The paper is to report the pharmacokinetics of sulfamethoxazole in healthy Han volunteers living at plain (PH) and native Han and Tibetan healthy volunteers living at high altitude (HNH and HNT). After healthy volunteers were administrated orally cotrimoxazole tablets, plasma concentration of sulfamethoxazole and metabolite N4-acetylsulfamethoxazole was determined by RP-HPLC, and plasma concentration-time data were analyzed by DAS 2.0 software to get the related pharmacokinetic parameters. The main pharmacokinetic parameters t(1/2) of sulfamethoxazole in PH, HNH and HNT were, respectively, 9.30 +/- 1.11, 10.99 +/- 1.23 and 10.44 +/- 1.05 h; tmax were 1.4 +/- 0.3, 2.0 +/- 1.1 and 1.8 +/- 0.4 h; Cmax were 94.42 +/- 15.26, 89.33 +/- 7.67 and 87.43 +/- 11.61 micro x mL(-1); AUC(0-t) were 1202.5 +/- 238.3, 1 434.7 +/- 193.9 and 1302.8 +/- 103.0 microg x h x mL(-1); AUC(0-infinity) were 1240.7 +/- 255.3, 1511.5 +/- 211.9 and 1363.9 +/- 116.5 microg x h x mL(-1); CL were 1.01 +/- 0.22, 0.81 +/- 0.12 and 0.89 +/- 0.08 L x h(-1) x kg(-1); V were 13.27 +/- 1.73, 12.81 +/- 2.15 and 13.28 +/- 1.20 L x kg(-1). Sulfamethoxazole pharmacokinetic parameters of HNH and HNT were significantly different from that of PH. The t(1/2) was significantly higher and the CL was significantly lower in HNH and HNT than that in PH, and the AUC(0-infinity) was significantly lower in HNT compared with HNH. This study found significant changes in the disposition of sulfamethoxazole under the special environment of high altitude hypoxia. This finding may provide some references for clinical rational application of sulfamethoxazole in HNH and HNT.

OBJECTIVE:To study the effects of Tibetan medicine Zuotai on the activities of cytochrome oxidase (CYP1A2) and drug metabolism enzyme N-acetyltransferase 2(NAT2)in rats. METHODS:70 SD rats were equally randomized into a normal control (normal saline) group,the groups of single administration of low,middle and high-dose (1.2,3.8 and 12 mg/kg) Zuotai and the groups of multiple administrations thereof(once daily for 12 consecutive days). The rats were given drugs ig. caffeine(25 mg/kg)was given ig to the rats in the normal control group and the groups of single administration on the 2nd day,and to those in the groups of multiple administrations on the 13th day. 5 h later,their urine was collected and added with vitamin C based on 10 mg/ml. High performance liquid chromatography (HPLC) was adopted to determine the cafeine metabolites contents of 5-acetami-do-6-formamido-3-methyl-uric acid(AFMU),1-methylxanthine(1X),1-methyl-uric acid(1U)and 1,7-dimethyl uric acid(17U) in rats’urine,and the activities of CYP1A2 and NAT2 were reflected through (AFMU+1X+1U)/17U and AFMU/(AFMU+1X+1U). RESULTS:Compared with normal control group,the(AFMU+1X+1U)/17U and AFMU/(AFMU+1X+1U)in rats were de-creased,namely the activities of CYP1A2 and NAT2 were lower in the groups of single administration of middle-dose Zuotai and multiple administrations of middle and high-dose Zuotai than in the normal control group. There was statistical difference (P<0.05). CONCLUSIONS:Zuotai can obviously inhibit the activities of CYP1A2 and NAT2 in rats.

Objective To study the effect of Tibetan medicine Zuotai on in vivo pharmacokinetics of crocin-1 in rats.Methods After im injection of crocin-1 (5 mg/kg) in control (continuously ig normal saline for 7 d) and expermental (continuously ig Zuotai suspension for 7 d or 21 d) rats,The plasma concentration of crocin-1 was determined by RP-HPLC,and plasma concentration-time data were analyzed by DAS 2.0 software to get the related pharmacokinetic parameters of crocin-1.Results After continuously ig administration of Zuotai [10 mg/(kg?d)] for 7 d and 12 d in experimental rats,the pharmacokinetic parameters of crocin-1 changed significantly.The AUC,Cmax,and MRT were significantly greater in experimental rats than those in control rats,and the CL and Vd were significantly lower than those in control rats,and the AUC of crocin-1 was greater in the 21 d administration group than that in the 7 d administration group.Conclusion The result demonstrates that Tibetan medicine significantly affects the pharmacokinetics of crocin-1 in rats.After administration of Zuotai in rats,the absorption degree of crocin-1 is significantly increased and the clearance rate is significantly decreased.

Objective To investigate the effect of enteral nutrition tolerance assessment form on the early enteral nutrition tolerance in patients with gastric cancer after operation. Methods According to the admission sequence, 108 patients with gastric cancer were divided into the control group and the experiment group with 54 cases in each group. Enteral nutrition was used in the control group, while enteral nutrition tolerance assessment form was used to evaulate and care patients in experiment group. Finally, the two groups were compared in the anal exhaust time and the rate of complications. Result Anal exhaust in the experiment group was significantly earlier than that in the control group and the rate of complications was significantly smaller than that of the control group (P < 0.05). Conclusions The enteral nutrition tolerance assessment form for systemic evaluation and intervention is effective in improvement of the patients′tolerance to enteral nutrition in early postoperative enteral nutrition support to patients with gastric cancer. It can promote the recovery of patients.

Objective To investigate the clinical features of gastric stump ulcer (GSU)after partial gastrectomy due to gastroduodenal ulcer.Methods From January 1st 2007 to October 31th 2013,272 patients with partial gastrectomy for gastroduodenal ulcer underwent gastroscopy due to upper gastrointestinal symptoms were collected.Among them,there were 237 male patients and 35 female patients with the average age (55 .4 ± 13.0 )years.The lesion location,symptoms and pathological changes of GSU were analyzed.Chi-square test and Fisher exact probability analysis were used for count data comparison.The t test was performed for measurement data comparison.Results There was no significant difference between patients with GSU after Billroth Ⅰ gastrectomy and Billroth Ⅱ gastrectomy in the incidence of dysphagia,nausea and vomiting,retrosternal pain,retrosternal buring sensation,upper abdominal pain, abdominal distention, acid regurgitation and (or) epigastric buring sensation, hematemesis and (or)melena (all P >0.05 ).The proportion of ulcer located in remnant stomach and anastomotic stoma of patients with Billroth Ⅰ gastrectomy (24.7%,18/73 and 72.6%,53/73 )was higher than those of patients with Billroth Ⅱ gastrectomy (10.1 %,20/199 and 58.3%,116/199 )and the difference was statistically significant (OR=2.929 and 1 .896,95 %CI :1 .448 to 5 .927 and 1 .055 to 3.409,χ2 =9.482 and 4.649,P =0.002 and 0.031 ).There was no significant difference between the proportion of afferent loop and efferent loop ulcer in patients with Billroth Ⅱ gastrectomy and the proportion of duodenal ulcer in patients with Billroth Ⅰ gastrectomy (P =0.619).The diameter of GSU of patients with BillrothⅠ((1.1±0.7)cm)was larger than that of ulcer of patients with BillrothⅡ((0.8±0.6)cm) and the difference was statistically significant (t = 3.591 ,P = 0.007 ).The incidence of intestinal metaplasia and atypic hyperplasia of GSU was 8.1 % (22/272),and there was no significant difference in gastric ulcer,stoma ulcer,nek ulcer,afferent loop and efferent loop ulcer (all P >0.05).The incidence of gastric stump cancer of GSU was 4.0% (11/272)and that of gastric ulcer,stoma ulcer,nek ulcer,afferent loop and efferent loop ulcer was 13.2% (5/38 ),2.4% (4/169 ),1.8% (1/55 )and 1/10,respectively.The incidence of gastric stump cancer of gastric ulcer was significantly higher than that of stoma ulcer and nek ulcer, the differences were statistically significant (OR =6.250 and 8.182,95%CI :1.593 to 24.519 and 0.915 to 73.126,χ2 =8.687 and 4.788,P =0.012 and 0.040).There was no statistically significant difference in the incidence of gastric stump cancer of GSU in other gastric parts (all P > 0.05 ).There was no statistically significant difference in the incidence of intestinal metaplasia,atypic hyperplasia and gastric stump cancer between case with BillrothⅠgastrectomy and case with Billroth Ⅱ gastrectomy (P =0.650 and 0.733).Among the 11 gastric stump cancers,the number of cases with the onset time with 20 years,20-30 years and beyond 30 years after gastrectomy were one,three,seven,respectively.Conclusion The incidence of intestinal metaplasia, atypic hyperplasia and gastric stump cancer of patients with GSU was high,and the predilection site of GSU was the remnant stomach.

BACKGROUND:Surrounding structure of intracristal ventricular septal defects(IVSD) and membranous ventricular septal defects(MVSD)is complicated,and it is difficult to perform transcatheter closure treatment.Corresponding animal models should be established to define an optimal interventional therapy.OBJECTIVE:To prepare the animal models of IVSD and MVSD under echoeardiogram location.DESIGN:Animal modeling experiment.SETTING:Department of Cardiology,Zhongshan Hospital Affiliated to Fudan University.MATERIALS:Six healthy adult dogs,irrespective of gender,were purchased from Shanghai Experimental Animal Center.Aorta and great saphenous vein stapler-puncher(St.Jude corporation,USA)was used.The main improvement is to cut the plastic shell even,thin,or shorter in order to reduce the resistance when puncturing the"purse"in the fight ventficle and the interventficular septum.Sonos 5500 multifunction ultrasonoscope(Philips,USA)was used,and the frequency of the probe was between 2.5-3.5 MHz.METHODS:Experiments were performed at the Zhongshan Hospital Affiliated to Fudan University and Central Laboratory of Shanghai Institute of Cardiovascular Disease from April to July 2006(biosaflety level 2).After anaesthesia,6 adult dogs were fixed at decumbent position.The interventricular septum was punetured to make the preparation with the location of echocardiography(ECHO)by using the modified aorta and great saphenous vein proximal stapler-puncher.Animal intervention met the Animal Ethical Committee of Fudan University.MAIN OUTCOME MEASURES:One week after the surgery,transthoracic echocardiography examination was used to check the VSD site,the highest shunt flow rate,the pressure difference between both sides of the VSD,as well as pulmonary artenal pressure.RESULTS:The VSD models were successfully established in three survivals and included in the final result.Two models of IVSD and one model of MVSD were examined by ECHO one week after the surgery.The diameter of VSD ranges from 1.8 to 3.6 mm.The Peak Flow Rate of the VSD ranges between 1.8 and 4.0 m/s.The pressure difierence of both sides of the VSD ranges between 42 and 51 mm Hg.The pulmonary arterial systolic pressure ranges from 23 to 29 mm Hg.CoNCLUSION:Located by the ECHO,it is possible to establish animal models of the IVSD and MVSD with the modified aorta and great saphenous vein proximal stapler-puncher.

This study is to investigate the effect of high altitude hypoxia on the activity and protein expression of CYP2C9 and CYP2C19. Rats from plain (P) and rats with acute middle altitude hypoxia (AMH), chronic middle altitude hypoxia (CMH), acute high altitude hypoxia (AHH) and chronic high altitude hypoxia (CHH) were administered orally phenytoin sodium (PHT) and omeprazole (OMZ) to evaluate the activity of CYP2C9 and CYP2C19, separately. The serum concentrations of PHT and metabolite 4'-hydroxyphenytoin (HPPH) at 12 h after treatment and the serum concentrations of OMZ and metabolite 5-hydroxy omeprazole (5-OHOMZ) at 3 h after treatment were determined by RP-HPLC. The activity of CYP2C9 and CYP2C19 was evaluated by the ratio of HPPH to PHT and the ratio of 5-OHOMZ to OMZ, respectively. The protein expressions of CYP2C9 and CYP2C19 were determined by ELISA method. The activities of CYP2C9 (HPPH/PHT) in P, AMH, CMH, AHH and CHH were 0.67 +/- 0.31, 0.75 +/- 0.29, 0.76 +/- 0.23, 0.79 +/- 0.31 and 0.75 +/- 0.18, respectively, and the activities of CYP2C19 (5-OHOMZ/OMZ) in P, AMH, CMH, AHH and CHH were 0.17 +/- 0.06, 0.20 +/- 0.10, 0.11 +/- 0.05, 0.37 +/- 0.13 and 0.19 +/- 0.05, respectively. The protein expressions of CYP2C9 in P, AMH, CMH, AHH and CHH were 4.20 +/- 1.27, 3.95 +/- 0.81, 3.93 +/- 1.11, 4.32 +/- 1.03 and 4.12 +/- 0.86 ng x g(-1), respectively, and the protein expressions of CYP2C19 in P, AMH, CMH, AHH and CHH were 3.91 +/- 1.82, 3.63 +/- 2.07, 2.55 +/- 0.85, 4.78 +/- 2.37 and 3.51 +/- 1.03 ng x g(-1), respectively. The activities and protein expressions of CYP2C9 in AMH, CMH, AHH and CHH were not significantly different with those of P. The protein expressions of CYP2C19 in AMH, CMH, AHH and CHH were not significantly different with those of P, but the activity of CYP2C19 in AHH was significantly higher than that of P. This study found significant changes in the activity of CYP2C19 under the special environment of acute high altitude hypoxia.

Objective To observe the curative effect of continuous gastrointestinal decompression after gastric lavage with edible oil on saving patients with oral aluminum phosphide poisoning.Methods Seventy-eight patients with oral aluminum phosphide admitted to the Department of Internal Emergency of the Second People's Hospital of Yunnan Province from October 2009 to October 2016 were divided into a mild poisoning group (39 cases), a moderate poisoning group (26 cases) and a severe poisoning group (13 cases) according to clinical manifestations and laboratory examinations, all the patients were treated with continuous gastrointestinal decompression after early gastric lavage with edible oil, including scavenging toxicant, correcting intracellular oxygen intake and metabolic disturbance, and inhibiting and eliminating inflammatory mediators. The difference of remission times of clinical symptoms, recovery times of abnormal indexes and hospitalization times were compared among patients with different disease severities. Results With the aggravation of disease, the remission times of clinical symptoms (hours: from mild to severe were 24±12, 54±18, 84±12), recovery times of abnormal indexes (hours: from mild to severe were 18±6, 72±0, 108±12) and hospitalization times (hours: from mild to severe 48±24, 120±24, 144±24) were all gradually extended. Of the 13 patients with severe poisoning, 2 patients died of multiple organ functional failure (MOF) after 28 hours of treatment because they were incapable of cooperating with continuous gastrointestinal decompression. There were 76 patients were clinically cured, the cure rate being 97.4%. In the follow-ups at 1 month and 6 months after the treatment, no abnormalities were seen.Conclusion Continuous gastrointestinal decompression after early gastric lavage with edible oil for saving patients with oral aluminum phosphide poisoning is an effective therapy worthwhile to be popularized.

Objective To investigate the clinical outcomes of sternoclavicular hook plate in treatment of the anterior sternoclavicular joint dislocation. Methods A new device named sternoclavicular hook plate was devised by our team. Between May 2002 and Octorber 2009, 66 patients with sternoclavicular joint anterior dislocation were treated with the new device, among whom there were 47 males and 19 females,aged 21-68 years old (average, 32.6 years old). Twenty-one cases were caused by crush injury, 5 cases by falling and 40 cases by traffic accident. Anterior fracture-dislocation was found in 41 cases. According to the Allman system, there were 35 cases of type Ⅱ and 31 cases of type Ⅲ. Patients were evaluated with serial clinical and radiographic examinations. Rockwood score were used after the operation to assess the curative effect. Results The average operative time was 33 min (range, 20-48 min). The mean blood loss was 60 ml (range, 20-90 ml). There were no vascular or peripheral nerve injuries in the patients. All incisions healed smoothly. The X-ray and CT showed that the reduction of sternoclavicular joint and the location of internal fixation were satisfactory. All the 66 patients were followed up for 12-37 months (average, 17 months). There was no internal fixation failure, redislocation or other complications. The sternoclavicular hook plate was removed 12 months after operation. The mean Rockwood's score was 13.2 (8 to 15). There were excellent in 50cases, good in 15 cases, and fair in 1 case. Conclusion The sternoclavicular hook plate is a new, safe and liable technique for sternoclavicular fracture-dislocation. This new technique is helpful for early functional exercises.

Objective To investigate the relationship between the co-expression of CD105 and cyclin D1 and lymph node metastasis and prognosis of esophageal squamous cell carcinoma ( ESCC ). Methods Eighty cases of ESCC tissue were collected at The First People's Hospital of Nantong. The expression of CD105 and cyclin D1 of ESCC was detected by immunohistochemistry. The relationship between the co-expression of CD105 and cyclin D1 and lymph node metastasis and prognosis of ESCC was analysed. Eighty normal esophageal tissues were selected as controls. All data were analysed by t test, chi-square test, and Pearson correlation analysis. Survival was analysed by the Kaplan-Meier survival curve. Microvessel density (MVD) was used to indicate the expression of CD105 in the form of -x±s. Results The expression of CD105 in ESCC tissues was higher (36±8) than that in normal esophageal tissues ( 11±3) (t =25. 129, P＜0.05). The positive rate of cyclin D1 expression in ESCC tissues was 61% (49/80), which was significantly higher than 23% (18/80) in normal esophageal tissues ( x2 =4.972, P＜0.05). The MVD value of 44 patients was ≤36 (LCD105), and nine of them had lymph node metastasis. The MVD value of the remaining 36 patient was ＞ 36 ( HCD105 ), and 26 of them had lymph node metastasis. Twenty-eight patients with positive expression of cyclin D1 had lymph node metastasis, while seven patients with negative expression of cyclin D1 had lymph node metastasis. The results of Pearson correlation analysis revealed that a high expression of CD105 and a positive cyclin D1 expression were correlated with lymph node metastasis (x2 =21.562, 9.217, P＜0.05). The survival times of 28 patients with positive cyclin D1 and HCD105,21 patients with positive cyclin D1 and LCD105, eight patients with negative cyclin D1 and HCD105, and 23 patients with negative cyclin D1 and LCD105 were (31±6) months, (47±7) months, (51±9) months and (61±5) months, respectively, with a significant difference among the four groups (F = 11.76, P ＜ 0. 05 ).Conclusion Co-expression of CD105 and cyclin D1 may be used as a prognostic factor of ESCC.