Objective To investigate the advantages and disadvantages of two different approaches (i.e.internal jugular vein and subclavian vein) when used for the implantation of central venus access ports (CVAP).Methods We retrospectively analyzed 620 patients who underwent the implantation of CVAP via the approach of internal jugular vein (n =222) or subclavian vein (n =398) and compared the success rate on first attempt as well as the incidences of peroperative and long-term complications.Results The implantation of CVAP was successfully performed in all the 620 patients,with the success rate on first attempt being 97.24％ (387/398) in the subclavian vein group and 89.19％ (198/222) in the internal jugular vein group (U =0.171,P ＜ 0.01).The incidences of perioperative/long-term complications were 0.90％ (2/222) /1.80％ (4/222) in the internal jugular vein group and 1.26％ (5/398) /2.01％ (8/398) in the subclavian vein group,showing no significant differences (all P ＞ 0.05).Conclusions The implantation of CVAP via either the internal jugular vein approach or subclavian vein approach is safe and reliable.Few complications will occur if performed properly.

0bjective To determine the immunogenicities of DNA vaccines expressing tat-rev-integrase(c-half)-vif-neffusion genes(TRIVN) derived from prevalent B', B'/C and AE recombinant subtypes of HIV-1 in China. Methods Two DNA vaccines were constructed by inserting the codon optimized tat-revintegrase(c-half)-vif-nef fusion genes derived from B' and B'/C subtype of HIV-1 into mammalian expression vector pSVI. 0. DNA vaccine containing tat-rev-integrase (c-half)-vif-nef fusion gene derived from HIV-1AE2f has been constructed previously. In vitro expression efficiencies of three DNA vaccines were determined by Western blot and their immunogenicities were compared by immunizing female BALB/c mice. IFN-γ ELISPOT assay was used to read out the specific T cell immunity. Results The constructed DNA vaccines were validated by restriction enzyme digestion and DNA sequencing. Western blot assay showed three constructed DNA vaccines could be expressed at a comparable level in vitro. After vaccination, AE-TRIVN mounted T cell immune responses at (948.0 ± 330.0) SFCs/106 splenocytes, followed by the mixed DNA vaccine[ (500.0 ± 155.0) SFCs/106 splenocytes ], RL-TRIVN r[ ( 195. 1 ± 44.0) SFCs/106 splenocytes ]and CN-TRIVN [ (89.5 ± 17.0) SFCs/106 splenocytes]. Interestingly, we observed that single DNA vaccination induced specific T cell responses predominantly targeting Integrase (C-half) and Vif, whereas the mixed DNA could significantly improve T cell responses against Nef. Conclusion AE-TRIVN was the most immunogenic among the three DNA vaccines and the mixed DNA vaccination could change the immunogenic hierarchy of T cell epitopes across the fusion genes vaccine.

Objective To investigate the diagnostic value of dual-energy CT pulmonary angiography (DE-CTPA) and dual-energy CT lung perfusion (DE-CTLP) in the assessment of pulmonary embolism comparing with pulmonary ventilation-perfusion scintigraphy. Methods Fifty patients suspected of PE (26 males, 24 females) underwent both DE-CTPA, DE-CTLP and pulmonary ventilation-perfusion scintigraphy. The results were compared and the correlation between the intravascular clots in DE-CTPA and the perfusion defects in DE-CTLP was analyzed. The sensitivity, specificity and accuracy of DE-CTLP for PE were assessed according to scintigraphic results which was considered as a "gold" standard. Result ( 1 ) Of 50 cases,920 segments in 46 cases were diagnostable, 4 cases were not included because of the poor image quality. lntravascular clots were found in 262 segments on DE-CTPA and perfusion defects in 266 segments were identified on DE-CTLP, while 268 segments were positive on scintigraphy. (2) The perfusion defects on DE-CTLP were correlated well with the clots on CTPA ( r = 0. 883, P < 0. 01 ). The Dual energy CT Lung perfusion imaging had a good consistence with scintigraphy (Kappa = 0. 940, P <0. 01 ). The sensitivity, specificity, positive and negative predictive value were 96. 2% (279/290), 98.0%(641/654), 95. 5% (279/292) and 98. 3% (641/652), respectively. (3)The radiation dose of DE-CTPA and CE-CTLP scan was(4. 37 ± 0. 47) mSv by using CareDose 4D technique. Conclusion DE-CTPA and CE-CTLP can provide pulmonary vascular morphology and parenchyma perfusion information which are useful and valuable for the diagnosis of PE.

Objective To explore the feasibility of evaluating cardiac structure, coronary artery,pulmonary artery and cardiac function in one single scan by 320-row CT ECG-gated double phase cardiac function scan mode. MethodsForty patients underwent the 320-detector row CT double phase cardiovascular angiography. The pulmonary phase and aortic phase were reconstructed in order to evaluate the pulmonary and coronary artery. MPR reconstructions of both pulmonary and aortic phase were used to analyze the function of the two ventricles. And the results of the cardiac function were compared with those of transthoracic echocardiography. Thirty-five cases could be analyzed and diagnosed, while the other 5 cases had to be given up because of the poor imaging quality. The mean heart rate was (71.2 ± 11.2) beat per min (bpm). No arrhythmia case included. Results ( 1 ) Pulmonary embolism were diagnosed in 11 cases,coronary artery disease (CAD) were found in 5 cases, while post-stent implantation were observed in 7 cases. Six cases of congenital heart disease were diagnosed with 3 ASD and 3 primary pulmonary hypertension. Another one was diagnosed with left atrial myxoma, and 5 cases were pulmonary embolism associated with CAD. All of above cases were verified by final clinical diagnosis. (2) The heart function parameters including LVEDd , RVEDd, LVESd, RVESd and LVEF were (36.7 ±3.3), (43.3 ± 3.4) mm,(31.6±5.1), (41.3 ±5.1) mm and (47.1 ±15.1) for CT, while those were (40.3 ±3.1), (47.3 ±4.2) mm,(37.3 ±5.6), (45.3 ±3.3) mm,and (46.0 ± 14.8) for ultrasound, respectively. The CT results were correlated with the ultrasound ( n = 35, r = 0.886-0.988, P ＜ 0.01 ). (3) The average radiation exposure was ( 5.4 ± 0.5 ) mSv. Conclusions 320-row CT ECG-gated double phase cardiac function scan mode is feasible for the "one-stop-shop" examination of the cardiovascular disease. This noninvasive method is recommended for the diagnosis, differential diagnosis, treatment and prognosis of cardiovascular disease.

Objective To investigate the accuracy of low-dose dual-source computed tomography (DSCT) coronary angiography in the step-and-shoot (SAS) mode for the diagnosis of coronary artery stenosis in comparison with conventional coronary angingraphy (CCA).Methods Prospective multiple-center study, 46 patients[mean age(58±9) years;bedy mass index(BMI) (25±3) kg/m2]underwent both DSCT in the SAS mode and CCA within 14 days.The inclusion criteria for contrast-enhanced CT: (1) heart rate less than 65 times/rain (bpm).(2) regular sinus rhythm, heart rate fluctuations within the range of 6 bpm. (3) holding breath well, breath-hold time is about 12-15 s.The exclusion criteria:(1) allergy to iodinecontaining contrast medium, nephropathy (serum creatinine level 120 μmol/L), heart failure and serious arrhythmias.(2) patients with coronary stents or bypass grafts.(3) heart rate can not be controlled very well (4)the patient could not take nitroglycerin.(5)BMI 30 kg/m2.(6) other heart disease: carcliomyopathy, valvular disease etc.Sensitivity, specificity, negative (NPV) and positive predictive value (PPV) were determined with CCA as standard of reference.The Kappa value between the two modalities and the two observers was calculated.Radiation dose values were measured.Results Mean heart rate during scanning was (61±6)bpm.99.19% (614/619) coronary segments were depicted with a diagnostic image quality. The vessel-based sensitivity, specificity, PPV, and NPV for the diagnosis of coronary artery stenosis were 96.2% (75/78), 88.2% (60/68), 90.4% (75/83), and 95.2% (60/63), respectively.The Kappa value between the two modalities was 0.848 (P=0.000).The mean effective dose of the SAS-CTCA was (2.95± 0.96) rosy(1.26-4.32 mSy).Conclusion In selected patients, DSCT coronary angiography in the SAS mode have good image quality, which allows for the accurate diagnosis of coronary stenosis at a low radiation dose.

OBJECTIVE:To establish the quality standard of Smilacina japonica. METHODS: S. japonica was identified qualitatively in respects of original plant morphology,character,microscopic identification,TLC,etc. The moisture,ash and extract of medicinal materials were determined. The content of(25S)-17α-hydroxy-5α-spirostane-9-ene-3β-O-β-D-glucopyranoyl-(1→2)-[ β-D-xylanosyl(1→3)]-β-D-glucopyranoyl(1→4)-β-D-galactopyranoside(SJ-13) was determined by HPLC. The determination was performed on Waters SunFire C18column with mobile phase consisted of acetonitrile-water(35∶65,V/V)at the flow rate of 1.0 mL/min. The detection wavelength was set at 203 nm and the column temperature was 20 ℃. The sample size was 10 μ L. RESULTS:The original plant was perennial herbal,with height of 30-60 cm. The surface of the medicinal material was brown to brownish brown,with wrinkle and 1 row cells in epidermis. The powder of medicinal material was grayish yellow and contained large amount of acicular crystal. TLC spots were clear and well-separated. The content of moisture was 5.26%-8.88%;the content of total ash was 4.60%-28.86%;the acid-insoluble ash was 1.56%-23.39%,water extract was 23.84%-51.26% and alcohol extract was 22.65%-57.36%. The linear range of SJ-13 were 8.92-31.22 μg(r＝0.999 9). RSDs of precision,stability and reproducibility tests were all lower than 1%. The average recoveries were 97.0%-99.2%(RSD＝0.8%,n＝6). RSD of durability test was lower than 1%. The content of SJ-13 was 4.40-29.80 mg/g in 10 batches of medicinal samples. CONCLUSIONS:The content of water, total ash,acid insoluble components should not exceed 11%,35%,28%;the content of water extract,alcohol extract and SJ-13 should not be less than 19%,18% and 4.40 mg/g,respectively. Established standard can be used for the quality control of S. japonica.

Diabetes mellitus is a metabolic disease characterized by hyperglycemia,resulting in chronic damage and dysfunction of many organs,such as the eyes,kidneys,heart,blood vessels,nerves,etc.,which increase the difficulty of treatment for diabetes.In recent years,gene therapy for diabetes mellitus has become a hot topic.Ultrasound targeted microbubble destruction (UTMD) has the advantage of safety,good repeatability and tissue targeting,and has become a potential strategy for gene delivery.The related study progresses of UTMD in gene therapy of diabetes mellitus were reviewed in this article.

Objective:To develop a cultural competency assessment scale for geriatric clinical nurse specialists and test its reliability and validity.Methods:Through literature research, qualitative interviews, expert correspondence, and pretesting, the cultural competency assessment scale for geriatric clinical nurse specialists was developed. A total of 140 geriatric nurses from 8 tertiary hospitals in Beijing, Guizhou, Harbin, Shandong and Shaanxi from July to September 2021 were selected for the survey.Results:The final cultural competency assessment scale for geriatric clinical nurse specialists consisted of 4 dimensions of cultural knowledge, cultural awareness, cultural skills, and cultural interaction behaviors, with 31 entries, Cronbach α coefficient of 0.953 for the scale, Cronbach α coefficient of 0.875-0.974 for the 4 dimensions, and retest reliability of 0.925. I-CVI was 0.857-1.000, and the average S-CVI was 0.974. The cumulative contribution of the four common factors was 72.51%. Conclusions:The reliability and validity of the cultural competency assessment scale for geriatric clinical nurse specialists are good and can be used to evaluate the cultural competency of geriatric clinical nurse specialists.

Objective To evaluate the causal relationship between gastroesophageal reflux disease(GERD)and obstructive sleep apnea(OSA)using two-sample Mendelian randomization(2SMR)and to identify potentially beneficial drugs and pathways for OSA from GERD treatment options.Methods The 2SMR was used as the primary analysis method,and multivariable Mendelian randomization(MVMR)was used to adjust for the potential impact of obesity on both diseases.Secondly,the DrugBank database was used to search for target genes of anti-reflux drugs used to treat GERD,and the dbSNP database was used to determine the target gene loci to identify the genetic tools of anti-reflux drugs.Significant target genes related to OSA risk were obtained through 2SMR analysis.Finally,the target genes were subjected to Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis and Gene Ontology(GO)analysis using the DAVID database.Results The genetically predicted risk of GERD was significantly associated with an increased risk of OSA[OR=1.43,95%CI=(1.33,1.54),P=5.29×10-22],and MVMR analysis showed that this result remained robust after adjusting for obesity.Four significant genes,including BCHE,DRD2,GRM5,and PTGER3,were identified,which are related to drugs such as nizatidine,bromperidol,ADX10059,and misoprostol.KEGG analysis identified three pathways.Conclusion GERD increases the risk of developing OSA,and anti-reflux drug targets can provide useful genetic clues for drug development in OSA treatment.