ObjectiveTo investigate the endoscopic and clinical characteristics of gastrointestinal Behcet's disease (BD). MethodsWe analyzed the clinical and follow-up data of 27 patients with gastrointestinal BD retrospectively.Results Most common locations involved were esophagus and ileocecum,74. 1％ (20/27) and 59. 3％ (16/27), respectively. The most common parenteral symptoms were oral ulcers (85.2％), genital ulcers (25.9％), ophthalmitis (7. 4％ ) and skin damage (7. 4％ ). The most common gastrointestinal symptom was chest pain (48. 1％, 13/27). Ulcer was the basic endoscopic feature,most of which were with uneven bottom and peripheral inflammatory response. There was no difference in endoscopic features between typical BD and atypical BD. Pathology showed typical small vasculitis (44. 4％,12/27). ConclusionClinical manifestations of intestinal BD vary. Symptoms are not necessarily consistent with the involved locations. A small number of patients with BD present with gastrointestinal symptoms as the first and only symptom, with serious complications in some patients. Physicians need to be fully aware of the disease.

Objective To study the function and diurnal variation of hypothalamic-pituitary-adrenal (HPA) axis and hypothalamic-pituitary-thyroid(HPT) axis,and the relationship with clinical characteristics of di-urnal rhythm in depressed patients. Methods Forty-nine depressed patients met diagnostic DSM-Ⅳ criteria and thirty-eight normal controls were collected. The plasma levels of cortisol (CORT), adrenocorticotropic hormone (ACTH), T3, T4, thyroid-stimulating hormone (TSH) at 7 am and 7 pm were measured by radioimmunoassay, then the results concemed were compared among the depressed groups with and without diurnal variation and control group by multivariate analysis of variance. Results The plasma level of morning CORT, morning and evening TSH ((365.94±120.78) nmol/L; (6.24±2.47)μIU/ml; (6.68±2.42)μIU/ml; respectively) were respective-ly higher than those of control group((284.91±83.39) nmol/L; (3.82±1.75)μIU/ml;(4.01±1.69)μIU/ ml, P<0.05). The plasma levels of morning and evening T4 were significantly lower than those of control group(P <0.05). The CORT morning-evening difference variable distinguished between depressed and control group (P< 0.001),but no significant differences could be found between the depressed groups with and without diurnal varia-tion. There were no significant differences in the CORT, T3, T4, TSH morning-evening difference variable between various clinical subtypes of depressed patient (unipolar/bipolar; psychotic/nonpsychotic). Conclusion Abnormal CORT morning-evening difference variable was observed in the depressed patients compared with normal controls,and may be used as a special trait mark of depressed group.

Objective To evaluate the significance of dilated intercellular space (DIS) of squamous epithelium in lower-esophagus which was measured at light microscopy (LM) in the diagnosis of gastroesophageal reflux disease (GERD). Methods This study was divided into two parts. The first part consists of 133 GERD patients with typical symptoms, including 75 erosive esophagitis (EE) and 58 non-erosive reflux disease (NERD);the second part consists of 25 healthy volunteers as control; ambulatory 24-hr esophageal pH monitoring, endoscopy and biopsies which were taken in lower esophagus were performed in all individuals. NERD patients with negative ambulatory 24-hr esophageal pH monitoring were undertaken PPI test. We selected 43 individuals randomly (4 control, 11 NERD and 28 EE) to measure the intercellular space diameter with LM and transmission electronic microscopy (TEM) simultaneously. All the samples were observed at immersion objective, taken pictures and make the scale at the same time; all the pictures were measured by the computer-assisted morphometry and in the samples for one ease should be measured 100 points and then calculate the mean intercellular space diameter, while the TEM has the same procedures. Results A total of 158 individuals (90 male, 68 female) were enrolled in this study. The mean intercellular space diameter with LM of the controls, the NERD and the EE patients were (0.61±0.10)μm, (1.12±0.61)μm and (1.30±0.19) μm, respectively, with significant differences between the control and NERD group, the control and EE group, the EE and NERD group (P <0.05); the mean intercellular space diameter with LM of EE subgroup of LA-A, LA-B, LA-C, LA-D were (1.31±0. 23)μm, (1.27±0.17)μm, (1.31±0.14)μm, (1.33±0.11)μm, respectively, without significant differences among every two subgroups (P > 0.05);NERD patients with positive and negative 24-hr ambulatory pH monitoring were 40 and 17 cases, and the mean intercellular space diameter with LM were (1.12±0.16) μm, (1.11±0.31) μm, respectively, without significant differences between them (P >0.05) ;the cut-off value of mean intercellular space diameter with LM was 0. 85 μm, if combination the clinical GERD symptom, endoscopy and 24-hr ambulatory pH monitoring as gold standard, its sensitivity was 95.5% and specificity was 100%;the intercellular space diameter of the controls, the NERD patients and the EE patients with TEM were (0. 30±0.14)μm, (1.33±0.28)μm, (1.40±0. 22)μm, respectively,with significant differences between the control and NERD group, the control and EE group (P < 0.05). It was significant correlation in intercellular space diameter between LM and TEM (r=0.737, P=0.000).Conclusions The intercellular space diameter of squamous epithelium in lower esophagus of GERD patients can make quantitative study with LM. It is significant correlation with TEM. DIS with LM is one of sensitive, specific and objective marker of GERD.

Objective To investigate the effect and mechanism of necrostatin-1 (Hec-1) on the level of HMGB-1 protein in liver of rats with hemorrhagic-traumatic shock.Methods A number of 96 male SD rats were divided into sham-operated group,dimethyl sulfoxide (DMSO) group and Nec-1 group (n=32in each) by randomized number method.Rat model of hemorrhagic-traumatic shock was made by fracture of femoral bone and tibia bone and exsanguination from femoral vein until 30 mmHg and maintained at 30-40 mmHg for 90 min,then the shed blood was transfused back with Ringer's solution.The rats in shamoperated group were only under anesthesia for separating and ligating blood vessels,without exsanguination to induce hemorrhagic shock and without replenishment with blood.Rats in Nec-1 group were given 1 mg/kg Nec-1 through femoral vein 5 min before replenishment with blood and Ringer' s solution,while the rats in DMSO group were given equal volume of DMSO solution instead.Eight rats in each group were sacrificed separately at 2 h,8 h,16 h and 24 h after replenishment.The serum and liver tissues of rats in each group were collected to detect serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST),and to observe the pathological changes in liver with hematoxylin-eosin (HE) staining.The level of HMGB-1 in serum was detected by using ELISA.The cytoplasm protein and total protein expressions of HMGB-1 were assessed by using western blot analysis.Results Compared with DMSO group,levels of serum ALT at 8 h (P ＜0.05),16 h (P ＜ 0.01) and 24 h (P ＜ 0.01) in Nec-1 group were significantly lower.Level of serum AST in Nec-1 group were lower compared with DMSO group at 8 h (P ＜ 0.01),16 h (P ＜ 0.01) and 24 h (P ＜0.01).Compared with DMSO group,levels of serum HMGB-1 at 8 h (P ＜ 0.05),16 h (P ＜0.01) and 24 h (P ＜ 0.01) in Nec-1 group were significantly lower.Under light microscopy and transmission electron microscope,hepatic lobule destroyed,the blood extravasated,the immunocyte infiltrated and cellular organelle destroyed were found.Compared with DMSO group,the level of HMGB-1 protein in cytoplasm protein in Nec-1 group were significantly decreased at 8 h (P ＜ 0.01),16 h (P ＜0.01) and 24 h (P ＜0.01).The level of HMGB-1 protein in total protein in Nec-1 group were significantly decreased 8 h (P ＜ 0.05) and 24 h (P ＜ 0.05).Conclusions Nec-1 can remarkably protect the liver of rats with hemorrhagic-traumatic shock,decrease the level of HMGB-1,and protect the hepatocyte effectively.

Objective To evaluate the clinical significance of intercellular space diameters (ISD)of squamous epithelium by light microscopy (LM) in lower esophagus of erosive reflux esophagitis (ERD),non-erosive reflux disease ( NERD), Barrett esophagus (BE) and healthy controls. Methods A total of 21 ERD and 21 NERD patients with reflux symptoms and confirmed with 24-hour esophageal pH monitoring, 13 BE patients diagnosed by gastroscopy and biopsy, and 20 other healthy controls were enrolled in the study.Samples of ERD, NERD and control group were collected at 2 cm above dentate line, and made HE slides in the conventional way. Images for measurement of ICS were acquired with oil lens ( × 1000). ICS of squamous epithelium was quantitatively measured by computer-assisted morphometry. Ten cells were taken for each sample, 10 consecutive ISD for each cell, i.e. 100 ISD for each subject. Mean ISD was calculated.Results Mean ISDs by LM in control, BE, ERD, and NERD groups were 0. 59, 0. 99, 1.29 and 1.06 μm, respectively. The mean ISDs in BE, ERD, and NERD group were much greater than that in control (P＜0. 05). The mean, maximal and minimal ISDs of group ERD were greater than those of NERD and BE (P = 0. 000). However, the ISDs of NERD and BE are of no significant difference ( P ＞ 0. 05 ). The cut-off value of mean ISD for diagnosis of gastro-esophageal reflux disease (GERD) was 0. 85 μm. Diagnostic sensitivity and specificity for ERD, NERD and BE were 89. 1% and 100. 0%, with reference to clinical symptoms, endoscopy and ISDs above the cut-off value. Conclusion Larger ISDs in lower esophagus by using LM will be found in all subgroups of GERD, including ERD, NERD and BE. Increased ISDs may be one of the markers for diagnosis of ERD, NERD and BE.

Objective To investigate the effects of necrostatin-1 (Nec-1) on the liver of rats with trauma induced hemorrhagic shock.Methods Trauma induced hemorrhagic shock model was produced by adopting the left femur,tibia fracture and soft tissue injury,bleeding and reperfusion in male Sprague-Dawley (SD) rats.A total of 22 rats were divided into model group and Nec-1 group with 11 rats in each group by randomized digital number method and the 72-hour mortality was observed.In addition,72 rats were randomly divided into sham group,model group,Nec-1 group with 24 rats in each group.Rats in sham group were only received anesthesia,separating and ligating blood vessels,without trauma induced hemorrhagic and reperfusion,and the rats in Nec-1 group were received 1 mg/kg Nec-1 through femoral vein 5 minutes before reperfusion,while the rats in model group were received the same amount of solvent.The serum and liver tissues of each group were collected at 2,4,8 hours after reperfusion.Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were detected by automatic biochemistry analyzer.The pathology changes in liver were observed by hematoxylin-eosin (HE) staining.The mRNA expressions of tumor necrosis factor-oα (TNF-α) and interleukin-1β (IL-1β) in the liver were detcrmined by reverse transcription-polymerase chain reaction (RT-PCR).The protein expressions of receptor interaction of protease 1/3 (RIP1/RIP3) were also assessed by Western Blot analysis.Results Compared with model group,Nec-1 significantly reduced the 72-hour mortality [18.18％ (2/11) vs.63.64％ (7/11),P=0.040].Two hours after trauma induced hemorrhagic shock and reperfusion,the expressions of ALT and AST in model group were significantly increased compared with those in sham group [ALT (U/L):110.21 ±22.32 vs.80.98 ± 19.94,AST (U/L):364.29 ±64.83 vs.279.76 ±70.64,both P＜0.05],and reached the peak at 8 hours [ALT (U/L):387.41 ± 47.11 vs.82.76 ± 22.44,AST (U/L):973.35 ± 77.51 vs.261.49 ±52.03,both P＜0.01].Levels of serum ALT and AST in Nec-1 group were significantly decreased compared with model group [ALT (U/L) 4 hours:144.64± 33.79 vs.213.96± 36.21,8 hours:159.48 ± 43.57 vs.387.41 ± 47.11; AST (U/L) 4 hours:398.78 ± 59.48 vs.630.61 ± 59.93,8 hours:427.38 ± 80.75 vs.973.35 ± 77.51,all P＜0.01].Under light microscopy,it was noted that the hepatic sinus expansion,liver cells degeneration,necrosis,as well as infiltration of abundant inflammatory cells were observed.But the pathology changes in hepatic tissues were significantly mitigated in Nec-1 group.Along with the time extension,the mRNA expressions of TNF-α and IL-1β and the protein expressions of RIP1 and RIP3 were markedly up-regulated.Compared with model group,difference in the mRNA expressions of TNF-α and IL-1β in hepatic tissues in Nec-1 group were statistically significant,and the most obvious difference was at 8 hours [TNF-α mRNA:1.457 ± 0.081 vs.2.317 ± 0.062,IL-1β mRNA:0.690 ± 0.087 vs.1.812 ± 0.112,both P＜0.01].But there was no statistically significant difference in RIP1 and RIP3 between Nec-1 group and model group [RIP1 protein 8 hours:0.561 ± 0.033 vs.0.587 ± 0.036,RIP3 protein 8 hours:0.976 ± 0.040 vs.1.044 ± 0.115,both P＞0.05].Conclusion Nec-1 may be remarkable protect effect on the liver of rats with trauma induced hemorrhage shock and reperfusion,and the intrinsic mechanisms need further investigation.

Objective To investigate the potential mechanism for symptoms related to epigastric discomfort in patients without Helicobacter pylori (H.pylori) infection.Methods Patients who underwent gastric endoscopy and conformed H.pylori negative by histologic examination were enrolled.Among them,232 adult patients were collected between August 2006 and November 2006 and 31 children were collected between September 2005 and August 2009.All patients showed no apparent abnormality by endoscopic examination.The endoscopic biopsy was examined with HE or Warthin-Starry staining.Results In adult group,arteriole obstruction was found in 16 (8.8%) cases and focal haemorrhage in 82 (45.6%) cases.Both were existed in 82 (45.6%) cases.The histopathologic findings showed that arteriole obstruction in transition zone (65.2 %,P = 0.159) was common,whereas the focal haemorrhage in gastric fundus and corpus (65.6%,P=0.001) was in predominance.The symptom of heartburn was less in patients with arteriole obstruction and/or focal haemorrhage in comparison with those without these changes (x2 =8.564,P=0.003).In adolescent group,arteriole obstruction and/or focal haemorrhage accounted for 96.8% (30/31).Conclusion Gastric mucosa ischemic resulted from arteriole obstruction are commonly seen in both adult and adolescent patients,which is an important reason for epigastric discomfort in H.pylori negative patients.

Objective To investigate the incidence of peptic ulcer (duodenal ulcer and gastric ulcer) and the development of Helicobacter pylori (Hp) infection in the population during 10 years after Hp eradication.Methods Subjects were chosen from general population and performed endoscopy.Among them,the individuals confirmed to be Hp positive were randomly divided into treatment group and placebo group.The patients in treatment group received OAC triple therapy (omeprazole 20 mg,clarithromycin 500 nag and amoxicillin 1000 re.g,twice daily) for one week.After that,both groups continuously followed up by endoscopy during at 1st,5th,8th and 10th year for incidence and relapse of peptic ulcer as well as status of Hp infection.The patients in treatment group were examined by 13C-UBT for Hp eradication one month after the completion of treatment.Results At the 1st year,the incidence of peptic ulcer between the treatment group and placebo group were 3.7% and 12.85% (P=0.0002),respectively.At the 5th year,they were 5.86% and 14.93% (P=0.0017),respectively.At the 8th year,they were 4.4% and 9.39% (P = 0.044),respectively.The incidence of peptic ulcer of the treatment group significantly decreased after the eradication therapy compared to the placebo group.After the eradication,at the 1st year,the recurrence rates were 3.70% and 38.1% between the treatment group and the placebo group (P=0.0027).At the 5th year,they were 14.81% and 42.86% (P=0.03).At 8th year,they were 14.81 and 47.62% (P=0.03),respectively.At the 10th year,they were 25.93% and 57.14% (P=0.028).Then the recurrence rates of the treatment group significantly decreased compared to the placebo group.During the 10-year follow up study,the rate of Hp reinfection after a successful eradication in the treatment group was high,and it was 46.4% at the 10th year.Conclusion Both the incidence and recurrence of peptic ulcer significantly decreased after Hp eradication.It is necessary of Hp eradication in patients with peptic ulcer.Hp reinfection after a successful eradication is more frequent.

Objectives To study the current prevalence and recent epidemiological changes of Helicobacter pylori (H. pylori) infection among children and adults residing in regions with high ( Muping, Shandong) and low (Yanqing, Beijing) incidence of gastric cancer in China. Methods A total of 2065 asymptomatic children aged 8-15 years and adults aged 40-79 years in the above two regions were examined from May to July 2006. The data obtained in early 1990s in the same two areas and those of 11 656 patients undergoing endoscopy in our hospital in 1991 and 2006 were also collected and studied. Results The prevalence ofH. pylori infection in Muping was significantly higher than that in Yanqing among both children (37.69% vs25.58%, P<0.001) and adults (50.95% vs41.35%, P < 0. 01 ). From 1991 to 2006 H. pylori prevalence among children aged 8-10 years decreased in Muping (60. 00% vs 32. 07% , P < 0.001), but not in Yanqing (24.06% vs 19.10%, P > 0. 05 ) . A significant decrease in H. pylori prevalence among adults in both regions was observed when the results of 2006 were compared with the data obtained in 1990 in Muping (50.95% vs 73.78% , P < 0. 001 ) and in 1992 inYanqing (41.35% vs 55. 35% , P < 0. 01 ) . The detected rate of H. pylori infection in patients undergoing endoscopy in our hospital decreased from 51. 88% in 1991 to 33. 59% in 2006 (P <0. 001). Conclusions The prevalence of H. pylori infection is significantly higher in areas with a high incidence of gastric cancer in China as compared with that in areas with a low incidence of gastric cancer among both children and adults. H. pylori infection may be a risk factor in gastric carcinogenesis. In the past decade or more, H.pylori infection rates have decreased in Chinese population.

OBJECTIVEThis article aimed to review the incidence of Helicobacter pylori (H. pylori) infection and its therapy.

DATA SOURCESRelevant articles published in English were identified by searching in PubMed from 2000 to 2013, with keywords "H. pylori". Important references from selected articles were also retrieved from Elsevier, Wiley, EBSCO, and SPRINGER. The Chinese articles published were searched from China National Knowledge Infrastructure (CNKI).

STUDY SELECTIONArticles about "prevalence", "gastric carcinoma", "peptic ulcer", "gastroesophageal reflux disease", "functional dyspepsia", "pathogenic mechanism", "therapy", "eradication rate", "antibiotic resistance", and "gene polymorphisms" were selected.

RESULTSThe decreased infection rates of H. pylori could also be linked to the changed disease spectrum, such as the decreased morbidity and recurrence rate of H. pylori-related peptic ulcer, and the increased morbidity of gastroesophageal reflux. Although different treatment regimens have been used for H. pylori infection, the H. pylori eradication rate declined gradually. Due to primary resistance to antibiotics, the gene polymorphism of host and infected strain, and the therapy regimes, H. pylori eradication became even more difficult.

CONCLUSIONSThe prevalence of H. pylori infection had been decreasing, but the rate of eradication failure has dramatically risen in many countries due to resistance to antibiotic. H. pylori therapy in clinical practice is becoming progressively more difficult.

Drug Resistance, Bacterial ; genetics ; Helicobacter Infections ; drug therapy ; epidemiology ; Helicobacter pylori ; drug effects ; genetics ; pathogenicity ; Humans