Clinical Analysis of Primary Tracheobronchial Tumors in Children and Evaluation of the Predicting Models for Mucoepidermoid Carcinoma

Objective:To determine the clinical characteristics and prognosis of primary tracheobronchial tumors(PTTs)in children,and to explore the most common tumor identification methods.Methods:The medical records of children with PTTs who were hospitalized at the Children's Hospital of Chongqing Medical University from January 1995 to January 2020 were reviewed retrospectively.The clinical features,imaging,treatments,and outcomes of these patients were statistically analyzed.Machine learning techniques such as Gaussian na?ve Bayes,support vector machine(SVM)and decision tree models were used to identify mucoepidermoid carcinoma(ME).Results:A total of 16 children were hospitalized with PTTs during the study period.This included 5(31.3%)children with ME,3(18.8%)children with inflammatory myofibroblastic tumors(IMT),2 children(12.5%)with sarcomas,2(12.5%)children with papillomatosis and 1 child(6.3%)each with carcinoid carcinoma,adenoid cystic carcinoma(ACC),hemangioma,and schwannoma,respectively.ME was the most common tumor type and amongst the 3 ME recognition methods,the SVM model showed the best performance.The main clinical symptoms of PPTs were cough(81.3%),breathlessness(50%),wheezing(43.8%),progressive dyspnea(37.5%),hemoptysis(37.5%),and fever(25%).Of the 16 patients,7 were treated with surgery,8 underwent bronchoscopic tumor resection,and 1 child died.Of the 11 other children,3 experienced recurrence,and the last 8 remained disease-free.No deaths were observed during the follow-up period.Conclusion:PTT are very rare in children and the highest percentage of cases is due to ME.The SVM model was highly accurate in identifying ME.Chest CT and bronchoscopy can effectively diagnose PTTs.Surgery and bronchoscopic intervention can both achieve good clinical results and the prognosis of the 11 children that were followed up was good.

Non-invasive estimation of pulmonary hypertension and clinical deterioration risk in pediatric congenital heart disease:Development and validation of predictive tools

To the Editor:Owing to the heterogeneity of congenital heart disease-associated pulmonary hypertension(CHDPH)disease and the development of the pulmonary vascular system in pediatric patients,the management of CHD-PH in children is signicantly different from that in adults.[1]Early identication and intervention of CHD-PH are of great signicance for disease management in children with CHD,and non-invasive,accurate clinical tools are urgently needed to predict PH risk in children with CHD.However,the applicability of the current risk-scoring system to pediatric CHD-PH remains unclear.Furthermore,there are presently no user-friendly,non-invasive online tools available for predicting CHD-PH,and there is a scarcity of related studies in Asian populations.This study aimed to develop and validate the prediction tools for estimating the risk of pulmonary hypertension and clinical deterioration in children with congenital heart disease.

Phase I trial of human umbilical cord-derived mesenchymal stem cells for treatment of severe bronchopulmonary dysplasia

Severe bronchopulmonary dysplasia(BPD)is a chronic lung disorder that primarily affects premature babies with extremely low birth weight and involves in multiple organ system;no effective pharmacotherapy for this disease exists,and mortality remains high.Based on the evidence from previous preclinical studies and phase I clinical trials,this study aims to test the safety of intravenous application of a single dose of human umbilical cord-derived mesenchymal stem cells(hUC-MSCs)in patients with severe BPD.The Mesenchymal Stem cells for Bronchopulmonary Dysplasia Treatment(MSBDT)trial is a single center,open-label,dose-escalation phase I clinical trial.Severe BPD patients were enrolled in Children Hospital of Chongqing Medical University,Chongqing,China.The first six patients were treated with low-dose hUC-MSCs(1×10^(6) cells/kg)and the next seven patients were treated with high-dose hUC-MSCs(5×10^(6) cells/kg).This study is registered with ClinicalTrials.gov,number NCT03558334.No prespecified infusion-associated adverse events,immediate complication,respiratory or cardiovascular compromise were observed during infusion and 24 h after infusion.No significant changes in safety laboratory values were observed.One death event occurred in the low-dose group on study day 10,and one death event occurred in the high-dose group on study day 24,while,after review in detail,the two cases are not believed to be infusion-associated events.In conclusion,intravenous application of a single dose of hUC-MSCs was tolerated in thirteen patients with severe BPD.