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Introduction: Primary arterial switch operation (ASO) is recommended to be performed in TGA patients preferably within neonatal period. The recommended primary ASO timing is delayed for many patients in China. However, little is known about surgical timing choice and in-hospital cost for these patients with overdue ASO. Hypothesis: There could still have an optimal surgical timing with lower rate of postoperative complication and less in-hospital cost for patients with overdue ASO. Methods: From January 1, 2007 to March 1, 2017, patients who were performed primary ASO in Fuwai hospital with d-TGA, with intact ventricular septum (TGA/IVS) or ventricular septal defects (TGA/VSD), were enrolled into this retrospective study. Patients with other cardiac abnormalities or major comorbid conditions were excluded from this study. The independent risk factors and the effects on major morbidity and in-hospital costs were determined by univariable and multivariable analyses. Results: A total of 392 patients met the inclusion criteria, and non-VSD patients accounted for 38.5% (n=151). The ten-year in-hospital mortality was 3.1% (n=12). There were 43.8% patients experiencing major morbidity (n=172). The mean age at operation was 203 days, and the median was 45 days (range: 3 to 2851 days). Age at operation was the independent risk factor of major morbidity in both TGA/IVS and TGA/VSD patients. TGA/IVS patients younger than 33 days (p =0.012, OR=0.313, 95% CI: 0.126-0.778) and TGA/VSD patients younger than 110 days (p =0.035, OR=0.500, 95% CI: 0.262-0.953) had significantly lower risk of major morbidities. The in-hospital cost was significantly reduced in TGA/IVS patients with age at operation between 10 and 33 days (p =0.035), and in TGA/VSD patients younger than 110 days (p =0.047). The postoperative complication rather than age at operation was an independent predictor to determine the in-hospital cost. Lung infection as a minor morbidity was detected in 39.5% patients (n=155), and the antibiotic resistance rate of bacteria was 41.1% in total 214 cases of positive sputum culture test. A strong correlation was found between lung infection and the major morbidity (p <0.001). Conclusions: Primary ASO should be performed before 33 days but later than 10 days after birth in TGA/IVS patients, and before 110 days after birth in TGA/VSD patients. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the patellofemoral joint adaptive changes after discoid lateral meniscus (DLM) plasty.Forty-one patients with unilateral complete type DLM tears were included in this study. Demographic variables, including gender, age, body mass index (BMI), injury to operation interval, type of injury, and follow-up time, were recorded. The evolution of physical examination, imaging index, and functional score were analyzed by Chi-squared test, Wilcoxon signed ranks test, and Friedman test. Mann-Whitney test was used to analyze the difference at different time points between group PFI > 1.6 and PFI < 1.6.After the patients received arthroscopic DLM plasty, the positive rate of Patella grinding test increased from 19.5% to 29.3%, and it showed significant increased at last follow-up time point (48.8%) (P = .005). Mechanical axis deviation (MAD) significant decreased from -0.7 ± 2.1 mm to -9.4 ± 3.2 mm (P < .001). Lateral patellofemoral angle (LPFA) and lateral shift distance (LSD), respectively, decreased from 11.9 ± 5.8° and 1.0 ± 4.0 mm to 7.2 ± 4.5° and -0.5 ± 3.3 mm (P < .001). Patellofemoral index (PFI) increased from 1.7 ± 0.3 to 1.9 ± 0.4 (P < .001). Kujala score and Lysholm score, respectively, increased from 65.9 ± 10.0 and 85.2 ± 6.4 mm to 61.8 ± 10.2 and 89.5 ± 5.0 (P < .001). Only LSD in group > 1.6 were significant lower than those in group < 1.6 (>1.6: -1.5 ± 2.8, -1.6 ± 2.7, -1.5 ± 2.6; <1.6: 0.8 ± 3.4, 0.4 ± 3.6, 0.6 ± 2.8. P = .010,.038,.011) at the 3 postoperative follow-up time points.After arthroscopic plasty for complete type DLM which decreased the thickness and width of the residual meniscus, in turn causing the varus deformity significantly decreased or a valgus inclination developed. Moreover, the consequent changes of patellofemoral joint caused a certain amount of patellar tilt and patellar dislocation, might aggravated the symptomatic anterolateral knee pain or the lateral patellar compression syndrome.