Objectives To investigate the clinical significance of CYP2C19 genotype detection for antiplatelet therapy of elder cardiovascular and cerebrovascular diseases(CCVD).Methods We enrolled all elderly patients with either cardiovascular or cerebrovascular disorders who received clopidogrel as mono drug or in combination with another antiplatelet drug aspirin as secondary prevention for more than 12 months in our hospital from January to August 2015.Somatotypes of CYP2C19 genotypes of all participants were assessed to analyze the relapse of cardiac-cerebral vascular diseases in these patients.Results A total of 250 patients were enrolled,including 179 male and 71 female,with average age of (85.2 ± 7.9) years.Among these patients,there were 97 (38.8％) cases with EM CYP2C19 genotypes,110 cases(44.0 ％) with IM CYP2C19 genotypes,43 cases(17.2 ％) with PM CYP2C19 genotypes.When treated with clopidogrel for antiplatelet in secondary prevention process,the rate of the relapse in cardiovascular event was 34.9％ and higher in PM CYP2C19 genotype than in EM and IM CYP2C19 genotype (19.6 ％ and 15.5 ％,respectively) (x2 =7.251,P =0.027).This phenomenon was similar to patients who received stent implantation(x2=6.393,P =0.041).However,no statistically significant difference was observed in the recurrence rate of cerebral vascular disease between three different genotypes(EM 29.9 ％,IM 20.0 ％,PM 27.9％,x2 =2.880,P =0.237).Conclusions Our results highlight that CYP2C19 genotype might be a potential guidance for secondary prevention of cardiovascular and cercbrovascular disorders among elderly patients.Clopidogrel may be less effective in patients with SM CYP2C19 genotype than those with EM or PM CYP2C19 genotype for secondary prevention of cardiovascular disease.

Objective To evaluate the effect of various methods of fecal exfoliated cell testing for screening of colorectal cancer.Methods The stool samples from 814 patients who underwent colonoscopy were collected for fecal exfoliated cell testing using diarrhea feces,twice naturally evacuated feces,magnetic separation or naturally evacuated combined with diarrhea feces.The fecal exfoliated cells were isolated and examined cytologically.The DNA quantitative analysis and gene detection were carried out.Fecal occult blood test was simultaneously performed in twice naturally evacuated feces and naturally evacuated combined with diarrhea feces.Results The sensitivity and specificity of exfoliated cells testing for colorectal Cancer was 66.27%(112 of 169 cases of colorectal cancer)and 99.56%(225 of 226 normal subjects),respectively.There was no correlation of positive rate with differentiations of colorectal cells or Duke's stages(P＞0.05).The nuclear DNA quantitative analysis showed that the sensitivity for detecting cancer was 76.09%for twice naturally evacuated feces and 68.29%for naturally evacuated combined with diarrhea feces,which was superior than diarrhea feces(26.31%)and magnetic separation (43.24%).The positive rate of genes detected in carcinoma tissues concordant with fecal exfoliated cells testing were 83.33%(25/30)for p53,9/10 for APC and 9/10 for K-ras.The sensitivity of cytology was higher than gene detection.The sensitivity of cancer detection was higher in combining exfoliated cells test with fecal occult blood test(93.10%)than exfoliated cells test(73.56%)or fecal occult blood test (80.46%)alone(P＜0.05).Conclusions Fecal exfoliated cells test is an effective method for screening of colorectal cancer.It is the best option for detecting cancer by twice tests of fecal exfoliated cells with liquid-based thin-layer cytological test,and combined with fecal occult blood test.

Objective To study the epidemiological characteristics of diabetes,and to provide effective prevention and intervention strategies for diabetes in Zhejiang Province.Methods Descriptive epidemiological method was used to analyze the surveillance data of diabetes from 2007 to 2012.Results 272 534 cases of new on-set diabetes were reported through the noncommunicable disease surveillance system in Zhejiang Province from 2007 to 2012,and the annual incidence was 277.08/100 000.According to different types of diabetes,the proportions of type 1,type 2,gestational,and other types diabetes were 0.69％,96.04％,2.23％,and 1.03％,respectively.The incidence was higher in urban and female population.The diabetes incidence was increased with 20.18％ per year and the growing speed of incidence in rural area and males were faster than those in urban area and females,respectively.The incidence in 70-year group was the highest and the growth speed in 20-year group was the fastest one.11.89％ of diabetes patients were diagnosed with complications simultaneously and the proportion of diabetic neuropathy,vasculopathy,and nephropathy was accounted for 82.81％.The incidence of diabetic complications was increased at first and then decreased from 2007 to 2012.Conclusion With the aging trends in Zhejiang province,the incidence will be increased rapidly,and the rural,male,and adolescence populations should be the focus objectives for the diabetes prevention and control in the future.Although the trend of diabetic complications incidence was tended to decline,the result should be confirmed by further researches.

OBJECTIVETo conduct a survival analysis of gastric cancer patients according to the data of population-based cancer registry during 2005-2010 in Zhejiang Province in order to provide information for prognosis assessment and control of this disease.

METHODSThe deadline of the last follow-up of 26, 536 patients was December 31st, 2012. Cumulative observed survival rate (OSR) and expected survival rate were calculated by life table and Hakulinen method.

RESULTSthe 1-, 3-, and 5-year OSR were 58.51%, 39.07%, and 33.08%, and the 1-, 3-, and 5-year relative survival rates (RSR) were 60.24%, 42.90%, and 39.03%, respectively. The 1-, 3-, and 5-year relative survival rates of males vs. females were 60.49% vs. 59.65%, 42.88% vs. 42.96%, and 38.76% vs. 39.64%, respectively, statistically with non-significant differences (χ(2) = 0.13, P > 0.05) between them. The 5-year OSR and RSR of urban patients were 39.15% and 46.30%, and the 5-year OSR and RSR of rural patients were 30.81% and 36.32%, with statistically significant differences between them (P < 0.05). The 15-44 age group had a better relative survival rate.

CONCLUSIONSThe survival rate of gastric cancer patients in Zhejiang Province is low. Work of cancer prevention and control should be strengthened. The wide variation in gastric cancer survival rates between urban and rural patients indicates that priority should be given to rural areas in allocating medical and public health resources.

China ; epidemiology ; Female ; Humans ; Male ; Prognosis ; Rural Population ; Stomach Neoplasms ; epidemiology ; Survival Analysis ; Survival Rate

Objective : To optimize the primary prevention strategies of birth defects in Zhejiang Province by Delphi method, so as to promote the capacity of birth defects prevention. Methods: The expert consultation questionnaire was developed based on the relevant policies of Zhejiang Province and literature. Ten experts from medical institutions and health administrative departments were employed for one round Delphi expert consultation. The weighted scores and priorities of ten measures for the primary prevention of birth defects in Zhejiang Province were determined, as well as the suggestions of optimizing the current policies. Results : The response rate of the experts was 90.91%; the coefficient of authority was 0.92; the coefficients of variation of ten measures were all less than 0.25; the coefficient of coordination was 0.31 ( P<0.05 ) , which indicated the opinions of the experts tended to be consistent. In the order of priority, ten primary prevention measures of birth defects were the improvement of birth defects surveillance network ( province, city and county level ) , the training of birth defects prevention talents, the construction of genetic consultation clinics, health education and publicity, the reproduction outpatient service construction for older people, free premarital medical examination, free pre-pregnancy eugenics test, the construction of drug consultation clinics, career planning and training of birth defect prevention and control consultants and free folic acid supplement to the whole population. Nine experts suggested that the following policies need to be optimized: birth defects surveillance system, free premarital medical examination, and health education and publicity. Conclusion In the primary prevention of birth defects in Zhejiang Province, the most urgent problem to be solved is the improvement of the three-level birth defects surveillance network.

Objective To describe the survival status and to analyze the factors associated with mortality on first-ever stroke patients.Methods The first-ever stroke patients registered in 2009 were collected from "Zhejiang provincial information system for NCDs' surveillance and management".Survival status and the cause of death through active and passive follow-up programs,were collected.Kaplan-Meier methods were used for survival description.Monovariant and multivariant Cox' s proportional hazard regression models were used to analyze risk factors on mortality.Results A total of 78 189 patients,who suffered from cerebral infarctions (ICD-10:I63),intracerebral haemorrhages (I61),subarachnoid haemorrhages (I60) and unspecified strokes (I64),accounted for 61.65％,30.42％,2.32％ and 5.62％,were recruited.33 265 cases died during the period of this study.27 147 cases were stroke related,accounted for 81.61％.6 122 cases died on the same day,with one-day case fatality as 7.83％ and the overall 28-day case fatality as 21.01％.The survival rates from one-year to four-year were 72.04％,68.92％,66.27％ and 64.29％,respectively.The four-year survival rates of I63,I61,I60 and I64 were 80.06％,50.15％,71.80％ and 21.41％,respectively.Effect of the model showed that the risk factors associated with mortality were age,gender,educational level,the diagnosis and quality of the hospitals on treatment,hypertension and the types of stroke incidences.Age had interacted with gender (P＜0.001).Results from the ‘single effect’ showed that males had higher risk than females in those younger than 75 years old,but vice versa in those older than 75 of age.Conclusion Patients appeared very high risk of death in both acute and sub-acute phases.Factors including age,gender,educational level,both quality on diagnosis and treatment of the hospitals,clinical types of hypertension and stroke etc.were at risk,associated with prognosis of the disease.

Objective:To investigate the correlation between cyclooxygenase-2(COX-2), estrogen receptor (ER), progesterone receptor(PR) and the formation of endometrial polyps and the increased malignant rate of postmenopausal endometrial polyps.Methods:From January 2018 to January 2019, a total of 160 postmenopausal women treated in the People's Hospital of Changxing County were selected and divided into endometrial polyps group(83 cases) and oothectomy group(42 cases), normal menopause group(35 cases) according to different diseases.The levels of COX-2, ER, PR in the three groups were measured.The expression of COX-2 in mesenchymal cells and glandular epithelial cells, the expression of ER in mesenchymal cells and glandular epithelial cells, the expression of PR in mesenchymal cells and glandular epithelial cells in the three groups were compared, and the correlation between COX-2, ER, PR and increased malignant rate of endometrial polyps was analyzed.Results:The positive expression rates of COX-2 in mesenchymal cells and glandular epithelial cells in the endometrial polyps group(16.9%, 30.1%) were higher than those in the normal menopause group(0.0%, 11.4%) and the oothectomy group(4.8%, 7.1%)(χ 2=4.568, 5.806, all P<0.05 ). There were no statistically significant differences in the expression of ER in mesenchymal cells and glandular epithelial cells among the three groups(χ 2=1.333, 1.412, all P>0.05). The expression of PR in mesenchymal cells and glandular epithelial cells in the endometrial polyps group was lower than that in the normal menopause group and the oothectomy group(χ 2=4.890, 5.022, all P<0.05). COX-2 was positively correlated with the increase in malignant rate of endometrial polyps( r=4.335, P<0.05), PR was negatively correlated with an increase in the malignant rate of endometrial polyps( r=-4.256, P<0.05), and ER had no significant correlation with an increase in the malignant rate of endometrial polyps( r=1.203, P>0.05). Conclusion:COX-2 and PR are significantly related to the formation of endometrial polyps and the increase in malignant rate of postmenopausal endometrial polyps, but there is no significant expression of ER.Therefore, the detection of COX-2 and PR levels is beneficial to provide a certain scientific basis for clinical treatment.

Diabetes has become the world's major public health problem in the 21th century.Increasing attention has been paid to the importance of healthy sleep abroad,whereas less attention has been paid to it in China.Through literature study,this paper summarizes the current status of epidemiology and laboratory research on the relationship between sleep duration and incidence of type 2 diabetes,insulin sensitivity and blood glucose control both at home and abroad,and introduces the underlying mechanisms in order to provide evidence for further studies and the prevention and management of diabetes.

Objective To evaluate the impact of diabetes prevalence and mortality on health life expectancy (HLE).Methods A cause-excluded health adjusted life expectancy method was used to quantitatively analyze the impact of diabetes on HLE and the composition of health life losses (HLL),using the integrated data on population mortality,self-assessed health status and diabetes prevalence.Results The HLE for people aged 15 was 55.80 in Zhejiang,in 2013.After removing the diabetes morbidity and mortality,the HLE for men aged 15 increased by 0.86 and 1.13,respectively,with an increase of 1.04 and 0.66 for urban and rural residents.Substantial increase of HLE was observed in women and urban residents than those for men and rural residents.HLL caused by diabetes mortality and morbidity appeared as 0.10 and 0.79,with a ratio of 7.92.Conclusion HLL caused by diabetes mortality was much greater than those caused by diabetes mortality,suggesting the most effective measure in reducing the diabetes-related HLL is to promote the healthy lifestyle in urban areas and especially for women.

OBJECTIVETo survey the incidence of acute coronary events (nonfatal acute myocardial infarction and death from coronary heart disease), and analyze the trend and distribution characteristics in permanent residents aged 25 years and more across 30 surveillance regions of Zhejiang province from 2010 to 2012.

METHODSThrough databases matching and duplicate checking, this study incorporated the register module of coronary disease and the cause of death register module in Zhejiang provincial information system for chronic non-communicable diseases surveillance and management. The distribution of incidence was calculated across gender, age groups, regions and times.

RESULTSA total of 31 872 person-time acute coronary events were identified. The gender- and age-standardized mean annual incidence was 81.56 per 100 000 people in overall population, with 94.33 in males and 68.27 in females. Age-standardized incidence was 87.90 and 77.36 per 100 000 people in urban and rural area, respectively. Urban area had higher incidence rate than rural in each of the three years, and had obvious trend of increasing (P < 0.001) compared with rural area (P = 0.331). Incidence rate also increased significantly with age (P < 0.001).In addition, compared with women, men had higher incidence in each age group (all P < 0.001). The incidence rate increased rapidly in population older than 75 years old. The highest incidence was observed in age group ≥ 85 years old, with 2 371.67 and 1 873.92 per 100 000 in males and females, respectively. Apparent seasonal trend was observed for acute coronary events, which was low in summer and high in winter.

CONCLUSIONSQuantity and incidence for acute coronary events in residents aged 25 years and more of Zhejiang surveillance regions increased during 2010 to 2012. Male had higher incidence than female, and the incidence in urban areas was higher compared with rural areas. Residents older than 75 years old were high risk population of events, and winter was the high-occurrence season.

Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Anterior Wall Myocardial Infarction ; China ; epidemiology ; Chronic Disease ; Coronary Artery Disease ; Coronary Disease ; diagnosis ; epidemiology ; Disease Management ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Rural Population