BACKGROUND:Vacuum bell therapy is increasingly used as a nonoperative treatment for pectus excavatum (PE). However, whether this intervention induces subcutaneous fat thickening and the mechanisms underlying such changes remain uncertain. This study aimed to quantify vacuum bell-associated adipose tissue changes and clarify their clinical implications. METHODS:Patients with PE treated with vacuum bell therapy at our center between July 2022 and January 2024 underwent low-dose chest computed tomography at treatment initiation and after one year of therapy. Measured parameters included the Haller index (HI), correction index, anterior and lateral chest wall subcutaneous fat thickness, skeletal depression depth (SkD), and surface depression depth (SuD). The fat influence rate (FIR) was calculated to quantify device-related adipogenesis stimulation. Multiple regression analysis was performed to identify factors associated with changes in anterior chest wall fat thickness. RESULTS:Forty-seven patients were included, with a median age of 7.0 years (range: 1-14). The mean HI decreased from 3.6 ± 0.7 to 3.2 ± 0.5, with improvement observed in 35 patients (74.5%). Anterior chest wall fat thickness increased in 45 patients (95.7%), rising from 4.0 ± 2.1 mm to 7.6 ± 3.3 mm. The mean FIR was 95% (IQR: 39%). Improvement in surface depression (4.0 ± 3.3 mm) exceeded skeletal improvement (1.4 ± 3.8 mm), and no predictors reached statistical significance in regression analysis. CONCLUSIONS:Vacuum bell therapy is effective and induces substantial anterior chest wall fat thickening, indicating that cosmetic improvement results from a dual mechanism involving skeletal remodeling and adipose thickening. LEVEL OF EVIDENCE:Level III.

The objective of this study was to summarize the clinical characteristics and surgical outcomes of pediatric patients with primary spontaneous pneumothorax (PSP) treated by thoracoscopic surgery at a single center. Additionally, we aimed to identify risk factors for postoperative recurrence. We retrospectively collected data from patients who underwent thoracoscopic surgery for PSP at the Department of Thoracic Surgery at Beijing Children's Hospital from March 2018 to March 2024. All patients underwent thoracoscopic wedge resection and pleurodesis. Based on Vanderschueren classification, we recorded intraoperative findings in the lung apices. Kaplan–Meier curves were used to assess postoperative recurrence trends over time. The log-rank test was used for univariate analysis, and the statistically significant factors in the univariate analysis were selected for further analysis in the multifactorial Cox regression model to explore the risk factors affecting postoperative recurrence in patients with PSP. A total of 90 cases of PSP were recorded during the study period and 63 cases of PSP were included in the study. The median age was 15.0 years, and male to female ratio was about 3:1. A total of 30 (30/63) patients had history of contralateral pneumothorax, 15 (15/63) had history of minimally invasive repair of pectus excavatum, and 6 (6/63) had Marfan's syndrome. All patients were treated with thoracoscopic pulmonary wedge resection and pleurodesis and were followed regularly after surgery. The K–Meier curve showed a declining trend in the first 2 years after surgery. Univariate analysis showed that gender, age, history of minimally invasive repair of pectus excavatum, history of contralateral pneumothorax, Marfan syndrome and Vanderschueren classification were significant risk factors for postoperative recurrence. Cox analysis demonstrated that male sex (HR = 5.25, p = 0.02, 95

Objective This study aims to translate the Pectus Excavatum Evaluation Questionnaire(PEEQ) into Chinese, and to comprehensively assess subjective outcomes in quality of life of children with pectus excavatum. Methods The PEEQ was translated from English to Chinese as according to the PRO translation guidelines. Structural validity and reliability of the questionnaire were examined by validated factor analysis and Cronbach’s alpha coefficient analysis respectively. Results The results of the validation factor analysis for the Chinese PEEQ parent’s and child’s questionnaires demonstrated that the fit indicators for each dimension met the required criteria. The overall Cronbach’s alpha coefficient of parent’s and child’s questionnaires were 0.840 and 0.854. Both the item-level content validity index (I-CVI) and scale-level content validity index (S-CVI) of each sub-questionnaire were 1. Conclusion The Chinese version of the PEEQ parent’s questionnaire is suitable as a proxy assessment for patients with PE, but the child’s questionnaire needs further adjustments.

OBJECTIVES The purpose of this retrospective study was to summarize our experience in performing robot-assisted thoracoscopic surgery (RATS) for mediastinal tumours in children to investigate its safety and feasibility. METHODS This retrospective study involved 149 patients with mediastinal tumours who were hospitalized in the Department of Thoracic Surgery of Beijing Children's Hospital, Capital Medical University, and underwent RATS for tumour resection from March 2021 to November 2022. Information on patient age, weight, tumour size, surgical incision selection, operative time, intraoperative bleeding, intraoperative complications, length of hospital stay, rate of conversion to thoracotomy, and follow-up conditions were summarized. RESULTS All 149 surgeries were successfully completed with no cases of mortality. There were 77 male and 72 female patients, with a mean age of 5.9 years (range: 6 months-16 years, 8 months) and a mean weight of 23.6 kg (8.0-72.0 kg). The mean maximum tumour diameter was 5.5 cm (2.0-12.0 cm), the mean operative time was 106.7 min (25.0-260.0 min), the mean intraoperative bleeding volume was 11.3 mL (1.0-400.0 mL), and the mean hospital stay was 7.2 days (4.0-14.0 days). All patients recovered well with no cases of tumour recurrence or mortality during the postoperative follow-up period (3-23 months). CONCLUSIONS RATS is safe and feasible to apply in children with mediastinal tumours who are > 6 months of age and weigh more than 8 kg in terms of short-term outcomes, but longer-term follow-up is needed to fully evaluate the benefits. For cases that are associated with greater surgical difficulty and risk, a comprehensive surgical plan should be fully prepared in advance of surgery.

Introduction Objective assessment of the severity of pectus excavatum (PE) mainly depends on internal imaging examination, which poses radiation exposure risks and high financial costs. Our study explores the feasibility of caliper-based external measurements of the body surface to assess PE severity. Materials and methods Patients with PE aged 4–18 years who underwent both internal imaging examinations and external measurements were chosen for the study. Overall, 176 patients underwent surgery and 21 underwent regular observation. The Haller index (HI) and correction index (CI) were used to derive the external measurement indices, HI-caliper and CI-caliper. Receiver-operator characteristic analysis provided the optimal cut-off values and compared the diagnostic values of HI-caliper and CI-caliper. Spearman's correlation coefficient and Cohen's kappa coefficient were used to analyze the correlation and consistency between HI-caliper or CI-caliper and HI-CT or CI-CT, respectively. Also, a paired samples t -test was used to compare the differences of HI-caliper or CI-caliper before and after surgery. Results HI-caliper and CI-caliper measurements had strong correlations with HI-CT and CI-CT results (rs = 0.70, p < 0.001; rs = 0.69, p < 0.001), respectively. The optimal cut-off values of HI-caliper and CI-caliper were 1.83 (sensitivity = 0.841, specificity = 0.905) and 12% (sensitivity = 0.881, specificity = 0.857), exhibiting comparable diagnostic values with HI-CT and CI-CT. HI-caliper > 1.83 or CI-caliper > 12% had medium intensity consistency with HI-CT ≥ 3.25 or CI-CT ≥ 28% ( k = 0.545, 95% confidence interval: 0.374–0.716, p < 0.001). The HI-caliper and CI-caliper values were significantly different before and after surgery. Conclusion Caliper-based external measurement is a feasible method to screen patients who require surgical intervention and for monitoring the progression of PE severity.

Introduction:Patients with pulmonary sequestration (PS), a rare congenital lung malformation, are mostly asymptomatic. Recurrent localized infection is a major complication, while sudden hemothorax is extremely rare. We present a case of intralobar PS presenting as hemothorax secondary to spontaneous pneumothorax and comprehensively review the relevant literature.Case Report:A 16-year-old male presented with chest pain after strenuous exercise. Chest X-ray showed a moderate pneumothorax. After admission and conservative treatment, he developed dizziness, amaurosis, and urinary incontinence. Bedside chest X-ray suggested a massive pleural effusion, and hemothorax was further identified via catheter drainage. Contrast-enhanced computed tomography was performed, and no abnormal blood vessels or leakage of contrast agent were observed. As the hemoglobin level continued to drop, exploratory thoracoscopic surgery was performed immediately. The abnormal systemic artery supplying the lung tissue was found to be ruptured; therefore, ligation of the abnormal artery with resection of the diseased lung tissue was performed. Pathological examination revealed non-specific manifestations of PS. He was followed up for 1 year without related complications.Conclusion:Our case suggests that the abnormal supply vessels of PS are unstable, which may cause sudden hemothorax. Therefore, patients with PS should undergo surgery promptly after diagnosis. In patients with hemothorax, we should consider the diagnosis of PS; however, contrast-enhanced computed tomography or angiography cannot confirm the diagnosis in all cases. Surgical intervention is recommended in emergency settings.

IMPORTANCE:Pulmonary inflammatory myofibroblastic tumors (PIMTs) are primary lung tumors in children. Misdiagnosis easily occurs because of the nonspecific clinical manifestations, laboratory examination results, and imaging findings in affected patients.OBJECTIVE:To summarize the clinical characteristics, diagnosis, and prognosis of children with PIMTs.METHODS:This retrospective analysis included 23 children with PIMTs who received treatment in our hospital from January 2008 to January 2019. The clinical manifestations, laboratory examination results, and computed tomography findings were retrospectively analyzed.RESULTS:The population included 13 boys and 10 girls, with a median age at onset of 78 months (range, 10-126 months). Fourteen patients had PIMT lesions in the right lung and nine patients had PIMT lesions in the left lung. The surgical procedures included pulmonary wedge resection, pulmonary lobectomy, and total pneumonectomy. The median operation time was 115 min (range, 45-235 min); the median intraoperative blood loss volume was 30 mL (range, 3-500 mL). During the operation, one patient each had pulmonary hemorrhage, vena cava hemorrhage, and thoracic duct injury. Postoperative complications included pulmonary embolism in one patient and tumor recurrence in two patients; neither of these complications recurred after reoperation. The median follow-up period was 49 months (range, 2-127 months).INTERPRETATION:Children with PIMTs exhibited good prognoses and primarily underwent surgical resection as treatment. Complete preoperative evaluation should be performed in affected patients.

Background Pleuropulmonary blastomas (PPB) are rare aggressive paediatric lung malignancies and are among the most common DICER1 -related disorders: it is estimated that 75–80% of children with a PPB have the DICER1 mutation. DICER1 mutations are responsible for familial tumour susceptibility syndrome with an increased risk of tumours. In approximately 35% of families with children manifesting PPB, further malignancies may be observed. Symptoms of DICER1 syndrome may vary, even within monozygotic twins. Preventive screening of carriers with DICER1 mutations is important and follow-up is undertaken as recommended by the 2016 International PPB Register. Case presentation We present two pairs of monozygotic twins. In one pair of 4-year, 2-month old girls, both with DICER1 mutation, one developed PPB(II) and her identical sibling had acute transient hepatitis. In the other pair of 19-month-old female babies, one had a history of bronchopulmonary hypoplasia and developed PPB(III) without DICER1 mutation, and her identical sibling had allergic asthma. Both patients with PPB were treated with R0 resection and received 12 cycles of postoperative chemotherapy. At the most recent review, the twins had been followed up for six and eight years, respectively, and they all remained healthy. However, the height and weight of the patients with PPB were lower than those of their respective identical sister. Conclusions PPB is rare, especially in monozygotic twins. We emphasise the importance of genetic testing and follow-up in monozygotic twins with PPB. During the follow-up, children surviving PPB should be monitored closely for growth and development disorders which caused by chemotherapy.

目的 探讨儿童胸膜肺母细胞瘤的发病年龄、临床表现、病理分型及特点、治疗原则及预后情况.方法 回顾性研究自2002年3月至2018年3月期间首都医科大学附属北京儿童医院收治的38例胸膜肺母细胞瘤患儿临床资料,并进行统计描述.结果 38例中男18例,女20例;首诊诊断为非肿瘤性病变者占比47.4％(18/38),从出现症状到手术或化疗干预的时间范围为5～210 d;Ⅰ型4例(10.5％),中位诊断年龄22个月;Ⅱ型12例(31.6％),中位诊断年龄37个月;Ⅲ型22例(57.9％),中位诊断年龄39.5个月.治疗方式包括手术及化疗.术中见肿瘤最大直径为2～18 cm,手术时间25～210 min,术中出血量2～500 mL(1例出血500 mL病例于术中行胸膜剥脱术);化疗方案多采用IVA-Do(异环磷酰胺+阿霉素+长春新碱+放线菌素D)和IVA(异环磷酰胺+长春新碱+放线菌素)方案,5年无瘤生存率为69.2％.结论 胸膜肺母细胞瘤是一种较为罕见的儿童恶性肿瘤,临床表现缺乏特异性,误诊率高,预后较差,需要手术与化疗联合进行治疗.儿科医生应该充分认识到PPB的严重性,对于出现气胸、多发部位肺囊性病变、肺囊肿家族史、PPB家族史、DICER1家族性综合征的胸腔占位性病变患儿应警惕本病的可能,并做到严密监测及随访.

Development. China’s pediatric surgery is a specialty first established in 1954 by Prof. Jinzhe Zhang, an academician of the Chinese Academy of Engineering. During the same period, several professors (most notably Anquan Ma, Yaxiong She, Zanyao Wang, and Erchang Tong) successively established pediatric surgery specialties in Shanghai and Wuhan, as well as in Shenyang, Chengdu, Chongqing, and Guangzhou. Initially, pediatric surgery primarily focused on treatment of emergencies, such as trauma, burns, surgical infection, and acute abdomen. Subsequently, as economic conditions improved, emergency cases decreased; in contrast, cases of congenital malformation increased annually as a focus of pediatric surgery.

Pleuropulmonary blastoma (PPB) is a rare malignant tumor in childhood that is highly invasive and has poor prognosis. We retrospectively analyzed patients with PPB who died within 30 days in hopes of providing a basis for improving diagnosis and treatment.

Objective: This study was performed to investigate the age at onset, clinical manifestations, pathological types and features, treatment, and prognosis of pleuropulmonary blastoma (PPB) in children in an attempt to reduce the misdiagnosis rate and achieve early detection and timely intervention. Methods: We retrospectively studied the clinical data of 41 pediatric patients with PPB who were treated in our center from March 2002 to November 2018. The data comprised the age at onset, clinical manifestations, characteristics of familial diseases, pathological types, surgical procedures, and prognosis. Results: Twenty male and 21 female patients were included, with a 0.95:1.00 male female ratio. In total, 51.2% of the patients were misdiagnosed as having nonneoplastic lesions at the first presentation. The interval from symptom onset to surgery/chemotherapy ranged from 5 to 210 days. The pathological types were type I (cystic) PPB (n = 5, 11.9%), for which the median age at diagnosis was 21 months (range, 8-24 months); (solid/cystic) II PPB (n = 12,28.6%), for which the median age at diagnosis was 37 months (range, 22-112 months); and type Ill (solid) PPB (n 23, 54.8%), for which the median age at diagnosis was 39 months (range, 19-156 months). The pathologic type was undefined in one patient (2.4%). The patients were mainly treated by surgery and chemotherapy. The 5-year disease-free survival rate was 69.2%. Conclusion: The clinical manifestations of PPB are nonspecific, its misdiagnosis rate is high, and it has a poor prognosis. Pediatricians should be aware of the seriousness of PPB. The possibility of PPB should be considered in children with pneumothorax, multiple pulmonary cystic lesions, a family history of pulmonary cysts, a family history of PPB, or space-occupying lesions associated with DICERI syndromes. The lesion should be closely monitored and surgically removed if necessary. The nature of the lesion should be identified early to minimize the risk of progression of the PPB to worse types because of misdiagnosis and missed diagnosis. Multidisciplinary treatment including surgery, chemotherapy, and or radiotherapy can be applied to patients with PPB. Type of study: Treatment study. (C) 2019 Elsevier Inc All rights reserved.

The treatment of pectus excavatum has always given priority to surgical treatment,the vacuum bellis used as aconservative treatment and auxiliary operationin the treatment of pectus excavatum at present.And its role in the treatment of pectus excavatum is gradually accepted by doctors at home and abroad.We also have more and more recognition and understanding about its application.In this paper,we review vacuum bell on the usage,indications and contraindications,side effects,using effects,intraoperative use,optimum age for use,correlation study of negative pressure and mechanics.

Objective To evaluate the thoracic status of patients with funnel chest by quantitative evaluation of chest Xray,and to explore the effect of Nuss surgery.Methods From October 2006 to February 2011,according to the inclusion criteria,there were 47 cases enrolled our group at last,then divided the cases into 3 groups,including pre-operative of Nuss procedure,recent post-bar removal and further post-bar removal.We measured data on chest radiography and statistical analysis,including the maximal distance of the outer boundary of each rib pairs (C,from the 1 st pair to the 9th),the distance between lung apex to the costophrenic angle (H) and the distance between the two costophrenic angles(W).Results All the 47 cases completed the Nuss procedure and Nuss bar removal safely and effectively.All the patients were followed up from 30 to 36 months,without recurrence or long-term complications.Three groups of thoracic data showed an increasing trend,recent post-bar removal and further post-bar removal compared with the same age normal children,the thoracic data of the Nuss bar position were shortened.With the prolongation of time after Nuss bar removal,thoracic data gradually approaching normal.Conclusion We can evaluate the level of pectus excavatum and effect of Nuss procedure through measuring the chest wall data.The chest wall of post-bar removal was significantly improvement compared to the cases of pre-Nuss procedure.There is some restrictions on the thoracic by the Nuss bar.we learn that the limitation of thoracic can be improve after some time.

Objective To provide data references for Nuss procedure biomechanics research,and to understand morphological pathological changes in children with pectus excavatum.Methods A retrospective study was conducted for 434 cases of pectus excavatum from January 2009 to December 2015 in our institution.The anterior rib width(RW),anterior intercostal space width(IS) and thickness of the rib in the middle(RT) on the right side of 3-7 ribs had been measured in each patient.The widths were compared between the IS of children with pectus excavatum and the bar which currently used in clinic.The measurement indexes were compared between healthy children and children with pectus excavatum.Results The IS of prepubertal children with pectus excavatum was less than the width of bar which currently used in clinic (12.7 mm).Children with pectus excavatum compared with healthy children,the IS from 4 to 6 and the 5th RW of children with pectus excavatum were less than healthy children (P ＜ 0.05),the 3rd and 4th RT were greater than healthy children (P ＜ 0.05).Conclusion The measured values will be useful for the improvement of pectus bar and Nuss procedure biomechanics research.By morphology contrast,it reflects the pectus excavatum deformity has some restriction in thoracic development and the cardiopulmonary function.

Objective To evaluate the efficacy of using sternal suspension technique in correcting pectus excavatum after open repair of congenital heart disease and improve the safety of this technique.Methods A retrospective study was conducted for 8 cases of pectus excavatum treated with sternal suspension procedure after open repair of congenital heart disease from October 2005 to October 2018 in our institution,5 males and 3 females.The median age of patients was 5.75 years (range 3.75-12.33 years) and the median Haller index was 4.20 (range 3.60-5.19).All patients underwent cardiac ultrasound and chest CT scan to evaluate the severity retrosternal adhesions.Results All patients underwent the sternal suspension procedure successfully with a median operation time 55 min (range 30-230 min) and a median blood loss of 2 ml (range 2-120 ml).There was one patient suffered pneumothorax after operation.The patients were followed up for4 months to 13 years with an excellent and good outcome.Conclusion Sternal suspension technique is a safe and effective procedure for pectus excavatum.To improve the security and reduce the incidence of cardiac injury,sternal suspension technique is a promising alternative for pectus patients with severe adhesion after open repair of congenital heart disease.

Objective By measuring the thoracic cage index with chest X-ray film in 3-17 years old healthy children,analyzing the bivariate correlations with age,to provide the reference data for evaluating and following up of chest wall deformity.Methods A retrospective study was conducted for 450 cases of health physical examination from May 2013 to March 2016 in our institution.The anterior intercostal space width(IS),the anterior rib width(RW),and thickness of the rib in the middle(RT) on the right side of 3-7 ribs have been measured in each patient.Statistical describing for each measurement index has been made,and Pearson correlation analysis was used to analyze the correlation between measurement values and ages.Results Each measurement index is strong positive correlated with age (0.6 ＜ r ＜ 0.8,P ＜ 0.05).Conclusion The anterior intercostal space width,the anterior rib width and the thickness of the ribs in the middle have a growing trend with age in children.It is indeed a useful way to measure thoracic cage data by using the chest X-ray film quantitative evaluation method.The measured values can be used as reference indexes.

Objective: To measure the force required for correcting pectus carinatum to the desired position and investigate the correlations of the required force with patients' gender, age, deformity type, severity and body mass index (BMI). Methods: A total of 125 patients with pectus carinatum were enrolled in the study from August 2013 to August 2016. Their gender, age, deformity type, severity and BMI were recorded. A chest wall compressor was used to measure the force required for correcting the chest wall deformity. Multivariate linear regression was used for data analysis. Results: Among the 125 patients, 112 were males and 13 were females. Their mean age was 13.7 +/- 1.5 years old, mean Haller index was 2.1 +/- 0.2, and mean BMI was 17.4 =1.8 kg/m(2). Multivariate linear regression analysis showed that the desirable force for correcting chest wall deformity was not correlated with gender and deformity type, but positively correlated with age and BMI and negatively correlated with Haller index. Conclusions: The desirable force measured for correcting chest wall deformities of patients with pectus carinatum positively correlates with age and BMI and negatively correlates with Haller index. The study provides valuable information for future improvement of implanted bar, bar fixation technique, and personalized surgery. Type of study: Retrospective study. (C) 2017 Elsevier Inc. All rights reserved.

Objective To explore the application of finite element method in biomechanical analysis of rib cage and simulation of mini-invasive surgery for correcting pectus carinatum.Methods Based on a rib cage model and a pectus bar model established by finite element methods,rib cage and pectus bar model was assembled by ABAQUS software.The position of pectus bar was parallel to xx axis and the highest position of sternum was set as the base position (set as base point)and set another 3 position of +20 mm,+10 mm and -10 mm in zz axis direction respectively.After setting a similar size of concentrated force on pectus bar in yy axis,ABAQUS software was utilized for calculating stress distribution and sternal displacement under static load and then analyzing the difference of stress distribution and sternal displacement among 4 different models.Results Simulation of mini-invasive surgery for correcting pectus carinatum showed that the force applied to front chest caused different sternal displacements and the max displacement at +20 mm site was 11 .20 mm,14.85 mm at +10 mm site,24.65 mm at base point site and 17.59 mm at - 10 mm site.The force could be transmitted to the back of rib cage by costal cartilage and the max stress at +20 mm was 85.56 MPa, 105.82 MPa at +10 mm site,84.93 MPa at base point site and 86.69 MPa at - 10 mm site.In this study,stress distribution was symmetrical bilaterally and bar location on the bottom of sternum resulted in the lowest stress distribution and maximal sternal displacement.Conclusions Simulation for mini-invasive surgery for correcting pectus carinatum may aid in optimizing preoperative plans and improving surgical outcomes.

Objective To explore the establishment of 3D thoracic model by finite element methods,and study the mechanical mechanism of minimally invasive surgery for correcting the chest wall deformity,and provide personalized surgery solution in the future.Methods According to admission and exclusion criteria,we selected 10 cases of pectus carinatum that received chest CT scan.The finite element model of pectus carinatum was established and analyzed by Mimics,ABAQUS,etc.The validity of finite element method for chest wall was verified by comparing the sternal displacement between the simulated values and actual values with the same force.Results The 3D finite element model of pectus carinatum was successfully established and analyzed.The stress distribution of the 10 cases in the posterior ribs was mainly in the 1-6 ribs on both sides,mostly concentrated in the 4th to 6th ribs,and the stress was symmetrical on both sides.Statistical analysis showed that the displacement value of the sternum was correlated,and the validity of the model was verified.Conclusion Mimics,ABAQUS and other finite element modeling and analysis software can effectively establish the thoracic 3D finite element model and mechanical analysis,which can help the further development of personalized minimally invasive surgery for correcting chest wall deformities.