Prevention and treatment strategies for esophageal stenosis after thoracoscopy for type Ⅲ esophageal atresia北大核心CSCD

Objective To explore the roles of esophageal stenosis control strategies in children with esophageal atresia (EA). Methods Retrospective analysis was conducted for clinical data of 56 children with type Ⅲ EA undergoing thoracoscopy from January 2017 to December 2022.There were 30 boys and 26 girls.The clinical types were ⅢA (n=12) and ⅢB (n=11) in group A. Birth weight was (2573.26±112.77) gram and operative age (31.70±5.86) hours.Eight cases had concurrent congenital heart disease (CHD). And 33 patients received traditional postoperative observation (group B). The clinical types were ⅢA (n=18) and ⅢB (n=15) in group B. Birth weight was (2 598.79±94.88) gram and operative age (37.00±7.15) hour.Six cases had concurrent CHD.Preoperative profiles and postoperative recovery of two groups were compared along with differential efficacy between the prevention and treatment strategy after comparing EA and traditional management mode. Results No statistically significant inter-group differences existed in operative age (P=0.593), body weight (P=0.863) or proportion of CHD (P=0.438). One-stage surgery was performed for repairing tracheoesophageal fistula and esophageal reconstruction.Later they were cured and discharged with regular follow-ups.The incidence of postoperative anastomotic stenosis was 26.09%(6/23) in group A versus 60.61%(20/33) in group B. The inter-group difference was insignificant (P=0.125). There were 0 cases (0%) of anastomotic leakage in group A versus 3 cases in group B (9.09%)(P=0.001). Average dilation frequency was[(0.61±0.27) vs (2.00±0.41), P=0.014]and incidence of postoperative refractory stenosis[0(0%) vs 4(12.12%), P=0.001]. The differences were statistically significant. Conclusions Perioperative comprehensive management plays some roles in the prevention and treatment of esophageal stricture after EA thoracoscopy.The clinical outcomes are satisfactory. © 2023 Chinese Medical Journals Publishing House Co.Ltd.. All rights reserved.     

Association between early-life factors and pubertal timing in girls北大核心CSCD

Objective To study the association between early-life factors (including birth weight, method of birth, gestational age, and history of gestational metabolic disorders) and pubertal timing in girls. Methods The stratified cluster sampling method was used to select the girls in grades 2-3 and 7-8 from three primary schools and three middle schools in Guangzhou, China from March to December, 2019, and breast development was examined for all girls. A questionnaire survey was performed to collect the information on early-life factors. The multivariate logistic regression model was used to evaluate the association of gestational metabolic disorders, birth weight, method of birth, and gestational age with pubertal timing in girls. The Bootstrap method was used to assess the mediation effect of body mass index (BMI) (Z score) between high birth weight (≥4 000 g) and pubertal timing. Results A total of 1 665 girls were enrolled, among whom 280 (16.82%) were judged to have early pubertal timing. The multivariate logistic regression analysis showed that high birth weight was associated with the increased risk of early pubertal timing (OR=2.12, 95%CI: 1.19-3.66, P=0.008). Nevertheless, no significant association was observed between other early-life factors and pubertal timing (P>0.05). The OR for the mediation effect of BMI (Z score) between high birth weight and early pubertal timing was 1.25 (95%CI: 1.09-1.47), accounting for 29.33% of the total effect of high birth weight on early pubertal timing. Conclusions High birth weight is associated with the increased risk of early pubertal timing in girls, and overweight/obesity may play a partial mediating role in the association between high birth weight and early pubertal timing in girls. © 2023 Xiangya Hospital of CSU. All rights reserved.     

胆道闭锁Kasai术后早期并发症的分析

Objective The purpose of this study was to evaluate the relation between early complications of Kasai operation and high-dose steroids and antibiotics and to demonstrate the prognosis of biliary atresia(BA). Methods 281 patients diagnosed with biliary atresia(BA) type Ⅲ,admitted from Aug. 1994 to Aug 2008 were retrospectively reviewed and followed up for two years. The patients were divided into two groups. Patients in Group A were controls while patients in Group B were treated with high-dose steroids and antibiotics. We evaluated the relation between early complications and age at operation (days), baseline bilirubin, different treatments and 2 year survival. Results 93 patients had early complications,and cholangitis is the most common, There is no statistics difference of complications in age at operation and baseline bilirubin. The complication rate was 63. 6% in group A, and 25. 7% in group B(P＜0. 01). The cholangitis rate was 56. 4% in group A and 23. 9% in group B (P＜0. 01). Two groups showed no significant difference in digestive tract bleeding. The visit frequency rate was 92. 5%, while 2 year survival rate was 51. 2%. Patients with early complications or cholangitis have a 34. 4% or 32. 9% 2 year survival rate, while those without have a 59. 6% or 59. 2%(P＜ 0. 01). Patients with high-dose treatment in group B have a better 2 year survival rate (54. 0% vs 40. 0% ,P＜0. 05). Conclusions Early cholangitis was the risk factor of outcome after Kasai operation. These data implied that the use of high-dose steroids and antibiotics can lower the occurrence of cholangitis and elevate 2 year survival rate.     

Influencing factors for the development and severity of bronchopulmonary dysplasia in preterm infants with a gestational age of <32 weeks and a birth weight of <1 500 g北大核心CSCD

Objective To study the influencing factors for the development and severity of bronchopulmonary dysplasia (BPD) in preterm infants with a gestational age of <32 weeks and a birth weight of <1 500 g. Methods A retrospective analysis was performed on the medical data of preterm infants with a gestational age of <32 weeks and a birth weight of <1 500 g who were admitted to Women and Children's Hospital Affiliated to Xiamen University from January 1, 2017 to December 31, 2021. According to oxygen dependence on day 28 after birth, they were divided into two groups: BPD (n=218) and non-BPD (n=142). According to disease severity based on oxygen concentration required at the corrected age of 36 weeks or at discharge, the infants with BPD were divided into two groups: mild BPD (n=154) and moderate/severe BPD (n=64). Indices such as perinatal data and nutritional status were compared between groups. The multivariate logistic regression analysis was used to determine the influencing factors for BPD and its severity. Results The incidence rate and severity of BPD increased with the reduction in gestational age and birth weight (P<0.05). The multivariate logistic regression analysis showed that a long duration of invasive mechanical ventilation (OR=1.320, P <0.05), hemodynamically significant patent ductus arteriosus (OR=2.032, P<0.05), and a prolonged time to reach oral calorie goal of 110 kcal/(kg·d) (OR=1.041, P<0.05) were risk factors for BPD, while an older gestational age was a protective factor against BPD (OR=0.535, P<0.05). Early-onset sepsis (OR=2.524, P<0.05) and a prolonged time to reach oral calorie goal of 110 kcal/(kg·d) (OR=1.029, P<0.05) were risk factors for moderate/severe BPD, while a high mean weight growth velocity was a protective factor against moderate/severe BPD (OR=0.906, P<0.05). Conclusions The incidence rate and severity of BPD in preterm infants with a gestational age of <32 weeks and a birth weight of <1 500 g can be reduced by shortening the duration of invasive mechanical ventilation, giving early treatment of early-onset sepsis and hemodynamically significant patent ductus arteriosus, adopting active enteral nutritional strategies, and increasing mean weight growth velocity. © 2022 Xiangya Hospital of CSU. All rights reserved.     

完全性大动脉转位患儿外科术后早期并发症和近期随访

Objective To present the short-term outcomes of the patients with transposition of the great arteries after repair. Methods Between 2008 and 2009,71 patients with transposition of the great arteries (TGA) underwent corrective surgeries at this center. The 71 TGA patients were divided into TGA/IVS group whose ventricle septum was intact, and TGA/VSD group who complicated with ventricle septum defect. Their clinical data and postoperative short-term outcomes were analyzed and compared. Results The postoperative complications included 7 (9. 9% ) patients presented with low cardiac output syndrome, 12 ( 16. 9% ) with pulmonary stenosis, 21 ( 29. 6% ) with arrhythmia, 6 (8. 5%) with diaphragmatic paralysis, 6 (8. 5%) with airway abnormalities, and 13 ( 18. 3% ) with bacteria in sputum culture. Three patients (4. 2%) died after surgery. Fifty four out of the 68 patients were followed up for an average period of 12. 0 ± 7. 4 months. Four (7. 4%) patients died during follow-up. Three patients (5. 6%) underwent interventional therapies for pulmonary stenosis. The survival rate of 57 patients was 87. 7% at the end of the first postoperative year. No differences of the postoperative complications and survival rate were noted between the TGA/IVS and TGA/VSD group.Conclusions The postoperative short-term outcomes of the patients with transposition of the great arteries are good.     

极低出生体质量儿闪光视觉诱发电位检测的临床意义

Objective To study the clinical significance of flash visual evoked potential(FVEP)detection in very low birth weight infants.Methods FVEP was performed in group of 43 very low birth weight infants with Medelecsynergy evoked potential instrument(Oxford Company,UK) comparing with the group of 56 term infants.Results The mean latency periods of N1,P1 and N2 waves in very low birth weight infant group were(181.43±26.73) ms,(217.27±26.54) ms,(249.21±26.49) ms respectively,while in term infant group were(159.51±18.27) ms,(200.26±13.94) ms,(231.56±15.72) ms.There were significant differences between two groups(P＜0.05,P＜0,001).The abnormal rates of main wave P1 were 75.6% and 0 respectively in very low birth weight infant group and term infant group.Furthermore,the major effect model for related influencing factors in very low birth weight infants with abnormal main wave was 3.898-2.861 intracranial lesion.Intracranial lesion was the independent risk factor for abnormal FVEP (0R=0.057,95% CI 0.006～0.579,P=0.015).Conclusion The abnormal rate of FVEP is higher in the very low birth weight infants,which is closely related to the intraeranial lesion.It is recomraended that FVEP is detected at least twice in the first month after birth or achieving the corrected gestational age of 42 weeks for dynamic observation.     

极低出生体质量儿闪光视觉诱发电位检测的临床意义

Objective To study the clinical significance of flash visual evoked potential(FVEP)detection in very low birth weight infants.Methods FVEP was performed in group of 43 very low birth weight infants with Medelecsynergy evoked potential instrument(Oxford Company,UK) comparing with the group of 56 term infants.Results The mean latency periods of N1,P1 and N2 waves in very low birth weight infant group were(181.43±26.73) ms,(217.27±26.54) ms,(249.21±26.49) ms respectively,while in term infant group were(159.51±18.27) ms,(200.26±13.94) ms,(231.56±15.72) ms.There were significant differences between two groups(P＜0.05,P＜0,001).The abnormal rates of main wave P1 were 75.6% and 0 respectively in very low birth weight infant group and term infant group.Furthermore,the major effect model for related influencing factors in very low birth weight infants with abnormal main wave was 3.898-2.861 intracranial lesion.Intracranial lesion was the independent risk factor for abnormal FVEP (0R=0.057,95% CI 0.006～0.579,P=0.015).Conclusion The abnormal rate of FVEP is higher in the very low birth weight infants,which is closely related to the intraeranial lesion.It is recomraended that FVEP is detected at least twice in the first month after birth or achieving the corrected gestational age of 42 weeks for dynamic observation.     

极低出生体质量儿闪光视觉诱发电位检测的临床意义

Objective To study the clinical significance of flash visual evoked potential(FVEP)detection in very low birth weight infants.Methods FVEP was performed in group of 43 very low birth weight infants with Medelecsynergy evoked potential instrument(Oxford Company,UK) comparing with the group of 56 term infants.Results The mean latency periods of N1,P1 and N2 waves in very low birth weight infant group were(181.43±26.73) ms,(217.27±26.54) ms,(249.21±26.49) ms respectively,while in term infant group were(159.51±18.27) ms,(200.26±13.94) ms,(231.56±15.72) ms.There were significant differences between two groups(P＜0.05,P＜0,001).The abnormal rates of main wave P1 were 75.6% and 0 respectively in very low birth weight infant group and term infant group.Furthermore,the major effect model for related influencing factors in very low birth weight infants with abnormal main wave was 3.898-2.861 intracranial lesion.Intracranial lesion was the independent risk factor for abnormal FVEP (0R=0.057,95% CI 0.006～0.579,P=0.015).Conclusion The abnormal rate of FVEP is higher in the very low birth weight infants,which is closely related to the intraeranial lesion.It is recomraended that FVEP is detected at least twice in the first month after birth or achieving the corrected gestational age of 42 weeks for dynamic observation.     

极低出生体质量儿闪光视觉诱发电位检测的临床意义

Objective To study the clinical significance of flash visual evoked potential(FVEP)detection in very low birth weight infants.Methods FVEP was performed in group of 43 very low birth weight infants with Medelecsynergy evoked potential instrument(Oxford Company,UK) comparing with the group of 56 term infants.Results The mean latency periods of N1,P1 and N2 waves in very low birth weight infant group were(181.43±26.73) ms,(217.27±26.54) ms,(249.21±26.49) ms respectively,while in term infant group were(159.51±18.27) ms,(200.26±13.94) ms,(231.56±15.72) ms.There were significant differences between two groups(P＜0.05,P＜0,001).The abnormal rates of main wave P1 were 75.6% and 0 respectively in very low birth weight infant group and term infant group.Furthermore,the major effect model for related influencing factors in very low birth weight infants with abnormal main wave was 3.898-2.861 intracranial lesion.Intracranial lesion was the independent risk factor for abnormal FVEP (0R=0.057,95% CI 0.006～0.579,P=0.015).Conclusion The abnormal rate of FVEP is higher in the very low birth weight infants,which is closely related to the intraeranial lesion.It is recomraended that FVEP is detected at least twice in the first month after birth or achieving the corrected gestational age of 42 weeks for dynamic observation.     

极低出生体质量儿闪光视觉诱发电位检测的临床意义

Objective To study the clinical significance of flash visual evoked potential(FVEP)detection in very low birth weight infants.Methods FVEP was performed in group of 43 very low birth weight infants with Medelecsynergy evoked potential instrument(Oxford Company,UK) comparing with the group of 56 term infants.Results The mean latency periods of N1,P1 and N2 waves in very low birth weight infant group were(181.43±26.73) ms,(217.27±26.54) ms,(249.21±26.49) ms respectively,while in term infant group were(159.51±18.27) ms,(200.26±13.94) ms,(231.56±15.72) ms.There were significant differences between two groups(P＜0.05,P＜0,001).The abnormal rates of main wave P1 were 75.6% and 0 respectively in very low birth weight infant group and term infant group.Furthermore,the major effect model for related influencing factors in very low birth weight infants with abnormal main wave was 3.898-2.861 intracranial lesion.Intracranial lesion was the independent risk factor for abnormal FVEP (0R=0.057,95% CI 0.006～0.579,P=0.015).Conclusion The abnormal rate of FVEP is higher in the very low birth weight infants,which is closely related to the intraeranial lesion.It is recomraended that FVEP is detected at least twice in the first month after birth or achieving the corrected gestational age of 42 weeks for dynamic observation.     

Tri-iodine-thyronin (T3)-hyperthyreosis (author's transl)

Report on a girl aged 12 years and 2 months and a boy aged almost 14. The first always had normal T4- with always raised T3, belongs, therefore, to the entity T3-hyperthyreosis described by Hollander in 1968. The boy had clear clinical signs of hyperthyreosis, but was untreated for 14 months, because a nuclear medical institute had found T4 to be normal and did not investigate T3. One suspects that proper treatment would have been given, if T3 would have been examined early. Discussion of the entity: T3 hyperthyreosis and of the circumstances under which T3 may be found to be raised even in the absence of the disease.