Objective The objective of this article was to compare patients' dose with electrocardiographic gated mA modulation (ECG) and ECG＆CAREDose 4D mode during coronary MSCT angiography.Methods The research was based on phantom experiment and computer simulation to get the mean value of peak skin dose data and effective dose data respectively and to analyze deterministic and stochastic radiation risk.Results The peak skin dose using ECG mode alone and using ECG＆CAREDose 4D mode with the same image noise level was (87.4±0.9) and (45.9 ± 1.2) mGy respectively.Effective dose was 17 and 10 mSy for ECG mode and ECG＆CAREDose 4D mode respectively.Comparing with ECG mode alone, ECG＆CAREDose 4D mode reduced organ dose of gonad, red marrow, lung, stomach, breast and thyroid by 40.0%, 36.7%, 39.3%, 37.7%, 38.8% and 38.9%, respectively. Conclusion Results showed that ECG ＆ CAREDose 4D mode can reduce radiation dose effectively comparing using ECG mode alone, and that ECG ＆ CAREDose 4D mode should be widely applied ehnically with appropriate initial settings.

Objective To investigate the applicability of Bakes Caregiving Outcom Scale(BCOS) in the study of primary family caregivers'burden of stroke survivors. Methods The BCOS was used to inves-tigate the 180 primary family caregivers of stroke survivors.The applicability of BCOS was evaluated by in-ternal consistency,construct validity and criterion-related validity. Results The correlation coefficient be-tween the items and the total BCOS score was 0.408～0.725 (P ＜ 0.01 ).The total Cronbach's α was 0.877.Factor analysis used for examining the construct validity showed that 3 components were extracted and their accumulated contribution rate reached 60.93%.Factor loading of each item ranged from 0.510 to 0.875.The criterion-related validity was - 0.461 by using self-rated burden as a criterion(P ＜ 0.01 ). Conclusions BCOS is applicable in the evaluation of the primary family caregivers' burden of stroke survivors.

This article describes the progress of developing the training base and training methods for bronchoscopists at Changhai hospital in recent years,and then discusses the potential issues and solutions that might occure in the course of training,and finally explores the model and methodology to optimize the training program for Chinese bronchosocpists.

{L-End}Objective To study the changes of complete blood cell count parameters and its influencing factors in patients with occupational silicosis (hereinafter referred to as "silicosis"). {L-End}Methods A total of 354 silicosis patients were selected as the research subjects using judgment sampling method. The patients were divided into stage Ⅰ, stage Ⅱ and stage Ⅲ groups according to the stage of silicosis. Based on the course of the disease, they were divided into groups of ≤3, >3-≤6, >6-≤9 and >9-≤12 years. The peripheral blood of the patients was collected for complete blood cell count analysis, and the influencing factors of complete blood cell count were analyzed by multiple linear regression model. {L-End}Results The levels of hemoglobin and the average red blood cell hemoglobin in patients with silicosis at stage Ⅱ and Ⅲ groups were lower than those at stageⅠgroup (all P<0.05). The percentage and counts of neutrophils increased in patients at stage Ⅲ group (all P<0.05), while the percentage and counts of lymphocytes decreased (all P<0.05) compared with those in stage Ⅰand Ⅱ groups. The percentage of eosinophils in patients at stage Ⅲ was lower than those at stage Ⅰ group (P<0.05). The red blood cell count in the courses of silicosis >6-􀰤9 years group was lower (P<0.05), and the percentage of neutrophils was higher, while the percentage of lymphocyte was lower in the courses of silicosis >6-􀰤9 years group and >9-􀰤12 years group (all P<0.05) compared with the courses of silicosis ≤3 years and >3-􀰤6 years groups. The mean corpuscular volume of the courses of silicosis >6-􀰤9 years group and the neutrophil count of the courses of silicosis >9-􀰤12 years group increased (all P<0.05) compared with the courses of silicosis ≤3 years group. The results of multiple linear regression analysis showed that the silicosis stage and course of silicosis were influencing factors of erythrocyte count (all P<0.05), gender and age of first dust-exposure were influencing factors of hemoglobin level (all P<0.05), while age at diagnosis, duration of dust-exposure, age of first dust-exposure and comorbidities were influencing factors of neutrophil count (all P<0.05). Gender, comorbidities, smoking and silicosis stage were influencing factors of lymphocyte count (all P<0.05). {L-End}Conclusion There are differences in complete blood cell count parameters in patients with silicosis at different stages and courses of the disease. Silicosis stage, course of disease, gender, age, smoking,comorbidities, duration of dust-exposure and age of first dust-exposure were influencing factors affecting complete blood cell count in silicosis patients.

Abstract: Objective To understand the phenotypic and genetic characteristics of Yersinia pestis strains isolated from Himalayan marmot natural focus area and domestic rat plague focus area in southern China, and provide reference for mastering the pathogenic characteristics of Yersinia pestis of two plague foci. Methods A total of 412 of Yersinia pestis strains isolated from Himalayan marmot plague focus and domestic rat plague focus of southern China were subjected to to sorbitol fermentation assays, virulence factor, different region (DFR) typing, and clustered regularly interspaced palindromic repeats (CRISPR) typing. Results The biochemical types of Y. pestis from the two plague foci showed distinct regional distribution features. Five biochemical phenotypes were identified in Yersinia pestis isolated from Himalayan marmot natural focus area, while only one biochemical phenotype was identified in strains isolated from the domestic rat plague focus of Southern China. Most of the Yersinia pestis isolated from the two plague foci were capable of producing the virulence factors of Fl and PstI. Among the strains from Himalayan marmot focus, 70.53% (201/285) were VW-positive, 75.09% (214/285) were Pgm-positive, 20.00% (57/285) of the strains were Pgm-negative, and 5.26% (15/285) were Pgm mixed-type strains. Among strains from domestic rat plague focus of southern China, 37.80% (48/127) were VW-positive, 29.13% (37/127) were Pgm-positive, 58.27% (74/127) were Pgm-negative, and 12.60% (16/127) were Pgm mixed-type strains. DFR typing revealed 22 genotypes of Y. pestis from the Himalayan marmot plague focus, with the main genotypes being type 5, 7, 8, 10, 19, 32 and 49. All strains from domestic rat plague focus area in southern China belonged to type 9. CRISPR typing revealed that all strains from the Himalayan marmot natural focus were classified into 7 CRISPR gene clusters and 14 CRISPR genotypes, with the main genotypes being G7, G22, G26-a1'and G22-A1'. All strains from domestic rat plague focus area in southern China belonged to CRISPR genotype G30, with the gene cluster being Ca8. Conclusions The phenotypes and genotypes of the Yersinia pestis of Himalayan marmot plague focus are diverse, with an obvious characteristics of geographical distribution. The phenotype and genotype of the Yersinia pestis of domestic rat plague focus of Southern China are single. DFR and CRISPR genotyping methods with phenotypic characteristics can effectively identify the Yersinia pestis isolated from the two plague foci, thereby meeting the needs of identification and traceability research.

Objective:To investigate the basic information and implementation of medical assistance for children of illness-caused poverty families.Methods:From March through September 2019, a customized questionnaire was used to collect by means of both field survey and on-site verification, the information of the sick children from such families registered on file from 17 counties in 6 provinces. These counties were the first to carry out the assistance pilot work under " Chinese Children Poverty Alleviation by Healthcare Program" . The data so acquired were subject to descriptive analysis.Results:A total of 312 questionnaires were recovered, and the median age of these child patients was 8.54 years. Diseases causing family poverty were mostly those in the circulatory system, nervous system, neoplastic disease of childhood and hematological disease, while unaffordability of medical bills ranked the top challenge when they seek medical services. Hierarchical diagnosis and treatment was made for 251 children: 193(76.89%)of them could be admitted to provincial or lower medical institutions, 43 children needed chronic disease management, and 15 children needed to be admitted by the National Children′s Medical Center for further diagnosis.Conclusions:The assistance for such families in poverty-stricken areas can be upgraded, by such means as disease prevention publicity and education, publicity of healthcare poverty alleviation policy awareness, improvement of medical competency of primary medical institutions and rational application of medical resources.

Objective:To study the clustered regularly interspaced short palindromic repeats (CRISPR) genotype of Yersinia pestis and its regional distribution characteristics in natural plague focus of Tibet Autonomous Region. Methods:A total of 125 representative Yersinia pestis strains isolated from natural plague focus in Tibet Autonomous Region at different times, regions, hosts and vectors were selected as experimental strains, and the phenol chloroform mixed extraction method was used to extract Yersinia pestis DNA. Three pairs of CRISPR primers (for YPa, YPb, YPc locus) were used to amplify the DNA of the experimental strains, and the CRISPR genotype of Yersinia pestis was determined by sequencing. Results:All 125 strains of Yersinia pestis had three CRISPR locus: YPa, YPb, and YPc. A total of 18 spacer were found, including 8 in YPa loci, 6 in YPb loci, and 4 in YPc loci. Two new types of spacers had been discovered, namely b52 and c14. CRISPR typing revealed 10 genotypes, including G1, G7, G7-b4''', G7-b52, G7-c2 -, G8, G22, G22-a4 -, G22-b4''', and G22-c14, of which 6 were newly discovered genotypes. Among the 125 experimental strains, G7 was the main genotype, accounting for 65.6% (82/125), which was distributed in 6 prefecture level citys and 1 region of Tibet Autonomous Region. Next were G22 and G7-c2 - genetypes, accounting for 14.4% (18/125) and 11.2% (14/125), respectively. G22 gene type was distributed in Nagqu, Changdu, Lhasa citys, and Ngari Prefecture, while G7-c2 - genetype was distributed in Shigatse and Shannan cities. Conclusion:The CRISPR locus of Yersinia pestis in natural plague focus of Tibet Autonomous Region is highly polymorphic, and the Yersinia pestis strains with different genotypes have obvious regional distribution characteristics.

BACKGROUNDThe mitochondrial displacement loop (D-loop) accumulates mutations and single nucleotide polymorphisms (SNPs) at a higher frequency than other regions of mitochondrial DNA (mtDNA). We previously identified disease risk-associated SNPs in the D-loop of chronic kidney disease (CKD) patients; in this study, we investigated the association of age-at-onset and D-loop SNPs in CKD patients.

METHODSThe D-loop region of mtDNA was sequenced in 119 CKD patients attending the Fourth Hospital of Hebei Medical University between 2002 and 2008. The age-at-onset curve of the CKD patients was calculated using the Kaplan-Meier method at each SNP site, and compared using the log-rank test.

RESULTSThe mean age of 119 CKD patients was (55.6±14.2) years, and 56.3% were males. The mean estimated glomerular filtration rate (eGFR) was (81.2±12.4) ml×min(-1)×1.73 m(-2), with 79.8% (n = 95) of patients having an eGFR <60 ml×min(-1)×1.73 m(-2). All participants had an eGFR >30 ml×min(-1)×1.73 m(-2). The age-at-onset for CKD patients who smoked was significantly lower than that of non-smoking CKD patients. The SNP sites of nucleotides 150C/T were identified for their association with age-at-onset using the log-rank test. The age-at-onset of patients with the minor allele T genotype was significantly lower than that of patients with the C genotype at the 150 SNP site (P = 0.010).

CONCLUSIONSGenetic polymorphisms in the D-loop appear to be predictive markers for age-at-onset in CKD patients. Accordingly, the analysis of genetic polymorphisms in the mitochondrial D-loop may help identify CKD patient subgroups at high risk of early onset disease.

Adult ; Aged ; DNA, Mitochondrial ; genetics ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Polymorphism, Single Nucleotide ; genetics ; Renal Insufficiency, Chronic ; genetics