Evaluation of a rapid stoolantigen test for the diagnosis of Helicobacter pylori infection in Chinese patients

OBJECTIVE: To evaluate the accuracy of a rapid assay that wasdeveloped to detect Helicobacter pylori antigen in the stool,using the principle of immunochromatography, in the Chinese population. METHODS: Eligible patients without prior treatment of H.pylori were recruited. An in‐house rapid urease test (RUT) andhistology were used as the gold standard. The results of the rapidstool antigen test were compared with the gold standard. RESULTS: Valid rapid stool antigen test results for interpretationwere obtained from 94 consecutive patients (mean age: 52.5, range:22?82 years). Sensitivity, specificity, positive predictivevalue, negative predictive value and accuracy were, respectively, 77.5%,87.0%, 81.6%, 83.9% and 83.0%.The test was easy to perform and results were available within 15 min. CONCLUSION: The rapid stool antigen test using immunochromatography accuratelydiagnoses H. pylori infection in Chinese patients.     

Evaluation of the gel test for antibody screening in a tertiary hospital in Hong Kong; insensitivity for some cold antibodies that are reactive at 37°C by conventional indirect antiglobulin tests

Summary The antiglobulin gel test (DiaMed) was compared with conventional IAT methods in pre-transfusion antibody screening in a tertiary hospital in Hong Kong. Antibody titrations showed that the gel system was more sensitive than the tube IAT method in detecting anti-D, anti-S, anti-s, but slightly less sensitive with anti-E. The gel tests detected all clinically significant warm reacting allo-antibodies detected by conventional IAT methods except one case of weak anti-E. It detected a case of anti-C missed in conventional screening. The number of serological investigations due to false positive screens, non-specific antibodies and clinically insignificant cold antibodies (anti-P, and anti-Lewis) were reduced. The gel system was fast and easy to use. It would reduce delays and inconvenience caused to patients due to false positive screens and non-specific antibodies without compromising detection of clinically significant antibodies. However, of concern was the failure to detect several cases of anti-Le^a and anti-P₁ that were reactive at 3 7°C by conventional IAT and one case of anti-H in a patient with Parabombay A.     

Bleeding peptic ulcer: An evolving role for surgical intervention

Abstract Early surgical intervention was previously advocated in patients > 60 years with bleeding peptic ulcer presenting with haemodynamic instability or ongoing transfusion requirements. It is, however, well recognized that emergency surgical intervention with its inherent risks must be reserved for highly selected patients in whom endoscopy initially fails to control exsanquinating haemorrhage or in whom life-threatening bleeding recurs. Therapeutic endoscopy for bleeding ulcer has led to a remarkable decline in rebleeding rates, the need for emergency surgery and mortality. Octogenarians are at risk, particularly when ulcer size exceeds 2 cm. Poor surgical candidates make up two-thirds of patients with major ulcer bleeding and operation is to be avoided if at all possible. Medical therapy with proton pump inhibitor and subsequent eradication of Helicobacter pylori following endoscopic treatment has been shown to be beneficial to outcomes. Should surgery be deemed necessary, it is likely that laparoscopic techniques to control bleeding, with or without the addition of an acid-reducing procedure, will find a role in haemodynamically stable patients undergoing operation on an early elective basis.     

合并使用ECMO和Drotrecogin alfa于重症病人的成功经验

目的急性心肌炎并发心衰竭可能因为封药物和动脉汽球帮浦反应不佳而死于心因性休克，目前许多文献支持使用体外循环机维持身体的机能，度过危险期，然而，再合并使用具抗发炎与抗凝血作用的“蛋白质C”制剂，提高急性心肌炎并发心衰竭的疗效则仍有待观察。本文描述四例病毒性心肌炎治疗情形，藉以探讨体外循环机合并蛋白质C＂制剂的疗效。方法2003年以来，本院陆续有四例病毒性心肌炎病人因为并发心衰竭而接受重症加护单位住院治疗，分别是二男二女，平均年龄37．2岁，发病前分别都有数天类流感症状，如发烧、胸痛和呼吸困难等，住院时胸部X光都呈现心脏扩大和两侧肺野浸润，虽然心电图显示ST上升，但是心导管摄影都排除心肌梗塞的可能，心脏超音波的左心室功能严重受损，住院初期虽然使用多种强心剂，病人仍并发呼吸衰竭和其它器官衰竭，其中两位病人接受体外循环机合并蛋白质C＂制剂的治疗，另一男性只接受蛋白质C＂制剂的治疗，以及一女性只接受体外循环机的治疗。结果所有接受蛋白质C＂制剂的治疗的三位病人都顺利脱离体外循环机和呼吸器，左心室功能也都恢复正常，出院後追踪并无发现任何神经学或其它後遗症，其中只接受体外循环机的治疗的女性因为红斑性狼沧病发症和感染而死亡；血清学证实其中三位为Parvovirus B19感染所致心肌炎。结论对于濒临死亡的急性心肌炎并发心衰竭的病患，特别是病毒性的致病源，合并“蛋白质C”制剂和体外循环机的治疗似乎有正面的意义。     

Epidemiology of gastric cancer in relation to diet and Helicobacter pylori infection

Abstract Gastric cancer is the second most common fatal malignancy in the world. In China, gastric cancer is now the second most common malignancy, while in Hong Kong, the mortality rate ranked fourth among all cancers in 1995. Dietary factors in gastric carcinogenesis came mostly from case-control studies. N-Nitroso compounds from dietary sources such as preserved, smoked and salted foods were found to be associated with gastric cancer. ß-Carotene, selenium and α-tocopherol have been shown in an intervention study to be favourable in the reduction of stomach cancer mortality. Fruits and vegetables showed the most consistent results of inverse association with gastric cancer. Dietary salt intake in preserved or salted foods is also shown to be associated with gastric cancer. Tea drinking, especially green tea, has a protective effect against gastric cancer as shown in some studies. Prospective case-control studies of the association between Helicobacter pylori infection and the subsequent development of gastric cancer showed that the odds ratio ranged from 2.8 to 6.0. However, results of similar case-control studies in countries with a high frequency of gastric cancer are controversial. Infection with H. pylori leads to changes in the vitamin C content of gastric juice, reactive oxygen metabolites, epithelial cell proliferation and apoptosis. Recently, CagA-positive strains were found to be associated with gastric cancer and also duodenal ulcers. The exact role of H. pylori in gastric carcinogenesis is still under investigation. Large-scale intervention studies are underway to examine dietary supplementation, H. pylori infection and gastric cancer. Helicobacter pylori eradication for gastric cancer prevention is being conducted in China and other parts of the world. In high-risk areas, for example in China, a combination approach including H. pylori eradication and dietary supplementation may be necessary.     

Early Gastric Cancer as a Possible Cause of Cauda Equina Syndrome and Disseminated Intravascular Coagulation

Abstract: Early gastric cancer is an important gastric malignancy which is defined as adenocarcinoma confined to the mucosa or submucosa of the stomach with or without simultaneous metastases involving regional lymph nodes. The prognosis of early gastric cancer is generally good with a 5-year survival rate of about 95%. Distant metastases and disseminated intravascular coagulation (DIC) usually occur in the advanced stage of gastric cancer but are relatively rare in early gastric cancer. Cauda equina syndrome has never before been reported as the initial presentation of gastric cancer, and to our knowledge, up to 1993, only 17 cases of early gastric cancer with synchronous liver metastases had been reported. Bone metastases with DIC and adrenal metastasis are both rare in early gastric cancer. Herein, we present a case of early gastric cancer with an initial presentation including cauda equina syndrome and DIC. Synchronous hepatic, adrenal gland, pulmonary, bone and bone marrow metastases were found two days after admission. The patient had a fulminant clinical course and died 45 days after the diagnosis. A small focus (0.8 × 0.5cm) of poorly differentiated adenocarcinoma located in the mucosa and submucosa at the gastric lower body with extensive lymphatic permeation around the primary focus and duodenum were noted at autopsy. Cancers with an unknown primary accounted for 4.9% of cancers presenting with disseminated intravascular coagulation. Our experience disclosed that early gastric cancer is a potential cause of cauda equina syndrome and disseminated intravascular coagulation.     

交沙霉素在中国汉族、维吾尔族及哈萨克族中的药代动力学比较

交沙霉素在中国汉族、维吾尔族及哈萨克族中的药代动力学比较李国昌陈春雁杨明义（新疆石河子医学院第一附属医院药剂科，石河子８３２００８；石河子农学院医院，石河子８３２００３）为探讨交沙霉素（ｊｏｓａｍｙｃｉｎ）在不同民族正常人体内过程，我们用相同的受...     

A 90-Day Chloroform Inhalation Study in Female and Male B6C3F1 Mice: Implications for Cancer Risk Assessment

High doses of chloroform induced liver cancer in male and femaleB6C3F₁ mice when administered by gavage, kidney cancer in maleOsborne-Mendel rats when given by gavage or in the drinkingwater, and kidney cancer in male BDF₁ mice when administeredby inhalation. The weight of evidence indicates that chloroformis acting through a nongenotoxic-cytotoxic mode of action. Thepresent study was designed to investigate the dose-responserelationships for chloroform-induced lesions and regenerativecell proliferation in B6C3F₁ mice as the basis for formulationof a biologically based risk assessment for inhaled chloroform.Different groups of female and male B6C3F₁ mice were exposedto atmospheric concentrations of 0, 0.3, 2, 10, 30, and 90 ppmchloroform 6 hr/day, 7 days/week for exposure periods of 4 daysor 3, 6, or 13 consecutive weeks. Some additional exposure groupswere exposed for 5 days/week for 13 weeks or were exposed for6 weeks and then examined at 13 weeks. Bromodeoxyuridine wasadministered via osmotic pumps implanted 3.5 days prior to necropsy,and the labeling index (LI, percentage of nuclei in S-phase)was evaluated iminunohistochemically from histological sections.Complete necropsy and microscopic evaluation revealed treatment-induceddose- and time-dependent lesions only in the livers and nasalpassages of the female and male mice and in the kidneys of themale mice. Large, sustained increases in the liver LI were seenin the 90-ppm groups at all time points. The female mice weremost sensitive, with a no-observed-adverse-effect level (NOAEL)for induced hepatic cell proliferation of 10 ppm. The hepaticLI in the 5 days/week groups were about half of those seen inthe 7 days/week groups and had returned to the normal baselinein the 6-week recovery groups. Induced renal histologic changesand regenerative cell proliferation were seen in the male miceat 30 and 90 ppm with 7 days/week exposures and also at 10 ppmwith the 5 days/week regimen. Nasal lesions were transient andconfined to mice exposed to 10, 30, or 90 ppm for 4 days. Ina previous cancer bioassay, a gavage dose of 477 mg/kg/day produced a 95% liver tumor incidence in female B6C3F₁ mice. Thisgavage dose is equivalent to a daily 6 hr/day inhalation exposureof approximately 80 ppm, based on the observed induced increasesin the LI as an internal dosimeter. The United States EnviromnentalProtection Agency currently uses the linearized multistage modelapplied to the mouse liver tumor data from the chloroform gavagestudy to estimate a virtually safe dose (VSD) as a one in amillion increased lifetime risk of cancer. The resulting valueis an airborne exposure concentration of 0.000008 ppm. Assumingthat chloroform-induced female mouse liver cancer is secondaryto events associated with necrosis and regenerative cell proliferation,then no increases in liver cancer in female mice would be predictedat the NOAEL of 10 ppm or below based on the results reportedhere. Applying an uncertainty factor of 1000 yields an estimateof a VSD at 0.01 ppm. This estimate relies on inhalation dataand is more consistent with the mode of action of chloroform.     

Comparative Short-Term Effects of Methyl Tertiary Butyl Ether and Unleaded Gasoline Vapor in Female B6C3F1 Mice

PS-6 unleaded gasoline (UG) and methyl tert-butyl ether (MTBE),an UG additive, with long-term exposure at high concentrationsincreased liver tumors selectively in female mice. PS-6 UG isa liver tumor promoter in N-nitrosodiethylamine-initiated femalemice and produces short-term effects potentially relevant toits tumor promoting ability. The new formulation of UG (91-01)and MTBE were evaluated for similar short-term effects in mouseliver. Mice were exposed to 7814 ppm MTBE, 2014 ppm 91-01 UG,or 2028 ppm PS-6 UG vapor for 3 or 21 days, 6 hr/day, 5 days/week.Relative liver weights increased and uterine weights decreasedin MTBE-, 91-01 UG-, and PS-6 UG-exposed mice. Because the decreasein relative uterine weight is suggestive of hormonal modulation,we evaluated the effects of MTBE, 91- 01 UG, and PS-6 UG invivo on hepatic 17-ß estradiol metabolism in vitro.Gavage treatment with either blend of UG and with MTBE increasedestrogen metabolism in isolated mouse hepatocytes. Hepatic microsomalP450 activity was assessed by 7-pentoxyresorufin-O-dealkylase(PROD) and 7-ethoxyresorufin-O-deethylase (EROD) activities.Similar increases in P450 content and PROD and EROD activitieswere observed in all exposed mice as compared to controls. Nohepatoxicity was observed in any treatment group. The hepaticlabeling index, as measured by the incorporation of 5-bromo-2'-deoxyuridine,was increased in all exposed mice at 3 days but not 21 days,indicating that MTBE and 91-01 UG are also hepatic mitogens.These data demonstrate that a newer blend of UG and the UG additiveMTBE elicit short-term effects similar to those of PS-6 UG.Given that these effects are potentially related to tumor promotionand the general lack of genotoxic activity, MTBE and 91-01 UGmay exhibit tumor promoting activity similar to that seen withPS-6 UG. Since the liver is under multihormonal control, theincrease in hepatic estrogen metabolism and uterine effectssupport a potential role for endocrine modulations in both MTBE-and UG-induced hepatocarcinogenesis.