Objective To explore the efficacy of bismuth containing quadruple therapy in the treatment of peptic ulcer in patients with Helicobacter pylori.Methods We selected 307 peptic ulcer patients with Helicobacter pylori.infection,and randomly divided them into observation group (152 cases)and control group (155 cases).The observation group received quadruple therapy:colloidal bismuth pectin,pantoprazole,amoxicillin and furazolidone, 14d.The control group received the standard triple therapy:pantoprazole,clarithromycin and amoxicillin,14d.The ulcer healing rate,H.pylori eradication rate and adverse reaction were compared between the two groups.Results The ulcer healing rates,remission rates,H.pylori eradication rates in the observation group were 93.5%,92.7%, 94.8%,92.3% respectively,which in the control group were 83.4%,82.7%,84.1%,80.6% respectively,there were statistically significant differences (χ2 =4.15,4.9,6,0.94,all P <0.05).The incidence of adverse reactions did not differ significantly between the two groups (P >0.05).Conclusion Bismuth containing quadruple therapy is associated with a higher rate of H.pylori eradication compared with the standard triple therapy.

BacKground:RectaI carcinoid is a rareIy seen neuroendocrine tumor. TiII now,there is controversiaI for the treatment modaIities of rectaI carcinoids with diameter between 1-2 cm. Aims:To study the expression of Ki-67 in rectaI carcinoids and the efficacy and safety of endoscopic resection. Methods:A totaI of 83 rectaI carcinoid patients with tumor diameter Iess than 1. 5 cm were enroIIed. AII patients were pathoIogicaIIy diagnosed and underwent endoscopic mucosaI resection from Jan. 2008 to Dec. 2013 at Chongqing Three Gorges CentraI HospitaI and Wuhan Tongji HospitaI. The medicaI records were retrospectiveIy reviewed and expression of Ki-67 in tumor tissue was assessed by immunohistochemistry. Results:AII patients underwent preoperative endoscopic uItrasonography. Tumors were Iimited to mucosa or submucosa, and no muscuIaris propria invoIvement or metastasis was seen. The mean foIIow-up duration was 38 months,and no recurrence or metastasis occurred. Ki-67 was IowIy expressed in aII rectaI carcinoids(0. 84% ± 0. 67%). When tumors were grouped by size,no significant differences in gender,age,tumor site and Ki-67 expression IeveI were seen between <1. 0 cm group and 1. 0-1. 5 cm group(P >0. 05). Furthermore,when tumors were grouped by a cutoff vaIue of mean Ki-67 index 0. 84%,differences in cIinicopathoIogicaI parameters between the two groups were not significant either( P >0. 05 ). Conclusions:Ki-67 is IowIy expressed in rectaI carcinoids Iess than 1. 5 cm in diameter enroIIed in this study,which denoted an inactive proIiferation. For rectaI carcinoids with diameter Iess than 1. 5 cm,with Iow Ki-67 expression and without muscuIaris propria invoIvement and metastasis, IocaI endoscopic excision is an effective and safe treatment modaIity.

Obj ective To explore the related influencing factors of acute pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP).Methods Clinical materials of 246 pa-tients with PEP after ERCP were analyzed retrospectively,and they were divided into two groups according to occurrence of PEP.Results The success rate of ERCP was 94.72%,and the inci-dence rate of PEP was 9.76%.In PEP group and non-PEP group,there were significant differ-ences of age,history of pancreatitis,pancreatic duct,frequency of pancreatic duct into the guide wire and EST (P<0.05).Conclusion Young age,a history of pancreatitis,pancreatic duct,fre-quency of pancreatic duct into the guide wire and EST are important influencing factors for occur-rence of acute pancreatitis after ERCP.

Obj ective To explore the related influencing factors of acute pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP).Methods Clinical materials of 246 pa-tients with PEP after ERCP were analyzed retrospectively,and they were divided into two groups according to occurrence of PEP.Results The success rate of ERCP was 94.72%,and the inci-dence rate of PEP was 9.76%.In PEP group and non-PEP group,there were significant differ-ences of age,history of pancreatitis,pancreatic duct,frequency of pancreatic duct into the guide wire and EST (P<0.05).Conclusion Young age,a history of pancreatitis,pancreatic duct,fre-quency of pancreatic duct into the guide wire and EST are important influencing factors for occur-rence of acute pancreatitis after ERCP.

Objective To investigate the clinical features,etiology,diagnosis and treatment of acute auditory agnosia.Methods We studied the clinical manifestation,diagnosis and treatment of acute auditory agnosia in a patient in our hospital.Results A 28 year oldyoung woman visited our department because she suffered from the tinnitus for 7 days and she could not distinguish the semantics for 1 day.There were no other abnormal symptoms in the central and peripheral nervous system on admission.Audiological testing showed normal,language testing showed that the speech discrimination score was zero.MRI showed extensive damage to temporal lope.MR spectroscopy revealed increased lactate and reduced N-acetyl aspartate.Acute auditory agnosia resulted from mitochondrial myopathy was considered.After symptomatic treatment,the symptoms were significantly improved.Molecular genetics examination showed the A3243G mtDNA mutation,further confirmed the diagnosis of mitochondrial encephalomyopathy with lactic acidosis and stroke like episodes (MELAS) syndrome.Conclusion Acute auditory agnosia and acute tinnitus can be the first symptoms in MELAS,thus,MELAS should be suspected in patients with acute auditory agnosia,acute tinnitus,sudden hearing loss in children and youth.Imaging examination plays an important role in the etiological diagnosis of acute auditory agnosia.