Objective  To investigate the correlation between ambulatory arterial stiffness index (AASI) and pulse pressure or blood pressure variability (BPV) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods  A total of 205 patients specifically diagnosed with OSAHS were enrolled as research objects. They completed general data collection, and polysomnography and ambulatory blood pressure monitoring. Based on the classification of circadian blood pressure rhythm, the study population was divided into a dipper blood pressure group (n=92) and a nondipper blood pressure group (n=113). We compared the general clinical characteristics between the two groups as well as the correlation between AASI and ambulatory blood pressure parameters by using Pearson correlation analysis. Multiple linear regression analysis was applied to explore the relationship between AASI and pulse pressure or BPV. Results   The AASI of the non-dipper blood pressure group was significantly higher than that of the dipper blood pressure group (P<0.01). AASI was positively correlated with age, 24-hour mean systolic blood pressure and pulse pressure, while it was negatively correlated with 24-hour mean diastolic blood pressure, and the decline ratio of nocturnal systolic and diastolic blood pressure (all P<0.05). Pulse pressure was associated with AASI if BPV remained constant (P＜0.05). Conclusion  The AASI of OSAHS patients demonstrates an association with pulse pressure and age. AASI may serve as a promising indicator reflecting arterial stiffness.

Objective  To develop a transfer learning-based classification model for sleep apnea syndrome using electrocardiogram (ECG) data, increasing its classification accuracy and clinical applicability. Methods  Based on the Apnea-ECG and MIT-BIH polysomnographic databases, with respiratory signals as input, we applied a Butterworth low-pass filter for denoising, and constructed an original data set. To address the problem of insufficient respiratory signal data, a model training method based on a transfer learning approach was proposed: first, ECG signals with a large sample size were used for model pre-training, and then they were fine-tuning for respiratory signals, finally fulfilling binary classification or multi-class classification tasks. A cascade model combining residual network and bidirectional long short-term memory network was proposed, which performed better in capturing the timing features of signals and improving classification performance. Additionally, the performance of this model was made comparative analysis with those of various classic convolutional neural networks. Results  Through comparative experiments, it was found that employing transfer learning approach could accelerate model convergence and improve the model's overall performance. Validated on the test set, the proposed cascade model demonstrated a favorable performance in both binary classification and multi-class classification tasks, achieving an accuracy of 95.43% on the binary classification task and 91.26% on the multi-class classification task. Conclusion  This study offers novel insights into the design of disease classification models under small-sample conditions, and validates the effectiveness of transfer learning in sleep apnea syndrome classification, thereby demonstrating its potential clinical utility.

Objective  To explore the association between obstructive sleep apnea syndrome (OSAS) and heart rate variability (HRV) or circadian rhythm of blood pressure in hypertensives. Methods  A total of 102 inpatients and outpatients with hypertension were selected in our study, and they were divided into hypertension with OSAS group (55 cases) and primary hypertension group (47 cases). This study enrolled 50 concurrent healthy subjects (all with organic diseases excluded, and without comorbidities of hypertension or OSAS) as a control group. We compared and analyzed the HRV time-domain indexes of SDANN and rMSSD, and HRV frequency-domain indexes of LF and HF, as well as apnea hypopnea index (AHI), nocturnal mean oxygen saturation level, daytime and nocturnal blood pressure levels, and changes of circadian blood pressure rhythm. Results  The nocturnal minimum saturation of arterial oxygen (SaO2) and nocturnal mean SaO2 of patients in the hypertension with OSAS group were both lower than those of patients in the primary hypertension group, while AHI was higher (all P＜0.05). There were no statistically significant differences in the above sleep respiratory parameters between the primary hypertension group and the control group (all P＞0.05). There were no statistically significant differences in the daytime and nocturnal blood pressure levels, and the incidence of non-dipper pattern between the primary hypertension group and the control group (all P＞0.05). Comparisons of the aforementioned parameters between the hypertension with OSAS group and the control group all demonstrated statistically significant differences (all P＜0.01). The hypertension with OSAS group exhibited a significantly higher prevalence of non-dipper circadian blood pressure rhythm compared to the other two groups (all P＜0.05). Compared to the other two groups, the values of SDANN and LF of patients in the hypertension with OSAS group were higher, while the values of rMSSD and HF were lower (all P＜0.05). There were no statistically significant differences in the LF, HF, SDANN and rMSSD values between the primary hypertension group and the control group (all P＞0.05). Conclusion  Patients with OSAS demonstrate increased nocturnal blood pressure level, enhanced sympathetic nerve tension and decreased vagus nerve tension, as well as increased risk of cardiovascular and cerebrovascular diseases.

Objective  To investigate the association between homocysteine (Hcy) and the C677T gene polymorphism in its key metabolic enzyme, methylenetetrahydrofolate reductase (MTHFR), and the complications of hypertension, type 2 diabetes mellitus and atherosclerosis in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods  A total of 85 OSAHS patients and 77 non-OSAHS patients were enrolled. The genotypes, and levels of serum Hcy, fasting blood glucose and hemoglobin Alc of all subjects were detected, while cervical vascular ultrasound was performed simultaneously. Hcy≥10 μmol/L was defined as hyperhomocysteinemia (HHcy). The serum Hcy levels were compared among patients with different genotypes. The Hcy levels, MTHFR C677T gene polymorphism, and C/T allele frequencies were compared among an OSAHS with complications group, a pure OSAHS group, and a control group (without OSAHS or complications). Then, multivariate binary Logistic regression analysis was performed to identify independent risk factors for complications in OSAHS patients with confounding factors adjusted. Results  The Hcy levels in the patients with CC, CT and TT genotypes were 10.11 (9.15, 11.07), 10.86 (9.58, 11.10) and 15.81 (11.43, 50.76) μmol/L, respectively. Hcy level in the patients with TT genotype was significantly higher than that in the cases with CT or CC genotypes (both P＜0.05). The Hcy levels of the OSAHS with complications group, the pure OSAHS group, and the control group were 11.16 (10.05, 13.80), 9.88 (9.31, 11.41), and 10.38 (9.29, 11.34) μmol/L, respectively. The Hcy level of the OSAHS with complications group was significantly higher than that of the pure OSAHS group (P<0.05). There were no statistically significant differences in gene polymorphism or C/T allele frequency among the three groups. After adjusting for confounding factors, it revealed that HHcy was an independent risk factor for concurrent complications in OSAHS patients, and the odds ratio (95% confidence interval) was 4.682 (1.261-17.380). Conclusion  The MTHFR C677T gene polymorphism affects serum Hcy level. HHcy is an independent risk factor for concurrent complications in OSAHS patients, however, neither the MTHFR C677T gene polymorphism nor the C/T allele frequency were associated with complications in OSAHS patients.

Objective  To explore the influence of colonization factor (CF) on the adhesion of Jiulian probiotics to intestinal mucosal epithelial cells, and the efficacy of Jiulian probiotics combined with CF in treating intestinal dysfunction. Methods  Twenty patients with intestinal dysfunction were selected. Based on whether the Jiulian probiotics were co-cultured with intestinal mucosal epithelial cells in combination with CF, they were divided into an experimental group (the Jiulian probiotic suspension was co-cultured with intestinal mucosal epithelial cells in combination with CF) and a control group (only the Jiulian probiotic suspension was co-cultured with intestinal mucosal epithelial cells). Observation was conducted using a self-controlled approach. The Jiulian probiotics that adhered to the intestinal mucosal epithelial cells were extracted separately 4 and 12 hours after co-cultivation; the number of formed colonies was counted, and the effect of CF on promoting the adhesion of the probiotics to the intestinal mucosal epithelial cells was analyzed. According to the gastrointestinal symptom rating scale (GSRS) scores, the curative effect was assessed between the two groups. Results  The Jiulian probiotics adherent to cells, harvested from the experimental group after 4 hours of co-cultivation, formed significantly more colonies than those harvested from the control group after 24-hour of cultivation (P<0.05), while the formed colonies after 12 hours of cocultivation were significantly more than those harvested from the control group (P<0.01). After the combination treatment, the GSRS score of the patients was significantly lower than that before the treatment (P<0.01), while symptoms such as abdominal pain and diarrhea were significantly improved. Conclusion  CF could promote the adhesion of Jiulian probiotics to intestinal mucosal epithelial cells. Probiotics combined with CF may become one of effective methods for treating intestinal dysfunction.

Objective  To investigate autonomic function changes in patients with neurally mediated syncope. Methods  We collected the clinical data of patients presenting with syncope or presyncope. According to the results of head-up tilt test (HUTT), they were divided into an HUTT positive (mixed type) group and an HUTT negative group, each with 53 cases. Each heart rate variability (HRV) index of the two groups were comparatively analyzed before HUTT and during the testing. Results  Before the testing, there were no statistically significant differences in the HRV time-domain indexes of SDNN, SDANN, SDNN index, rMSSD, pNN50, and TINN between the two groups (all P>005); there were also no statistically significant differences in the HRV frequency-domain indexes of LF, HF and LF/HF between the two groups (all P>0.05). During the process of HUTT, if the during-HUTT indexes were compared between the two groups, it revealed that rMSSD value of the HUTT positive (mixed type) group was significantly higher than that of the HUTT negative group (P<0.05). Conclusion  Compared to pre-HUTT HRV indexes, during-HUTT HRV indexes demonstrate greater clinical significance. The presence of vagal overactivity immediately at the onset of syncope in patients with neurally mediated syncope.

Objective  To investigate the efficacy of sugemalimab combined with cisplatin plus paclitaxel regimen in patients with advanced nonsmall cell lung cancer (NSCLC). Methods  Seventy patients with advanced NSCLC were selected as study objects; by using a randomized single-blind method, they were assigned into a control group and a sugemalimab group, with 35 cases in each group. The control group received cisplatin plus paclitaxel therapy, while the sugemalimab group adopted sugemalimab in addition to the control group's regimen. The short-term efficacy, occurrence of adverse reactions, prognosis, levels of cytokeratin 19 fragment antigen 21-1 (CYFRA21-1), carcinoembryonic antigen, squamous cell carcinoma antigen (SCC-Ag), carbohydrate antigen 125 (CA125) and carbohydrate antigen 50 (CA50), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTCQLQ-C30) scores were compared between the two groups before and after treatment. Results   After three treatment cycles, the sugemalimab group showed a significantly higher disease control rate compared to the control group ［80.00% (28/35) vs. 57.14% (20/35), P<0.05］; the levels of CYFRA21-1, carcinoembryonic antigen, SCC-Ag, CA125, and CA50 were all significantly lower in the sugemalimab group than those in the control group (all P<0.01). The sugemalimab group also exhibited significantly lower EORTCQLQ-C30 symptom scores compared to the control group, with significantly higher functional and overall quality of life scores (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). After one year of follow-up, the survival rate was significantly higher in the sugemalimab group than that in the control group ［73.53% (25/34) vs. 51.52% (17/33), P<0.05］. Conclusion  Combining sugemalimab with the cisplatin plus paclitaxel regimen improves treatment efficacy in patients with advanced NSCLC, further reduces tumor marker levels, increases quality of life and survival rates, and demonstrates a favorable safety.

ObjectiveTo investigate the anesthesia effect of dexmedetomidine combined with esketamine in elderly patients with orthopedic lower extremity surgery. MethodsEighty elderly patients undergoing orthopedic lower extremity surgery were randomly divided into two groups, with 40 cases in each group. The control group was given esketamine for anesthesia, while the drug combination group was given dexmedetomidine combined with esketamine for anesthesia. The anesthesia indexes between the two groups of patients were compared, as well as the vital signs, sedation degree, pain degree, and cognitive status before operation (T0), 6 hours after operation (T1), 12 hours after operation (T2) and 48 hours after operation (T3). The occurrence of adverse reactions was also compared between the two groups. ResultsThe recovery time of spontaneous respiration, anesthesia recovery time, orientation recovery time and extubation time in the drug combination group were all significantly shorter than those in the control group (P＜0.05). There were statistically significant differences in heart rate and mean arterial pressure (MAP) at different times in the control group (P<0.01), but there was no statistically significant difference in blood oxygen saturation (SpO2) at different times in the control group (P>0.05). There were no statistically significant differences in heart rate, MAP and SpO2 at different times in the drug combination group (P>0.05). At T1, T2 and T3, heart rate and MAP of the drug combination group were both lower than those of the control group (all P<0.01). There were statistically significant differences in sedation scores at different times in the control group (P<0.01), while there were no statistically significant differences in sedation scores at different times in the drug combination group (all P>0.05). At different times, the sedation scores of the drug combination group were all significantly higher than those of the control group (all P<0.01). There were statistically significant differences in pain scores at different times between the two groups (P<0.01). At T1, T2 and T3, the pain scores of the drug combination group were all significantly lower than those of the control group (all P<0.01). There were statistically significant differences in mini-mental state examination (MMSE) scores between the two groups at different times (all P<0.01). At 24 hours after the operation, MMSE score of the drug combination group was significantly higher than that of the control group (P<0.01); there was no statistically significant difference in MMSE score between the two groups at 72 h, 1 week and 1 month after the operation (all P>0.05). The total incidence of adverse reactions in the drug combination group was 5.00%, significantly lower than 22.50% in the control group (P<0.05). Conclusion  Compared to anesthesia using esketamine alone, dexmedetomidine combined with esketamine is safe and effective for elderly patients with orthopedic lower extremity surgery. It could significantly shorten the recovery time of anesthesia, stabilize perioperative hemodynamics, improve the effect of sedation and analgesia, and reduce the risk of cognitive dysfunction 24 hours after surgery with lower incidence rates of adverse reactions.

Systemic lupus erythematosus (SLE) is an autoimmune disease that produces a large number of pathogenic autoantibodies and immune complexes, damaging multiple tissues and organs. With the update of the classification criteria proposed by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) in 2019, as well as the guidelines for the diagnosis and treatment of SLE, our understandings of SLE, and the level of its diagnosis and treatment have been significantly improved. However, due to the incompletely elucidated pathogenesis of the disease, there is still a lack of targeted intervention measures at present, and the prognosis is not optimistic. In the study of the pathogenesis of SLE, the imbalance of Th17/Treg cells has drawn significant attention. Probing into the key molecules related to their equilibrium is expected to open up a new path for the precise treatment of SLE.

Continuous renal replacement therapy (CRRT) is an extracorporeal blood purification method used for critically ill patients with conditions such as acute kidney injury. The therapeutic effect of CRRT is influenced by the blood flow rate in the extracorporeal circuit. Low blood flow rate is significantly associated with circuit clotting and treatment interruption, while excessively high blood flow rate may lead to elevated circuit pressure, similarly impair therapeutic outcomes. At present, the optimal extracorporeal blood flow rate for CRRT remains unclear. Additionally, the special needs of different populations should be considered during the treatment, and how to set blood flow rate in various treatment scenarios is still an unresolved issue. This article provides a review of the current research status and future prospect of blood flow rate in CRRT, aiming to offer references for clinical practice and further research in this area.