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Song WY, Zhou Y, Wu C, Pan ZX, Li YG. A preliminary study on the normal values of the thoracic Haller index in children. Eur J Cardiothorac Surg 2024; 65:ezae143. [PMID: 38588563 DOI: 10.1093/ejcts/ezae143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/21/2024] [Accepted: 04/06/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVES The Haller index (HI) is widely utilized as a quantitative indicator to assess the extent of the pectus excavatum (PE) deformity, which is the most common chest wall abnormality in children. Both preoperative correction planning and postoperative follow-up need to be based on the standard of normal thoracic growth and development. However, there is currently no established reference range for the HI in children. Consequently, the goal of this study was to conduct a preliminary investigation of normal HI values among children to understand thoracic developmental characteristics. METHODS Chest computed tomography images obtained from January 2012 to March 2022 were randomly selected from the imaging system of the Children's Hospital of Chongqing Medical University. We divided the images of children into a total of 19 groups: aged 0-3 months (1 group), 4-12 months (1 group) and 1 year to 17 years (17 groups), with 50 males and 50 females, totaling 100 children in each group. HI was measured in the plane where the lowest point of the anterior thoracic wall was located and statistically analysed using SPSS 26.0 software. RESULTS A total of 1900 patients were included in the study. Our results showed that HI, transverse diameter and anterior-posterior diameter were positively correlated with age (P < 0.05). Using age as the independent variable and HI as the dependent variable, the best-fit regression equations were HI-male = 2.047 * Age0.054(R2 = 0.276, P<0.0001) and HI-female = 2.045 * Age0.067(R2 = 0.398, P<0.0001). Males had significantly larger thoracic diameters than females, and there was little difference in the HI between the 2 sexes. CONCLUSIONS The HI rapidly increases during the neonatal period, slowly increases during infancy and stops increasing during puberty, with no significant differences between the sexes.
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Affiliation(s)
- Wan-Yi Song
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Zhou
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zheng-Xia Pan
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yong-Gang Li
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
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Wang Q, Pan Z, Wu C, Li Y, Wang G, Dai J, Ren C, Xie Y, Xiong L, Zhang L, Li H. Single Incision non-thoracoscopic Nuss procedure for children with pectus excavatum: protocol for a multicenter, non-masked, randomized controlled trial. Front Surg 2023; 10:1210452. [PMID: 37538392 PMCID: PMC10394465 DOI: 10.3389/fsurg.2023.1210452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/29/2023] [Indexed: 08/05/2023] Open
Abstract
Background Nuss procedure is the most common method of surgical treatment to pectus excavatum (PE). A significant percentage of surgeons choose to use thoracoscopic assistance during the Nuss procedure (TNP) to avoid cardiac injury. However, our previous findings confirm the safety of single incision Non-thoracoscopic Nuss Procedure (SINTNP). Hence, Further studies, particularly prospective randomized controlled trials, are necessary to assess the value of SINTNP for PE. Methods This study is a prospective, superiority, multicenter, non-masked, randomized controlled trial that investigates the outcome and hospitalization medical expense of SINTNP compared to TNP for PE. A total of 320 eligible patients according to sample size calculation by retrospective data will be randomly assigned to the SINTNP group or the TNP group at a 1:1 ratio using stratified blocked randomization and the zone length was set as four. Patients aged between 3 and 18 years old for the first surgery and without combination of complex anomalies such as Marfan syndrome and congenital heart disease will be considered for the study. The co-primary endpoint is thoracic related complications and medical expense during hospitalization. Thoracic related complications were defined as pneumothorax, pleural effusion, pneumonia and incision infection. The secondary endpoints include surgery duration and length of hospital stay.The registration number for this study protocol is ChiCTR230073081 (Chinese Clinical Trial Registry, A Primary Registry of International Clinical Trial Registry Platform, World Health Organization).
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Affiliation(s)
- Quan Wang
- Department of Cardiothoracic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Medical University, Chongqing, China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yonggang Li
- Department of Cardiothoracic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Wang
- Department of Cardiothoracic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Jiangtao Dai
- Department of Cardiothoracic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Chunnian Ren
- Department of Cardiothoracic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Medical University, Chongqing, China
| | - Yiming Xie
- Department of Pediatric Surgery, Chongqing Three Gorges Central Hospital, Chongqing, China
| | - Liangjun Xiong
- Department of Pediatric Surgery, Qujing Maternal and Child Health Hospital, Qujing, China
| | - Libing Zhang
- Department of Pediatric Surgery, Chengdu Women and Children’s Central Hospital, Chengdu, China
| | - Hongbo Li
- Department of Cardiothoracic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Medical University, Chongqing, China
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Li H, Fan S, Kong X, Pan Z, Wu C, Li Y, Wang G, Dai J, He D, Wang Q. Academic performance in children with pectus excavatum: a real-world research with propensity score matching. Ther Adv Respir Dis 2023; 17:17534666231155779. [PMID: 36846947 PMCID: PMC9972046 DOI: 10.1177/17534666231155779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/23/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND The optimal timing of surgery for pectus excavatum (PE) is controversial. A large proportion of children will not undergo surgery before puberty. However, untimely surgery may lead to a decline in the children's social adaptation and competitiveness because the children have already developed psychological and physiological impairments due to PE at an early age. The study retrospectively compared the academic performance in PE children undergoing the Nuss procedure versus nonsurgical observation. METHODS This retrospective real-world research study included 480 PE patients with definite surgical indications, in whom it was first recommended that they undergo surgery between the ages of 6 and 12 years old. Academic performance was collected at baseline and 6 years later. A generalized linear regression was calculated to screen the factors affecting the performance. A propensity score matching (PSM) analysis was conducted to reduce the potential for confounding factors between surgical and nonsurgical PE patients. RESULTS Haller index (HI) and pulmonary function were recognized as factors affecting baseline performance according to the generalized linear regression. For PE children with surgical indications, their academic performance significantly declined after 6 years of nonsurgical observation (52.1% ± 17.1% versus 58.3% ± 16.7%, p = 0.042). The academic performance in the surgery group was better than that in the nonsurgery group 6 years after PSM (60.7% ± 17.7% versus 52.1% ± 17.1%, p = 0.008). CONCLUSIONS The severity of PE will affect the academic performance of children.For PE children with definite surgical indications between the ages of 6 and 12 years old, surgical intervention rather than nonsurgical observation is more conducive to the development of children's academic performance.
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Affiliation(s)
- Hongbo Li
- Department of Cardiothoracic Surgery, Ministry
of Education Key Laboratory of Child Development and Disorders, National
Clinical Research Center for Child Health and Disorders, China International
Science and Technology Cooperation Base of Child Development and Critical
Disorders, Children’s Hospital of Chongqing Medical University, Chongqing,
China
- Chongqing Higher Institution Engineering
Research Center of Children’s Medical Big Data Intelligent Application,
Chongqing, China
- Chongqing Key Laboratory of Pediatrics,
Chongqing Medical University, Chongqing, China
| | - Shulei Fan
- Department of Respiratory Medicine, Second
Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiangpan Kong
- Department of Cardiothoracic Surgery, Ministry
of Education Key Laboratory of Child Development and Disorders, National
Clinical Research Center for Child Health and Disorders, China International
Science and Technology Cooperation Base of Child Development and Critical
Disorders, Children’s Hospital of Chongqing Medical University, Chongqing,
China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery, Ministry
of Education Key Laboratory of Child Development and Disorders, National
Clinical Research Center for Child Health and Disorders, China International
Science and Technology Cooperation Base of Child Development and Critical
Disorders, Children’s Hospital of Chongqing Medical University, Chongqing,
China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Ministry
of Education Key Laboratory of Child Development and Disorders, National
Clinical Research Center for Child Health and Disorders, China International
Science and Technology Cooperation Base of Child Development and Critical
Disorders, Children’s Hospital of Chongqing Medical University, Chongqing,
China
| | - Yonggang Li
- Department of Cardiothoracic Surgery, Ministry
of Education Key Laboratory of Child Development and Disorders, National
Clinical Research Center for Child Health and Disorders, China International
Science and Technology Cooperation Base of Child Development and Critical
Disorders, Children’s Hospital of Chongqing Medical University, Chongqing,
China
| | - Gang Wang
- Department of Cardiothoracic Surgery, Ministry
of Education Key Laboratory of Child Development and Disorders, National
Clinical Research Center for Child Health and Disorders, China International
Science and Technology Cooperation Base of Child Development and Critical
Disorders, Children’s Hospital of Chongqing Medical University, Chongqing,
China
| | - Jiangtao Dai
- Department of Cardiothoracic Surgery, Ministry
of Education Key Laboratory of Child Development and Disorders, National
Clinical Research Center for Child Health and Disorders, China International
Science and Technology Cooperation Base of Child Development and Critical
Disorders, Children’s Hospital of Chongqing Medical University, Chongqing,
China
| | - Dawei He
- Chongqing Higher Institution Engineering
Research Center of Children’s Medical Big Data Intelligent Application,
Chongqing, China
- Chongqing Key Laboratory of Pediatrics,
Chongqing Medical University, Chongqing, China
| | - Quan Wang
- Department of Cardiothoracic Surgery, Ministry
of Education Key Laboratory of Child Development and Disorders, National
Clinical Research Center for Child Health and Disorders, China International
Science and Technology Cooperation Base of Child Development and Critical
Disorders, Children’s Hospital of Chongqing Medical University, No.136
Zhongshan Second Road, Yuzhong District, Chongqing 400014, China
- Chongqing Higher Institution Engineering
Research Center of Children’s Medical Big Data Intelligent Application,
Chongqing, China
- Chongqing Key Laboratory of Pediatrics,
Chongqing Medical University, Chongqing, China
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Song J, Wang Q, Pan Z, Wu C, Li Y, Wang G, Dai J, Xi L, Li H. The Safety and Efficacy of the Modified Single Incision Non-thoracoscopic Nuss Procedure for Children With Pectus Excavatum. Front Pediatr 2022; 10:831617. [PMID: 35211432 PMCID: PMC8861268 DOI: 10.3389/fped.2022.831617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study described and evaluated the safety and efficacy of a modified single incision non-thoracoscopic Nuss procedure in pectus excavatum (PE) children. METHODS PE patients undergoing the non-thoracoscopic Nuss procedure at the Children's Hospital of Chongqing Medical University between January 2017 and December 2020 were retrospectively enrolled. The patients were divided into two groups according to operation procedures: the double incision Nuss (DN) group and the modified single incision Nuss (SN) group. Propensity score matching (PSM) was applied before evaluation of operative and postoperative characteristics to reduce selection bias. RESULTS Of the 502 patients included, 261 were enrolled in the DN group, and 241 in the SN group. The operation time [35.0 (30.0-40.0) vs. 50.0 (40.0-55.0) minutes, P < 0.001] and postoperative inpatient stay [7.0 (6.0-8.0) vs. 7.0 (7.0-8.0) days, P < 0.001] of the patients in the SN group after PSM were significantly shorter than those of the patients in the DN group after PSM. Moreover, median blood loss was significantly less in the SN group after PSM than that in the DN group after PSM [2.0 (1.0-5.0) vs. 5.0 (2.0-5.0) ml, P < 0.001]. There were no significant differences in the incidence of complications between the two groups (P > 0.05). Bar removal was performed in 85 patients in the SN group within 24-42 months after surgery. Additionally, the SN group patients had a significantly lower Haller index (HI) after bar removal [2.36 (2.15-2.55) vs. 3.76 (3.18-4.26), P < 0.001] compared to the initial HI. CONCLUSIONS The modified procedure is safe and effective for children with PE and is worthy of clinical application.
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Affiliation(s)
- Jishuo Song
- Department of Day Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Quan Wang
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Chun Wu
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yonggang Li
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Gang Wang
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jiangtao Dai
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Linyun Xi
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hongbo Li
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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