Objective:To investigate the changes in N100, P300, and N400 of event-related potential(ERP) in children with obstructive sleep apnea (OSA), and provide the basis for evaluating cognitive and neurological impairment in pediatric OSA.Methods:Totally 108 children aged 5-10 years who visited the Sleep Center of Beijing Children's Hospital due to snoring or mouth breathing were recruited from June to September, 2023, and ultimately 90 children were included in the study.According to the obstructive sleep apnea hypopnea index (OAHI) in their polysomnography (PSG) results, children with OAHI>1 time/h were classified as OSA group ( n=74), and children with OAHI ≤ 1 time/h were classified as non-OSA group ( n=16).All participants completed the auditory oddball and Peabody image vocabulary test tasks, and the EEG data collected through ERP technology were compared between the two groups.SPSS 26.0 software was used for statistical analysis, and independent samples t-test or non parametric test was used for comparison between the two groups. Results:The P300 latency of OSA children in lead Fz was significantly longer than that of non OSA children (330.00(308.00, 396.00) ms, 309.00(294.50, 337.50)ms), and the difference was statistically significant ( Z=-2.143, P=0.032). The latency of P300 was positively correlated with apnea hypopnea index(AHI)(Fz lead: r=0.332, Cz lead: r=0.239, Pz lead: r=0.213, all P<0.05). There was no statistically significant difference in P300 latency between Cz and Pz leads ( Z=-1.615, P=0.106; Z=-1.055, P=0.291). There was no statistically significant difference in the amplitude of P300 among the leads (all P>0.05). There was no statistically significant difference in the amplitude and latency of N100 and N400 (both P>0.05). Conclusion:The latency of P300 in OSA children is significantly longer than that in non-OSA children, indicating impaired cognitive function. The latency of auditory P300 might serve as an early neuroelectrophysiological biomarker for identifying cognitive impairment in OSA children.

Objective:To investigate the changes in N100, P300, and N400 of event-related potential(ERP) in children with obstructive sleep apnea (OSA), and provide the basis for evaluating cognitive and neurological impairment in pediatric OSA.Methods:Totally 108 children aged 5-10 years who visited the Sleep Center of Beijing Children's Hospital due to snoring or mouth breathing were recruited from June to September, 2023, and ultimately 90 children were included in the study.According to the obstructive sleep apnea hypopnea index (OAHI) in their polysomnography (PSG) results, children with OAHI>1 time/h were classified as OSA group ( n=74), and children with OAHI ≤ 1 time/h were classified as non-OSA group ( n=16).All participants completed the auditory oddball and Peabody image vocabulary test tasks, and the EEG data collected through ERP technology were compared between the two groups.SPSS 26.0 software was used for statistical analysis, and independent samples t-test or non parametric test was used for comparison between the two groups. Results:The P300 latency of OSA children in lead Fz was significantly longer than that of non OSA children (330.00(308.00, 396.00) ms, 309.00(294.50, 337.50)ms), and the difference was statistically significant ( Z=-2.143, P=0.032). The latency of P300 was positively correlated with apnea hypopnea index(AHI)(Fz lead: r=0.332, Cz lead: r=0.239, Pz lead: r=0.213, all P<0.05). There was no statistically significant difference in P300 latency between Cz and Pz leads ( Z=-1.615, P=0.106; Z=-1.055, P=0.291). There was no statistically significant difference in the amplitude of P300 among the leads (all P>0.05). There was no statistically significant difference in the amplitude and latency of N100 and N400 (both P>0.05). Conclusion:The latency of P300 in OSA children is significantly longer than that in non-OSA children, indicating impaired cognitive function. The latency of auditory P300 might serve as an early neuroelectrophysiological biomarker for identifying cognitive impairment in OSA children.

[Objective]Taking the research and innovation ability cultivation for professional degree graduate student of traditional Chinese medicine(TCM)as an example,to actively explore a new model for building the research and innovation ability cultivation system for professional degree graduate students.[Methods]This study identifies key challenges in cultivating research innovation capabilities among Master's students in TCM under existing policies,proposes systemic reforms encompassing policy frameworks,curricular models,platform and project development,evaluation standards and other training methodologies,and explores the construction of a novel system for enhancing the research innovation capacity of TCM Master's students and summarizes practical outcomes achieved under this new system.[Results]The main issues in the current cultivation of research and innovation ability for professional degree graduate student of TCM include:inadequate policy support,fragmented of innovation courses,difficulty in platform support and unclear ability indicators.The team has developed a new"Tri-party Collaboration and Four-Wheel Drive"model,through the collaboration of the university,clinical medical colleges and graduate training bases,and constructed a new system for cultivating research and innovation ability,guided by"policy and institutional incentives",based on"curriculum model reform",supported by"platform and project integration",and measured by"evaluation standards".Practice has proven that this system has significantly increased the number of high-level academic papers published by graduate students,the number of excellent dissertations and the number of students pursuing doctoral degrees.[Conclusion]By gathering the combined efforts of three parties,The Second School of Clinical Medicine,Zhejiang Chinese Medical University is focusing on building a new system for cultivating research and innovation abilities of professional degree graduate students in TCM,which plays a positive role in cultivating skilled clinical and excellent scientific research talents in traditional Chinese medicine,and is worthy of further improvement and promotion.

Objective:To investigate the genetic etiology of 15 patients with suspected Marfan syndrome(MFS).Methods:Fifteen patients clinically suspected of having MFS who attended the Women and Children′s Hospital Affiliated to Qingdao University between January 2020 and August 2024 were enrolled. Amniotic fluid samples from fetuses and EDTA-anticoagulated peripheral blood samples from the patients and their family members were collected. Genomic DNA was extracted and subjected to whole exome sequencing(WES). Variants identified in positive cases were further validated by Sanger sequencing. The pathogenicity of the detected variants was assessed according to the guidelines and supplemental criteria of the American College of Medical Genetics and Genomics(ACMG).Results:All 15 patients were found to carry variants in the FBN1 gene, including 9 pathogenic variants, 5 likely pathogenic variants, and 1 variant of uncertain significance(VUS). Notably, eight novel pathogenic or likely pathogenic variants not previously reported in the literature were identified: c. 213G>C, c. 469G>T, c. 3337+ 2dup, c. 4087+ 1G>T, c. 7331_7334dup, c. 8146del, c. 8227dup, and c. 8425_8426insG. According to the revised Ghent criteria(2010), only 2 patients could be clinically diagnosed with MFS prior to WES. However, after incorporating WES-derived molecular evidence, 8 patients fulfilled the diagnostic criteria for MFS.Conclusion:The combination of WES and clinical phenotype assessment can substantially improve the diagnostic yield for MFS. Furthermore, the identification of these novel FBN1 variants expands the mutational spectrum of the gene and provides valuable evidence for future genetic counselling, prenatal diagnosis, and pathogenicity interpretation of neighboring variants.

Objective:To evaluate the relationship between sevoflurane preconditioning-induced reduction of cognitive impairment and hippocampal necroptosis after cardiopulmonary bypass (CPB) in rats.Methods:Sixty SPF healthy male Sprague-Dawley rats, aged 6 months, weighing 400-450 g, were divided into 4 groups ( n=15 each) using the random number table method: control group (group C), sevoflurane group (Sev group), CPB group and CPB+ sevoflurane preconditioning group (CPB+ Sev group). The rats were exposed to 0.4% sevoflurane for 2 h in CPB+ Sev group and Sev group. The CPB model was established at 30 min after the end of sevoflurane preconditioning in CPB+ Sev group. The open field test was performed to assess the autonomic movement ability on the 2nd day after CPB. The Morris water maze test was used to assess the cognitive function on the 3rd day after CPB. The hippocampal tissues were removed after the end of the Morris water maze test for determination of the necroptosis rate and cytosolic calcium concentration of hippocampal neuron ([Ca 2+ ] i) (by flow cytometry) and the expression of phosphorylated receptor-interacting protein kinase 1 (p-RIPK1), phosphorylated RIPK3 and phosphorylated mixed-lineage kinase-like domain (p-MLKL) (by Western blot) and for microscopic examination of the ultrastructure of hippocampal neurons (by transmission electron microscopy). Results:There was no statistically significant difference in the parameters of the open field test among the four groups ( P>0.05). Compared with group C, the escape latency was significantly prolonged, the number of crossing the original platform was decreased, the time of staying at the original platform quadrant was shortened, the hippocampal necroptosis rate and [Ca 2+ ] i were increased, the expression of p-RIPK1, p-RIPK3 and p-MLKL was up-regulated ( P<0.05), the organelles of hippocampal neurons swelled, lysosomes broke, and some chromatin in nuclei dissoluted in CPB group. Compared with CPB group, the escape latency was significantly shortened, the number of crossing the original platform was increased, the time of staying at the original platform quadrant was prolonged, the hippocampal necroptosis rate and [Ca 2+ ] i were decreased, the expression of p-RIPK1, p-RIPK3 and p-MLKL was down-regulated ( P<0.05), and the damage to the ultrastructure of hippocampal neurons was sinificantly reduced in CPB+ Sev group ( P<0.05). Conclusions:The mechanism by which sevoflurane preconditioning attenuates cognitive impairment may be related to the inhibition of calcium overload-mediated hippocampal necroptosis in a rat model of CPB.

Objective To explore the clinical effect of using the Brisson technique combined with a precise measurement scheme in the treatment of hidden penis.Methods The clinical data of 120 children with hidden penis treated in our hospital from January 2021 to June 2024 were retrospectively analyzed.The enrolled children were randomly divided into the study group(n=60)and the control group(n=60).The study group was treated with the Brisson technique combined with a precise measurement scheme,and the cutting of the penile skin was designed according to the data.The control group was treated with the traditional Devine technique.The surgical effects,penile lengths before and after surgery,and the incidence of postoperative complications of the children in the two groups were compared and analyzed.Results The effective rate of the study group reached 100％,which was significantly higher than that of the control group(93％,P＜0.05).Six months after surgery,the penile length of the children in the study group was longer than that in the control group,and the difference was statistically significant(P＜0.05).The incidence of surgical complications in the study group was 5％,which was significantly lower than that in the control group(17％,P＜0.05).Conclusion Using the Brisson technique combined with a precise measurement scheme to treat hidden penis has a good effect,a high effective rate,and a low incidence of complications.

Objective:To explore the impact of the Guided Care nursing model on exercise adherence and knee joint function recovery in patients after total knee arthroplasty (TKA) .Methods:A total of 106 TKA patients from Zhengzhou Orthopedic Hospital, selected by convenience sampling between January 2023 and January 2024, were randomly assigned to the observation group and the control group (53 patients in each group) . The control group received routine nursing care, while the observation group received Guided Care nursing model intervention in addition to the routine care. Exercise adherence (assessed using the Orthopedic Patients' Exercise Adherence Scale) , knee joint function recovery [assessed using the Hospital for Special Surgery Knee Score (HSS) and Range of Motion (ROM) ] , and postoperative complication rates were compared between the two groups.Results:After intervention, the observation group showed significantly higher total scores for exercise adherence, HSS scores, and ROM compared to the control group ( P<0.05) . Additionally, the total postoperative complication rate in the observation group was lower than that of the control group, with statistically significant difference ( P<0.05) . Conclusions:The Guided Care nursing model intervention effectively improves exercise adherence in TKA patients, accelerates knee joint function recovery, and reduces postoperative complications.

Objective:To explore the efficacy of multi-component exercise intervention in the rehabilitation nursing of elderly patients with intertrochanteric femoral fractures and frailty.Methods:Between January and December 2023, 130 elderly patients with intertrochanteric femoral fractures and frailty admitted to Zhengzhou Orthopaedic Hospital were selected by convenience sampling method. The patients were divided into control group ( n=65) and observation group ( n=65) using the random number table method. Control group implemented conventional nursing and observation group was treated with multi-component exercise intervention, both intervening for three months. The rehabilitation status of two groups of patients was evaluated with the Modified Barthel Index (MBI) and Functional Independence Measure (FIM) . Harris Hip Score (HHS) , Physical Frailty Phenotype, Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) and Compliance Scale of Functional Exercise for Orthopedic Patients were used to evaluate the hip function, frailty, quality of life and exercise compliance. Results:After intervention, the MBI score, FIM score and SF-36 score of control group were lower than those of observation group, and the Physical Frailty Phenotype score was higher than that of observation group, and the differences were statistically significant ( P<0.05) . At one and three months after intervention, the HHS scores of observation group were higher than those of control group, and the differences were statistically significant ( P<0.05) . During the intervention period, the exercise compliance of patients in observation group was higher than that of control group, and the difference was statistically significant ( P<0.05) . Conclusions:Multi-component exercise intervention promotes postoperative rehabilitation, improves hip function and quality of life, alleviates the frailty, and enhances exercise compliance in elderly patients with intertrochanteric femoral fractures and frailty.

Objective:To evaluate the relationship between sevoflurane preconditioning-induced reduction of cognitive impairment and hippocampal necroptosis after cardiopulmonary bypass (CPB) in rats.Methods:Sixty SPF healthy male Sprague-Dawley rats, aged 6 months, weighing 400-450 g, were divided into 4 groups ( n=15 each) using the random number table method: control group (group C), sevoflurane group (Sev group), CPB group and CPB+ sevoflurane preconditioning group (CPB+ Sev group). The rats were exposed to 0.4% sevoflurane for 2 h in CPB+ Sev group and Sev group. The CPB model was established at 30 min after the end of sevoflurane preconditioning in CPB+ Sev group. The open field test was performed to assess the autonomic movement ability on the 2nd day after CPB. The Morris water maze test was used to assess the cognitive function on the 3rd day after CPB. The hippocampal tissues were removed after the end of the Morris water maze test for determination of the necroptosis rate and cytosolic calcium concentration of hippocampal neuron ([Ca 2+ ] i) (by flow cytometry) and the expression of phosphorylated receptor-interacting protein kinase 1 (p-RIPK1), phosphorylated RIPK3 and phosphorylated mixed-lineage kinase-like domain (p-MLKL) (by Western blot) and for microscopic examination of the ultrastructure of hippocampal neurons (by transmission electron microscopy). Results:There was no statistically significant difference in the parameters of the open field test among the four groups ( P>0.05). Compared with group C, the escape latency was significantly prolonged, the number of crossing the original platform was decreased, the time of staying at the original platform quadrant was shortened, the hippocampal necroptosis rate and [Ca 2+ ] i were increased, the expression of p-RIPK1, p-RIPK3 and p-MLKL was up-regulated ( P<0.05), the organelles of hippocampal neurons swelled, lysosomes broke, and some chromatin in nuclei dissoluted in CPB group. Compared with CPB group, the escape latency was significantly shortened, the number of crossing the original platform was increased, the time of staying at the original platform quadrant was prolonged, the hippocampal necroptosis rate and [Ca 2+ ] i were decreased, the expression of p-RIPK1, p-RIPK3 and p-MLKL was down-regulated ( P<0.05), and the damage to the ultrastructure of hippocampal neurons was sinificantly reduced in CPB+ Sev group ( P<0.05). Conclusions:The mechanism by which sevoflurane preconditioning attenuates cognitive impairment may be related to the inhibition of calcium overload-mediated hippocampal necroptosis in a rat model of CPB.

Objective:To explore the genetic etiology of fetal skeletal dysplasia using whole exome sequencing (WES) and copy number variation sequencing (CNV-seq) techniques, and the feasibility of using WES as the first-tier method for such fetuses.Methods:Seventy four fetuses with skeletal dysplasia detected by prenatal ultrasound at the Genetic Testing Center of the Women and Children′s Hospital Affiliated to Qingdao University from January 2020 to August 2024 were selected as the study subjects. Fetal muscle and peripheral blood samples of the pregnant women and their spouses were collected and subjected to WES analysis. CNV-seq was carried out on all fetal muscle tissue samples. And the results were compared with the CNVs indicated by WES. Genetic etiologies were analyzed across different subtypes of skeletal dysplasia. And the feasibility of using WES as the first-tier genetic test for similar fetuses was assessed, in addition with a systematic cost-effectiveness analysis. This study was approved by the Medical Ethics Committee of the Hospital (Ethics No.: QFELL-YJ-2024-201).Results:A total of 50 fetuses were diagnosed, which yielded a diagnostic rate of 67.57%. These included 6 chromosomal aneuploidies, 4 chromosomal CNVs and 40 monogenic disorders. The monogenic diseases had involved 46 variant sites in 23 pathogenic genes, among which 12 were unreported previously, including MYH3: c. 735T>C, ALPL: c. 1324C>T, NEK9: c. 1973G>A, MAGEL2: c. 2024_2025del, LMBR1: c. 423+ 4914A>C, NEB: c. 21273_21276del, COL1A1: c. 2651G>C and c. 2758G>C, ASPM: c. 2473delinsGA, TBX5: c. 704G>A, DYNC2H1: c. 10893del, and DYNC2I2: c. 1270C>T. Substantial concordance was reached between WES-derived CNV calls and CNV-seq findings. No clinically significant CNV was exclusively detected by CNV-seq. Cost-effectiveness modeling demonstrated that implementing WES as the first-tier genetic testing method could reduce the total expenditure when WES unit cost remained below 6.4 folds that of the CNV-seq. Conclusion:Genetic variants including single nucleotide variations (SNV) of monogenic disorders, chromosomal aneuploidies and genomic CNVs are important causes for fetal skeletal dysplasia. WES is an accurate and efficient method for analyzing the etiology of fetal skeletal dysplasia, particularly in those with a family history of similar phenotype or maternal history of adverse pregnancies.