Pain assessment in children is vital in clinical practice. Accurate evaluation of pain intensity in children is the prerequisite for implementing effective analgesic interventions, it is necessary to chose age-specific assessment tools tailored to developmental stages of children. The degrees of patin reported by children themselves are the gold standard for evaluation, and self-assessment should be prioritized when feasible. In addition, behavioral and physiological assessments also show good reliability and validity. This review summarizes current domestic and international researches on pediatric pain assessment tools and their clinical applications, aiming to provide reference for optimizing pain evaluation in pediatric practice.

Objective:To analyze the epidemiological and clinical characteristics of pertussis cases identified through active surveillance.Methods:Active surveillance for pertussis was conducted in three sentinel hospitals in Yiwu, Zhejiang Province, and Yongcheng, Henan Province. The study population included cases that met the surveillance case definition and sought medical care at outpatient/emergency departments or were hospitalized between June 1, 2021, and May 31, 2022. Samples were collected for bacterial culture and PCR detection. Case information and clinical data were collected. Differences in rates were assessed using the chi-square test or Fisher's exact probability test, and the differences in cough time were compared using the Mann-Whitney U test. Results:Among 1 423 cases of pertussis surveillance, the positive rate of pertussis was 28.11% (400/1 423), with a median age of 5 years (interquartile range: 2, 8). The positive rate in Yongcheng, Henan Province, and Yiwu, Zhejiang Province were 39.27% (216/550) and 21.08% (184/873), respectively; the positive rate of pertussis was highest in July 2021, and the highest positive rate of pertussis was among those aged 10-14. The positive rate of pertussis in hospitalized cases was higher than in outpatient/emergency cases (26.68%) ( χ2=4.16, P=0.041). Among the 400 laboratory test-positive cases, the highest proportion of atypical symptom cases was in adults aged 20-59 (43.33%, 13/30). The specificity rates of apnea and worsening nocturnal cough in monitored cases under 3 months of age were 100.00% and 73.81%, respectively. Among monitored cases aged 3 months to 9 years, the proportions of symptoms including worsening nighttime cough (63.00%) and night sweats (4.59%) in test-positive cases were significantly higher than those in the test-negative group (47.77% and 0.56%, respectively), with statistically significant differences (both P<0.05). The specificity rates of worsened nighttime coughing and night sweats were 52.23% and 99.44%, respectively. Conclusions:The active surveillance results for pertussis showed that the 10-14 age group exhibited the highest positivity rate. Active surveillance enhanced the detection rate of pertussis. Among laboratory-confirmed cases, the proportion of atypical symptoms was the highest in adults, suggesting that laboratory testing should be combined to diagnose programs of pertussis. For infants under 3 months, worsening nighttime cough and apnea increase the diagnostic specificity, while for individuals aged 3 to 9 years old, worsening nighttime cough and night sweats increase the diagnostic specificity.

OBJECTIVE: To explore clinical efficacy of autologous platelet-rich plasma(PRP) in treating Rockwood type Ⅲ acromioclavicular dislocation. METHODS: From January 2019 to July 2021, 32 patients with Rockwood type Ⅲ acromioclavicular dislocation were treated with minimally invasive adjustable titanium plate internal fixation, and were divided into PRP group and control group according to whether PRP treatment was performed, with 16 patients in each group. In PRP group, there were 10 males and 6 females, aged from 28 to 47 years old with an average of (36.75±7.14) years old;the time from injury to surgery ranged from 1 to 31 h with an average of (26.13±3.98) h;5 patients on the left side and 11 patients on the right side;PRP was injected once during operation and the 4th and 8th weeks after operation respectively. In control group, there were 8 males and 8 females, aged from 30 to 52 years old with an average of (38.50±5.48) years old; the time from injury to surgery ranged from 1 to 29 h with an average of (25.48±3.11) h;7 patients on the left side and 9 patients on the right side; minimally invasive surgical treatment was performed. Visual analogue scale(VAS) was used to evaluate pain and Constant-Murley score for shoulder joint function was used to evaluate the recovery of shoulder joint movement function before operation and 1, 3, 6, and 12 months after operation respectively. RESULTS: All patients were followed up for 12 to 28 months with an average of (18.3±5.2) months. All incisions patients healed well without adverse events such as infection. Postoperative VAS of PRP group at 1, 3, and 6 months were (5.5±1.2), (3.7±1.6), and (2.4±1.2), respectively, while were lower than those of control group (6.6±1.4), (4.9±1.1), and (3.7±1.3), respectively;and had statistical differences between two groups (P<0.05). There was no statistically significant difference in VAS between two groups before operation and 12 months after operation (P>0.05). Postoperative Constant-Murley scores of PRP group at 1, 3, and 6 months were (64.09±11.61), (73.19±12.89), and (82.61±14.81) points, respectively, which were higher than those of control group were (52.32±17.42), (61.65±14.43), and (72.52±11.04) respectively;and the differences were statistically significant (P<0.05). There was no statistically significant difference in Constant-Murley scores at 12 months after operation between two groups (P>0.05). In PRP group, there was no statistically significant difference at 6 months and 12 months after operation (P>0.05), while there were statistically significant differences at the other time points (1 month after operation compared with before operation, 3 months after operation compared with 6 months after operation, and 3 months after operation compared with 1 month after operation) (P<0.05). In control group, there was no statistically significant difference when comparing 1 month and 3 months after operation (P>0.05), while at the other time points (1 month after operation with before operation, 3 months after operation with 6 months after operation, and 6 months after operation with 12 months after operation), the differences were all statistically significant (P<0.05). CONCLUSION Adjustable titanium plate fixation combined with postoperative injection of PRP for the treatment of Rockwood type III acromioclavicular joint dislocation has effect of promoting the recovery of shoulder joint function and reducing pain.
Humans ; Male ; Female ; Adult ; Middle Aged ; Platelet-Rich Plasma ; Acromioclavicular Joint/surgery* ; Bone Plates ; Titanium ; Joint Dislocations/therapy* ; Fracture Fixation, Internal/methods*

Neurofibromatosis type 1 (NF1) presents with a diverse range of symptoms that can affect the skin, bones, eyes, central nervous system, and other organs. This article reports the diagnosis and treatment process of a patient with NF1 complicated by bilateral severe-to-profound sensorineural hearing loss. Genetic testing revealed a heterozygous variant of NF1 NM_ 000267.3: c.4054_ 4058del(p.Ser1352LeufsTer20, supporting the diagnosis of NF1. After thorough evaluation, a right cochlear implantation was performed, yielding satisfactory postoperative results. This case suggests that NF1 patients may exhibit phenotypic heterogeneity and atypicality, providing a reference for clinicians in the diagnosis and treatment of such patients.

Objective:To analyze the epidemiological and clinical characteristics of pertussis cases identified through active surveillance.Methods:Active surveillance for pertussis was conducted in three sentinel hospitals in Yiwu, Zhejiang Province, and Yongcheng, Henan Province. The study population included cases that met the surveillance case definition and sought medical care at outpatient/emergency departments or were hospitalized between June 1, 2021, and May 31, 2022. Samples were collected for bacterial culture and PCR detection. Case information and clinical data were collected. Differences in rates were assessed using the chi-square test or Fisher's exact probability test, and the differences in cough time were compared using the Mann-Whitney U test. Results:Among 1 423 cases of pertussis surveillance, the positive rate of pertussis was 28.11% (400/1 423), with a median age of 5 years (interquartile range: 2, 8). The positive rate in Yongcheng, Henan Province, and Yiwu, Zhejiang Province were 39.27% (216/550) and 21.08% (184/873), respectively; the positive rate of pertussis was highest in July 2021, and the highest positive rate of pertussis was among those aged 10-14. The positive rate of pertussis in hospitalized cases was higher than in outpatient/emergency cases (26.68%) ( χ2=4.16, P=0.041). Among the 400 laboratory test-positive cases, the highest proportion of atypical symptom cases was in adults aged 20-59 (43.33%, 13/30). The specificity rates of apnea and worsening nocturnal cough in monitored cases under 3 months of age were 100.00% and 73.81%, respectively. Among monitored cases aged 3 months to 9 years, the proportions of symptoms including worsening nighttime cough (63.00%) and night sweats (4.59%) in test-positive cases were significantly higher than those in the test-negative group (47.77% and 0.56%, respectively), with statistically significant differences (both P<0.05). The specificity rates of worsened nighttime coughing and night sweats were 52.23% and 99.44%, respectively. Conclusions:The active surveillance results for pertussis showed that the 10-14 age group exhibited the highest positivity rate. Active surveillance enhanced the detection rate of pertussis. Among laboratory-confirmed cases, the proportion of atypical symptoms was the highest in adults, suggesting that laboratory testing should be combined to diagnose programs of pertussis. For infants under 3 months, worsening nighttime cough and apnea increase the diagnostic specificity, while for individuals aged 3 to 9 years old, worsening nighttime cough and night sweats increase the diagnostic specificity.

Objective To observe the association of the changes in monocyte to high density lipo-protein cholesterol ratio(MHR)and thromboxane B2(TXB2)with risk of left atrial appendage thrombus(LAAT)in elderly patients with atrial fibrillation(AF).Methods A retrospective study was conducted on 152 elderly AF patients admitted in our hospital from May 2022 to May 2024.According to the results of transesophageal echocardiography,they were divided into thrombus group(46 cases)and non-thrombus group(106 cases).Blood MHR and TXB2 levels were measured and calculated,and the predictive efficacy of MHR and TXB2 levels for the risk of LAAT was analyzed.Results The thrombus group had older age,larger left atrial diameter(LAD),higher monocyte count,and larger proportion of persistent AF(P＜0.01),while lower LVEF and HDL-C levels when compared with the non-thrombus group(P＜0.05,P＜0.01).The MHR and TXB2 level were significantly higher in the thrombus group than those in non-thrombus group(P＜0.01).Multivariate logistic regression analysis indicated that age(OR=1.244,95％CI:1.022-1.466,P=0.028),persistent AF(OR=29.290,95％CI:4.573-187.610,P=0.000),LAD(OR=1.502,95％CI:1.203-1.876,P=0.000),MHR(OR=1.115,95％CI:1.055-1.178,P=0.000)and TXB2(OR=1.064,95％CI:1.031-1.097,P=0.000)were risk fac-tors for LAAT in elderly AF patients,and LVEF(OR=0.813,95％CI:0.707-0.935,P=0.004)was a protective factor.ROC curve analysis suggested that the AUC value of MHR and TXB2 in evaluating the risk of LAAT in elderly AF patients was 0.767 and 0.829,respectively.Conclusion MHR and TXB2 are abnormally elevated in elderly AF patients with LAAT.They are risk factors affecting the occurrence of LAAT,and have certain predictive value for the risk of LAAT.

Pain assessment in children is vital in clinical practice. Accurate evaluation of pain intensity in children is the prerequisite for implementing effective analgesic interventions, it is necessary to chose age-specific assessment tools tailored to developmental stages of children. The degrees of patin reported by children themselves are the gold standard for evaluation, and self-assessment should be prioritized when feasible. In addition, behavioral and physiological assessments also show good reliability and validity. This review summarizes current domestic and international researches on pediatric pain assessment tools and their clinical applications, aiming to provide reference for optimizing pain evaluation in pediatric practice.

Objective To observe the association of the changes in monocyte to high density lipo-protein cholesterol ratio(MHR)and thromboxane B2(TXB2)with risk of left atrial appendage thrombus(LAAT)in elderly patients with atrial fibrillation(AF).Methods A retrospective study was conducted on 152 elderly AF patients admitted in our hospital from May 2022 to May 2024.According to the results of transesophageal echocardiography,they were divided into thrombus group(46 cases)and non-thrombus group(106 cases).Blood MHR and TXB2 levels were measured and calculated,and the predictive efficacy of MHR and TXB2 levels for the risk of LAAT was analyzed.Results The thrombus group had older age,larger left atrial diameter(LAD),higher monocyte count,and larger proportion of persistent AF(P＜0.01),while lower LVEF and HDL-C levels when compared with the non-thrombus group(P＜0.05,P＜0.01).The MHR and TXB2 level were significantly higher in the thrombus group than those in non-thrombus group(P＜0.01).Multivariate logistic regression analysis indicated that age(OR=1.244,95％CI:1.022-1.466,P=0.028),persistent AF(OR=29.290,95％CI:4.573-187.610,P=0.000),LAD(OR=1.502,95％CI:1.203-1.876,P=0.000),MHR(OR=1.115,95％CI:1.055-1.178,P=0.000)and TXB2(OR=1.064,95％CI:1.031-1.097,P=0.000)were risk fac-tors for LAAT in elderly AF patients,and LVEF(OR=0.813,95％CI:0.707-0.935,P=0.004)was a protective factor.ROC curve analysis suggested that the AUC value of MHR and TXB2 in evaluating the risk of LAAT in elderly AF patients was 0.767 and 0.829,respectively.Conclusion MHR and TXB2 are abnormally elevated in elderly AF patients with LAAT.They are risk factors affecting the occurrence of LAAT,and have certain predictive value for the risk of LAAT.

AIM:To explore the core target and mechanism of α-Linolenic acid(ALA)in improving neuroinflammation through network pharmacology combined with in vitro experiments.METHODS:Pharmacological studies have shown that ALA has anti-inflammatory,antioxidant,and neuroprotec-tive properties.The targets of α-Linolenic acid were obtained from PharmMapper and Swiss Tar-get Prediction databases,the targets of neuroin-flammation were searched from GeneCards,TTD and OMIM databases,and the potential targets of ALA and neuroinflammation were obtained from Wayne diagram.Protein interaction network(pro-tein-protein interaction,PPI)of potential targets was constructed by STRING website,and the core targets in PPI were screened by Cytoscape 3.8.0 software.At the same time,potential targets are imported into DAVID database,GO and KEGG data were obtained and the results were visualized.Autodock vina and Pymol software were used to dock the selected core targets with ALA and visual-ize the results.An in vitro model of neuroinflamma-tion was constructed,and cell growth status,oxida-tive stress,and migration or repairing capacity were determined by CCK-8 analysis,SOD,MDA and cell scratches,and the expression of IL-6,iba 1,COX-2(PTGS2),and iNOS proteins was determined by ELISA or Western blot experiments.RESULTS:Network pharmacology analysis revealed 46 poten-tial targets of ALA for neuroinflammation,and 10 core targets,including IL-6 and PTGS 2.With 232 entries enriched by GO enrichment analysis and 70 signaling pathways enriched by KEGG enrichment analysis,molecular docking showed that ALA can form hydrogen bonding with COX-2.Experiments showed that ALA could improve cell viability,allevi-ate cell oxidative stress levels,and promote cell mi-gration and motor repair in an in vitro model of neuroinflammation.CONCLUSIONS:ALA may im-prove neuroinflammation by alleviating oxidative stress and inhibiting IL-6 and COX-2 protein expres-sion.

Objective:To investigate the predictive performance of triglyceride and triglyceride glucose (TyG) index in the first trimester for the onset of gestational diabetes mellitus (GDM).Methods:Pregnant women who visited Beijing Chaoyang Maternal and Child Health Care Hospital and Beijing Haidian Maternal and Child Health Care Hospital from 2019 to 2022 were prospectively included. Concurrently, 78 healthy non-pregnant women who visited the Department of Endocrinology of Peking Union Medical College Hospital were included. The clinical characteristics and laboratory biomarkers including fasting blood glucose and blood lipid profiles were collected at the first visit in early pregnancy. Oral glucose tolerance test (OGTT) was performed at 24-28 weeks of gestation for GDM screening. Multivariate Logistic regression analysis was used to determine the association between biomarkers in early pregnancy and the risk of GDM. The receiver operating characteristic curve was used to evaluate the predictive performance and to identify the optimal cut-off value of triglyceride and TyG index in the first trimester for the risk of GDM.Results:A total of 1 677 pregnant women were included in this study, and the prevalence of GDM in our cohort was 19.6%. Compared with women who did not develop GDM, women with GDM showed an older maternal age, higher pre-pregnancy body mass index, and increased levels of laboratory biomarkers including fasting blood glucose, fasting insulin, total cholesterol, triglyceride, low-density lipoprotein cholesterol, TyG index, and Homeostasis Model Assessment of Insulin Resistance ( P<0.001). Logistic regression analysis showed that both triglyceride and TyG index in the first trimester were independent risk factors for GDM. The optimal cut-off values of triglyceride and TyG index for predicting the risk of GDM were 0.93 mmol/L and 8.10, respectively. The predictive performance can be further improved if maternal age and pre-pregnancy BMI are included. Conclusion:Triglyceride and TyG index in early pregnancy are closely associated with the risk of GDM, and can be used as early predictors of GDM.