Exploration of surgical treatment indications for invasive pulmonary aspergillosis and mucormycosis in children / 中华胸心血管外科杂志

Objective:To review and analyze clinical data of patients with invasive pulmonary aspergillosis and mucormycosis, and to explore the surgical indication.Methods:Clinical data of 10 patients with invasive pulmonary aspergillosis and mucormycosis were analyzed retrospectively from March 2018 to November 2022 in our hospital, Department of Thoracic Surgery.Results:The age of children varied from 2.58 years old to 16.00 years old and 6 children were males while 4 females. Five patients suffer from invasive pulmonary aspergillosis. Five patients suffer from invasive pulmonary mucormycosis. The operative indication of 7 patients was the risk of massive bleeding in the airway. The surgical indication for two patients is to control infection and continue treating malignant tumors. One patient chose surgical treatment because the infection could not be cured after long-term antifungal treatment but the focus was limited. Two patients died of sudden acute hemoptysis before operation, the prognosis of 8 patients undergoing surgical treatment was good.Conclusion:The lethal rate of invasive pulmonary aspergillosis and mucormycosis is very high. Antifungal drug treatment combined with timely surgical treatment can save patients lives.

Clinical characteristics of pulmonary vein stenosis in children / 中华实用儿科临床杂志

Objective:To analyze the clinical characteristics of pulmonary vein stenosis (PVS) in children, and to explore its treatment and prognostic factors.Methods:The clinical data of 19 children with PVS treated in Beijing Children′s Hospital, Capital Medical University from October 2016 to March 2022 were analyzed retrospectively.There were 16 males and 3 females.The median age at diagnosis was (2.81±1.95) years.A descriptive analysis of clinical characteristics of children was made.Results:Of the 19 children, 14 cases (73.7%) had primary PVS and 5 cases (26.3%) had secondary PVS after surgery of anomalous pulmonary venous connection (APVC). Thirteen children (68.4%) had hemoptysis.In the hemoptysis children, 5 cases had life-threatening massive hemoptysis, and 11 cases (57.9%) had a history of recurrent respiratory tract infection or pneumonia.Other manifestations of hemoptysis included failure to thrive (6 cases), cyanosis (5 cases), and dyspnea (3 cases). Complications were pulmonary hypertension (6 cases) and right heart failure (3 cases). There were 16 cases (84.2%) of unilateral PVS and 3 cases of bilateral PVS.Interlobular septal thickening, grid shadow and ground glass opacities were found on CT of all PVS cases.Ten cases underwent surgery, and 2 cases of them received angioplasty, but restenosis occurred in both of them.Eight children underwent pulmonary lobectomy, and their clinical symptoms were all relieved after operation.Nine patients were treated conservatively, and 3 cases of them died of bilateral PVS secondary to APVC.The remaining 6 alive cases still had intermittent clinical symptoms during follow-up.Conclusions:Hemoptysis and recurrent respiratory tract infection are the main clinical manifestations of PVS in children, and life-threatening massive hemoptysis can occur.Lobectomy is an effective treatment for unilateral PVS.The prognosis of secondary PVS after APVC is poorer and its mortality is higher, compared with primary PVS.

Diagnosis and treatment of rare esophageal hamartoma in children / 中华胸心血管外科杂志

Objective:To summarize the clinical features, diagnosis and treatment experience of esophageal hamartoma in children.Methods:From December 2013 to December 2019, 3 cases of esophageal hamartoma were admitted to our hospital, and a retrospective analysis was conducted.Results:There were 1 male and 2 females, with an average age of 6.4 years old. The clinical manifestations were vomiting in 2 cases and dysphagia with esophageal foreign body sensation in 1 case. Esophagography, chest contrast-enhanced CT, and esophagoscopy showed esophageal stenosis or esophageal mass effectg, and esophageal dilatation above the affected segment. The tumor was found in upper esophagus in 1 case and lower esophagus in 2 cases. Tumors were complete resection in all 3 cases and the patients were discharged smoothly. All the 3 cases were followed up after surgery for 10-74 months(average 37 months), and 1 case had gastroesophageal reflux. No stenosis or recurrence was found in all the cases, and all the patients could eat normal diet.Conclusion:The main manifestations of esophageal hamartoma in children are vomiting and choking. Complete surgical resection is the main treatment method, and the prognosis is good.

Treatment of bifid ribs by gasless endoscopy using lift device / 中华胸心血管外科杂志

Objective:Gasless laparoscopic surgery using lifting device was first introduced in 1993 mainly for general surgery and gynecology. Here we report its application in bifid rib treatment and explore the feasibility and safety of the surgery.Methods:From July 2008 to December 2019, according to the enrollment criteria, 278 patients of bifid ribs were treated at the Department of Thoracic Surgery, Beijing Children’s Hospital, Capital Medical University, including 183 males and 95 females, the mean age was(5.7±2.5) years old. There were 242 cases of single bifid rib and 36 cases of multiple bifid ribs. The bifid ribs were more common on the right side, as 184 cases had bifid ribs on right side, while only 68 cases on the left side and 26 cases on both sides. Patients’ clinical data were retrospectively summarized and analyzed, including the patients’ gender, age, location and type of bifid rib, perioperative outcome, and follow-up.Results:All the 278 patients successfully completed the operation. The abnormality was most frequently found in the fifth rib(incidence ranking: fifth > fourth > third > sixth). The mean operation time was(64.5±16.1)min, and the mean blood loss was(4.8±2.1)ml. No serious complications occurred during the surgery. Follow-up was done for 7 to 120 months, and no recurrent patients were observed.Conclusion:Gasless endoscopy with lifting device has been used as a safe and effective method to treat bifid ribs in our hospital. This surgery leads to less injury, smaller incision, and no scars on the front chest. Gasless endoscopic surgery with lifting device can be one of the options for correcting bifid ribs.

Clinical characteristics and long-term survival quality in single-center children with low and intermediate-risk neuroblastoma / 中华实用儿科临床杂志

Objective:To summarize the clinical characteristics of single-center children with low and intermediate-risk neuroblastoma (NB), report the long-term follow-up results of the growth and survival quality, and provide a basis for further clinical research.Methods:Clinical characteristics, including the sex, age, stage, risk of disease, and metastatic site of 370 newly treated children with low and intermediate-risk NB admitted to Hematology Oncology Center, Beijing Children′s Hospital from March 2007 to June 2019 were retrospectively analyzed.Kaplan-Meier method was used for survival analysis.WHO Anthro Plus was used for calculating Z score.Results:A total of 370 eligible children with low and intermediate-risk NB were included, with the mean age at onset of 16.8 months (1-191 months). Among them, 148 cases (40%) were younger than 12 months old.Mediastinal region was the most common primary site of NB (47.8%, 177 cases), followed by retroperitoneum/adrenal gland (41.4%, 153 cases). The median follow-up time of 370 patients was 31 months (0.3-157.0 months), the 5-years event free survival (EFS) and 5-year overall survival (OS) were 86.2% and 96.9%, respectively.Thirty-seven cases had growth and deve-lopment problems, of which 22 cases had stunted growth, 6 cases had low body mass, 9 cases had wasting, and 7.3%(27/370 cases) had scoliosis.5.5% of them had heart damage and 5.0%(18/357 cases) had kidney damage, involving 12 cases related to the primary tumor and 6 cases were surgically related.30.2%(95/315 cases) of them had hair changed after chemotherapy, and curly hair was the most common change.Compared with before treatment, 14.9% of the children had a personality change, with an impatient being the most common.Conclusions:The 5-year overall survival rate of the single-center large sample of low and intermediate-risk NB was high, mediastinal was the most common primary site of tumor, and the long-term quality of life is good, but there were still treatment-related side effects, and further clinical monitoring and long-term follow-up were needed.

Clinical analysis of multi-disciplinary treatment for cervical neuroblastoma / 中华实用儿科临床杂志

Objective:To summarize the clinical features, treatment and outcomes of cervical neuroblastoma (NB) subjected to multi-disciplinary treatment.Methods:The clinical features of cervical NB patients who were admitted to Beijing Children′s Hospital, Capital Medical University from February 2015 to October 2018, were retrospectively analyzed.The tumor makers [lactate dehydrogenase(LDH), neuron-specific enolase(NSE), urine homovanillic acid/creatinine(HVA/Crn), and urine vanillyl-mandelic acid/creatinine(VMA/Crn)], index of tumor burden(KTB), bone marrow examination, histopathologic types, N- MYC, gene amplification and 11q23 depletion type, staging and grouping, treatment and outcomes were analyzed.Follow-up was ended on March 31 st, 2019. Results:The 13 cervical NB patients aged from 1 month to 47 months (median age: 10 months), and 8 patients (61.5%) were younger than 18 months old.The course of disease ranged from 0.5 to 24.0 months (median course: more than 1 month). Seven patients (53.8%) presented with cervical masses.According to International Neuroblastoma Staging System (INSS), 8 patients (61.5%) were identified as stage Ⅱ, 3 patients (23.1%) as stage Ⅲ, and 2 patients (15.4%) as stage Ⅳ.There were 8 patients (61.1%) at low risk, 4 patients (30.8%) at intermediate risk, 1 patient (7.7%) at high risk.As for the laboratory examinations, LDH was increased in 7 patients (53.8%), and normal in 5 patients (38.5%). NSE was increased in 9 patients (69.2%), and normal in 4 patients (30.8%). Urine VMA/Crn was increased in 5 patients (38.5%), and normal in 8 patients (61.5%). HVA/Crn was increased in 8 patients (61.5%), and normal in 5 patients (38.5%). KTB was increased in 5 patients (38.5%), and normal in 5 patients (38.5%). No NB cell was detected in bone marrow of 13 patients.The pathologic type was NB in 9 patients (69.2%), and ganglioneuroma in 4 patients (30.8%). N-MYC gene amplification and 11q depletion were not detected.All the 13 patients accepted regular chemotherapy, radiotherapy and primary tumor resection in accordance with the staging and clinical risk grouping.The range of follow-up time was 5 to 48 months (median: 24 months). All of the patients fi-nished their treatment and were followed up regularly.Nine patients (69.2%) achieved complete remission, 4 patients (30.8%) achieved partial remission, and none of the patients had progression of disease.Conclusions:Cervical NB subjected to multi-disciplinary treatment has a smaller age at admission, mostly presented with cervical masses and rarely accompanied with distant metastasis.They are mostly at low risk or intermediate risk, and can achieve good outcomes after regular treatment.

Clinical analysis of neuroblastoma with pulmonary or pleural involvement / 中华实用儿科临床杂志

Objective To analyze the clinical characteristics of children with neuroblastoma (NB) complicated with lung or pleural metastasis,further to explore the correlation between characteristics and short-term outcome of NB,so as to provide a basis for clinical diagnosis and treatment.Methods A retrospective analysis was performed concerning the age of onset,clinical features,treatment and outcome of 36 patients with NB who were admitted at Blood Tumor Center,Beijing Children's Hospital of Capital Medical University from December 2007 to December 2017.The diagnostic criteria,therapeutic regimen and therapeutic efficacy criteria of the enrolled children were all based on the NB protocol of Beijing Children's Hospital of Capital Medical University (BCH-NB-2007),the clinical stage was based on international clinical stage of neuroblastoma (INSS stage),and stratified treatment was conducted according to the BCH-NB risk grouping standard.The follow-up period lasted till October 31,2018.Results (1) The common clinical features of grouped children:36 patients were selected into the group,accounted for 5.99％ (36/601 cases) in total hospitalized NB children,they were less than 10 years old,10 cases under 18 months,and the median age was 29.5 months (9-105 months);20 cases were male,and 16 cases were female;the primary tumor was located in the retroperitoneal site in 19 cases,accounting for 52.78％,9 cases in adrenal site,accounting for 25.00％,and 8 cases in mediastinal site,accounting for 22.22％.Risk groups:29 cases were in high-risk group,6 cases were in medium-risk group and 1 case was in low-risk group.The main symptoms were of pain onset in 8 cases,fever in 6 cases,local mass in 6 cases,abdominal mass in 4 cases,mediastinal mass in 3 cases,paleness in 3 cases,subcutaneous nodules in 2 cases,abdominal distension in 2 cases,lower limb swelling in 1 case,and diarrhea in 1 case.Among them,16 cases had respiratory system symptoms first,accounting for 44.4％.(2) Laboratory examination:there were 35 patients of neuron-specific enolase (NSE) ≥25 μg/L on the initial diagnosis,of which 11 cases were more than 370 μg/L,the value of serum lactate dehydrogenase (LDH) ≥ 717.5 U/L in 25 patients,accounting for 69.44％,and 10 cases were accompanied by N-myc gene amplification.(3) Imaging examination:on the first diagnosis,chest/abdomen CT showed 75.75％ (24/33 cases) of pleural or lung involvement,PET-CT showed 81.8％ (27/33 cases) of pleural or lung involvement,B-ultrasound showed 41.67 ％ (5/12 cases) of pleural or lung involvement;3 imaging examinations showed:1 positive in 16 cases,2 positive in 16 cases,and 3 positive in 4 cases.(4)Comparison of clinical features of pleural and pulmonary involvement:among the 30 children with pleural involvement,6 cases had respiratory symptoms,3 cases had respiratory symptoms on the 6 cases with pulmonary involvement only,and 4 cases with pleural and pulmonary involvement had no respiratory symptoms at first diagnosis.(5)Treatment and outcome:2 cases died because of critical condition after diagnosis,5 cases didn't receive the law treatment,29 cases accepted law stratification treatment,among them,1 case in low risk group,INSS-Ⅳ,alleviate current (CR);4 cases in the moderate group,INSS-Ⅳ,CR in 2 cases,partial response (PR) in 1 case,progress in 1 case,new tumor foci occurring after chemotherapy discontinuation for 13 months.Twenty-four cases were in the high-risk group,event occurred in 7 cases (29.17％) of them,1 case had progression by postoperative evaluation,4 cases of progression at 1.5,2.0,3.0 and 6.0 months after cessation of chemotherapy,and 2 cases had recurrence at 11 and 17 months after cessation of chemotherapy.Overall survival rate (OS) was 41.4％ for all children analyzed by Kaplan-Merier,and 32.9％ of them were predicted to have 3-year event-free survival.Conclusions Children with pulmonary or pleural metastasis of neuroblastoma have no specific respiratory symptoms.CT scan might be a useful method for diagnosing the group Ⅳ children with pulmonary or pleural metastasis of neuroblastoma.Moreover,there seemed to be no significant correlation between the N-myc gene expression and survival prognosis of these children.

A control study of measuring thoracic cage indexes in 3-17 years old healthy children and children with pectus excavatum / 中华胸心血管外科杂志

Objective To provide data references for Nuss procedure biomechanics research,and to understand morphological pathological changes in children with pectus excavatum.Methods A retrospective study was conducted for 434 cases of pectus excavatum from January 2009 to December 2015 in our institution.The anterior rib width(RW),anterior intercostal space width(IS) and thickness of the rib in the middle(RT) on the right side of 3-7 ribs had been measured in each patient.The widths were compared between the IS of children with pectus excavatum and the bar which currently used in clinic.The measurement indexes were compared between healthy children and children with pectus excavatum.Results The IS of prepubertal children with pectus excavatum was less than the width of bar which currently used in clinic (12.7 mm).Children with pectus excavatum compared with healthy children,the IS from 4 to 6 and the 5th RW of children with pectus excavatum were less than healthy children (P ＜ 0.05),the 3rd and 4th RT were greater than healthy children (P ＜ 0.05).Conclusion The measured values will be useful for the improvement of pectus bar and Nuss procedure biomechanics research.By morphology contrast,it reflects the pectus excavatum deformity has some restriction in thoracic development and the cardiopulmonary function.

Sternal suspension technique in treatment of pectus excavatum after open repair of congenital heart disease / 中华胸心血管外科杂志

Objective To evaluate the efficacy of using sternal suspension technique in correcting pectus excavatum after open repair of congenital heart disease and improve the safety of this technique.Methods A retrospective study was conducted for 8 cases of pectus excavatum treated with sternal suspension procedure after open repair of congenital heart disease from October 2005 to October 2018 in our institution,5 males and 3 females.The median age of patients was 5.75 years (range 3.75-12.33 years) and the median Haller index was 4.20 (range 3.60-5.19).All patients underwent cardiac ultrasound and chest CT scan to evaluate the severity retrosternal adhesions.Results All patients underwent the sternal suspension procedure successfully with a median operation time 55 min (range 30-230 min) and a median blood loss of 2 ml (range 2-120 ml).There was one patient suffered pneumothorax after operation.The patients were followed up for4 months to 13 years with an excellent and good outcome.Conclusion Sternal suspension technique is a safe and effective procedure for pectus excavatum.To improve the security and reduce the incidence of cardiac injury,sternal suspension technique is a promising alternative for pectus patients with severe adhesion after open repair of congenital heart disease.

Application of vacuum bell in the treatment of pectus excavatum / 中华胸心血管外科杂志

The treatment of pectus excavatum has always given priority to surgical treatment,the vacuum bellis used as aconservative treatment and auxiliary operationin the treatment of pectus excavatum at present.And its role in the treatment of pectus excavatum is gradually accepted by doctors at home and abroad.We also have more and more recognition and understanding about its application.In this paper,we review vacuum bell on the usage,indications and contraindications,side effects,using effects,intraoperative use,optimum age for use,correlation study of negative pressure and mechanics.

A control study of measuring thoracic cage indexes in 3-17 years old healthy children and children with pectus excavatum / 中华胸心血管外科杂志

Objective@#To provide data references for Nuss procedure biomechanics research, and to understand morphological pathological changes in children with pectus excavatum.@*Methods@#A retrospective study was conducted for 434 cases of pectus excavatum from January 2009 to December 2015 in our institution. The anterior rib width(RW), anterior intercostal space width(IS) and thickness of the rib in the middle(RT) on the right side of 3-7 ribs had been measured in each patient. The widths were compared between the IS of children with pectus excavatum and the bar which currently used in clinic. The measurement indexes were compared between healthy children and children with pectus excavatum.@*Results@#The IS of prepubertal children with pectus excavatum was less than the width of bar which currently used in clinic (12.7 mm). Children with pectus excavatum compared with healthy children, the IS from 4 to 6 and the 5th RW of children with pectus excavatum were less than healthy children (P<0.05), the 3rd and 4th RT were greater than healthy children (P<0.05).@*Conclusion@#The measured values will be useful for the improvement of pectus bar and Nuss procedure biomechanics research. By morphology contrast, it reflects the pectus excavatum deformity has some restriction in thoracic development and the cardiopulmonary function.

Sternal suspension technique in treatment of pectus excavatum after open repair of congenital heart disease / 中华胸心血管外科杂志

Objective@#To evaluate the efficacy of using sternal suspension technique in correcting pectus excavatum after open repair of congenital heart disease and improve the safety of this technique.@*Methods@#A retrospective study was conducted for 8 cases of pectus excavatum treated with sternal suspension procedure after open repair of congenital heart disease from October 2005 to October 2018 in our institution, 5 males and 3 females. The median age of patients was 5.75 years (range 3.75-12.33 years) and the median Haller index was 4.20(range 3.60-5.19). All patients underwent cardiac ultrasound and chest CT scan to evaluate the severity retrosternal adhesions.@*Results@#All patients underwent the sternal suspension procedure successfully with a median operation time 55 min (range 30-230 min) and a median blood loss of 2 ml (range 2-120 ml). There was one patient suffered pneumothorax after operation. The patients were followed up for 4 months to 13 years with an excellent and good outcome.@*Conclusion@#Sternal suspension technique is a safe and effective procedure for pectus excavatum. To improve the security and reduce the incidence of cardiac injury, sternal suspension technique is a promising alternative for pectus patients with severe adhesion after open repair of congenital heart disease.

Application of vacuum bell in the treatment of pectus excavatum / 中华胸心血管外科杂志

The treatment of pectus excavatum has always given priority to surgical treatment, the vacuum bellis used as aconservative treatment and auxiliary operationin the treatment of pectus excavatum at present. And its role in the treatment of pectus excavatum is gradually accepted by doctors at home and abroad. We also have more and more recognition and understanding about its application. In this paper, we review vacuum bell on the usage, indications and contraindications, side effects, using effects, intraoperative use, optimum age for use, correlation study of negative pressure and mechanics.

Clinical analysis of neuroblastoma with pulmonary or pleural involvement / 中华实用儿科临床杂志

Objective@#To analyze the clinical characteristics of children with neuroblastoma (NB) complica-ted with lung or pleural metastasis, further to explore the correlation between characteristics and short-term outcome of NB, so as to provide a basis for clinical diagnosis and treatment.@*Methods@#A retrospective analysis was performed concerning the age of onset, clinical features, treatment and outcome of 36 patients with NB who were admitted at Blood Tumor Center, Beijing Children′s Hospital of Capital Medical University from December 2007 to December 2017.The diagnostic criteria, therapeutic regimen and therapeutic efficacy criteria of the enrolled children were all based on the NB protocol of Beijing Children′s Hospital of Capital Medical University (BCH-NB-2007), the clinical stage was based on international clinical stage of neuroblastoma (INSS stage), and stratified treatment was conducted according to the BCH-NB risk grouping standard.The follow-up period lasted till October 31, 2018.@*Results@#(1)The common clinical features of grouped children: 36 patients were selected into the group, accounted for 5.99% (36/601 cases) in total hospitalized NB children, they were less than 10 years old, 10 cases under 18 months, and the median age was 29.5 months (9-105 months); 20 cases were male, and 16 cases were female; the primary tumor was located in the retroperitoneal site in 19 cases, accounting for 52.78%, 9 cases in adrenal site, accounting for 25.00%, and 8 cases in mediastinal site, accounting for 22.22%.Risk groups: 29 cases were in high-risk group, 6 cases were in medium-risk group and 1 case was in low-risk group.The main symptoms were of pain onset in 8 cases, fever in 6 cases, local mass in 6 cases, abdominal mass in 4 cases, mediastinal mass in 3 cases, paleness in 3 cases, subcutaneous nodules in 2 cases, abdominal distension in 2 cases, lower limb swelling in 1 case, and diarrhea in 1 case. Among them, 16 cases had respiratory system symptoms first, accounting for 44.4%.(2)Laboratory examination: there were 35 patients of neuron-specific enolase (NSE) ≥25 μg/L on the initial diagnosis, of which 11 cases were more than 370 μg/L, the value of serum lactate dehydrogenase (LDH) ≥717.5 U/L in 25 patients, accounting for 69.44%, and 10 cases were accompanied by N-myc gene amplification.(3)Imaging examination: on the first diagnosis, chest/abdomen CT showed 75.75%(24/33 cases) of pleural or lung involvement, PET-CT showed 81.8% (27/33 cases) of pleural or lung involvement, B-ultrasound showed 41.67%(5/12 cases) of pleural or lung involvement; 3 imaging examinations showed: 1 positive in 16 cases, 2 positive in 16 cases, and 3 positive in 4 cases.(4)Comparison of clinical features of pleural and pulmonary involvement: among the 30 children with pleural involvement, 6 cases had respiratory symptoms, 3 cases had respiratory symptoms on the 6 cases with pulmonary involvement only, and 4 cases with pleural and pulmonary involvement had no respiratory symptoms at first diagnosis.(5)Treatment and outcome: 2 cases died because of critical condition after diagnosis, 5 cases didn′t receive the law treatment, 29 cases accepted law stratification treatment, among them, 1 case in low risk group, INSS-Ⅳ, alleviate current (CR); 4 cases in the moderate group, INSS-Ⅳ, CR in 2 cases, partial response (PR) in 1 case, progress in 1 case, new tumor foci occurring after chemotherapy discontinuation for 13 months. Twenty-four cases were in the high-risk group, event occurred in 7 cases (29.17%) of them, 1 case had progression by postoperative evaluation, 4 cases of progression at 1.5, 2.0, 3.0 and 6.0 months after cessation of chemotherapy, and 2 cases had recurrence at 11 and 17 months after cessation of chemotherapy.Overall survival rate (OS) was 41.4% for all children analyzed by Kaplan-Merier, and 32.9% of them were predicted to have 3-year event-free survival.@*Conclusions@#Children with pulmonary or pleural metastasis of neuroblastoma have no specific respiratory symptoms.CT scan might be a useful method for diagnosing the group Ⅳ children with pulmonary or pleural metastasis of neuroblastoma.Moreover, there seemed to be no significant correlation between the N-myc gene expression and survival prognosis of these children.

Chest X-ray film evaluate the impact of Nuss procedure on chest wall / 中华胸心血管外科杂志

Objective To evaluate the thoracic status of patients with funnel chest by quantitative evaluation of chest Xray,and to explore the effect of Nuss surgery.Methods From October 2006 to February 2011,according to the inclusion criteria,there were 47 cases enrolled our group at last,then divided the cases into 3 groups,including pre-operative of Nuss procedure,recent post-bar removal and further post-bar removal.We measured data on chest radiography and statistical analysis,including the maximal distance of the outer boundary of each rib pairs (C,from the 1 st pair to the 9th),the distance between lung apex to the costophrenic angle (H) and the distance between the two costophrenic angles(W).Results All the 47 cases completed the Nuss procedure and Nuss bar removal safely and effectively.All the patients were followed up from 30 to 36 months,without recurrence or long-term complications.Three groups of thoracic data showed an increasing trend,recent post-bar removal and further post-bar removal compared with the same age normal children,the thoracic data of the Nuss bar position were shortened.With the prolongation of time after Nuss bar removal,thoracic data gradually approaching normal.Conclusion We can evaluate the level of pectus excavatum and effect of Nuss procedure through measuring the chest wall data.The chest wall of post-bar removal was significantly improvement compared to the cases of pre-Nuss procedure.There is some restrictions on the thoracic by the Nuss bar.we learn that the limitation of thoracic can be improve after some time.

Establishment and verification of pectus carinatum model by finite element methods / 中华胸心血管外科杂志

Objective To explore the establishment of 3D thoracic model by finite element methods,and study the mechanical mechanism of minimally invasive surgery for correcting the chest wall deformity,and provide personalized surgery solution in the future.Methods According to admission and exclusion criteria,we selected 10 cases of pectus carinatum that received chest CT scan.The finite element model of pectus carinatum was established and analyzed by Mimics,ABAQUS,etc.The validity of finite element method for chest wall was verified by comparing the sternal displacement between the simulated values and actual values with the same force.Results The 3D finite element model of pectus carinatum was successfully established and analyzed.The stress distribution of the 10 cases in the posterior ribs was mainly in the 1-6 ribs on both sides,mostly concentrated in the 4th to 6th ribs,and the stress was symmetrical on both sides.Statistical analysis showed that the displacement value of the sternum was correlated,and the validity of the model was verified.Conclusion Mimics,ABAQUS and other finite element modeling and analysis software can effectively establish the thoracic 3D finite element model and mechanical analysis,which can help the further development of personalized minimally invasive surgery for correcting chest wall deformities.

The diagnosis and treatment of congenital pulmonary airway malformation in children / 中华胸心血管外科杂志

Objective The purpose of the study is introducing the concept and classification of congenital pulmonary airway malformation(CPAM),and summarizing the clinical features,imaging,pathological features and treatment methods of congenital pulmonary airway malformation.Methods 283 cases were retrospectively analyzed from April 2012 to November 2017,which were treated by thoracic surgery,pathological diagnosis were isolated congenital pulmonary airway abnormalities except combination of other deformity surgery at the same time.we analyze the clinical data,surgical methods,operation and postoperative pathology classification.Results All the 283 cases were successfully performed without severe surgical complications and secondary thoracotomy.There were 167 males and 116 females,male∶ female =1.44∶1;Age:0.77-166 months,median age 20.67 months;The operation time was 25-220 min,median time was 75min,and the bleeding volume was 1-250 ml,and the median blood volume was 5 ml.Among them,80 patients underwent thoracotomy,203 cases of thoracoscopic surgery,19 cases were transferred.Postoperative pathology 57 cases of type 1,194 cases of type 2,5 cases of type 3,9 cases of type 4.Conclusion CCAM has been renamed as congenital pulmonary airway malformation (CPAM) and has been reclassified.CPAM can be detected by imaging examination,and the diagnosis is based on histopathological examination,and the prognosis is better after the complete surgical resection of lung lesions.Thoracoscopic minimally invasive surgery could make less surgical trauma,small and beautiful wound,which is suggested to be promoted widely.

Measurement of thoracic cage indexes with X-ray film in 3-17 years old healthy children / 中华胸心血管外科杂志

Objective By measuring the thoracic cage index with chest X-ray film in 3-17 years old healthy children,analyzing the bivariate correlations with age,to provide the reference data for evaluating and following up of chest wall deformity.Methods A retrospective study was conducted for 450 cases of health physical examination from May 2013 to March 2016 in our institution.The anterior intercostal space width(IS),the anterior rib width(RW),and thickness of the rib in the middle(RT) on the right side of 3-7 ribs have been measured in each patient.Statistical describing for each measurement index has been made,and Pearson correlation analysis was used to analyze the correlation between measurement values and ages.Results Each measurement index is strong positive correlated with age (0.6 ＜ r ＜ 0.8,P ＜ 0.05).Conclusion The anterior intercostal space width,the anterior rib width and the thickness of the ribs in the middle have a growing trend with age in children.It is indeed a useful way to measure thoracic cage data by using the chest X-ray film quantitative evaluation method.The measured values can be used as reference indexes.

Automatic diagnosis of pectus carinatum for children based on the improved Haller index / 生物医学工程学杂志

Pectus carinatum (PC) is one of the most common chest wall anomalies, which is characterized by the protrusion of the anterior chest wall including the sternum and adjacent costal cartilages. Mildly patients suffer from mental problems such as self-abasement, while severely suffering patients are disturbed by significant cardiopulmonary symptoms. The traditional Haller index, which is widely used clinically to evaluate the severity of PC, is deficient in diagnosis efficiency and classification. This paper presents an improved Haller index algorithm for PC: first, the contour of the patient chest in the axial computed tomography (CT) slice where the most convex thorax presents is extracted; and then a cubic B-spline curve is employed to fit the extracted contour followed by an eclipse fitting procedure; finally, the improved Haller index and the classification index are automatically calculated based on the analytic curves. The results of CT data analysis using 22 preoperative and postoperative patient CT datasets show that the proposed diagnostic index for PC can diagnose and classify PC patients correctly, which confirms the feasibility of the evaluation index. Furthermore, digital measurement techniques can be employed to improve the diagnostic efficiency of PC, achieving one small step towards the computer-aided intelligent diagnosis and treatment for pediatric chest wall malformations.

Clinical effects of Sini powder combing with enema in treatment of chronic nonspecific ulcerative colitis / 中国生化药物杂志

Objective To research clinical effects of Sini powder combing with enema in treatment of chronic nonspecific ulcerative colitis.Methods132 patients with chronic nonspecific ulcerative colitis treated in our hospital from January 2015 to October 2016 were randomly divided into two groups,with 66 cases in each group.The control group was treated with enema,and observation group was treated with Sini powder combing with enema to analyse effect of Sini powder.Results①The total effective rate was 93.94% in the observation group,higher than control group 75.76%(P<0.05).②After treatment,serum CRP,IL-8 and TNF-ɑ level of observation group were (14.92±3.04)mg/L、(0.52±0.05)μg/L、(18.65±3.18)ng/L,lower than control group(23.04±3.31)mg/L、(0.75±0.08)μg/L、(25.59±3.62)ng/L(all P<0.05).③ ESR and PLT level of observation group were(11.16±2.27)mm/h、(220.6±15.8)×10.9/L,lower than control group(15.93±2.58)mm/h、(258.3±18.9)×10.9/L(all P<0.05).④The adverse reaction rate was 15.15% in the observation group,and 21.22% in the control group, the difference was not statistically significant.⑤ The recurrence rate was 23.81% in the observation group,lower than control group 39.06%(P<0.05).ConclusionSini powder can improve the effect in treatment of chronic nonspecific ulcerative colitis and has higher security.