Objective To analyze levofloxacin resistance in Helicobacter pylori (Hp) and the sequence difference of gyrA gene in levofloxacin resistance and sensitive Hp strains. To explore the function of gyrA gene mutation in the development of levofloxacin resistance Hp strain.Methods From July 2007 to December 2008 in Department of Gastroenterology, Jinhua People hospital of Zhejiang Province, the gastric mucosa from gastroscopy biopsy of chronic gastritis and peptic ulcer patients were cultured in Hp selective medium under microaerobic condition at 37 degrees for three to five days. The Hp strains were isolated and identified by oxidase test, catalase test,urease test and UreA gene detecting. The levofloxacin susceptibility was determined by E-test and then resistance and sensitive strains were screened. The genomic DNA of Hp strains was isolated. The gyrA gene was amplified by PCR and the sequences were analyzed. Results 38 clinical isolated Hp strains were passed the levofloxacin susceptibility E-test, among those the minimum inhibitory concentration (MIC) of 12 strains was over 1.0 μg/ml, the percentage of resistant strain was 31.58%, while the sensitive stains was 68.42%. The gyrA gene sequence result indicated 10 resistant strain with 261, 271 and 272 10 site mutation, 2 strains with C261A mutation, one strain with C261G mutation, two strains with G271A mutation, 2 strains with A272G mutation, 2 strains with C261A,G271T andA272G mutation, 1 strain with C261G and A272G mutation. However, no mutation sites were found in 26 sensitive strains. Conclusion The rate of levofloxacir-resistance in isolated clinical Hp strain was high. The drug-resistance was associated with 261,271 and 272. site mutation of gyrA gene.

Objective To investigate the expression and significance of heme oxygenase-1(HO-1) in gastric adenocarcinoma and its peritoneal metastatic tissues, as well as drug-resistant cell strains. Methods The expression of HO-1 in patients with (n=68) or without (n=46) peritoneal metastasis of gastric adenocarinoma was examined. The expression of HO-1 in cancerous tissue, peritoneal metastatic foci, and normal peritoneum was detected by immunohistochemistry. The expression of HO-1 protein in metastatic foci and drug-resistant cell strains was measured by Western blotting. Results The positive expression of HO-1 was 39.7% (27/68) in gastric adenocarcinoma tissues with metastasis and 41.2% (28/68) in peritoneal metastatic tissues, which was significantly higher than that in normal peritoneum (0%,0/68,P<0.01) and gastric adenocarcinoma tissues without metastasis (21.7%, 10/46, P<0.05). The Western blot study showed that the HO-1 expression in metastatic tissues was higher than that in normal peritoneum (P<0.05). The expression of HO-1 protein was markedly increased in GC9811-P drug-resistant cell strains compared with its parental cell strains (P<0.05). Conclusions The increased expression of HO-1 may be involved in the peritoneal metastasis of gastric adenocarcinoma, and related to the malignant potential. The underlying signal pathways in neopastic epithelium may also be related to the multi-drug resistance.

Objective To analyze the drug resistant characteristics of 84 clinical isolated Helicobacter pylori (Hp) strains, and to observe the inhibitory effects of anti-Hp Lactobacillus acidophilus (La)4 and La6 on different antibiotic-resistant Hp strains. Methods Hp strains were isolated and cultured from gastric mucosa of 84 different gastropathy patients (20 patients with chronic gastritis, 24 with gastric ulcer, 19 with duodenal ulcer and 16 with gastric cancer). The minimum inhibitory concentration (MIC) of metronidazole, clarithromycin and amoxicillin were tested by E-test in order to determine the resistance of these three antibiotics in clinical isolated Hp strains. With standard La as control, the supernatant of anti-Hp La4 and La6 was added into Hp strains culture wells. Hp strains were cultured in solid media for 72 hours, and then inhibition ring were recorded. Anti-Hp Lactobacillus acidophilus liquid was also added to culture medium of different Hp strains, which were in liquid culture, culture medium were taken at different time points (4,8,12,24,48 hrs) to calculate bacteria colony number and test urease activity. Results In 84 clinical isolated Hp strains, the resistant rates of metronidazole, clarithromycin and amoxicillin resistance rates were 67.9%, 17.9% and 1.2% respectively. Of those 11 strains were mixed drug resistance, which included 10 strains of metronidazole and clarithromycin mixed drug resistance, and one of metronidazole and amoxicillin mixed drug resistance. In solid culture conditions, supernatant of anti-Hp Lactobacillus acidophilus La4 and La6 had obvious inhibitory effect on antibiotic-resistant and non-resistant Hp strains. In liquid culture conditions, anti-Hp Lactobacillu acidophilus La4 and La6 bacterium liquid could inhibit the proliferation of antibiotic-resistant and non-resistant Hp strains, the antagonistic role was significantly stronger than the standard Lactobacillus acidophilus strains (P<0.05). The urease activity of antibiotic-resistant Hp strains was inhibited since mixed cultured with anti-Hp Lactobacillu acidophilus La4 and La6 for 4 hours, the urease activity gradually decreased as culture time extended, and the inhibitory role was significantly stronger than the standard Lactobacillus acidophilus strains (P<0.05). Conclusions In 84 Hp strains, most were metronidazole resistant strains, followed by clarithromycin resistant strains, metronidazole and clarithromycin mixed resistance strains. In vitro, anti-Hp Lactobacillu acidophilus La4 and La6 had obvious inhibitory effects on antibiotic-resistant and non-resistant Hp strains.

Objective To assess the liver histopathological characteristics of chronic hepatitis B (CHB) patients with alanine aminotransferase(ALT)lower than 2 times the upper limit of normal (ULN) through liver biopsy, and try to provide subjective evidence for clinical anti-viral treatment.Methods From October 2005 to August 2010, patients accepted liver biopsy in department of infectious disease, Sichuan provincial people's hospital were enrolled. The criteria for liver biopsy was as follow, (1) HBsAg-positive for more than 6 months, (2) HBeAg-positive patients with HBV DNA ≥103 copies/ml or HBeAg-negative patients with HBV DNA≥ 104copies/ml, (3) ALT was lower than 2 times ULN for more than 6 months,and without any hepatic protectants, (4) never accepted any antiviral treatment before, including IFN or nucleoside analogues, (5) willing to accept liver biopsy. Before liver biopsy, routine blood test, prothrombin time, liver function test, hepatitis B antigen and antibody test, HBV DNA quantification were examined. The biopsy position was located under routine ultrasound, liver biopsy were performed to assess the grading of inflammation and necrosis and the degree of fibrosis. The correlation between all the factors and liver inflammation and fibrosis were analyzed. Results Totally 383 cases (240 males and 143 females) met the diagnostic criteria, aged from 16 to 59 years old and the mean age was 28.0 years old. Cases of liver inflammation in G0, G1, G2, G3andG4 grade was 2 cases (0.5％), 165 cases (43.1％), 191 cases (49.9％), 25 cases (6.5 ％ ) and 0 cases (0 ％ ) respectively, cases≥G2 grade accounted 56.4 ％ of total. Meanwhile,stage of fibrosis in S0, S1, S2, S3 and S4 was 103 cases (26.9％), 265 cases (69. 2％), 13 cases (3.4％), 2 cases (0.5％) and 0 cases (0％) respectively, percentage of liver fibrosis in S2stage and over was only 3.9％. The occurrence of serious liver inflammation was associated with age, ALT levels, HBV DNA levels and HBeAg status (P＜0.05). There was no obvious association between HBV DNA level and liver fibrosis (P＞0.05). Conclusions There were obvious liver inflammation and different degree of liver fibrosis in CHB patients with alanine aminotransferase(ALT)lower than 2 times ULN. The degree of liver injury assessed by liver biopsys is recommended as an evaluation for the necessary of anti-viral therapy.

Objective To analyze the risk factors of mortality in hospitalized patients with peptic ulcer bleeding (PUB).Methods From January 2003 to December 2012,1 210 patients with PUB were collected.Among them,1 170 patients were cured (cured group) and 40 patients died (dead group).The general information and clinical data of patients were collected,which included gender,age,smoking history,non-steroidal anti-inflammatory drugs intake,haematemesis,shock,blood infusion and rebleeding.The information of patients combined with other diseases was also collected.The lab findings and gastroendoscopy findings were also collected,including hemoglobin,platelets,serum albumin,blood urea nitrogen,serum creatinine levels,coagulation,location of ulcer and Forrest classification.Chi-square test was performed for comparison between groups of count data.The t-test was used for comparison between groups of measurement data and normally distributed,and Mann-Whitney rank sum test was used for non-normal distribution.The risk factors of mortality of patients with PUB were analyzed by univariate and multivariate Logistic regression analysis.Results The rates of age over 65,combined with other diseases,shock,rebleeding,abnormal coagulation,Forrest classification above Ⅱ b,medicine spraying to stop bleeding under gastroendoscope,gastroendoscopic hemostasis with titanium clip and operation of dead group (57.5％,23/40; 27.5％,11/40; 25.0％,10/40; 42.5％,17/40; 25.0％,10/40; 35.0％,14/40; 15.0％,6/40; 12.5％,5/40 and 17.5％,7/40) were all higher than those of cured group (25.0％,293/1 170; 7.4％,86/1 170; 12.5％,146/1 170; 13.1％,153/1 170; 5.1％,60/1 170; 20.9％,244/1 170; 4.8％,56/1 170; 4.1％,48/1 170 and 6.5％,76/1 170).The differences were statistically significant (x2 =21.117,18.651,5.400,27.728,9.203,4.613,6.332,4.661 and 5.710,all P＜0.05).The serum albumin level of dead group ((28.71±7.13) g/L) was lower than that of cured group ((32.82±7.55) g/L) and the difference was statistically significant (t=2.215,P＜0.05).Between the groups,there were no significant differences in gender distribution,rate of patients smoking,rate of patients taking non-steroidal anti-inflammatory drugs,rate of patients with haematemesis,volume of blood infusion,location of ulcer,dosage of proton pump inhibitor (PPI),average hemoglobin level,blood urea nitrogen level,serum creatinine and platelet count (all P＞0.01).Age over 65,combined with other diseases and rebleeding were the independent risk factors of mortality of patients with PUB during hospitalization (OR=4.821,12.959 and9.627,all P＜0.01).Conclusion Age over 65,combined with other diseases and rebleeding are the independent risk factors of mortality of patients with PUB during hospitalization.

Objective To investigate the injury of nonsteroidal anti-inflammatory drug (NSAID) in small intestinal mucosa and the protective role of muscovite.Methods From December 2012 to June 2013,28 healthy volunteers without intestinal mucosal injury showed by capsule endoscopy were selected as objects of this study.Based on computer-generated random number table,the subjects were divided into muscovite group and control group.Subjects of muscovite group orally took muscovite 3 g twice daily,diclofenac 75 mg twice daily and omeprazole 20 mg once a day.The medicine for control group were as same as muscovite group but no muscovite.Patient in both groups took medicines for two weeks.All subjects underwent capsule endoscopy examination after the medication.Before and after the medication,the clinical symptoms of subjects and the changes of small intestinal mucosa under endoscopy were compared.The t-test was performed for comparison between the groups in normally distributed measurement data.For non-normal distributed measurement data,Wilcoxon rank sum test was used for comparison between the groups.Chi-square test or Fisher's exact test was implemented for comparison between the groups of count data.Results There were no differences in the incidences of the injury of the intestinal mucosa,ulceration,petechiae and (or) erythema,mucosal exposure between muscovite group (5/14,4/14,3/14 and 1/14,respectively) and control group (10/14,8/14,7/14 and 3/14,respectively) (all P＞0.05).Both the incidences of intestinal mucosal erosions and lymphangiectasis of muscovite group (4/14 and 1/14) were lower than those of control group (10/14 and 8/14) and the differences were statistically significant (x2 =5.143,Fisher's exact test,both P＜0.05).All the number of injury of the intestinal mucosa,ulceration and erosions of muscovite group (0.00(2.00),0.00(1.00),0.00(1.25),respectively) were lower than those of control group (5.50(17.25),2.00(9.75),3.00(5.00),respectively) and the differences were statistically significant (Z=-2.156,-1.988 and -2.338,all P＜0.05).There was no statistically significant difference in the number of petechiae and (or) erythema between muscovite group and control group (P＞0.05).In muscovite group,the number of grade zero,one,two,three and four intestinal mucosa injury was nine,zero,one,three and one; in control group was four,zero,two,two and six.There was statistically significant difference between the two groups (Z=-2.108,P＜0.05).In muscovite group,the number of mucosa injury in the upper,middle and lower sections of small intestine was 0.00(0.25),0.00(0.25),0.00(0.75),respectively,and there was no significant difference in the distribution of small intestinal mucosa injury in the group (all P＞ 0.05).In control group,the number of mucosa injury in the upper,middle and lower sections of small intestine was 2.00(4.00),0.00(4.25),3.00(9.75),respectively,and there was statistically significant difference in the distribution of small intestinal mucosa injury in the group (x2 =7.189,P＜0.05).The number of small intestinal mucosa injury in the upper and lower sections of control group was more than that of muscovite group and the difference was statistically significant (Z=-2.087 and-2.502,both P＜ 0.05).Conclusion Short-term orally taking NSAID lead to small intestinal mucosal injury and muscovite could reduce NSAID-related small intestinal mucosal injury.

Objective To evaluate the efficacy of 10-day compound allantoin containing quadruple regimen in the treatment of chronic gastritis with Helicobacter pylori (H.pylori) infection,and to compare with the bismuth-containing quadruple therapy.Methods Altogether 173 patients with H.pylori positive chronic gastritis confirmed by gastric endoscope were divided into 10-day compound allantoin containing quadruple regimen group (n =43),24-day compound allantoin containing quadruple regimen group (n =46),10-day bismuth-containing quadruple regimen group (n =42) and 24-day bismuth-containing quadruple regimen group (n =42).After the treatment,the eradication rate of H.pylori,the rate of gastrointestinal symptoms (epigastric pain,bloating and belching) relief and the adverse effects of each group were observed.Intention-to-treat (ITT),per-protocol (PP) statistical analysis and chi-square analysis were performed for statistical analysis.Results H.pylori eradication rates of 10-day compound allantoin containing quadruple regimen group,24-day compound allantoin containing quadruple regimen group,10-day bismuth-containing quadruple regimen group and 24-day bismuth-containing quadruple regimen group analyzed by ITT were 90.7％ (39/43),91.3％ (42/46),90.5％ (38/42) and 88.1％ (37/42),respectively; while analyzed by PP were 90.7％ (39/43),93.3％ (42/45),90.5％ (38/42) and 90.2％ (37/41),respectively.And there were no statistical differences between groups (all P＞0.05).Ten days after the treatment,the rates of epigastric pain relief of 24-day compound allantoin containing quadruple regimen group and 24-day bismuth-containing quadruple regimen group were 81.1％ (30/37) and 78.8％ (26/33),respectively,the rates of bloating relief were 82.4％ (28/34) and 71.0％ (22/31),respectively,and the rates of belching relief were 76.9％ (20/26) and 75.0％ (21/28),respectively.There were no statistical differences between the two groups (all P＞ 0.05).However after 24-day treatment,the rates of epigastric pain relief of 24-day compound allantoin containing quadruple regimen group and 24-day bismuth-containing quadruple regimen group were 91.9 ％ (34/37) and 87.9％ (29/33),respectively,the rates of bloating relief were 94.1％ (32/34) and 87.1％ (27/31),respectively,and the rates of belching relief were 96.2％ (25/26) and 85.7％ (24/28),respectively.There were no statistical differences between the two groups (all P＞0.05).And the rates of epigastric pain and bloating relief increased after 24-day treatment compared with those of 10-day treatment,however the differences were not statistically significant between the two groups (all P＞ 0.05).In 24-day compound allantoin containing quadruple regimen group,the rate of belching relief was higher after 24-day treatment compared with that of 10-day treatment,and the difference was statistically significant (x2=4.127,P=0.042).No severe adverse effects were observed in each group,and there were no adverse effects such as oral metal odor,tongue black and melena in compound allantoin containing quadruple therapy.Conclusions Ten-day compound allantoin containing quadruple therapy as first-line approach in the treatment of chronic gastritis with H.pylori infection can get better H.pylori eradication and the efficacy is similar to bismuth quadruple therapy.Meanwhile the symptom relief rate is high and no obvious adverse effects were found.

Objective To study the diagnostic value of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) combined with the new category of papanicolaou society of cytopathology in solid pancreatic lesions (SPL) rapid on-site evaluation (ROSE).Methods From February 2011 to October 2014,225 patients with SPL who underwent EUS-FNA and obtained the cytological diagnosis were enrolled.The lesions were finally diagnosed according to pathological results,imaging and follow-up data,and then the sensitivity,specificity,and accuracy of EUS-FNA in the diagnosis of SPL were calculated based on the new papanicolaou society of cytopathology terminology.Logistic stepwise regression analysis was performed to analyze the risk factors.Results Among 225 patients with SPL,96 cases (42.7％)had uncertain cytological diagnosis,17.3％ (39/225) could not be diagnosed,8.0％ (18/225) were atypical lesions,and 17.3％ (39/225) were suspicious malignant carcinomas.Among 129 cases (57.3％)with certain cytological diagnosis,15.1％ (34/225) were benign lesions,14.7％ (33/225) were tumors (benign or others) and 27.6％ (62/225) were malignant tumors.When atypical lesions were added into non-tumor lesions or tumor lesions,the sensitivity,specificity and accuracy of diagnosis were 87.3 ％,91.7％,88.2％,and 94.7％,72.2％,90.3％,respectively.Serum CA125≥14 kU/L (odds ratio (OR) =7.13,95％ confidence interval (CI) 2.02 to 25.22,P=0.002) and history of biliary disease (OR=3.85,95％CI 1.22 to 12.51,P=0.022) were two independent risk factors of pancreatic tumors.Conclusions Despite of a high percentage of uncertain cytological diagnosis,EUS-FNA still has high diagnostic value in SPL when combined with the new papanicolaou society of cytopathology terminology.Furthermore,serum CA125≥14 kU/L and history of biliary disease may help to diagnose pancreatic tumors.

Objective To explore the difference in gastric residual volume (GRV) between singledose and split-dose bowel preparation before colonoscopy under general anesthesia.Methods From October 8th to December 30th in 2016,the out-patients undergoing gastroscopy and colonoscopy with anesthesia services on the same day were selected and divided into the traditional single-dose bowel preparation group and split-dose bowel preparation group.The GRV and intestinal preparation quality were compared between the two groups.T test was used for statistical analysis and multiple linear regression analysis was performed for the influence factors of GRV analysis.Results A total of 121 patients were enrolled,60 patients in the spilt-dose bowel preparation group and 61 in the traditional single-dose bowel preparation group.The mean GRV of the split-dose bowel preparation group was (17.3 ± 12.2) mL,which was lower than that of the single-dose bowel preparation group ((23.7 ± 14.6) mL),and the difference was statistically significant (t =2.642,P=0.009).The score of intestinal preparation quality of the split-dose bowel preparation group was 8.05 ± 0.85,which was higher than that of the single-dose bowel preparation group (7.67±1.19),and the difference was statistically significant (t =-2.002,P=0.048).Fasting time was related with GRV (odd ratios (OR)=1.732,95％ contidence interval (CI) O.299 to 3.168,P=0.018).Conclusion The GRV of patients with split-dose bowel preparation before colonoscopy is lower than that of traditional single-dose bowel preparation,thus reducing the risk of aspiration during anesthesia.

Objective To investigate the effects of antibiotic prophylaxis on post-operation complications after endoscopic retrograde cholangio-pancreatography (ERCP).Methods From January 1st,2011 to December 31st,2013,1 951 patients undergoing ERCP were enrolled and divided into postoperative antibiotic prophylaxis group (antibiotics group,630 cases) and postoperative non-antibiotic treatment group (non-antibiotics group,1 321 cases).Complications after ERCP were compared between the two groups.Chi square test,single factor analysis and multiple factor analysis were performed for statistical analysis.Results Among the 1 951 patients,277 patients had postoperative complications:101 patients (5.18％) with post-endoscopic retrograde cholangio-pancreatography pancreatitis (PEP),54 patients (2.77％) with hyperamylasemia,134 patients (6.87％) with biliary infection,eight patients (0.41％) with hemorrhage,one patient (0.05％) with intestinal obstruction and one patient (0.05％) with perforation.The incidence of postoperative biliary infection of antibiotics group was 4.44％ (28/630),which was lower than that of non-antibiotics group (8.02％,106/1 321),and the difference was statistically significant (x2 =8.546,P =0.030).The incidences of PEP of antibiotics group and nonantibiotics group were 4.92％ (31/630) and 5.30％ (70/1 321),respectively.The incidences of postoperative hyperamylasemia of antibiotics group and non-antibiotics group were 3.02％oo (19/630) and 2.65％ (35/1 321),respectively.The incidences of upper gastrointestinal hemorrhage were 3.02％ (19/630) and 2.65％ (35/1 321),respectively.The incidences of intestinal obstruction were 0 (0/630) and 0.08％ (1/1 321),respectively,while the incidences of perforation post-operation were 0.16％ (1/630) and 0 (0/1 321),respectively,and the differences were not statistically significant (all P＞0.05).Cholangiocarcinoma (odd ratios (OR)=2.93,95％ confidence interval (CI) 1.88 to 4.56,P＜0.01) and repeated ERCP during hospitalization (OR=2.53,95 ％ CI 1.63 to 3.93,P＜0.01) were the independent risk factors of cholangitis after operation.However,endoscopic sphincterotomy (OR=0.65,95 ％ CI 0.44 to 0.97,P =0.030) and antibiotics prophylaxis (OR =0.64,95％ CI 0.39 to 0.95,P =0.030) were the protective factors.Conclusions Antibiotic prophylaxis after ERCP can reduce the occurrence of postoperative cholangitis.Paitents with cholangiocarcinoma,repeated ERCP procedures during hospitalization or without endoscopic sphincterotomy should be recommended for antibiotic prophylaxis.