Objective:To evaluate the effectiveness of empiric eradication therapy recommendations and medication principles for refractory infections based on the 2022 Helicobacter pylori ( H. pylori) infection treatment guidelines in China in clinical practice. Methods:A retrospective analysis was conducted to evaluate the eradication efficacy of H. pylori and the safety and treatment compliance among of 637 patients with refractory H. pylori infection in our center over the past 10 years. Risk factors affecting efficacy of H. pylori eradication were evaluated. Results:The overall eradication rate, incidence of adverse reactions and medication percentage of 14-day bismuth quadruple therapy were 92.3%, 40.3% and 92.2%, respectively. The eradication rate, incidence of adverse reactions, and proportion of administered treatments were as follows: 87.3%, 36.4% and 92.7% for amoxicillin+metronidazole; 91.1%, 39.2% and 93.7% for amoxicillin+tetracycline; 92.9%, 23.8% and 94.0% for amoxicillin+furazolidone; 92.1%, 47.1% and 90.0% for tetracycline+metronidazole; 94.5%, 41.7% and 92.0% for tetracycline+furazolidone, and 91.3%, 46.3% and 92.5% for furazolidone+metronidazole. Poor compliance was a risk factor for the failure of eradication therapy (94.7% vs. 64.0%, P<0.05). There was no statistically significant difference ( P>0.05) in the eradication rate among patients in terms of sex, age, body mass index, smoking status, alcohol consumption, previous eradication frequency, eradication interval, or eradication regimens. Conclusion:The empirical treatment regimens and medication principles recommended in the 2022 H. pylori infection treatment guidelines in China achieve good eradication efficacy, safety, and compliance.

Objective To evaluate the effect of Helicobacter pylori(H.pylori)infection on colorectal adenoma(CRA)recurrence after polypectomy and to study other potential prognosis factors associated with CRA recurrence.Methods This single-centered retrospective cohort study included 808 patients with CRA who underwent colonoscopy,polypectomy,and gastroscopy between January 2005 and October 2022.The patients were classified into three groups based on H.pylori infection status:persistently negative(group A,n=626),initially positive but turned negative(group B,n=141),and persistently positive(group C,n=41).The CRA recurrence and high-risk CRA or colorectal cancer(CRC)occurrence were assessed,and potential prognosis factors for recurrence were analyzed.Results During a median follow-up period of 1.6(1.1,2.4)years,the recurrence rate was 56.4%(456/808),including 124 cases(15.3%)of high-risk CRA/CRC[of which 5 cases(0.6%)were CRC]and 332 cases(41.1%)of low-risk CRA.The recurrence rates in the three groups were 55.4%(347/626),60.3%(85/141),and 58.5%(24/41),respectively,with no statistically significant difference(log-rank χ2=0.525,P=0.769).The high-risk CRA/CRC recurrence rates in the three groups were 14.9%(93/626),17.7%(25/141),and 14.6%(6/41),respectively,showing no significant intergroup differences(log-rank χ2=0.340,P=0.844).Multivariate analysis identified increasing age(HR=1.011,95%CI:1.002-1.021,P=0.020)and baseline high-risk CRA(HR=1.428,95%CI:1.183-1.724,P<0.001)as independent prognosis factors for CRA recurrence.Conclusions This study did not find a significant correlation between H.pylori infection and CRA recurrence after polypectomy.Increasing age and baseline high-risk CRA are prognosis factors for CRA recurrence.

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 To evaluate the effect of Helicobacter pylori(H.pylori)infection on colorectal adenoma(CRA)recurrence after polypectomy and to study other potential prognosis factors associated with CRA recurrence.Methods This single-centered retrospective cohort study included 808 patients with CRA who underwent colonoscopy,polypectomy,and gastroscopy between January 2005 and October 2022.The patients were classified into three groups based on H.pylori infection status:persistently negative(group A,n=626),initially positive but turned negative(group B,n=141),and persistently positive(group C,n=41).The CRA recurrence and high-risk CRA or colorectal cancer(CRC)occurrence were assessed,and potential prognosis factors for recurrence were analyzed.Results During a median follow-up period of 1.6(1.1,2.4)years,the recurrence rate was 56.4%(456/808),including 124 cases(15.3%)of high-risk CRA/CRC[of which 5 cases(0.6%)were CRC]and 332 cases(41.1%)of low-risk CRA.The recurrence rates in the three groups were 55.4%(347/626),60.3%(85/141),and 58.5%(24/41),respectively,with no statistically significant difference(log-rank χ2=0.525,P=0.769).The high-risk CRA/CRC recurrence rates in the three groups were 14.9%(93/626),17.7%(25/141),and 14.6%(6/41),respectively,showing no significant intergroup differences(log-rank χ2=0.340,P=0.844).Multivariate analysis identified increasing age(HR=1.011,95%CI:1.002-1.021,P=0.020)and baseline high-risk CRA(HR=1.428,95%CI:1.183-1.724,P<0.001)as independent prognosis factors for CRA recurrence.Conclusions This study did not find a significant correlation between H.pylori infection and CRA recurrence after polypectomy.Increasing age and baseline high-risk CRA are prognosis factors for CRA recurrence.

Objective:To evaluate the effectiveness of empiric eradication therapy recommendations and medication principles for refractory infections based on the 2022 Helicobacter pylori ( H. pylori) infection treatment guidelines in China in clinical practice. Methods:A retrospective analysis was conducted to evaluate the eradication efficacy of H. pylori and the safety and treatment compliance among of 637 patients with refractory H. pylori infection in our center over the past 10 years. Risk factors affecting efficacy of H. pylori eradication were evaluated. Results:The overall eradication rate, incidence of adverse reactions and medication percentage of 14-day bismuth quadruple therapy were 92.3%, 40.3% and 92.2%, respectively. The eradication rate, incidence of adverse reactions, and proportion of administered treatments were as follows: 87.3%, 36.4% and 92.7% for amoxicillin+metronidazole; 91.1%, 39.2% and 93.7% for amoxicillin+tetracycline; 92.9%, 23.8% and 94.0% for amoxicillin+furazolidone; 92.1%, 47.1% and 90.0% for tetracycline+metronidazole; 94.5%, 41.7% and 92.0% for tetracycline+furazolidone, and 91.3%, 46.3% and 92.5% for furazolidone+metronidazole. Poor compliance was a risk factor for the failure of eradication therapy (94.7% vs. 64.0%, P<0.05). There was no statistically significant difference ( P>0.05) in the eradication rate among patients in terms of sex, age, body mass index, smoking status, alcohol consumption, previous eradication frequency, eradication interval, or eradication regimens. Conclusion:The empirical treatment regimens and medication principles recommended in the 2022 H. pylori infection treatment guidelines in China achieve good eradication efficacy, safety, and compliance.

Lactobacilli are important colonizing bacteria in female reproductive tract， among which Lactobacillus crispatus is closely associated with reproductive tract health and plays a crucial role in maintaining the vaginal microbiota balance. A decrease in the abundance of Lactobacillus crispatus may be correlated with various female reproductive tract diseases， such as bacterial vaginosis and vulvovaginal candidiasis， and it can even lead to adverse pregnancy outcomes such as infertility and embryo arrest. This article provides an overview of the basic characteristics of Lactobacillus crispatus， relationship between the decrease of its quantity and reproductive tract diseases， its ability to inhibit pathogenic bacteria such as Candida albicans and Chlamydia trachomatis， and the anti-inflammatory effects of Lactobacillus crispatus. The aim is to provide references for the use of Lactobacillus crispatus in vaginal therapeutics.

BACKGROUND: Given the general unavailability, common adverse effects, and complicated administration of tetracycline, the clinical application of classic bismuth quadruple therapy (BQT) is greatly limited. Whether minocycline can replace tetracycline for Helicobacter pylori ( H . pylori ) eradication is unknown. We aimed to compare the eradication rate, safety, and compliance between minocycline- and tetracycline-containing BQT as first-line regimens. METHODS: This randomized controlled trial was conducted on 434 naïve patients with H . pylori infection. The participants were randomly assigned to 14-day minocycline-containing BQT group (bismuth potassium citrate 110 mg q.i.d., esomeprazole 20 mg b.i.d., metronidazole 400 mg q.i.d., and minocycline 100 mg b.i.d.) and tetracycline-containing BQT group (bismuth potassium citrate/esomeprazole/metronidazole with doses same as above and tetracycline 500 mg q.i.d.). Safety and compliance were assessed within 3 days after eradication. Urea breath test was performed at 4-8 weeks after eradication to evaluate outcome. We used a noninferiority test to compare the eradication rates of the two groups. The intergroup differences were evaluated using Pearson chi-squared or Fisher's exact test for categorical variables and Student's t -test for continuous variables. RESULTS: As for the eradication rates of minocycline- and tetracycline-containing BQT, the results of both intention-to-treat (ITT) and per-protocol (PP) analyses showed that the difference rate of lower limit of 95% confidence interval (CI) was >-10.0% (ITT analysis: 181/217 [83.4%] vs . 180/217 [82.9%], with a rate difference of 0.5% [-6.9% to 7.9%]; PP analysis: 177/193 [91.7%] vs . 176/191 [92.1%], with a rate difference of -0.4% [-5.6% to 6.4%]). Except for dizziness more common (35/215 [16.3%] vs . 13/214 [6.1%], P = 0.001) in minocycline-containing therapy groups, the incidences of adverse events (75/215 [34.9%] vs . 88/214 [41.1%]) and compliance (195/215 [90.7%] vs . 192/214 [89.7%]) were similar between the two groups. CONCLUSION: The eradication efficacy of minocycline-containing BQT was noninferior to tetracycline-containing BQT as first-line regimen for H . pylori eradication with similar safety and compliance. TRIAL REGISTRATION ClinicalTrials.gov, ChiCTR 1900023646.
Humans ; Bismuth/therapeutic use* ; Metronidazole/therapeutic use* ; Esomeprazole/pharmacology* ; Minocycline/pharmacology* ; Helicobacter pylori ; Potassium Citrate/therapeutic use* ; Anti-Bacterial Agents ; Tetracycline/adverse effects* ; Helicobacter Infections/drug therapy* ; Drug Therapy, Combination ; Amoxicillin

Background::Helicobacter pylori ( H. pylori) infection is an infectious disease with a prevalence rate of up to 50% worldwide. It can cause indigestion, gastritis, peptic ulcer, and gastric cancer. H. pylori eradication treatment can effectively control disease progression and reduce the risk of the above conditions. However, the escalating trend of antibiotic resistance presents a global challenge for H. pylori eradication. We aim to provide guidance on pharmacological treatment of H. pylori infection. Methods::This clinical practice guideline is developed following the World Health Organization’s recommended process, adopting Grading of Recommendations Assessment, Development and Evaluation in assessing evidence quality, and utilizing Evidence to Decision framework to formulate clinical recommendations, minimizing bias and increasing transparency of the clinical practice guideline development process. We used the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement and The Appraisal of Guidelines for Research and Evaluation II (AGREE II) as reporting and conduct guides to ensure the guideline’s completeness and transparency.Results::Though decreasing in developed countries, the prevalence of H. pylori remains high in developing countries, causing a major public health burden. This clinical practice guideline contains 12 recommendations concerning pharmacological treatment for H. pylori eradication. Among them, it is worth highlighting that bismuth preparations are inexpensive, safe, and effective, consequently making bismuth quadruple therapy a preferred choice for initial and rescue treatment. In empirical treatment, high-dose dual therapy is equally effective compared with bismuth quadruple therapy. Conclusions::The 12 recommendations in this clinical practice guideline are formed with consideration for stakeholders’ values and preferences, resource use, feasibility, and acceptability. Recommendations are generalizable to resource limited settings with similar antibiotic resistance pattern as China, and lower middle-income countries facing comparable sociological and technical challenges.Registration::Guidelines International Network (GIN) website, https://guidelines.ebmportal.com/node/69996.

Objective:To analyze the impact of previous exposure to macrolide, quinolones and nitroimidazole antibiotics on eradication rate of bismuth quadruple therapy (BQT) in newly diagnosed patients with Helicobacter pylori( H. pylori). Methods:A total of 469 patients with H. pylori initially treated at the Third Hospital of Peking University from September 2017 to August 2020 were retrospectively recruited. The therapeutic regimens were BQT containing clarithromycin/levofloxacin/metronidazole recommended by Chinese guidelines. Clinical data were collected, including general demographic data, exposure history of antibiotics, CYP2C16 metabolic pattern, endoscopic diagnosis, bacterial density, H.pylori resistance, eradication results, etc. Univariate analysis, Chi-square test, Fisher exact probability test, Kruskal-Wallis H test and Logistic regression model were used as statistical methods. Results:Among different eradication therapies, univariate and multivariate analyses suggested that previous exposure to macrolides ( OR=3.37,95 %CI 1.04-10.98, P<0.05) was relevant to the decreased eradication rate of BQT containing clarithromycin. This may be due to increased resistance to clarithromycin ( OR=6.12,95 %CI 3.99-9.40, P<0.01).The previous exposure to quinolones ( OR=3.65, 95 %CI 1.27-10.49, P<0.05) was relevant to the decreased eradication rate of BQT containing levofloxacin, which was probably explained by the increased resistance to levofloxacin ( OR=2.50, 95 %CI 1.69-3.71, P<0.01). But the previous history of nitroimidazole did not impact the efficacy of BQT containing metronidazole. Conclusions:In patients newly diagnosed with H.pylori infection, the previous exposure to macrolide or quinolones antibiotics is related to lower eradiation rates of H. pylori. Although the exposure to nitroimidazole also indicates drug resistance to metronidazole, the clinical efficacy of BQT with metronidazole 400 mg four times a day is not affected.

0bjective To evaluate the changes in blood oxygen saturation and pulse rate of the nurses under abrupt highland advancing and provide the fundamentals for those nurses under abrupt highland advancing to Tibet. Methods We selected 12 nursing staffs abruptly advanced to Lhasa at an altitude of 3 650 meters for Abrupt Advancing Group then chose 12 nursing staffs over there for Highland Group from November 2017 to December 2017. To assess whether there is a difference about the change of blood oxygen saturation and pulse rate between these two groups, we measured them in 24 nurses and 360 shifts before work and at 0.5, 1.0, 3.0, 6.0 h after work. Then, we compared the changes in blood oxygen saturation and pulse rate between different ages, sexes, shifts. Results No significant difference in blood oxygen saturation was observed between the two groups before starting work (P > 0.05). Blood oxygen saturation of Abrupt Advancing Group (0.5, 1.0, 3.0, 6.0 h) after work was respectively 0.91±0.01, 0.91±0.02, 0.91±0.02, 0.91±0.01. Meanwhile, the parameters of Highland Group was separately 0.94± 0.02, 0.93 ± 0.01, 0.94 ± 0.01, 0.94 ± 0.01. There was a significant difference between the two groups (t=5.153-8.151, P<0.05 or 0.01). Before work, the pulse rate was (85.38±2.38), (91.62±2.79),(89.79±2.05), (89.12±2.29), (89.72±2.31) times/min for Abruptly Advancing Group, (93.52±2.64), (93.52±2.82), (94.52± 2.73), (94.52±2.56), (93.52±2.96) times/min for Highland Group. The difference between the two groups was statistically significant (t=3.875-10.182, P<0.01). Besides, no difference about the changes in blood oxygen saturation of Abruptly Advancing Group between different shifts was observed (t=3.561-8.321, P<0.05 or 0.01). The difference of pulse rate in Abruptly Advancing Group was statistically significant (t=1.529-4.968, P<0.05 or 0.01). There was no significant difference of blood oxygen saturation and pulse rate in Abruptly Advancing Group between the age of 21 to 30 and 31 to 40 years old, whether before or after work (P > 0.05). A positive difference between the sexes could be found about the changes in the blood oxygen saturation of Abruptly Advancing Group at 0.5, 1.0, 3.0 and 6.0 h after work. What′s more, there was a significant difference in pulse rates before and after work (t=3.283-6.719, P<0.05 or 0.01). Conclusions The nursing staff in the Abruptly Advancing Group shows decreased blood oxygen saturation and increased pulse rate compared to those in the Highland Group during working period. In addition, the changes show more significant in those working at night, but they adapted gradually. Gender and working time have a significant effect on the change in blood oxygen saturation and increased pulse rate of the nursing staff.