Application of electronic bronchoscope in 65 children with congential tracheoesophageal fistula during perioperative period / 中国小儿急救医学

Objective:To explore the value and risk of electronic bronchoscope applied in perioperative management of children with congential tracheoesophageal fistula.Methods:Sixty-five children with congential tracheoesophageal fistula performed electronic bronchoscope examination from September 2014 to November 2020 were enrolled in this study.The results of examination and complications were analyzed.Results:Sixty-three children with congenital tracheoesophageal fistula were diagnosed by electronic bronchoscopy.The diagnosis rate was 96.92%.Fifty-four children with congenital tracheoesophageal fistula were diagnosed by esophagography.The diagnosis rate was 91.53%.Sixty-one children with congenital tracheoesophageal fistula were diagnosed by multislice spiral computed tomography.The diagnosis rate was 93.85%.Airway anatomic abnormity was found in 27 children, including three cases of nasopharyngeal soft tissue collapse, 14 cases of laryngomalacia, five cases of tracheal stenosis, nine cases of tracheobronchomalacia, and nine cases of tracheobronchial and abnormal opening of the bronchus.The incidence was 41.54%.Three children with difficult ventilator weaning were related to tracheobronchial stenosis or tracheobronchomalacia.They were gradually weaning from ventilator after a long period of mechanical ventilation and treatment.Two children with transient decrease in oxygen saturation were noticed as complication.Conclusion:Electronic bronchoscopy is a safe and effective method for the diagnosis of congenital tracheoesophageal fistula and recurrence after operation.It is of great value to the airway management after operation by early detection of respiratory anatomic abnormity.

Analysis of polysomnographic monitoring results of 523 children in a tertiary hospital in Gansu province / 中国小儿急救医学

Objective:To analyze the results of polysomnography(PSG) in 523 children, and explore the sleep monitoring results and related influencing factors of obstructive sleep apnea hypopnea syndrome(OSAHS).Methods:The PSG monitoring results of children with OSAHS and non-OSAHS were analyzed for children aging from 0 to 16 years old, who were monitored at Sleep Medicine Center of Gansu Maternal and Child Health Hospital from January 2014 to December 2019.Results:A total of 523 children underwent PSG monitoring during the past 5 years.The male to female ratio was 1∶0.47, of which 66.9%(350/523)were children with OSAHS.The average proportion of rapid eye movement sleep was 1.95%(7.7/394). The height of non-OSAHS group was significantly higher than that of OSAHS group[(108.72±16.39)cm vs.(104.80±16.60)cm, P=0.016]. The incidence of OSAHS decreased with age( P=0.038). The apnea index, hypopnea index, apnea hypopnea index, obstructive apnea index, microarousal index, oxygen desaturation index, mean apnea time, and longest apnea time in the OSAHS group were higher than those in the non-OSAHS group( P<0.05). And the lowest oxygen saturation and the mean oxygen saturation during sleep were lower than those in the non-OSAHS group( P<0.05). Logistic regression analysis on the clinical data of OSAHS children showed that open mouth breathing and snoring at night had significant effects on children′s OSAHS, and the differences were statistically significant( P<0.05). Conclusion:PSG is of great significance for the diagnosis of OSAHS.The more severe the degree of OSAHS, the worse severe the night sleep hypoxemia.PSG should be recommended before taking any treatment for children with sleep disorders.

Summary of clinical experience on tracheobronchial foreign bodies in children for 10 years / 中国小儿急救医学

Objective:To investigate the clinical manifestations and characteristics of tracheobronchial foreign bodies in children, and improve the diagnosis and treatment of foreign bodies.Methods:A retrospective analysis was performed on the clinical data of children with tracheobronchial foreign bodies confirmed by fiberoptic bronchoscopy between January 2010 to December 2019.The children with tracheobronchial foreign body who were treated in the Maternal and Child Health Hospital of Gansu Province.Results:A total of 967 cases were operated by soft electronic bronchoscope, and foreign bodies were removed by means of foreign body forceps or nets.Among them, 19 cases(3 cases with subglottic foreign bodies, one with row of pins, and the rest 15 cases with foreign bodies completely wrapped by granulation)were not removed, two cases were spontaneously coughed, and 946 cases (97.8%)were removed.Bronchial foreign bodies in children were more common in boys, with the ratio of male to female being 2.14∶1.The main age of onset was 1-3 years old(88.8%). The incidence was slightly higher in rural areas than that in urban areas(46.5% in urban areas, 53.5% in rural areas). Foreign bodies were inhaled most in March and least in June.From the perspective of season, winter and spring were more than summer and autumn.The foreign body types inhaled were mainly exogenous plant foreign body, accounting for 93.0%, among which peanut(31.7%)and melon seeds(19.2%)were the most common.The duration of foreign body inhalation was up to 347 cases(35.9%)in 1-3 days.There were 501 cases(51.8%)with endoscopic endobronchial inflammation, and 196 cases of children with varying degrees of granulomatous hyperplasia, accounting for 39.1% and 20.3% of the total.The foreign body in the right bronchus accounted for 50.0% and the left bronchus for 43.7%.There were 793 cases confirmed by imaging, with a positive rate of 81.9%, and 90.9% confirmed by CT.Conclusion:About 88.8% of tracheobronchial foreign bodies occurred in 1 to 3 years of age.The occurrence of foreign bodies had obvious gender, urban-rural and seasonal distribution characteristics, and more cases were male, in rural and winter as well as spring.

Clinical application of suspensory incision and suture technique in endoscopic full-thickness resection for muscularis propria tumor of gastric fundus (with video) / 中华消化内镜杂志

Objective:To evaluate the clinical value of suspensory incision and suture technique in endoscopic full-thickness resection (EFTR) for muscularis propria tumor of gastric fundus.Methods:A retrospective analysis was performed on the data of 20 patients with muscularis propria tumor in gastric fundus and undergoing EFTR in the First Medical Center of PLA General Hospital from June 2017 to June 2019. Patients were divided into the observation group (9 cases) treated with suspensory incision and suture technique in EFTR and the control group (11 cases) treated with traditional EFTR method. The baseline data and perioperative data of the two groups were analyzed.Results:EFTR was successfully performed on all 20 patients. The tumor size of the observation group and the control group was 10.0 (7.5, 21.0) mm and 14.0 (10.0, 20.0) mm, respectively. The resection time of the two groups was 26.4±6.3 min and 35.5±11.4 min, respectively. The postoperative hospital stay was 6.4±1.0 d and 7.7±1.5 d, respectively. No postoperative delayed bleeding, perforation, or other complications occurred in the two groups.Conclusion:Using suspensory incision and suture technique is safe and effective during EFTR for muscularis propria tumor in gastric fundus, and can reduce operation time. This technique is worth applying in clinic.

A multi-center study on the normal range of exhaled nitric oxide in 6-18-year-old children in China / 中华实用儿科临床杂志

Objective:To investigate the normal range of exhaled nitric oxide (FeNO) in 6-18-year-old children in China, so as to provide a data base for the establishment of FeNO standards for Chinese children.Methods:A multi-center study was conducted on 5 949 children aged 6-18 (3 101 males and 2 848 females) in 16 pro-vinces of 7 administrative districts in China.According to the technical standard recommended by American Thoracic Society/European Respiratory Association, FeNO was measured, and the relationship of FeNO with the sex, age, height, weight, body mass index and region was discussed.Results:The geometric mean FeNO value of Chinese children aged 6-18 was 14.1 ppb, and its 95% confidence interval (skewness distribution) was 1.0-38.2 ppb.The geometric mean FeNO values of children aged 6-11 and 12-18 were 13.1 ppb and 15.7 ppb, respectively, and their 95% confidence intervals (skewness distribution) were 1.0-38.1 ppb and 2.0-38.2 ppb.For children at and under 11 years old, FeNO decreased with age, with a mean decline of 1 ppb per year.The multiple linear regression results suggested that there was a significant correlation between FeNO and age for children aged 6-11, and FeNO of children aged 12-18 was significantly correlated with the gender, height, and region(all P<0.01). Conclusions:FeNO values of Chinese children and adolescents in this study are higher than those obtained by the previous study conducted from 2010 to 2012.For children aged 12-18, 16 ppb is recommended as the clinical cut-off point.For children at or under 11 years old, the influence of age on FeNO should be considered, and the cut-off point of FeNO decreases by 1 ppb as the age is reduced by one year.

Clinical characteristics of severe infant laryngomalacia diagnosed by flexible bronchoscopy and the curative effect of laser therapy / 中华实用儿科临床杂志

Objective To explore the clinical characteristics of severe infant laryngomalacia diagnosed by flexible bronchoscopy,and to investigate the effectiveness and safety of treatment on it.Methods Data of 29 severe laryngomalacia patients from Gansu Provincial Maternity and Child-Care Hospital diagnosed by flexible bronchoscopy were analyzed from March 2013 to July 2015,retrospectively.Twelve cases of them received laser therapy under balanced intravenous anesthesia.Preoperative and postoperative pulse oxygen saturation(SpO2),pulmonary function,and dyspnea index were analyzed statistically.Results After supraglottoplasty with laser,the findings were as follows:SpO2(94.26 ± 1.30) ％,tidal volume (6.11 ± 0.77) mL/kg,time to peak tidal expiratory flow/expiratory time 27.42 ±3.51,volume at time of peak expiratory flow/expiratory volume 30.95 ± 5.46,and dyspnea index 1.95 ± 1.05;while preoperative findings were SpO2 (82.45 ± 1.35)％,tidal volume(5.30 ± 1.03) mL/kg,time to peak tidal expiratory flow/expiratory time 27.42 ± 3.51,volume at time of peak expiratory flow/expiratory volume 21.93 ± 7.23,and dyspnea index 2.75 ± 0.84,respectively,and there were significant differences between the preoperative and postoperative therapy (all P ＜ 0.05).Complications were not observed over the next 6 months after operations.Conclusions Severe infant laryngomalacia has influence on living quality of patients,which can be diagnosed by flexible bronchoscopy.Laser therapy is a safe effective cure for it.

Different anesthesia research in pediatric foreign bodies via fiberoptic bronchoscopy / 中国小儿急救医学

Objective To investigate the clinical effect of two different anaesthesia methods in removing the tracheobronchial foreign bodies in children.Methods This was a retrospective study with 56 hospitalized children through fiberoptic bronchoscope foreign body removing since September 2010 to July 2013 in Gansu Provincial Maternity and Child-Care Hospital.All of the children whose age from 8 months to 11 years were diagnosed of tracheal-bronchial foreign body.Among 56 cases,30 cases were operated with deep sedation anesthesia(deep sedation anesthesia group),and 26 cases with general anesthesia(general anesthesia group).The clinical effect of the two kinds of anesthesia were compared.Results The success rate of foreign bodies in deep sedation anesthesia group and general anesthesia group were 83.33％ and 96.15％ respectively (P ＞ 0.05),there were no statistical differences in oxygen desaturation (86.67 ％ vs 92.31％),cyanosis(30.00％ vs 26.92％),bleeding (16.67％ vs 15.38％),fever (6.67％ vs 3.85％),voice hoarse (40.00％ vs 34.62％),vomiting (26.67 ％ vs 19.23 ％),and other complications between two groups (P ＞ 0.05,respectively).There were significant differences in the rate of choking cough(11.54％ vs 93.33％) and resistance (0 vs 73.33％) between general anesthesia group and deep sedation anesthesia group (P ＜ 0.05).Compared with the deep sedation anesthesia group,the average hospitalization cost[(4 718.73 ± 1 012.61) (￥) vs (4 050.25 ± 1 176.75) (￥)] was bigger,and the average setup time [(18.54 ± 3.46) min vs (6.50-± 1.70) min] was longer,but the average removal of foreign body time [(13.32 ± 6.38) min vs (39.52 ± 15.68) min] was smaller in general anesthesia group,there were significant differences between two groups(P ＜ 0.05,respectively),while there was no statistical difference in the average hospitalization days [(5.46 ± 1.65) d vs (5.67 ± 1.65) d] between two groups (P ＞ 0.05).Conclusion Compared with the deep sedation anesthesia,the success rate of removal foreign bodies is higher,and the removal foreign body time as well as comfort are all significantly improved through general anesthesia,but the average hospitalization cost and average preparation time of general anesthesia are bigger than those of deep sedation anesthesia.

Bronchoscopy induced pulmonary interventional procedures in pediatrics:training experience in Taipei Veterans General Hospital Taiwan, China / 中国小儿急救医学

Interventional pulmonary procedures performed by flexible bronchoscopy has been widely used in the adult clinics.However,pediatric interventional pulmonary procedures are different from adult in anesthesia methods,equipment,technology and so on.At present.it is more limited.This review showed the experiences of pediatric bronchoscopy in Taipei Veterans General Hospital of Taiwan,China.

The clinical efficacy of mesalazine and bifid-triple viable combination therapy in patients with ulcerative colitis / 中华消化杂志

Objective To observe the clinical efficacy of mesalazine and bifid-triple viable combination therapy in patients with ulcerative colitis (UC).Methods Thirty-eight UC patients were evenly divided into mesalazine group and combination group. Patients in mesalazine group were administrated with mesalazine (1.0 g/time,four times/day),and on the basis of this,the patients in combination group were added into bifid-triple viable (420 mg/time,three times/day).The course of treatment was eight weeks.The improvement of patients' clinical symptom and manifestation under colonoscope were observed at second day after hospitalization and eight weeks after medication.Mayo disease activity index was used for scoring.Before and after the treatment,the expression of intestinal mucosa nuclear factor kappa B (NF-κB),tumor necrosis factor-α (TNF-a) and cyclooxygenase-2 (COX-2) were tested by immunohistochemical staining and the levels of serum TNF-α,interleukin-8 (IL-8), interleukin-10 (IL-10) were determined by double antibody sandwich enzyme-linked immunosorbent assay.The level of serum superoxide dismutase (SOD) and malondialdehyde (MDA) was detected by nitrite method and thiobarbituric acid coloration method.Before and after treatment was compared with paired t-test,and qualitative data was analyzed with ordinal rank sum test.Results Mayo disease activity index score of the combination group decreased from 7.16±2.01 to 1.63± 1.30 while the mesalazine group from 7.42 ± 1.95 to 3.00 ± 1.25.The difference of reduction was statistically significant (t =2.093,P =0.043).The efficiency of the combination group was higher than that of mesalazine group (16/19 vs 10/19,Fisher's exact test,P=0.039).After treatment,the expressions of NF-κB,TNF-α and COX-2 in colonic mucosa of two groups were both lower than those of before treatment,and in combination group the decrease were more significant (t value was 2.262,2.607 and 2.522 respectively,P value was 0.027,0.012 and 0.014 respectively).After treatment,the concentration of IL-8 of mesalazine group and the combination group both significantly decreased,however IL-10 significantly increased. The difference between these two groups was statistically significant (t value of TNF-α,IL-8 and IL-10 was 4.244,6.858 and 6.802 respectively,all P＜ 0.01). After treatment,both SOD vitality of two groups increased compare with that before treatment,however the level of MDA was lower than that before treatment and the changes of combination group were more significant.Conclusion The combination therapy with mesalazine and bifid-triple viable can effectively suppress inflammatory response in mild and moderate ulcerative colitis,and bifid-triple viable may play a role as adjuvant therapy for patients with UC.

Study on the association between vitamin D receptor gene polymorphism of ApaI and BsmI and vitamin D deficiency rickets / 中国医师杂志

ObjectiveTo study the distribution characters and linkage disequilibrium of vitamin D receptor(VDR) gene ApaI and BsmI polymorphism,and explore the genetic susceptibility of VDR and vitamin D deficiency rickets.MethodsVDR gene ApaI and BsmI polymorphisms were determined by PCRRFLP technology in 56 cases of rickets and 76 cases of normal children.The frequencies of the VDR genotype and allele were compared between the two groups.The software SHEsis was used to make linkage disequilibrium analysis.Results No significant difference was found in either the frequency distribution of VDR gene ApaI and BsmI polymorphism or allele of them between two groups; Two polymorphisms didn't show linkage disequilibrium and D' and r2 were 0.23 and 0.01,respectively.ConclusionsThe ApaI and BsmI polymorphism of VDR gene might be not associated with vitamin D deficiency rickets.Two polymorphisms didn't show linkage disequilibrium.