Objective To provide evidence for timely diagnosis and treatment of Kawasaki disease through assessing the relationship between the duration of fever and the incidence of coronary artery lesion in patients with Kawasaki disease. Methods To retrospectively analyze the clinical information of 352 inpatients with Kawasaki disease (including typical Kawasaki disease, incomplete Kawasaki disease, and non-responsive to intravenous immunoglobulin treatment Kawasaki disease ) from January 1997 to December 2007. The relationship between the duration of fever and the incidence of coronary artery lesion was presented by a linear trend plot, using Cochran-Armitage trend test. A value of P lt; 0.05 was considered statistically significant. Results Among 352 patients with Kawasaki disease, 88 had coronary artery lesions. Sixty-eight out of 294 patients with typical Kawasaki disease, 20 out of 58 patients with incomplete Kawasaki disease, and 18 out of 44 patients with non-responsive Kawasaki disease had coronary artery lesions. Linear trend analysis showed that the duration of fever in all 352 patients with Kawasaki disease and 294 cases with typical Kawasaki disease was positively correlated with the incidence of coronary artery lesion (Plt;0.05). However, in patients with incomplete Kawasaki disease and non-responsive Kawasaki disease, the relationship between the duration of fever and the incidence of coronary artery lesion was not significant (Pgt; 0.05). Conclusion The longer the duration of fever was in patients with Kawasaki disease, higher the risk of coronary artery lesion.
Objective A meta-analysis was performed for a comparison of outcomes between surgery and balloon angioplasty (BA) for native coarctation of the aorta (NCA) in pediatric patients. Methods Electronic databases, including PubMed, EMbase, Medline, Cochrane Library, Weipu Data, Wanfang Data and CNKI were searched systematically for the literature aimed mainly at comparing the therapeutic effects for NCA administrated by surgery and BA. Corresponding data sets were extracted and two reviewers independently assessed the methodological quality. Results Ten studies meeting the inclusion criteria were included, involving a total of 723 subjects. It was observed that compared with BA, surgery was significantly associated with a lower incidence of recoarctation (OR, 0.43; 95%CI, 0.30–0.63; P<0.001), repeat intervention due to recoarctation (OR, 0.40; 95%CI, 0.27–0.61;P<0.001) and lower residual transcoarctation gradient in mid to long term follow up (WMD –0.85; 95%CI, –12.34 to –3.76;P<0.001). Compared with BA, surgery was significantly associated with a longer hospitalization time (WMD, 19.40; 95%CI, 15.82–22.99;P<0.001). Incidence of aneurysm formation (OR, 0.64; 95%CI, 0.26–1.57;P=0.33), complications(OR, 1.77; 95%CI, 0.95–3.28; P=0.07), perioperative mortality (OR, 2.57; 95%CI, 0.87–7.61, P=0.09) and immediate transcoarctation residual gradient (WMD –1.66; 95%CI, –4.23–0.90; P=0.2) were not statistically different between surgery and BA. Conclusions Compared with BA, surgery was significantly associated with a lower incidence of recoarctation, repeat intervention due to re-CoA and residual transcoarctation gradient in mid to long term follow up. On the contrary, BA was significantly associated with a shorter hospitalization time. Incidence of aneurysm formation, perioperative mortality, complications and immediate transcoarctation residual gradient were similar between surgery and BA.
Objective A meta-analysis was performed for a comparison of outcomes between transcatheter closure and transthoracic closure for simple congenital heart diseases (CHD). Methods Electronic databases, including PubMed, EMbase, Scopus, CNKI, Wanfang Data and Weipu Data were searched systematically for the literature aimed mainly at comparing the therapeutic effects for CHD administrated by transcatheter closure and transthoracic closure. Corresponding data sets were extracted and two reviewers independently assessed the methodological quality. The meta-analysis was conducted with Revman 5.3. Results Twelve studies meeting the inclusion criteria were included, involving 8 studies regarding to atrial septal defect (ASD), 2 studies regarding to ventricular septal defect (VSD) and 2 studies with regard to patent ductus arteriosus (PDA). A total of 1 423 patients were included. It was observed that compared with transthoracic closure, transcatheter closure entailed a lower complication rate (OR=5.62, 95%CI 2.78 to 11.36, P<0.001). However, meta-analysis of operative success rate(OR=1.65, 95%CI 0.92 to 2.98, P=0.09), instantly (OR=0.75, 95%CI 0.40 to 1.41, P=0.37) and long-term (OR=0.72, 95%CI 0.25 to 2.05, P=0.54) persistent shunt after surgery showed no significant differences between two approaches. No publication bias was found according to the funnel plot of complication rate and operative success rate. Conclusion In the treatment of simple CHD such as ASD, VSD and PDA, compared with transthoracic closure, a lower complication rate were associated with transcatheter closure. Meanwhile, operative success rate, instantly and long-term persistent shunt after surgery were not statistically different between the two surgical approaches. However, this study was based on retrospective studies, the level of evidence remained low. More large sample size randomized controlled trials should be designed to explore the safety and effectiveness of these two approaches in the treatment of CHD.
Objective To summarize the clinical characteristics of coarctation of the aorta (CoA) associated with intracardiac anomalies in infants. Methods The data from August 2009 to August 2017 of 86 infants who were diagnosed with CoA associated with intracardiac anomalies were analyzed. Preoperative diagnosis, surgical findings and post-operation follow-up were analyzed retrospectively. There were 56 males and 30 females at age of 1–346 (95.1±78.0)d. All the included patients underwent single-stage repair of CoA associated with intracardiac anomalies. Results Mean operative time was 279.0±56.4 min, mean cardiopulmonary bypass time was 162.3±51.0 min, and mean aorta cross-clamp time was 74.7±25.2 min. Mean length of ICU stay and ventilation time was 7.4±4.7 days and 101.1±75.4 hours, respectively. The residual transcoarctation gradient before discharge was lower than pre-operative transcoarctation gradient significantly (42.3±17.7 mm Hg vs. 22.1±9.4 mm Hg, P<0.001), and 7 early deaths were observed after surgery. The mean follow-up time of 79 hospital survivors was 31.0±27.4 months. And no late death was found. Transcoarctation gradient of hospital survivors in the last time follow-up was 21.2±11.0 mm Hg. Transcoarctation gradient of 29 patients was higher than 20 mm Hg. However, only 4 patients with significant clinical symptom of lower limbs retardation were recommended for ballon angioplasty consultant. The cumulative recoarctation-free survival in 2-year follow-up was 69.2%. Conclusions To avoid early second-stage operations, single-stage repair of CoA associated with intracardiac anomalies is effective and safe, and the outcomes of early to mid term follow-up are satisfactory.
Objective To summarize and analyze the clinical efficacy of negative pressure suction cup in the treatment of young children (≤ 6 years old) with pectus excavatum. Methods The relevant clinical medical records of the children with pectus excavatum who received negative pressure suction cup treatment in our hospital outpatient department from May 2019 to January 2023 were collected. The age, sex, type, severity, depth of depression, duration of use and prognosis of children with pectus excavatum were retrospectively analyzed. Results Finally 100 children were treated with negative pressure suction cups according to the doctor’s advice for at least 3 months. The 99 patients was effective, the effective rate was 99%, the excellent and good rate was 52.00%, and the complication rate was 8.00%, After treatment, the Haller index and the depth of sternal depression were reduced compared with those before treatment (P<0.001), and there was no statistical difference in the effective rate and excellent rate between different genders, different ages, different types of pectus excavatum, or different severity (P＞0.05). Conclusion Negative pressure suction cup is safe and effective in the treatment of youngchildren (≤ 6 years old) with pectus excavatum, and the correction effect has nothing to do with gender, type and severity .
Objective To investigate the clinical significance of the level of serum amylase and serum IgA and total IgE in henoch-schonlein purpura patients with gastrointestinal involvement (also known as "Henoch purpura "). Methods Levels of serum amylase and serum IgA and total IgE in henoch-schonlein purpura patients with or without abdominal pain or patients with acute abdominal pain were compared. Results The average level (180.3 ± 15.8 IU) of serum amylase of Henoch purpura patients was significantly higher than HSP patients without abdominal pain and acute abdominal pain patients (F=32.214, P=0.009); Ratio of cases of increased level of serum IgA in henoch purpura abdomen patients was 44.2%, and there was no significant difference with HSP patients without abdominal pain. But ratio of two groups was respectively higher than the acute abdominal pain patients group (χ2=13.73, P=0.001); Ratio of cases of increased level of serum IgE in Henoch purpura abdomen patients accounted for 40.4%, but there was no significant difference among the three group (χ2=1.80，P=0.41). Conclusion Levels of serum amylase increase and serum IgA increase conduce to diagnose HSP patients with the onset of abdominal pain, and serum total IgE has little significance.
ObjectiveTo compare and analyze the treatment effect of thoracoscopic surgery and traditional open surgery on infants with congenital diaphragmatic eventration, and summarize the experience of thoracoscopic surgery in infants with congenital diaphragmatic eventration.MethodsWe retrospectively analyzed the clinical data of 105 children with congenital diaphragmatic eventration who received operation in the Department of Cardiothoracic Surgery of Children’s Hospital of Chongqing Medical University from January 2010 to January 2019. The patients were divided into an open group and a thoracoscopic group according to the operation methods. There were 41 patients in the thoracoscopic group, including 30 males and 11 females, with an average of 13.42±11.08 months (range: 1 d to 3 years). There were 64 patients in the open group, including 44 males and 20 females, with an average age of 8.21±9.33 months (range: 15.0 d to 1.6 years). The operation time, intraoperative bleeding volume, postoperative mechanical ventilation time, hospital stay and other operation indexes as well as the mortality, recurrence rate and complication rate of the two groups were observed.ResultsThe operation indexes such as operation time, intraoperative bleeding volume, postoperative mechanical ventilation time, thoracic drainage time, CCU stay and hospital stay of the thoracoscopic group were better than those in the open group (P<0.05). There was no statistical difference between two groups in postoperative diaphgram muscles descent, postoperative feeding time or patients needing thoracic drainage (P>0.05). The incidence of postoperative complications in the thoracoscopic group (19.51%) was lower than that in the open group (23.44%, P>0.05), and the difference in mortality and recurrence rate between the two groups was not statistically significant (P>0.05).ConclusionBoth thoracoscopic diaphragmatic plication and traditional open surgery can effectively treat congenital diaphragmatic eventration, but compared with traditional open surgery, thoracoscopic diaphragmatic plication has the advantages of shorter operation time, less trauma, more rapid recovery and fewer complications, so it should be the first choice for children with congenital diaphragmatic eventration.