groups: control group, high caloric group (about 1.5 times caloric intake of control group), low caloric group (about 0.5 times caloric intake of control group), siRNA plus low caloric group (low caloric treatment pretreated with special siRNA targeting hepatocyte nuclear factor 3γ (HNF3γ)), and siRNA plus high caloric group (high caloric treatment pretreated with special siRNA targeting HNF3γ). The gene and protein expressions of HNF3γ and NADPH oxidase 4 (NOX4) were quantified by real-time quantitative PCR (RT-qPCR) and Western blotting, respectively. Intracellular reactive oxygen species (ROS) production was measured by flow cytometry. Endothelial cells senescence was assayed by senescence associated β-galactosidase staining. After verifying the binding of HNF3γ to NOX4 promoter region by chromatin immunoprecipitation assay (ChIP), NOX4 promoter activity was assayed by dual-luciferase reporter system. Compared with the control group, the mRNA and protein expression levels of HNF3γ,and the ratio of phosphorylated HNF3γ protein increased significantly (P

The mortality and morbidity of geriatric patients is much higher than for younger patients, especially when critically ill. This may be attributed to a lower reserve capacity in most organs and systems, reduced ability to deal with physical stress and the presence of acute or chronic co-mobidities. Parenteral and enteral nutrition support can improve the clinical condition of the elderly patient and result in better outcomes, such as lower mortality, reduced hospital stay and reduced medical costs. There is a need to standardize nutrition screening and assessment, and the implementation of appropriate evidence based nutritional support of geriatric patients in China. The Chinese Medical Association's Group of Geriatric Nutrition Support has developed guidelines by researching the present situation in Chinese hospitals and by referring to the guidelines from both American Society for Parenteral and Enteral Nutrition (ASPEN) and the European Society for Clinical Nutrition and Metabolism (ESPEN).老年患者的疾病发病率及死亡率较年轻患者明显升高，特别是危重症老年患 者。这与老年人机体储备功能差，抵抗应激能力下降以及合并有多种急慢性疾 病有关。肠外与肠内营养支持可以有效的改善老年患者的疾病状态及临床结 局，包括降低死亡率、减少住院时间和总体住院费用。因此，在中国亟需针对 于老年患者的基于循证医学规范的营养筛查、评估及支持的指南性纲领。中华 医学会肠外肠内营养学分会老年学组参考美国肠外肠内营养学会（ASPEN） 和欧洲肠外肠内营养学会（ESPEN）发表的临床指南，结合中国的研究进 展，制定了本指南。.

To investigate a reliable and easy assessment method for swallowing function by evaluating objectively the recovery process of swallowing function in patients six months after supracricoid partial laryngectomy.The swallowing function of patients who underwent supracricoid partial laryngectomy was evaluated six months after operation in Nanfang Hospital of Southern Medical University between January 2013 and February 2014 with two methods, the modified barium swallow (MBS) and fiberoptic endoscopic evaluation of swallowing (FEES), combined with modified penetration aspiration scale (MPAS). Furthermore, the feasibility, reliability and accuracy of these two methods were compared.Eleven patients were enrolled. MPAS equals score 1 for solid food, semiliquid food, and liquid food was defined as a criteria of normal swallowing function. By MBS evaluation, the numbers of patients with normal swallowing function were two cases at day 16-30 postoperation, two cases at day 31-45 postoperation, five cases at day 46-90 postoperation, and six cases at day 91-180 postoperation, respectively. By FEES evaluation, the above numbers were three cases, four cases, six cases and eight cases, respectively. When the aspiration was minimal and ejected completely and MPAS was less than or equal to score 4 for solid food, semiliquid food, and liquid food, the gastric tube could be removed. According to this standard, the gastric tube was removed in all cases, and the mean time was (21.7 ± 9.8) days. A good correlation was obtained between these two methods when evaluating solid and semiliquid food, and the Kappa values were 0.802 and 0.844, respectively. However, a little agreement was obtained between these two methods when evaluating liquid food, and the Kappa value was 0.529.Patients who underwent supracricoid partial laryngectomy could restore good swallowing function in six months after the operation. Both the MBS and FEES are valuable procedures for evaluating objectively the swallowing function in patients after supracricoid partial laryngectomy. The FEES is much better than MBS, because FEES is a simple operation performed alone by otolaryngologists with no radiation.

To investigate the guiding function of three-dimensional CT scan in the operation of eagle syndrome.There were 48 cases of eagle syndrome hospitalized during July 2006 to June 2010 who underwent both three-dimensional reconstruction of CT scan and adem position and lateral X ray film. The images were measured by specialist of radiology department.The detail of styloid process is showed more precisely by three-dimensional CT scan, which is able to determine the existence of interrupt, decline, ossification in styloid process. There was significant difference in the measured value (20.83%) between X ray and CT scan (4.16 ± 1.27)cm vs (3.11 ± 0.62)cm, P0.05, in 10 cases. We could not touch styloid process in oral approach in 6 cases (12. 5%), which also had diagnostic confliction between X ray and three-dimensional CT scan. Five patients whose styloid process could not be touched during surgery had longer operation time than the other 41 patients.Three-dimensional CT has good repeatability, high detailed distinguishability, which is an important basis to diagnose eagle syndrome. When X ray shows prolonged styloid process which can not be palpable in oral, we suggest further three-dimensional CT to avoid unnecessary surgery.

To explore the ways of quantitative and objective evaluation for analyzing the multiple influence factors on middle ear function in the patients with primarily diagnosed NPC, and to analyze the influence factors of middle ear function in the patients with primarily diagnosed nasopharyngeal carcinoma (NPC).Three hundred and twenty cases (320 ears) of primarily diagnosed NPC patients were examinated with electric otoscope, acoustic immittance measurement, pure tone audiometry, nasopharynx and middle ear CT or MRI scanning, eustachian tube function examination, and electronic nasopharyngoscope. A series of quantitative methods, as the influence factors including T stage, clinical stage, location, diffusion type and form of tumor, eustachian tube function, pharynx mouth shape, imaging extension (nasal, skull base, pharyngeal recess, parapharyngeal space, tensor veli palatini muscle, levator veli palatini and so on), were used to evaluate the middle ear function. SPSS 13.0 was used to anlyze the single and multiple factors in statistics.T stage, clinical stage, location, diffusion type, and form of tumor, pharynx mouth shape, imaging extension (nasal, skull base, pharyngeal recess, parapharyngeal space, tensor veli palatini muscle, levator veli palatini) were the single influence factors on the function of middle ear in primarily diagnosed NPC patients. The gender, age, pathological types, N staging and M staging of NPC patients primarily diagnosed had no effect on middle ear function. The multple factors analysis showed that T stage, tumor location, the function of eustachian tube, tensor veli palatini muscle invasion, and skull base invasion were independent factor of affecting the middle ear function on primarily diagnosed NPC patients.In this study, the influence factors of middle ear function with primarily diagnosed NPC were related to T stage, location of tumor, the function of eustachian tube, tensor veli palatini muscle invasion, skull base invasion, otitis media and quantitative criteria. The way of quantitative analysis could be used to evaluate objectively the middle ear function in patients with primarily diagnosed NPC.

Stem cells can be differentiated into many kinds of somatic cells under defined culture conditions. In addition, the homing possess can be partially imitated by co-culture of stem cells with mature somatic cells. Regarding the importance of clinical application of adipose-derived stem cells (ADSCs), our review first introduced the sources and signs of ADSCs, and then the current knowledge of ADSCs co-culture technology, including drug and chemical induced culture, two-dimensional (2D) and three-dimensional (3D) co-culture, mechanisms of ADSCs differentiation, and application development in recent years in details. Finally, we also addressed prospects of ADSCs.

To review the biochemical characteristics, application progress, and prospects of the adipose-derived stem cells (ADSCs).The recent original experimental and clinical literature about ADSCs was extensively reviewed and analyzed.ADSCs can be readily harvested in large numbers from adipose tissue with properties of stable proliferation and potential differentiation in vitro. Significant progress of ADSCs is made in the animal experiment and the clinical application. It has been widely used in the clinical treatment of cardiovascular disease, metabolic disease, encephalopathy, and tissue engineering repair.ADSCs have gradually replaced bone marrow mesenchymal stem cells and become the focused hot spot of regenerative medicine and stem cells.

To investigate how the size of tonsil affects the curative effect of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) treated with Uvulopalatopharyngoplasty (UPPP).Fifty-four cases with OSAHS treated with UPPP in our department were analyzed retrospectively. The polysomnography (PSG) was examined again one years or longer after operation.There was no statistical difference between different tonsil size groups in age, apnea-hypopnea index (AHI), body mass index (BMI) and the lowest Pulse Oxygen Saturation (lowest SpO2) before operation. But there was a statistical difference in curative effect after operation between groups. The lowest SpO2 raised obviously in groups with bigger tonsils. In serious OSAHS group, there was a statistical difference in the composing of tonsil size grade in different curative effect groups.Patients with bigger size of tonsil will receive a better result after UPPP while the lowest SpO2 will be improved more prominent. To serious OSAHS, we should treat them individually.

Excessive caloric intake is a contributing risk factor for human metabolic disorders. Caloric restriction may prolong a person's life by lowering the incidence of deadly diseases. Reactive oxygen species (ROS) in peripheral blood mononuclear cells (PBMC) have been associated with the biochemical basis of the relationship between caloric intake and pathophysiologic processes. Polymorphisms associated with ROS generation genes are being increasingly implicated in inter-individual responses to daily caloric intake alterations. In the current study, a single nucleotide polymorphism, rs1836882, in the nicotinamide adenine dinucleotide phosphate oxidase 4 (NOX4) gene's promoter region was found to modulate associations between dietary caloric intake and ROS levels in PBMC. Based on rs1836882, 656 Chinese Han participants were classified into CC, CT and TT genotypes. ROS levels in PBMC were significantly higher in the CC or CT genotypes compared with the TT genotype with the same increases in daily caloric intake. Using an electrophoretic mobility shift assay, NOX4 promoter region with rs1836882 (T) was observed to have a higher affinity for hepatocyte nuclear factor gamma (HNF3γ) protein than rs1836882 (C). HNF3γ protein over-expression decreased NOX4 gene transcriptional activity in the TT genotype more than in the CC genotype (5.68% vs. 2.12%, P

Background The effects of brain natriuretic peptide (BNP) on the risk of cardiovascular disease and atherosclerosis have been studied. However, little information is available regarding peripheral arterial disease (PAD), particularly among subjects with type-2 diabetes mellitus (T2DM). The aim of our study was to assess the potential relationship between BNP levels and PAD among T2DM patients. Methods The study cohort was 507 T2DM outpatients in which BNP levels were measured. Cross-sectional associations between BNP levels (in tertiles) and PAD were examined. Results Compared withT2DM patients without PAD, BNP levels were markedly higher in patients with PAD (p = 0.001). Correlation analyses showed that the BNP level was negatively correlated with the ankle–brachial index (r = −0.453, p = 0.033). At a cutoff value of 78.2 pg/ml, the BNP level showed a sensitivity of 71.9%, a specificity of 68.1%, and a positive predictive value of 84.3% for a diagnosis of PAD. The area under the receiver-operating characteristic curve increased significantly if BNP levels were incorporated into a predictive model of the potential risk factors for PAD (0.85 vs 0.81, p = 0.029). Conclusions BNP is a potential and promising biomarker for PAD screening in T2DM patients.