A strategy for second-line anti-Helicobacter pylori therapy in eradication-failure patients

Although available H. pylori eradication regimens in Japan fail to cure 10-20% of patients, an optimal re-treatment therapy for eradication-failure patients has still not been established. Since patient compliance, bacterial resistance and genotypic differences in CYP2C19 influence the eradication rate, re-eradication therapy should be selected, taking them into consideration. In the West, meta-analysis of the second-line treatment of H. pylori infection showed therapies comprising ranitidine bismuth and two antimicrobials are very effective re-treatment therapies irrespective of factors influencing H. pylori eradication. However ranitidine bismuth is not available in Japan and re-eradication therapy consisting of PPI, amoxicillin and metronidazole have been often undertaken and have achieved high eradication rate, even including patients with metronidazole resistant H. pylori.     

首次根除幽门螺杆菌失败后二线药物治疗临床研究

目的 研究首次根除幽门螺杆菌（Hp）失败后二线药物的疗效,提高Hp最终根除率.方法 选择我院消化科门诊经胃镜确诊慢性胃炎、消化性溃疡、胃癌等常见上消化道疾病Hp阳性患者,经首次根除Hp失败后病例750例作为研究对象,并随机分为A、B、C三组各250例.A组250例,首先以PPI标准剂量＋果胶铋300 mg＋左氧氟沙星200 mg＋四环素500 mg,bid,治疗7d;之后再以PPI标准剂量＋果胶铋300 mg＋阿奇霉素250 mg＋呋喃唑酮100 mg,bid,治疗7d.B组250例,PPI标准剂量＋果胶铋300 mg＋阿奇霉素250 mg＋呋喃唑酮100 mg,bid,疗程14 d.C组250例,PPI标准剂量＋果胶铋300 mg＋左氧氟沙星200 mg＋四环素500 mg,bid,疗程14 d.结果 A、B、C三组Hp根除率分别为99.0％、86.0％、94.0％.A组大于B组和C组.结论 对于首次根除Hp失败患者,采取PPI＋果胶铋＋左氧氟沙星（或阿奇霉素）＋四环素（或呋喃唑酮）四联14 d疗法有较高的根除率,尤其是A组14 d序贯疗法根除Hp疗效更佳,三组均有用药简单,价格低廉,副作用少,患者依从性好,易于接受等特点.     

118例反流性食管炎患者血清幽门螺杆菌抗体、胃蛋白酶原检测的临床意义

目的探讨反流性食管炎(RE)患者进行血清幽门螺杆菌(HP)抗体、胃蛋白酶原(PG)检测的意义。方法对118例RE患者(RE组)、60其他胃病患者(其他胃病组)和60例例健康体检者(健康组)进行血清HP抗体、PG水平检测,比较RE组、其他胃病组、健康组之间及RE组不同病变程度患者之间血清PGⅠ、PGⅡ水平、PGR和HP抗体阳性率。结果 RE组血清PGⅠ水平、PGR及HP抗体阳性率均低于其他胃病组和健康组,健康组低于其它胃病组,差异有统计学意义(P0.05),血清PGⅡ水平3组差异无统计学意义(P0.05);RE组A、B级患者血清PGⅠ水平、PGR及HP抗体阳性率均低于C、D级患者(P0.05),差异有统计学意义,血清PGⅡ水平与C、D级患者差异无统计学意义(P0.05)。结论 RE患者血清PGⅠ水平、PGR及HP抗体阳性率降低,HP感染是RE的一种保护机制,病情随感染程度的降低而加重,血清HP抗体、PG水平检测在RE的诊断及病情判断方面有重要的临床参考价值。     

Clinical efficacy of combined anti-Helicobacter treatment of patients with duodenal ulcer

84 patients with duodenal ulcer and positive by Helicobacter pylori (HP) were divided into two groups. Group 1 consisted of 42 patients who received omeprasol, metranidasol and clarithromycin. Group 2 of 42 patients received rovamycin instead of clarythromycin. The results of the study show that anti-HP regimen with rovamycin is superior to clarythromycin by main criteria (percent of healed ulcers, HP eradication, time to remission, recurrence rate, side effects rate). Thus, three-component therapy of patients with recurrent duodenal ulcer maintains intragastric acidity optimal for fast healing of ulcer defect.     

Assessment of readiness for adherence by HIV-positive males who had previously failed treatment.

The purpose of this prospective pilot study was to examine the relationship between the level of readiness for health behavior change and adherence by HIV-positive males (n = 19) who had previously failed treatment due to nonadherence. Participants completed the Index of Readiness (IR), an instrument measuring readiness to initiate health behavior change, prior to beginning new antiretroviral medications. After 6 months, participants were divided into two mutually exclusive groups: those who reached and sustained viral suppression and those who did not. Participants who experienced and sustained viral suppression had statistically significantly higher scores on the Identification of Barriers/Creating Strategies subscale of the IR compared to participants who did not reach viral suppression. Results from this preliminary study indicate that readiness may be a key component in successful adherence and that the IR may be a useful tool in assessing readiness for adherence to antiretroviral medications.     

Efficacy of sitafloxacin-based rescue therapy for Helicobacter pylori after failures of first- and second-line therapies

Sitafloxacin-based triple therapy achieved 83.6% (per-protocol) and 78.2% (intention-to-treat) success in eradicating Helicobacter pylori among 78 Japanese patients after clarithromycin-based first-line and metronidazole-based second-line triple therapies failed. Eradication succeeded in 32 out of 43 patients, even with gyrA mutation-positive Helicobacter pylori (per protocol). The position of the gyrA mutation (N87 or D91) was determined to be a better marker than MIC levels for predicting outcomes of sitafloxacin-based treatment.     

The treatment strategy of H. pylori infection and the new triple therapy

The strategies against H. pylori infection have been developed very fast. Since the efficacy of mono-therapy (one antimicrobial drug) and dual-therapy (proton-pump inhibitor (PPI) + one antimicrobial drug) were not good, and the safety of classical triple therapy (bismuth + two antimicrobial drugs) was bad, new triple-therapy consisted with PPI + two antimicrobial drugs is considered as a standard regimen of the treatment of H. pylori infection. However there are several questions about this new strategy which we have to answer. The first question is how can we diagnose the cure of H. pylori infection and when we should do it? The second one is which statistical method should we choose for evaluating the success rate? The third one is which drug should we use and how long should the patient continuing to have the drug? A lot of scientific research are need to clarify these questions.     

Continuous axillary block for paediatric trauma patients who failed with PCA therapy

The purpose of this paper is to report the effectiveness and safety of axillary nerve blocks in reducing pain in paediatrics after the failure of other pain treatments. We describe two cases of paediatric patients with traumatic injury who had successful pain control with continuous axillary blocks after failed pain treatment with a patient controlled analgesia (PCA). Recommendations regarding pain management strategies follow these cases.     

Current antiviral combination therapy for chronic hepatitis C patients who failed to interferon alfa-based treatment

What is known and Objective: Interferon‐alfa‐based therapy is effective in the treatment of Hepatitis C. However, some patients fail to respond and others relapse, after initially responding. Our objective was to assess the efficacy, safety and predictive factors for sustained virological response (SVR) to peginterferon plus ribavirin in chronic hepatitis C patients who failed to interferon‐alfa (IFNα)‐based therapy. Methods: Seventy‐five consecutive patients who failed to IFNα‐based therapy were retreated with peginterferon plus ribavirin. Of these patients, 85% were infected by genotype 1. The primary endpoint was SVR. Results and Discussion: Of 75 non‐responder (n = 54) or relapser patients (n = 21), 50 were previously treated with IFNα‐monotherapy and 25 with IFNα plus ribavirin. Global SVR rate was 41·3%: for patients re‐treated with IFNα the response was 48% whilst for those retreated with IFNα plus ribavirin, it was 28%. For previous non‐responders the SVR rate was 37% and for relapsers it was 52·4%. What is new and Conclusion: Retreatment with peginterferon plus ribavirin is an effective option for some chronic hepatitis C non‐responder or relapser patients. Higher SVR rate was achieved in relapsers and in those patients who received IFNα monotherapy previously.     

血清胃蛋白酶原、胃泌素-17和幽门螺杆菌IgG抗体对萎缩性胃炎的诊断价值

目的 探讨血清Ⅰ型胃蛋白酶原(PGⅠ)和Ⅱ型胃蛋白酶原(PGⅡ)、胃蛋白酶原(PGⅠ/PGⅡ)比值、胃泌素-17(G-17)和幽门螺杆菌IgG抗体(IgG anti-HP)水平与萎缩性胃炎(AG)发生的关系及其诊断价值.方法 分别采用胶乳免疫比浊法和酶联免疫吸附试验(ELISA)法检测48例AG患者及48名健康对照者血...     

A trial of a test-and-treat strategy for Helicobacter pylori positive dyspeptic patients in general practice

Computer models of different strategies for the management of dyspepsia in primary care indicate that a 'test-and-treat' approach is likely to be associated with the lowest costs and acceptable clinical outcomes. We present information on computer modelling studies and report the findings of a randomised trial comparing a Helicobacter pylori test-and-treat strategy with referral to direct access endoscopy in the management of dyspepsia in general practice. We compared costs and clinical outcomes in patients managed for one year in study (test-and-treat) and control (endoscopy) practices in south London. Patients aged less than 45 years presenting with persistent dyspepsia without alarm symptoms (141 study patients, 91 control patients) were studied. In the one-year follow-up period there were 17 endoscopies in the study group: all the control patients underwent initial endoscopy and five further endoscopies were performed. None revealed peptic ulcer or cancer. Forty-three (30%) of the study patients compared with 16 (17%) of the controls were referred to hospital clinics (p < 0.025). The cost of management per patient for one year in the study group was 205.67 Pounds, compared with 404.31 Pounds in the control group (p < 0.0001). Clinical outcomes in both groups at one year were comparable. An H. pylori test-and-treat strategy for dyspeptic patients aged less than 45, employing office-based serology testing, appears to be associated with substantially lower costs than initial endoscopy and with similar clinical outcomes.     

Prolonged response to nilutamide in a patient with stage D0.5 prostate cancer who previously failed androgen deprivation therapy

There is currently no standard therapy for patients with prostate cancer who have progressive rise in PSA levels despite treatment with hormonal ablation and antiandrogen withdrawal (stage D0.5). One potential treatment option is the use of a different androgen receptor antagonist (ARA), such as nilutamide. We report a case of a 66-year-old gentleman with greater than a 46 month sustained response to nilutamide therapy after failing bicalutamide therapy and its subsequent withdrawal. The patient continues to have undetectable PSA levels and an excellent performance status. This case demonstrates the prolonged response to a second-line ARA in patients deemed to have androgen insensitive prostate cancer. Further investigation of the potential role of nilutamide therapy as second-line antiandrogen therapy is warranted as monotherapy and/or in combination with other promising novel approaches including PSA-based vaccines.     

ESWL补救治疗输尿管镜气压弹道碎石失败的输尿管结石28例临床观察

目的探讨输尿管镜下气压弹道碎石术治疗输尿管结石失败后体外冲击波碎石（ESWL）补救的治疗效果。方法回顾性分析2007年5月至2008年12月输尿管结石患者28例,均为输尿管镜下气压弹道碎石术失败,采用ESWL补救治疗,观察碎石的效果。结果28例经体外冲击波碎石治疗,碎石效果良好,碎石逐步随尿液排出体外,1～2周后在膀胱镜下拔除双J管,复查尿路平片示无残余结石。结论输尿管镜下气压弹道碎石对于输尿管下段结石效果较好,上段结石容易因结石上漂造成气压弹道碎石失败,体外冲击波碎石提供了补救治疗的方法,碎石效果好。     

Eradication therapy of Helicobacter pylori for elderly patients in Japan

In Japan, an eradication therapy of Helicobacter pylori(H. pylori) for peptic ulcers of stomach and duodenum was approved by a health insurance since November 1, 2000. A method of an eradication therapy is as follows. Adult patients are received lansoprazole 30 mg, amoxicillin 750 mg, clarithromycin 200-400 mg at the same time twice daily for seven days. This therapy is based on a guideline of a Japanese association of Helicobacter Research. Many elderly patients have complications such as hypertension, cerebral vascular disturbance, heart failure and so on. Moreover, they often take a several medicine including NSAIDs(non-steroidal anti-inflammatory drugs). Therefore, you should pay attention especially to interaction of drugs when planning an eradication therapy of H. pylori for elderly patients.     

A new strategy for patients with dementia

There are 800,000 people with dementia in the UK, of whom about 82,000 live in Scotland. The general population is ageing, and because the risk of developing dementia increases with age, the number of people with dementia in Scotland is expected to double over the next 25 years (Alzheimer Scotland 2011). A sharp increase in the number of people with dementia who present to emergency departments (EDs) and acute care settings. Up to one in four of all general hospital beds in the UK are occupied by people aged over 65 years who have dementia (Alzheimer's Society 2009), yet their specific needs are often poorly understood by healthcare staff (Alzheimer's Society 2009, Mental Welfare Commission 2010). This article describes the development of an online resource for ED staff in Scotland, and of the associated infrastructure, to improve the care experience for people with dementia, their families and carers.