Clinical assessment of the treatment for pulmonary artery sling combined with anomalous bronchial branching and congenital tracheal stenosis / 中华胸心血管外科杂志

Objective:To summarize the morphological characteristics and clinical experience of pulmonary artery sling(PAS) combined with anomalous bronchial branching, and provide new considerations for surgically treating PAS.Methods:A retrospective review of surgical experience of all patients with anomalous bronchial branching from January 2012 to December 2018 at Shanghai Children's Medical Center was conducted. There are 4 types according to the morphology of anomalous bronchial branching: tracheal bronchus, bronchial trifurcation, bridging bronchus, tracheal bronchus combined with bronchial trifurcation. The proportion of patients with anomalous bronchial branching combined with PAS was counted. The rate of tracheoplasty for four types was determined. We measured the interbronchial and subcarinal/subpseudocarinal angles before and after tracheoplasty.Results:140 patients were included in our study. The tracheal diameter of 11(21%, 11/53) patients with tracheal bronchus and 4(9%, 4/44) patients with bronchial trifurcation was normal. Among these patients, 125 patients had congenital tracheal stenosis(CTS). 115 patients underwent tracheoplasty. The rate of tracheoplasty of bridging bronchus was higher than tracheal bronchus(100% vs. 60%, P=0.000). One-stage surgery was performed in 76(61%) patients who had PAS. The interbronchial and subcarinal/subpseudocarinal angles were significantly reduced postoperatively( P=0.000). Conclusion:It is difficult to explain merely with vascular compression in patients with PAS with CTS and anomalous bronchial branching. One-stage slide tracheoplasty is currently the optimal option.

Advancein surgicaltreatment of congenital tracheal stenosis in children / 中华胸心血管外科杂志

Congenital tracheal stenosis is a rarebut life-threatening disorder. In recent years, the improvement of surgical skills has significantly reduced the incidence of postoperative complications and mortality in children. Through researching the relevant published articles and books, this review introduces the pathology, types, commonsurgical methods of congenital tracheal stenosis, summarizes the surgical indications for tracheoplasty, and prospects for providing some suggestions for thetreatment of congenital tracheal stenosis.

Construction of patient-level prediction model for in-hospital mortality in congenital heart disease surgery: regression and machine learning analysis / 中华胸心血管外科杂志

Objective:Explore a predictive model for predicting postoperative hospital mortality in children with congenital heart disease.Methods:We retrospectively analyzed the characteristics of all children with congenital heart disease from January 1, 2006 to December 31, 2017 at Shanghai Children's Medical Center. Each procedure was assigned a complexity score based on Aristotle Score. In-hospital death prediction models including a procedure complexity score and patient-level risk factors were constructed using logistic regression analysis and machine learning methods. The predictive values of the models were tested by C-index. Results:A total of 24 693 patients underwent CHD operations were include in the study, there were 585 (2.4%) in-hospital deaths. In-hospital mortality for each procedure varies between 0 to 77.8%, with 32 procedures with 0 death record. The prediction model constructed using logistic regression found that in addition to the complexity score, other risk factors included age, height, operation history, echocardiography characteristics as well as certain laboratory test results (mainly coagulation factors) were significantly correlated with in-hospital death. Receiver operating curve analysis showed that prediction with only the complexity score resulted in an AUC of 0.654 (95% CI: 0.628-0, 681, P<0.01) while model containing patient-level risk factors had significant higher prediction value with AUC of 0.886 (95% CI: 0.868-0.904, P<0.01). Training with machine learning method resulted in a final prediction model with high prediction value ( AUC 0.889, with a sensitivity value for death prediction of 0.817). The key risk factors in machine learning model are in general agree with the logistic regression model however with subtle differences. Conclusion:Through combination of procedure complexity score with pre-operative patient-level factors, predictive model constructed using regression or machine learning method had high accuracy in in-hospital mortality prediction.

Advancein surgicaltreatment of congenital tracheal stenosis in children / 中华胸心血管外科杂志

Congenital tracheal stenosis is a rarebut life-threatening disorder. In recent years, the improvement of surgical skills has significantly reduced the incidence of postoperative complications and mortality in children. Through researching the relevant published articles and books, this review introduces the pathology, types, commonsurgical methods of congenital tracheal stenosis, summarizes the surgical indications for tracheoplasty, and prospects for providing some suggestions for thetreatment of congenital tracheal stenosis.

Association of BCAS3 rs11653176 gene polymorphism with the occurrence of gout / 中华内分泌代谢杂志

Objective To explore the relationship between the polymorphisms of the primary gout predisposing gene (BCAS3) rs11653176 locus and the incidence of gout in Han Chinese men in coastal areas of Shandong Province. Methods One hundred and fifty-two cases of patients with gout remission,68 cases of acute stage,252 patients with hyperuricemia, and 280 healthy subjects, total males, were enrolled. Genotyping the rs11653176 locus of BCAS3 gene by TaqMan probe technique. The expression level of BCAS3 gene mRNA in each PBMC was measured by RT-qPCR. The levels of tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), and interleukin-18(IL-18)in serum were measured by ELISA. Results The change of allele frequency of rs11653176 locus in BCAS3 gene was associated with gout(P<0.01). BCAS3 mRNA in patients with gout was significantly higher than that of healthy people and patients with hyperuricemia(P<0.01). In gout patients, the expression level of BCAS3 gene containing C allele was higher than that of T allele(mRNA,P<0.05). The inflammatory factors in the acute phase of gout were significantly higher than those in phases of remission and hyperuricemia(P<0. 01). Conclusion Changes in the allele frequency of BCAS3 alleles rs11653176(high C, low T)may contribute to the expression of this gene,and lead to gout. And the onset of gout is closely related to the production of inflammatory factors.