Objective To analyze the susceptible range and antibiotic resistance of clinical isolates of Helicobacter pylori(H.pylori) in Shijiazhuang area.Methods (1)H.pylori strains:55.(2)Drugs:Metronidazole,Ornidazole,Azithrumyein,Clarithromycin,Amoxicillin,Tetracycline and Furazolidone.(3)Sensitive test:filter paper agar diffusion method.Results The antibiotic resistance rate of Metronidazole,Ornidazole,Azithrumyein,Clarithromycin,Amoxicillin,Tetracycline and Furazolidone was 92.73%,85.45%,45.45%,9.09%,0,0,0,respectively.Conclusion The antibiotic resistance rate of H.pylori from Shijiazhuang area to Metronidazole,Ornidazole and Azithrumyein are very high,and the resistant strains to Clarithromycin has been found.There are no resistant strains to Amoxicillin,Tetracycline and Furazolidone.

Objective To investigate the prevalence of cytotoxin associated gene(cagA)and vacuolating cytotoxin gene(vacA)subtypes of Helicobacter pylori(H.pylori)in patients with upper gastrointestinal disease in Shijiazhuang area,and to assess the relationship between cagA,vacA subtypes and H.pylori related gastrointestinal disease.Methods Totally 55 H.pylori strains were isolated from patients with chronic gastrointestinal disease in Shijiazhuang area.Bacterial DNA from all these strains was extractedThe prevalence and genetic diversity in cagA 3′ region,vacA signal sequence and middle-region alleles were studied by the technique of polymerase chain reaction(PCR).Results In Shijiazhuang area,H.pylori cagA positive rate was 89.1%(49/55);cagA positive rate was not significant ly different between chronic gastritis and peptic ulcer(?~2=0.376,P=0.540).There were three vacA subtypes,including s1a/ m2 90.4%(47/52),s1a/ m1b-m2 5.8%(3/52)and s1a/ m1b 3.8%(2/52).The vacA s1a/m2 subtype showed no significant difference between chronic gastritis and peptic ulcer(?~2=0,P=1.000).Conclusion cagA~+and vacA s1a/m2 subtype of H.pylori are predominant in patients with upper gastrointestinal disease in Shijiazhuang area.There is no relationship between cagA,vacA subtypes and H.pylori related gastrointestinal disease.

Objective To investigate the effect of long-term proton pump inhibitor on osteoporosis in elderly patients.Methods A total of 150 patients with peptic ulcer treated in our hospital from January 2011 to January 2015 were selected as the observation group.150 healthy subjects were selected as the control group.The age,height,body weight and PPI time of the two groups were recorded.The changes of bone mineral density before and after treatment were measured by bone mineral density analyzer,ineluding lumbar L1-4,radial density and ulna density.The changes of bone mineral density were observed and recorded in the observation group before treatment,six months,1 year and 2 years after treatment.Results After treatment,the levels of gastrin were significantly increased in the observation group,and the serum calcium concentration and bone mineral density were significantly decreased (P＜0.05).The density of lumbar vertebrae,radius and ulna was significantly lower in observation group than those of control group (P＜0.05).With the prolongation of PPIs,lumbar vertebrae,radius and ulna density in observation group showed a decreasing trend.Conclusion Long-term application of proton pump inhibitors in elderly patients can cause bone loss.

Objective To investigate the correlation between the drug resistance of Helicobacter pylori (H .pylori )and clinical eradication efficacy of bismuth-based quadruple therapies,and to guide clinical rational drug use in the region.Methods A total of 260 patients with H .pylori infections were collected.H .pylori from biopsied gastric mucosa tissues were isolated and cultured.Drug resistant rates of isolated H .pylori to metronidazole,clarithromycin,amoxicillin,levofloxacin and furanzolidone were tested.Patients were randomly divided into clarithromycin,levofloxacin,furanzolidone and metronidazole groups by completely randomized design.All patients received bismuth potassium 220 mg,esomeprazole 20 mg and amoxicillin 1 000 mg twice daily,and according to group received clarithromycin 500 mg, levofloxacin 200 mg,furanzolidone 100 mg and metronidazole 400 mg,twice daily,espectively.The treatment course was 10 days.At least four weeks after treatment,13 Curea breath test or 14 Curea breath test was taken.According to the intention to treat (ITT)and per-protocal (PP),the eradication rate of each group was caculated.Chi square test was performed to compare the differences between groups. Results The drug resistant rate of H .pylori to metronidazole,clarithromycin,amoxicillin,levofloxacin and furanzolidone was 94.2% (146/155 ), 21 .3% (33/155 ), 2.6% (4/155 ), 5 .8% (9/155 ) and 1 .9%(3/155),respectively.According to ITT analysis,the eradication rate of clarithromycin group, levofloxacin group,furanzolidone group and metronidazole group was 81 .5 %(53/65 ),90.8%(59/65 ), 93.8% (61/65 )and 75 .4%(49/65),respectively.And according to PP analysis which was 84.1 %(53/63),92.2%(59/64),95 .3%(61/64)and 79.0%(49/62 ),respectively.The differences between furanzolidone group and metronidazole group,clarithromycin group were staistcally significant (χ2ITT =8.509 and 4.561 ;χ2PP = 7.592 and 4.323,all P < 0.05 ).There was no statistical significance in the H .pylori eradication rate between resistant strains and sensitive strains of each group.Conclusion Bismuth-based quadruple therapy can overcome antibiotic resistance,the eradication rate of protocal with furanzolidone is higher and with good safety,which can be the first-line treatment for H .pylori eradication.

Objective To evaluate the efficacy and safety of different bismuth-based quadruple therapies for Helicobacter pylori (H.pylori) eradication.Methods From December 2012 to October 2013,240 patients with H.pylori infection were collected and evenly divided into clarithromycin group,levofloxacin group,furanzolidone group and metronidazole group.Each group received bismuth potassium citrate 220 mg,esomeprazole 20 mg and amoxicillin 1 000 mg twice daily.In addition,each group received clarithromycin 500 mg,levofloxacin 200 mg,furanzolidone 100 mg,and metronidazole 400 mg,respectively.The course of treatment was 10 days.At least four weeks after the end of therapy and withdrawal the medicine,patients underwent fasting 13C-urea breath test or 14C-urea breath test.The negative result indicated as successful H.pylori eradication.The adverse effects were observed and recorded during treatment.The rate of H.pylori eradication was analyzed by the intention to treat (ITT) analysis and per protocol (PP) analysis.Chi-square test was performed for eradication rate comparison among groups.Results According to ITT analysis,the eradication rate of clarithromycin group,levofloxacin group,furanzolidone group and metronidazole group was 81.67％ (49/60),88.33％ (53/60),93.33％ (56/60) and 73.33％ (44/60),respectively,and according to PP analysis which was 85.96％ (49/57),89.83％ (53/59),94.92％ (56/59) and 75.86％ (44/58),respectively.The differences among four groups were statistically significant (x2 ＝10.13 and 9.89,both P＜0.05).The differences between furanzolidone group and metronidazole group were statistically significant (x2 =8.64 and 8.55,both P＜0.01).There were no statisticaly significant differences in adverse effects among the four groups (x2 =0.47,P＞0.05).Conclusion The H.pylori eradication rate is high in furanzolidone contained bismuth based quadruple therapy and with good safety,which could be the first line treatment for H.pylori eradication.

Objective To evaluate the efficacy of four-way pipe fitting with laryngeal mask airway (LMA) for airway management during tracheal stent implantation.Methods Thirty-six patients of both sexes,aged 18-64 yr,of American Society of Anesthesiology physical status Ⅱ or Ⅲ,scheduled for elective tracheal stent implantation,were allocated into 2 groups (n =18 each) using a random number table method:four-way pipe fitting with LMA group (FWP-LMA group) and rigid bronchoscope group.LMA was inserted after anesthesia induction,and the four-way pipe fitting and anesthesia machine were connected to perform intermittent positive pressure ventilation in FWP-LMA group.A rigid bronchoscope was implanted,and jet ventilator was used to assist ventilation in rigid bronchoscope group.The development of intraoperative hyoxemia,hypertension and tachycardia was recorded.Blood gas analysis was performed before operation and at the end of operation to record pH value,the partial pressure of arterial oxygen and partial pressure of arterial carbon dioxide.The success rate of tracheal stent implantation at first attempt and development of postoperative pharyngeal complications were also recorded.Results Operation was canceled due to rigid bronchoscope implantation in one patient in rigid bronchoscope group.Compared with rigid bronchoscope group,the pH value and partial pressure of arterial oxygen were significantly increased,and the partial pressure of arterial carbon dioxide was decreased at the end of operation,the incidence of intraoperative hyoxemia,hypertension and tachycardia was decreased,the incidence of postoperative sore throat and hoarseness was markedly decreased,operation time was prolonged,and the success rate of tracheal stent implantation at first attempt was decreased in FWP-LMA group (P＜ 0.05).Conclusion The four-way pipe fitting with LMA produces better ventilation effect,induces slighter stress responses with fewer complications and can be safely used for airway management during tracheal stent implantation.

Objective:To determine the oxygen concentration threshold for explosion induced by high-frequency electric knife or argon knife at different energies.Methods:① In vivo experiment The smooth muscle tissue or adipose-rich tissue in 10 pairs of isolated porcine lungs and trachea was electrocauterized at 30 and 50 W with high-frequency electroknife or argon knife at different oxygen concentrations.The initial oxygen concentration was 20%, the oxygen concentration was gradually increased in increments of 5% until the oxygen concentration reached 80%.Each sample was electrocauterized 10 times at each concentration, and the number of explosion was recorded.As long as one explosion occurred, it could be considered that the concentration could induce explosion, and the minimum oxygen concentration inducing explosion was considered as the threshold.② Measurement of oxygen concentration in the airway of patients received bronchoscopic intervention Thirty patients scheduled for elective bronchoscopy with cryotherapy were selected, the oxygen concentration inhaled was reduced from 100% until 50% in decrements of 10%, and the oxygen concentration in airway was measured with the AIRVO 2 transnasal high-flow oxygen inhalation device.ICC consistency analysis was performed between the oxygen concentration in airway and oxygen concentration inhaled. Results:In adipose-rich tissues, the threshold of the oxygen concentration for explosion was 70% at 30 W and 65% at 50 W when using the high-frequency electric knife; the threshold of the oxygen concentration for explosion was 35% at 30 W and 30% at 50 W when using the high-frequency argon knife.In smooth muscle tissues, no explosion occurred at each oxygen concentration when using the high-frequency electric knife and argon knife at 30 or 50 W, and the threshold value was above 80%.There was moderate consistency (ICC value 0.722, 95% CI 0.537-0.850, P<0.001) between the oxygen concentration in airway and oxygen concentration inhaled. Conclusions:In smooth muscle tissues, explosion is not easy to occur at oxygen concentrations below 80% when using the high-frequency electric knife or argon knife.In adipose-rich tissues, explosion is not easy to occur at oxygen concentrations less than 70% at 30 W and at oxygen concentrations less than 65% at 50 W when using the high-frequency electric knife; explosion is not easy to occur at oxygen concentrations less than 35% at 30 W and at oxygen concentrations less than 30% at 50 W when using the high-frequency argon knife.The threshold of oxygen concentrations in airway can be determined using the oxygen concentration inhaled.