Recommendations for prescription review of antipyretic-analgesics in symptomatic treatment of children with fever / 中华实用儿科临床杂志

Antipyretic-analgesics are currently one of the most prescribed drugs in children.The clinical application of antipyretic-analgesics for children in our country still have irrational phenomenon, which affects the therapeutic effect and even poses hidden dangers to the safety of children.In this paper, suggestions were put forward from the indications, dosage form/route, dosage suitability, pathophysiological characteristics of children with individual differences and drug interactions in the symptomatic treatment of febrile children, so as to provide reference for the general pharmacists when conducting prescription review.

Non-pharmaceutical interventions for respiratory virus infection in children and its effect / 中华实用儿科临床杂志

With the emergence of new respiratory virus, it is more apparent for the vulnerability of population to respiratory viral infection.Non-pharmaceutical interventions (NPIs) for respiratory virus infection have become the main way to prevent corona virus disease 2019.Some studies had proven its effectiveness.In addition, the NPIs also significantly reduced the incidence and hospitalization rate of other respiratory disease in children.NPIs for respiratory virus infection in children have its particularity and challenge.In daily life, it is important to guide children how to do the NPIs, so as to protect susceptible children and reduce the disease burden in children′s health system.Therefore, the aerosol transmission, the specificity of the NPIs in children, and the impact on childhood respiratory diseases are described in this article, to improve the prevention of common respiratory diseases in children.

Interpretation of guideline on adrenaline autoinjector application: European Academy of Allergy and Clinical Immunology anaphylaxis guideline (2021 update) / 中华实用儿科临床杂志

Anaphylaxis is a hypersensitivity reaction that is rapid in onset, multi-system involved and can be fatal.Adrenaline is the first-line treatment of anaphylaxis.Adrenaline autoinjector is an important device in emergent situation.In European Academy of Allergy and Clinical Immunology anaphylaxis guideline updated in 2021, adrenaline autoinjector is systemically described and recommended.The following interpretation is focused on adrenaline autoinjector, including advantages, indications for prescription, pharmacokinetic data, dose and long-term management, aimed to enhance understanding of this device and standardize future application.

Clinical and genetic characteristics and differential diagnosis in children with autosomal dominant hyper-IgE syndrome / 中华实用儿科临床杂志

Objective:To summarize the clinical features of children with autosomal dominant hyper-IgE syndrome (AD-HIES) and the differential diagnosis of hyper-IgE syndrome and allergic diseases as well.Methods:All clinical data, including general information, clinical features, and genetic changes, from 7 children with AD-HIES who were diagnosed in Beijing Children′s Hospital Affiliated to Capital Medical University from April 2016 to June 2020 were analyzed retrospectively.The diagnostic criteria are based on the National Institutes of Health′s (NIH)′s hyper-IgE syndrome score and combined with the results of gene detection, shown as follows: (1) NIH score over 40, with signal transducer and activator of transcription 3 gene ( STAT3) pathogenic mutation; (2) NIH score between 20 and 40, with reported STAT3 pathogenic mutation; (3) NIH score less than 20 points was excluded. Results:There were 3 males and 4 females.The onset age of 7 cases was within 2 months after birth, and the mean age at diagnosis was 3 years old.All seven cases had recurrent skin or lung infections, with 4 cases having skin and lung infections, 1 case of skin abscesses at the BCG vaccination site, and 2 cases without skin infection suffering from recurrent pneumonia.The mean onset age of skin abscess in 5 cases was 1.5 years, and pus culture of 3 cases were Staphylococcus aureus.Four cases developed bullae and 6 cases had lung infections.Four cases had otitis media, and oral thrush was seen in 4 cases.One case of skin and lung infection developed liver abscess and sepsis.Seven cases had eczema, which was disco-vered in the neonatal period for 6 cases.Four cases had the symptoms of eczema for the first visit.Two cases had food allergy, and 1 case had recurrent wheezing within 1 year old.The serum IgE level and blood eosinophil count in 7 children were elevated.All children had heterozygous pathogenic mutations in STAT3.Six patients had de novo mutations.There were 6 different mutation sites.The 4 mutation sites were reported: c.1145G>A, c.1144C>T, and c. 1699A>G were missense mutations, and c. 1139+ 5G>A was splicing mutation.Two mutation sites had not been reported: c.1031A>C was missense mutation, and c. 2050G>T was nonsense mutation.The pathogenic grade of them were likely pathogenic, and the NIH score of 2 cases were above 40 score, which was consistent with the clinical diagnosis of hyper-IgE syndrome. Conclusions:Eczema is a common and early clinical manifestation of hyper-IgE syndrome, along with elevated IgE levels and eosinophil counts that need to be differentiated from allergic diseases.On the contrary, it often had recurrent skin abscesses or pneumonia, which was prone to bullae.The clinical manifestations of young children were atypical, and genetic testing was helpful for early diagnosis.

Long-term prognosis of allergic bronchopulmonary aspergillosis in children with cystic fibrosis / 中华实用儿科临床杂志

Objective:To analyze the long-term prognosis and prognostic factors of allergic bronchopulmonary aspergillosis(ABPA) in children suffering from cystic fibrosis (CF).Methods:An observational study was performed.All children who were admitted to the Department of Respiratory, Beijing Children′s Hospital, Capital Medical University from August 2014 to June 2018, with more than 2 years of followed up for the diagnosis of CF accompanied by ABPA were involved.Results:Three children met the inclusion criteria, with 2 boys and 1 girl, and their diagnostic age were 14, 8 and 9 years old, respectively.The follow-up duration ranged from 2 to 6 years.All the 3 cases were treated with systemic corticosteroids and antifungal agent.In case 1, the initial dose of prednisone was 0.75 mg/(kg·d), and the course of treatment was more than 5 years.The corticosteroid-dependent patient suffered from expectoration and chest pain, and radiographic findings indicated exacerbation, while his lung function was normal.Treating with initial dose of prednisone 2 mg/(kg·d) for 9 months, case 2 had normal serum immunoglobulin E(IgE) concentration, but his pulmonary artery was infiltrated by lesions, thus leasing to lobectomy.In case 3, the initial dose of prednisone was 0.6 mg/(kg·d), and the course of treatment was 18 months.And she developed persistent hypoxemia, and decreased pulmonary function, so lung transplantation was necessary 2 years after diagnosis.Conclusions:Systemic glucocorticoid combined with antifungal therapy is the main treatment for CF with ABPA, but there are individual differences in the efficacy.The level of serum total IgE is not always consistent with lung function and chest images.The overall prognosis is poor, and it is infeasible to evaluate the prognosis by single factor.

Analysis of death status and change trend of asthma among Chinese people aged 0-19 years from 2008 to 2018 / 中华实用儿科临床杂志

Objective:To analyze the death rate of asthma among Chinese people aged 0-19 years in 2018 and the trend of asthma mortality between 2008 and 2018, in order to guide the research of asthma control management and prevention strategy, and reduce the mortality of childhood asthma in China.Methods:Data from the national disease surveillance points system (DSPs) was adopted.The mortality rates of 0-19-year-old people in different age groups, genders, places of residence and geographical regions from 2008 to 2018 were calculated, and the national death toll of asthma was estimated as well.The annual percentage change (APC) and average annual percentage change (AAPC) were calculated, and the death rate of asthma among Chinese people aged 0-19 years in 2018 and change trend of asthma mortality from 2008 to 2018 were analyzed.Results:In 2018, there was no significant gender diffe-rence in asthma mortality among Chinese people aged 0-19 years among different age groups, places of residence and geographical regions(all P>0.05). From 2008 to 2018, the mortality rate of people aged 0-19 fluctuated from 0.023/100 000 to 0.046/100 000, the highest mortality rate was in 2009 and 2012, and the lowest was in 2018. It was estimated that the total number of deaths among people aged 0-19 years reached the highest in 2009 (148 cases) and the lowest in 2018 (70 cases). It is estimated that the total number of deaths among people aged 0-19 years in China from 2008 to 2018 was 1 158 cases.From 2008 to 2018, the total mortality rate of asthma in Chinese population aged 0-19 years decreased significantly (AAPC=-7.6%, 95% CI: -10.4%--4.7%). There was a significant decrease in male group(AAPC=-7.4%, 95% CI: -12.5%--2.0%), female group(AAPC=-7.5%, 95% CI: -12.7%--2.0%), 1-<5 years old group(AAPC=-11.4%, 95% CI: -17.9%--4.5%), 15-19 years old group(AAPC=-14.4%, 95% CI: -24.8%--2.6%), rural group(AAPC=-9.0%, 95% CI: -13.1%--4.8%) and central areas(AAPC=-13.1%, 95% CI: -24.0%--0.5%), with statistical significance(all P<0.05). Conclusions:The total mortality of asthma in 0-19-year old population decreased significantly from 2008 to 2018.The mortality rate of asthma in 0-19-year old people in China is at the low level around the world.

Asthma related death and its risk factors in children / 中华实用儿科临床杂志

Bronchial asthma is the most common chronic respiratory disease in children.With the increasing use of inhaled corticosteroids, asthma deaths in the world have decreased by nearly two thirds.Mortality of childhood asthma is very low, ranging from 0 to 0.7/100 000, however, most of risk factors of asthma death could be avoidable.Risk factors of asthma death include poor asthma control, poor treatment compliance, insufficient medicine prescribed by doctors, insufficient monitoring of lung function, mental and psychological problems, food allergy, insufficient recognition and treatment of asthma exacerbation, improper use of β 2-receptor agonist, insufficient application of asthma action plan, et al.The mortality and risk factors of asthma in children were reviewed, which could support further improving asthma management strategies.

Interpretation of World Allergy Organization anaphylaxis guidance 2020 / 中华实用儿科临床杂志

Anaphylaxis is the most severe clinical presentation of acute systemic allergic reactions.The occurrence of anaphylaxis has increased in recent years, and subsequently, there is a need to continue disseminating knowledge on the diagnosis and management, so every healthcare professional is prepared to deal with such emergencies.This updated position document keep guidance aligned with the current state of the art of knowledge in anaphylaxis management including definition, diagnostic criteria, severity grading, elicitors and cofactors, acute treatment and long-term management of anaphylaxis.Intramuscular Adrenaline continues to be the first-line treatment for anaphylaxis.After an anaphylaxis occurrence, patients should be referred to a specialist to assess the potential cause and to be educated on prevention of recurrences and self-management.

Recommedations for the diagnosis and treatment of anaphylaxis in Chinese children / 中华实用儿科临床杂志

Anaphylaxis is increasingly in children, which is currently undernotified, underdiagnosed, and undertreated in China.In order to further improved the understanding and management of anaphylaxis, this issue reviews the pathogenesis, triggers and risk factors, clinical diagnosis and management of anaphylaxis, thus offers the recommedations of anaphylaxis in Chinese children based on previous published evidence-based guidelines and practice parameters.Recommendation aims to develop guiding principles for the diagnosis and management of anaphylaxis in children, and provide a framework for the development of new guidelines.

Application of D-dimer in diagnosis and prognosis of childhood Mycoplasma pneumoniae pneumonia / 中华实用儿科临床杂志

Objective@#To analyze the practical value of D-dimer in diseases condition judgment and prognosis evaluation of childhood Mycoplasma pneumoniae pneumonia (MPP).@*Methods@#Retrospective analysis was performed on clinical data of 606 MPP at Department of Respiratory, Beijing Children′s Hospital, Capital Medical University from January 2009 to July 2017, and the subjects were divided a severe group (298 cases) and a moderate group (308 cases) according to severity.By comparing clinical characteristics, laboratory tests and imaging findings, multivariate Logistic regression analysis for significant single factors was accomplished, which was to find out the independent factors affecting the severity of childhood MPP in acute phase.Receiver operating characteristic (ROC) curves were drawn in the area under the curve (AUC) and the diagnosis threshold value was calculated, which could be used to judge the predicators affecting the severity judgment of childhood MPP in acute phase.And the prognosis was judged according to the convalescent fiberoptic bronchoscopic indicators in recovery phase.@*Results@#The levels of white blood cells (WBC)[(10.25±3.76)×109/L], neutrophil(Neu)[(7.31±3.76)×109/L], platelet (PLT)[(334.66±143.80)×109/L], C-reactive protein(CRP)[(69.00±80.50) mg/L], erythrocyte sedimentation (ESR)[(39.38±26.29) mm/1h], lactate dehydrogenase (LDH)[(436.61±248.96) IU/L], fibrinogen(Fib)[(4.61±1.36) g/L] and D-dimer [(2.09±1.66) mg/L]in the severe group were higher than those in the moderate group[(7.55±3.14)×109/L, (4.77±2.54)×109/L, (291.60±109.19)×109/L, (23.40±42.50) mg/L, (30.25±16.18) mm/1 h, (318.05±116.97) IU/L, (4.18±0.88) g, (0.58±0.72) mg/L], and the differences were statistically significant (all P<0.01). The levels of Neu, PLT, CRP, LDH and D-dimer were independent and relevant factors for the severity of acute MPP.The area under each ROC curve was Neu 0.719, PLT 0.592, LDH 0.675, CRP 0.749, D-dimer 0.848, and each diagnostic threshold was 6.5× 109/L, 265.5×109/L, 417.5 IU/L, 28.9 mg/L, 0.73 mg/L, respectively.Obviously, D-dimer had the highest sensitivity and specificity for the severe MPP.There was a significant difference in D-dimer level between the endobronchial inflammation group and the subbronchial stenosis, poor ventilation and occlusion group of fiberoptic bronchoscopy [(1.11±0.26) mg/L vs.(2.14±1.84) mg/L, t=-5.870, P<0.05].@*Conclusion@#D-dimer levels can be used as one of the most sensitive indicator for determining the severity and prognosis of MPP.

Clinical characteristics of community-acquired influenza virus pneumonia in hospitalized children / 中华实用儿科临床杂志

Objective To analyze the clinical characteristics of community-acquired influenza virus pneumonia in hospitalized children and improve the clinicians' understanding level of this disease.Methods Data of 70 cases with community-acquired influenza virus pneumonia admitted to the Respiratory Department and Infectious Disease,Beijing Children's Hospital,Capital Medical University,from November 2009 to April 2018 were collected and the clinical characteristics were analyzed.Results Of the 70 cases,61 cases(89.7％) were discharged after improvement.The median age was 3.5 years old,and 50 cases(71.4％) were 0 to 5 years old.There were 29 cases with severe influenza pneumonia,41 cases with mild influenza pneumonia,3 cases died,and 19 cases (27.1％) had underlying diseases.Sixty-four cases (91.4％) were hospitalized in winter and spring.The first symptoms were mainly fever in 64 cases (91.4％) and cough in 65 cases (92.9％),and temperatures were mostly from 39.1 ℃ to 41.0 ℃.Lung auscultation was dominated by moist rales (30 cases,58.8％) and wheezing (8 cases,15.7％).There were many complications of influenza virus pneumonia,including 19 cases with myocardial injury,11 cases with liver function injury,4 cases with toxic encephalopathy,3 cases with electrolyte disturbance,2 cases with multiple organ failure,2 cases with hemophagocytic syndrome,and 1 case with septic shock.Chest radiographic results reveal bilateral inflammation in 40 children (57.1％),prodominatly in lower lobe lesions (39 cases).The common changes were patchy shadow,interstitial parenchymal lesion,ground glass shadow,and pleural effusion.Forty-seven children (67.1％) were infected by influenza A,and 23 children(32.9％) were co-infected.The percentage of severe cases with underlying diseases (68.4％) was significantly higher than that in children without chronic diseases (31.4％),the difference was statistically significant (x2 =7.830,P =0.005).The increase rate of C reaction protein (CRP) in severe cases (54.3％) was significantly higher than that in mild cases (28.6％),the difference was statistically significant (x2 =4.769,P =0.029).Conclusions Community-acquired influenza virus pneumonia in children mainly occurs in winter and spring.It is more common seen in children under 5 years of age.The main clinical manifestations of community-acquired influenza virus pneumonia are high fever and cough,extrapulmonary complications are more common.Most children have moist rales and showed bilateral inflammation and lower lobe lesions in chest radiography.Children with underlying diseases are more likely to develop severe influenza virus pneumonia.Elevated CRP is associated with severe influenza virus pneumonia.Most patients have a good prognosis,but there are still cases of death.

Design and application of spectacle frame for eye moxibustion / 中国针灸

The new style spectacle frame for eye moxibustion is designed, which is characterized by adjustable direction, constant temperature and smoke absorption. Combined with mechanical structure design and physical and chemical technology, a new style of moxibustion spectacle frame is designed by means of spring mechanism, damping bearing, filter cotton, etc. The moxibustion spectacle frame includes the right and left eye frames, spectacle legs, nose mask, eye mask, slide rod, screw rod, spring structure, damping bearing, support rod and pin. The eye mask can prevent from the risks induced by the burning moxa stick. A ventilate hole is designed in the lower part of the nose mask to keep breathing unobstructed. In the upper end of the ventilate hole, a filter cotton is placed to prevent from moxa smoke penetrating to the nasal cavity. The spring structure can keep relatively the fixed distance between the combustion area and the acupoints. Such device ensures the safety of eye moxibustion, reduces the complexity of operation and is suitable for moxibustion treatment for all kinds of eye diseases.

Application of D-dimer in diagnosis and prognosis of childhood Mycoplasma pneumoniae pneumonia / 中华实用儿科临床杂志

Objective To analyze the practical value of D-dimer in diseases condition judgment and prognosis evaluation of childhood Mycoplasma pneumoniae pneumonia (MPP).Methods Retrospective analysis was performed on clinical data of 606 MPP at Department of Respiratory,Beijing Children's Hospital,Capital Medical University from January 2009 to July 2017,and the subjects were divided a severe group (298 cases) and a moderate group (308 cases) according to severity.By comparing clinical characteristics,laboratory tests and imaging findings,multivariate Logistic regression analysis for significant single factors was accomplished,which was to find out the independent factors affecting the severity of childhood MPP in acute phase.Receiver operating characteristic (ROC) curves were drawn in the area under the curve (AUC) and the diagnosis threshold value was calculated,which could be used to judge the predicators affecting the severity judgment of childhood MPP in acute phase.And the prognosis was judged according to the convalescent fiberoptic bronchoscopic indicators in recovery phase.Results The levels of white blood cells (WBC) [(10.25 ± 3.76) × 109/L],neutrophil (Neu) [(7.31 ± 3.76) × 109/L],platelet (PLT) [(334.66 ± 143.80) × 109/L],C-reactive protein (CRP) [(69.00 ± 80.50) mg/L],erythrocyte sedimentation (ESR) [(39.38 ± 26.29) mm/1 h],lactate dehydrogenase (LDH) [(436.61 ± 248.96) IU/L],fibrinogen (Fib) [(4.61 ± 1.36) g/L] and D-dimer [(2.09 ± 1.66) mg/L] in the severe group were higher than those in the moderate group [(7.55 ±3.14) × 109/L,(4.77 ±2.54) × 109/L,(291.60 ± 109.19) × 109/L,(23.40 ±42.50) mg/L,(30.25 ± 16.18) mm/1 h,(318.05 ± 116.97) IU/L,(4.18 ±0.88) g,(0.58 ±0.72) mg/L],and the differences were statistically significant (all P ＜ 0.01).The levels of Neu,PLT,CRP,LDH and D-dimer were independent and relevant factors for the severity of acute MPP.The area under each ROC curve was Neu 0.719,PLT 0.592,LDH 0.675,CRP 0.749,D-dimer 0.848,and each diagnostic threshold was 6.5 × 109/L,265.5 × 109/L,417.5 IU/L,28.9 mg/L,0.73 mg/L,respectively.Obviously,D-dimer had the highest sensitivity and specificity for the severe MPP.There was a significant difference in D-dimer level between the endobronchial inflammation group and the subbronchial stenosis,poor ventilation and occlusion group of fiberoptic bronchoscopy [(1.11 ± 0.26) mg/L vs.(2.14 ± 1.84) mg/L,t =-5.870,P ＜ 0.05].Conclusion D-dimer levels can be used as one of the most sensitive indicator for determining the severity and prognosis of MPP.

Study on genetic mutation of surfactant dysfunction in children with interstitial lung disease / 中华实用儿科临床杂志

Objective To study the genetic mutation of surfactant dysfunction in children with interstitial lung disease.Methods The surfactant protein B (SFTPB),surfactant protein (SFTPC),ATP binding cassette transporter A3 (ABCA3) gene sequence detection were conducted for 26 patients with interstitial lung disease who were onset before 2 years old or without specific etiology after the biopsy during January 2012 to December 2017 in Beijing Children's Hospital Affiliated to Capital Medical University,then the result of gene sequence detection and the clinical data were analyzed.The method of gene analysis is PCR amplify and Sanger sequencing.Results (1) In total,4 cases of abnormal gene mutations had been found,of which 3 cases were pathogenic SFTPC gene mutations,such as c.218T ＞ C,IVS4,+ 1G ＞ C,c.115G ＞ T,1 case was ABCA3 compound heterozygous mutations,such as C.3913 T ＞ C and heterozygous deletion in Exon 13-18.(2)There were also 7 uncertain or suspected cases.Four cases were undefined pathogenic SFTPC mutations,such as c.406G ＞ C,IVS4,+ 12 G ＞ G,c.364T ＞ C,c.68G ＞ A.Three cases had been found with two ABCA3 heterozygous gene mutations,which were not confirmed by parents.The lung pathology of the patient with SFTPC (IVS4,+ 12 T ＞ G) and heterozygous ABCA3 (c.737C ＞ T)gene mutations was amyloidosis,and there was similar history in his family.(3) No pathogenic gene mutation was found in the 15 cases.No pathogenic SFTPB gene mutation was found in all the patient.Lung biopsy was performed in 2 cases of SFTPC c.115G ＞ T and ABCA3 compound heterozygous mutation,the lung tissue of this 2 cases were nonspecific interstitial pneumonia (NSIP).One case of SFTPC c.115G ＞ T had died at the age of 14 years old and 1 case of IVS4,+ 1G ＞ C had died at the age of 11 months old.Only 1 case of SFTPC c.218T ＞ C gene mutation with the similar family history,had improved significantly after glucocorticoid treatment,another case of ABCA3 compound heterozygous mutation was mildly improved after the glucocorticoid treatment.The chest CT/high resolution computed tomography displayed diffuse ground glass opacity in 4 cases,and cystic in 2 cases,all 2 cases with cystic were cases of SFTPC mutation and were dead.Conclusions The gene mutation of surfactant dysfunction is associated with interstitial lung disease in children.The pathology feature can be NSIP,and the prognosis may be poor in some cases,and the treatment of the corticosteroids may be effective in few case.

Clinical characteristics of bronchopulmonary foregut malformation / 中华儿科杂志

Objective@#To analyze the clinical characteristics, diagnosis and treatment of bronchopulmonary foregut malformation(BPFM).@*Method@#The clinical manifestations, imaging findings and treatment of 8 patients with BPFM were analyzed retrospectively from January 2006 to May 2016 in Beijing Children′s Hospital.@*Result@#The age of children varied from 2 months to 7 years and 3 children were male while 5 female. Symptoms showed cough in 6 cases, fever in 4 cases, bucking when intaking of fluids or foods in 3 cases, tachypnea in 1 case, wheezing in 1 case, vomiting in 1 case, haematemesis in 1 case Pulmonary signs were decreased breath sounds in 4 cases, phlegm rale in 3 cases, shortness of breath in 2 cases, wheeze in 1 case, and retraction in 1 case. The upper gastrointestinal series showed abnormal fistulous tracts arising from the esophagus or the gastric fundus and extending into the mass in the lung. CT showed pulmonary sequestration and prompted the tube between lung and esophagus. Six children underwent pneumonectomy and esophageal fistula repair. They were discharged and their symptoms were improved. Two cases of children were discharged from a hospital without surgery.@*Conclusion@#Bronchopulmonary foregut malformation usually has its onset in early stage of life. The most common symptoms include recurrent pneumonia or bucking when intaking of fluids or foods. CT can demonstrate the bronchopulmonary sequestration and evaluate the communication with the gastrointestinal tract. The upper gastrointestinal series can demonstrate the abnormal tract directly. Pneumonectomy and esophageal fistula repair are the treatment of this disease.

A Multi-centered Cross-sectional Study of Disease Burden of Pain of Inpatients in Southwest China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pain is a common burden of disease globally; yet, it is not systematically investigated in China, especially in hospitalized patients. This study was aimed at clarifying the epidemiological characteristics of pain and related factors in hospitalized patients in Southwest China.</p><p><b>METHODS</b>A cross-sectional study was conducted to investigate the prevalence, severity, and influencing factors of pain and modes of postoperative analgesia in hospitalized patients from 17 hospitals in Southwest China. A prevalidated questionnaire was employed to calibrate all of these items within 3 days from March 18, 2015 to March 20, 2015.</p><p><b>RESULTS</b>A total of 2293 patients were surveyed, the incidence of pain was 57.4% in all hospitalized patients at rest, of which 62.1% were with acute pain and 37.9% had persistent to chronic pain. Among surgical patients, 90.8% of them complained of acute postoperative pain at rest and 97.1% in motion. The incidence of acute postoperative moderate-to-severe pain was 28.8% at rest and 45.1% in motion. Surgical patients reported higher incidences of pain, especially acute and persistent pain compared with nonsurgical patients (P < 0.05). Postoperative pain occurred predominately at surgical sites (95.2%) as compared with nonsurgical sites (4.8%). Agedness, lower education level, surgery, and history of smoking were factors associated with increased duration and severity of postoperative pain and nonsurgical pain (P < 0.05).</p><p><b>CONCLUSIONS</b>Pain is a common burden of disease in China, of which surgical pain constituted an important component. Surgical patients complained more severe pain than those who did not undergo surgery. Postoperative analgesia still needs to be improved to control pain after surgery. Patients' perception might influence the efficacy of pain management, which should be implemented with a multidisciplinary approach.</p>

Analysis of allergic bronchopulmonary aspergillosis in 8 children / 中华实用儿科临床杂志

Objective To summarize the clinical features of the allergic bronchopulmonary aspergillosis (ABPA) in children,in order to improve the understanding for ABPA and make early diagnosis and treatment of the disease.Methods A retrospective study was performed on ABPA patients diagnosed in Department of Respiratory Medicine,Beijing Children's Hospital Affiliated to Capital Medical University from March 2010 to December 2013.The clinical features,laboratory results,image characteristics and the prognosis information were reviewed.Results Eight ABPA cases met the diagnostic criterion.All patients were school-age children (7 years and 2 months to 13 years and 8 months old).Cough (8 cases),productive sputum (8 cases),wheezing (5 cases),fever (4 cases) and hemoptysis (3 cases) were the main clinical features.Six of the 8 patients showed eosinophilia.IgE level was elevated in 7 patients (1.000-5.000 IU/L).All 8 patients were allergic to aspergillus fumigatus,while only 2 cases were positive in sputum culture for aspergillus fumigatus.CT scans showed pulmonary opacities in all 8 cases,while 7 patients had typical central bronchiectasis.Seven patients were treated with the regimen,which included glucocorticosteroid,antifungal agents (voriconazole or itraconazole) and regular bronchoscope.The symptoms of all treated patients relieved,the total serum IgE level and eosinophil cell count decreased spontaneously after the therapy.Conclusions ABPA is rare in children and the clinical features are non-specific.If the patient has elevated total IgE level in serum and eosinophilia,especially in patients with underling diseases,ABPA should be suspected.The positive result of specific antibodies to aspergillus fumigatus and central bronchiectasis on the radiology may give the suggestive diagnosis.ABPA patients generally have good response to the therapy of glucocorticosteroid and antifungal agents.

Pulmonary embolism and pulmonary vein thrombosis in children / 中华实用儿科临床杂志

Pulmonary embolism or pulmonary vein thrombosis is rare in children but does occur.Compare to adults,the vast majority of children with PE have risk factors.The clinical manifestation includes shortness of breath,pleuritic chest pain,and hemoptysis,however,which are not specific.The majority of evidence for treatments in the pediatric population is extrapolated from adult populations; the choice of treatment should be guided by risks and benefits,underlying disease,and especially,the hemodynamic stability of the patient.This article reviews the current knowledge of pulmonary embolism and pulmonary vein thrombosis in the pediatric population,summarizing its characteristics from epidemiological aspects to diagnostic and therapeutic relevant issues.

Clinical analysis and follow-up of neonatal lower respiratory tract infection with respiratory syncytial virus / 中华实用儿科临床杂志

Objective To investigate the clinical features of neonatal lower respiratory tract infection (LRTI)with respiratory syncytial virus(RSV),and to explore the relationship between clinical features and recurrcnt cough or wheezing after discharge.Methods From May 2008 to May 2013,the data of 41 neonates diagnosed as LRTI with RSV infection in New Century International Children's Hospital were analyzed retrospectively.The clinical features and follow-up results were observed.Results All the neonates had cough,92.7％ (38/41 cases) had choking,85.4％ (35/41 cases) had runny nose and nasal obstruction,31.7％ (13/41 cases) had fever,65.9％ (27/41 cases) had wheezing sound during physical examination,29.3％ (12/41 cases)of the neonates were accompanied with bacterial infection(n=29),in which 50.0％ (6/12 cases) were infected by staphylococcus aureus.Compared to the neonates only with RSV infection,the proportion of fever was higher in those with RSV combined with bacterial infection (n =12)(x2 =6.034,P ＜ 0.05),and there were no statistical differences between the neonates with or without bacterial infection in white blood cell count and with or without shadow in chest X-ray(x2 =0.859,2.064,P =0.485,0.202).Compared with the neonates without family history of atopy,the neonates with the family history of atopy were more likely to get wheezing (88.2％ vs 57.1％,x2 =4.871,P ＜ 0.05) during primary infection.During the follow-up,there was higher proportion of children with family history of atopy in the group with subsequent recurrent cough and/or wheezing than in the group without subsequent recurrent cough and/or wheezing (71.4％ vs 26.3％,x2 =6.388,P ＜ 0.05).Conclusions Cough,choking are most common symptoms in neonatal LRTI with RSV,and there is no wheezing sound during phy-sical examination in some neonates.LRTI with RSV is likely combined with bacterial infection.Wheezing is more common in the neonates with family history of atopy.The RSV LTRI neonates with family history of atopy incline to get subsequent recurrent cough or wheeze after discharge.

Children's dental fluorosis and estrogen receptor α gene Xba I polymorphism / 中国地方病学杂志

Objectives To explore the relationship between polymorphism in estrogen receptor alpha (ERα)gene Xba I and child dental fluorosis.Methods Qiulou township of Kaifeng and Sunying township of Tongxu counties of Henan province were chosen as the investigation spots in 2006.An area of water drinking endemic fluorosis(high fluoride area)and a non-endemic area(control area)were chosen in every spot,where dental fluorosis of children aged 8 to 12 years old were examined and diagnosed by using the Dean method.The children in the high fluoride areas were divided into dental fluorosis group and control group of the endemic areas according to dental fluorosis status,and the children in the control areas as control gruop of non-endemic areas.The Xba I polymorphism in the ERα gene was genotyped using the PCR-RFLP procedure.The fluoride levels in the urine samples from the three groups were detected by fluoride ion selective electrode and over standard rate of the urine was counted.Results The prevalence rate of dental fluorosis in high fluoride areas was 51.7%(74/143)and the community fluorosis index was 1.310.No dental fluorosis case was checked out in the control and the community fluorosis index was 0.021.The over standard rate of urine fluoride in dental fluorosis group[84.6%(121/143)]was significantly higher than that of control in non-endemic area[9.6%(9/94);χ2=125.95,P<0.01].The frequency distribution of ERα Xba I genotype was XX 6.8%(5/74),xx 36.5%(27/74),xx 56.8%(42/74)in dental fluorosis group;XX 15.9%(11/69),Xx 37.7%(26/69),xx 46.4%(32/69)in the eontrol of the endemic areas;XX 14.9%(14/94),Xx 43.6%(41/94),xx 41.5%(39/94)in children from the control in non-endemic area,respectively.No significant difference was found among the three groups(χ2= 3.450, P > 0.05). Allele frequency of ERα Xba I genotypes was X 22.7%(30/132), x 77.3%(102/132) in dental fluorosis group and X 35.5%(39/110),x 64.5% (71/110) in the control in endemic area when urine fluorosis of children was exceeding standard and significant difference was found in this two groups(χ2 = 4.768, P < 0.05; OR = 0.535,95% CI:0.305 - 0.941). Conclusion Children who carried X allele frequency of ERα Xba I genotypes have a lower risk of dental fluorosis when children with high-loaded fluoride status.