BACKGROUND Resistance to clarithromycin(CLA)and levofloxacin(LFX)of Helicobacter pylori(H.pylori)is increasing in severity,and successful eradication is essential.Presently,the eradication success rate has greatly dec...BACKGROUND Resistance to clarithromycin(CLA)and levofloxacin(LFX)of Helicobacter pylori(H.pylori)is increasing in severity,and successful eradication is essential.Presently,the eradication success rate has greatly declined,leaving a large number of patients with previous treatment histories.AIM To investigate secondary resistance rates,explore risk factors for antibiotic resistance,and assess the efficacy of susceptibility-guided therapy.METHODS We recruited 154 subjects positive for Urea Breath Test who attended The First Affiliated Hospital of China Medical University between July 2022 and April 2023.Participants underwent a string test after an overnight fast.The gastric juice was obtained and transferred to vials containing storage solution.Subsequently,DNA extraction and the specific DNA amplification were performed using quantitative polymerase chain reaction(qPCR).Demographic information was also analyzed as part of the study.Based on these results,the participants were administered susceptibility-guided treatment.Efficacy was compared with that of the empiric treatment group.RESULTS A total of 132 individuals tested positive for the H.pylori ureA gene by qPCR technique.CLA resistance rate reached a high level of 82.6%(n=109),LFX resistance rate was 69.7%(n=92)and dual resistance was 62.1%(n=82).Gastric symptoms[odds ratio(OR)=2.782;95%confidence interval(95%CI):1.076-7.194;P=0.035]and rural residence(OR=5.152;95%CI:1.407-18.861;P=0.013)were independent risk factors for secondary resistance to CLA and LFX,respectively.A total of 102 and 100 individuals received susceptibility-guided therapies and empiric treatment,respectively.The antibiotic susceptibility-guided treatment and empiric treatment groups achieved successful eradication rates of 75.5%(77/102)and 59.0%(59/411)by the intention-to-treat(ITT)analysis and 90.6%(77/85)and 70.2%(59/84)by the per-protocol(PP)analysis,respectively.The eradication rates of these two treatment strategies were significantly different in both ITT(P=0.001)and PP(P=0.012)analyses.CONCLUSION H.pylori presented high secondary resistance rates to CLA and LFX.For patients with previous treatment failures,treatments should be guided by antibiotic susceptibility tests or regional antibiotic resistance profile.展开更多
Pituitary stalk interruption syndrome(PSIS)is a rare congenital abnormality characterized by thinning or disappearance of the pituitary stalk,hypoplasia of the anterior pituitary and an ectopic posterior pituitary.Alt...Pituitary stalk interruption syndrome(PSIS)is a rare congenital abnormality characterized by thinning or disappearance of the pituitary stalk,hypoplasia of the anterior pituitary and an ectopic posterior pituitary.Although the etiology of PSIS is still unclear,gene changes and perinatal adverse events such as breech delivery may play important roles in the pathogenesis of PSIS.PSIS can cause multiple hormone deficiencies,such as growth hormone,which then cause a series of changes in the human body.On the one hand,hormone changes affect growth and development,and on the other hand,they could affect human metabolism and subsequently the liver resulting in nonalcoholic fatty liver disease(NAFLD).Under the synergistic effect of multiple mechanisms,the progression of NAFLD caused by PSIS is faster than that due to other causes.Therefore,in addition to early identification of PSIS,timely hormone replacement therapy and monitoring of relevant hormone levels,clinicians should routinely assess the liver function while managing PSIS.展开更多
Clonorchis sinensis infection is still a major public health problem.It is estimated that more than 15 million people worldwide are infected,especially in Northeast China,Taiwan,South Korea,and North Vietnam.The detec...Clonorchis sinensis infection is still a major public health problem.It is estimated that more than 15 million people worldwide are infected,especially in Northeast China,Taiwan,South Korea,and North Vietnam.The detection of Clonorchis sinensis eggs in feces and bile is still the only gold standard for the diagnosis of Clonorchis sinensis infection,and new detection methods are needed to improve the detection rate.After Clonorchis sinensis invades the human body,it mainly parasitizes the hepatobiliary tract.Therefore,it is closely related to hepatobiliary diseases such as cholangitis,bile duct stones,liver fibrosis,and cholangiocarcinoma.The increase in immunoglobulin G4(IgG4)caused by Clonorchis sinensis infection is rare and there are few reports about the relevant mechanism.It may be related to the inflammatory factors interleukin(IL)-4,IL-10,and IL-13 produced by human phagocytes,T cells,B cells,and other immune cells in the process of resisting the invasion of Clonorchis sinensis.However,this finding still needs further clarification and confirmation.This article reviews the epidemiology,clinical manifestations,serology,imaging,pathogenic mechanism,and control measures of Clonorchis sinensis infection to help establish the diagnostic process for Clonorchis sinensis.We report novel mechanisms of IgG4 elevation due to Clonorchis sinensis infection to provide more experience and a theoretical basis for clinical diagnosis and treatment of this infection.展开更多
BACKGROUND We invented Endoscopic Ruler,a new endoscopic device to measure the size of varices in patients with cirrhosis and portal hypertension.AIM To assess the feasibility and safety of Endoscopic Ruler,and evalua...BACKGROUND We invented Endoscopic Ruler,a new endoscopic device to measure the size of varices in patients with cirrhosis and portal hypertension.AIM To assess the feasibility and safety of Endoscopic Ruler,and evaluate the agreement on identifying large oesophageal varices(OV)between Endoscopic Ruler and the endoscopists,as well as the interobserver agreement on diagnosing large OV using Endoscopic Ruler.METHODS We prospectively and consecutively enrolled patients with cirrhosis from 11 hospitals,all of whom got esophagogastroduodenoscopy(EGD)with Endoscopic Ruler.The primary study outcome was a successful measurement of the size of varices using Endoscopic Ruler.The secondary outcomes included adverse events,operation time,the agreement of identifying large OV between the objective measurement of Endoscopic Ruler and the empirical reading of endoscopists,together with the interobserver agreement on diagnosing large OV by Endoscopic Ruler.RESULTS From November 2020 to April 2022,a total of 120 eligible patients with cirrhosis were recruited and all of them underwent EGD examinations with Endoscopic Ruler successfully without any adverse event.The median operation time of Endoscopic Ruler was 3.00 min[interquartile range(IQR):3.00 min].The kappa value between Endoscopic Ruler and the endoscopists while detecting large OV was 0.52,demonstrating a moderate agreement.The kappa value for diagnosing large OV using Endoscopic Ruler among the six independent observers was 0.77,demonstrating a substantial agreement.CONCLUSION The data demonstrates that Endoscopic Ruler is feasible and safe for measuring the size of varices in patients with cirrhosis and portal hypertension.Endoscopic Ruler is potential to promote the clinical practice of the two-grade classification system of OV.展开更多
嗜酸粒细胞性胰腺炎(EP)是一种非常罕见的疾病,单纯由胰腺嗜酸性粒细胞浸润引起。EP容易被误诊为胰腺癌,给患者造成不必要的经济负担和身体伤害。2017年至今,我们报告了3例EP病例,均通过类固醇治愈,未出现复发。我们回顾性分析了3例患...嗜酸粒细胞性胰腺炎(EP)是一种非常罕见的疾病,单纯由胰腺嗜酸性粒细胞浸润引起。EP容易被误诊为胰腺癌,给患者造成不必要的经济负担和身体伤害。2017年至今,我们报告了3例EP病例,均通过类固醇治愈,未出现复发。我们回顾性分析了3例患者的临床表现、血清学表现、影像学特点(超声、CT和MRI)、病理诊断及治疗,并对其进行了电话随访。此外,在Web of Science和PubMed数据库上使用与EP相关的关键词进行了文献检索,并纳入了不受出版日期或语言限制的病例报告。我们对最终共纳入的19例病例进行了分析,并明确了EP的诊断标准。我们提出的EP诊断流程可以很好地对EP进行诊断。希望我们的诊断标准和诊断流程能够降低EP误诊率,以提高临床诊治水平。同时,我们也期望通过更多的EP病例来检验我们提出的诊断标准,并设计出一个更为系统的诊断流程图。展开更多
基金The study was reviewed and approved by the the Human Ethics Review Committee of the First Affiliated Hospital of China Medical University(Approval No.2021325).
文摘BACKGROUND Resistance to clarithromycin(CLA)and levofloxacin(LFX)of Helicobacter pylori(H.pylori)is increasing in severity,and successful eradication is essential.Presently,the eradication success rate has greatly declined,leaving a large number of patients with previous treatment histories.AIM To investigate secondary resistance rates,explore risk factors for antibiotic resistance,and assess the efficacy of susceptibility-guided therapy.METHODS We recruited 154 subjects positive for Urea Breath Test who attended The First Affiliated Hospital of China Medical University between July 2022 and April 2023.Participants underwent a string test after an overnight fast.The gastric juice was obtained and transferred to vials containing storage solution.Subsequently,DNA extraction and the specific DNA amplification were performed using quantitative polymerase chain reaction(qPCR).Demographic information was also analyzed as part of the study.Based on these results,the participants were administered susceptibility-guided treatment.Efficacy was compared with that of the empiric treatment group.RESULTS A total of 132 individuals tested positive for the H.pylori ureA gene by qPCR technique.CLA resistance rate reached a high level of 82.6%(n=109),LFX resistance rate was 69.7%(n=92)and dual resistance was 62.1%(n=82).Gastric symptoms[odds ratio(OR)=2.782;95%confidence interval(95%CI):1.076-7.194;P=0.035]and rural residence(OR=5.152;95%CI:1.407-18.861;P=0.013)were independent risk factors for secondary resistance to CLA and LFX,respectively.A total of 102 and 100 individuals received susceptibility-guided therapies and empiric treatment,respectively.The antibiotic susceptibility-guided treatment and empiric treatment groups achieved successful eradication rates of 75.5%(77/102)and 59.0%(59/411)by the intention-to-treat(ITT)analysis and 90.6%(77/85)and 70.2%(59/84)by the per-protocol(PP)analysis,respectively.The eradication rates of these two treatment strategies were significantly different in both ITT(P=0.001)and PP(P=0.012)analyses.CONCLUSION H.pylori presented high secondary resistance rates to CLA and LFX.For patients with previous treatment failures,treatments should be guided by antibiotic susceptibility tests or regional antibiotic resistance profile.
基金Supported by The Innovative Talent Support Program of The Institution of Higher Learning in Liaoning Province,No.2018-478The Innovative Talents of Science and Technology Support Program of Young and Middle People of Shenyang,No.RC170446.
文摘Pituitary stalk interruption syndrome(PSIS)is a rare congenital abnormality characterized by thinning or disappearance of the pituitary stalk,hypoplasia of the anterior pituitary and an ectopic posterior pituitary.Although the etiology of PSIS is still unclear,gene changes and perinatal adverse events such as breech delivery may play important roles in the pathogenesis of PSIS.PSIS can cause multiple hormone deficiencies,such as growth hormone,which then cause a series of changes in the human body.On the one hand,hormone changes affect growth and development,and on the other hand,they could affect human metabolism and subsequently the liver resulting in nonalcoholic fatty liver disease(NAFLD).Under the synergistic effect of multiple mechanisms,the progression of NAFLD caused by PSIS is faster than that due to other causes.Therefore,in addition to early identification of PSIS,timely hormone replacement therapy and monitoring of relevant hormone levels,clinicians should routinely assess the liver function while managing PSIS.
文摘Clonorchis sinensis infection is still a major public health problem.It is estimated that more than 15 million people worldwide are infected,especially in Northeast China,Taiwan,South Korea,and North Vietnam.The detection of Clonorchis sinensis eggs in feces and bile is still the only gold standard for the diagnosis of Clonorchis sinensis infection,and new detection methods are needed to improve the detection rate.After Clonorchis sinensis invades the human body,it mainly parasitizes the hepatobiliary tract.Therefore,it is closely related to hepatobiliary diseases such as cholangitis,bile duct stones,liver fibrosis,and cholangiocarcinoma.The increase in immunoglobulin G4(IgG4)caused by Clonorchis sinensis infection is rare and there are few reports about the relevant mechanism.It may be related to the inflammatory factors interleukin(IL)-4,IL-10,and IL-13 produced by human phagocytes,T cells,B cells,and other immune cells in the process of resisting the invasion of Clonorchis sinensis.However,this finding still needs further clarification and confirmation.This article reviews the epidemiology,clinical manifestations,serology,imaging,pathogenic mechanism,and control measures of Clonorchis sinensis infection to help establish the diagnostic process for Clonorchis sinensis.We report novel mechanisms of IgG4 elevation due to Clonorchis sinensis infection to provide more experience and a theoretical basis for clinical diagnosis and treatment of this infection.
基金This study is registered at https://www.clinicaltrials.gov/.The registration identification number is NCT04639323.
文摘BACKGROUND We invented Endoscopic Ruler,a new endoscopic device to measure the size of varices in patients with cirrhosis and portal hypertension.AIM To assess the feasibility and safety of Endoscopic Ruler,and evaluate the agreement on identifying large oesophageal varices(OV)between Endoscopic Ruler and the endoscopists,as well as the interobserver agreement on diagnosing large OV using Endoscopic Ruler.METHODS We prospectively and consecutively enrolled patients with cirrhosis from 11 hospitals,all of whom got esophagogastroduodenoscopy(EGD)with Endoscopic Ruler.The primary study outcome was a successful measurement of the size of varices using Endoscopic Ruler.The secondary outcomes included adverse events,operation time,the agreement of identifying large OV between the objective measurement of Endoscopic Ruler and the empirical reading of endoscopists,together with the interobserver agreement on diagnosing large OV by Endoscopic Ruler.RESULTS From November 2020 to April 2022,a total of 120 eligible patients with cirrhosis were recruited and all of them underwent EGD examinations with Endoscopic Ruler successfully without any adverse event.The median operation time of Endoscopic Ruler was 3.00 min[interquartile range(IQR):3.00 min].The kappa value between Endoscopic Ruler and the endoscopists while detecting large OV was 0.52,demonstrating a moderate agreement.The kappa value for diagnosing large OV using Endoscopic Ruler among the six independent observers was 0.77,demonstrating a substantial agreement.CONCLUSION The data demonstrates that Endoscopic Ruler is feasible and safe for measuring the size of varices in patients with cirrhosis and portal hypertension.Endoscopic Ruler is potential to promote the clinical practice of the two-grade classification system of OV.
基金Support Program for Young and Middle-Aged Science and Technology Innovation Talents of Shenyang [No.RC170446].
文摘嗜酸粒细胞性胰腺炎(EP)是一种非常罕见的疾病,单纯由胰腺嗜酸性粒细胞浸润引起。EP容易被误诊为胰腺癌,给患者造成不必要的经济负担和身体伤害。2017年至今,我们报告了3例EP病例,均通过类固醇治愈,未出现复发。我们回顾性分析了3例患者的临床表现、血清学表现、影像学特点(超声、CT和MRI)、病理诊断及治疗,并对其进行了电话随访。此外,在Web of Science和PubMed数据库上使用与EP相关的关键词进行了文献检索,并纳入了不受出版日期或语言限制的病例报告。我们对最终共纳入的19例病例进行了分析,并明确了EP的诊断标准。我们提出的EP诊断流程可以很好地对EP进行诊断。希望我们的诊断标准和诊断流程能够降低EP误诊率,以提高临床诊治水平。同时,我们也期望通过更多的EP病例来检验我们提出的诊断标准,并设计出一个更为系统的诊断流程图。
