Objective To investigate the antibiotic resistance trend of commonly used antibiotics of Helicobacter pylori (H.pylori) in Huzhou district,and to summarize the efficacy of eradication in related digestive diseases.Methods In year 2009,2013,2014 and 2015,8 139 gastric mucosa samples of patients undergoing gastroendoscopy examination were collected and H.pylori strains were isolated and cultured.The situation of resistance to levofloxacin,clarithromycin,metronidazole,amoxicillin,tetracycline and furazolidone was analyzed.The infection and antibiotics resistance of H.pylori were analyzed in 11 digestive diseases including functional dyspepsia,chronic gastritis,acute gastritis,duodenitis,gastric ulcer,duodenal ulcer,gastrointestinal dysfunction,gastric cancer,residual gastritis,reflux esophagitis and gastric lymphoma.The eradication schemes and eradication rate of H.pylori was reviewed in six digestive diseases including functional dyspepsia,chronic gastritis,duodenitis,gastric ulcer,duodenal ulcer and reflux esophagitis.Fisher's exact test was performed to compare the differences among the groups.Results A total of 3 263 H.pylori strains were obtained and the infection rate of H.pylori was 40.09％ (3 263/8 139).The H.pylori infection rates of 11 digestive diseases were from 0 to 57.89％,and which was high in duodenal ulcer,gastric ulcer,duodenitis,chronic gastritis and functional dyspepsia (57.89％,726/1 254;49.83％,301/604;42.91％,118/275;37.45％,1 518/4 053 and 36.78％,146/397;respectively).The results of single antibiotic resistance analysis in six digestive diseases needed or planed for H.pylori eradication indicated that resistance rate of H.pylori to levofloxacin and clarithromycin reached 23.09％ (663/2 871) and 17.87％ (513/2 871),respectively.The resistance rate tolevofloxacin dramatically increased from 5.03％ (8/159) in 2009 to 28.24％ (586/2 075) in 2015;the resistance rate to clarithromycin increased from 12.58％ (20/159) in 2009 to 21.78％ (452/2 075) in 2015;meanwhile,the resistance rate of H.pylori to metronidazole was nearly 100.00％.However,the resistance rates to amoxicillin,tetracycline and tetracycline were all zero.The results of double antibiotic resistance analysis in six digestive diseases needed or planed for H.pylori eradication indicated that the rate of both levofloxacin and clarithromycin resistance was 7.73 ％ (222/2 871).The double antibiotic resistance rate of levofloxacin and clarithromycin in different diseases fluctuated between 4.82 ％ and 10.96 ％.Totally 1 479patients of six digestive diseases were treated with quadruple therapy,and 1 363 patients were followed up after eradication therapy,with the eradication rate of 85.99％ (1 172/1 363).Conclusions In Huzhou district,for six common digestive diseases needed or planed for H.pylori eradication,any combination of two drugs in all three drugs including amoxicillin,tetracycline and furazolidone is the first choice for treatment.Only when patients are allergic to penicillin or furazolidone and tetracycline can not be obtained,will levofloxacin and clarithromycin be chosen.A high eradication rate can be achieved by choosing eradication schemes according to the results of H.pylori drug sensitivity test in local region.

OBJECTIVETo investigate the changes in hemodynamics and depth of anesthesia under monitored anesthesia care (MAC) in patients undergoing percutaneous dilatational tracheostomy (PDT).

METHODSForty-six patients with oral cancer were divided into two groups with 23 cases each: Local anesthesia group (group L) and MAC group (group M). Local and intratracheal surface anesthesia were performed with 2% lidocaine in group L. Midazolam, propofol and fentanyl were added to group M after local and intratracheal surface anesthesia, then PDT was carried out. During the induction, observer's assessment of alertness/sedation(OAA/S) scale was used to assess the depth of sedation. Mean arterial blood pressure (MAP), heart rate (HR), state entropy (SE) and response entropy (RE) were recorded before anesthesia (basal value, T1), after local anesthesia (T2), after intravenous administration/before incision (T3), during incision (T4), during dilating with stretching pliers (T5) and endotracheal intubation (T6). A postoperative follow-up was taken in group M.

RESULTSMAP and HR increased significantly at T4-T6 in group L and decreased at T3 (P < 0.05) with no change at T4-T6 in group M compared with those in T1. MAP and HR at T3-T6 in group M were obviously lower than those in group L. SE and RE at T3-T6 in group M were obviously lower than those at T1 or in group L (P < 0.01) and decreased significantly with the reduction of OAA/S scale (P < 0.05) during the induction. Intraoperative awareness in group M was not found through postoperative follow-up.

CONCLUSIONPatients undergoing PDT under MAC has more comfortability, more stable hemodynamics and no memory, so MAC is a better anesthesia for PDT than local anesthesia.

Anesthesia ; Female ; Heart Rate ; Humans ; Male ; Middle Aged ; Propofol ; Tracheostomy

Objective:To explore the clinical application values of a nomogram based on preoperative breast MRI and axillary ultrasonography imaging parameters for predicting the risk of sentinel lymph node (SLN) metastasis in early-stage breast cancer patients.Methods:Three hundred and ninty-seven female patients (mean age 48.0±10.7 years old, range 25-81 years old) who admitted to Sun Yat-sen University Cancer Center from May 2007 to December 2017 were enrolled in this study. All patients were diagnosed as primary unilateral invasive early-stage breast cancer confirmed by surgical pathology. Preoperative breast MRI, axillary ultrasonography and clinical pathological data of enrolled patients were retrospectively analyzed. According to the pathological results of sentinel lymph node biopsy (SLNB), the cases were divided into negative SLN group ( n=200) and positive SLN group ( n=197). Clinicopathologic data, MRI and axillary ultrasound features were analyzed and compared between two groups. Logistic regression analysis was used to select independent risk factors. Then a predictive model was constructed and a nomogram was made for visualizing the associations between the predictive factors and SLN metastasis. Goodness-of-fit of the model was evaluated by using the Hosmer-Lemeshow test. Predictive performance was assessed based on the receiver operating characteristic (ROC) curves. Bootstrap resampling was performed for internal validation. Results:Significant differences were found in patient age, lymphovascular invasion status, PR status, HER2 status and molecular subtype between negative and positive SLN groups (all P<0.05); MRI features including tumor size, mass margin, long and short diameter, as well as the ratio of long to short diameter of LNs, LN margin, presence or absence of LN hilum, and axillary LNs symmetry were found significantly different between negative and positive SLN groups (all P<0.05); as for the axillary LN ultrasonography parameters, the interface between cortex and medulla, presence or absence of cortical thickening, and LN hilum were significantly different between negative and positive SLN groups (all P<0.05). Logistic regression analysis results showed that several factors could be identified as predictors of SLN metastasis, including patient age, MRI features (lymph node margin, presence or absence of lymph node hilum, and lymph node symmetry), axillary ultrasonography descriptors (presence or absence of cortical thickening) and pathological factors (lympovascular invasion, PR and HER2 status). The nomogram with patient age and the above imaging factors showed good,prediction performance with the area under the ROC as 0.778. Combining with the pathological parameters, the prediction performance of the nomogram model was significantly improved, yielding the area under the ROC of 0.866. Conclusions:The nomogram based on breast MRI and axillary ultrasonography can be applied as a noninvasive quantitative tool to predict the risk of SLN metastasis in early-stage breast cancer, which may facilitate decision-making for axillary treament strategy preoperatively.

BACKGROUND: Small cell lung cancer (SCLC) is characterized by poor differentiation, high malignancy and rapid growth fast, short double time, early and extensive metastatic malignancy. In clinical, chemotherapy is the main treatment method, while resistance to multiple chemotherapy drugs in six to nine months has been a major clinical challenge in SCLC treatment. Therefore, It has important clinical value to building SCLC aninimal model which is similar to patients with SCLC. Animal model of xenotransplantation (PDX) from the patients with small cell lung cancer can well retain the characteristics of primary tumor and is an ideal preclinical animal model. The study is aimed to establish SCLC PDX animal model and induce the chemoresistance model to help to study the mechanism of chemoresistance and individual treatment. METHODS: Fresh surgical excision or puncture specimens from SCLC patients were transplanted into B-NSGTM mice subcutaneous tissues with severe immunodeficiency in one hour after operation the B-NSGTM mice subcutaneous in 1 hour, and inject chemotherapy drugs intraperitoneally after its tumor growed to 400 mm³ with EP which is cisplatin 8 mg/kg eight days and etoposide 5 mg/kg every two days until 8 cycles. Measure the tumor volum and mice weights regularly, then re-engrafted the largest tumor and continue chemotherapy. RESULTS: Nine cases were conducted for B-NSG mice modeling. Three of nine cases could be engrafted to new B-NSG mice at least two generation. The SCLC PDX animal models have been established successfully. After adopting chemotherapy drugs, the chemoresistance PDX models have been established. High homogeneity was found between xenograft tumor and patient's tumor in histopathology, immunohistochemical phenotype (Syn, CD56, Ki67). CONCLUSIONS The SCLC PDX animal model and the chemoresistance PDX animal model have been successfully constructed, the success rate is 33%, which provides a platform for the clinical research, seeking for biological markers and choosing individual treatment methods of SCLC.
Animals ; Antineoplastic Combined Chemotherapy Protocols ; pharmacology ; Cisplatin ; administration & dosage ; Disease Models, Animal ; Drug Resistance, Neoplasm ; Etoposide ; administration & dosage ; Female ; Humans ; Interleukin Receptor Common gamma Subunit ; deficiency ; genetics ; Lung Neoplasms ; drug therapy ; metabolism ; pathology ; Mice, Inbred BALB C ; Mice, Inbred NOD ; Mice, Knockout ; Mice, SCID ; Small Cell Lung Carcinoma ; drug therapy ; metabolism ; pathology ; Transplantation, Heterologous ; methods ; Xenograft Model Antitumor Assays

Objective:To evaluate the efficacy and safety of hypomethylating agents (HMA) in patients with myelodysplastic syndromes (MDS) .Methods:A total of 409 MDS patients from 45 hospitals in Zhejiang province who received at least four consecutive cycles of HMA monotherapy as initial therapy were enrolled to evaluate the efficacy and safety of HMA. Mann-Whitney U or Chi-square tests were used to compare the differences in the clinical data. Logistic regression and Cox regression were used to analyze the factors affecting efficacy and survival. Kaplan-Meier was used for survival analysis. Results:Patients received HMA treatment for a median of 6 cycles (range, 4-25 cycles) . The complete remission (CR) rate was 33.98% and the overall response rate (ORR) was 77.02%. Multivariate analysis revealed that complex karyotype ( P=0.02, OR=0.39, 95% CI 0.18-0.84) was an independent favorable factor for CR rate. TP53 mutation ( P=0.02, OR=0.22, 95% CI 0.06-0.77) was a predictive factor for a higher ORR. The median OS for the HMA-treated patients was 25.67 (95% CI 21.14-30.19) months. HMA response ( P=0.036, HR=0.47, 95% CI 0.23-0.95) was an independent favorable prognostic factor, whereas complex karyotype ( P=0.024, HR=2.14, 95% CI 1.10-4.15) , leukemia transformation ( P<0.001, HR=2.839, 95% CI 1.64-4.92) , and TP53 mutation ( P=0.012, HR=2.19, 95% CI 1.19-4.07) were independent adverse prognostic factors. There was no significant difference in efficacy and survival between the reduced and standard doses of HMA. The CR rate and ORR of MDS patients treated with decitabine and azacitidine were not significantly different. The median OS of patients treated with decitabine was longer compared with that of patients treated with azacitidine (29.53 months vs 20.17 months, P=0.007) . The incidence of bone marrow suppression and pneumonia in the decitabine group was higher compared with that in the azacitidine group. Conclusion:Continuous and regular use of appropriate doses of hypomethylating agents may benefit MDS patients to the greatest extent if it is tolerated.