[Exploratory study on quantitative analysis of nocturnal breathing patterns in patients with acute heart failure based on wearable devices]

Patients with acute heart failure (AHF) often experience dyspnea, and monitoring and quantifying their breathing patterns can provide reference information for disease and prognosis assessment. In this study, 39 AHF patients and 24 healthy subjects were included. Nighttime chest-abdominal respiratory signals were collected using wearable devices, and the differences in nocturnal breathing patterns between the two groups were quantitatively analyzed. Compared with the healthy group, the AHF group showed a higher mean breathing rate (BR_mean) [(21.03 ± 3.84) beat/min vs. (15.95 ± 3.08) beat/min, P < 0.001], and larger R_RSBI_cv [70.96% (54.34%-104.28)% vs. 58.48% (45.34%-65.95)%, P = 0.005], greater AB_ratio_cv [(22.52 ± 7.14)% vs. (17.10 ± 6.83)%, P = 0.004], and smaller SampEn (0.67 ± 0.37 vs. 1.01 ± 0.29, P < 0.001). Additionally, the mean inspiratory time (TI_mean) and expiration time (TE_mean) were shorter, TI_cv and TE_cv were greater. Furthermore, the LBI_cv was greater, while SD1 and SD2 on the Poincare plot were larger in the AHF group, all of which showed statistically significant differences. Logistic regression calibration revealed that the TI_mean reduction was a risk factor for AHF. The BR_ mean demonstrated the strongest ability to distinguish between the two groups, with an area under the curve (AUC) of 0.846. Parameters such as breathing period, amplitude, coordination, and nonlinear parameters effectively quantify abnormal breathing patterns in AHF patients. Specifically, the reduction in TI_mean serves as a risk factor for AHF, while the BR_mean distinguishes between the two groups. These findings have the potential to provide new information for the assessment of AHF patients.

[A case report of primary extubation by partial cricotracheal resection for severe subglottic stenosis]

This patient suffered from severe subglottic stenosis(grade Ⅳb). During partial cricotracheal resection, we cut through the cricothyroid membrane and the cricoid arch along the line from the lower edge of the thyroid cartilage to 5 mm of the inferior thyroid cartilage corner anteromedially. This can protect the cricothyroid joint, effectively protect the recurrent laryngeal nerve, and also support the airway. Strictly adhere to airway separation, avoid excessive separation of scars, and combine with reasonable postoperative management to achieve a safe extubation.

[The effect of expression of pepsin in vocal polyps on postoperative curative effect]

Objective:To investigate the effect of tissue pepsin expression of vocal polyps on the postoperative curative effect. Methods:Retrospectively analyze the data of 112 patients diagnosed with vocal cord polyps and undergone surgery from June 2019 to March 2021. The cases were divided into positive group and negative group according to the immunohistochemical pepsin expression. The preoperative reflux symptom index （RSI） and the reflux finding score （RFS） were compared, and the recovery of the voice acoustic function and postoperative vocal cord morphology were analyzed. Results:Among the postoperative specimens of 112 patients,76 cases were positive for pepsin staining, accounting for 67.9%, and 36 cases were negative, accounting for 32.1%. In the pepsin-positive group, 48 cases of vocal cord morphology returned to normal, and 20 cases remained scar or edema in the operation area, 8 cases of polyps relapsed; in the pepsin-negative group, a total of 32 cases of vocal cord morphology returned to normal, 4 cases of remained scar or edema in the operation area, no relapsed cases, the difference in vocal cord morphology recovery was significant （χ²=8.689, P=0.013）. The symptoms of hoarseness improved after 12 weeks. The differences between pre and post operative of G grade, VHI, MPT, fundamental frequency perturbation and amplitude perturbation assessed by GRBAS were significant （P<0.05）; postoperative G grade, VHI, MPT, fundamental frequency perturbation and amplitude perturbation were compared between the pepsin-positive group and the pepsin-negative group, and the differences were significant （all P<0.05）. Conclusion:The expression of pepsin in vocal polyps is a significant clinical indicator that affects the acoustic effect and morphological recovery of vocal cords after surgery. For patients with positive expression, acid suppression treatment should be strengthened after surgery.

[The experimental study on the biological rhythm expression of substance P in allergic airway inflammation mice]

Objective:To establish the murine models of allergic airway inflammation, and to investigate the biological rhythm expression of substance P in it. Method:Eighty-four BALB/c mice were divided into 14 groups, which were airway inflammation groups（0: 00 group, 04: 00 group, 08: 00 group, 12: 00 group, 16: 00 group, 20: 00 group, 24: 00 group） and normal control groups（0: 00 group, 04: 00 group, 08: 00 group, 12: 00 group, 16: 00 group, 20: 00 group, 24: 00 group）. The allergic airway inflammation models of mice were established by intraperitoneal injection of ovalbumin（OVA）, nasal challenge and aerosol inhalation with OVA. The plasma substance P levels were measured by ELISA. The expression of substance P in nasal mucosa, left lung tissue and left bronchial tissue during different time periods was obversed with RT-PCR and immunohistochemical technique. Result:In allergic airway inflammation groups, the plasma substance P levels were higher than in normal control groups（P<0.05）, and 0: 00 group（321.99±28.93） pg/mL, 04: 00 group（310.76±25.31） pg/mL and 24: 00 group（335.62±28.29） pg/mL were higher than other experimental groups（P<0.05）. The expression of substance P mRNA in nasal mucosa, left lung tissue and left bronchial tissue was higher than control groups（P<0.01）. By observing immunohistochemical sections, the expression of substance P in allergic airway inflammation groups was higer than control groups. Conclusion:The expression of substance P is high in allergic airway inflammation mice and the peaks are during 04: 00-08: 00 in the early morning, which may provide new basis for treating allergic airway inflammation.

[Interaction between atorvastatin and voriconazole in rat plasma: a HPLC-MS/MS-based study]

OBJECTIVE

To develop a high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) method for simultaneous determination of atorvastatin and voriconazole in rat plasma and investigate the pharmacokinetics of atorvastatin and the changes in voriconazole concentration in rats after administration.

METHODS

Plasma samples were collected from rats after intragastric administration of atorvastatin alone or in combination with voriconazole. The samples were treated with sodium acetate acidification, and atorvastatin and voriconazole in the plasma were extracted using a liquidliquid extraction method with methyl tert-butyl ether as the extractant. The extracts were then separated on a Thermo Hypersil Gold C18 (2.1×100 mm, 1.9 μm) column within 6 min with gradient elution using acetonitrile and water (containing 0.1% formic acid) as the mobile phase; mass spectrometry detection was achieved in selective reaction monitoring (SRM) mode under the positive ion scanning mode of heated electrospray ion source (H-ESI) and using transition mass of m/z 559.2→440.2 for atorvastatin and m/z 350→280 for voriconazole, with m/z370.2→252 for lansoprazole (the internal standard) as the quantitative ion.

RESULTS

The calibration curves were linear within the concentration range of 0.01-100 ng/mL (r=0.9957) for atorvastatin and 0.025-100 ng/mL (r=0.9966) for voriconazole. The intra-day and inter-day precisions were all less than 13%, and the recovery was between 66.50% and 82.67%; the stability of the plasma samples met the requirements of testing. The AUC_{0-24 h} of atorvastatin in rat plasma after single and combined administration was 438.78±139.61 and 927.43±204.12 h·μg·L^-1, CLz/F was 23.89±8.14 and 10.43±2.58 L·h^-1·kg^-1, C_max was 149.62±131.10 and 159.37±36.83 μg/L, t_1/2 was 5.08±1.63 and (5.58±2.11 h, and T_max was 0.37±0.14 and 3.60±1.52 h, respectively; AUC_{0-24 h}, CLZ/F and T_max of atorvastatin in rat plasma differed significantly between single and combined administration. The HPLC-MS/MS system also allowed simultaneous determination of voriconazole concentration in rat plasma after combined administration.

CONCLUSIONS

The HPLC-MS/MS system we established in this study is simple, rapid and sensitive and allows simultaneous determination of atorvastatin and voriconazole in rat plasma. Some pharmacokinetic parameters of atorvastatin are changed in the presence of voriconazole, and their clinical significance needs further investigation.

[Effect of aberrant H3K27me3 modification in promoter regions on cAMP response element modulator α expression in CD4+ T cells from patients with systemic lupus erythematosus]

OBJECTIVE

Increased cAMP response element modulator α (CREMα) in T cells plays an essential role in the pathogenesis of systemic lupus erythematosus (SLE). The aim of this study was to investigate the mechanisms that elevates CREMα expression in SLE.

METHODS

CD4⁺ T cells from 5 healthy volunteers and 5 SLE patients were isolated for analysis of histone H3 lysine 27 trimethylation (H3K27me3) enrichment in different gene promoters using chromatin immunoprecipitation (ChIP) microarray. The levels of H3K27me3, H3K27 demethylases Jumonji domain containing 3 (JMJD3) and ubiquitously transcribed X (UTX), and H3K27 methyltransferase enhancer of zeste homolog 2 (EZH2) within the CREMα promoter were subsequently tested by ChIP and real?time PCR in CD4⁺ T cells from 30 normal controls and 30 SLE patients; CREMα mRNA level was also determined by real?time RT?PCR.

RESULTS

Analysis of ChIP microarray data identified that H3K27me3 enrichment at the CREMα promoter in CD4⁺ T cells from SLE patients was 0.23 times that of the normal control subjects. The results of ChIP and real?time PCR confirmed a marked decrease of H3K27me3 enrichment at the CREMα promoter in CD4⁺ T cells from SLE patients (P<0.001). The level of H3K27me3 at the promoter was negatively correlated with CREMα mRNA level in CD4⁺ T cells from SLE patients (P<0.001). In addition, a sharp increase was observed in JMJD3 binding at the CREMα promoter region in CD4⁺ T cells from SLE patients (P<0.001), and it was negatively correlated with H3K27me3 enrichment (P<0.001) and positively correlated with CREMα mRNA level (P<0.001). There were no significant changes in UTX (P=0.172) or EZH2 (P=0.281) binding at the CREMα promoter region in CD4⁺ T cells from SLE patients as compared to normal controls.

CONCLUSION

Increased JMJD3 binding down-regulates H3K27me3 enrichment at the CREMα promoter in CD4⁺ T cells of SLE patients to stimulate CREMα overexpression and result in the development of SLE.