Objective:To investigate the application effect of a novel zipper device in wound healing after incision and drainage of cuta-neous abscesses in children,and to explore its optimal intervention timing.Methods:A total of 50 children who attended the outpatient service of Department of Pediatric surgery from September 2023 to September 2024 were enrolled and divided into two groups accord-ing to the parity of the date of visit.The 26 children with the odd date of visit were enrolled as experimental group,and the 24 children with the even date of visit were enrolled as control group.The same anti-infective dressings were used for wound dressing in both groups after incision and drainage,and when there was a significant reduction in wound exudate and the fresh granulation tissue emerged at wound base,the zipper device was used for the children in the experimental group,and dressing change was performed for the children in the control group until the wound was completely healed.The two groups were compared in terms of wound healing time,healing rate,and the total costs of dressing change,and the multiple linear regression model and the restricted cubic spline(RCS)model were used to analyze the association between the in-tervention time of the zipper device and wound healing time.Re-sults:Compared with the control group,the experimental group had a significantly shorter wound healing time,a significantly higher wound healing rate,and significantly lower total costs of dressing change(P<0.001).The multiple linear regression model showed that the infection size of skin abscess and the intervention time of the zipper device were strongly associated with wound healing time(P<0.05).After adjustment for infection size,the RCS model analysis showed a significant linear dose-response relationship between intervention time and wound healing time(Pnonlinear=0.406),and wound healing time shortened with the reduction in intervention time(P<0.001).Conclusion:The application of the novel zipper device can help with the healing of cutaneous abscesses in children,and it is recommended to apply the device as early as possible after control of wound infection,in order to promote early wound healing.

Objective:To investigate the real experience of early postoperative kinesiophobia in school-aged children after limb frac-ture surgery.Methods:A descriptive qualitative research method was used to conduct semi-structured interviews with sixteen children with limb fractures and their families in the ward of pediatric orthopedics in a grade A tertiary hospital in Chongqing,China,and a con-tent analysis was used to summarize and extract key themes from the interview data.Results:Three main themes and ten subthemes were extracted.The theme of pain cognition and catastrophic thinking included the subthemes of children's pain perception and activ-ity restriction,parents'pain perception and catastrophic reactions,and the interactive influence of pain cognition among different indi-viduals;the theme of medical education and risk perception included the subthemes of fear and concerns about refracture,the relation-ship between personality traits,help-seeking behavior,and internal-ized anxiety,and the impact of medical education on risk percep-tion;the theme of psychosocial stress and self-motivation included the subthemes of family members'attitudes toward academic inter-ruption,children's social disruption and compensatory media use,the mutual influence of compensatory indulgence and reinforced sick role behavior,and positive reinforcement enhancing children's self-driven recovery.Conclusion:Healthcare providers should closely monitor the recovery of limb motor function in the early stage af-ter surgery in children with fractures and provide personalized medical services and rehabilitation guidance to children and their fami-lies based on the pain perception,personality traits,and rehabilitation needs of children.

Objective:To investigate the effect of miR-22-3p and apoptosis-inducing factor,mitochondrion-associated 1(AIFM1)on mitochondrial homeostasis and apoptosis of pulmonary artery smooth muscle cells(PASMCs)under hypoxic conditions by establishing an in vitro model of pulmonary hypertension(PAH).Methods:PASMCs were cultured under hypoxic conditions to establish an in vitro model of PAH,and the expression levels of AIFM1 and miR-22-3p were upregulated or downregulated.Reverse transcription quantita-tive polymerase chain reaction(RT-qPCR)and Western blotting were used to measure the expression levels of AIFM1,miR-22-3p,and cleaved cysteine-aspartic protease-3(Cleaved Caspase-3).cell counting kit-8(CCK-8)assay was used to measure the prolifera-tive activity of cells,and flow cytometry was used to measure cell apoptosis.Mitochondrial superoxide indicator(mitoSOX)and adenos-ine triphosphate(ATP)assay kits were used to observe mitochondrial function and dynamics,and Mito-Tracker Red CMXRos(Mito-Tracker)was used to measure the change in mitochondrial circum-ference.Dual-luciferase reporter assay was used to validate the interaction between AIFM1 and miR-22-3p.Results:Hypoxia increased the content of mitochondrial ROS,reduced the level of ATP,promoted mitochondrial fission,and reduced cell apoptosis in PASMCs.AIFM1 overexpression improved mitochondrial homeo-stasis and increased cell apoptosis,while miR-22-3p negatively regulated AIFM1 and reversed the effect of AIFM1 overexpression.Conclusion:This study shows that miR-22-3p enhances mitochon-drial homeostasis,proliferation,and apoptosis in hypoxia-induced PASMCs by targeting AIFM1,which provides a potential theoretical basis for the prevention and treatment of PAH.

Objective To compare the efficacy and adverse reactions of doxycycline and levofloxacin in children with macrolide non-responsive mycoplasma pneumonia(MUMPP).Methods Clinical data of 240 MUMPP children admitted to our hospital from November 2023 to July 2024 were retrospectively analyzed,and they were divided into doxycycline group and levofloxacin group according to drug use,with 120 cases in each group.The efficacy of the two groups were compared,the time when body temperature dropped to nor-mal after taking antipyretics,the time when cough was reduced,the time when lung riles were resolved,the length of hospital stay,the peripheral blood indicators[WBC,neutrophilic granulocyte percentage,C reactive protein(CRP),lactate dehydrogenase(LDH),D-dimer],the lung imaging recovery and the occurrence of ad-verse reactions.Results There was no significant difference in total effective rate between doxycycline group and levofloxacin group(93.33％vs.90.00％,P＜0.05).Compared with levofloxacin group,the duration of hospital stay in doxycycline group was shorter[(6.22±2.24)d vs.(7.39±2.47)d],and the duration of lung crackles disappeared longer[(4.47±2.06)d vs.(3.50±1.79)d],with statistical significance(P＜0.05).Af-ter treatment,the neutrophil percentage,CRP and LDH levels in the two groups were lower than before treat-ment,and the differences were statistically significant(P＜0.05).There was no significant difference in the incidence of adverse reactions between doxycycline group and levofloxacin group(15.83％vs.15.00％,P＞0.05).Conclusion Both doxycycline and levofloxacin have good efficacy in MUMPP children,with low inci-dence of adverse reactions and no serious adverse reactions.

Objective To evaluate the clinical value of non-invasive ultrasound hemodynamic monito-ring in critically ill neonates in plateau area(altitude＞2 500 m).Methods A total of 205 critically ill neo-nates admitted to the NICU of Qamdo People's Hospital from September 2023 to December 2024 were ran-domly divided into the control group(n=105)and the observation group(n=100)using a random number table.There was no statistically significant difference in the baseline data between the two groups(P＞0.05).The observation group underwent noninvasive ultrasonic hemodynamic monitoring within 12 hours of admis-sion,measuring corrected flow time(FTC),stroke volume(SV),cardiac index,systemic vascular resistance index(SVRI),and myocardial contractility index(SMII).The control group received conventional monito-ring.The treatment was adjusted based on the results.The above parameters were remeasured 4-8 hours af-ter treatment adjustment.Hospital stay and 28 d survival rate were compared between the two groups.Multi-ple linear regression and binary logistic regression were used to analyze the factors influencing hospital stay and 28 d survival rate,respectively.Results Compared to pre-treatment levels,the observation group showed significant post-treatment decreases in FTC[(364.03±47.70)ms vs.(414.09±52.20)ms]and SVRI[(1 521.00±186.93)dyn·s·(cm5)-1·(m2)-1 vs.(1 720.00±347.31)dyn·s·(cm5)-1·(m2)-1].Con-versely,significant increases were observed in SV[(5.23±0.66)mL vs.(5.09±0.88)mL],cardiac index[(3.35±1.17)L·min-1·(m2)-1 vs.(3.19±0.99)L·min-1·(m2)-1],and SMII[(0.56±0.10)W/m2 vs.(0.51±0.14)W/m2](P＜0.05).The observation group had a significantly shorter hospital stay than the control group[(11.53±3.61)d vs.(13.83±2.56)d,P＜0.05].The 28 d survival rate was higher in the ob-servation group(100.0％vs.98.1％),although the difference was not statistically significant(P＞0.05).Multiple linear regression analysis revealed that both gestational age and cardiac index were negatively correla-ted with the duration of hospital stay.Binary logistic regression analysis indicated that birth weight was a sig-nificant factor influencing the 28 d survival rate(OR=4.600,95％CI:2.465-10.654,P=0.001).Conclusion Non-invasive ultrasonic hemodynamic monitoring can facilitate early identification of hemodynamic alterations in critically ill neonates in platean area,which could guide treatment and potentially reducing hospital stay.

Objective To investigate the changing antimicrobial resistance profiles of Streptococcus pneumoniae isolates from children in Chongqing area from 2011 to 2022,and to provide evidence for rational use of antibiotics and prevention of nosocomial infections.Methods The clinical data of S.pneumoniae strains isolated from pediatric patients during 2011-2022 were retrospectively analyzed.Antimicrobial susceptibility testing was performed with commercial automated systems and E-test.The results were interpreted according to the breakpoints in CLSI document(2022 edition).Results A total of 26 668 strains of S.pneumoniae were isolated during the 12-year period.The proportion of S.pneumoniae was 16.0％in the total pathogenic bacterial isolates and 46.4％in all the gram-positive bacterial pathogens.S.pneumoniae strains were mainly isolated from respiratory specimens(97.1％),followed by blood samples(1.5％).The highest proportion of S.pneumoniae isolates was in infants(38.2％),followed by toddlers(32.4％),preschool age(22.9％),school age(5.6％),adolescents(0.6％)and neonates(0.4％).All of the 38 strains of nonmeningitis SS.pneumoniae(0.1％)isolated from cerebrospinal fluid were resistant to penicillin.Overall,35.7％and 32.4％of these strains were resistant to cefotaxime and meropenem,respectively.The majority of S.pneumoniae(99.9％,26 630/26 668)were nonmeningitis isolates.The prevalence of penicillin-susceptible(PSSP),-intermediate(PISP),and-resistant(PRSP)strains was 71.9％(16 083),25.1％(5 610),and 3.0％(674),respectively.The prevalence of PRSP in infants and preschool children was higher than that in other age groups.The nonmeningitis S.pneumoniae isolates showed higher than 95％resistance rate to erythromycin,clindamycin and tetracycline,but 0.2％,0.2％and 0.1％resistance rate to levofloxacin,moxifloxacin and rifampicin,respectively.No S.pneumoniae strains were found resistant to vancomycin or linezolid.Conclusions The proportion and antimicrobial resistance profiles of S.pneumoniae strains isolated from pediatric patients varied with age group and specimen type.The decreasing prevalence of PRSP may inform empirical treatment of S.pneumoniae infections in children in Chongqing area.

Objective:To investigate the clinical distribution characteristics changes in antimicrobial resistance, and carbapenemase resistance genes of Klebsiella pneumoniae isolated from children in Chongqing region during the period of January 2019 to December 2024, providing a basis for the rational use of antibiotics and the prevention and control of nosocomial infections.Methods:An observational study was conducted to retrospectively analyze 5 020 Klebsiella pneumoniae (KP) isolates detected in four hospitals of the Southwest Pediatric Laboratory Specialty Alliance. Antimicrobial susceptibility testing was performed by the minimum inhibitory concentration method combined with the disk diffusion method. Results were interpreted according to the 2024 Clinical and Laboratory Standards Institute (CLSI) standards. Carbapenemase resistance genes were detected by polymerase chain reaction (PCR) combined with Sanger sequencing. WHONET 5.6 was used for resistance analysis and SPSS 19.0 for statistical analysis. The chi-square test was used to assess trends in resistance rates, ESBL detection rates, and resistance rates of different CRKP carbapenemase genotypes from 2019 to 2024. Statistical significance was confirmed if the two-tailed P-value was <0.05. Results:A total of 5 020 strains were isolated, with a detection rate of 5.1% (5 020/99 063). The majority were from sputum (59.2%, 2 970/5 020), followed by pus (17.1%, 857), urine (9.7%, 487), venous blood (6.5%, 326), secretions (2.6%, 130), and other specimens (5.0%, 250).The lowest resistance rate was to amikacin (3.8%), followed by levofloxacin (10.9%), imipenem (19.1%), and meropenem (19.9%). Resistance rates to cefoperazone/sulbactam ( χ2=9.982 0, P=0.001 6), piperacillin/tazobactam ( χ2=10.110 0, P=0.001 5), ceftazidime ( χ2=3.849 0, P=0.049 8), cefotaxime ( χ2=7.605 0, P=0.005 8), cefepime ( χ2=13.510 0, P=0.000 2), aztreonam ( χ2=6.457 0, P=0.011 1), imipenem ( χ2=4.672 0, P=0.030 7), and levofloxacin ( χ2=7.555 0, P=0.006 0) showed an annual increasing trend. The main carbapenemase genes were blaNDM-5 (42.2%, 127/301), blaNDM-1 (33.9%, 102/301), and blaKPC-2 (17.3%, 52/301). Patients with KPC-2-producing strains (median age, 240 days) were older than those with NDM-1/NDM-5-producing strains (median age, 40 days) ( χ2=22.620 0, P<0.000 1). In neonatal wards, the detection rate of NDM-KP was higher than that of KPC-KP (64.6%, 148/229 vs. 26.9%, 14/52, χ2=24.680 0, P<0.000 1), whereas in ICUs, it was lower (6.1%, 14/229 vs. 26.9%, 14/52, χ2=20.450 0, P<0.000 1). Conclusion:In Chongqing region, the isolation rate of K. pneumoniae from sputum was the highest with most cases from neonatal wards. Resistance to carbapenems showed an upward trend. BlaNDM-5 was the predominant genotype in pediatric CRKP. Patients with KPC-KP were older than those with NDM-KP. NDM-KP predominated in neonatal wards, while KPC-KP predominated in ICUs, with KPC-KP showing higher antimicrobial resistance.

Objective:To analyze the research status of family management for children with cancer, explore research hotspots and development trends, so as to provide reference for subsequent research and clinical practice in family management for children with cancer.Methods:Literature related to family management for children with cancer was retrieved from the Web of Science Core Collection Database. The search period was from January 31, 2014 to December 31, 2024. CiteSpace 6.4.R1 was employed for bibliometric analysis.Results:A total of 647 articles were included. The annual publication volume showed an overall trend of first decreasing, then increasing, and fluctuating upward. The authors conducting the study on family management for children with cancer formed a distinct core team. The United States and the University of Pennsylvania were the top countries and institutions in terms of publications, with close collaboration and exchange among institutions. Research focuses on recurrence treatment, social support systems, and deepening precision interventions for Ewing sarcoma. The development of technology driven management tools, cross-cultural research, and the integration of policy and ethical studies represent a future trend.Conclusions:Research focuses on key areas such as recurrence treatment, social support systems, and precision interventions for Ewing sarcoma, emphasizing family management practices, building social support networks, and identifying therapeutic targets. In the future, technology driven management tools should be developed to achieve intelligence, cross-cultural research should be deepened, and a humanized management model should be constructed by combining policy and ethical research, in order to improve the efficiency and effectiveness of subsequent related research and clinical practice for family management for children with cancer.

Cystic fibrosis(CF)is an autosomal recessive genetic disorder caused by mutations of the gene encoding the cystic fibrosis transmembrane conductance regulator(CFTR),which disrupts chloride ion transport across cell membranes,leading to multi-system involvement.The respiratory system is the most affected organ and the leading cause of mortality in affected children.With increased awareness and advancements in genetic testing,the number of diagnosed cases has increased in China.Notably,the genetic mutation profiles and clinical phenotypes of Chinese CF patients are significantly different from those reported in Western populations,posing challenges for clinical diagnosis and management.Currently,significant progress has been made in the treatment of CF in the international arena,with genotype-phenotype studies laying the foundation for personalized therapy,and small-molecule therapies such as CFTR modulators offering new hope for CF patients.This review summarizes the pathogenesis,clinical features,genotype-phenotype correlations,and therapeutic advancements in CF,aiming to enhance clinicians'understanding of the disease,reduce misdiagnosis and underdiagnosis,and facilitate early diagnosis and treatment.

Purpose To analyze the ultrasonic manifestations of extrarenal extracranial malignant rhabdoid tumor(EERT)in children to enhance the awareness of its early diagnosis.Materials and Methods Clinical data of 13 children with EERT diagnosed by pathology from the Children's Hospital of Chongqing Medical University were collected retrospectively from January 2014 to March 2024.The ultrasonic manifestations of these cases were summarized and compared with their pathological results.Results Among the 13 children with EERT,10 cases had tumors located in soft tissues of the extremities,and 3 cases had tumors located in the abdomen.The tumors showed irregular shapes and indistinct borders on ultrasonic images,and the average of the maximum diameters of the tumors measured by ultrasound was(10.43±2.57)cm.The interior of the tumors mostly appeared as heterogeneous hypoechoic lesions;9 of the tumors were accompanied by small patchy regions of anechoic areas(cystic degeneration or liquefaction);9 of the tumors were accompanied by strong echoes(calcification);12 of the tumors had relatively abundant blood supply.Conclusion Ultrasonic images of EERT in children have certain characteristics.Mastering the ultrasonic manifestations could assist in the clinical diagnosis and follow-up of this disease.