Objective To summarize and analyze the clinical efficacy of negative pressure suction bell in the treatment of young children (≤6 years) with pectus excavatum. Methods The relevant clinical medical records of the children with pectus excavatum who received negative pressure suction bell treatment in the Outpatient Department of Children’s Hospital of Chongqing Medical University 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 A total of 100 pediatric patients were ultimately included in the study, comprising 74 males and 26 females. The age distribution was 57 patients aged 0-3 years and 43 patients aged 3-6 years. All patients were prescribed and used a negative pressure suction device for at least 3 months, after which they returned to our department's outpatient clinic for follow-up. The treatment demonstrated clinical effectiveness in 99 patients, yielding an efficacy rate of 99.00%. The excellent/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/good rate between different genders, different ages, different types of pectus excavatum, or different severity (P＞0.05). Conclusion Negative pressure suction bell is safe and effective in the treatment of young children (≤6 years) with pectus excavatum, and the correction effect has nothing to do with gender, type and severity.

Objective To analyze the clinical and immunological characteristics of a rare case of CHARGE syndrome,we summarize the genotype and phenotype in the Chinese patient population,and explore the underlying immunopathogenic mechanisms.Methods Clinical data from a pediatric patient with CHARGE syndrome were collected and analyzed.A comprehensive analysis of the Chinese patient population was conducted.Gene analysis and immunological characterization were performed using flow cytometry,deep sequencing,and quantitative PCR.Results The proband was a premature female infant whose primary clinical manifestations included congenital heart disease,recurrent respiratory infections,respiratory failure,airway dysplasia,hearing impairment,and bilateral choroidal coloboma.Whole-exome sequencing revealed a de novo heterozygous nonsense mutation in the CHD7 gene,c.5122C＞T(p.Gln1708Ter),classified as pathogenic according to ACMG criteria.Immunological studies indicated impaired thymic output of T cells,significant alterations in the number and proportion of CD8+T cell subsets,increased apoptosis,and defective activation and production of key effector cytokines such as IFN-γ by CD8+T cells.However,no significant abnormalities were observed in peripheral lymphocyte proliferation.Conclusion CHARGE syndrome is a rare autosomal dominant genetic disorder primarily caused by mutations in the CHD7 gene.The main clinical features include ocular defects,cardiac disease,choanal atresia/cleft lip and palate,growth retardation,gonadal hypoplasia,and ear anomalies.This case study suggests that CHARGE syndrome is associated with abnormalities in the development,apoptosis,and effector functions of immune cells.

Objective To analyze the clinical and immunological characteristics of a rare case of CHARGE syndrome,we summarize the genotype and phenotype in the Chinese patient population,and explore the underlying immunopathogenic mechanisms.Methods Clinical data from a pediatric patient with CHARGE syndrome were collected and analyzed.A comprehensive analysis of the Chinese patient population was conducted.Gene analysis and immunological characterization were performed using flow cytometry,deep sequencing,and quantitative PCR.Results The proband was a premature female infant whose primary clinical manifestations included congenital heart disease,recurrent respiratory infections,respiratory failure,airway dysplasia,hearing impairment,and bilateral choroidal coloboma.Whole-exome sequencing revealed a de novo heterozygous nonsense mutation in the CHD7 gene,c.5122C＞T(p.Gln1708Ter),classified as pathogenic according to ACMG criteria.Immunological studies indicated impaired thymic output of T cells,significant alterations in the number and proportion of CD8+T cell subsets,increased apoptosis,and defective activation and production of key effector cytokines such as IFN-γ by CD8+T cells.However,no significant abnormalities were observed in peripheral lymphocyte proliferation.Conclusion CHARGE syndrome is a rare autosomal dominant genetic disorder primarily caused by mutations in the CHD7 gene.The main clinical features include ocular defects,cardiac disease,choanal atresia/cleft lip and palate,growth retardation,gonadal hypoplasia,and ear anomalies.This case study suggests that CHARGE syndrome is associated with abnormalities in the development,apoptosis,and effector functions of immune cells.

Objective    To 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. Methods    We 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. Results    The 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). Conclusion    Both 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.

Objective    To study effect of different surgical treatments for patent ductus arteriosus in children. Method    A total of 38 patients with patent ductus arteriosus who underwent surgical treatment of cardiothoracic surgery between January 2016 and December 2017 in our hospital were as an observation group (12 patients with severing suture, 26 patients with ligation, 14 males and 24 females, aged 0.08–8.67 years). In the same period, 38 patients with patent ductus arteriosus who underwent interventional closure in the Department of Cardiology were as a control group (17 males and 21 females, aged 0.50–5.42 years). The clinical effectiveness of the two groups was compared. Results    The operation time, postoperative hospital stay, and blood transfusion rate in the observation group were higher than those in the control group with statistical differences (P<0.05). There was no statistical difference in intraoperative blood loss and complications between the two groups. Conclusions    In patients with a single patent ductus arteriosus or a small catheter, interventional closure of the patent ductus arteriosus is less trauma and faster recovery. But in patients with lower weigh, premature, other intracardiac malformations, large catheter, moderate or severe pulmonary hypertension, the surgery is better.

Objective To investigate the effect of early involvement in clinical practice in improving comprehensive abilities of medical students and strengthening their occupational cognition. Methods The students in the 5-year class of 2014 of pediatrics in our university were enrolled as subjects, among whom 78 students who received early involvement in clinical practice and teaching were enrolled as experimental group and 81 students who did not receive such teaching were enrolled as control group. A questionnaire survey was performed for the students participating in the teaching, including basic information, pre-training quality evaluation, development of personal knowledge and abilities, and comments or suggestions. The two groups were compared in terms of the score of the theoretical course of pediatric surgery, so as to explore whether"early involvement in clinical practice"could improve the theoretical study of students. Finally, the performance of students in clinical practice was evaluated and compared between the two groups to assess the role of "early involvement in clinical practice" in improving comprehensive abilities and occupational cognition. Results More than 90％of the students were satisfied with early involvement in clinical practice and they thought this activity helped them to improve clinical thinking, strengthen occupational cognition, enhance learning interests, improve communication skills, and promote the combination of basic and clinical knowledge. In addition, the follow-up analysis found that compared with the control group, the experimental group had a significantly higher average score [(74.59 ±0.50) vs. (68.89 ±0.67)] and a significantly higher proportion of students with a score of >70, and no students failed. As for the score of clinical practice, the experimental group had significantly better clinical work proficiency, clinical thinking, operational ability,and doctor-patient communication ability than the control group. Conclusion Early involvement in clinical practice among medical students can improve their comprehensive abilities and help to cultivate clinical thinking and doctor-patient communication skills and strengthen their occupational cognition, which lays a good foundation for cultivating high-quality talents through medical education.

Pectus excavatum is the most common congenital deformity of the chest wall in children.Currently, surgery remains to be the most effective treatment available for this disease.The Nuss procedure has become the most widely used technique in clinical work since 1998.However, the optimal operation time remains controversial, no consensus exists among surgeons.Mostly, surgeons from western countries believe it′s best to repair the deformity around the time of puberty, while Chinese surgeons prefer to perform the surgery earlier, mainly at three to six years old, or around school age.Hence, this review was carried out to summarize the surgical results and postoperative complications of Nuss procedure among different age groups, purposed to offer a reference for the rational decision of pediatric surgeons.

Objective Analysis the influence risk factors of infants and young children tetralogy of Fallot for radical treatment , and explore the perioperative treatment methods .Methods 195 cases(include death group and survival group)of hospitalized data of TOF resection in this hospital were collected in January 2003 to November 2012 ,then statistical analysis was done .Results Uni-variate analysis of variance showed ,age ,weight ,McGoon ratio ,cardiopulmonary bypass time and aortic clamping time were statisti-cally significant in two groups ,Multivariate Logistic regression analysis showed McGoon ratio <1 .0 ,cardiopulmonary bypass time>90 min ,aortic clamping time>70 min ,age<3 months were related to the postoperative death of TOF radical operation .Conclu-sion It is safe and reliable of radical surgery in infants and young children ,McGoon ratio ,cardiopulmonary bypass time and aortic clamping time ,age are the risk factors of the postoperative death of TOF radical operation .

Objective To explore the diagnosis and surgical treatment experience of vascular ring in infants and children.Methods Fourteen cases (9 boys and 5 girls,aged 2 months to 6 years,weighted 4.5 - 15.0 kg) with vascular ring were diagnosed and treated surgically in Children's Hospital of Chongqing Medical University from Sep.2009 to Dec.2010.All children underwent X-ray,echocardiography and spiral computed tomography examination preoperatively.Bronchoscopy and barium swallow was performed in 5 cases respectively.The pathological types of vascular rings included double aortic arch in 1 ( 7.1％ ),pulmonary artery sling in 7 (50.0％),right aortic arch with left patent ductus arteriosus or persistent left ligament in 6 (42.9％).Associated cardiac anomalies were present in 7 (50.0％) patients.Tracheal stenosis of different length ( 12％ -62％ ) and severity (45％ -74％ cross-sectional luminal narrowing) was observed in the group.Barium swallow in 5cases showed localized compression of the esophagus.12 cases underwent repair of vascular ring with cardiopulmonary bypass (CPB),and the associated congenital heart defects were repaired simultaneously.2 cases of right aortic arch with left patent ductus arteriosus or persistent left ligament underwent surgery without CPB.Results The median duration of CPB in 12 cases and aortic cross-clamp time in 7 patients were 77.5 minutes ( range:55 - 186 minutes) and 36 minutes ( range:22 - 110 minutes) respectively.The median duration of postoperative ventilation and ICU stay were 21 hours (range:7 -308 hours) and 79.5 hours (range:16-314 hours) respectively.One baby with pulmonary artery sling died on the postoperative 12th day ( in-hospital mortality 7.1％ ).Of the 13 cases discharged from the hospital,1 case were lost to follow up.In the follow-up ( 1- 15 months) of 12 cases,digestive symptoms were disappeared.Development,exercise tolerance and symptoms showed obvious improvement,although 5 (41.7％) patients had residual respiratory problems.Conclusion Prolonged or recurrent aerodigestive issues in children should alert the pediatrician to the possibility of a vascular ring.Multislice spiral CT scanning is the best imaging modality.All vascular rings should be surgically corrected,and the associated long-segment severe tracheal stenosis needs.The short to midterm outcomes of surgical division are excellent.

Objective ; To study the pulmonary function changes before and after operation in infants with pectus excavatum( PE). Methods; Thirty - two patients under 3 years were selected as study group and thoracoplasty were performed in all cases. The same number of normal infants with identical basic conditions was chosen as control group. Lung function was measured before, 3 and 12 months after operation respectively in study group and in control group. The effects of thoracoplasty on lung function in infants with PK was analyzed. Meanwhile the clinical results were assessed postoperatively. Results:TE/TI, % V - PK and V25/PK in study group were abnormal before operation and significantly improved 1 year after operation. Except that one had logical notch in thorax, all patients had satisfactory results. Conclusions; The effects of thoracoplasty on infants with PE under 3 years is satisfactory and the lung function could recover to normal about one year after operation.