OBJECTIVE：To investigate the effects of rabepr azole on the pharmacokinetic characteristics of clopidogrel and its active metabolite in healthy volunteers with different CYP2C19 genotypes. METHODS ：Healthy volunteers were selected as subjects，and then randomly divided into extensive metabolizer （EM）group，intermediate metabolizer （IM）group，and poor metabolizer（PM）group with 8 subjects in each group ，according to their CYP2C19 genotypes by random number table. In single-dose，randomized，open，two-cycle-crossover design ，each group was given Clopidogrel bisulfate tablets 300 mg or Clopidogrel bisulfate tablets 300 mg+Rabeprazole sodium enteric-coated tablets 20 mg. UPLC-MS/MS method was adopted to detect the concentration of clopidogrel and its active metabolite derivative （MP-H4）. The pharmacokinetic parameters were calculated and compared by DAS 2.0 software. RESULTS ：There was no statistical significance in clinical data as age ，height， body weight ，liver enzymes and serum creatinine among 3 kinds of metabolism subjects （P＞0.05）. Compared with subjects receiving clopidogrel alone ，cmax and AUC 0－t of clopidogrel of subjects combined with rabeprazole in EM group were increased by 36％ and 27％，while those of MP-H 4 were decreased by 34％ and 28％（P＜0.01）；cmax and AUC 0－t of clopidogrel of subjects combined with rabeprazole in IM group were increased by 19％ and 18％，while those of MP-H 4 were decreased by 19％ and 16％ （P＜0.05 or P＜0.01）；there was no statistical significance in cmax and AUC 0－t of clopidogrel and MP-H 4 in PM group after receiving rabeprazole additionally as well as tmax of clopidogrel and MP-H 4 in all metablism subjects ，compared with clopidogrel alone（P＞0.05）. CONCLUSIONS ：Among CYP2C19 EM and IM subjects ，combined use of rabeprazole can significantly increase the exposure of clopidogrel and decrease the exposure of its active metabolite MP-H 4，but has no significant impact on clopidogrel and its active metabolite in CYP2C19 PM subjects.

Objectives:To understand the association between obesity and the risk for colorectal advanced adenoma.Methods:Community residents aged 45 to 74 who had participated in the Shanghai community-based colorectal cancer (CRC) screening project in 2008 were included in our study. Anthropometries information including body weight, height and risk factors for colorectal advanced adenoma were collected. Results on colonoscopic diagnosis and personal health records were used for supplementary outcome information retrieval. Multivariate Cox proportional hazard regression models were used to evaluate the hazard ratio ( HR) and 95 %CI of obesity on the risk for colorectal advanced adenoma. Results:20 811 residents were followed up for 122 739.36 person-years, with a median follow-up time of 5.87 years. A total of 657 cases of advanced adenomas were identified. After adjusting for potential confounding risk factors such as age, sex, family history of CRC, level of education, marriage, cigarette smoking, alcohol drinking, foods intake including fat, fried or pickled, vegetables and fruits etc., the HR was 1.25 (95 %CI: 1.04-1.51) for obese people when compared with the normal weight persons. Further stratified analysis by age, gender and family history of CRC, results showed that obese people had a much higher risk of colorectal advanced adenoma than those with normal weight (male: HR=1.57, 95 %CI: 1.20-2.04; more than 60- year-old: HR=1.63, 95 %CI: 1.23-2.16). Conclusion:Data from this large scale population-based study revealed that obesity might be an independent risk factor for colorectal advanced adenoma and the risk increases along with the increase of BMI in China.

Objective To investigate the clinical efficacy of the laparoscopic radical resection and the conventional laparotomy for colorectal cancer. Methods The clinical data of 106 patients with colorectal cancer treated by surgery from March 2011 to January 2016 were retrospectively analyzed, including 55 patients receiving laparoscopic surgery (laparoscopic group) and 51 patients treated by traditional surgery (conventional laparotomy group). The clinical effects of both groups were compared. Results The operation time in conventional laparotomy group was shorter than that in laparoscopic group [(141.2 ±40.6) min vs. (192.0±32.5) min, t=7.136, P<0.05]. The blood loss of the laparoscopic operation group was lower than that of conventional laparotomy group [(81.2 ±16.5) ml vs. (168.0 ±36.2) ml, t= 16.077, P< 0.05]. The recovery time of gastrointestinal function and hospital stay time in laparoscopic surgery group were significantly shorter than those in the laparotomy group (t= 12.236, t= 9.524, all P< 0.05). There were no statistical differences in the number of captured lymph nodes, complications and the length of bowel resection between two groups (all P>0.05). There were no severe complications and death case in both groups. Patients were followed up for 10-60 months, and there were no significant differences on recurrence and metastasis between two groups (P> 0.05). Conclusion Compared with the conventional laparotomy, laparoscopic radical resection is an effective method for the treatment of colorectal cancer with small trauma, less bleeding and fast recovery, which is worthy of clinical application.

Objective To investigate the continuous ambulatory peritoneal dialysis (CAPD) and daytime ambulatory peritoneal dialysis (DAPD) on sleep and quality of life. Methods In this is a multi-center cross-sectional survey, we used the Pittsburgh Sleep Index Scale (PSQI) and the Chinese version of peritoneal dialysis patient quality of life scale, the unified investigating time, the organized trained peritoneal dialysis nurses qualified to conduct research full-time. Survey content includes general information, sleep and quality of life, laboratory tests, dialysis adequacy and other indicators, and the results were pooled analysis. Results A total of 325 hospitalized peritoneal dialysis patients were included in the study, including 177 patients in CAPD, 148 patients in DAPD. The total scores of QOL, physical function, physical factors, psychological status, social function and life satisfaction were (72.61± 10.94), (19.44±3.65), (59.69±7.31), (32.65±5.65), (24.82±6.03), (15.42±5.47)and (74.06±13.59), (20.16± 2.95), (58.99 ± 5.86), (34.58 ± 6.17), (25.10 ± 5.01), (15.36 ± 4.28). The score of CAPD in the mental state dimension was significantly lower than that in DAPD patients (t=-3.715, P<0.01). Else, there was no significant difference between the two groups (P> 0.05). Conclusions Sleep and quality of life in peritoneal dialysis patients are lower than normal adults. Dialysis modes have an impact on sleep andquality of life of patients, health care workers should fully assess the physical and mental state of the patients in order to select the appropriate mode of dialysis.

Objective To investigate the continuous ambulatory peritoneal dialysis ( CAPD) and daytime ambulatory perito-neal dialysis ( DAPD) on sleep quality. Methods This is a multi-center cross-sectional survey, we used the Pittsburgh Sleep Index Scale ( PSQI) ,the unified investigating time, the organized trained peritoneal dialysis nurses qualified to conduct research full-time. Survey content includes general information, sleep index, laboratory tests, dialysis adequacy and other indicators, and the results were pooled analysis. Results A total of eight hospitals of 325 patients undergoing peritoneal dialysis were included in this study,which CAPD patients and DAPD Pittsburgh Sleep Quality Index Scale scores were 6.88 ±2.43,6.71 ±2.69, the difference was not statisti-cally significant (P>0.01).DAPD patients had a lower sleep efficiency than CAPD patients, but it had no difference between subjec-tive feeling, CAPD patients were more likely to have more nocturnal cough, snoring and other symptoms and lower quality of life in mental status scores than DAPD patients(P<0.01). Conclusion Sleep quality of peritoneal dialysis patients scored lower than the norm.Dialysis modes have an impact on sleep quality of patients, health care workers should fully assess the physical and mental state of the patients in order to select the appropriate mode of dialysis.

Objective:To evaluate the effectiveness and safety of endovascular treatment in solving symptomatic cerebral artery tandem lesions.Methods:From June 201 2 to February 201 4,1 2 cases (24 lesions)with symptomatic cerebral artery tandem lesions were accepted for the endovascular treatment. The distributions of the tandem lesions were as follows:the common carotid artery and internal carotid ar-tery (1 case),the internal carotid artery and the proximal of the carotid cavernous sinus segment (3 ca-ses),the internal carotid artery and the distal of the carotid cavernous sinus segment (4 cases),the in-tracranial segment of internal carotid artery and middle cerebral artery M1 segment (2 cases),the first segment of vertebral artery and intracranial segment of vertebral artery (2 cases).All of these cases were treated from distal lesions to proximal lesions except for tandem lesions in the internal carotid artery and the distal of the carotid cavernous sinus segment in order to obtain better support.Tandem lesions were treated in the same operation with local anesthesia or general anesthesia.The procedures of the 1 2 cases retrospectively were analyzed and the peri-operation complications and responsibility region recurrent is-chemic stroke incidents observed.Results:All tandem lesions were solved successfully all at once.There were no peri-operation complications or recurrent ischemic stroke incidents.There were no recurrent is-chemic stroke incidents or stent restenosis cases in the follow-up.Conclusion:It is safe and effective for selective endovascular treatment in solving symptomatic cerebral artery tandem lesions at the same time, but we should take careful preoperative evaluation and improve the operation plan.

Objective:To anslysis the hemodynamic states of vertebrobasilar dolichoectasia based on computational fluid dynamics technique.Methods:The original DICOM format image data from a patient with vertebrobasilar dolichoectasia (VBD), were imported by the Mimics software directly,and the 3D Objects were constructed.The simulation of model was made with Ansys software, the hemodynamic pa-rameters such as streamlines, wall shear stress( WSS) and wall pressure were described.Results:There was stable laminar flow in proximal basilar artery and was no blood flow mixed by bilateral vertebral arter-y.However, Spiral flows were appeared in distal tortuous basilar artery.The low WSS regions in the ver-tebra-basilar junction section and inferior segment of basilar artery were coincide with the high wall pres-sure regions.It could be speculated the initial growth regions might be located in the vertebra-basilar junction section and inferior segment of basilar artery.Local regions with low WSS and high wall pressure might be associated with the occurrence and development of VBD.Conclusion: CFD numerical simula-tion maybe can provide a theoretical basis for the role of hemodynamic factors in occurrence and develop-ment of VBD.

OBJECTIVETo analyze the epidemiology data on plague in five counties in Zhejiang province and to evaluate the risk of plague in theses areas.

METHODSWe selected five monitoring stations as a risk assessment (Qingyuan county, Longquan city, Yiwu city, Wencheng county, and Ruian city) in Zhejiang province where the plague epidemic more serious in the history. At least one constant site and 1-4 variable sites where plague occurred in history were selected for monitoring. We collected the five counties (cities) surveillance data of indoor rat density, indoor Rattus flavipectus density, the Xenopsylla cheopis index of rat, the Xenopsylla cheopis index of Rattus flavipectus in 1995-2014. Isolation of Yersinia pestis was conducted among 171,201 liver samples and F1 antibody were detected among 228,775 serum samples. Risk matrix, Borda count method, and Delphi approach were conducted to assess risk of the plague of five counties (cities) in Zhejiang province.

RESULTSIndoor rat density in Qingyuan county, Longquan city, Yiwu city, Wencheng county, Ruian city was 1.58%-5.50%, 1.13%-9.76%, 0.56%-3.67%, 2.83%-16.08%, 7.16%-15.96%, respectively; Indoor Rattus flavipectus density of five counties (cities) was 0.08%-2.23%, 0-2.02%, 0-0.54%, 0.71%-5.58%, 0.55%-4.92%, respectively. The Xenopsylla cheopis index of rat in Qingyuan county and Wencheng county was 0.011-0.500 and 0.015-0.227, respectively; The Xenopsylla cheopis index of Rattus flavipectus of Qingyuan county and Wencheng county was 0.119-3.412 and 0.100-1.430, respectively; Ruian City and Yiwu city cannot collected Xenopsylla cheopis, Long quan city only collected the Xenopsylla cheopis index of rat in the five years. Yersinia pestis were not isolated in five counties (cities).There were 3 Apodemus agrarius samples positive of plague F1 antibody test, in Longquan city and Yiwu city in 2005. Borda count method to assess the Longquan city, Yiwu (Borda point were both 321) plague risk was higher than three other regions; Delphi approach to evaluation five counties (cities) belong to the plague had a lower risk areas, according to the level of risk score (Pf) Longquan city and Yiwu (Pf was 0.314, 0.292, respectively) plague risk were higher than three other regions (Pf were all 0.292).

CONCLUSIONThe main host and media were lower in five key plague surveillance counties (cities) of Zhejiang province; The result of Borda count method and Delphi approach for risk assessment indicated that endogenous plague recrudescence was at lower level, but Longquan city and Yiwu city risk were higher than other counties (cities).

Animals ; Cities ; Epidemics ; Epidemiological Monitoring ; Humans ; Murinae ; Plague ; Rats ; Risk Assessment ; Yersinia pestis

Objective:To analyze correlation factors of hemodynamic damage after carotid artery stenting.Methods:In this study, 66 cases (71 lesions) who undertook carotid artery stenting were col-lected and the correlation factors of hemodynamic damage were analyzed .Results:Hemodynamic damage emerged in 23 cases (32.4%), of which, 11.3%developed hypotension.The distance between bifurca-tion and lesions (P=0.002 0), plaque distribution (P=0.000 2), plaque character (P=0.001 9), post-dilation ( P =0.002 6 ) were associated with hemodynamic damage by single factor analysis . However, only eccentric plaque (P=0.015 3) and calcified plaque (P=0.009 7) were associated with hemodynamic damage by multiple factors analysis .All the patients could reach stable circulation by drugs during operation , and no cerebral ischemic events ( transient ischemic attack or stroke ) and cardiovascu-lar ischemic events happened .Conclusion: The distance between bifurcation and lesions , eccentric plaques, calcified plaques are correlation factors of hemodynamic damage .

Objective To study the cerebral energy metabolism changes of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) through hydrogen magnetic resonance spectroscopy examination (1 HMRS ) and its relationship with partial pressure of oxygen / carbon dioxide tension.Methods Totally 13 cases of AECOPD patients and 10 cases of age-matched healthy people underwent HMRS examination.The ratios of n-acetyl-aspartate(NAA)/creatine(Cr),choline (Cho)/Cr,myo-inositol(MI)/Cr of parieto-temporal and occipital areas of brain were detected.Blood gas analysis were also used to detect partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2).Results NAA / Cr of parieto-temporal and occipital areas of brain (1.32±0.12,1.48±0.12) were lower in AECOPD group than those in control group (1.45±0.11,1.58±0.10) (P＜ 0.05),MI/Cr (0.23±0.07,0.30±0.11) were also decreased compared with control group (0.40±0.14,0.46±0.12) (P＜ 0.01),while Cho/Cr of parieto -temporal and occipital areas of brain between the AECOPD group and control group showed no significant difference (P＞0.05).NAA/Cr of parieto temporal and occipital areas of brain were positively correlated with PaO2 (r=0.46 and 0.44),and MI/Cr of these areas of brain were also positively related with PaO2 (r=0.63 and 0.50),but MI / Cr of parieto tempora was negatively correlated with PaCO2 (r =- 0.472). Conclusions Cerebral metabolite changes may occur in AECOPD patients,and this has relationship with hypoxia and carbon dioxide retention.