BACKGROUND: Owing to the high prevalence of antibiotic resistance in Helicobacter pylori ( H. pylori ) in China, bismuth-containing quadruple therapies have been recommended for H. pylori eradication. This study compared the efficacy and safety of quadruple regimens containing vonoprazan vs . esomeprazole for H. pylori eradication in a patient population in China. METHODS: This was a phase 3, multicenter, randomized, double-blind study. Patients with confirmed H. pylori infection were randomized 1:1 to receive quadruple therapy for 14 days: amoxicillin 1000 mg and clarithromycin 500 mg after meals, bismuth potassium citrate 600 mg before meals, plus either vonoprazan 20 mg or esomeprazole 20 mg before meals, all twice daily. The primary outcome was the eradication rate of H. pylori , evaluated using a 13 C urea breath test at 4 weeks after treatment. The non-inferiority margin was at 10%. RESULTS: The study included 510 patients, 506 of whom completed the follow-up assessment. The primary analysis revealed eradication rates of 86.8% (210/242) and 86.7% (208/240) for vonoprazan and esomeprazole therapy, respectively (treatment difference: 0.1%; 95% confidence interval [CI]: -5.95, 6.17; non-inferiority P  = 0.0009). Per-protocol analysis showed eradication rates of 87.4% for vonoprazan and 86.3% for esomeprazole (treatment difference: 1.2%; 95% CI: -5.03, 7.36; non-inferiority P  = 0.0004). Vonoprazan and esomeprazole were well tolerated, with similar safety profiles. CONCLUSION: Vonoprazan was found to be well-tolerated and non-inferior to esomeprazole for eradicating H. pylori in patients from China. TRIAL REGISTRATION ClinicalTrials.gov , NCT04198363.
Humans ; Esomeprazole/therapeutic use* ; Double-Blind Method ; Helicobacter Infections/drug therapy* ; Male ; Female ; Middle Aged ; Helicobacter pylori/pathogenicity* ; Pyrroles/therapeutic use* ; Sulfonamides/therapeutic use* ; Adult ; Clarithromycin/therapeutic use* ; Amoxicillin/therapeutic use* ; Aged ; Anti-Bacterial Agents/therapeutic use* ; Pyrrolidines/therapeutic use* ; Drug Therapy, Combination ; Proton Pump Inhibitors/therapeutic use*

Objective The study aimed to explore the mechanism of Mume Fructus and Rosa multiflora in the treatment of recurrent oral ulceration(ROU)through network pharmacology and animal experiments.Methods The chemical components of Mume Fructus and Rosa multiflora were filtrated by OB and DL,which were respectively searched from TCMSP and references.The targets were predicted by TCMSP and Swiss Target Prediction.The targets of ROU were searched from OMIM and GeneCards database.Cystoscape 3.2.1 software was used to construct the"components-targets"network and analysis gene ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway with Clue GO.The protein-protein interaction(PPI)network analysis was carried out on the common targets by String database and Cystoscape 3.2.1 software.Moreover,after constructing the rat model of ROU,the pathological changes of oral mucosa of rats were observed by HE staining,and the effects of Mume Fructus and Rosa multiflora on inflammatory factors and key targets were detected by ELISA and Western blot.Results 33 active ingredients were selected for treating ROU,among which quercetin,ursolic acid,β-sitosterol,stigmasterol,palmitic acid,apioline and kaempferol were the core components.Key targets such as STAT3,PIK3R1,PIK3CA,STAT1,JAK2 and IL-6 were screened.GO functional enrichment and KEGG enrichment analysis showed that the core targets mainly affected the process of response to organic substance,cellular response to chemical stimulus and cellular response to organic substance,involving NF-κB,JAK-STAT,IL-17 and other signaling pathways.Experimental results in rats showed that Mume Fructus and Rosa multiflora could significantly improve the pathological status of ulcer mucosal tissue,reduce the expression of IL-1β,IL-6,TNF-α and IFN-γ,and reduce the expression of JAK2 and STAT1 in oral mucosa.Conclusion The anti-ROU effect of Mume Fructus and Rosa multiflora may be achieved by regulating the JAK2-STAT1 signaling pathway,reducing the levels of IL-1β,IL-6,TNF-α and IFN-γ inflammatory factors.

Objective The study aimed to explore the mechanism of Mume Fructus and Rosa multiflora in the treatment of recurrent oral ulceration(ROU)through network pharmacology and animal experiments.Methods The chemical components of Mume Fructus and Rosa multiflora were filtrated by OB and DL,which were respectively searched from TCMSP and references.The targets were predicted by TCMSP and Swiss Target Prediction.The targets of ROU were searched from OMIM and GeneCards database.Cystoscape 3.2.1 software was used to construct the"components-targets"network and analysis gene ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway with Clue GO.The protein-protein interaction(PPI)network analysis was carried out on the common targets by String database and Cystoscape 3.2.1 software.Moreover,after constructing the rat model of ROU,the pathological changes of oral mucosa of rats were observed by HE staining,and the effects of Mume Fructus and Rosa multiflora on inflammatory factors and key targets were detected by ELISA and Western blot.Results 33 active ingredients were selected for treating ROU,among which quercetin,ursolic acid,β-sitosterol,stigmasterol,palmitic acid,apioline and kaempferol were the core components.Key targets such as STAT3,PIK3R1,PIK3CA,STAT1,JAK2 and IL-6 were screened.GO functional enrichment and KEGG enrichment analysis showed that the core targets mainly affected the process of response to organic substance,cellular response to chemical stimulus and cellular response to organic substance,involving NF-κB,JAK-STAT,IL-17 and other signaling pathways.Experimental results in rats showed that Mume Fructus and Rosa multiflora could significantly improve the pathological status of ulcer mucosal tissue,reduce the expression of IL-1β,IL-6,TNF-α and IFN-γ,and reduce the expression of JAK2 and STAT1 in oral mucosa.Conclusion The anti-ROU effect of Mume Fructus and Rosa multiflora may be achieved by regulating the JAK2-STAT1 signaling pathway,reducing the levels of IL-1β,IL-6,TNF-α and IFN-γ inflammatory factors.

Objective To observe the effect of esketamine on intraoperative analgesic management of burn patients.Methods A prospective randomized controlled study was conducted in which 104 patients with scab grafting under general anesthesia in the Fourth Medical Center of the PLA General Hospital from December 2023 to September 2024 were selected as the study subjects.The patients were divided into esketamine group and sufentanil group according to random number table method,with 52 cases in each group.Basic data,laboratory examination indicators,perioperative circulation of patients[including mean arterial pressure(MAP),heart rate(HR)],perioperative anxiety and pain scales[including self-rating anxiety scale(SAS),visual analog scale for anxiety(VAS-A),visual analog scale for pain(VAS-P),numerical rating scale(NRS),and the occurrence of postoperative adverse reactions.Results After excluding 6 patients who withdrew and 3 who required changes in anesthesia,95 patients completed the study(47 in the esketamine group and 48 in the sufentanil group).Compared with sufentanil group,patients in the two groups had stable intraoperative circulation,esketamine group had higher MAP at 2 minutes after anesthesia intubation(T3),at intraoperative skin removal(T4),at intraoperative skin grafting(T5),and at exit room(T6),HR was faster at T3-T5(P<0.05),and the time from surgery to extubation was extended[minutes:7.0(5.0,11.0)vs.5.0(3.8,8.3),P<0.05],the first exhaust time was significantly shortened[hours:3.8(1.5,7.3)vs.6.2(3.4,10.5),P<0.05],the proportion of increased secretion during recovery period was significantly higher[36.2%(17/47)vs.16.7%(8/48),P<0.05],and the VAS-P score at rest 24 hours after surgery[0.0(0.0,1.0)vs.0.5(0.0,1.0),P<0.05]and VAS-P score during exercise[1.5(1.0,2.0)vs.2.0(1.0,3.0),P<0.05]were significantly lower.There were no significant differences in anesthesia drug consumption and postoperative adverse reactions between the two groups.Conclusion Esketamine is safe and feasible for intraoperative analgesia management of burn patients,and it is a potential drug for perioperative frugal opioid anesthesia management.

Objective To observe the effect of esketamine on intraoperative analgesic management of burn patients.Methods A prospective randomized controlled study was conducted in which 104 patients with scab grafting under general anesthesia in the Fourth Medical Center of the PLA General Hospital from December 2023 to September 2024 were selected as the study subjects.The patients were divided into esketamine group and sufentanil group according to random number table method,with 52 cases in each group.Basic data,laboratory examination indicators,perioperative circulation of patients[including mean arterial pressure(MAP),heart rate(HR)],perioperative anxiety and pain scales[including self-rating anxiety scale(SAS),visual analog scale for anxiety(VAS-A),visual analog scale for pain(VAS-P),numerical rating scale(NRS),and the occurrence of postoperative adverse reactions.Results After excluding 6 patients who withdrew and 3 who required changes in anesthesia,95 patients completed the study(47 in the esketamine group and 48 in the sufentanil group).Compared with sufentanil group,patients in the two groups had stable intraoperative circulation,esketamine group had higher MAP at 2 minutes after anesthesia intubation(T3),at intraoperative skin removal(T4),at intraoperative skin grafting(T5),and at exit room(T6),HR was faster at T3-T5(P<0.05),and the time from surgery to extubation was extended[minutes:7.0(5.0,11.0)vs.5.0(3.8,8.3),P<0.05],the first exhaust time was significantly shortened[hours:3.8(1.5,7.3)vs.6.2(3.4,10.5),P<0.05],the proportion of increased secretion during recovery period was significantly higher[36.2%(17/47)vs.16.7%(8/48),P<0.05],and the VAS-P score at rest 24 hours after surgery[0.0(0.0,1.0)vs.0.5(0.0,1.0),P<0.05]and VAS-P score during exercise[1.5(1.0,2.0)vs.2.0(1.0,3.0),P<0.05]were significantly lower.There were no significant differences in anesthesia drug consumption and postoperative adverse reactions between the two groups.Conclusion Esketamine is safe and feasible for intraoperative analgesia management of burn patients,and it is a potential drug for perioperative frugal opioid anesthesia management.

OBJECTIVE: To evaluate the value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for assessing disease activity in patients with rheumatoid arthritis (RA) treated with tofacitinib. METHODS: This retrospective study was conducted among 98 RA patients in active stage treated with tofacitinib in Third Xiangya Hospital and 100 healthy control subjects from the Health Management Center of the hospital from 2019 to 2021. We collected blood samples from all the participants for measurement of erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and other blood parameters 1 month before and 6 months after tofacitinib treatment. We further evaluated PLR and NLR before and after tofacitinib treatment in the RA patients, and analyzed their correlations with RA disease activity. RESULTS: PLR and NLR increased significantly in RA patients as compared with the healthy controls. In the RA patients, PLR and NLR were positively correlated with the levels of hs- CRP, ESR, IL- 6, Disease Activity Score of 28 joints-ESR (DAS28-ESR), anti-cyclic citrullinated peptide (CCP), and rheumatoid factor (RF) before and after tofacitinib treatment. Tofacitinib treatment for 6 months significantly decreased hs-CRP, ESR, IL-6, CCP, RF and DAS28-ESR levels in the RA patients. CONCLUSION NLR and PLR can be useful biomarkers for assessing disease activity in RA patients treated with tofacitinib.
Humans ; Neutrophils ; Retrospective Studies ; C-Reactive Protein/analysis* ; Interleukin-6/metabolism* ; Arthritis, Rheumatoid ; Lymphocytes

Extensive burns can cause nonnegligible acute and chronic damage to central nervous system of patients. The damage of central nervous system may have a profound impact on patients, including neurobehavioral changes such as post-traumatic stress disorder, depression, anxiety, and sleep disorder. These changes may persist after injury, greatly affecting patients' integration into society and return to work. This paper systematically reviewed the clinical manifestations, pathogenesis, and current intervention methods of mental disorders in patients with extensive burns, aiming to provide a basis for further understanding, prevention, and treatment of patients with mental disorders after burns.

Objective:To review and summarize the main problems that have occurred in the history of manned spaceflight worldwide and the experience of the medical rescue support for astronauts at the main landing site since the first manned spaceflight mission of the Shenzhou-5 in China in 2003, focus on the technical status and return characteristics during the construction of the space station since the Shenzhou-12, and formulate a targeted injury treatment plan to ensure the safety of astronauts.Methods:This article summarized the lessons of accidental injuries of astronauts in foreign aerospace history, especially in the space station stage, combined with the experience of medical support of astronauts in manned spaceflight in China, and put forward a series of organizations, plans and treatments according to the mission characteristics of long-term orbits and adjustments of the main landing sites of space station mission spacecraft.Results:On the basis of the original pre-cabin emergency and helicopter ICU comprehensive rescue platform, the emergency procedures were further optimized, and the treatment plans under different complex terrains and the principles of rapid treatment and evacuation of astronauts were formulated.Conclusions:The effective treatment of astronauts returning from the space station in various situations could be ensured by the comprehensive rescue plan for the medical rescue of the space station mission and the construction and organization of the helicopter rescue platform.

Objective:This study aims to analyze the characteristics and basic principles of emergency surgery risks and anesthesia care of medical support at the landing site for China’s taikonauts of the Shenzhou-12, and to summarize China’s experience in medical support at the landing site for manned spaceflight, and ensure supports in special environments such as an emergency return of manned spaceflight.Methods:This study was carried out through literature research on relevant reports on the emergency surgery risks and aids of domestic and foreign astronauts at the landing sites, and summaries of the experience in medical support for taikonauts of spacecrafts from Shenzhou-5 to Shenzhou-11 at the landing sites. At the same time, according to the characteristics of Shenzhou-12 such as the long on-orbit time, the adjustment in the landing area, the optimization of the mission mode, and new search and rescue power, a series of organization, pre-arranged planning, equipment allocation, and effective anesthesia treatment plan were proposed and inspected in practice.Results:Based on the original anesthesia care plan of medical support, the first-aid carrier was adjusted and modified, the first-aid procedure was optimized, a new generation of supraglottic airway opening tool, video laryngoscope, portable ultrasound, and other devices were added, and the anesthesia care plan at the landing site for manned spaceflight was formulated to provide strong support for the medical care of taikonauts that had stayed in the outer space for a long time.Conclusions:Upon the targeted improvement and process optimization, the anesthesia care plan of medical support for taikonauts of Shenzhen-12 in the landing area fully meets the anesthesia requirement of medical support in special environments such as the emergency return of the taikonauts that have stayed in the outer space for a long time under the new orbital altitude.

Objective:To investigate the application of case-based learning (CBL) combined with evidence-based learning (EBL) teaching in clinical teaching of oncology.Methods:Totally 57 resident doctors were divided into experimental group and control group. The experimental group received CBL and EBL teaching, and the control one received lecture-based learning (LBL) teaching. The teaching effect was evaluated by examination and questionnaire, and the data were analyzed by SPSS 20.0.Results:The examination scores of the experimental group and the control group were (85.393±7.213) and (81.276±8.035), and the ones of case analysis were (34.393±2.485) and (32.379±3.005) respectively. Meanwhile, questionnaire survey showed that the evaluations of experimental group were significantly better than those of the control one in promoting learning interest and initiative, retrieval ability, self-learning ability, clinical thinking and learning efficiency ( P<0.05). Conclusion:The teaching effect of integration of CBL and EBL is better than LBL.