[Respiratory virus infection and its influence on outcome in children with septic shock].

Objective: To investigate respiratory virus infection in children with septic shock in pediatric care units (PICU) in China and its influence on clinical outcomes. Methods: The clinical data of children with septic shock in children's PICU from January 2018 to December 2019 in 10 Chinese hospitals were retrospectively collected. They were divided into the pre-COVID-19 and post-COVID-19 groups according to the onset of disease, and the characteristics and composition of respiratory virus in the 2 groups were compared. Matching age, malignant underlying diseases, bacteria, fungi and other viruses, a new database was generated using 1∶1 propensity score matching method. The children were divided into the respiratory virus group and non-respiratory virus group according to the presence or absence of respiratory virus infection; their clinical characteristics, diagnosis, and treatment were compared by t-test, rank sum test and Chi-square test. The correlation between respiratory virus infection and the clinical outcomes was analyzed by logistic regression. Results: A total of 1 247 children with septic shock were included in the study, of them 748 were male; the age was 37 (11, 105) months. In the pre-and post-COVID-19 groups, there were 530 and 717 cases of septic shock, respectively; the positive rate of respiratory virus was 14.9% (79 cases) and 9.8% (70 cases); the seasonal distribution of septic shock was 28.9% (153/530) and 25.9% (185/717) in autumn, and 30.3% (161/530) and 28.3% (203/717) in winter, respectively, and the corresponding positive rates of respiratory viruses were 19.6% (30/153) and 15.7% (29/185) in autumn, and 21.1% (34/161) and 15.3% (31/203) in winter, respectively. The positive rates of influenza virus and adenovirus in the post-COVID-19 group were lower than those in the pre-COVID-19 group (2.1% (15/717) vs. 7.5% (40/530), and 0.7% (5/717) vs. 3.2% (17/530), χ2=21.51 and 11.08, respectively; all P<0.05). Rhinovirus virus were higher than those in the pre-Covid-19 group (1.7% (12/717) vs. 0.2% (1/530), χ2=6.51, P=0.011). After propensity score matching, there were 147 cases in both the respiratory virus group and the non-respiratory virus group. Rate of respiratory failure, acute respiratory distress, rate of disseminated coagulation dysfunction, and immunoglobulin usage of the respiratory virus group were higher than those of non-respiratory virus group (77.6% (114/147) vs. 59.2% (87/147), 17.7% (26/147) vs. 4.1% (6/147), 15.6% (25/147) vs. 4.1% (7/147), and 35.4% (52/147) vs. 21.4% (32/147); χ2=11.07, 14.02, 11.06 and 6.67, all P<0.05); and PICU hospitalization of the former was longer than that of the later (7 (3, 16) vs. 3 (1, 7)d, Z=5.01, P<0.001). Univariate logistic regression analysis showed that the presence of respiratory viral infection was associated with respiratory failure, disseminated coagulation dysfunction, the use of mechanical ventilation, and the use of immunoglobulin and anti-respiratory viral drugs (OR=2.42, 0.22, 0.25, 0.56 and 1.12, all P<0.05). Conclusions: The composition of respiratory virus infection in children with septic shock is different between pre and post-COVID-19. Respiratory viral infection is associated with organ dysfunction in children with septic shock. Decreasing respiratory viral infection through respiratory protection may improve the clinical outcome of these children.

[Mediating effect of unhealthy lifestyle and depressive symptom on association between life course factors and ageing health].

Objective: To explore the mediating effect of unhealthy lifestyle and depressive symptom on the associations between life course factors and aging health. Methods: The study included 6 217 participants (aged ≥45 years) from the China Health and Retirement Longitudinal Study (CHARLS). We used principal component analysis (PCA) and hierarchical clustering analysis (HCA) to divide participants into six subgroups based on 70 life course factors. Five key life course factors were identified based on correlation analysis and their contribution to aging health. Physiological dysregulation (PD) was calculated by using eight biomarkers in the 2015 CHARLS biomarker dataset. Linear regression, logistic regression, and mediation models were used to explore the complex associations of life course subgroups, key factors, unhealthy lifestyle, depression symptom with PD. Results: Life course subgroups were significantly associated with PD after adjusting chronological age and gender (ß: 0.08-0.17, all P<0.05). Life-course subgroups and key factors, including adverse experiences in adulthood and lower education level, were significantly associated with unhealthy lifestyle (ß: 0.04-0.52, all P<0.05). Life-course subgroups and key factors, including childhood trauma, parental health in childhood, adverse experiences in adulthood, and lower education level, were significantly associated with depression symptom (OR: 1.16-4.76, all P<0.05). Mediation analysis showed that unhealthy lifestyle had partial mediating effect on the association of life course subgroups and key factors, including adverse experiences in adulthood, and lower education levels, with PD (3.1%-3.6%). Depression symptom had partial mediating effect on the association of life course subgroups and key factors, including childhood trauma, adverse experience in adulthood, and lower education level, with PD (6.0%-16.2%). Conclusions: Unhealthy lifestyle and depression symptom has partial mediating effect on the impact of life course factors on aging health. It is important to pay attention to these two modifiable factors while targeting childhood trauma and adverse experience in adulthood.

[Study on the 5-year trend and influencing factors of lipoprotein (a) concentration in community-based population].

Objective: To explore the trend and influencing factors of serum lipoprotein (a) (Lp(a)) concentration over time in Chinese community populations. Methods: This study is a prospective cohort study. The participants were enrolled from Chinese Multi-provincial Cohort Study- Beijing projects, completed the cardiovascular disease risk factor surveys in 2002 and 2007, and the serum Lp (a) concentration were measured. Based on the Lp(a) concentration at baseline (2002) and follow-up (2007), the participants were classified into subgroups of <30.0 mg/dl (1 mg/dl=0.01 g/L) group, 30.0 to 49.9 mg/dl group, and ≥50.0 mg/dl group, respectively. Multivariable logistic regression analysis was used to identify influencing factors associated with Lp (a) absolute change (≥20 mg/dl) and relative change (≥20%) within 5 years. Results: Among 1 955 participants with age of (56.5±8.0) years old and 821 male (42.0%) at baseline, there were 1 657 (84.8%), 184 (9.4%) and 114 (5.8%) participants in Lp(a)<30.0 mg/dl group, 30.0 to 49.9 mg/dl group and ≥50.0 mg/dl group, respectively. Among the baseline Lp(a) concentration of 30.0-49.9 mg/dl group, 68 (37.0%) participants progressed to Lp(a) ≥50.0 mg/dl after 5 years follow-up, and 102 (55.4%) remained at this level. Participants with baseline Lp(a)<30.0 mg/dl (92%, 1 524/1 657) or Lp(a)≥50.0 mg/dl (94.7%, 108/114) tended to be maintained at their respective levels. The results of the multivariate logistic regression analysis showed that, in addition to the high level of baseline Lp(a) concentration, family history of cardiovascular disease, elevated fasting blood glucose and usage of oral lipid-lowering drugs were the influencing factors of Lp(a) changes over time (P<0.05). Conclusions: Adults with borderline-high Lp(a) concentrations (30.0 to 49.9 mg/dl) could be considered for repeated testing, especially for those with a family history of cardiovascular disease, elevated fasting blood glucose and usage of statins.

[Attach importance to the moderate diagnosis and treatment of multiple pulmonary nodules].

With the popularization of chest computed tomography examination in physical examination, the detection rate of multiple pulmonary nodules has significantly increased. However, there are no unified guidelines or consensus for the diagnosis and treatment of multiple pulmonary nodules, and the clinical diagnosis and treatment of such patients are often inadequate or excessive. Therefore, it is of great clinical significance to attach importance to the moderate diagnosis and treatment of multiple pulmonary nodules and formulate unified clinical practice standards for the prevention of lung cancer and the diagnosis and treatment of multiple pulmonary nodules.

[Risk factors for pulmonary atelectasis in adults with tracheobronchial tuberculosis].

Objective: To investigate the risk factors for pulmonary atelectasis in adults with tracheobronchial tuberculosis(TBTB). Methods: Clinical data of adult patients (≥18 years old) with TBTB from February 2018 to December 2021 in Public Health Clinical Center of Chengdu were retrospectively analyzed. A total of 258 patients were included, with a male to female ratio of 1∶1.43. The median age was 31(24, 48) years. Clinical data including clinical characteristics, previous misdiagnoses/missed diagnoses before admission, pulmonary atelectasis, the time from symptom onset to atelectasis and bronchoscopy, bronchoscopy and interventional treatment were collected according to the inclusion and exclusion criteria. Patients were divided into two groups according to whether they had pulmonary atelectasis. Differences between the two groups were compared. Binary logistic regression was used to analyze the risk factors for pulmonary atelectasis. Results: The prevalence of pulmonary atelectasis was 14.7%, which was most common in the left upper lobe (26.3%). The median time from symptom onset to atelectasis was 130.50(29.75,358.50)d, and the median time from atelectasis to bronchoscopy was 5(3,7)d. The median age, the proportion of misdiagnosis of TBTB before admission, and the time from symptom onset to bronchoscopy in the atelectasis group were higher than those without atelectasis, and the proportion of receiving bronchoscopy examination and interventional therapy previously, and the proportion of pulmonary cavities were lower than those without atelectasis (all P<0.05). The proportions of cicatrices stricture type and lumen occlusion type in the atelectasis group were higher than those without atelectasis, while the proportions of inflammatory infiltration type and ulceration necrosis type were lower than those without atelectasis (all P<0.05). Older age (OR=1.036, 95%CI: 1.012-1.061), previous misdiagnosis(OR=2.759, 95%CI: 1.100-6.922), longer time from symptom onset to bronchoscopy examination (OR=1.002, 95%CI: 1.000-1.005) and cicatrices stricture type (OR=2.989, 95%CI: 1.279-6.985) were independent risk factors for pulmonary atelectasis in adults with TBTB (all P<0.05). Of the patients with atelectasis who underwent bronchoscopy interventional therapy, 86.7% had lung reexpansion or partial reexpansion. Conclusions: The prevalence of pulmonary atelectasis is 14.7% in adult patients with TBTB. The most common site of atelectasis is left upper lobe. The TBTB type of lumen occlusion is complicated by pulmonary atelectasis in 100% of cases. Being older, misdiagnosed as other diseases, longer time from onset of symptoms to bronchoscopy examination, and being the cicatrices stricture type are factors for developing pulmonary atelectasis. Early diagnosis and treatment are needed to reduce the incidence of pulmonary atelectasis and increase the rate of pulmonary reexpansion.

[Analysis on the allocation equality in occupational health technology service resource in Gansu Province].

Objective: To investigate and analyze the allocation equality of occupational health technology service resource of Gansu disease control and prevention institutions, providing reference basis for optimizing the allocation of occupational health technology service resources. Methods: Combined with the survey data in September 2021, Gansu Province was divided into five economic regions by geographical location and economic characteristics. Taking the service number of enterprises and workers as the analysis dimensions, the allocation level of occupational health technology service resources in different regions was compared. The allocation equality was analyzed through Lorentz curve, Gini coefficient and Theil index. Results: There were 301 occupational health technicians and 1914 sampling and testing equipments of Gansu Provincial disease control and prevention institutions in 2021. All of the technicians and equipments were used for serving 1952 enterprises and 465800 workers. The curvature of Lorentz curves and Gini coefficient which measured by the service number of enterprises and workers were: occupational health technicians>radioactive factor sampling and testing equipment >physical factor sampling and testing equipment >chemical factor sampling and testing equipment, and chemical factor sampling and testing equipment>physical factor sampling and testing equipment >radioactive factor sampling and testing equipment >occupational health technicians, respectively. Theil index of occupational health technology service resources suggested that differences in regions were the main unfair reason effected the allocation of occupational health technicians and radioactive factor sampling and testing equipment, while the differences between regions were the main unfair reason effected the allocation of chemical and physical factor sampling and testing equipment. Conclusion: The allocation equality in occupational health technology service resources of Gansu Provincial disease control and prevention institutions was not enough, and the differences in regions and between regions should be considered. This study suggests that it is necessary to introduce more occupational health technicians. The allocation of occupational health technology service resources should match with the number of local enterprises and the types of potential hazard factors of enterprises as far as possible.

Changes in physical activity behavior in children and adolescents: a systematic review and meta-analysis based on a trans-theoretical model.

OBJECTIVE: This article presents a systematic review and meta-analysis of cross-sectional studies of physical activity (PA) behavioral changes in children and adolescents based on the trans-theoretical model (TTM). The main purpose is to test the rationality of TTM and the secondary purpose is to analyze whether PA can effectively identify the stages of change. MATERIALS AND METHODS: The databases CNKI, Wan-Fang, VIP, WOS, PubMed, and EBSCO were searched by computer. Two researchers independently reviewed the literature, extracted data, and evaluated the quality of the literature. Stata 23.0 software was used for statistical analysis. RESULTS: A total of 17 articles of medium and high quality were included in the meta-analysis. First, the behavior changes of PA of children and adolescents are related to the process of change (POC), self-efficacy (SEI), and decisional balance (DBL). The POC, SEI, and DBL have obvious stage characteristics. Second, with increasing intensity of PA, the degree of discrimination of stage of change (SOC) also improved, but PA could not still fully distinguish each stage. CONCLUSIONS: It is suggested that follow-up studies should compare the stages of change of different criteria by comprehensive behavioral data, exercise willingness, and exercise habits. Furthermore, it is recommended that more studies use longitudinal surveys or experimental interventions to test the rationality of TTM. It is suggested that the follow-up study design more standardized measurement tools to explore the change in PA behavior of children and adolescents.

[Application of oral fluid in SARS-CoV-2 nucleic acid and antibody detection].

This study aimed to explore the application value of new biological specimen oral fluid in SARS-CoV-2 nucleic acid and antibody detection. Oral fluid and paired respiratory and blood specimens from 7 confirmed cases of two COVID-19 cluster epidemic were collected in Beijing from October to November 2021. SARS-CoV-2 virus and IgG antibody were detected by real time PCR kits and serum antibody detection reagents, and SARS-CoV-2 IgG antibody in oral fluids was detected by a new established method of magnetic particle chemiluminescence. The results showed that the nucleic acid amplification test of SARS-CoV-2 on nasopharyngeal swabs, throat swabs and oral fluid specimens from 3 confirmed cases of COVID-19 was positive, among which the Ct value for ORF1a/b and N gene of oral fluid samples in 2 cases was close to that of throat swab, and the Ct value of oral fluid sample for 1 case was higher than that of throat swab. The complete genome sequence of one oral fluid specimen was obtained, which belonged to the VOC/Delta variant strain. The SARS-CoV-2 IgG antibodies of the paired oral fluid and serum were all positive, and the S/CO values of oral fluid were all lower than those of serum. The series of oral fluid results showed that SARS-CoV-2 IgG antibody level increased from 11 to 32 days after the onset of the disease.

Effects of air pollutant exposure on lung function in exercisers: a systematic review and meta-analysis.

OBJECTIVE: The aim of this study is to systematically evaluate the effect of air pollutant exposure on lung function in exercisers. MATERIALS AND METHODS: Computer search Web of Science, PubMed, EBSCO and Cochrane Library, MINORS scale for literature quality evaluation, and Stata 12.0 software for statistical analysis. RESULTS: According to the literature inclusion and exclusion criteria, a total of 14 pieces of literature were screened and included in the Meta-analysis, and the literature quality was relatively high. Meta-analysis shows that air pollutant exposure has no significant effect on FVC, FEV1 and PEF of exercisers (p>0.05); but it can significantly increase the FeNO level of exercisers [Z=2.26, p = 0.024, SMD=-0.228, 95% CI= (-0.426, -0.031)]. Egger linear regression analysis shows that FVC [ß=-4.64, p = 0.004, 95% CI= (-7.32,-1.95)] has the possibility of publication bias; FEV1, PEF and FeNO p>0.05 and 95% CI contains 0, there is no publication bias in the included literature. There is no sensitivity problem in the included literature, and the combined result is robust and reliable. CONCLUSIONS: Exposure to air pollutants may cause allergic airway inflammation by increasing FeNO levels in exercised populations, and adversely affecting human health.

[Application of acellular bovine pericardium patch in implant based immediate breast reconstruction].

Objective: To examine the clinical effect of acellular bovine pericardium patch in implant based immediate breast reconstruction. Methods: The clinicopathological information of 141 breast cancer patients, who admitted to Department of Breast Reconstruction and Oncoplastic Surgery, Tianjin Medical University Cancer Hospital, underwent immediate mammoplasty with implants combined with acellular bovine pericardium patches were analyzed from June 2016 to October 2019. All patients were female, with the age of (38.8±8.5) years (range: 13 to 60 years). The body mass index was (21.9±2.5) kg/m2 (range: 16.0 to 32.3 kg/m2). There were 39 cases of duct carcinoma in situ, 46 cases of stage Ⅰ, 40 cases of stage Ⅱ and 16 cases of stage Ⅲ. All patients received nipple-areola-sparing mastectomy or skin-sparing mastectomy with sentinel lymph node biopsy or axillary lymph node dissection, and prosthesis implantation with sub-pectoralis combined with breast patch. The correlation of clinicopathological characters and complications was assessed by t test, χ2 test, Fisher's exact probability method and Logistic regression. Pre-and post-operative aesthetic, quality of life scores were recorded. Results: The operation time (M(IQR)) was 3.6(1.5) hours (range: 3.0 to 6.5 hours). The early postoperative complication rate was 22.0% (31/141), prosthesis removal was the main postoperative complication, accounting for 64.5% (20/31) of the total complications, of which 15 cases occurred in the first 30 patients. The follow-up time was 28(8) months (range: 20 to 53 months), The most frequent long-term complications were capsular contracture and implant displacement, with the incidence of 11.2% (14/125) and 10.4% (13/125), respectively. Multivariate analysis showed that prosthesis volume ≥300 ml (OR=8.173, 95%CI: 1.302 to 51.315, P=0.021) and peri-areolar incision (OR=7.809, 95%CI: 2.162 to 28.211, P<0.01) were independent relative factors for the occurrence of short-term postoperative local complications. After 2 years of operation, the score of breast appearance satisfaction was 71.7±15.5, postoperative effect satisfaction was 90.4±9.5, psychological satisfaction was 90.7±17.1, sexual satisfaction was 70.1±25.1. The immediate postoperative satisfaction rate at discharge was 95.4% (134/141), and 17.6% (22/125) of patients had the intention to received revision surgery. Conclusions: Prosthesis volume ≥300 ml and peri-areolar incision were independent realtive factors for short-term local complications after bovine pericardium patch combined with prosthesis implantation in the immediate breast reconstruction. After completing the learning curve, the postoperative complications of the procedure could be decreased.

Mating-Type Genes Control Sexual Reproduction, Conidial Germination, and Virulence in Cochliobolus lunatus.

Cochliobolus lunatus (anamorph: Curvularia lunata) is a major pathogenic fungus that causes the Curvularia leaf spot of maize. ClMAT1-1-1 and ClMAT1-2-1, the C. lunatus orthologs of C. heterostrophus ChMAT1-1-1 and ChMAT1-2-1, were investigated in the present study to uncover their functions in C. lunatus. Southern blot analysis showed that these mating-type MAT genes exist in the C. lunatus genome as a single copy. ClMAT1-1-1 and ClMAT1-2-1 were knocked out and complemented to generate ΔClmat1-1-1 and ΔClmat1-2-1 and ΔClmat1-1-1-C and ΔClmat1-2-1-C, respectively. The mutant strains had defective sexual development and failed to produce pseudothecia. There were no significant differences in growth rate or conidia production between the mutant and wild-type strains. However, the aerial mycelia and mycelial dry weight of ΔClmat1-1-1 and ΔClmat1-2-1 were lower than those of wild type, suggesting that MAT genes affect asexual development. ClMAT genes were involved in the responses to cell wall integrity and osmotic adaptation. ΔClmat1-2-1 had a lower conidial germination rate than the wild-type strain CX-3. The virulence of ΔClmat1-2-1 and ΔClmat1-1-1 was also reduced compared with the wild-type. Complementary strains could restore all the phenotypes.

[Determination of manganese in urine by direct dilution-inductively coupled plasma mass spectrometry].

Objective: To establish a direct dilution-inductively coupled plasma mass spectrometry method for the determination of manganese in urine. Methods: Using 1% nitric acid solution as diluent, the urine dilution factor and internal standard elements were determined by single factor rotation experiment. The linear range, correlation coefficient, precision, accuracy and detection limit of the direct dilution-inductively coupled plasma mass spectrometry for the determination of manganese in urine were evaluated. Results: The linear range of this method was 0.0-20 µg/L, the correlation coefficient was 0.999 9, the detection limit was 0.02 µg/L, the recoveries were 84.65%-103.40%, the relative standard deviations were 0.26%-8.17%. Conclusion: This method has the advantages of simple operation, high sensitivity and low detection limit. It can be used for the determination of urine manganese at the same time with other elements. It is suitable for the determination of urine manganese in workers and ordinary people.

[Value of abnormal expression of Krüppel-like zinc-finger protein transcription factor 5 in the diagnosis and prognosis of liver cancer].

Objective: To explore the value of Krüppel-like factor 5 (KLF5), a family member of the zinc finger protein transcription factor, in the diagnosis and prognostic evaluation of hepatocellular carcinoma (HCC). Methods: Cancerous and non-cancerous tissues were collected from 126 cases after HCC surgery by self-matching method with microarray fabrication. Immunohistochemistry was used to analyze the expression of KLF5, clinicopathological characteristics and prognostic value. The sera of 222 cases with chronic liver disease were collected and their KLF5 levels were quantitatively determined by enzyme-linked immunosorbent assay (ELISA). Simultaneously, 40 normal human sera were used as controls to evaluate the value of abnormal KLF5 in the diagnosis and differentiation of benign and malignant liver diseases. T-test, Z-test and χ (2) test were performed on the data. Results: The positive expression rate of KLF5 in the HCC group was 95.2% (120/126), which was significantly higher than the non-cancerous group 38.9% (49/126; χ (2) = 14.385, P < 0.001). KLF5 expression was significantly correlated with TNM stage (stage I 35%, stage II 40%, stage III 74.4%, stage IV 78.1%), tumor size, alpha fetoprotein (AFP) concentration, portal vein embolism, HBV infection and 5-year survival rate. Univariate/multivariate analysis showed that KLF5 high expression was an independent predictor of HCC prognosis. The serum KLF5 level was significantly higher in HCC patients than liver cirrhosis, chronic hepatitis and normal control group (P < 0.001). With the serum KLF5 > 800 ng/ml and AFP > 25 µg/L as limit, the positive rates for HCC diagnosis were 90.48% and 73.81%, respectively, which were lower than the AFP specificity and false positive rate, and was helpful for the differential diagnosis of benign and malignant liver diseases. Conclusion: The overexpression of KLF5 in liver cancer tissues and blood is closely related to the HCC clinical stage and prognosis. Moreover, KLF5 analysis is helpful for HCC diagnosis and differential diagnosis.

Generative design of bioinspired wings based on deployable hindwings of Anomala Corpulenta Motschulsky.

In view of the application prospect of the hindwing of Anomala Corpulenta Motschulsky in the field of foldable Micro Aerial Vehicles (MAVs), this paper investigated the morphology, macro/microstructure of the hindwing, and the nanomechanical properties of the wing veins and the wing membrane. It revealed the variation of nanohardness and elastic modulus between different veins and different positions of the same wing veins. This paper established a 3D coupling model of the hindwing based on the principle of coupling bionics. This paper presents a simulation analysis of the structural statics (uniform load distribution) and aerodynamics (under different attack angles, flight velocities, and flapping frequencies). Two 3D coupling models (HW-I and HW-II) of the hindwing were discussed the deformation and flight aerodynamic performance of Workbenches and Fluent. On that basis, the bionic wing was generatively designed, and a 3D bionic wing (BioW) model was established using the generative design method. Simulation analyses were performed through structural statics and aerodynamics. The results showed that the stress distribution was relatively uniform and that the overall displacement deformation was minimal for the BioW model. Moreover, the BioW model had better flight efficiency and aerodynamic performance.

[Association between apolipoprotein E-containing HDL-C and coronary heart disease risk: a community-based cohort study].

Objective: To assess whether apolipoprotein E-containing HDL-C (APOE-HDL-C) is causally associated with coronary heart disease (CHD) risk. Methods: In total, 5 417 cardiovascular disease-free participants at baseline were followed up for up to 10 years in the Chinese Multi-provincial Cohort Study. APOE-HDL-C and HDL-C were measured in all participants. APOE-HDL-C/total HDL-C ratio was calculated. Multivariate Cox regression was employed to assess the association between HDL-C related biomarkers and 10-year CHD incident risk. Results: A total of 100 incident CHD events occurred during a mean 6.8 years follow-up. High levels of baseline HDL-C related biomarkers were significantly negatively associated with incident CHD risk. Comparison with participant with lowest level of APOE-HDL-C/total HDL-C ratio, those with highest level of APOE-HDL-C/total HDL-C ratio had 74% decreased risk of CHD (HR=0.26, 95%CI: 0.12-0.71). The individual with the highest level of APOE-HDL-C/total HDL-C ratio had the lowest absolute risk[0.48% (0.44%-0.52%)] of CHD, which was significantly lower than that [0.83% (0.78%-0.88%)] of the individual with the highest level of HDL-C. Conclusions: Our findings revealed that the APOE-HDL-C/total HDL-C ratio was significantly related to a 10-year increased risk of incident CHD, even beyond HDL-C. It seemed that APOE-HDL-C could serve as a new indicator of the anti-atherosclerotic function of HDL.

[The relationship between premature atrial complexes and recurrence of atrial fibrillation: a meta-analysis].

Objective: To explore the relationship between premature atrial complexes (PACs) and recurrence of atrial fibrillation (AF). Methods: Published literature was searched in PubMed, Embase, Web of Science, Cochrane, Weipu, China national knowledge infrastructure, Wanfang and China Biology Medicine disc up to 25 March 2020. RevMan5.3 software was used to analyzed the data and publication bias was performed by Stata 15.1. Results: A total of 8 studies were identified, including 1 252 AF patients with a mean age of 61.67 years, and male patients accounted for 70.6%. During follow-up, AF recurred in 425 cases. Meta-analysis showed that frequent PACs was an independent risk factor for recurrence of AF (HR=2.64, 95%CI:1.40-4.97). Subgroup analyses showed that PACs not only increasedthe risk of recurrence of AF after electrical cardioversion (HR=2.38, 95%CI:1.25-4.51), but also significantly increased the risk of recurrence of AF after catheter ablation cardioversion (HR=2.90, 95%CI:1.11-7.60). Conclusions: PACs is significantly associated with AF recurrence.

[A novel mutation of SCN4A gene causes hypokalemic periodic paralysis in a Chinese family].

Objective: To report a Chinese family with hypokalemic periodic paralysis (HOKPP) and investigate the clinical and pathogenic gene characteristics of the family. Methods: The clinical, electrophysiological and pathological data of the proband of the family were analyzed, and the information of the family was investigated in detail. The peripheral venous blood of the six members of the family was collected and their genomic DNA was extracted. The genes related to periodic paralysis analysis of the proband were performed by the second generation sequencing. The pathogenicity of the mutant protein was respectively analyzed by the bioinformatics software SIFT, Polyphen2 and Mutation Tasker. The cosegregation analysis of phenotype and genotype of the family was performed by the first generation sequencing. Results: There were 3 patients in the family with the onset age of 21 to 42 years old. All the patients manifested with vomiting as the first symptoms, then presented with muscle weakness accompanied by muscle soreness. The muscle weakness gradually relieved in 3 to 5 days. Creatine kinase (CK) of the proband significantly increased. Electromyographic exercise test was positive, however, electromyography and muscle pathological analysis were normal. The genes related to periodic paralysis analysis of the proband found a novel mutation (c.2458A>T (p.N.820Y)) of SCN4A gene which was located in the conservative region. The function analysis showed it was a pathogenic mutation. Moreover, the first generation sequencing confirmed that the mutation was cosegregated with patients in the family. Meanwhile, it was found that the proband's son carried the same mutation, but without any symptom, indicating that he was a pre-symptomatic patient. Conclusions: Vomiting can be one of the symptoms of the patients with HOKPP. The novel mutation of SCN4A gene c.2458 A>T is the pathogenic mutation of the family. Patients with periodic paralysis should be tested for blood potassium and genes as early as possible to facilitate early diagnosis and genetic counseling.