The second edition of the expert consensus on pediatric nutrition was formed based on a global update of pediatric nutrition guidelines or consensus worldwide, the management of congenital heart disease, and the results of multi-center clinical nutrition research for congenital heart disease following the first Chinese consensus edition of 2016. The consensus was also shaped by the results of three discussion sessions and two questionnaires conducted by the 13-member collaboration group. This process was informed by both clinical guidelines and expert consensus. The quality of literature, both in English and Chinese, and the level of recommendations were evaluated using the Grading of Recommendations Assessment, Development, and Evaluations (GRADE) system.
Objective:To explore the association between serum level of alpha-fetoprotein (AFP) at the end of first-line therapy and the prognosis of patients with hepatoblastoma (HB).Methods:From December 2007 to May 2022, the relevant clinical data were retrospectively reviewed for 72 HB patients aged under 18 year. There were 42 boys and 30 girls with a median diagnostic age at 27.8(0.3-150.3) month. And 69.4% of them were aged under 3 year. All of them completed a first-line therapy after a definite diagnosis. Two major outcome parameters were event-free survival (EFS) and overall survival (OS). Chi-square test, survival analysis and COX proportional hazards model were utilized for evaluating the risk factors of prognosis of HB patients.Results:Two, 14, 25 and 31 patients were classified into very-low-risk, low-risk, median-risk and high-risk groups. After a first-line therapy, 46/72 patients (63.9%) had serum level of AFP ≤10 ng/ml and 55/72 patients (76.4%) achieved complete remission (CR) as evaluated by imaging. Recurrence rate in individuals with AFP >10 ng/ml was significantly higher than those with AFP ≤10 ng/ml (65.4% vs 15.2%), 3-year event-free survival (3yr-EFS) was 31.4% and 80.7% ( P<0.01) and overall survival (OS) 63.0% and 96.6% ( P<0.01). For CR cases, 3yr-EFS/OS was higher among individuals with AFP≤10 ng/ml than those with AFP >10 ng/ml. Even without CR, 3yr-EFS was considerably higher in AFP ≤10 ng/ml group. Multivariate analysis indicated that AFP >10 ng/ml after a first-line therapy was an independent predictor. Conclusion:The prognosis of HB patients without serum AFP≤10 ng/ml after a first-line therapy remains poor and treatment should be intensified.
Currarino syndrome (CS) is a rare congenital malformation characterized by three major clinical features of sacral agenesis, anorectal malformations and presacral mass.It can be divided into complete, mild and minimal CS according to clinical features.Besides the above triad, some patients may suffer from some abnormalities of multi-systems.MNX1 gene is closely correlated with the disease.The authors searched and collected the clinical and genotypic profiles of 297 mutation carriers.A total of 145 different MNX1 pathogenic variants related to CS have been reported in the literature so far.And patient phenotypes and clinical characteristics were recorded.No significant correlation existed between CS type and the location of mutation sites.However, chromosomal variation such as microdeletion of MNX1 gene coded for more serious phenotype.The distribution of mutation sites was concentrated in coding region of the homeodomain in MNX1.Mutations within homeodomain may alter DNA binding specificity.Furthermore, a rare homozygous mutation carrier of MNX1 hinted at a priority for islet function in CS patients.Different phenotypes of individuals carrying the same mutation within the same family may implicate the involvements of other regulators in the pathogenic mechanism.A new clue was detected for candidate genes in CS pathogenesis through enrichment analysis of 491 proteins interacting with MNX1 in early human embryonic developmental process.More attention should be devoted to the developments of pancreas, sensory organs and reproductive structures.
Biliary atresia (BA) refers to a cholestatic disease involving intrahepatic and extrahepatic bile ducts.Its etiology has remained elusive.Kasai operation and liver transplantation are sequential treatments.Eventually BA children die from end-stage liver diseases under an age of 2 years if not treated promptly.They tend to require comprehensive postoperative managements, including standardized vaccination.Yet there is an ongoing controversy on the specific implementations.Therefore this review focused upon current vaccination efforts and summarized expert recommendations to provide rationales for standardized postoperative vaccination of BA children.
Objective:To explore the clinical features of accessory spleen in hereditary spherocytosis (HS) and track the prognosis of children with residual accessory spleen after splenectomy to improve the diagnosis and treatment of HS.Methods:The relevant clinical data were retrospectively reviewed for 54 HS children undergoing splenectomy from January 2017 to December 2021.There were 30 boys and 24 girls with an average operative age of (8.2±3.5) years.The imaging data and clinical characteristics of accessory spleen were recorded.The prognosis was evaluated by either telephone or WeChat, including postoperative severe infection and recurrence of hemolytic anemia.The followed-up results of children with residual accessory spleen were also analyzed.Results:Accessory spleen was detected by preoperative examination in 26(26/54, 48.1%) children, including 4(4/26, 15.4%) in splenic hilum.There were 16, 6 and 3 cases with 1, 2 and 3 accessory spleens respectively.A total of 37 accessory spleens were identified, predominantly in splenic hilum (30/37, 81.1%) and ienocolic ligament (5/37, 13.5%). Fifty children (50/54, 92.6%) were followed up with an average time of 2.8(1.5, 3.6) years and an average age of (11.1±3.4) years.One child (1/50, 2.0%) developed severe infections twice post-splenectomy.Seven cases (7/54, 13.0%) had residual accessory spleen post-splenectomy and were followed up with an average time of (3.7±0.9) years.No accessory spleen was found in 4 children during splenectomy.Accessory spleen was found in 1 child during operation but was not removed.Indirect bilirubin continued rising within 3 years post-splenectomy with an expanding volume of residual accessory spleen and another accessory spleen was found by ultrasound at 3 years post-splenectomy.However, bilirubin and accessory spleens stabilized after 3 to 5 years of follow-up.The remainders with residual accessory spleen were followed up without severe infection or recurrence of hemolytic anemia.Conclusions:Accessory spleen is prevalent in HS and it predominates in splenic hilum.A preoperative diagnosis of accessory spleen is rather challenging, requiring careful explorations and a complete removal.Jaundice after splenectomy in HS should be on a high alert for accessory spleen residue.Children with residual accessory spleen may have an immediate postoperative onset of hemolysis without anemia.Regular follow-ups are required.
Objective:To explore the clinical efficacy of progressive individualized options for esophageal stenosis (ES) in children.Methods:From January 2017 to December 2022, retrospective review was conducted for 106 ES children with regular follow-ups.There were 59 boys and 47 girls with an age range of (3.00±0.75) year and a body weight of (9.00±1.25) kg.The causes were anastomotic (n=58), corrosive (n=47) and congenital (n=1). Sequential treatments of direct balloon dilation under gastroscope, submucosal injection of drugs into esophagus, esophageal stenting and surgical procedures were applied.After interventions, degree of ES was observed by esophagography and gastroscopy along with dysphagia grade for evaluating clinical efficacy.Differences were compared by t or χ2 test. Results:All of them were discharged uneventfully.After balloon dilatation, the outcomes were excellent under direct gastroscopic view alone (n=55). Among 35 children with balloon dilation plus esophageal submucosal drug injection, the outcomes were excellent (n=25) and esophageal stenting (n=10). Among 25 children with esophageal stenting, the outcomes were excellent (n=21) and additional surgery (n=4). Surgical procedures were performed with excellent outcomes (n=5).Conclusions:The clinical outcomes progressive individualized options of direct visualization balloon dilation under gastroscope, balloon dilation plus submucosal injection of drugs into esophagus, esophageal stenting and surgical procedure are precise, convenient and efficacious for ES in children.
Objective:To explore the clinical characteristics and treatment outcomes of lower tibial fracture plus proximal fibula fracture in children.Methods:The clinical and radiological data were retrospectively reviewed for 9 children with lower tibial fracture plus proximal fibula fracture from January 2015 to December 2020.There were 5 boys and 4 girls with an average age of 9.7 years.The mechanism of injury included traffic accident (n=3) and sports activities (n=6). The specific fractures were closed (n=8) and open (n=1). Missed diagnosis was detected in 2 cases, including peroneal nerve injury (n=1). There were lower one-third diaphyseal fracture of tibia (n=8) and tibial shaft fracture plus distal tibial epiphysis fracture (n=1). On radiograph, tibial fracture line was oblique with high outside and low inside.Except for greenstick fractures (n=3), racture line of fibula was high anterolaterally and low posteromedially (n=6). Radiography was performed for evaluating the status of reduction and healing.And Johner-Wruh's criteria were applied for evaluating the clinical outcomes during postoperative follow-ups.Results:The procedures included cast fixation (n=4) and surgery for tibia with internal fixation (n=5). The latter included intramedullary nailing (n=4) and intramedullary nailing plus Kirschner wire (n=1). Cast immobilization was performed for fibula fracture.The mean follow-up period was 16.7(12-24) months.All fibula and tibial fractures healed without wound infection, fracture re-displacement or osteofascial compartment syndrome.The symptoms of peroneal nerve injury disappeared at Month 2 post-injury.At the last follow-up, according to the Johner-Wruh criteria of tibial fracture evaluation, the outcomes were excellent (n=8) and decent (n=1).Conclusions:In children with oblique fracture of lower tibia, proximal fibular fracture mayt be missed.Meticulous physical examinations and proper selections of appropriate radiographic sites should be performed to minimize its occurrence.Restoring alignment and stabilizing tibial fracture is a major therapeutic goal.Surgical fixation is generally not required for proximal fibula fractures.
Objective:To summarize the management experiences and follow-up outcomes of persistent fifth aortic arch (PFAA) cases and to explore their anatomical characteristics and surgical approaches for optimal outcomes.Methods:From January 2017 to December 2022, retrospective review was performed for 5 children hospitalized with systemic-systemic type PFAA.There were 2 boys and 3 girls.A definite diagnosis was made by computed tomography angiography (CTA) in neonatal period.There were coarctation of the fifth aortic arch with interruption of the fourth aortic arch (n=4) and double-lumen aortic arch without stenosis (n=1). None had serious intracardiac malformation.Clinical features, imaging studies and surgical approaches were examined.Results:Two cases underwent two different kinds of surgical methods to reconstruct aorta.One case was followed up for over 4 years without stenosis and another case of restenosis at 6 months postoperatively underwent percutaneous balloon dilatation.One girl of chromosomal abnormality died after declining treatments.One case complicated with complex variation of aorta and its branches became lost during follow-ups.The anatomical combination of right PFAA with interruption of right fourth aortic arch, aberrant left subclavian artery and Kommerell diverticulum at the stump of left arch has not been reported in the literature.Conclusions:CTA is the most effective non-invasive diagnostic tool for PFAA.In light of the histological characteristics of PFAA, tissue of fifth arch should be removed as completely as possible to prevent postoperative restenosis.
Objective:To explore the effect of miR-20a-5p on the growth of neuroblastoma SH-SY5Y and SK-N-BE cells transplanted tumors in nude mice and to elucidate the possible regulatory mechanisms.Methods:SK-N-BE and SH-SY5Y cells were divided into original cell, negative control and miR-20a-5p overexpression groups.They were SK-N-BE, SK-N-BE-miR-20a-5p-NC, SK-N-BE-miR-20a-5p overexpression, SH-SY5Y, SH-SY5Y-miR-20a-5p-NC and SH-SY5Y-miR-20a-5p overexpression groups.Twenty-four BALB/c nude mice were randomized into six groups.Different subgroups of two cell lines were inoculated subcutaneously in right axilla of nude mice.Successful tumor formation was determined when tumor size reached 100 mm 3 in SK-N-BE/SH-SY5Y group.When average diameter of tumor block did not exceed 15 mm, blood sample was harvested and nude mice were euthanized for measuring the value of tumor volume/mass.miR-20a-5p miRNA content and NFKBIB (IKBβ) and NF-κB mRNA content in each group were measured by quantitative real-time polymerase chain reaction (RT-qPCR). Results:In SK-N-BE/SH-SY5Y cell lines, tumor volume and mass of miR-20a-5p overexpression group spiked markedly as compared with original cell line group ( P<0.05); No significant difference existed in tumor volume or mass between negative control and original cell line groups ( P>0.05). RT-qPCR results indicated that, in two cell lines, miR-20a-5p miRNA, NF-κB mRNA in miR-20a-5p overexpression group rose significantly as compared with original cell line group while the expression of NFKBIB mRNA dropped markedly ( P<0.05); MiR-20a-5p miRNA, NFKBIB and NF-κB spiked in negative control group as compared with original cell line group.No significant difference existed in mRNA content ( P>0.05). Western blot implied that, in two cell lines, comparing miR-20a-5p overexpression and original cell line groups, relative expression level of NF-κB protein rose obviously while relative expression level of NFKBIB protein declined with statistical significance ( P<0.05); No statistically significant inter-group difference existed in the relative expression level of NFKBIB/NF-κB protein ( P>0.05). Conclusions:miR-20a-5p may activate NF-κB through blunting the expression of NFKBIB.The pathway further promotes the growth of SK-N-BE/SH-SY5Y cells in nude mice.It may be utilized as a potential interventional therapeutic target for neuroblastoma.
Objective:To explore the effect of early heparin anticoagulation on D-dimer of blood coagulation parameters in young and low-birth-weight congenital heart disease (CHD) after cardiopulmonary bypass (CPB).Methods:From December 2019 to December 2021, the relevant clinical data were retrospectively reviewed for 102 children undergoing CPB-assisted open-heart surgery for CHD at Shanxi Children's Hospital.There were 57 boys and 45 girls.Based upon an injection of heparin or not, they were assigned into two groups of observation (5 U·kg -1·h -1 low-dose heparin dosing) and control (non-heparin dosing). Fifty-four children in observation group were (119.81±66.90) day in age and (5.4±1.1) kg in weight.And 48 children in control group were (138.00±67.67) day in age and (5.65±1.31) kg in weight.Coagulation functions of two groups were detected preoperatively, postoperatively (admission into CCU), before medication (before heparin on the next day post-operation) and after medication (24h after heparin dosing). The change trends of D-dimer of coagulation function and the difference were observed between two groups.Pearson χ2 test was utilized for counting data and t-test or Wilcoxon two-sample rank sum test for measurement data. Results:No significant inter-group differences existed in gender, age or weight ( P>0.05). No significant inter-group differences in D-dimer distribution pre/postoperatively or before medication ( P>0.05); After medication, D-dimer was significantly lower in observation group than that in control group and the difference was statistically significant ( Z=-2.21, P=0.027). The inter-group change of D-dimer after and before medication was statistically significant ( Z=-2.17, P=0.030). In observation group, D-dimer level continued rising pre/postoperatively and before medication and the difference was statistically significant ( P<0.05); No significant difference existed between before and after medication ( Z=-0.33, P=0.740). The difference was statistically significant after medication and post-operation ( Z=-3.41, P=0.001). The difference of D-dimer was statistically significant after medication as compared with that preoperatively ( Z=-3.06, P=0.002). It was still higher than that pre-operation.In control group, D-dimer continued rising from preoperative to after medication and statistically significant differences existed in D-dimer during each period ( P<0.05). Conclusions:Early use of low-dose heparin anticoagulant therapy after CPB can relieve the coagulation dysfunction caused by CPB, and is conducive to the prevention of postoperative thrombosis and DIC.
Objective:To explore the effect of PHB on autophagy and cisplatin sensitivity in hypoxia-induced neuroblastoma.Methods:SH-SY5Y and SK-N-SH cells were cultured in vitro and logarithmically grown for subsequent experiments.Both sh-NC and sh-PHB were transfected into cells and successful transfection was verified by real-time quantitative polymerase chain reaction (RT-qPCR). After hypoxia treatment, cells were treated with different doses of cisplatin (0/5/10/25/50/100 μM). CCK-8 kit was employed for detecting cell viability.The protein expression levels of Beclin1, LCII/LCI, Bax, Bcl-2 and caspase-3 in cells were detected by Western blot.And apoptosis was examined by flow cytometry.And SPSS 22.0 software package was utilized for one-way analysis of variance or Student's t test.And P<0.05 was deemed as statistically significant. Results:As compared with control group, both RT-qPCR and Western blot indicated that the expression level of PHB was significantly up-regulated in hypoxia-induced SH-SY5Y/SK-N-SH cells.Successful transfection was confirmed by RT-qPCR.Western blot indicated that the expression level of Beclin1 and LC3II/LC3I ratio were significantly up-regulated in hypoxia group as compared with control group.However, the expression level of Beclin1 and LC3II/LC3I ratio declined markedly in hypoxia+ sh-PHB group as compared with hypoxia+ sh-NC group.In addition, CCK-8 assay indicated a marked decline of cell activity after cisplatin dosing in hypoxia+ sh-PHB group versus hypoxia+ sh-NC group.Flow cytometry hinted that apoptotic level spiked markedly in hypoxia+ sh-PHB+ cisplatin group as compared with hypoxia+ sh-NC+ cisplatin group.And Western blot revealed that the expression levels of caspase-3 and Bax were significantly up-regulated while the expression level of Bcl-2 dropped in hypoxia+ sh-PHB+ cisplatin group as compared with hypoxia+ sh-NC+ cisplatin group.Conclusions:Silencing PHB may suppress hypoxia-induced autophagy and boost the sensitivity of cisplatin chemotherapy in neuroblastoma.
Objective:To summarize the major causes of death for congenital omphalocele so as to optimize its treatments in children.Methods:Retrospective review was performed for the clinical data of 15 children dying from omphalocele from June 2015 to June 2022.There were 8 boys and 7 girls.Term was premature (n=5) and mature (n=10). Gestational week, gender, weight, somatotype, complicated malformations and causes were analyzed.Results:Size was giant (n=13) and small (n=2). The associated conditions were pulmonary hypertension (n=13), patent ductus arteriosus (n=13), atrial septal defect (n=15), ventricular septal defect (n=9), congenital diaphragmatic hernia (n=1), non-compaction of ventricular myocardium, bronchopulmonary dysplasia (n=4), Merkel's diverticulum (n=3) and congenital intestinal malrotation (n=9). Neonatal necrotizing enterocolitis (n=1), respiratory syncytial virus infection (n=2) and pneumorrhagia (n=2) occurred during treatment.Eight deaths were due to pulmonary hypertension.Two cases were abandoned due to complicated malformations, one death occurred without repairing congenital diaphragmatic hernia, two deaths were caused by respiratory syncytial virus infection, one child died from heart failure due to non-compaction of ventricular myocardium and another from heart failure after double-outlet RV surgery.Conclusions:Children with congenital omphalocele may die from various causes.And pulmonary hypertension is a major cause.Other diseases and complications should be aggressively managed during hospitalization.
Objective:To summarize the surgical experiences and follow-up results of different surgical approaches for interrupted aortic arch (IAA) and to optimize surgical planning.Methods:From October 2012 to September 2020, 53 IAA children aged under 1 year were selected as study subjects.The concurrent conditions included ventricular septal defect (VSD, n=41), subaortic membrane and severe stenosis, parachute mitral valve & intramitral annulus (n=1), main aorta-pulmonary window (APW, n=6), common arterial trunk (n=1), complete atrial ventricular septal defect (n=1), double outlet of right ventricle & abnormal origin of coronary artery (n=1) and bicuspid aortic valve (n=1). Primary anatomical correction (n=52) and staged surgery (n=1) were performed.The procedures included end-to-end anastomosis of descending aorta & proximal aortic arch (n=8), extended end-to-side anastomosis of descending aorta & proximal aortic arch (n=28), extended end-to-side anastomosis of descending aorta and proximal aortic arch + bovine pericardial patch widened anterior wall of aortic arch (n=12), left subclavian artery inversion and direct anastomosis of descending aorta (n=2) and extended end-to-side anastomosis of descending aorta and proximal aortic arch and widening of anterior aortic wall with pulmonary vascular patch (n=3). The parameters of delayed sternal closure time, postoperative mortality and restenoticc rate were statistically analyzed with SPSS 22.0.Results:The outcomes were survival (n=48), death (n=5) and delayed thoracic closure (n=26). Two postoperative children underwent extracorporeal membrane oxygenation (ECMO) assisted circulation due to low cardiac output syndrome.One case of postoperative cardiac tamponade underwent emergency thoracotomy for hemostasis; Staphylococcus aureus was detected in blood culture of 1 child and cure obtained after antibiotic dosing of imipenem and vancomycin.In another case, chylothorax disappeared after a combination of fasting and with parenteral nutrition.One child developed postoperative convulsions and cranial MRI hinted at hypoxic-ischemic encephalopathy.After intensive nutrition and rehabilitation, he was discharged after improvements.One child underwent percutaneous balloon dilation of aortic arch with a pressure difference of 86 mmHg(1 mmHg=0.133 kPa) at 1 year postoperatively.And others were followed up with a pressure difference of <30 mmHg for 1 year.Conclusions:Upon a definite diagnosis of IAA, early surgical intervention is mandatory.Proper surgical approaches should be based upon the location, extent and associated intracardiac abnormalities.Surgical intervention is indicated for such chronic conditions as subaortic membrane formation and left ventricular outflow obstruction.
Objective:To summarize the outcomes of neurologic development disorders after surgery with selective cerebral perfusion (SCP) in children of aortic arch malformations (including coarctation of aorta & interruption of aortic arch).Methods:From May 2019 to June 2021, the relevant clinical data were retrospectively reviewed for 58 children operated for aortic arch malformation.According to whether or not SCP was applied, they were assigned into two groups of SCP (n=22) and circulatory arrest (n=11). Basic profiles of age, gender, weight, clinical manifestations, hospitalization stay, intraoperative bypass duration, aortic occlusion duration, postoperative blood levels of lactate & procalcitonin and postoperative complications were retrospectively reviewed.Thirty-three of them underwent cranial magnetic resonance imaging (MRI). Griffiths mental development assessment score (GDS-C) was assessed at 1 year postoperatively.It was expressed as developmental quotient (DQ). DQ values between two groups were compared by independent t-test.Results:There were 34 boys and 24 girls with an age range of (1-2 052) day.They were followed up for 1 to 3 years after discharge and weighting from 2.5 to 21.4 kg.Postoperative lactate value was (2.41±1.08) mmol/l and (3.19±1.22) mmol/l in SCP and circulatory arrest groups respectively ( P<0.05). GDS-C test results indicated that average DQ scores of hand-eye coordination energy area was (94.51±14.53) and (81.95±18.16) in SCP and circulatory arrest groups respectively ( P<0.05). However, scores of DQ in sports, personal-social, hearing and language areas were higher in SCP group than those in circulatory arrest group.The differences were not statistically significant.The percentage of individuals with DQ ≥70 in hearing and language areas was equal in two groups.However, percentage ratio in other areas was higher in SCP group than that in circulatory arrest group. Conclusions:Mild hypothermia with SCP may be applied with fewer neurological complications.As a feasible, safe and effective cerebral protection measure, SCP provides effective cerebral perfusion and reduces the risk of central nervous system complications due to cerebral ischemia of traditional arch surgery in children.
Objective:To systematically review the safety and feasibility of perioperative application of enhanced recovery after surgery (ERAS) for children with congenital choledochal cyst.Methods:The literatures about the application of ERAS in pediatric congenital choledochal cyst were searched in Chinese and English databases including Wanfang Medical Network, CNKI, PubMed, Web of Science and EBSCO.Only Chinese and English literatures were searched from January 1, 2000 to August 31, 2021.English and Chinese keywords included enhanced recovery after surgery, fast track surgery, ERAS, FTS, choledochal cysts, choledochocyst, bile duct cyst, biliary dilatation and surgery.Two researchers were selected to complete data entry, including case load, perioperative interventional measures, initial postoperative exhaust and defecation time, postoperative length of stay and complications.Meta-analysis was performed with Stata 13.0 software.And I2 test was utilized for examining the heterogeneity between the eligible studies.And fixed/random-effect model was employed according to the test results.Publication bias was assessed by Begg's test.Sensitivity analysis was performed for initial postoperative defecation time and postoperative hospitalization stay.Results:Seven articles with a total of 478 cases were retrieved.As compared with conventional group, ERAS group had significantly shorter initial postoperative defecation (SMD=1.19, 95% CI: 0.86-1.52, P<0.001) and postoperative length of hospitalization stay (SMD=1.97, 95% CI: 1.55-2.38, P<0.001). ERAS group had a lower incidence of postoperative incision infection ( OR=0.32, 95% CI: 0.10-0.98, P<0.05), postoperative anastomotic leakage ( OR=0.16, 95% CI: 0.03-0.91, P<0.05) and postoperative respiratory tract infection ( OR=0.19, 95% CI: 0.06-0.60, P<0.05). Conclusions:For children with choledochal cyst, application of ERAS concept in perioperative period is both safe and feasible.It may accelerate the recovery of postoperative intestinal function, shorten postoperative length of stay and lower the occurrence of postoperative complications.
Congenital tracheal stenosis (CTS) is a rare congenital malformation.And 69% of CTS children also suffer from congenital heart diseases (CHDs). Proper management of dual malformations has been a focus of clinical attention.With a rapid pace of technical development, the diagnosis and treatment of such patients have also changed.This systematic review summarized the diagnosis and treatment of CHD children with CTS.It was intended to provide clinical references and assist cardiothoracic surgeons in the proper management of CTS.
As a progressive, idiopathic and fibrous occlusive bile duct disease with a poor prognosis, biliary atresia (BA) poses a serious risk to the survival.The underlying cause of BA has remained unknown.A gold standard for diagnosing BA is invasive intraoperative cholangiography.Diagnostic and prognostic tools with a high level of sensitivity and specificity and convenient handling are urgently needed in clinical practices.The diagnostic values of bilirubin, matrix metalloproteinase-7 and γ-glutamyl transpeptidase for BA have been widely recognized.However, the relationship between such emerging serological tests as interleukin-3, β-amyloid, autotaxin, micro-RNA, M2BPGi, growth factors and diagnosis, hepatic fibrosis and native liver survival should be further examined.This review summarized the relevant literatures from three aspects of serological test parameters related to BA diagnosing, liver fibrosis and native liver survival after Kasai surgery to provide clinical rationales for properly managing BA.
With no obvious clinical symptoms, testicular microlithiasis (TM) is frequently detected during routine physical examination or consultations of other diseases.Adult TM is correlated with testicular tumors and male infertility.And it appears in a growing number of children, especially those with cryptorchidism.This review summarized the latest researches on the correlation between TM and cryptorchidism in children to provide references for clinical practices.
