Efficacy and safety of high-dose esomeprazole–amoxicillin dual therapy for Helicobacter pylori rescue treatment: a multicenter,prospective, randomized,controlled trial

Background:High-dose dual therapy (HDDT) with proton pump inhibitors (PPIs) and amoxicillin has attracted widespread attention due to its favorable efficacy in eradicating Helicobacter pylori (H. pylori). This study aimed to compare the efficacy and safety of high-dose PPI–amoxicillin dual therapy and bismuth-containing quadruple therapy for H. pylori rescue treatment.Methods:This was a prospective, randomized, multicenter, non-inferiority trial. Patients recruited from eight centers who had failed previous treatment were randomly (1:1) allocated to two eradication groups: HDDT (esomeprazole 40 mg and amoxicillin 1000 mg three times daily; the HDDT group) and bismuth-containing quadruple therapy (esomeprazole 40 mg, bismuth potassium citrate 220 mg, and furazolidone 100 mg twice daily, combined with tetracycline 500 mg three times daily; the tetracycline, furazolidone, esomeprazole, and bismuth [TFEB] group) for 14 days. The primary endpoint was the H. pylori eradication rate. The secondary endpoints were adverse effects, symptom improvement rates, and patient compliance.Results:A total of 658 patients who met the criteria were enrolled in this study. The HDDT group achieved eradication rates of 75.4% (248/329), 81.0% (248/306), and 81.3% (248/305) asdetermined by the intention-to-treat (ITT), modified intention-to-treat (MITT), and per-protocol (PP) analyses, respectively. The eradication rates were similar to those in the TFEB group: 78.1% (257/329), 84.2% (257/305), and 85.1% (257/302). The lower 95% confidence interval boundary (−9.19% in the ITT analysis, − 9.21% in the MITT analysis, and −9.73% in the PP analysis) was greater than the predefined non-inferiority margin of −10%, establishing a non-inferiority of the HDDT group vs. the TFEB group. The incidence of adverse events in the HDDT group was significantly lower than that in the TFEB group (11.1% vs. 26.8%, P < 0.001). Symptom improvement rates and patients’ compliance were similar between the two groups.Conclusions:Fourteen-day HDDT is non-inferior to bismuth-containing quadruple therapy, with fewer adverse effects and good treatment compliance, suggesting HDDT as an alternative for H. pylori rescue treatment in the local region.Trial registration:Clinicaltrials.gov, {"type":"clinical-trial","attrs":{"text":"NCT04678492","term_id":"NCT04678492"}}NCT04678492.     

A short review of male genito-urinary lesions caused by coronavirus disease 2019

Coronavirus disease 2019 (COVID-19) is a novel infectious disease that has spread worldwide since it first appeared in December 2019. It can cause pathologies in several organs of the body through direct and indirect mechanisms. After more than two years of study, the effects of COVID-19 on the genitourinary system are now well-evidenced as COVID-19 has considerable effects on the kidneys, testes, vas deferens, epididymis, seminal vesicles, prostate, and penis. Renal invasion is mainly characterized by acute kidney injury. Testicular invasion is characterized by orchitis, testicular epididymitis, etc. Although COVID-19 has been suspected to spread via serum, evidence for the presence of the virus in the semen of patients is currently scarce. COVID-19 also impacts the sexual function of patients to varying degrees, with some patients developing erectile dysfunction. The underlying mechanisms of COVID-19 invasion into the genitourinary system have not been clearly identified, and more clinical studies are required. This review discusses the impact of COVID-19 on the genitourinary system and male health.     

Development and clinical validation of a necroptosis-related gene signature for prediction of prognosis and tumor immunity in lung adenocarcinoma

Necroptosis is a new programmed formation of necrotizing cell death, which plays important role in tumor biological regulation, including tumorigenesis and immunity. In this study, we aimed to establish and validate a prediction model based on necroptosis-related genes (NRGs) for lung adenocarcinoma (LUAD) prognosis and tumor immunity. The training set consisted of samples from The Cancer Genome Atlas (TCGA) dataset (n = 334), and the validation sets consisted of samples from the Gene Expression Omnibus (GEO) (n = 439) and clinical (n = 20) datasets. Gene Oncology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis showed that 28 necroptosis-related differentially expressed genes (DEGs) were enriched in cell death and immune regulation. RT-qPCR and western blot results showed the low expression of necroptosis markers in LUAD cells. A prognostic gene signature based on 6 NRGs (PYGB, IL1A, IFNAR2, BIRC3, H2AFY2, and H2AFX) was constructed and the risk score was calculated. Multivariate Cox regression analysis showed that the risk score was an independent risk factor [hazard ratio (HR) = 1.220, 95% confidence interval (CI): 1.154-1.290, P<0.001]. In the TCGA cohort, a high-risk score was associated with poor prognosis, weak immune infiltration, and low expression at immune checkpoints, which was validated in the GEO and clinical cohorts. Our findings showed that the patients in the low-risk group had a better progression-free survival (PFS) [not reached vs. 8.5 months, HR = 0.18, 95% CI: 0.04-0.72, P<0.001] than those in the high-risk score group. Immunotherapy tolerance was found to be correlated with the high-risk score, and the risk score combined with PD-L1 (AUC = 0.808, 95% CI: 0.613-1.000) could better predict the immunotherapy response of LUAD. A nomogram was shown to have a strong ability to predict the individual survival rate of patients with LUAD in the TCGA and {"type":"entrez-geo","attrs":{"text":"GSE68465","term_id":"68465"}}GSE68465 cohorts. We constructed and validated a potential prognostic signature consisting of 6 NRGs to predict the prognosis and tumor immunity of LUAD, which may be helpful to guide the individualized immunotherapy of LUAD.     

Development and Validation of Nutrition Literacy Assessment Instrument for Chinese Pregnant Women

The study was designed to develop and validate the nutrition literacy assessment instrument for pregnant women in China (NLAI-P). The dimension, components and questions of NLAI-P were identified via literature review and expert consultation. A panel of experts evaluated the content validity. The construct validity was evaluated by using the exploratory factor analyses (EFA) and confirmatory factor analyses (CFA). Cronbach’s α coefficient and split-half reliability were applied for examining the reliability. The NLAI-P was divided into 3 dimensions including knowledge, behavior and skill dimension. Findings showed NLAI-P possessed the satisfactory content validity (content validity index = 0.98, content validity ratio = 0.97), acceptable construct validity (χ²/df = 1.82, GFI = 0.86, AGFI = 0.84, RMSEA = 0.046) and good reliability (Cronbach’s α coefficient = 0.82). The average scores of NLAI-P were 46.59 ± 9.27. With the adjustment of confounding factors, education level presented a significantly positive correlation with NLAI-P scores. In conclusion, NLAI-P were valid and reliable to inspect NL level of pregnant women in China. Poor NL was prevalent among Chinese pregnant women. Based on the education level, taking targeted propaganda and education measures would achieve the optimal effect. NLAI-P can be applied as the tool for monitoring and assessing NL of pregnant women, and facilitate the designation of targeted interventions policies.     

双侧肾上腺结核误诊肾上腺肿瘤一例

我国肾上腺结核仍是原发性肾上腺皮质功能不全（primary adrenal insufficiency,PAI）也称Addison病的主要原因。本文探讨如何诊断早期肾上腺结核,降低误诊率,以利最大限度保留残余肾上腺功能。     

丝氨酸蛋白酶Omi/HtrA2表达增加促进心肌衰老的作用

目的 观察线粒体促凋亡蛋白Omi/HtrA2表达增加对心肌衰老的影响。方法 构建心肌特异性过表达Omi/HtrA2小鼠模型,通过Western blotting法检测衰老标志物p53、p21、p16表达水平;分析Omi/HtrA2与衰老标志物表达的相关性;构建Omi/HtrA2稳转H9c2细胞系,通过Western blotting法检测Omi/HtrA2表达增加后衰老指标p53、p21、p16的改变;通过β-半乳糖苷酶(β-gal)染色比较β-半乳糖苷酶染色阳性衰老细胞的改变;通过Omi/HtrA2特异性抑制剂UCF101抑制Omi/HtrA2功能,检测抑制Omi/HtrA2活性后衰老标志物的表达水平及阳性衰老细胞变化。结果 (1)与对照组相比,心肌特异性过表达Omi/HtrA2小鼠心肌组织中,Omi/HtrA2表达量显著增加(P<0.01);过表达Omi/HtrA2心肌组织衰老标志物p53、p21、p16增加(P<0.01);(2)在心肌组织中Omi/HtrA2表达量与衰老标志物p53、p21、p16呈正相关(P<0.05);(3)与H9c2细胞(control组)相比,Omi/HtrA2稳转H9c2细胞(Omi组)衰老标志物p53、p21、p16表达增加(P<0.05);β-半乳糖苷酶染色结果显示,Omi组衰老细胞增加;与Omi组相比,Omi/HtrA2特异性抑制剂UCF101处理组(Omi+UCF101组)衰老标志物p53、p21、p16表达降低(P<0.05);β-半乳糖苷酶染色阳性细胞减少。结论 Omi/HtrA2的表达与衰老标志物呈正相关,表达增加的Omi/HtrA2促进心肌衰老。     

茵栀黄口服液联合蓝光照射治疗新生儿黄疸39例临床观察

目的:观察茵栀黄口服液联合蓝光照射治疗新生儿黄疸临床疗效。方法:选择新生儿黄疸患者117例作为对象,按照治疗方法不同分为A组(茵栀黄口服液组)、B组(蓝光照射治疗组)及C组(联合治疗组),每组均为39例,观察1周后各组患儿的胆红素降低水平及治疗效果。结果:联合治疗组自第2天至1周后其患儿胆红素水平及总体的治疗效果明显优于单纯茵栀黄口服液组及蓝光照射治疗组,差异具有统计学意义(P0.05);治疗期间单纯蓝光照射治疗组的胆红素水平稍低于茵栀黄口服液组,两组间整体治疗效果比较差异无统计学意义。结论:茵栀黄口服液联合蓝光照射治疗新生儿黄疸临床疗效较好,相关并发症较少,值得临床推广应用。     

丹蒌方干预冠心病稳定性心绞痛痰瘀互结证的临床生化基础研究

[目的]通过多中心、精细化的临床研究,旨在通过对比丹蒌方干预冠心病稳定性心绞痛痰瘀互结证患者和健康人的临床生化指标,探究其临床生化基础。[方法]从全国7家临床研究中心共入组受试者82例,脱失4例,最终入组冠心病痰瘀互结证患者38例,在西医常规治疗的基础上加服中药丹蒌片治疗,健康人40例不予干预。分别检测内皮细胞损伤、脂质代谢、黏附分子、炎症介质、金属蛋白酶、同型半胱氨酸和凝血功能共7类28项指标,冠心病患者分别检测0、8、12周水平,健康人检测第0周水平。[结果]冠心病痰瘀互结证与高密度脂蛋白胆固醇(HDL-C)、基质金属蛋白酶9(MMP9)、活化部分凝血活酶时间(APTT)相关性较大,通过丹蒌方的治疗可降低患者炎症因子水平,改善血管内皮损伤情况。[结论]丹蒌方干预冠心病稳定性心绞痛痰瘀互结证的机制与调节内皮损伤、脂质代谢、炎症因子、凝血功能、金属蛋白酶有关,可为下一步研究提供参考依据。     

从肝论治肺癌的优势

本文以中医学及现代医学理论为出发点,结合部分近现代学者从肝论治肺癌的经验,阐述其理论基础,分析作用机制,总结临床疗效。分析从肝论治肺癌的优势。中医学理论支持从肝论治肺癌治则,认为肝肺生理相关、病理相连,临床可分为肝郁气滞、气滞血瘀、肝火犯肺、肝肺阴虚四证。临床研究亦支持此观点,从肝论治是肺癌治疗中的重要治则,能明显改善患者身心及呼吸系统症状,提高免疫功能,增强正气,改善生命质量,最终达到扶正祛邪的抗肿瘤目的。其作用机制与诱导细胞凋亡、抑制肿瘤细胞增殖有关。     

超声引导下臂丛复合肋间臂神经阻滞在肱骨内上髁骨折手术中的应用

目的 探讨臂丛神经阻滞+肋间臂神经阻滞在肱骨内上髁骨折手术中的临床效果.方法 将本院收治的需要进行肱骨内上髁骨折手术的患者60例,随机分为试验组和对照组,各30例,试验组患者麻醉方式选择臂丛神经阻滞+肋间臂神经阻滞,对照组选择臂丛神经阻滞的麻醉方式;以针刺法测定手术切口感觉阻滞效果并记录,注药后30min评价阻滞完善成功率.结果 对照组患者在手术中有7例需辅助静脉镇痛药,11例需要改为全麻,其余阻滞完善;试验组患者的麻醉效果良好,25例阻滞完善,4例需辅助静脉镇痛药,l例最后改为全麻完成手术;两组均未观察到局麻药中毒、气胸等并发症.结论 超声引导臂丛复合肋间臂神经阻滞可以安全地运用于肱骨内上髁的骨折,麻醉效果显著,可以在临床麻醉中进行推广.