Objective To investigate the clinical characteristics,diagnosis and treatment of congenital tracheobiliary fistula (CTBF) in children.Methods A case of CTBF admitted into the Department of Pediatric Respiration,Hubei Maternal and Child Health Care Hospital in 2016 was reported,and the related literatures were reviewed.The clinical features,diagnostic methods,treatment status and clinical outcomes of the disease were analyzed.Results The patient was 3 years and 7 months old.The main clinical manifestations were recurrent cough,pneumonia and atelectasis.CTBF was diagnosed by means of iodine oil radiography and treated with biological glue plugging under bronchoscopic guidance.So far,only 30 cases of CTBF have been reported in the English literatures,but only 2 cases in the Chinese literatures.The main clinical manifestations were cough,dyspnea,sputum or bile vomiting,aspiration pneumonia,atelectasis or emphysema.Diagnostic methods for CTBF included bronchoscopy,bronchial angiography and cholangiography,hepatobiliary scan,CT scan and magnetic resonance imaging.Except for this case treated with biological glue plugging under bronchoscopic guidance,all other patients were treated with surgery.The operation methods included fistula ligation,gastrostomy,liver resection,fistula jejunum Roux-en-Y anastomosis,hepatic hilum jejunum anastomosis,gallbladder jejunum anastomosis,etc.Only 4 cases died,and the rest of the patients recovered.Conclusions CTBF should be suspected in children with persistent chronic cough.Iodine oil radiography through bronchoscopy is a simple and feasible method for diagnosis of CTBF.Besides surgery,the lavage and the biological glue plugging method through bronchoscopy is also an effective way to treat CTBF in children without severe biliary malformation.

Objective:To investigate the clinical characteristics in older adult patients with sepsis and heart failure, and to analyze the influential factors of prognosis.Methods:Eighty-eight older adult patients with sepsis and heart failure who received treatment at Lishui Central Hospital from January 2020 to December 2022 were retrospectively included in the heart failure group. Eighty-eight older adult patients with sepsis, who did not have heart failure, were selected in a 1:1 ratio to form a non-heart failure group. Based on their survival status during hospitalization, the patients in the heart failure group were divided into two subgroups: the survival group and the death group. Logistic regression analysis was performed to identify the risk factors associated with the development of heart failure and adverse disease outcomes in older adult patients with sepsis.Results:There were no statistically significant differences in sex, smoking history, alcohol consumption history, history of hypertension, and history of diabetes between the heart failure group and the non-heart failure group (all P > 0.05). However, the proportion of patients aged 75 years or older in the heart failure group was 52.27% (46/88), which was significantly higher than the proportion in the non-heart failure group [34.09% (30/88), χ2 = 5.93, P < 0.05]. The proportion of patients with respiratory system infections in the heart failure group was 53.41% (47/88), which was significantly higher than the proportion in the non-heart failure group [29.55% (26/88), χ2 = 10.37, P < 0.05]. Logistic regression analysis showed that advanced age and respiratory system infections are independent risk factors for the development of heart failure in patients with sepsis. Among patients with sepsis and heart failure, 45 survived and 43 died, resulting in a mortality rate of 48.86%. The average age of patients in the death group was (76.27 ± 4.14) years, which was significantly higher than that in the survival group [(72.29 ± 4.06) years, t = 4.55, P < 0.05]. The brain natriuretic peptide level and the Acute Physiology and Chronic Health Evaluation II (APACHE II) score in the death group were (636.70 ± 70.29) pg/mL and (31.93 ± 3.08) points, respectively, both of which were significantly higher than those in the survival group [(552.80 ± 54.66) pg/mL, (27.06 ± 3.80) points, t = 6.27, 6.59, both P < 0.05]. The lactate clearance rate and serum albumin level in the death group were (13.63 ± 4.84)% and (26.09 ± 4.77) g/L, respectively, both of which were significantly lower than those in the survival group [(19.94 ± 5.07)%, (30.55 ± 5.17) g/L, t = 5.97, 4.20, both P < 0.05]. Logistic regression analysis showed that in patients with sepsis and heart failure, advanced age, elevated serum brain natriuretic peptide levels, and high APACHE II scores are risk factors for poor prognosis and death. A high lactate clearance rate at 24 hours and elevated serum albumin levels are protective factors for survival. Conclusion:Advanced age and respiratory system infections increase the risk of heart failure in patients with sepsis. Advanced age, elevated brain natriuretic peptide levels, and high APACHE II scores are associated with an increased risk of death in these patients. High lactate clearance rates and elevated serum albumin levels are indicative of a reduced risk of death in patients with sepsis.