Helicobacter pylori(Hp)is a common Gram-negative bacillus causing gastrointestinal infec-tions.It mainly exists on the surface of gastric epithelial cells and in mucus and is associated with gastric ulcers,gastric cancer,and gastric mucosa-associated lymphomas.Studies have shown that Hp can induce or exacerbate certain extragastric diseases and is associated with the occurrence of coronavirus disease 2019.It is hypothesized that Hp may be indirectly or directly involved in the occurrence and development of diseases by stimulating the production of inflammatory cytokines or inducing cross-immune reactions.In addition,Hp can enter Candida to release toxins continuously and play a role in escaping the recognition of the host immune system and the bacteri-cidal effect of drugs.This article reviews the research progress in Hp-associated extragastric diseases in recent years,aiming to draw the attention of clinical workers to Hp-associated extragastric diseases and enrich the knowledge about Hp infection for formulating countermeasures to avoid the aggravation or triggering of other disea-ses by Hp.

Objective To experimentally validate the effects of a self-developed heat-stable thickening agent on the textual characteristics of enteral nutrition solutions of standard concentration and its applicability in improving dysphagia.Methods A gradient of different doses of the self-developed thickening agent(1.0 g,1.5 g,2.0 g,2.5 g,and 3.0 g)and three commonly used commercial thickeners were mixed with 23.391 g of a complete nutrition formula powder dissolved in 85 mL of purified water to prepare 100 mL standard concentration nutrition solutions.The textual parameters(cohesiveness,viscosity,thickness,and hardness)of these nutrition solutions were measured using a texture analyzer at various temperature gradients(20℃,40℃,60℃,and 80℃)to compare their thermal stability.A dysphagia rat model was created via epiglottectomy to explore the effects of the thickener on lung tissue damage scores and levels of inflammatory markers.The rats were divided into a test intervention group,a positive control group,a negative control group,and a blank control group(no surgery and normal feeding after fasting for one day),with 15 rats in each group.After fasting for one day post-surgery,the test intervention group was fed with the standard concentration nutrition solution thickened with the self-developed thickener,while the positive control group was given a standard concentration nutrition solution thickened with product 3,and the negative control group was fed a normal diet.All groups were fed for two weeks with food dyed with food-grade green dye.General conditions,body mass,and food intake were observed and recorded.After two weeks,abdominal aorta blood was collected,and heart,liver,spleen,lung,and kidney tissues were harvested and weighed to calculate the lung tissue organ coefficient.The organ conditions were evaluated using routine H&E staining,and lung damage was semi-quantitatively analyzed based on the Mikawa scoring criteria.Blood supernatants were collected to measure the total serum protein and albumin levels to determine the nutritional status of the rats.The expression of IL-6 and TNF-α genes in lung tissues was measured by RT-qPCR.IL-6 and TNF-α protein expression levels in lung tissues,lung tissue homogenate,and serum were measured by ELISA.The aspiration incidence rate was calculated.Results Within the dosage range of 1.0 g to 3.0 g,the self-developed thickener in the test samples exhibited superior thermal stability in cohesiveness compared to the three commercially available thickeners,with a statistically significant difference(P<0.01).The differences in the thermal stability of viscosity and hardness between the self-developed thickener and the three commercially available thickeners were not statistically significant.The viscosity stability was optimal for the self-developed thickener,followed by the commercially available thickeners 1 and 3,with thickeners 2 being the least stable,though the differences were not statistically significant(P>0.05).Product 1 showed the best thermal stability in thickness,followed by the self-developed thickener and product 2,while the product 3 exhibited the worst performance,with the difference being statistically significant(P<0.01).The self-developed thickener had the best thermal stability in hardness at temperatures ranging from 20℃to 80℃,followed by products 1 and 2,with product 3 being the least stable.However,the differences were not statistically significant(P>0.05).Animal experiment results indicated that the body weight gain in the positive control group and the test intervention group was lower than that in the blank and negative control groups(P<0.01).The spleen coefficient of the intervention group was lower than that of the positive control group and the blank control group(P<0.01),while the heart,liver,and kidney coefficients were lower than those of the blank control group(P<0.01).The differences in the lung coefficient of the intervention group and those of the other three groups were no statistically significant.Levels of TP and ALB in the test intervention group,the positive control group,and the negative control group were all lower than those in the blank control group,with statistically significant differences(P<0.01).ELISA results showed that serum IL-6 levels in the blank and test intervention groups were lower than those in the negative and positive control groups(P<0.05),while the difference in the other indicators across the four groups were not statistically significant(P>0.05).There were no statistically significant differences among the four groups in terms of lung tissue damage pathology scores,or in the levels of IL-6 and TNF-α gene expression in lung tissues.The aspiration incidence rate was 0% in all groups.Conclusion The self-developed enteral nutrition thickening agent demonstrated excellent thermal stability and swallowing safety.Further research to explore its application in patients with dysphagia is warranted.

Reasonable intra-hospital hierarchical diagnosis and treatment system will effectively guide the patients to see a doctor on demand and improve the efficiency of medical services. Beijing Tongren Hospital, Capital Medical University, has explored the intra-hospital hierarchical diagnosis and treatment system depending on different situatioins such as for new patients, subsequent visit patient, and the same patients with different clinical stage. Through establishing a series of intra-hospital hierarchical diagnosis and treatment modes, such as the well-known expert team, the outpatient service for specialized diseases, the multidisciplinary outpatient service for complex diseases, the nursing service, and the pharmaceutical care service, the outpatients could be oriented by specialties and disciplines and graded by the complexity in diagnosis and treatment of diseases. Relying on the appointment methods such as referral and revisit to open up the information channel, it can optimize the time cost and economic cost of patients, reflect the functional positioning of the tertiary hospitals, and improve patients′ sense of medical access and happiness.