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Pediatric chronic pain can lead to serious consequences in terms of daily functioning and global quality of life. Mindfulness-based intervention (MBI) approaches that emphasize accepting rather than controlling pain have gained increasing attention in adults with chronic pain. The effectiveness of MBIs for chronic pain in the pediatric population remains unknown. The aim of the Peacefull program was to study the feasibility in France of a mindfulness program for adolescents with chronic pain, based on a program especially developed in Canada and Belgium.

The majority of patients with acute back pain have no serious underlying disease; however, many internal diseases can be manifested as acute or chronic back pain. Therefore, in the assessment of patients with back pain the clinical history and clinical examination are important in order to detect indications for a possible underlying disease. Particularly red flags that indicate an acute or life-threatening disease should not be missed. In most cases where such red flags, risk factors or clinical indications are not present, no systematic search for internal underlying diseases is necessary. This article summarizes the most relevant differential diagnoses and clinical indications as well as warning symptoms.

Benign acute childhood myositis (BACM) is a rare, transient, and self-limited inflammatory condition of the skeletal muscle that usually occurs after a viral infection. It affects pre-school and school-aged children at a median age of 6-9 years, with a male predominance. Patients can be managed with analgesia, rest, and adequate hydration at home.

Multiple aspects of a multidomain assessment have been validated for identifying concussion, however, researchers have yet to determine which components are related to referral for vestibular therapy.

PROcedure SPECific Postoperative Pain ManagemenT (PROSPECT) guidelines recommend erector spinae plane (ESP) block or paravertebral block (PVB) for postoperative analgesia after video-assisted thoracoscopic surgery (VATS). However, there are few trials comparing the effectiveness of these techniques on patient-centric outcomes, and none evaluating chronic postsurgical pain (CPSP). Furthermore, there are no available trials comparing ultrasound-guided ESP with surgically placed PVB in this patient cohort.

Military and/or emergency services personnel may be required to perform high-intensity physical activity during exposure to elevated inspired carbon dioxide (CO). Although many of the physiological consequences of hypercapnia are well characterized, the effects of graded increases in inspired CO on self-paced endurance performance have not been determined. The aim of this study was to compare the effects of 0%, 2%, and 4% inspired CO on two-mile run performance as well as physiological and perceptual responses during time trial exercise. Twelve physically active volunteers (peak oxygen uptake = 49±5 mL kg min; 3 women) performed three experimental trials in a randomized, single-blind, crossover manner, breathing 21% oxygen with either 0%, 2%, or 4% CO. During each trial, participants completed 10 minutes of walking at ~40% peak oxygen uptake followed by a self-paced two-mile treadmill time trial. One participant was unable to complete the 4% CO trial due to lightheadedness during the run. Compared to the 0% CO trial, run performance was 5±3% and 7±3% slower in the 2% and 4% CO trials, respectively (both p<0.001). Run performance was significantly slower with 4% vs. 2% CO (p=0.046). The dose-dependent performance impairments were accompanied by stepwise increases in mean ventilation, despite significant reductions in running speed. Dyspnea and headache were significantly elevated during the 4% CO trial compared to both the 0% and 2% trials. Overall, our findings show that graded increases in inspired CO impair endurance performance in a stepwise manner in healthy humans.

Frailty is a multidimensional state related to accumulation of age- and disease-related deficits across multiple domains. Older people represent the fastest growing segment of the peri-operative population, and 25-50% of older surgical patients live with frailty. When frailty is present before surgery, adjusted rates of morbidity and mortality increase at least two-fold; the odds of delirium and loss of independence are increased more than four- and five-fold, respectively. Care of the older person with frailty presenting for emergency surgery requires individualised and evidence-based care given the high-risk and complex nature of their presentations. Before surgery, frailty should be assessed using a multidimensional frailty instrument (most likely the Clinical Frailty Scale), and all members of the peri-operative team should be aware of each patient's frailty status. When frailty is present, pre-operative care should focus on documenting and communicating individualised risk, considering advanced care directives and engaging shared decision-making when feasible. Shared multidisciplinary care should be initiated. Peri-operatively, analgesia that avoids polypharmacy should be provided, along with delirium prevention strategies and consideration of postoperative care in a monitored environment. After the acute surgical episode, transition out of hospital requires that adequate support be in place, along with clear discharge instructions, and review of new and existing prescription medications. Advanced care directives should be reviewed or initiated in case of readmission. Overall, substantial knowledge gaps about the optimal peri-operative care of older people with frailty must be addressed through robust, patient-oriented research.

Although acute COVID-19 has been milder in children and young people compared with adults, there is a concern that they may suffer persistent symptoms. There is a need to define the clinical phenotype, determine those most at risk, the natural course of the condition and evaluate preventive and therapeutic strategies for both mental health and physical symptoms.

The purpose of this study was to evaluate the pharmacokinetics and tissue distribution of Corydalis yanhusuo total alkaloids transdermal patch (CTTP) following Shenque acupoint application in rats. The concentrations of Corydaline (CDL), Tetrahydropalmatine (THP), Tetrahydrocolumbamine (THC), Protopine (PRO), and Dehydrocorydaline (DHC) in rat plasma and various tissues were simultaneously detected by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) after Shenque acupoint administration of CTTP. Plasma, heart, liver, spleen, lung, and kidney tissue samples were collected at specific times and separated by gradient elution on an ACQUITY UPLC HSS T3 column (1.8 μm, 100 mm×2.1 mm) with a mobile phase of 0.01% formic acid aqueous solution and acetonitrile-0.01% formic acid. The methodological results showed that the selectivity, linear range, accuracy, precision, stability, matrix effect, and extraction recovery of the established method met the requirements of biological sample analysis. The results denoted that CTTP following Shenque acupoint administration rapidly delivered adequate drug into rat blood and maintained an effective plasma level for a significantly longer time than non-acupoint administration. Furthermore, CTTP effectively reached the liver through Shenque acupoint administration and showed tissue selectivity. The data obtained could provide a prospect for the treatment of chronic pain with CTTP following Shenque acupoint application.

We present a case of a 13-year-old boy with Crohn's disease (CD) who presented with abdominal pain and diarrhea. On examination, there was tenderness on the lower abdomen. Laboratory examinations showed elevated inflammatory parameters. A CT scan showed active inflammation of the ileum and rectosigmoid colon with the comb sign. A diagnosis of exacerbation of CD was made. The comb sign refers to hypervascularity of the mesentery with vascular dilatation, tortuosity, and wide spacing of the vasa recta that are aligned as the teeth of a comb. This sign is not always pathognomonic for CD; however, it may help identification of acute exacerbation in known CD and differentiating active CD from hypovascular disease such as lymphoma. The comb sign can be highly correlated with the endoscopic severity rather than mural thickening in CD.