基于网络药理学和实验验证研究柴胡疏肝散治疗慢性萎缩性胃炎的作用机制＊

目的 通过网络药理学的方法进行预测，再深一步进行动物实验验证来研究柴胡疏肝散治疗CAG的作用机制。方法 首先在TCMSP数据库中检索柴胡疏肝散的所有活性成分与药物靶点；通过收集PharmGkb、OMIM、GeneCards和DrugBank数据库中收录的慢性萎缩性胃炎的相关靶点。将药物靶点与疾病靶点进行映射筛选出交集靶点，将得到的交集靶点构建PPI网络与活性成分-共同靶点网络，并对其进行GO和KEGG富集分析。最后利用Vina软件进行分子对接实验验证，并通过免疫印迹法验证柴胡疏肝散对两种受体蛋白EGFR和STAT1的影响。结果 最终筛选得到柴胡疏肝散活性成分104个，潜在靶点238个，与慢性萎缩性胃炎的交集靶点52个；GO与KEGG富集分析分别得到2166条目和148条目，主要涉及到JAK-STAT信号通路、TNF信号通路、HIF-1信号通路等；分子对接结果显示EGFR、STAT1两个靶点能够与核心活性成分能够自发结合成较为稳定的构像；免疫印迹法实验证明柴胡疏肝散能够降低大鼠胃黏膜组织EGFR和STAT1蛋白表达。结论 通过网络药理学和实验验证，发现柴胡疏肝散可能通过调节EGFR和STAT1蛋白表达来共同调控胃黏膜细胞增殖与凋亡，进而发挥着治疗慢性萎缩性胃炎的效果，为深入进行柴胡疏肝散治疗慢性萎缩性胃炎的作用机制研究提供新思路和新方法。     

The efficacy and safety of Xiangsha Liujunzi decoction in the treatment of chronic non-atrophic gastritis: A protocol for a systematic review and meta-analysis

Background:Chronic non-atrophic gastritis is the most common type of chronic gastritis. Even if treated with current standard pharmacotherapy, the efficacy is not very satisfactory due to many factors. Traditional Chinese Medicine decoctions are increasingly used in the treatment of chronic gastritis, and many studies have shown that Xiangsha Liujunzi decoction is effective and safe in the treatment of chronic non-atrophic gastritis. However, it is controversy if Xiangsha Liujunzi decoction can provide an evidence-based clinical efficacy and safety in the treatment of chronic non-atrophic gastritis.Methods:We will go through 8 databases, and conduct a systematic review of Xiangsha Liujunzi decoction and health-related outcomes in chronic non-atrophic gastritis patients according to the Preferred Reporting Items for Systematic Reviews. The primary objective is to assess the impact of Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on clinical outcomes relevant to chronic non-atrophic gastritis patients, such as clinical effective rate,Helicobacter pylori eradication rate, efficacy under endoscopy, 1-year recurrent rate, and number of reported adverse events. Cochrane Risk Assessment Tool will be used to assess the quality of eligible studies according to the Cochrane handbook.Results:The results of this systematic review will provide a synthesis of current evidence of Xiangsha Liujunzi decoction and we have a specific opportunity to determine the efficacy and safety of it.Conclusion:This study will explore whether or not Xiangsha Liujunzi decoction can be used as one of the complementary and alternative therapies in the treatment of chronic non-atrophic gastritis.Registration number:Identifier: DOI 10.17605/OSF.IO/TX27U (https://osf.io/tx27u/).     

Inverse correlation between gastroesophageal reflux disease and atrophic gastritis assessed by endoscopy and serology

BACKGROUND Helicobacter pylori(H.pylori)infection is known to prevent the occurrence of gastroesophageal reflux disease(GERD)by inducing gastric mucosal atrophy.However,little is known about the relationship between atrophic gastritis(AG)and GERD.AIM To confirm the inverse correlation between AG and the occurrence and severity of GERD.METHODS Individuals receiving health checkups who underwent upper gastrointestinal endoscopy at Seoul National University Healthcare System Gangnam Center were included.The grade of reflux esophagitis was evaluated according to the Los Angeles classification.Endoscopic AG(EAG)was categorized into six grades.Serologic AG(SAG)was defined as pepsinogen I≤70 ng/m L and pepsinogen I/II ratio≤3.0.The association between the extent of EAG and SAG and the occurrence and severity of GERD was evaluated using multivariate logistic regression analysis.RESULTS In total,4684 individuals with GERD were compared with 21901 healthy controls.In multivariate logistic regression analysis,advanced age,male sex,body mass index>23 kg/m2,presence of metabolic syndrome,current smoking,and alcohol consumption were associated with an increased risk of GERD.Seropositivity for H.pylori immunoglobulin G antibodies was associated with a decreased risk of GERD.There was an inverse correlation between the extent of EAG and occurrence of GERD:Odds ratio(OR),1.01[95%confidence interval(CI):0.90-1.14]in C1,0.87(0.78-0.97)in C2,0.71(0.62-0.80)in C3,0.52(0.44-0.61)in O1,0.37(0.29-0.48)in O2,and 0.28(0.18-0.43)in O3.Additionally,the extent of EAG showed an inverse correlation with the severity of GERD.The presence of SAG was correlated with a reduced risk of GERD(OR=0.49,95%CI:0.28-0.87,P=0.014).CONCLUSION The extent of EAG and SAG exhibited strong inverse relationships with the occurrence and severity of GERD.AG followed by H.pylori infection may be independently protect against GERD.     

Development of deep learning segmentation models for coronary X-ray angiography: Quality assessment by a new global segmentation score and comparison with human performance

Introduction and objectivesAlthough automatic artificial intelligence (AI) coronary angiography (CAG) segmentation is arguably the first step toward future clinical application, it is underexplored. We aimed to (1) develop AI models for CAG segmentation and (2) assess the results using similarity scores and a set of criteria defined by expert physicians.MethodsPatients undergoing CAG were randomly selected in a retrospective study at a single center. Per incidence, an ideal frame was segmented, forming a baseline human dataset (BH), used for training a baseline AI model (BAI). Enhanced human segmentation (EH) was created by combining the best of both. An enhanced AI model (EAI) was trained using the EH. Results were assessed by experts using 11 weighted criteria, combined into a Global Segmentation Score (GSS: 0–100 points). Generalized Dice Score (GDS) and Dice Similarity Coefficient (DSC) were also used for AI models assessment.Results1664 processed images were generated. GSS for BH, EH, BAI and EAI were 96.9+/-5.7; 98.9+/-3.1; 86.1+/-10.1 and 90+/-7.6, respectively (95% confidence interval, p<0.001 for both paired and global differences). The GDS for the BAI and EAI was 0.9234±0.0361 and 0.9348±0.0284, respectively. The DSC for the coronary tree was 0.8904±0.0464 and 0.9134±0.0410 for the BAI and EAI, respectively. The EAI outperformed the BAI in all coronary segmentation tasks, but performed less well in some catheter segmentation tasks.ConclusionsWe successfully developed AI models capable of CAG segmentation, with good performance as assessed by all scores.     

慢性非萎缩性胃炎研究的知识图谱分析——基于VOSviewer和CiteSpace的计量分析＊

目的 本研究利用可视化工具VOSviewer和可视化工具CiteSpace对慢性非萎缩性胃炎的研究进行直观可视化分析，通过对该领域的主要研究热点、研究机构以及作者共被引分析，绘制出慢性非萎缩性胃炎研究发展的知识图谱。方法 检索中国知网（CNKI）近十年收录的相关期刊文献，采用VOSviewer和CiteSpace绘制其知识图谱。结果 共检索出1190条文献，其中符合纳入标准研究文献233篇。通过可视化表明，“幽门螺杆菌”“临床研究”和“临床观察”是突显强度最高的3个关键词。结论 通过知识图谱可视化分析，本研究得到慢性非萎缩性胃炎研究领域的具有影响力的作者、重要研究机构，进一步展示出慢性非萎缩性胃炎研究的热点领域。     

降逆胃舒汤治疗萎缩性胃炎疗效及对患者病理评分的影响

目的:研究降逆胃舒汤对幽门螺杆菌感染致萎缩性胃炎病理评分的功效。方法:选取238例幽门螺杆菌感染致萎缩性胃炎患者作为本次研究观察对象,入选患者遵循随机数字表法平均分配入对照组与治疗组,对照组以常规西药四联疗法治疗,治疗组在对照组疗法的基础上给予降逆胃舒汤治疗; 治疗3个月后,观察两组患者HP清除率并随访6个月统计复发率,观察两组患者中医证候积分、胃黏膜胃镜征象积分、胃黏膜病理评分及血清胃泌素-17(G-17)、血清胃蛋白酶原Ⅰ、Ⅱ(PGⅠ、PGⅡ)、PGⅠ/PGⅡ比值(PGR)治疗前、后的变化情况。结果:治疗前两组患者各项中医证候、胃黏膜胃镜积分、病理评分及血清指标表达水平比较,差异无统计学意义(P>0.05); 治疗后两组患者各项中医证候、胃黏膜胃镜积分、病理评分及血清指标表达水平比较,差异有统计学意义(P<0.05),治疗组均优于对照组(P<0.05); 治疗后3个月时治疗组HP清除率为88.24%、对照组为73.11%,随访6个月治疗组复发率为3.81%,对照组为18.39%,两组HP根除率、复发率比较,差异有统计学意义(P<0.05)。结论:降逆胃舒汤能够提高幽门螺杆菌清除率并降低复发,更有效缓解幽门螺杆菌感染致萎缩性胃炎的各项中医证候,进一步改善患者胃黏膜病理评分与胃镜征象,更良好的调节患者血清指标。     

Helicobacter pylori infection,chronic atrophic gastritis and risk of stomach and esophagus cancer: Results from the prospective population-based ESTHER cohort study

Helicobacter pylori (H. pylori) infection is considered as principal cause of gastric cancer. It is further associated with a reduced risk of esophageal adenocarcinomas. In a large prospective population-based cohort study including 9,949 subjects with average observation time of 13.8 years, we assessed the risk of invasive gastric and esophageal cancer according to H. pylori infection and presence of chronic atrophic gastritis (CAG). Incidence rates and hazard ratios (HR) derived by Cox proportional hazards models and adjusted for relevant confounders were derived by seroprevalence of H. pylori and cytotoxin-associated gene A (CagA) antibodies and presence of CAG based on serological markers at baseline, respectively. During follow-up, 30 cases of noncardia gastric cancer and 33 cases of esophageal cancer were observed. Infection by H. pylori without and with expression of CagA was associated with a 5.2-fold (95% confidence interval 1.00–27.1) and an 18.2-fold (4.3–77.4) increase of noncardia gastric cancer incidence. A 0.65-fold decreased risk of esophageal adenocarcinomas (HR 0.35, 0.12–0.97) was observed among H. pylori-infected individuals. In participants infected with CagA expressed H. pylori, the presence of mild/moderate and severe CAG was associated with a 6.4-fold (1.3–31.0) and an 11.8-fold (3.1–45.4) increase of gastric cancer incidence, respectively. The results of this prospective population-based cohort study may contribute relevant evidence to the ongoing research of H. pylori-related cancers. The results may furthermore enhance the empirical basis for risk stratification among H. pylori-infected people and for recommendations regarding H. pylori screening and treatment among older adults in a Western population.     

人参、白术有效组分群对慢性萎缩性胃炎大鼠口腔、肠道菌群的影响

目的研究人参、白术有效组分群对慢性萎缩性胃炎大鼠口腔、肠道菌群的影响。方法将大鼠随机分为空白组、模型组、给药(人参白术有效组分群)组,用主动免疫法复制慢性萎缩性胃炎模型。HE染色、扫描电子显微技术观察胃黏膜组织显微及超微结构,高通量测序技术检测肠道及口腔菌群,利用SPSS软件进行相关性分析。结果人参、白术有效组分群能改善慢性萎缩性胃炎大鼠胃组织病理形态(P<0.05);增加大鼠肠道、口腔菌群多样性及丰富度(P<0.05);减少肠道、口腔中致病菌群(普雷沃氏菌科_UCG-003、梭杆菌属)的数目(P<0.05)。其中,大鼠病理学评分与其口腔、肠道菌群的丰度、多样性以及门、属水平上的差异菌具有相关性(P<0.05)。结论人参、白术有效组分群对慢性萎缩性胃炎大鼠有良好的保护作用,缓解胃黏膜萎缩,其作用机制可能与改善肠道和口腔菌群有关。     

慢性萎缩性胃炎患者中医舌象特征研究＊

目的 探讨慢性萎缩性胃炎患者的舌象特点，分析胃粘膜病理学改变与中医舌象变化的相关性。方法 本研究运用舌象仪采集慢性萎缩性胃炎患者的舌象信息，采用病例对照研究方法比较不同病理阶段的胃病患者舌象客观参数和特征，描述舌象特征的变化趋势，分析慢性萎缩性胃炎患者较常见的舌象特征。结果 慢性萎缩性胃炎组的舌色参数R值和V值显著高于慢性非萎缩性胃炎组与胃癌组（P < 0.05）；慢性萎缩性胃炎组中舌质红的患者显著多于慢性非萎缩性胃炎组与胃癌组（P < 0.01）；慢性萎缩性胃炎组的舌苔厚薄指数和剥苔指数均显著低于慢性非萎缩性胃炎组与胃癌组（P < 0.01），慢性萎缩性胃炎组中舌苔厚的患者显著多于慢性非萎缩性胃炎组与胃癌组（P < 0.01）；结论 舌质红和舌苔厚是慢性萎缩性胃炎患者常见的舌象特征。