Background The anomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA) and congenital left main coronary artery atresia (CLMCA-A) are two kinds of very rare coronary heart diseases which affect heart function profoundly.This study aimed to retrospectively illustrate the clinical features and therapy experience of ALCAPA and CLMCA-A patients.Methods From April 1984 to July 2012,in Beijing Anzhen Hospital,23 patients were diagnosed with ALCAPA and 4 patients with CLMCA-A.We summarized the clinical data of the 27 cases and retrospectively analyzed the clinical manifestation,diagnosis,and treatments of these two kinds of congenital coronary abnormalities.Results The 23 patients (13 males and 10 females,aged ranging from 2.5 months to 65 years) identified with ALCAPA were classified into infantile type (age of onset younger than 12 months,16 cases) and adult type (age of onset older than 12 months,7 cases).Four patients were diagnosed with CLMCA-A (three males and one female,aged ranging from 3 months to 2 years).The main clinical manifestations of infantile-type ALCAPA and CLMCA-A include repeated respiratory tract infection,heart failure,dyspnea,feeding intolerance,diaphoresis,and failure to thrive.And these two congenital coronary abnormalities might be misdiagnosed as endocardial fibroelastosis,dilated cardiomyopathy,and acute myocardial infarction.As for the adult-type ALCAPA,cardiac murmurs and discomfort of the precordial area are the most common presentations and might be misdiagnosed as coronary heart disease,myocarditis,or patent ductus arteriosus.In ECG examination:Infantile-type ALCAPA and CLMCA-A showed abnormal Q waves with T wave inversion in leads I,avL,and V4-V6,especially in lead avL.However,ECG of adult-type ALCAPA lacked distinct features.In chest radiography:pulmonary congestion and cardiomegaly were the most common findings in infantile-type ALCAPA and CLMCA-A,while pulmonary artery segment dilation was more common in adult type.In echocardiography,the common features of infantile-type ALCAPA and CLMCA-A included left ventricular enlargement,left ventricular systolic function normal or mildly reduced in CLMCA-A or significantly reduced in ALCAPA,and moderate to large mitral valve.It was performed in 9 of 23 cases of ALCAPA and showed the origin of the dilated right coronary artery (RCA) from the right sinus of the aortic root and absence of LCA origin in angiography.After opacification of RCA,reverse flow in the LCA and pulmonary artery was visualized through coronary artery collateral circulation.Angio was performed in three of the four cases of CLMCA-A and showed left main coronary artery was a blind end,with diameter of only 1.1-2.0 mm.Treatment and prognosis:21 patients with ALCAPA had cardiac surgery and 6 of them died postoperatively.Fifteen postoperative patients survived without overt symptoms within the follow-up period of 6-166 months (median 17 months).As for treatment of CLMCA-A,four patients took digoxin and diuretics without undergoing cardiac surgery.Their clinical symptoms improved during the close follow-ups.Conclusions ALCAPA and CLMCA-A are two rare coronary artery abnormalities that affect cardiac function in infants and children.In younger patients with cardiomegaly and heart dysfunction these two congenital coronary diseases should be noticed.

Objective:To systematically evaluate the care experience of family caregivers for amyotrophic lateral sclerosis (ALS) patients, providing guidance for home care of ALS patients.Methods:Qualitative studies on the care experience of family caregivers for ALS patients were retrieved from PubMed, American Psychological Association Psychnet, CINAHL, Web of Science, Medline, Cochrane Library, Embase, China Biology Medicine disc, WanFang Data, VIP, and China National Knowledge Infrastructure. The search period was from database establishment to October 30, 2022. The quality of literature was evaluated using the quality evaluation criteria for qualitative research of the Australia Joanna Briggs Institute Evidence-Based Health Care Center (2016 edition). The aggregative integration method was used to integrate the results using NVivo 11 software.Results:A total of 11 studies were included. A total of 22 complete and clear results were extracted and combined to form eight new categories, which were integrated into three results, namely, family caregivers facing personal development limitations and various family difficulties, experiencing complex and chaotic emotional experiences, and craving for diversified care support.Conclusions:Nursing staff should pay attention to the impact of ALS on their patient's family caregivers, provide caregiver knowledge and skill guidance, promote positive emotional experiences, and offer diversified care support to improve the quality of life of patients and family caregivers.

OBJECTIVES: An accurate estimation of cancer patients is the basis of epidemiological studies and health services. However in Korea, cancer patients visiting out-patient clinics are usually ruled out of such studies and so these studies are suspected of underestimating the cancer patient population. The purpose of this study is to construct a more complete, hospital-based cancer patient registry using multiple sources of medical information. METHODS: We constructed a cancer patient detection algorithm using records from various sources that were obtained from both the in-patients and out-patients seen at Asan Medical Center (AMC) for any reason. The medical data from the potentially incident cancer patients was reviewed four months after first being detected by the algorithm to determine whether these patients actually did or did not have cancer. RESULTS: Besides the traditional practice of reviewing the charts of in-patients upon their discharge, five more sources of information were added for this algorithm, i.e., pathology reports, the national severe disease registry, the reason for treatment, prescriptions of chemotherapeutic agents and radiation therapy reports. The constructed algorithm was observed to have a PPV of 87.04%. Compared to the results of traditional practice, 36.8% of registry failures were avoided using the AMC algorithm. CONCLUSIONS: To minimize loss in the cancer registry, various data sources should be utilized, and the AMC algorithm can be a successful model for this. Further research will be required in order to apply novel and innovative technology to the electronic medical records system in order to generate new signals from data that has not been previously used.
Adult ; Female ; Hospitals ; Humans ; Male ; *Medical Records ; Middle Aged ; Neoplasms/*diagnosis ; Organizational Case Studies ; *Program Development ; *Registries ; Republic of Korea

Objective:To understand the present situation of self-acceptance of elderly in nursing home and explore its influencing factors, so as to provide basis for improving self-acceptance level of elderly in nursing home.Methods:Totally 415 elderly people in 3 Medical and nursing homes in Fuyang city of Anhui province were selected by Self-Acceptance Scale, and influencing factors were analyzed.Results:The total score of Self-Acceptance Scale of the elderly in nursing home was (44.11±7.25) points, the score rate was 67.86% (44.11/65), in the middle level; the results of multiple linear stepwise regression showed that the relationship with children, hobbies, number of children, length of stay in nursing home, frequency of visits and age were the main influencing factors ( F value was 48.228, P<0.001). Conclusion:The self-acceptance of the elderly in nursing home is in the middle level. The nursing home or social should pay attention to the higher age group and the newly admitted elderly in nursing home, give such people timely psychological guidance, help them to plan their later life, cultivate their interests and hobbies through recreational activities, and take corresponding measures to harmonize their relationship with their children in order to improve their self-acceptance level and promote mental health.

Objective To evaluate the safety and efficiency of domestic snare applied during retrograde percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions.Methods A total of 27 patients who underwent retrograde PCI for CTO and used domestic snare during the procedure were enrolled in our study from March 2012 to November 2016.Clinical data, angiographic characteristics and PCI details were collected.Clinical data, characteristics of CTO lesion, effect of the domestic snare and snaring time were retrospectively analyzed.Special complications related to the domestic snare and major adverse cardiovascular events (MACE) were also documented.Results Domestic snare was used in all the procedures, which included facillitating the micro-catheter to pass through the CTO lesions in 6 patients and assisting the RG3/rotational guide-wire externalization in all the 27 patients.Mean snaring time was 3.5±5.4 minutes.Stents were successfully implanted in 26 patients except in 1 patient who failed to receive stent implantation for severe coronary calcification.No complications including coronary dissection, fracture of guide-wire and unreleased snare happened during the procedures and no MACE occurred during hospitalization.Conclusions Domestic snare facilitates retrograde micro-catheter crossing CTO lesions and retrograde guide-wire entering the guiding catheter and externalization.It is a simple, safe and efficient method.

Objective To evaluate the methods in early warning of schistosomiasis and elimination of snails in an ecological public forest in Yexie Town of Songjiang District, and provide the basis for monitoring and controlling snails in forest land in the future. Methods The monitoring data of snails, schistosomiasis and snail elimination in the public forest were collected to evaluate the effect of controlling snails. Results The area with existence of snails was found to be 10.47 hm², and it was decreased by 98.28% after three times of snail elimination.A total of 1 904 serological tests was performed (test rate of 88.76%) with the positive rate of 0.16%.Pathogenic test result was negative in 3 subjects examined.Serological samples of 11 dogs and 1 sheep were all negative for the test.None of the 1 480 live snails tested was found to be positive in infection.The awareness rate of schistosomiasis control knowledge and behavior formation in 275 students were 98.2% and 95.3%, respectively. Conclusion The snails in the public forest in Yexie Town have been effectively controlled, but there are still scattered living snails.The measures in eliminating and monitoring of snails should be continued and strengthened.

Purpose: We report three cases of asymptomatic pseudo-optic discs in chorioretinal colobomas highlighted on visual fields patterns.Case summary: (Case 1) A 36-year-old man was found to have a pseudo-optic disc below the optic nerve with a relatively intact neurosensory retina over the lesion. There were no obvious abnormalities on the visual field test, so he underwent no treatment and was followed up every 6 months. (Case 2) A 37-year-old woman diagnosed with glaucoma had abrupt convergence of the neurosensory retinal layers on the boundary of the pseudo-optic disc and a focal retinal nerve fiber layer defect in the inferior sector. An antiglaucoma eyedrop was used to manage the superior hemifield defect, and no significant progression was observed in the structural and functional tests during the 5-year follow-up. (Case 3) A 57-year-old man had a pseudo-optic disc with diffuse retinal nerve fiber layer atrophy in both the superior and inferior sectors. The pseudo-optic disc had protruded into the vitreous cavity. Antiglaucoma eyedrops were used to manage both the superior and inferior hemifield defects, and no significant progression was observed using the structural and functional tests during the 6-year follow-up period. Conclusions Various visual field results may occur with pseudo-optic discs in chorioretinal colobomas depending on the status of residual retinal tissues and underlying glaucoma. Further evaluations and management options should be considered according to the patient’s condition.

BACKGROUND: High-risk group neuroblastoma (HRNB) is one of the most incurable diseases in pediatric oncology field. This report explores the effectiveness, safety and feasibility of triple high dose chemotherapy followed by autologous stem cell transplantation (HDCT/ASCT) in contrast with single HDCT/ASCT for HRNB.METHODS: From Jan. 2001 to Dec. 2009, 25 patients newly diagnosed as HRNB have been analyzed. This study is a retrospective analysis with the medical records of these 25 HRNB patients.RESULTS: Eleven (44%) and the other fourteen (56%) patients were treated with single HDCT/ASCT and triple HDCT/ASCT, respectively. The 5-year event-free survival (EFS) of the whole group in HRNB is 37.2+/-10.0%. The 5-year EFS of single HDCT/ASCT and triple HDCT/ASCT were 27.3+/-13.4% and 46.8+/-13.8%, respectively (P=0.38). Between two groups, there were no statistically significant differences including clinical features, outcome, transplantation-related toxicities, and short-term/long-term complications.CONCLUSION: Triple HDCT/ASCT group showed similar transplantation-related toxicities and long-term complications when compared to single HDCT/ASCT group. We need more exploration to conclude the triple HDCT/ASCT as an optimal treatment for HRNB patients.
Disease-Free Survival ; Humans ; Medical Records ; Neuroblastoma ; Retrospective Studies ; Stem Cell Transplantation ; Stem Cells

Objective:To evaluate the application value of bismuth shielding combined with organ tube current modulation (X-care) in brain CT scanning by measuring the radiation dose of sensitive organs.Methods:The head and neck phantom was scanned with Siemens dual source CT at the same volume CT dose index (CTDI vol) by X-care, bismuth shielding and x-care combined with bismuth shielding, and by dual energy CT angiography (DE-CTA) with and without bismuth shielding. The CT values of cerebral vessels, adjacent brain tissues and cerebrospinal fluid and image noise were measured, and the contrast noise ratio of cerebral vessels and brain parenchyma was calculated. Organ dose equivalent ( HT) was calculated by placing thermoluminescent personal dosimeter (TLD), and CTDI vol and dose length product (DLP) were recorded after each scan. Results:Under the same CTDI vol, the mean values of HT, lens with X-care, Bi shielding and X-care combined with Bi shielding were(37.89 ± 2.00), (42.20 ± 2.96) and (28.21 ± 1.31) mSv, respectively, significantly lower than those of conventional sequence scanning( F=186.52, P<0.05). The values of HT, thyroid with Bi shielding and X-care combined with Bi shielding were (0.77 ± 0.07) and (0.89 ± 0.08) mSv, lower than those of routine brain scan and X-care( F=103.26, P<0.05). The values of HT, lens and HT, thyroidof DE-CTA with bismuth shielding were (11.56 ± 1.04) and (0.32 ± 0.03) mSv, respectively, significantly lower than those without bismuth shielding( t=5.07, P<0.05). There was no significant difference in noise and CNR in routine brain scan between with and without X-care, bismuth shielding and X-care combined with bismuth shielding. There was no significant difference in noise and CNR in dual energy CTA scanning between with and without Bi shielding. Conclusions:Using bismuth shielding and organ tube current modulation, we can significantly reduce organ dose of lens and thyroid during brain CT scanning without sacrificing the image quality.

The purpose of this study was to investigate the status of clinical nutrition services provided at tertiary hospitals and general hospitals in Korea. In total, 157 questionnaires were distributed to the departments of nutrition at hospitals on September 2013. The results of this study are as follows. The median number of beds was 607 and average length of stay was 8 days. 63.1% of dietitians had over 5 years of career experience. Nutritional screening rate was 97% in tertiary hospitals but only 67.2% in general hospitals (P<0.001). The rate of equipment with computerized nutritional screening system was 100% in tertiary hospitals but 71.9% in general hospitals (P<0.001). Hospitals with the best regarding nutritional care were hospitals accredited by JCI (Joint Commission International). On the other hand, hospitals not accredited by the JCI but KOIHA (Korea Institute for Healthcare Accreditation) showed the lowest performance rate of nutritional care. Nutrition support teams (NSTs) were established in all tertiary hospitals but in only 73% of general hospitals (P<0.001). The rate of actively operating NSTs was 89% in tertiary hospitals but only 62% in general hospitals (P<0.001). There is a need to provide proper standardized clinical nutrition services as a primary treatment and we observed large variations in the quality of nutritional service between hospitals. Therefore, local solutions are needed to implement nutritional programs and policies for improved service and care.
Cross-Sectional Studies* ; Delivery of Health Care ; Hand ; Hospitals, General* ; Korea ; Length of Stay ; Mass Screening ; Nutritionists ; Surveys and Questionnaires ; Tertiary Care Centers*