With the rapid development of the society, the detection rate of dyslipidemia in children has gradually increased. At present, there are few data on the application of traditional Chinese medicine (TCM) constitution identification in sub-health of children, and there is a lack of clinical correlation data analysis.
To observe the trend of changes in TCM constitution and blood lipid metabolism in children, and to analyze the correlation between them, thus providing relevant basis for subsequent continuous monitoring research.
Sourced from the Shanghai Child and Adolescent Health Cohort (SCAHC), a total of 2 080 healthy primary school students in the second and third grade from Pudong New Area, Shanghai were selected as the research subjects. Using the＂Zhaoming System＂that was independently developed by Shanghai University of Traditional Chinese Medicine, physical information of included subjects in 2021 (first year) and 2022 (second year) was collected. Based on the TCM constitution classification of facial complexion and tongue appearance, clinical symptoms and signs and questionnaire information, children were divided into five types of constitution, including the spleen-deficiency constitution, balanced constitution, Qi-stagnation constitution, deficiency-heat constitution, and excess heat constitution (unbalanced constitution referred to all constitutions except for the balanced constitution). Blood samples were collected to detect on triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and total cholesterol (TC). To analyze and compare the incidence of blood lipid abnormalities in children of different genders, as well as the distribution characteristics and changes of TCM constitution in different ages and genders. Multivariate Logistic regression analysis was performed to explore the correlation between TCM constitution and dyslipidemia in children.
Among the 2 080 children, 1 122 (53.9%) were males and 958 (46.1%) were females, with an average age of (8.2±0.4) years. There were 522 children with dyslipidemia (25.09%), including 272 males (52.1%) and 250 females (47.9%). In 2021, there were 815 (39.2%) cases of the balanced constitution and 1 265 (60.8%) cases of the unbalanced constitution. In 2022, 764 (36.7%) children had a balanced constitution and 1 316 (63.3%) had a unbalanced constitution. There was a statistically significant difference in the distribution of TCM constitution in children between 2021 and 2022 (χ2=106.28, P<0.001). The detection rate of unbalanced constitution in boys was significantly higher than that in girls (χ22021=14.073, P<0.001; χ22022=20.090, P<0.001). Multivariate Logistic regression analysis, after excluding demographic factors such as gender and age, showed that elevated HDL-C in children was a contributing factor to the occurrence of balanced constitution (OR=1.624, 95%CI=1.258-2.097, P<0.001), and deficiency-heat constitution (OR=0.654, 95%CI=0.499-0.858, P=0.002) .
Through analyzing the changing trend in TCM constitution and blood lipid metabolism in children from the SCAHC cohort, an increased HDL-C promotes the occurrence of balanced constitution but inhibits the occurrence of deficiency-heat constitution.
At present, the proportion of DRUG-RESISTANT epilepsy (DRE) in children is still maintained at about 30%, and it is often combined with mental retardation, affecting the quality of life, so the diagnosis and treatment of DRE is still a major challenge in neurology.
Analyze the genetic and clinical characteristics of DRE in children to provide a theoretical basis for clinical genetic testing.
A retrospective analysis of 95 children with DRE who were hospitalized in Hebei Children's Hospital from 2020 to 2022. According to the genetic test results, they were divided into gene mutation positive group (44 cases) and gene mutation negative group (51 cases). Collected general information (including gender, age of onset, medication use, history of febrile convulsions, family history of epilepsy, etc.), clinical features (seizure types, epilepsy syndromes, developmental conditions), and ancillary examinations [genetic testing, video electroencephalography (VEEG) examination, neuroimaging] from the children, and analyse the genetic aetiology and clinical features of DRE.
Of the 95 children with DRE, 55 (57.9%) were male and 40 (42.1%) were female, with a median age of onset of 1.00 (0.50, 4.00) years and number of medications used of 3 (2, 4) ; the age of onset of the children in the mutation-positive group was younger than that in the mutation-negative group (Z=-5.322, P=0.001) ; comparing the gender of the children, history of febrile seizures, family history of epilepsy, and number of medications used in the two groups, the differences were not statistically significant (P>0.05). Epileptic syndromes were diagnosed in 38 (40.0%) of the children, of which 76.3% (29/38) had onset in the neonatal or infantile period; the percentage of epileptic syndromes was higher in the mutation-positive group than in the mutation-negative group (χ2=12.065, P=0.001). Clinical seizure types were diverse, with 2 or more seizure types being the most common, accounting for 52.6% (50/95), followed by a single focal seizure, accounting for 33.7% (32/95) ; there was no statistically significant difference in the comparison of seizure types between the two groups of children with DRE (χ2=2.920, P=0.404). Developmental screening was improved in 57 children, of whom 43 (75.4%) showed varying degrees of developmental delay after the onset of the disease, and 33 (76.7%) showed generalised developmental delay; the percentage of children with developmental delay in the mutation-positive group was higher than that in the mutation-negative group (χ2=5.728, P=0.017). Genetic variations were detected in 44 cases, resulting in a positive detection rate of 46.3%, predominantly involving ion channel-related mutations, with SCN1A being the most prevalent single-gene mutation. Ninety (94.7%) children had abnormal VEEG examinations, with focal epileptic discharges predominating; the percentage of peak dysrhythmias was higher in the mutation-positive group than in the mutation-negative group (χ2=7.425, P=0.006). Structural etiology was present in 25 (26.3%) children, including 12 in the mutation-positive group and 13 in the mutation-negative group; the difference in the structural etiology of the children with DRE was not statistically significant when comparing the two groups (χ2=0.039, P=0.844) .
Genetic factors are an important etiological factor for DRE in children. The young age of onset and developmental delay suggests that it is related to a genetic etiology, and genetic testing should be actively improved at an early stage, which can help in the early diagnosis of DRE and precise treatment.
Enuresis is one of the common diseases in children and adolescents, and in recent years, enuresis has posed a great threat to the physical and mental health of children and adolescents, seriously affecting the quality of life of the affected children, and bringing a serious burden to the society and families. At present, there are still controversies about the influencing factors of enuresis in children and adolescents, and there are few relevant systematic evaluations at home and abroad.
To explore the prevalence and influencing factors of enuresis in children and adolescents in China using Meta-analysis.
Computer searches were conducted for relevant studies in the databases of CNKI, Wanfang Data, VIP, SinoMed, PubMed, Embase, Web of Science, and Cochrane Library from the construction of the database to May 2024. Independent screening and cross-checking by 2 investigators, cross-sectional studies were assessed using the Agency for Healthcare Research and Quality, and Meta-analysis was performed using Stata 17.0 software.
A total of 27 papers were included, including 243 530 children patients. The results showed that the prevalence of enuresis in Chinese children and adolescents was 6.1% (95%CI=5.1%-7.2%), of which, male (OR=1.52, 95%CI=1.41-1.64), family history of enuresis (OR=3.46, 95%CI=2.01-5.93), constipation (OR=2.32, 95%CI=1.59-3.40), history of urinary tract infections (OR=2.33, 95%CI=1.81-3.01), and sleep disorder (OR=2.01, 95%CI=1.10-3.67), urinary frequency (OR=1.90, 95%CI=1.43-2.52), urinary urgency (OR=1.67, 95%CI=1.31-2.12), and urinary incontinence (OR=4.85, 95%CI=2.78-8.45) were risk factors for enuresis in children and adolescents (P<0.05) ; urinary training (OR=0.11, 95%CI=0.02-0.46) was a protective factor for enuresis in children and adolescents (P<0.05) .
The prevalence of enuresis is high in Chinese children and adolescents, and that gender, family history of enuresis, constipation, history of urinary tract infection, voiding training, sleep disorders, urinary frequency, urinary urgency, and urinary incontinence are the main influencing factors of enuresis in children and adolescents. Therefore, in the future, early identification and intervention of enuresis in children and adolescents should be carried out, parents' attention to enuresis should be raised, and the popularisation of disease education should be done to reduce the prevalence of enuresis and improve the quality of life of the affected children and their families.
There are many types of vestibular function examination, each with different targets and positive rates. Clinical opinions vary on how to appropriately select examination methods for vertigo patients.
To explore the application value of vestibular function combined with audiological examination in peripheral vertigo diseases, and provide a reference basis for the diagnosis and differential diagnosis of clinical vertigo diseases.
Patients with dizziness or vertigo as the main complaint were selected from January 2021 to January 2022 in the Vertigo Clinic of the First People's Hospital of Yibin. All patients finished the examination within 7 days including pure tone audiometry (PTA), caloric test, video head impulse test (vHIT) and head-shaking test (HST). The vestibular function examination and audiological examination results were compared.
A total of 120 patients with vertigo who met the inclusion and exclusion criteria had complete case data, there were 40 cases of sudden deafness with vertigo (SDV), benign paroxysmal positional vertigo (BPPV), and vestibular migraine (VM). The PTA in SDV patients was sensorineural deafness, 25 cases with caloric test abnormalities (62.50%), 16 cases with vHIT abnormalities (40.00%), 28 cases with HST abnormalities (70.00%). Nine BPPV patients had PTA abnormalities (22.50%), including 7 ears with sensorineural deafness, 2 ears with conduction deafness, 18 cases with caloric test abnormalities (45.00%), 21 cases with vHIT abnormalities (52.50%), and 20 cases with HST abnormalities (50.00%). There were 21 cases (52.50%) of PTA abnormalities in VM patients, all with sensorineural deafness, of which 26 ears had high-frequency hearing-light-moderate decline and 7 ears had low-frequency light-moderate decline. There were 16 cases with caloric test abnormalities (40.00%), 17 cases with vHIT abnormalities (42.50%), and 27 cases with HST abnormalities (67.50%). The proportion of hearing abnormalities in the three groups was statistically significant difference (χ2=50.26, P<0.001), and there were no statistically significant difference among the results of vestibular function examination (P>0.05) .
The vestibular function combined with audiological examination is helpful to the localization diagnosis of peripheral vertigo and to improve the detection rate and differential diagnosis of vertigo diseases.
Simplified left atrial appendage occlusion (LAAO) is one of the important treatment methods for preventing thromboembolism in patients with nonvalvular atrial fibrillation. Currently, there are few studies on the value of cardiac 3-dimensional computed tomography (3D-CT) in the simplified LAAO.
To investigate the feasibility, safety, surgical efficacy and postoperative follow-up value of 3D-CT in simplified LAAO.
We prospectively recruited 52 patients who underwent simplified LAAO in the Second Affiliated Hospital of Anhui Medical University from May 2021 to January 2024. They were randomly assigned into the control group and study group by lottery. Preoperative transesophageal echocardiography (TEE) and preoperative cardiac 3D-CT were performed in the control group and study group, respectively. The baseline data, maximum ostium diameter and maximum depth of the left atrial appendage (LAA), match rate between the delivered sheath and the axis of LAA, operation time, time for x-ray exposure and dose, consumption of contrast agent, the rate of non-recapture and non-change of occlusion device, peri-device leakage (PDL), and perioperative complications were collected. A 3D-CT follow-up was performed for 90 days after LAAO.
Both the control group and the study group comprised 26 cases each, using the WATCHMAN device for LAAO, with no serious perioperative complications. Preoperative examinations showed no intracardiac thrombus in all patients. In the control group, the maximum ostium diameter of the LAA measured by preoperative TEE and intraoperative DSA was (22.9±4.1) mm and (25.4±2.9) mm, respectively, not showing a positive correlation (r=0.374, P=0.060). The usable depth of the LAA in the control group measured by preoperative TEE and intraoperative DSA was (25.7±8.1) mm and (23.7±3.4) mm, respectively, showing a positive correlation (r=0.392, P=0.048). In the study group, the maximum ostium diameter of the LAA measured by preoperative 3D-CT and intraoperative DSA was (25.0±3.3) mm and (24.9±5.8) mm, respectively, showing a positive correlation (r=0.566, P=0.003). The usable depth of the LAA in the study group measured by preoperative 3D-CT and intraoperative DSA was (23.5±4.2) mm and (23.1±4.0) mm, respectively, showing a positive correlation (r=0.774, P<0.001). The match rate between the delivered sheath and the axis of LAA was significantly higher in the study group than that of control group (96.2%, n=25; 76.9%, n=20; χ2=4.172, P=0.042). Patients in the study group had significantly shorter atrial septal puncture time, occlusion time, and exposure time to X-ray, and lower X-ray dose and consumption of contrast agent compared to those of the control group (P<0.05). The incidence of intraoperative minor PDL in the study group was significantly lower than that in the control group (P<0.05). A total of 37 patients, with 16 cases in the control group and 21 in the study group, completed the 90-day follow-up after LAAO. No device-related thrombus (DRT) or PDL larger than 5 mm was found, and incomplete device endothelialization was observed in some patients.
Reoperative cardiac 3D-CT in simplified LAAO benefits a shorter operation time, shorter fluoroscopy time, less dosage to X-ray exposure, and lower rate of minor PDL. It also demonstrates certain advantages of detecting incomplete endothelialization in postoperative follow-up. With the advancement of 3D-CT in the application of LAAO, it can be combined with 3D printing technology in the future to simulate the procedural process accurately, making LAAO safer and more efficient.
