Objective:To analyze the clinical characteristics of different types of anomalous origin of the coronary artery.Methods:A case-series study was conducted.Based on the clinical data of children diagnosed with anomalous origin of the coronary artery at Shanghai Children′s Medical Center, Shanghai Jiao Tong University School of Medicine from January 2013 to January 2023, the diseases of different types of anomalous origin of the coronary artery were summarized.Results:A total of 177 children with anomalous origin of the coronary artery were treated.Among them, 122 children developed the anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), including 54 males and 68 females, with a median age of 1.2 years; 6 children developed the anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA), including 3 males and 3 females, with a median age of 4.3 years; 9 children developed the anomalous left coronary artery from the right coronary sinus (ALCA), including 6 males and 3 females, with a median age of 9.5 years; 40 children developed the anomalous right coronary artery from the left coronary sinus (ARCA), including 24 males and 16 females, with a median age of 7.7 years.Most children diagnosed with ALCAPA had onset within 1 year of age, with chronic heart failure as the main manifestation, and young children were often accompanied by severe mitral regurgitation.A total of 111 children underwent surgery, and 11 children died.Six children with ARCAPA had no obvious clinical symptoms and were treated by operation according to the principle of double coronary circulation after diagnosis.Nine children with ALCA started with syncope, chest pain or abdominal pain after exercise.Eight of the children underwent surgical treatment, including 1 who received a heart transplant.Of the 40 children with ARCA, 23 children had clinical manifestations, with chest tightness, syncope, and chest pain after exercise as chief complaints; 16 children were tested positive for treadmill exercise before surgery; and a total of 13 children received surgical treatment.Conclusions:Different types of anomalous origin of the coronary artery vary in severity.The clinical manifestations of the anomalous origin of the left coronary artery are generally serious, and most of such patients have the risk of cardiac insufficiency or sudden death.Once diagnosed, surgical treatment should be performed timely.The clinical manifestations of the anomalous origin of the right coronary artery are relatively mild, and only a few may have serious consequences, which are usually treated according to the principle of individualization or double coronary circulation.

Objective:To analyze the coronary angiographic (CAG) characteristics of coronary artery lesion (CAL) in children with Kawasaki disease (KD), and to clarify the necessity of CAG in the diagnosis and treatment of KD combined with CAL in children.Methods:It was a retrospective study to analyze the clinical data, electrocardiogram, echocardiography, time and findings of CAG in children with KD and CAL who underwent CAG in Shanghai Children′s Medical Center of Shanghai Jiao Tong University School of Medicine from January 2013 to August 2022.The distribution, type, severity, and prognosis of CAL were analyzed.Results:A total of 117 children with KD and CAL were included in the analysis.The onset age of KD was from 2 months to 12.8 years old, and the age of performing CAG was from 8 months to 18.1 years old.A total of 234 coronary artery lesions were detected in 117 cases.Among them, CAL in the right coronary artery (RCA), left anterior descending branch (LAD), left main coronary artery and left circumflex artery were detected in 96 branches(41.1%), 78 branches(33.3%), 44 branches(18.8%), and 16 branches(6.8%), respectively.Unilateral coronary artery involvement was detected in 43 cases (36.8%), of which LAD was the dominant; while bilateral involvement was detected in 74 cases (63.2%), among which, LAD and RCA were the most involved arteries.Stratified by the degree of coronary involvement, large coronary aneurysms and severe coronary stenosis were most frequently occurred in the RCA and LAD.In contrast, 10 cases (13.6%), 20 cases (24.3%), 55 cases (45.8%) and 37 cases (67.3%) of intraluminal lesions were found in small, medium and large coronary aneurysms, and stenosis or occlusion, respectively.The incidence of intraluminal lesions tended to be higher in the site of severe lesions.CAG showed stenosis or occlusion in a total of 55 cases, and collateral circulation at varying degrees was found in cases of severe stenosis or occlusion.Conclusions:CAL in children with KD are complex and varied.Although clinical symptoms, routine electrocardiogram and cardiac ultrasound may indicate severe CAL.Their applications are limited by the diagnosis of the type (especially stenosis), degree, and extent of CAL, as well as the detection of extracoronary lesions.CAG is of great significance to identify vascular lesions and guide clinical management of KD combined with CAL in children.

Objective:To study the characteristics and influencing factors of coping styles of clinical ophthalmic interns under psychological stress, so as to provide scientific basis for promoting the mental health development of medical students.Methods:In 2019, 103 students of Sun Yat-sen University who participated in clinical practice of ophthalmology were investigated by cluster sampling with general situation questionnaire and simple coping style questionnaire. The database was established by Epidata, and the data was statistically analyzed by SPSS 25.0 software.Results:The scores of positive coping and negative coping were (1.70±0.10) and (1.30±0.05) respectively, which were all lower than the norm ( P < 0.001). The scores of non first time practice students were 0.087 points higher than those of first time practice students; the scores of eight-year students were 0.124 points higher than those of five-year students; the scores of positive coping increased by 0.015 points for each level of family income increase. Men scored 0.027 points higher than women in negative coping scores; eight-year students scored 0.053 points lower than five-year students in negative coping scores; family income increased by one grade, negative coping scores decreased by 0.017 points; rural registered residence students scored 0.035 points higher than urban registered residence students in negative coping scores; non first practice students scored 0.074 points higher than the first practice students in negative coping scores. Conclusion:Educators should pay close attention to the coping styles of clinical ophthalmic interns, carry out mental health education and guidance of coping methods according to the characteristics of different groups, take effective measures to improve students' stress coping ability and promote the smooth development of clinical practice in ophthalmology.

OBJECTIVE: To track analysis of viral nucleic acid test results in patients with re-positive SARS-CoV-2 infection, and provide clinical reference for nucleic acid test of re-positive cases. METHODS: A retrospective study was conducted. The multiple nucleic acid results of 96 cases with SARS-CoV-2 infection tested by medical laboratory of Shenzhen Luohu Hospital Group from January to September in 2022 were analyzed. The test dates and cycle threshold (Ct) values of detectable positive virus nucleic acid in the 96 cases were summarized and analyzed. RESULTS: A total of 96 patients with SARS-CoV-2 infection were retested re-sampled for nucleic acid testing at least 12 days after the initial positive screening. Among them, 54 cases (56.25%) had Ct value of < 35 for nucleocapsid protein gene (N) and/or open reading frame 1ab gene (ORF 1ab), 42 cases (43.75%) had Ct value ≥ 35. In the re-sampling of infected patients, N gene titers were 25.08 to 39.98 Ct cycles, and ORF 1ab gene titers were 23.16 to 39.56 Ct cycles. Compared with the positive results of the initial screening, the Ct values of N gene and/or ORF 1ab gene positive were increased in 90 cases (93.75%). Among them, the patients with the longest duration of nucleic acid positive could still be positive for double targets (the Ct value of N gene was 38.60, and the Ct value of ORF 1ab gene was 38.11) at an interval of 178 days after the initial positive screening. CONCLUSIONS Patients infected with SARS-CoV-2 can be sustained or repeatedly tested positive for nucleic acid for a long period of time, and most of them had Ct values < 35. But whether it is infectious needs to be comprehensively evaluated by combining epidemiology, variant type, samples with the alive virus, and clinical symptoms and signs.
Humans ; COVID-19 ; SARS-CoV-2 ; Retrospective Studies ; Hospital Units ; Nucleic Acids

In order to accurately master and understand the national occupational health standard Diagnosis for Occupational Radiation Thyroid Disease(GBZ 101-2020), the significance of the publication of this standard, the relevant background, the basic principles of the revision, the main basis for technical content revision, and the application of the standard are described. To provide guidance for t the physcians for occupational disease diagnosiss to understand the diagnostic principles, make correct diagnosis and avoid confusion in using the standard, so as to better protect the occupational health rights of radiation workers.

Objective:To investigate the clinical value of serum monocyte/high-density lipoprotein ratio (MHR) level in the diagnosis of coronary heart disease(CHD).Methods:A total of 127 patients who underwent coronary angiography in the cardiology department of the Third Hospital of Changsha were enrolled as subjects. Patients with coronary artery stenosis ≥50% were included in the CHD group ( n=97), and patients with coronary artery stenosis <50% were included in the control group ( n=30). According to the clinical classification of CHD, the patients were divided into stable angina group ( n=31), unstable angina group ( n=35) and acute myocardial infarction group ( n=31). The general clinical data of the selected cases were collected, and the serum MHR, myeloperoxidase (MPO) and high sensitivity C-reactive protein (hs-CRP) were detected. The degree of coronary artery lesions was scored by Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score system, and the number of coronary artery lesions was counted. The relationship between MHR level, MPO, hs-CRP and the degree of coronary artery stenosis in CHD group was analyzed. The MHR level of CHD was divided into three subgroups by triquartile: the differences of SYNTAX score and the number of coronary artery lesions were compared in the low MHR group (≤0.41, n=40), the middle MHR group (0.410.48, n=27). The value of serum MHR in diagnosing CHD was analyzed by receiver operating characteristic (ROC) curve. The risk factors of CHD were analyzed by multivariate logistic regression. Results:(1) The serum MHR level in CHD group was higher than that in non-CHD group ( P<0.001). In different clinical subgroups of CHD: the levels of serum MHR were significantly higher in acute myocardial infarction group than unstable angina group and stable angina group ( P<0.001). (2) There was a positive correlation between serum MHR, MPO level with SYNTAX score in CHD group ( r=0.878, 0.477, 0.285, all P<0.001). (3) The SYNTAX score in high MHR group was higher than those in middle MHR and low MHR group; the SYNTAX score in middle MHR group was higher than that of low MHR group ( P<0.001); There was no significant difference in the number of coronary artery lesions among the three MHR level subgroups ( P>0.05). (4) Multivariate logistic regression analysis showed that LDL-C ( OR=1.107, 95% CI: 0.974-1.259), MHR ( OR=1.873, 95% CI: 1.352-2.496) were independent risk factors for CHD (all P<0.05). (5) ROC curve showed that the area under the curve of MHR in diagnosing CHD was 0.987, and the sensitivity was 82.8%. Conclusions:Serum MHR level is higher in patients with CHD, which is closely related to the severity of coronary artery disease and is an independent risk factor of CHD.

Objective:To explore the associations of urinary retinol binding protein (RBP) and β 2-microglobulin (β 2-MG) with urinary albumin to creatinine ratio (UACR) and renal function in hospitalized patients with type 2 diabetes mellitus (T2DM). Methods:A total of 1 030 Chinese patients with T2DM were included in this study. The subjects were divided into the UACR normal group (<30 mg/g), microalbuminuria group (30-300 mg/g) and macroalbuminuria group (>300 mg/g). Patients with normal UACR were further divided into two groups according to the estimated glomerular filtration rate (eGFR): the eGFR low group (<90 ml·min -1·1.73m -2) and the normal eGFR group (≥90 ml·min -1·1.73m -2). Urine RBP and β 2-MG levels among the groups were compared. Multiple linear regression analyses were applied to evaluate risk factors of urine RBP and β 2-MG. Results:In all patients ( n=1 030), urine RBP and β 2-MG increased gradually with the increase of UACR across the three groups, the proportions of abnormal urine RBP (>0.7 mg/L) and β 2-MG (>370 μg/L) in these groups were 3.8%, 8.5%, 39.0% ( P<0.001), and 12.9%, 26.7%, 46.8% ( P<0.001), respectively. In the UACR normal group ( n=788), 12.2% of the patients were with eGFR<90 ml·min -1·1.73m -2. The proportion of abnormal β 2-MG (>370 μg/L) was higher in the eGFR low group than that in the eGFR normal group (29.2% vs. 10.7%, P<0.001). Multivariate linear stepwise regression analyses were performed using natural logarithm of urine RBP or β 2-MG as dependent variable, and showed that urine RBP was independently associated with UACR ( β=0.0005, P<0.001), serum creatinine ( β=0.006, P<0.001) and glycosylated hemoglobin A1c ( β=0.050, P=0.001), and β 2-MG was independently correlated with UACR ( β=0.000 4, P<0.001), serum creatinine ( β=0.011, P<0.001), systolic blood pressure ( β=0.005, P=0.031) and fasting blood-glucose ( β=0.027, P=0.046). Conclusions:Urine RBP and β 2-MG are positively associated with high UACR and impaired renal function in T2DM patients, and these changes could occur before UACR and eGFR turned out to be abnormal. It is recommended that urine RBP and β 2-MG be detected as early as possible to identify diabetic kidney disease in patients with normal UACR and eGFR.

Objective:To investigate the late effects induced by external ionizing radiation through long-term follow-up of the victims exposed to 60Co radiation source at " 4.26" accident in Henan in 1999, and to provide valuable experience in the radiological medicine. Methods:Medical observations of the clinical symptoms, signs, eye lens examination and previous medical history of the five exposed victims were performed and recorded. The changes of the laboratory routine examinations, immune function, thyroid function, reproductive hormone levels, tumor markers, radiation genetic indicators as well as ultrasound examination of thyroid, cardiac, reproductive system, electrocardiogram, chest CT were systematically reviewed.Results:The typical radiation-induced cataract was found in " Mei" 2-3 years after 60Co accidental irradiation. 13 years after irradiation, the cataract surgery and intraocular lens implantation in left eye were performed followed by the same operation in right eye in November 2019. Different degrees phacoscotasmus under the posterior capsule or equatorial part of the eyes were also found in the rest of victims. ECG result of " Mei" indicated myocardial ischemia 7 years after accident. " Tian" confirmed diagnosis coronary heart disease 12 years after irradiation, and the surgery about coronary angiography heart stent implantation was taken at 20 years after irradiation. Five victims showed increased serum total cholesterol and/or triglycerides, and 4 victims showed bilateral or unilateral common carotid atherosclerotic plaque formation. Higher levels of thyroid stimulating hormone (TSH) were observed in " Mei" at 11 years after the irradiation. The thyroglobulin antibody (TGA)and thyroid microsomal antibody (TMA) were obviously increased in " Yi" , accompanied by thyroid uneven found by ultrasound. The thyroid nodules in " Mei" and " Min" were observed at 15 years after irradiation. The diagnosis of diffuse large B cell lymphoma(DLBL) in " Tian" was confirmed at 13 years after irradiation. Slightly higher of Neuron-specific enolase(NSE) were found in " Tian" , " Min" and " Yi" . A small nodule was detected from chest CT of " Tian" . Most of the chromosome aberrations observed in peripheral blood lymphocytes from the victims were stable chromosomal aberration such as translocation (t) with a few dicentric chromosome (dic) and acentric fragment (ace) in " Wang" and " Tian" . Conclusions:Ionizing radiation can cause variable degrees of deterministic effects in lens, thyroid gland and cardiovascular circulatory system and stochastic effects such as neoplasm. The genetic damages will last long in the patients.

Neuroendocrine prostate cancer(NEPC) is a prostate cancer subtype with a very high degree of malignancy and a special molecular phenotype.NEPC is not sensitive to endocrine therapy, and there are currently no specific drugs, so there is a lack of effective clinical treatment.New advances in NEPC therapeutic include chemical therapy, targeted drug therapy based on molecular phenotype and other non-targeted drug therapy. This article summarizes the current treatment methods, pharmaceutical, and clinical research results for NEPC, aiming to deepen clinicians' more comprehensive understanding of NEPC patients' treatment strategies.