Clinical analysis of 4 acute ischemic stroke children treated with endovascular thrombectomy / 中华儿科杂志

Objective: To assess the feasibility of endovascular thrombectomy (EVT) for the treatment of acute ischemic stroke (AIS) in children. Methods: Clinical data and follow-up information of 4 AIS children who received EVT in the Department of Intervention & Hemangioma at the Children's Hospital of the Capital Institute of Pediatrics from December 2020 to June 2021 were collected retrospectively. The vascular recanalization after EVT was assessed by the modified thrombolysis in cerebral infarction (mTICI) score. Efficacy outcomes were assessed with initial and postprocedural Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score, and the modified Rankin scale (mRS) score at 3 and 6 months after treatment. Safety assessments included perioperative complications and intracranial hemorrhage post-treatment. Results: A total of 5 EVT treatment were performed on 4 children with AIS, of whom 3 were male. The age of onset was 4.6, 13.8, 7.8, 8.0, 8.9 years, respectively. The time from symptom onset to initiation of EVT was 19.0, 25.0, 22.0, 4.0, 16.5 hours, respectively and all patients achieved successful recanalization of the vessel after EVT (mTICI≥2b). The PedNIHSS score was 39, 14, 25, 39, 24 before treatment and decreased to 8, 1, 12, 39, 5 at discharge. All the procedures were performed with no perioperative complications. Only 1 patient with congenital heart disease had a recurrent AIS with malignant brain oedema and brain hernia. Although the occluded vessels were successfully recanalized,the symptoms were not improved and this patient died after treatment abandonment. The other 3 patients achieved good recovery at 6 months postoperatively. The mRS score of 3 patients was 3, 1, 2 at 3 months after EVT and decreased to 2, 1, 1 at 6 months. Conclusion: EVT treatment may be feasible and safe for pediatric AIS due to large vessel occlusion even when the treatment was initiated 6 hours post stroke, but children with heart disease may have a dismal prognosis.

Classification of the pectus excavatum and minimally invasive Nuss procedure / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the improvement of the Nuss procedure with the classification of the pectus excavatum by symmetry and extend the indication of the operation for a better outcome.</p><p><b>METHODS</b>The clinic data of 403 patients who underwent repair of pectus excavatum by Nuss technique and its modifications from July 2002 to September 2007 were reviewed retrospectively. There were 299 male patients and 104 female patients. The age ranged from 2 years and seven months old to 32 years old, with a mean of (8.0 +/- 5.1) years old. The entire group of the CT index ranged from 3.25 to 51.20, with a mean of (5.0 +/- 3.0). According to the morphology of the pectus and practically the bar shaping, Park's classification was simplified to symmetric type, eccentric type, and unbalanced type. The patients of symmetric type were all received original Nuss procedure, and the other two types underwent the procedure using characteristic bar shaping and technical modification.</p><p><b>RESULTS</b>Among the 403 patients, 257 patients (63.8%) were symmetric pectus excavatum, and 48 patients (11.9%) were eccentric, other 98 patients (24.3%) were unbalanced type. All the patients underwent the procedure successfully. The total time of the procedure ranged from 30 to 165 min, with a mean of (45.7 +/- 12.6) min. Volume of blood loss during the operation ranged from 1 to 80 ml, with a mean of (4.8 +/- 6.2) ml. The days of hospitalization ranged from 4 to 12 d, with a mean of (7.1 +/- 1.0) d. The duration of following up ranged from 1 month to 5 years, and the results of the repair were excellent in 391 patients (97.0%). Five patients received a further operation, including 1 patient of recurrent pectus excavatum caused by bar displacement, 4 patients of protruding side way. There were 23 patients of complications for an overall complication rate of 5.7%. And the other 18 patients of complications included 2 patients of pericardium perforation, 2 patients of bar displacements caused intercostal dilaceration, 2 patients of diaphragmatic muscle injuries, 1 patient of hemothorax, 8 patients of pneumothorax, 2 patients of intermittent pains for 2 months, 1 patient of scoliosis caused by persistent pain.</p><p><b>CONCLUSION</b>To classify the pectus excavatum with symmetry and to choose different ways of procedure can extend the indication of Nuss procedure and receive a better outcome.</p>