Second-line treatment for failure to eradicate Helicobacter pylori: a randomized trial comparing four treatment strategies

AIM: To compare the efficacy of different regimens in patients in whom previous Helicobacter pylori eradication therapy has failed. METHODS: In this study named StratHegy patients (n=287) were randomized to receive one of three empirical triple therapy regimens or a strategy based on antibiotic susceptibility. The empirical regimens were omeprazole, 20 mg b.d., plus amoxicillin, 1000 mg b.d., and clarithromycin, 500 mg b.d., for 7 days (OAC7), clarithromycin, 500 mg b.d., for 14 days (OAC14) or metronidazole, 500 mg b.d., for 14 days (OAM14). In the susceptibility-based strategy, patients with clarithromycin-susceptible strains received OAC14, whilst the others received OAM14. The 13C-urea breath test was performed before randomization and 4-5 weeks after eradication therapy. RESULTS : In the intention-to-treat analysis, the eradication rates for empirical therapies were as follows: OAC7, 47.4% (27/57); OAC14, 34.5% (20/58); OAM14, 63.2% (36/57); it was 74.3% (84/113) for the susceptibility-based treatment (P<0.01 when compared with OAC7 and OAC14). In patients receiving clarithromycin, the eradication rates were 80% for clarithromycin-susceptible strains and 16% for clarithromycin-resistant strains; in patients receiving OAM14, the eradication rates were 81% for metronidazole-susceptible strains and 59% for metronidazole-resistant strains. CONCLUSIONS: Eradication rates of approximately 75% can be achieved with second-line triple therapy based on antibiotic susceptibility testing. If susceptibility testing is not available, OAM14 is an appropriate alternative.     

建国前广西生命统计资料再分析

本文根据1937～1942年广西生命统计资料追编了全省人口寿命表,采用ICD-9疾病分类方法分析了主要死亡原因,对解放前我国人口平均期望寿命35岁提出质疑。通过半个世纪人口死亡谱的对照,论证了我国建国以来防治疾病取得的成就与人寿延长的原因。     

住院精神分裂症患者疗效的影响因素对照研究

目的探讨住院精神分裂症患者疗效的影响因素。方法将203例精神分裂症患者按临床疗效分组,临床痊愈和显著好转者132例为显效组,临床好转和无效者71例为对照组,采用自编《住院精神分裂症患者一般情况调查表》进行回顾性统计、分析。结果住院患者中女性、低技术工人、阴性症状突出者、病前无诱因的疗效较差(P<0.05)。其疗效与住院天数、总住院费用成正相关,与日均费用成负相关(P<0.01)。结论精神分裂症药物治疗应充分、足程,临床应重视对女性、低技术工人的治疗观察,并加强精神疾病知识健康教育,同时健全社会保障体系以提高住院精神分裂症患者的疗效。     

深圳市宝安区孕产妇死亡原因分析

目的:探讨降低孕产妇死亡率,消除新生儿破伤风方法。方法:选自深圳市宝安区妇幼保健院2004年1月1日~2005年9月30日对广东省孕产妇死亡监测点之一的深圳市宝安区8个镇和2个城区2年来所发生的孕产妇死亡共30例进行个案调查核实,对监测点所发生的孕产妇死亡接报后实行三级(镇、区、市)实地调查、核实,通过三级评审明确死因、性质,按规定逐级上报的方法。结果:2年来该地区同期活产数58671例,孕产妇死亡共30例,平均孕产妇死亡率51·13/10万,其中流动人口死亡共29例,死亡率49·42/10万,暂住人口孕产妇死亡1例,死亡率19·18/10万,常住人口死亡数为零。孕产妇死亡主要原因依次为:产科出血9例,羊水栓塞8例,妊娠期高血压疾病5例,肺炎3例,心脏病1例,产褥感染1例,胃癌晚期1例,主动脉夹层瘤破裂1例,猝死1例。结论:制定出有效干预措施防止孕产妇死亡的发生。     

序贯用药治疗异位妊娠132例临床分析

目的:观察使用甲氨蝶呤(m ethotrexate,MTX)与米非司酮(m ifepristone)序贯给药治疗异位妊娠的可行性。方法:异位妊娠确诊患者132例,按MTX 40 mg/m2的剂量肌注,12~24 h再给予米非司酮300 mg顿服;间隔3~5天,如疗效不显著可重复治疗,最多用药可达4次。采用免疫荧光法(参考值≤2.9 IU/L)检测治疗前后血β-HCG的变化。结果:大部分病例给药后血β-HCG有不同程度的下降,132例患者中有119例达到治愈标准,占90.1%。结论:应用MTX与米非司酮序贯给药是治疗异位妊娠的有效方法。     

Risk factors for trachoma in Mali

OBJECTIVES: Prior to commencing a campaign to eliminate blinding trachoma in Mali, a national disease prevalence survey was conducted from March 1996 to June 1997. The prevalence of trachoma was estimated and potential risk factors were studied. METHODS: In each of Mali's seven regions (excluding the capital Bamako), a sample of 30 clusters was taken from the general population, in accordance with the principle of probability proportional to the size of the community. All children under 10 years of age were examined. The simplified clinical coding system proposed by the World Health Organization was used. The position of each village was established and subsequently related to the nearest meteorological station. Socioeconomic and environmental information was collected at both village and household level. The mother or caretaker of each child was questioned about availability and use of water for washing the child. At the time of examination, facial cleanliness and the presence of flies on the face were noted. RESULTS: A total of 15,187 children under 10 years of age were examined. The prevalence of active trachoma (follicular [TF] or intense trachoma [TI]) was 34.9% (95% CI : 32.3-37.6) and the prevalence of TI was 4.2% (95% CI : 3.5-5.0). Aridity/environmental dryness appears to be a risk factor influencing the current geographical distribution of trachoma. Small villages had considerably higher trachoma prevalence than their larger neighbours. The proximity of a medical centre and the existence of social organizations such as a women's association were associated with lower levels of trachoma. Crowded living conditions increased the risk. Using a monetary marker of wealth, we observed a linear inverse relation between wealth and trachoma prevalence. The presence of a dirty face was strongly associated with trachoma (odds ratio [OR] = 3.67) as was the presence of flies on the child's face (OR = 3.62). Trachoma prevalence increased with distance to a water source. Disease prevalence decreased with a higher frequency of both face washing and bathing. CONCLUSIONS: Of all the risk factors examined, facial cleanliness had the strongest association with the prevalence of trachoma. This was followed by the presence of flies on the child's face. Both face washing and bathing showed beneficial effects. Socioeconomic factors such as wealth were significantly explanatory. It is likely that hygiene education and fly control by environmental improvement could have a very significant impact on the prevalence of trachoma in Mali.     

红霉素环11,12-碳酸酯的体外抗菌活性研究

目的评 价红霉素环11，12-碳酸酯的体外抗菌活性。方法 采用琼脂平皿二倍稀释法测定国产和进口红霉素环11，12-碳酸酯对临床分离致病菌的体外抗菌作用，并与红霉素、罗红霉素、克拉霉素、地红霉素、阿奇霉素和乙酰螺旋霉素进行了比较。结果 国产和进口红霉素环11，12-碳酸酯对579株临床分离菌的抗菌活性相近，对革兰氏阳性菌和厌氧菌的抗菌活性比红霉素强2～8倍，优于罗红霉素、克拉霉素、地红霉索、阿奇霉素、乙酰螺旋霉素，但对革兰氏阴性菌的抗菌活性稍弱于阿奇霉素。红霉索环11，12-碳酸酯对金葡菌显示抑菌作用，对化脓链球菌在2～4倍MIC浓度时显示杀菌作用；红霉素环11，12-碳酸酯抗金葡菌和化脓链球菌的活性随着pH的增加而增强，接种量和血清浓度对国产红霉素环11，12-碳酸酯抗金葡菌和化脓链球菌的活性无明显影响。结论 红霉素环11，12-碳酸酯具有较强的体外抗菌活性，国产红霉素环11，12-碳酸酯抗菌活性与进口相近，优于红霉素、罗红霉素、克拉霉素、地红霉素、阿奇霉素和乙酰螺旋霉素。     

帕珠沙星合成中的Hofmann重排反应

将帕珠沙星的合成关键中间体(3S)—9—氟—10—(1—氨甲酰基环丙基)—3—甲基—7—氧代—2，3—二氢—7H—吡啶[1，2，3—de]—1，4—苯并嚼嗪—6—羧酸溶于甲醇钠／甲醇溶液中，于—40℃加溴进行Hofmann重排得到帕珠沙星。收率69％。     

吲哚美辛脂质体注射液的制备、含量测定及稳定性

本文报道了吲哚美辛脂质体制备方法，建立了紫外分光光度法测定吲哚美辛的含量，方法的平均回收率为１０１．５％，变异系数０．７１％。考察了不同ｐＨ值对吲哚美辛脂质体稳定性的影响。结果表明所制备的吲哚美辛脂质体在ｐＨ５．５最稳定。     

No impact of repeated endoscopic screens on gastric cancer mortality in a prospectively followed Chinese population at high risk.

BACKGROUND: Gastric cancer (GC) is the leading cause of cancer deaths in China. Our study prospectively evaluated the impact of repeated endoscopic screens on GC mortality in a high-risk population in China. METHODS: Between 1989 and 1999, a population-based gastroscopic screening was conducted in 4,394 residents of Linqu County, China, a region with the highest rates of GC worldwide. Residents ages 35 to 64 years received initial gastroscopies with biopsies in 1989. Repeated endoscopies were performed in 1994 and 1999. Cancer occurrences and deaths were actively monitored throughout the entire period until July 2000. Mortality from GC was compared with expected values based on mortality rates obtained for Linqu in the 1990-1992 Chinese Cancer Mortality Survey. RESULTS: Between March 1989 and July 2000, 39,303 person-years were accumulated; 85 new GCs occurred, 29 (34.5%) were in early stage. Fifty-eight cases (68%) were identified at one of the screens. The number of observed deaths from GC (37) was close to the expected (36.8). The standardized mortality ratio was 1.01 (95% CI 0.72-1.37) for the entire cohort, 1.13 (95% CI 0.77-1.57) for males, and 0.65 (95% CI 0.26-1.32) for females. CONCLUSIONS: Despite high population coverage with repeated screens, no reduction in GC mortality was observed in this high-risk population in China.