Objective:To characterize the longitudinal and dynamic high-density lipoprotein (HDL) trajectories in critically ill children and explore their correlation with clinical outcomes.Methods:Retrospective cohort study.All critically ill children admitted to the Pediatric Intensive Care Unit (PICU) of West China Hospital, Sichuan University from January 1, 2015 to October 1, 2020 were included in this retrospective study.Group-based trajectory modeling (GBTM) was applied to characterize the HDL trajectories in days 0-6 post-PICU admission and develop HDL trajectory groups.The in-hospital mortality rate was reported as frequency (%) and then compared by the Chi-square test or Fisher′s exact test between HDL trajectory groups.The length of stay (LOS) in the PICU was described by M( Q1, Q3), and its difference between HDL trajectory groups was evaluated by the Kruskal Wallis test.Logistic regression and multiple linear regression were used to determine the correlation between HDL trajectories and clinical outcomes.The primary outcome was in-hospital mortality rate, and the secondary outcome was LOS in the PICU. Results:A total of 4 384 critically ill children were ultimately enrolled in the study, and 6 HDL trajectory groups were developed based on GBTM analyses: group 1 (758 cases), the lowest HDL group; group 2 (1 413 cases), the low HDL group; group 3 (74 cases), the low-to-high HDL group; group 4 (621 cases), the medium HDL group; group 5 (1 371 cases), the high HDL group; and group 6 (147 cases), the highest HDL group.Logistic regression analysis showed that compared with critically ill children in group 1, those belonging to groups 2, 3, 4, 5, and 6 were at lower risks of in-hospital mortality with odds ratio ( OR): 0.475, 95%confidence interval ( CI): 0.352-0.641, P<0.001; OR: 0.093, 95% CI: 0.013-0.679, P=0.019; OR: 0.322, 95% CI: 0.208-0.479, P<0.001; OR: 0.263, 95% CI: 0.185-0.374, P<0.001, and OR: 0.142, 95% CI: 0.044-0.454, P=0.001, respectively.Multiple linear regression analysis revealed that compared with critically ill children in group 1, those belonging to groups 4, 5, and 6 had the trend of shorter LOS in PICU, and the β value and 95% CI were β: -4.332, 95% CI: -5.238- -3.426, P<0.001; β: -3.053, 95% CI: -3.809--2.297, P<0.001; β: -6.281, 95% CI: -7.842--4.721, P<0.001, respectively. Conclusions:The dynamic HDL trajectories during 0-6 days after PICU admission are associated with in-hospital mortality rate of critically ill children.The HDL trajectory at a persistently low level is associated with higher mortality, while the HDL trajectory at a persistently high level or with the trend from a low level rising to a high level shows a lower risk of mortality.It is suggested that the HDL trajectory model may become an indicator to predict the condition and prognosis of critically ill children.

OBJECTIVES: To analyze the Nogo-P3 component of event-related potential (ERP) in the process of visual acuity processing, to provide electrophysiological evidence for objective evaluation of visual acuity. METHODS: Twenty-six subjects with no other ocular diseases except for ametropia were recruited, and all subjects had uncorrected visual acuity both eyes 1/10 (evaluated using Monoyer chart). Block letter E with different visual angles and directions were used as graphic stimuli. The Go/Nogo paradigm was used for ERP studies. The visual angle of Go stimulation angle was 1°15', Nogo stimuli were 1°15', 55', 24' and 15'. The visual acuity test was performed on each of the two naked eyes separately in all subjects, and the characteristics of the Nogo-P3 component were analyzed. RESULTS: The latency of Nogo-P3 showed no difference between the stimuli of 1°15' and 55', and between Nogo stimulation angle 24' and 15'. There was significant difference between Nogo stimulation angle 1°15' and 24', and between Nogo stimulation angle 1°15' and 15' (P<0.05). There was significant difference between Nogo stimulation angle 55' and 24', and between Nogo stimulation angle 55' and 15' (P<0.05). No significant differences were observed in the Nogo-P3 amplitude among Nogo stimulation. CONCLUSIONS In the Go/Nogo paradigm, Nogo-P3 can reflect the cognitive response of subjects to Nogo stimulation, which can be used for objective evaluation of visual acuity.
Electroencephalography ; Evoked Potentials/physiology* ; Humans ; Photic Stimulation ; Reaction Time/physiology* ; Refractive Errors ; Visual Acuity

Objective The tests of three types of auditory evoked potentials （AEPs） were performed on normal young adults, to understand the frequency characteristics of different testing methods and the relationship between response threshold and pure tone audiometry threshold of different methods, and to discuss the forensic value of 3 types of AEPs to evaluate hearing function. Methods Twenty normal young adults were selected, their standard pure tone audiometry threshold, short-term pure tone audiometry threshold and the response threshold of 3 types of AEPs （tone burst-auditory brainstem response, 40 Hz auditory event-related potential and slow vertex response） at 0.5 kHz, 1.0 kHz, 2.0 kHz and 4.0 kHz were recorded. The relationship between the response threshold and standard pure tone audiometry threshold, short-term pure tone audiometry threshold of 3 types of AEPs at different frequencies as well as the differences between different types of AEPs were analyzed. Results The short-term pure tone audiometry threshold was higher than the standard pure tone audiometry threshold at each frequency. The response threshold and standard pure tone audiometry threshold of the 3 types of AEPs all had a certain correlation, and the response threshold of the 3 types of AEPs was higher than short-term pure tone audiometry threshold and standard pure tone audiometry threshold at each frequency. The differences in the differences between the response threshold and standard pure tone audiometry threshold of the 3 types of AEPs at different frequencies had statistical significance. Linear regression mathematical models were established to infer the standard pure tone audiometry threshold （hearing level） from response threshold （sound pressure level） of 3 types of AEPs of normal young adults. Conclusion When using response threshold of different types of AEPs to estimate pure tone audiometry threshold, conversion and correction are needed. Combined use of different types of AEPs could improve the accuracy of hearing function evaluation.
Audiometry, Evoked Response ; Audiometry, Pure-Tone ; Auditory Threshold ; Evoked Potentials, Auditory ; Evoked Potentials, Auditory, Brain Stem ; Hearing ; Humans ; Young Adult

Objective :To study sympathetic activity in aged patients with essential hypertension (EH) complicated left ven-tricular hypertrophy (LVH).Methods : A total of 248 aged EH patients were selected from our hospital from Jun 2015 to Jun 2017- According to blood pressure level ,they were divided into EH stage 1 group (n＝78) ,stage 2 group (n＝89) and stage 3 group (n＝81).According to presence of LVH ,patients were divided into no LVH group (n＝122) and complicat-ed LVH group (n＝126).According to blood pressure level ,LVH patients were divided into stage 1 group (n＝28) ,stage 2 group (n＝41) and stage 3 group (n＝57).Another 130 healthy aged people undergoing physical examination were regar-ded as normal aged group .Plasma norepinephrine (NE) and epinephrine (E) contents were measured and compared among all groups ,and 24h DCG was performed.Results :Compared with normal aged group ,there were significant rise in plasma contents of NE [ (238-33 ± 18-04) ng／L vs.(312-90 ± 23-20) ng／L ,(279-28 ± 20-85) ng／L] ,E [ (262-86 ± 24-56) ng／L vs.(366-57 ± 25-53) ng／L ,(301-20 ± 23-80) ng／L] in complicated LVH group and no LVH group ( P＝0-001 all) ,and plasma NE and E contents gradually and significantly rose along with blood pressure stage rose , P＝0-001 all. Compared with normal aged group ,there was significant rise in mean heart rate [ (64-80 ± 5-40) beats／min vs.(69-02 ± 4-56) beats／min ,(66-72 ± 4-98) beats／min] in complicated LVH group and no LVH group ( P＝0-001 ,0-017) ;signif-icant reductions in SDNN [ (122-07 ± 7-73) ms vs.(109-51 ± 8-13) ms ,(99-25 ± 7-89) ms] ,SDANN [ (111-72 ± 13-33) ms vs.(103-52 ± 10-41) ms ,(94-78 ± 8-75) ms] ,rMSSD [ (43-98 ± 6-31) ms vs.(37-25 ± 6-42) ms ,(32-05 ± 5-19) ms] and PNN50 [ (7-67 ± 0-71)% vs.(5-41 ± 0-67)%,(3-39 ± 0-63)%] in no LVH group and complicated LVH group , P＝0-001 all ,above indexes gradually and significantly reduced along with blood pressure stage rose , P＝0-001 all.Conclusion :Sympathetic activity significantly elevates in aged EH + LVH patients.Controlling sympathetic ac-tivity will help to improve prognosis .

In this study,we aimed to study the pattern visual evoked potentials (P-VEPs) in two eyes with varying visual acuity in one eye and to provide an objective estimation of visual acuity by comparing P-VEPs in one and two eyes.Thirty subjects were chosen,who had one eye with an acuity of 5.0,4.85,4.6,4.0,or scieropia and obstructed vision and the other eye with an acuity of 5.0,respectively.P-VEPs were detected under the large grating stimuli at 3×4 spatial frequency,moderate grating stimuli (12× 16 spatial frequency) and small grating stimuli (48×64 spatial frequency).Under large grating stimuli,there was no significant difference in P100 peak latency between the groups,nor was there a significant difference between the amplitude of two eyes and the amplitude of one normal-vision eye.Under moderate and small grating stimuli,there was a significant difference in P100 peak latency between the group with both eyes having an acuity of 5.0 and the group with visual acuity below 4.0 in one eye.There was a significant difference in P100 amplitude between the group with visual acuity of 5.0 in both eyes and the group with one normal-vision eye.There was no significant difference in the amplitude of two eyes and the amplitude of one normal-vision eye between any other two groups.In forensic identification,characteristics and variability of P-VEPs in one and two eyes can be used to identify malingering or decline in visual acuity.

Objective To investigate the clinical significance of biochemical markers in EBC and serum in patients with bronchial asthma and chronic obstructive pulmonary disease overlap syndrome(ACOS). Methods We selected Patients with chronic airway inflammatory diseases in our hospital,These patients underwent clinical trial after the stable phase,including 18 ACOS patients,22 asthma patients,24 COPD patients and 20 healthy non-smokers in the same period.8-isoPG and other inflammatory factors levels in EBC and serum were measured in the selected patients. A comparative analysis was performed. Results The levels of EBC 8-isoPG in the ACOS group were significantly higher than those in the healthy control group,The levels of serum and EBC 8-isoPG in the ACOS group were significantly higher than the asthma group and the COPD group(P < 0.05). The level of 8-isoPG in EBC was not related to age,smoking index,weight,and FEV1value(P>0.05).Conclusions Inflam-matory factors including 8-isoPG,are involved in chronic inflammation in lung tissues of patients with ACOS. 8-isoPG in EBC may have potential value in identifying ACOS from COPD and asthma as biomarkers and deserve further study.

Objective To explore the necessity of setting up the course on clinical healthcare-associated infection (HAI) and effectiveness of the case-based teaching method in medical higher education.Methods 198 students who underwent internship in a hospital between July 2015 and July 2016 were selected,according to whether they selected clinical HAI coures,they were divided into course selective group(n =107,adopted case-based teaching method) and unselective group(n =91),questionnaire survey on the knowledge and attitude of HAI was carried out.Results The average score on HAI in selective group was higher than that of unselective group([85.3 ± 1.6] vs [58.3 ± 1.8],t =111.72,P＜0.01).Before and after conducted case-based teaching method,21.49％ and 47.66％ of students actively studied respectively,difference was significant (x2 =16.195,P＜0.01).Conclusion It is necessary to carry out a systematic course on HAI,case-based teaching method can improve the learning enthusiasm of students.

AIM:To determine the role of nuclear receptor subfamily 6,group A,member 1 (NR6A1) in vascular smooth muscle cell (VSMC) apoptosis.METHODS:NR6A1 protein was over-expressed in the VSMCs by infection of adenovirus.The effect of NR6A1 on the viability of VSMCs was measured by MTT assay.DAPI staining,TUNEL staining and caspase activity assay were conducted.DNA microarray was used to quickly screen the target genes of NR6A1.The effect of receptor-interacting serine/threonine-protein kinase 3 (RIPK3) silencing on NR6A1-induced apoptosis of the VSMCs was further analyzed.RESULTS:Adenovirus-mediated over-expression of NR6A1 induced the apoptosis of VSMCs.The RIPK3 gene expression was up-regulated by NR6A1 over-expression in the VSMCs.NR6A1-induced VSMC apoptosis was inhibited by RIPK3 silencing.CONCLUSION:NR6A1 promotes VSMC apoptosis by up-regulating the RIPK3 gene expression.

OBJECTIVETo evaluate the therapeutic effect of methylprednisolone for electrical status epilepticus during sleep (ESES) in children.

METHODThe clinical and EEG data of 82 epilepsy patients with ESES, which included benign childhood epilepsy with centro temporal spikes (BECT) variants, epilepsy with continuous spikes and waves during slow sleep (CSWS) , Landau-Kleffner syndrome (LKS) collected from department of pediatrics, Peking University First Hospital were analyzed from July 2007 to September 2012. During ESES period, all patients received methylprednisolone treatment for three courses, which included methylprednisolone intravenous infusion for three days, followed by oral prednisone for four days every time. After three courses, prednisone [1-2 mg/(kg × d)] were taken by all patients for 6 months. The ESES phenomenon and seizures were observed before and after treatment. The efficacy of corticosteroid on ESES suppression, seizure control of three epilepsy syndrome were analyzed.

RESULTThirty-nine cases were male and 43 cases were female. The epilepsy syndromes included 49 patients diagnosed as benign childhood epilepsy with centrotemporal spike (BECT) variants, 27 patients diagnosed as epilepsy with continuous spikes and waves during slow sleep (CSWS), and 6 patients diagnosed as LKS. Age of onset ranged from 1 year and 4 months to 11 years. The age of ESES newly monitored was from 2 years to 10 years and 8 months. The total effective rate of corticosteroid was 83% (68/82) for ESES, BECT variants was 82% (40/49), CSWS was 81% (22/27), LKS was 100% (6/6). There was no statistically significant difference in effective rates between the front two (χ² = 0.09, P > 0.05). The seizures were improved in the first month after methylprednisolone treatment in 3 epilepsy syndromes. The recurrence rate of BECT variants was 47% (23/49) , CSWS was 59% (16/27) , LKS was 50% (3/6) after 1 year follow up. There was no association between disease parameters, including age at seizure onset, duration of ESES and the treatment effect of ESES examined by Kruskal-Wallis method (χ² = 3.585, 0.932, P > 0.05).

CONCLUSIONMethylprednisolone was effective for improving ESES and seizures in 3 epilepsy syndromes combined with ESES. There was no significant correlation between age at seizure onset, duration of ESES and treatment effect of ESES.

Adrenal Cortex Hormones ; therapeutic use ; Child ; Child, Preschool ; Electroencephalography ; Female ; Humans ; Infant ; Landau-Kleffner Syndrome ; drug therapy ; physiopathology ; Male ; Methylprednisolone ; therapeutic use ; Pediatrics ; Seizures ; prevention & control ; Sleep ; physiology ; Status Epilepticus ; drug therapy ; physiopathology ; Treatment Outcome