Objective    To explore the relationship between myocardial viability in patients with coronary artery disease who underwent elective coronary artery bypass grafting (CABG) and early application of intra-aortic balloon pump (IABP) after coronary revascularization, and to provide relevant clinical reference for the pre-implantation of 16G single-lumen catheter in the femoral artery of high-risk patients to facilitate the addition of IABP after operation. Methods    This retrospective study included 521 patients (414 males and 107 females, aged 62.50±8.82 years) who underwent positron emission tomography (PET)-computed tomography (CT) perfusion-metabolism imaging prior to CABG surgery in our institution from December 2015 to August 2020. The myocardial viability information and left ventricular functional parameters were measured, including the proportion of non-viable myocardium (perfusion-metabolic imaging match), hibernating myocardium (perfusion-metabolic imaging mismatch) and dysfunctional myocardium (non-viable+viable myocardium), left ventricular ejection fraction, left ventricular end-diastolic volume and left ventricular end-systolic volume (LVESV). The patients were divided into an IABP group and a non-IABP group  according to whether they received IABP treatment after revascularization. The clinical data were reviewed and compared to explore significant impact factors between the two groups. And the multivariate logistic regression analysis was performed to investigate the correlation between preoperative myocardial viability and early use of IABP after CABG. Results    In multivariate logistic regression analysis, the amount of non-viable, dysfunctional myocardium and LVESV value were identified as the independent predictors for the probability of IABP use in the initial postoperative period. Receiver operating characteristic analysis showed that 9.5% non-viable myocardium, 19.5% dysfunctional myocardium, and LVESV of 114.5 mL were the optimal cutoff for predicting early IABP implantation during CABG. Conclusion    The myocardial survival status displayed by preoperative PET-CT myocardial perfusion-metabolism imaging can predict the possibility of applying IABP in CABG perioperative period. In addition to routine pre-anesthesia assessment, anesthesiologists can conduct risk stratification assessment for patients with CABG according to the results of preoperative myocardial viability imaging, which is of great significance to ensure the perioperative safety of high-risk patients with CABG.

Objective:To analyze the clinical characteristics, therapeutic modalities and prognosis of desmoplastic small round cell tumor (DSRCT) in children, and to summarize the international research progress.Methods:A total of 8 children with DSRCT admitted to Shanghai Children′s Medical Center, Shanghai Jiaotong University, School of Medicine, from January 1999 to August 2019 were retrospectively studied.The clinical characteristics, consultation process and follow-up results were summarized, and the Kaplan-Meier survival analysis method was used to calculate the survival rate.Results:Among these 8 cases, there were 6 male children and 2 female children.Seven cases originated in the abdomen and pelvis, and 1 case originated in the sacral region.All cases had infiltrate surrounding tissues or viscera, and 4 cases(50%) had extra-peritoneal metastasis, including distant lymph node metastasis, liver, lung and bone metastasis.All patients received chemotherapy, among which 3 patients received radiotherapy, and 2 patients received autologous hematopoietic stem cell transplantation.The medical follow-up was continued to February 15, 2020, with the median follow-up period being 59 months.Three cases died and 5 cases survived (2 cases in complete remission, 1 case in recurrent relapse, 2 cases in partial remission still under treatment). The median relapse time was 14.5 months, the 3-year relapse-free survival rate was (30.0±17.5)%, and 3-year overall survival was (51.4±20.4)%.Conclusions:Half of DSRCT had distant metastasis; the prognosis was poor despite the aggressive multimodality therapeutic approaches, such as chemotherapy, cytoreductive surgery, and whole abdominopelvic radiotherapy and stem cell transplantation.

Objective:To evaluate the long-term outcomes and prognostic factors of postoperative residual or recurrent fibrosarcoma in children.Methods:Clinical data of 26 patients continually admitted to Shanghai Children′s Medical Center between April 2004 and February 2019 with postoperative residual or recurrent fibrosarcoma were analyzed retrospectively. All patients were treated with Shanghai Children′s Medical Center-rhabdomyosarcoma-1999 (SCMC-RS-99) regimen and timely radical tumor resection. Before chemotherapy, according to the surgery and imaging examination, 26 patients were divided into 2 groups: postoperative residual group and postoperative recurrent group. Clinical features and long-term follow-up results of patients were summarized. Kaplan-Meier analysis was used to evaluate the overall survival (OS) and event-free survival (EFS) rates, Log-Rank test and Cox proportional hazards models were used for univariate and multivariate prognostic analysis of factors including age (<3 years or 3-18 years old), gender, primary tumor site, postoperative stage, disease status, ETS variant 6 (ETV6) gene and chemotherapy drugs.Results:Among 26 cases, 13 were male and 13 were female, 17 cases were in postoperative residual group and 9 cases were in postoperative recurrent group. Until the last follow-up at December 31, 2019, the median follow-up time was 73 months (ranged from 10 to 188 months).The 5-year OS and EFS rates were (86±7)% and (77±9)%. Univariate analysis showed that, the 5-year EFS rate of postoperative residual group was significantly higher than that of the postoperative recurrent group ((94±5)% vs.(63±16)%,χ 2=5.106, P=0.024), the 5-year EFS rate of patients <3 years old was significantly higher than that of patients 3-18 years old ((94±5)% vs. (62±17)%, χ 2=6.507, P=0.011). Gender (χ 2=0.445), primary tumor site (χ 2=0.258), postoperative stage (χ 2=3.046), ETV6 gene (χ 2=1.496), and whether doxorubicin-containing drugs in chemotherapy (χ 2=1.692) did not exhibit significant impact on 5-EFS rate (all P>0.05). Age, postoperative stage and disease status were included in COX proportional risk model for multivariate analysis, which showed that age >3 years old ( HR=8.95, 95 %CI 0.73-109.50, P=0.086), stage Ⅲ-Ⅳ ( HR=16.50, 95 %CI 0.84-321.40, P=0.065) and postoperative recurrence ( HR=10.60, 95 %CI 0.84-134.30, P=0.068) had no significant impact on EFS rate. Conclusion:Children with postoperative residual or postoperative recurrent fibrosarcoma still had good remission rate and long-term survival, especially young children without recurrence have a significant survival advantage.

Objective: To assess the efficacy of stratified treatment of pediatric non-distant metastatic rhabdomyosarcoma (RMS). Methods: A retrospective review was conducted in 129 pediatric patients with non-distant metastatic RMS between January 2005 and December 2016 at Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine.According to their pathological types, TNM stages and postoperative pathologic staging, the 129 patients were grouped a low-risk group, an intermediate-risk group and a high-risk group.Multimodality therapies were applied to all patients including chemotherapy, surgery and radiotherapy.The overall survival (OS) and event-free survival (EFS) rates were analyzed by using the Kaplan-Meier method. Results: Of 129 patients, 119 cases were included in this study.In 119 patients, the age of onset for the RMS ranged from 7 to 191 months, with the median onset age of 48 months.The median follow-up time was 40 months for event-free patients with RMS, and 36 months for all the 119 patients.The 5-year OS and EFS for all patients were (92.1±2.9)% and (76.5±4.4)%, respectively.While the 5-year EFS for patients in the low-risk group, intermediate-risk group and high-risk group were all above 70%, and the difference among the three groups was not statistically significant (χ²=2.679, P=0.262). A subsequent univariate analysis revealed that the onset age for RMS (≤1 year old or≥10 years old), TNM stage and postoperative pathologic stage were important predictors of EFS with statistical significance (all P<0.05), while gender, pathological type and primary site of RMS did not exhibit any significant impact on 5-EFS (all P>0.05). The 5-year EFS of RMS patients with Forkhead Box Protein O1(FOXO1)-positive was significantly lower than that of FOXO1-negative patients [(56.3%±14.8)% vs.(83.3±15.2)%], and the difference was statistically significant (χ²=4.588, P=0.028). Conclusions It is important that the stratification treatment should be strictly implemented on RMS patients.First, further improvement is necessary for the treatment of patients in the low-risk group due to their poorer prognosis compared to that of their intermediate-risk counterparts, for whom one feasible option is to reduce the dose of chemotherapy drug.Furthermore, FOXO1 can be used as an indicator for poor prognosis, where stratified treatment is necessary for pediatric patients with RMS.

Objective To evaluate the outcomes of children with stage Ⅳ malignant extracranial germ cell tumors. Methods Twenty-five patients were enrolled in the retrospective analysis. Event-free survival (EFS) and overall survival (OS) rates were estimated by Kaplan-Meier method with SPSS 13.0. Results Of the 25 children, there were 13 males and 12 females. The mean age at diagnosis was 2 years old (ranged 1 to 11). Five patients receiving chemotherapy in another hospital before (n=1), or giving up treatment after confirmed diagnosis (n=1), or giving up effective treatment after received less than 2 cycles (n=3) were excluded from this analysis. Of the 20 patients, 90.0% (18/20) achieved complete remission and 5.0% (1/20) achieved partial remission after treatment. The 5-year EFS rate and 5-year OS rate were 70.0%±10.2% and 82.4%±9.2% respectively. There was no death occurred due to complications. Conclusions The effect of this treatment program is positive. The cumulative dose of the drugs is not high, compared with other schemes such as PEB, but there are more drugs involved. Whether these drugs may cause long-term adverse reactions needs further research.

Objective: To investigate the long-term efficacy and prognostic factors of pediatric relapsed Wilms tumor (WT) after retreatment. Method: Sixteen children in Shanghai Children′s Medical Center with relapsed Wilms tumor were enrolled consecutively in this study between April 2006 and June 2016. All patients were diagnosed according to pathology, imaging and medical and surgical oncologist′s assistance. Relapse treatment included surgical excision, chemotherapy and selective radiation therapy. The clinical features, long-term outcomes and prognostic factors of patients were analyzed retrospectively.Survival data were analyzed by Kaplan-Meier.Log-Rank analysis was used for univariate analysis. Result: One case was excluded because of giving up the therapy even though no disease progress was identified. A total of 15 cases (5 males and 10 females) were included in this study. The median age at diagnosis was 3.8 years (range 0.5-9.1 years). The tumor staging at diagnosis included one case of stageⅠ, 7 cases of stageⅡand 7 cases of stage Ⅲ. Among cases of stage Ⅲ, 6 cases had radiation therapy history. The pathology of all patients′ recurrent tumor was favorable histology (FH). The median follow-up time was 34.6 months (range 12.5-132.7 months) until March 21, 2017. The time from initial diagnosis to relapse was 7.9 months (range 3.1-17.9 months). Four cases experienced local recurrence, 9 cases relapsed with metastases (6 cases in lungs, 2 in livers, 1 in mediastinum) and 2 cases relapsed in both local site and with metastases. Except to 2 cases received irregular retreatment, 13 cases received regimen I (doxorubicin, vincristine, epoposide and cyclophosphamide for 25 weeks) as relapsed chemotherapy. Five cases received autologous bone marrow transplantation (ABMT). Until the last follow-up, 8 cases achieved continuous complete remission (range 6.7-104.3 months), 3 cases had relapse again or progressing and 4 cases died. The estimated 5-year overall survival (OS) rate and event free survival (EFS) rate were (70±15)% and (52±15)%. According to whether received ABMT or not, the 5-year EFS rate were 51% and 53%. According to whether relapsed within 6 months after diagnosis or not, the 5-year EFS rate were 38% and 56% respectively. Conclusion The 5-year EFS rate of pediatric relapsed FH WT have reached above 50% by multi-disciplinary treatment in our experience and we encourage patients and doctors to receive retreatment.

Objective: To assess the clinical features and long-term outcomes of neuroblastoma (NB) in children less than 18 months of age, so as to provide evidence for further improvement of treatment. Method: Clinical data(sex, age, stage, risk group, treatment response, follow-up, etc.) of 155 NB patients under age of 18 months from June 2000 to December 2015 in Shanghai Children′s Medical Center were analyzed retrospectively. The clinical features were summarized and the long-term follow-up results were evaluated. The overall survival (OS) and event-free survival (EFS) were analyzed by using Kaplan-Meier method. Factors including age, stage, risk group, bone marrow and bone metastasis, N-MYC status and dehydrogenase(LDH) level were analyzed by Log-Rank test. Result: Totally 155 eligible patients (96 males, 59 females) were included. The median age of disease onset was 7 months (11 days to 18 months). There were 31 cases of stage 1, 19 cases of stage 2, 45 cases of stage 3, 38 cases of stage 4 and 21 cases of stage 4S. The median follow-up time was 36 months (range 4 to 189 months), the 3-year and 5-year EFS rate were 89.6% and 85.2% respectively and the 3-year and 5-year OS rate were 96.2% and 94.1%, respectively. A total of 15 recurrent or progressed cases were observed. The median time to first recurrence was 11 months (range 3 to 39 months), 6 cases eventually died. Second malignancy occurred in one patient. The patients who had relapsed disease within 12 months from initial diagnosis have much lower 3-year OS rate than those in whom the disease recurred 12 months later (25.7% vs. 83.3%, P=0.020). Although the number of chemotherapy courses in median-high risk group reduced from 8.6 courses to 7.5 courses after the revision in 2008, the survival rate showed no significant difference between before and after (5-year EFS 74.4% vs. 84.3%, 5-year OS 89.0% vs. 92.9%, both P>0.05). In patients with stage 1 and stage 2, the 3-year EFS of 34 cases with surgery alone and 16 cases accepted chemotherapy were both 100%. Age at diagnosis, stage, risk group, MYCN status, LDH level, bone marrow involvement and bone infiltration had significant impacts on prognosis(all P<0.05). Conclusion Satisfactory outcomes could be achieved in neuroblastoma in children aged within 18 months; the prognosis was better in children at age less than 12 months compared with 12-18 months. MYCN amplification, LDH more than 5 times upper limit of normal range, bone marrow and bone infiltration were associated with worse prognosis.Excellent survival rates could be achieved in children with stage 1 and 2 disease within 18 month′s old accepted surgery alone, chemotherapy or radiotherapy could be avoided in these patients so as to reduce long-term adverse reactions.

Objective To analyze the clinical characteristics and prognosis of rare soft tissue sarcomas.Method Clinical data of 51 patients with rare soft tissue sarcomas including fibrosarcoma,synovial sarcoma,extrarenal rhabdoid tumor,alveolar soft part sarcoma,desmoplastic small round cell tumor and undifferentiated sarcoma in children and adolescents,diagnosed at Shanghai Children's Medical Center from June 1998 to December 2013,were retrospectively analyzed.All types were treated with the same strategy and chemotherapy regimens.Their clinical features,treatment and prognosis were discussed.Result Seventeen patients with fibrosarcoma,10 with synovial sarcoma,9 with extrarenal rhabdoid tumor,6 with alveolar soft part sarcoma,3 with desmoplastic small round cell tumor and 6 with undifferentiated sarcoma were included.The mean age at initial diagnosis was 5 years(range from 1 month to 13.5 years).The most common primary site of tumors was limbs,followed by the thoracic and abdominal cavity,accounting for 41％ and 24％ respectively.Twelve cases presented distant tissue or organ involvement in which bone metastases occupied the first place.Seven cases(accounting for 14％)were at stage Ⅰ,13 cases were at stage Ⅱ (accounting for 25％),19 cases were at stage Ⅲ (accounting for 37％) and 12 cases were at stage Ⅳ (accounting for 24％).The median follow-up period was 36 months(range from 1 month to 123 months).Forty-four patients achieved complete remission and 3 patients achieved partial remission after initial treatment,the overall response rate was 92％.Subsequent follow-up showed 29 patients remained relapse-free while 13 patients had relapsed disease.Overall survival and event-free survival at 2 years were 88％ and 57％.Postoperative surgical staging was the main prognostic factors.Patients with stage Ⅲ + Ⅳ had poorer results than those with Ⅰ + Ⅱ (x2 =4.909,P =0.027).Conclusion These 6 types of soft tissue sarcomas are rare in children and adolescents.The tumor can occur anywhere in the body but commonly presents in the extremities.Complete resection of tumor remains the most important modality of treatment and is directly related to prognosis.Neoadjuvant chemotherapy helps improve the resection rate of some unresectable tumors at diagnosis.Radiation therapy is primarily adopted for focal tumor control.

Objective To compare the treatment accomplishmentsand adverse effects of the mixed- or single-application of etomidate and propofol during modified electroconvulsive therapy (MECT) in schizophrenics with hypertension. Methods Ninety hospitalized schizophrenics with hypertension undergoing MECT were ran-domly assigned to 3 groups: Group EP(etomidate = 0.3 mg/kg and propofol = 1.0 mg/kg), Group E (etomi-date = 0.7 mg/kg) and Group P (propofol = 2.0 mg/kg). Changes of SBP, DBP and HR were recorded before anesthesia, after induction, electrical stimulation instantly and 5 min after electrical stimulation. The average pe-riods of epileptic seizure (ESD), postictal suppression index (PSI) and the adverse reactions were also recorded. Results The ESD and PSI scores were significantly higher in Group EP and Group E than those in Group P (P < 0.05). SBP and DBP in Group E were significantly higher at the electrical stimulation instant than those af-ter induction (P < 0.05). SBP and DBP in Group P were significantly lower after induction than those before anesthesia(P < 0.05). The injection pain of Group EP and Group E were lower than that of Group P(P < 0.05). No significant differences were found among 3 groups in the adverse reactions such as nausea/vomiting anddys-phoria.Conclusion The mixed liquor of etomidate and propofol can extend the time of seizure, reduce the nega-tive reaction of cardiovascular system and adverse reactions during MECT in schizophrenics with hypertension.

Objective To compare the biomechanical pull-out strength (POS) of three different fixations in upper thoracic vertebras using translaminar screws (TLS), translaminar facet screws (TLFS), and transpedicle screws (TPS), respectively. Methods Nine fresh human cadaveric cervicothoracic junction spines specimens which including T1-T3 vertebras were harvested. The vertebras specimens were scanned using dual-energy radiograph absorptiometry for bone mineral density. Both of screw insertion techniques at each vertebrae was randomized. All the screw insertions were based on direct observation and the CT scan on the pedicles. The peak of insertional torque (IT) was recorded and axial pull-out testing was performed to simulate intraoperative failure of fixation. Results The mean peak IT of the TFLS, TPS and TLS were (0.43±0.01), (0.40±0.01), (0.35±).01) N·m, respectively. There was no statistically significant difference between the TFLS and TPS, and between the TPS and TLS was same. But the TFLS generated statistically greater peak 1T in comparison with the TLS(t=-13.86, P＜0.05). The mean POS of TLFS was (771±106) N,which had no statistically significant difference in comparison with the TPS(733±65) N. And the TLS (663±86) N was same. But the TFLS generated statistically greater POS in comparison with the TLS (t=9.907, P＜0.05). The peak IT showed a strong positive correlation with POS in three screw techniques. Bone mineral density correlation with POS in all methods of fixation. Conclusion It was not a significant difference to compare POS of TLS and TLFS to that of TPS respectively. TLS and TLFS appear to be a biomechanically sound alternative in the upper thoracic spine, and appear to be a safe and effective technique for instrumenting the upper thoracic spine.