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Factors associated with mortality in congenital malformations of the gastrointestinal tract in a tertiary center in Senegal. 在塞内加尔的一个三级中心胃肠道先天性畸形的死亡率相关因素。
IF 0.8 4区 医学 Q4 PEDIATRICS Pub Date : 2022-01-01 DOI: 10.1136/wjps-2022-000463
Florent Tshibwid A Zeng, Papa Alassane Mbaye, Doudou Gueye, Ndèye Fatou Seck, Ibrahima Bocar Wellé, Rosalie Niang, Youssouph Diedhiou, Mbaye Fall, Ndèye Aby Ndoye, Aloïse Sagna, Oumar Ndour, Gabriel Ngom

Objective: Patients with congenital malformations (CMs) of the gastrointestinal tract (GIT) have a very high mortality. However, the literature on the factors associated with mortality in these patients is scarce in sub-Saharan Africa. The aim of this study is to identify independent risk factors for mortality in patients with CMs of the GIT at our pediatric surgical department.

Methods: We conducted a retrospective analysis of cases with CMs of the GIT managed at a tertiary center from 2018 to 2021. Patients were subdivided into two groups based on the outcomes, and variables with a significant difference were analyzed by logistic regression.

Results: Our review included 226 patients, 63 of whom died (27.88%). Patient age ranged from 0 to 15 years. Taking into account statistical significance, mortality was more frequent in neonates than in older patients (57.30% vs 6.15%), in patients coming out of the Dakar area than in those from the Dakar area (43.75% vs 19.18%), in patients with abnormal prenatal ultrasound than in those with normal ultrasound (100% vs 26.67%), in premature children than in those born at term (78.57% vs 21.87%), in patients with an additional malformation than in those with an isolated malformation (69.23% vs 25.35%), and in those with intestinal, esophageal, duodenal and colonic atresia than in those with other diagnoses (100%, 89%, 56.25% and 50%, respectively). Referred patients died more than those who changed hospitals or came from home (55.29% vs 25% and 9.09%, respectively). On multivariable logistic regression, two independent factors of mortality were identified: presence of associated malformation [odds ratio (OR)=13.299; 95% Confidence interval (CI) 1.370 to 129.137] and diagnosis of esophageal atresia (OR=46.529; 95% CI 5.828 to 371.425).

Conclusion: The presence of an associated malformation or diagnosis of esophageal atresia increases mortality in patients with CMs of the GIT in our environment.

目的:胃肠道先天性畸形(CMs)患者的死亡率很高。然而,在撒哈拉以南非洲,关于这些患者死亡率相关因素的文献很少。本研究的目的是确定我们儿科外科GIT CMs患者死亡率的独立危险因素。方法:回顾性分析2018年至2021年在某三级中心管理的GIT CMs病例。根据结果将患者再分为两组,对差异显著的变量进行logistic回归分析。结果:纳入226例患者,其中63例死亡(27.88%)。患者年龄0 ~ 15岁。考虑到统计学意义,新生儿死亡率高于老年患者(57.30% vs 6.15%),达喀尔地区出生的患者死亡率高于达喀尔地区出生的患者死亡率(43.75% vs 19.18%),产前超声异常患者死亡率高于正常超声患者死亡率(100% vs 26.67%),早产儿死亡率高于足月新生儿死亡率(78.57% vs 21.87%)。附加畸形患者比孤立畸形患者(69.23% vs 25.35%),肠、食管、十二指肠和结肠闭锁患者比其他诊断的患者(分别为100%、89%、56.25%和50%)。转诊患者的死亡率高于转院或回家的患者(分别为55.29%比25%和9.09%)。在多变量logistic回归中,确定了两个独立的死亡因素:相关畸形的存在[优势比(OR)=13.299;95%可信区间(CI) 1.370 ~ 129.137)和食管闭锁的诊断(OR=46.529;95% CI 5.828 ~ 371.425)。结论:在我们的环境中,伴有相关畸形或诊断为食管闭锁的胃肠道CMs患者死亡率增高。
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引用次数: 2
Pattern of congenital anomalies among pediatric surgical patients in a tertiary care hospital in northern Tanzania. 坦桑尼亚北部一家三级医院儿科外科患者先天性异常的模式。
IF 0.8 4区 医学 Q4 PEDIATRICS Pub Date : 2022-01-01 DOI: 10.1136/wjps-2021-000410
Faraja Mussa Magwesela, Happiness Rabiel, Catherine Mlelwa Mung'ong'o

Background: Congenital anomalies are major causes of morbidity and mortality in children under 5 years of age and make a significant contribution to the surgical burden of diseases. Most anomalies have multifactorial causes and commonly affect the central nervous, cardiovascular, gastrointestinal and musculoskeletal systems. Countries with improved pediatric surgical care have shown dramatic reductions in morbidity and mortality rates. The aim of this study was to analyze the pattern of congenital anomalies presenting in our surgical departments in patients under 5 years of age.

Methods: A retrospective descriptive study was done. Data were obtained from clinical records of patients under 5 years of age, who underwent surgical correction of their congenital anomalies between 2017 and 2021. Analysis was done to identify the proportion of congenital anomalies managed in our setting.

Results: Congenital anomalies contributed 4.6% of overall surgical burden. Totally, 822 patients with congenital anomalies were included for analysis. The most commonly diagnosed congenital anomaly was inguinal hernia, followed by hydrocephalus, neural tube defects and cleft lips. The most commonly affected system was the central nervous system, anterior abdominal wall, orofacial and digestive system in decreasing order of frequency. Most of our patients presented outside the neonatal period (84.4%), and few (16.1%) had more than one system affected. Male children comprised 64%.

Conclusions: Delayed presentation of children with congenital anomalies is still a significant problem in our area. Prevention through nutritional supplementation and antenatal screening is crucial. The true epidemiology of congenital anomalies in northern Tanzania is still obscure.

背景:先天性畸形是5岁以下儿童发病和死亡的主要原因,也是造成外科疾病负担的重要因素。大多数异常有多因素的原因,通常影响中枢神经,心血管,胃肠道和肌肉骨骼系统。在儿科外科护理得到改善的国家,发病率和死亡率显著降低。本研究的目的是分析在我们的外科部门出现的5岁以下患者的先天性异常的模式。方法:回顾性描述性研究。数据来自于2017年至2021年间接受先天性畸形手术矫正的5岁以下患者的临床记录。我们进行了分析,以确定在我们的设置管理先天性异常的比例。结果:先天性异常占总手术负担的4.6%。共纳入822例先天性畸形患者进行分析。最常见的先天性异常是腹股沟疝,其次是脑积水、神经管缺损和唇裂。最常见的受累系统依次为中枢神经系统、前腹壁、口面和消化系统。大多数患者出现在新生儿期(84.4%)之外,少数患者(16.1%)不止一个系统受到影响。男孩占64%。结论:先天性畸形患儿的延迟出现在我们地区仍然是一个严重的问题。通过营养补充和产前筛查进行预防至关重要。在坦桑尼亚北部,先天性畸形的真正流行病学仍然模糊不清。
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引用次数: 3
Expression and possible role of Smad3 in postnecrotizing enterocolitis stricture. Smad3在坏死性小肠结肠炎狭窄中的表达及其可能的作用。
IF 0.8 4区 医学 Q4 PEDIATRICS Pub Date : 2022-01-01 DOI: 10.1136/wjps-2021-000289
Rui Chen, Chengjie Lv, Xiaoxia Zhao, Dong Ma, Dengming Lai, Yun Zhao, Luyin Zhang, Jinfa Tou

Objective: To investigate the expression of Smad3 (mothers against decapentaplegic homolog 3) protein in postnecrotizing enterocolitis stricture and its possible mechanism of action.

Methods: We used immunohistochemistry to detect the expression characteristics of Smad3 and nuclear factor kappa B (NF-κB) proteins in human postnecrotizing enterocolitis stricture. We cultured IEC-6 (crypt epithelial cells of rat small intestine) in vitro and inhibited the expression of Smad3 using siRNA technique. Quantitative PCR, western blotting, and ELISA were used to detect the changes in transforming growth factor-β1 (TGF-β1), NF-κB, tumor necrosis factor-α (TNF-α), vascular endothelial growth factor (VEGF), and zonula occludens-1 (ZO-1) messenger RNA (mRNA) and protein expressions in IEC-6 cells. CCK8 kit and Transwell cellular migration were used to detect cell proliferation and migration. Changes in epithelial-mesenchymal transition (EMT) markers (E-cadherin and vimentin) in IEC-6 cells were detected by immunofluorescence technique.

Results: The results showed that Smad3 protein and NF-κB protein were overexpressed in narrow intestinal tissues and that Smad3 protein expression was positively correlated with NF-κB protein expression. After inhibiting the expression of Smad3 in IEC-6 cells, the mRNA expressions of NF-κB, TGF-β1, ZO-1, and VEGF decreased, whereas the mRNA expression of TNF-α did not significantly change. TGF-β1, NF-κB, and TNF-α protein expressions in IEC-6 cells decreased, whereas ZO-1 and intracellular VEGF protein expressions increased. IEC-6 cell proliferation and migration capacity decreased. There was no significant change in protein expression levels of EMT markers E-cadherin and vimentin and also extracellular VEGF protein expression.

Conclusions: We suspect that the high expression of Smad3 protein in postnecrotizing enterocolitis stricture may promote the occurrence and development of secondary intestinal stenosis. The mechanism may be related to the regulation of TGF-β1, NF-κB, TNF-α, ZO-1, and VEGF mRNA and protein expression. This may also be related to the ability of Smad3 to promote epithelial cell proliferation and migration.

目的:探讨坏死性小肠结肠炎狭窄组织中Smad3蛋白的表达及其可能的作用机制。方法:采用免疫组化方法检测Smad3和核因子κB (NF-κB)蛋白在人坏死性小肠结肠炎狭窄组织中的表达特征。体外培养大鼠小肠隐窝上皮细胞IEC-6,利用siRNA技术抑制Smad3的表达。采用定量PCR、western blotting、ELISA检测IEC-6细胞中转化生长因子-β1 (TGF-β1)、NF-κB、肿瘤坏死因子-α (TNF-α)、血管内皮生长因子(VEGF)、闭塞带-1 (ZO-1)信使RNA (mRNA)及蛋白表达的变化。CCK8试剂盒和Transwell细胞迁移检测细胞增殖和迁移。免疫荧光法检测IEC-6细胞上皮间质转化(epithelial-mesenchymal transition, EMT)标志物E-cadherin和vimentin的变化。结果:结果显示Smad3蛋白和NF-κB蛋白在狭窄肠组织中过表达,且Smad3蛋白表达与NF-κB蛋白表达呈正相关。抑制Smad3在IEC-6细胞中的表达后,NF-κB、TGF-β1、ZO-1、VEGF mRNA表达量下降,TNF-α mRNA表达量无明显变化。TGF-β1、NF-κB、TNF-α蛋白在IEC-6细胞中的表达降低,ZO-1、细胞内VEGF蛋白表达升高。IEC-6细胞增殖和迁移能力下降。EMT标志物E-cadherin和vimentin蛋白表达水平及细胞外VEGF蛋白表达无显著变化。结论:我们推测Smad3蛋白在坏死性小肠结肠炎狭窄中的高表达可能促进继发性肠狭窄的发生和发展。其机制可能与调节TGF-β1、NF-κB、TNF-α、ZO-1、VEGF mRNA及蛋白表达有关。这也可能与Smad3促进上皮细胞增殖和迁移的能力有关。
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引用次数: 0
Addressing barriers to evidence-based medicine in pediatric surgery: an introduction to the Canadian Association of Paediatric Surgeons Evidence-Based Resource. 解决儿科外科循证医学障碍:加拿大儿科外科医生循证资源协会简介。
IF 0.8 4区 医学 Q4 PEDIATRICS Pub Date : 2022-01-01 DOI: 10.1136/wjps-2021-000332
Viviane Grandpierre, Irina Oltean, Manvinder Kaur, Ahmed Nasr

Background: Pediatric surgical practice lags behind medicine in presence and use of evidence, primarily due to time constraints of using existing tools that are not specific to pediatric surgery, lack of sufficient patient data and unstructured pediatric surgery training methods.

Method: We developed, disseminated and tested the effectiveness of an evidence-based resource for pediatric surgeons and researchers that provides brief, informative summaries of quality-assessed systematic reviews and meta-analyses on conflicting pediatric surgery topics.

Results: Responses of 91 actively practicing surgeons who used the resource were analysed. The majority of participants found the resource useful (75%), improved their patient care (66.6%), and more than half (54.2%) found it useful in identifying research gaps. Almost all participants reported that the resource could be used as a teaching tool (93%).

Conclusion: Lack of awareness of the resource is the primary barrier to its routine use, leading to potential calls for more active dissemination worldwide. Users of the Canadian Association of Paediatric Surgeons Evidence-Based Resource find that the summaries are useful, identify research gaps, help mitigate multiple barriers to evidence-based medicine, and may improve patient care.

背景:儿科外科实践在证据的存在和使用方面落后于医学,主要是由于使用现有非儿科外科专用工具的时间限制,缺乏足够的患者数据和非结构化的儿科外科培训方法。方法:我们为儿科外科医生和研究人员开发、传播并测试了一个循证资源的有效性,该资源提供了关于冲突儿科外科主题的质量评估系统综述和荟萃分析的简短、信息丰富的摘要。结果:对91名积极执业的外科医生的反馈进行了分析。大多数参与者认为资源有用(75%),改善了他们的病人护理(66.6%),超过一半(54.2%)的人认为它有助于确定研究差距。几乎所有的参与者(93%)都表示该资源可以用作教学工具。结论:缺乏对该资源的认识是其常规使用的主要障碍,因此可能需要在全球范围内进行更积极的传播。加拿大儿科外科医生协会循证资源的用户发现总结是有用的,确定了研究差距,有助于减轻循证医学的多重障碍,并可能改善患者护理。
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引用次数: 2
Prognostic factors in children with acute fulminant myocarditis receiving venoarterial extracorporeal membrane oxygenation. 急性暴发性心肌炎患儿接受静脉体外膜氧合的预后因素。
IF 0.8 4区 医学 Q4 PEDIATRICS Pub Date : 2022-01-01 DOI: 10.1136/wjps-2021-000271
Mingwei Sun, Qing Zong, Li Fen Ye, Yong Fan, Lijun Yang, Ru Lin

Background: Pediatric acute fulminant myocarditis (AFM) is a very dangerous disease that may lead to acute heart failure or even sudden death. Previous reports have identified some prognostic factors in adult AFM; however, there is no such research on children with AFM on venoarterial extracorporeal membrane oxygenation (VA-ECMO). This study aimed to find relevant prognostic factors for predicting adverse clinical outcomes.

Methods: A retrospective analysis was performed in an affiliated university children's hospital with consecutive patients receiving VA-ECMO for AFM from July 2010 to November 2020. These children were classified into a survivor group (n=33) and a non-survivor group (n=8). Patient demographics, clinical events, laboratory findings, and electrocardiographic and echocardiographic parameters were analyzed.

Results: Peak serum creatinine (SCr) and peak creatine kinase isoenzyme MB during ECMO had joint predictive value for in-hospital mortality (p=0.011, AUC=0.962). Based on multivariable logistic regression analysis, peak SCr level during ECMO support was an independent predictor of in-hospital mortality (OR=1.035, 95% CI 1.006 to 1.064, p=0.017, AUC=0.936, with optimal cut-off value of 78 μmol/L).

Conclusion: Tissue hypoperfusion and consequent end-organ damage ultimately hampered the outcomes. The need for left atrial decompression indicated a sicker patient on ECMO and introduced additional risk for complications. Earlier and more cautious deployment would likely be associated with decreased risk of complications and mortality.

背景:小儿急性暴发性心肌炎(AFM)是一种非常危险的疾病,可导致急性心力衰竭甚至猝死。以前的报告已经确定了成人AFM的一些预后因素;然而,对AFM患儿进行静脉动脉体外膜氧合(VA-ECMO)的研究尚未见。本研究旨在寻找预测不良临床结果的相关预后因素。方法:回顾性分析2010年7月至2020年11月在某附属大学儿童医院连续接受VA-ECMO治疗AFM的患者。这些儿童被分为幸存者组(n=33)和非幸存者组(n=8)。分析患者人口统计学、临床事件、实验室结果、心电图和超声心动图参数。结果:ECMO时血清肌酐(SCr)峰值和肌酸激酶同工酶(MB)峰值对院内死亡率具有联合预测价值(p=0.011, AUC=0.962)。多变量logistic回归分析显示,ECMO支持期间SCr峰值水平是院内死亡率的独立预测因子(OR=1.035, 95% CI 1.006 ~ 1.064, p=0.017, AUC=0.936,最佳临界值为78 μmol/L)。结论:组织灌注不足和由此引起的终末器官损伤最终影响了预后。左心房减压的需要表明患者在ECMO上病情较重,并引入了并发症的额外风险。更早和更谨慎的部署可能会降低并发症和死亡率的风险。
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引用次数: 2
Ten cases of intradiaphragmatic extralobar pulmonary sequestration: a single-center experience. 术中肺叶外肺隔离10例:单中心经验。
IF 0.8 4区 医学 Q4 PEDIATRICS Pub Date : 2022-01-01 DOI: 10.1136/wjps-2021-000334
Yue Gao, Xu Han, Jie Jin, Zheng Tan

Background: Intradiaphragmatic extralobar pulmonary sequestration (IDEPS) is a rare type of pulmonary sequestration (PS). The purpose of this study is to assess diagnosis and operative treatment of IDEPS.

Methods: Patients with PS who were diagnosed and treated in our center from January 2015 to December 2020 were analyzed retrospectively to identify patients with IDEPS.

Results: Totally, 215 patients with PS were treated surgically, including 10 cases with IDEPS. Prenatal ultrasounds and postnatal-enhanced CT showed the presence of IDEPS in four cases and in seven cases, respectively. The three-dimensional (3D) reconstruction software was performed perfectly to identify the location of the lesions in 10 cases. The surgeries were performed smoothly by laparoscopic surgery in one case, video-assisted thoracic surgery (VATS) in five cases and Da Vinci robot-assisted thoracoscopic surgery (DVRATS) in four cases. In the VATS group, the average operative duration, intraoperative blood loss volume, length of stay after operation, and postoperative thoracic catheter indwelling duration were 48 min, 3.8 mL, 6.4 days and 2.2 days, respectively. That of the DVRATS group were 80 min, 3.5 mL, 4.3 days and 1.5 days, respectively. No side effects had appeared.

Conclusions: The 3D reconstruction software was proven to be capable in assisting the assessment of IDEPS. We suggested early surgery to treat IDEPS, and the best path was accessing the mass from the chest. Both DVRATS and VATS for the treatment of an IDEPS are safe, feasible, and effective. Furthermore, DVRATS provides a 3D magnified view, more flexibility and precision.

背景:肺隔离(IDEPS)是一种罕见的肺隔离类型。本研究的目的是评估IDEPS的诊断和手术治疗。方法:回顾性分析2015年1月至2020年12月在我中心诊断和治疗的PS患者,以确定IDEPS患者。结果:215例PS患者接受手术治疗,其中10例为IDEPS。产前超声和产后增强CT分别显示4例和7例存在IDEPS。应用三维重建软件对10例病灶进行了准确定位。腹腔镜手术1例,视频辅助胸腔镜手术(VATS) 5例,达芬奇机器人辅助胸腔镜手术(DVRATS) 4例,手术顺利进行。VATS组平均手术时间48 min,术中出血量3.8 mL,术后住院时间6.4天,术后胸导管留置时间2.2天。DVRATS组分别为80 min、3.5 mL、4.3 d和1.5 d。没有出现任何副作用。结论:三维重建软件能够帮助评估IDEPS。我们建议早期手术治疗IDEPS,最佳途径是从胸部进入肿块。dvrat和VATS治疗IDEPS都是安全、可行和有效的。此外,DVRATS提供3D放大视图,更加灵活和精确。
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引用次数: 1
High platelet distribution width can independently predict testicular survival in testicular torsion among patients with steady-state sickle cell anemia. 高血小板分布宽度可以独立预测稳态镰状细胞性贫血患者睾丸扭转患者的睾丸存活。
IF 0.8 4区 医学 Q4 PEDIATRICS Pub Date : 2022-01-01 DOI: 10.1136/wjps-2021-000358
Essa A Adawi, Mazen Ahmed Ghanem, Ahmed Mazen Ghanem, Manal A Safan, Mohamed G Elsayed, Mohammed A Aqeel

Objective: This study aimed to evaluate the predictive value of platelet volume indices (PVI), such as mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT), as prognostic indicators of testicular viability in torsion patients with steady-state sickle cell anemia (SCA) who underwent surgical exploration.

Methods: Forty-eight patients with SCA with testicular torsion and 46 male control subjects were enrolled in the study. All patients underwent scrotal color Doppler ultrasonography before surgery, and PVI (MPV, PDW, and PCT) values were measured in all participants. Symptom duration and testicular volume were also recorded.

Results: The testicular salvage rate in patients with SCA was 73% after surgery. Analyses showed that MPV, PDW, and PCT values were significantly higher in torsed SCA as compared with controls (p<0.05). Orchiectomy in patients with SCA showed significantly higher MPV, PDW, and PCT values than the orchiopexy group (p<0.05). The MPV values of orchiectomy patients showed a higher significant cut-off of ≥11.5 fL, which is higher than in torsed patients without SCA, as an indicator of testis survival. PDW also demonstrated a higher significant cut-off of ≥12.7 fL for detorsion outcomes in patients with SCA. Symptom duration of less than 7 hours was also significantly correlated with orchiopexy (p≤0.001). Univariate analysis showed that higher MPV, increased PDW, and symptom duration were indicative of the outcome of testicular detorsion in SCA. Multivariable analysis showed that increased PDW and symptom duration are prognostic parameters for testicular viability in SCA.

Conclusion: Increased PDW and symptom duration can be used as parameters for predicting testicular detorsion outcomes in patients with steady-state SCA.

目的:本研究旨在评价血小板体积指数(PVI)如平均血小板体积(MPV)、血小板分布宽度(PDW)、血小板电积(PCT)作为手术探查扭转型稳态镰状细胞性贫血(SCA)患者睾丸活力的预后指标的预测价值。方法:选取48例SCA合并睾丸扭转患者和46例男性对照。所有患者术前均行阴囊彩色多普勒超声检查,测量所有患者的PVI (MPV、PDW和PCT)值。同时记录症状持续时间和睾丸体积。结果:SCA患者术后睾丸保留率为73%。分析显示,与对照组相比,扭曲型SCA患者的MPV、PDW和PCT值显著高于对照组(结论:PDW升高和症状持续时间可作为预测稳态SCA患者睾丸扭曲结局的参数。
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引用次数: 1
Postoperative apnea after pyloromyotomy for infantile hypertrophic pyloric stenosis. 婴儿肥厚性幽门狭窄幽门肌切开术后呼吸暂停。
IF 0.8 4区 医学 Q4 PEDIATRICS Pub Date : 2022-01-01 DOI: 10.1136/wjps-2021-000391
Anna Camporesi, Veronica Diotto, Elena Zoia, Simone Rotta, Federica Tarantino, Laura Maria Giuditta Eccher, Valeria Calcaterra, Gloria Pelizzo, Marco Gemma

Objective: Infantile hypertrophic pyloric stenosis (IHPS), which causes gastric outlet obstruction and hypochloremic hypokalemic metabolic alkalosis, could pose a risk of postoperative apnea in patients. The aim of this study is to evaluate the incidence of postoperative apnea in babies admitted to a tertiary-level pediatric surgical center in Milano, Italy with diagnosis of IHPS in 2010-2019. The secondary objective is to evaluate the risk factors for postoperative apnea.

Methods: This is a single-center, retrospective, observational cohort study. All patients admitted to our institution with diagnosis of IHPS during the study period were enrolled. Demographic and surgical variables, along with blood gas parameters, were obtained from the population. Postoperative apnea was defined as a respiratory pause longer than 15 s or a respiratory pause lasting less than 15 s, but associated with either bradycardia (heart rate <120 per minute), desaturation (SatO2 <90%), cyanosis, or hypotonia. Occurrence was obtained from nursing charts and was recorded as a no/yes dichotomous variable.

Results: Of 122 patients, 12 (9.84%) experienced apnea and 110 (90.16%) did not. Using univariate analysis, we found that only postoperative hemoglobin was significantly different between the groups (p=0.03). No significant multivariable model was better than this univariate model for prediction of apnea.

Conclusions: Postoperative anemia, possibly due to hemodilution, increased the risk of postoperative apnea. It could be hypothesized that anemia can be added as another apnea-contributing factor in a population at risk due to metabolic changes.

目的:婴儿肥厚性幽门狭窄(IHPS)可引起胃出口梗阻和低氯血症性低钾血症代谢性碱中毒,可能对患者术后呼吸暂停造成危险。本研究的目的是评估2010-2019年意大利米兰一家三级儿科外科中心诊断为IHPS的婴儿术后呼吸暂停的发生率。次要目的是评估术后呼吸暂停的危险因素。方法:这是一项单中心、回顾性、观察性队列研究。所有在研究期间被诊断为IHPS的患者入组。从人群中获得人口统计学和外科变量以及血气参数。术后呼吸暂停定义为呼吸暂停时间大于15秒或呼吸暂停时间小于15秒,但与心动过缓(心率2)相关。结果:122例患者中,12例(9.84%)出现呼吸暂停,110例(90.16%)未出现呼吸暂停。通过单因素分析,我们发现两组之间只有术后血红蛋白有显著差异(p=0.03)。在预测呼吸暂停方面,没有显著的多变量模型优于单变量模型。结论:术后贫血,可能是由于血液稀释,增加了术后呼吸暂停的风险。可以假设,由于代谢变化,贫血可以作为另一个导致呼吸暂停的因素添加到高危人群中。
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引用次数: 0
Distribution of multiple chalazia in eyelids of pediatrics requiring surgery in southeast China: a hospital-based cross-sectional study. 中国东南地区需要外科手术的儿科眼睑多发白斑分布:一项基于医院的横断面研究。
IF 0.8 4区 医学 Q4 PEDIATRICS Pub Date : 2022-01-01 DOI: 10.1136/wjps-2021-000408
Xiao-Yu Zheng, Robert M Dorazio, Bonnie Nga Kwan Choy, Ting-Yan Wang, Su-Juan Zhao, Zheng-Yan Zhao

Background: Multiple chalazia are common in children, and many are treated by surgery. However, the distribution of different types of multiple chalazia has not been studied. This research aimed to investigate the location and number of multiple chalazia in pediatrics who need surgical treatments.

Methods: Patients with multiple chalazia treated by incision and curettage surgery (I&C) in a tertiary children's hospital between June and December 2016 were reviewed. Demographic data, locations, and numbers of chalazia were recorded. Data were analyzed using generalized linear models of the counts and the occurrences of chalazia. Hypotheses were tested using likelihood ratio tests appropriate for each type of data.

Results: The study included 128 subjects, most of which were 1-3 years old. The majority of patients had bilateral chalazia (95.3%), and the proportions of patients with internal, external, and marginal chalazion differed dramatically (99.2%, 61.7%, and 2.3%, respectively). The number of internal and external chalazia did not vary significantly with gender, age, or residence of the patients. Internal chalazia were located more frequently in the upper lids (p<0.001). External chalazia showed no preference of localization. The average number of internal chalazia in each eyelid did not relate to the presence of external chalazia.

Conclusions: Multiple chalazia are common among younger children in southeast China. The anatomical distribution varies depending on the type of chalazion. Multiple chalazia often occur bilaterally and internally. If doctors are more aware of the anatomical distribution of chalazia, this might result in a higher success rate of I&C.

背景:儿童多发查拉兹病很常见,多数通过手术治疗。然而,不同类型的多重裂裂菌的分布尚未得到研究。本研究旨在探讨儿科中需要手术治疗的多重查拉兹病的位置和数量。方法:回顾性分析2016年6月至12月在某三级儿童医院行切口刮除手术(I&C)治疗的多发吸尘病患者。记录了chalazia的人口统计数据、地点和数量。数据分析采用广义线性模型的计数和chalazia的发生。使用适合每种类型数据的似然比检验来检验假设。结果:共纳入受试者128人,其中以1 ~ 3岁儿童居多。大多数患者为双侧瞪眼(95.3%),内、外、边缘瞪眼的患者比例差异显著(分别为99.2%、61.7%和2.3%)。内部和外部chalazia的数量与患者的性别、年龄和居住地没有显著差异。结论:中国东南地区低龄儿童多发合眼。其解剖分布因其类型而异。多重合欢症常发生在两侧和内部。如果医生对合点的解剖分布有更多的了解,这可能会提高I&C的成功率。
{"title":"Distribution of multiple chalazia in eyelids of pediatrics requiring surgery in southeast China: a hospital-based cross-sectional study.","authors":"Xiao-Yu Zheng,&nbsp;Robert M Dorazio,&nbsp;Bonnie Nga Kwan Choy,&nbsp;Ting-Yan Wang,&nbsp;Su-Juan Zhao,&nbsp;Zheng-Yan Zhao","doi":"10.1136/wjps-2021-000408","DOIUrl":"https://doi.org/10.1136/wjps-2021-000408","url":null,"abstract":"<p><strong>Background: </strong>Multiple chalazia are common in children, and many are treated by surgery. However, the distribution of different types of multiple chalazia has not been studied. This research aimed to investigate the location and number of multiple chalazia in pediatrics who need surgical treatments.</p><p><strong>Methods: </strong>Patients with multiple chalazia treated by incision and curettage surgery (I&C) in a tertiary children's hospital between June and December 2016 were reviewed. Demographic data, locations, and numbers of chalazia were recorded. Data were analyzed using generalized linear models of the counts and the occurrences of chalazia. Hypotheses were tested using likelihood ratio tests appropriate for each type of data.</p><p><strong>Results: </strong>The study included 128 subjects, most of which were 1-3 years old. The majority of patients had bilateral chalazia (95.3%), and the proportions of patients with internal, external, and marginal chalazion differed dramatically (99.2%, 61.7%, and 2.3%, respectively). The number of internal and external chalazia did not vary significantly with gender, age, or residence of the patients. Internal chalazia were located more frequently in the upper lids (p<0.001). External chalazia showed no preference of localization. The average number of internal chalazia in each eyelid did not relate to the presence of external chalazia.</p><p><strong>Conclusions: </strong>Multiple chalazia are common among younger children in southeast China. The anatomical distribution varies depending on the type of chalazion. Multiple chalazia often occur bilaterally and internally. If doctors are more aware of the anatomical distribution of chalazia, this might result in a higher success rate of I&C.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"5 3","pages":"e000408"},"PeriodicalIF":0.8,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2d/7b/wjps-2021-000408.PMC9648573.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10370048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Analysis and comparison of failure causes of minimally invasive surgical closure of ventricular septal defects in children. 小儿室间隔缺损微创手术闭合失败原因分析与比较。
IF 0.8 4区 医学 Q4 PEDIATRICS Pub Date : 2022-01-01 DOI: 10.1136/wjps-2022-000432
Jin Yu, Zhuo Shi, Jingjing Qian, Lianglong Ma, Baofu Zhang, Liyang Ying, Qiang Shu

Objectives: The aims of the present study were to explore the causes of minimally invasive surgical ventricular septal defect (VSD) closure failure under transesophageal echocardiography guidance and thus to improve the success rate of surgical VSD closure.

Methods: From January 2015 to December 2019, 522 children with VSD underwent minimally invasive surgical closure. Nineteen procedures (3.64%) were unsuccessful. The failure causes, VSD locations and surgical incision approaches were retrospectively analyzed.

Results: Among the 19 patients (3.64%) with unsuccessful outcomes, 18 were switched to cardiopulmonary bypass (CPB) surgery, and 1 was closed successfully using an occlusion device a year later. The causes of failure included occlusion device shedding or shifting (n=6), failure of the guidewire (or the sheath) to pass through a small defect (n=5), device-related valve regurgitation (n=4), significant residual shunt (n=2), ventricular fibrillation (n=1), and continuous sharp blood pressure decreases (n=1). Patients with high VSD had a slightly higher failure rate than those with perimembranous VSD (p=0.049), and its key reason is the high proportion of occlusion device shedding or shifting (p=0.001). No significant difference in the failure rate was found between patients with different surgical incision approaches.

Conclusions: Minimally invasive surgery has a high success rate for perimembranous VSDs. Occlusion device shedding or shifting is the most common cause of failure. The shedding or shifting risk of eccentric occlusion devices being used only for high VSDs is much greater than that of concentric occlusion devices being used for perimembranous VSDs, which increases the risk of conversion to CPB surgery for high VSDs.

目的:探讨经食管超声心动图引导下微创室间隔缺损(ventricular septal缺损,VSD)手术关闭失败的原因,提高手术关闭VSD的成功率。方法:2015年1月至2019年12月,522例室间隔缺损患儿行微创手术缝合。19例(3.64%)手术不成功。回顾性分析手术失败原因、VSD部位及手术切口入路。结果:19例(3.64%)预后不成功的患者中,18例转行体外循环(CPB)手术,1年后使用闭塞装置成功关闭1例。失败的原因包括闭塞装置脱落或移位(n=6),导丝(或鞘)未能通过小缺陷(n=5),装置相关瓣膜返流(n=4),明显残留分流(n=2),心室颤动(n=1)和持续急剧血压下降(n=1)。高VSD患者的失败率略高于膜周VSD患者(p=0.049),其关键原因是闭塞器脱落或移位比例高(p=0.001)。不同手术切口入路患者的手术失败率无明显差异。结论:微创手术治疗膜周室间隔缺损成功率高。闭塞装置脱落或移位是最常见的失败原因。仅用于高位VSDs的偏心闭塞装置的脱落或移位风险远大于用于膜周VSDs的同心闭塞装置,这增加了高位VSDs转为CPB手术的风险。
{"title":"Analysis and comparison of failure causes of minimally invasive surgical closure of ventricular septal defects in children.","authors":"Jin Yu,&nbsp;Zhuo Shi,&nbsp;Jingjing Qian,&nbsp;Lianglong Ma,&nbsp;Baofu Zhang,&nbsp;Liyang Ying,&nbsp;Qiang Shu","doi":"10.1136/wjps-2022-000432","DOIUrl":"https://doi.org/10.1136/wjps-2022-000432","url":null,"abstract":"<p><strong>Objectives: </strong>The aims of the present study were to explore the causes of minimally invasive surgical ventricular septal defect (VSD) closure failure under transesophageal echocardiography guidance and thus to improve the success rate of surgical VSD closure.</p><p><strong>Methods: </strong>From January 2015 to December 2019, 522 children with VSD underwent minimally invasive surgical closure. Nineteen procedures (3.64%) were unsuccessful. The failure causes, VSD locations and surgical incision approaches were retrospectively analyzed.</p><p><strong>Results: </strong>Among the 19 patients (3.64%) with unsuccessful outcomes, 18 were switched to cardiopulmonary bypass (CPB) surgery, and 1 was closed successfully using an occlusion device a year later. The causes of failure included occlusion device shedding or shifting (n=6), failure of the guidewire (or the sheath) to pass through a small defect (n=5), device-related valve regurgitation (n=4), significant residual shunt (n=2), ventricular fibrillation (n=1), and continuous sharp blood pressure decreases (n=1). Patients with high VSD had a slightly higher failure rate than those with perimembranous VSD (p=0.049), and its key reason is the high proportion of occlusion device shedding or shifting (p=0.001). No significant difference in the failure rate was found between patients with different surgical incision approaches.</p><p><strong>Conclusions: </strong>Minimally invasive surgery has a high success rate for perimembranous VSDs. Occlusion device shedding or shifting is the most common cause of failure. The shedding or shifting risk of eccentric occlusion devices being used only for high VSDs is much greater than that of concentric occlusion devices being used for perimembranous VSDs, which increases the risk of conversion to CPB surgery for high VSDs.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"6 1","pages":"e000432"},"PeriodicalIF":0.8,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3a/87/wjps-2022-000432.PMC9933489.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10772213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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World Journal of Pediatric Surgery
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