Background:With the widespread use of vonoprazan-based dual therapy for Helicobacter pylori(Hp)eradication,a comparative analysis of its efficacy and safety against bismuth-containing quadruple therapy is warranted.Aims:To compare the efficacy and safety of vonoprazan and amoxicillin-based 14-day dual therapy and 10-day bismuth-containing quadruple therapy for eradication of Hp infection.Methods:This study is a single-center,prospective,randomized,controlled,open-label,non-inferiority trial.Patients with chronic gastritis,diagnosed with Hp infection and scheduled for eradication therapy at Yuancheng District People's Hospital between December 2023 and December 2025 are planned to enroll in this study and randomly assigned into two groups.Patients in the control group received bismuth-containing quadruple therapy(vonoprazan 20 mg+bismuth potassium citrate 220 mg+amoxicillin 1.0 g+furazolidone 0.1 g,all twice daily)for 10 days,and those in the treatment group received dual therapy(vonoprazan 20 mg twice daily+amoxicillin 1.0 g three times daily)for 14 days.Both groups were supplemented with compound lactobacillus capsule.Adverse events were recorded during the treatment period.Hp eradication was assessed by 13C-or 14C-urea breath test at least four weeks after the completion of therapy.Results:As of the interim analysis,a total of 160 patients have been enrolled in the study,with 80 in each group.The per-protocol(PP)Hp eradication rates were 93.6%(95%CI:85.6%-97.9%)for the treatment group and 94.7%(95%CI:86.8%-98.5%)for the control group,with an intergroup difference of-1.147%(95%CI:-8.5%-6.1%).While in intention-to-treat(ITT)analysis,the Hp eradication rates were 91.2%(95%CI:82.9%-96.4%)for the treatment group and 90.0%(95%CI:81.2%-95.6%)for the control group,with an intergroup difference of 1.25%(95%CI:-7.8%-10.4%).Non-inferiority was confirmed for both PP and ITT analyses(P=0.012,P=0.021).No significant difference in symptoms relieve was observed between the two groups(92.1%vs.91.0%,P=0.81).The incidence of adverse events was significantly lower in the treatment group(7.7%vs.18.4%,P=0.043).The symptoms were mild and required no intervention.Conclusions:The 14-day vonoprazan-amoxicillin dual therapy is non-inferior to 10-day bismuth-containing quadruple therapy in Hp eradication rate with fewer adverse events,making it a preferred option for family-based management and primary care settings for Hp eradication.

Background:With the widespread use of vonoprazan-based dual therapy for Helicobacter pylori(Hp)eradication,a comparative analysis of its efficacy and safety against bismuth-containing quadruple therapy is warranted.Aims:To compare the efficacy and safety of vonoprazan and amoxicillin-based 14-day dual therapy and 10-day bismuth-containing quadruple therapy for eradication of Hp infection.Methods:This study is a single-center,prospective,randomized,controlled,open-label,non-inferiority trial.Patients with chronic gastritis,diagnosed with Hp infection and scheduled for eradication therapy at Yuancheng District People's Hospital between December 2023 and December 2025 are planned to enroll in this study and randomly assigned into two groups.Patients in the control group received bismuth-containing quadruple therapy(vonoprazan 20 mg+bismuth potassium citrate 220 mg+amoxicillin 1.0 g+furazolidone 0.1 g,all twice daily)for 10 days,and those in the treatment group received dual therapy(vonoprazan 20 mg twice daily+amoxicillin 1.0 g three times daily)for 14 days.Both groups were supplemented with compound lactobacillus capsule.Adverse events were recorded during the treatment period.Hp eradication was assessed by 13C-or 14C-urea breath test at least four weeks after the completion of therapy.Results:As of the interim analysis,a total of 160 patients have been enrolled in the study,with 80 in each group.The per-protocol(PP)Hp eradication rates were 93.6%(95%CI:85.6%-97.9%)for the treatment group and 94.7%(95%CI:86.8%-98.5%)for the control group,with an intergroup difference of-1.147%(95%CI:-8.5%-6.1%).While in intention-to-treat(ITT)analysis,the Hp eradication rates were 91.2%(95%CI:82.9%-96.4%)for the treatment group and 90.0%(95%CI:81.2%-95.6%)for the control group,with an intergroup difference of 1.25%(95%CI:-7.8%-10.4%).Non-inferiority was confirmed for both PP and ITT analyses(P=0.012,P=0.021).No significant difference in symptoms relieve was observed between the two groups(92.1%vs.91.0%,P=0.81).The incidence of adverse events was significantly lower in the treatment group(7.7%vs.18.4%,P=0.043).The symptoms were mild and required no intervention.Conclusions:The 14-day vonoprazan-amoxicillin dual therapy is non-inferior to 10-day bismuth-containing quadruple therapy in Hp eradication rate with fewer adverse events,making it a preferred option for family-based management and primary care settings for Hp eradication.

Objective To observe the value of AcoStream thrombus aspiration catheter for treating intermediate-high risk acute pulmonary embolism(APE).Methods Twenty-six patients with intermediate-high risk APE who underwent treatment with AcoStream thrombus aspiration catheter were retrospectively collected.The immediate technical success rate,procedure success rate and thrombus clearance rate of target vessels were recorded,as well as clinical success rate and complications in perioperative period and the recurrence of pulmonary embolism(PE)during follow-up.Results Among 26 patients with intermediate-high risk APE,the immediate technical success rate was 100%(26/26),the procedure success rate was 92.31%(24/26),and the immediate thrombus clearance rate of target vessels was 63.37%as median,including 16 cases(16/26,61.54%)achieved thrombus clearance rate grade Ⅱ or above.The perioperative period clinical success rate of treating intermediate-high risk APE was 96.15%(25/26).Two patients experienced transient arrhythmia and other 2 patients experienced worsening transient chest tightness during the procedure,and 1 case developed hematoma at the puncture site after treatment.During follow-up,no recurrence of symptomatic PE was observed.Conclusion AcoStream thrombus aspiration catheter was safe and effective for treating intermediate-high risk APE,worthy clinical promotion and application.

Objective To observe the value of AcoStream thrombus aspiration catheter for treating intermediate-high risk acute pulmonary embolism(APE).Methods Twenty-six patients with intermediate-high risk APE who underwent treatment with AcoStream thrombus aspiration catheter were retrospectively collected.The immediate technical success rate,procedure success rate and thrombus clearance rate of target vessels were recorded,as well as clinical success rate and complications in perioperative period and the recurrence of pulmonary embolism(PE)during follow-up.Results Among 26 patients with intermediate-high risk APE,the immediate technical success rate was 100%(26/26),the procedure success rate was 92.31%(24/26),and the immediate thrombus clearance rate of target vessels was 63.37%as median,including 16 cases(16/26,61.54%)achieved thrombus clearance rate grade Ⅱ or above.The perioperative period clinical success rate of treating intermediate-high risk APE was 96.15%(25/26).Two patients experienced transient arrhythmia and other 2 patients experienced worsening transient chest tightness during the procedure,and 1 case developed hematoma at the puncture site after treatment.During follow-up,no recurrence of symptomatic PE was observed.Conclusion AcoStream thrombus aspiration catheter was safe and effective for treating intermediate-high risk APE,worthy clinical promotion and application.

Objective:To examine the expression of OUT domain deubiquitinase with linear linkage specificity(OTULIN)in gastric cancer tissues and explore the impact of OTULIN silencing on the proliferation of gastric cancer MKN45 and AGS cells as well as its underlying mechanisms. Methods:Immunohistochemical staining was performed to detect the expression level of OTULIN in 73 gastric cancer tissues and 24 normal gastric mucosa.The association between OTULIN expression and the prognosis as well as the clinicopathological features of gastric cancer patients was analyzed.The above results were validated using public data from The Cancer Genome Atlas(TCGA)database and Gene Expression Omnibus(GEO)database.CRISPR/Cas9 gene editing technology was used to construct OTULIN-knockout gastric cancer cells MKN45 and AGS.The efficiency of gene knockout was validated by Western blotting.The effects of OTULIN knockout on the proliferation of gastric cancer cells MKN45 and AGS were assessed by CCK-8 assay and soft agar colony formation assay.Immunoprecipitation-mass spectrometry technique was exploited to identify potential protein substrates interacting with OTULIN and linear ubiquitin molecule INT-Ub.7KR.The changes in the activity of rate-limiting enzymes for glycolysis were measured using pyruvate kinase(PK)activity assay kit and lactate production was analyzed by lactate colorimetric/fluorometric assay kit in OTULIN-depleted cells.The effect of OTULIN on substrate linear ubiquitination was evaluated using co-immunoprecipitation and Western blotting. Results:The expression level of OTULIN in gastric cancer tissues was higher than that in normal gastric mucosa(P=0.004 1)as revealed by immunohistochemical analysis.Patients with higher OTULIN expression in the cancer tissues had a lower suvival time(P=0.007 7).Analysis of datasets from TCGA and GEO databases also confirmed that OTULIN was highly expressed in gastric tissues(P＜0.05)and high OTULIN expression was associated with poor prognosis(P=0.011).Statistical analysis also showed that higher expression of OTULIN was correlated with later TNM stages(P=0.027 3)and was an independent indicator for shorter survival time of gastric cancer patients(P=0.04).Knockout of OTULIN significantly inhibited the proliferation(P＜0.000 1),decreased the activity of PK(P＜0.01)and reduced lactate production(P＜0.01)of gastric cancer cells.OTULIN interacted with several key enzymes in the glycolysis pathway and downregulated the linear ubiquitination levels of these enzymes,including pyruvate kinase M1(PKM1),PKM2,lactate dehydrogenase A(LDHA)and LDHB. Conclusion:OTULIN is a novel biomarker for predicting the prognosis of gastric cancer patients.It activates the glycolytic pathway and promote the progression of gastric cancer possibly by downregulating the linear ubiquitination modification of rate-limiting enzymes in glycolysis.

Objective:To investigate the effect of long-term low dose ionizing radiation on the levels of interleukin (IL) and TGF-β1 in the population in high background radiation area(HBRA).Methods:Appropriate amount of peripheral blood was drawn from 41 and 44 healthy men aged 45-65 years who were randomly selected from Tangkou town of Yangjiang city (HBRA) and Hengpo town of Enping city (control area, CA), respectively. After centrifugation and stratification, the upper plasma of blood was separated to determine IL-2, sIL-2R, IL-4, IL-5 and TGF-β1 by using ELISA. The difference of plasma IL of the residents in those two regions was analyzed. The influence of region, age, smoking, drinking and income on the indexes of ILs and TGF-β1 was evaluated by Covariance analysis.Results:The concentration of IL-2 at HBRA area was slightly higher than those in the control area, but the other indexes were lower than those in CA residents. The differences of IL-5 ( t=7.124, P<0.001) and TGF-β1 ( t=4.900, P<0.001) between two areas were significant statistically. Covariance analysis showed that smoking had a significant effect on IL-2 level ( F=5.283, P<0.05). Conclusions:Under the influence of long-term low-dose ionizing radiation, all kinds of plasma interleukin levels of residents in HBRA were different with that in CA. The immune balance was biased towards Th1 type cytokines, and the immune function in HBRA was slightly stronger than that in CA, suggesting that long-term chronic low-dose ionizing radiation may induce adaptive changes in the immune function, which needs further study.

Objective: To summarize the status of immediate breast reconstruction (IBR) after mastectomy in Beijing City, Tianjin City and Hebei Province. Methods: A retrospective analysis was made on the data of 382 cases with breast cancer who were treated and followed up successfully with immediate breast reconstruction after mastectomy from January 2012 to December 2016 in Beijing City, Tianjin City and Hebei Province. Clinic data of the followed-up 382 cases (all female, age (38.5±4.2) years (range: 24 to 70 years)), including general information, tumor information, sugery methods, and treatments after surgery were collected. The survival status, metastasis,complications and prognosis were followed up. Cosmetic effcet was evalated by Harris method, and life quality by Functional Assessment of Cancer Therapy-Breast scale (FACT-B). χ² test was used to compare the difference between year 2012 and year 2013 to 2016. Bonferroni method was used to correct the inspection level, which was 0.05/10=0.005. The trend of IBR rate (ratio of IBR to modified radical mastectomy) from 2013 to 2016 was analyzed by trend χ² test. Results: There was 46 cases in stage 0, 152 cases in stage Ⅰ, 165 cases in stage Ⅱ, 19 cases in stage Ⅲ. Twenty-five cases was treated by neoadjuvant chemotherapy, 231 by chemotherapy and 35 by radiotherapy. The proportion of implant reconstruction was 48.7% (186/382), more than expanded of 21.5% (82/382), with latissimus dorsi of 12.0% (46/382), TRAM of 8.9% (34/382), DIEP of 2.1% (8/382), and latissimus plus implant of 6.8% (26/382). According to the Harris standard, the excellent and good rate of the cosmetic effect of the reconstructed breast was 93.7%. The score of FACT-B was 108.20±16.9 (range: 67 to 144) 1 year postoperatively. Compared with 2012, the IBR rate was significant increased, till 2015, the IBR rate was 153/10 000 cases (χ²=47.028, P=0.000). Conclusions There is a significant increase on IBR rate in Beijing City, Tianjin City and Hebei province by year. Most of cases received IBR is stage Ⅰ to Ⅱ. Implant reconstruction is the main reconstructive method. Postoperative cosmetic effects and quality of life are both meet patients′ demon.

Objective To evaluate the feasibility of the combination of amplification refractory mutation system (ARMS) and quantitative real-time polymerase chain reaction (PCR) method in fast detection of clarithromycin resistance of Helicobacter pylori (H.pylori) in gastric mucosa.Methods A total of 150 gastric mucosal specimens with positive H.pylori culture were collected from the H.pylori positive patients who failed in H.pylori eradication from January to August in 2013.The drug resistant gene mutation types of H.pylori in these samples were detected by quantitative real-time PCR based on ARMS.And the accuracy was confirmed by sequencing.The clarithromycin resistance of H.pylori was determined by E-assay.Chi-square test was used for statistical analysis.Results Among 149 gastric mucosal specimens (one specimens without wild type or mutation type had been eliminated),the results of quantitative real-time PCR based on ARMS of two samples were not consistent with the results of sequencing;the consistent rate was 98.7％ (147/149).Among 149 specimens with positive H.pylori culture,104 samples (69.8％) were clarithromycin resistance.In 101 samples the clarithromycin resistance was detected by quantitative real-time PCR based on ARMS;the consistent rate was 97.1％ (101/104).Both E-assay and clarithromycin resistant rate detected by E-assay or quantitative real-time PCR based on ARMS was 69.8％ (104/149) and 67.8％ (101/149),respectively,and the difference was not significant (x2 =0.141,P=0.932).Conclusion The combination of ARMS and quantitative real-time PCR method in fast detection of clarithromycin resistance of H.pylori in gastric mucosa is strongly feasible and highly consistent has high consistent rate with sequencing and E-assay.

ObjectiveTo evaluate the diagnostic value of multi-slice CT (MSCT) and multi-dimensional reconstructions for congenital pulmonary stenosis (PS) in children.MethodsThe enhanced thin CT images of 33 patients with PS were retrospectively analyzed,the data was transmitted to the workstation for multi-planar reformation ( MPR),volume rendering technique (VRT) and maximum intensity projection (MIP).The CT imaging features of PS were analyzed combining with operation resul ts and Ultrasonic Cardiogram (UCG).ResultsIn 33 cases of PS,there were 17 cases with pulmonary valve stenosis (PVS),10 cases with right ventricular infundibulum stenosis (RVIS),and 6 cases with pulmonary trunk stenosis (PTS).The first two were correctly diagnosed by UCG,5 cases of PVS and Icases of RVIS were correctly diagnosed by MSCTA,the later was correctly diagnosed by UCG and MSCTA.In 14 cases with collateral circulations between aorta and pulmonary artery ( APC ),all were correctly diagnosed by MSCTA,only 3 case was diagnosed by UCG,1 case was misdiagnosed as PDA.UCG can clearly demonstrate the others intra-cardiac deformities,such as ASD,VSD,RVH,PFO,SV,DORV,TECD and TBD,the accuracy rate of MSCTA was 39.4％,and MSCTA can clearly demonstrate the origin,course and diameter of extracardiac vascular abnormalities,such as PDA,RAA,TGA,TAPVD,CoA,PLSV and VLSA,the accuracy rate of UCG was 697％.ConclusionsMSCT and multi-dimensional reconstruction were a kind of non-invasive method,it was a good approach for extra-cardiac vascular malformations and APC in PS.Combining with UCG,it can further be used to improve the diagnostic accuracy of intra-cardiac malformation and supply diagnostic evidence for clinical treatment.