Objective:To compare the eradication rate and incidence of adverse reactions between cefuroxime-containing and amoxicillin-containing bismuth quadruple regimen in the treatment of Helicobacter pylori ( H. pylori), and to evaluate the efficacy and safety of cefuroxime in the H. pylori infection patients with positive penicillin skin test results. Methods:From December 2020 to December 2021, a total of 498 patients who received initial H. pylori eradication treatment at the H. pylori Specialized Outpatient Clinic of the First Affiliated Hospital of Soochow University were selected to participate in this prospective cohort study. According to the history of penicillin allergy or positive penicillin skin test results, the patients were divided into amoxicillin group and cefuroxime group. A total of 394 patients were included in the amoxicillin group, and the treatment regimen was esomeprazole 20 mg, bismuth 220 mg, amoxicillin 1 g and clarithromycin 500 mg orally twice a day. A total of 104 patients were included in the cefuroxime group, and the treatment regimen was esomeprazole 20 mg, bismuth 220 mg, cefuroxime 500 mg and clarithromycin 500 mg orally twice a day. The treatment period was 14 days. 13C-urea breath test was conducted during 4 to 8 weeks after the treatment. The eradication rates of the 2 groups were compared by intention-to-treat (ITT) analysis and per-protocol (PP) analysis. The incidence of adverse reactions was compared between the 2 groups. Chi-square test was used for statistical analysis. Results:The results of ITT analysis and PP analysis indicated that the eradication rates of amoxicillin group were 84.3% (332/394, 95% confidence interval (95% CI) 80.6% to 87.6%) and 90.5% (332/367, 95% CI 87.2% to 93.3%), respectively, and the eradication rates of cefuroxime group were 62.5% (65/104, 95% CI 52.7% to 71.7%) and 69.1% (65/94, 95% CI 58.8% to 78.7%), respectively. The eradication rates of amoxicillin group in ITT and PP analysis were both higher than those of cefuroxime group, and the differences were statistically significant ( χ2=24.11 and 28.44, both P<0.001). The incidence of adverse reactions of amoxicillin group and cefuroxime group was 10.9% (43/394) and 14.4% (15/104), respectively, and there was no significant difference ( P>0.05). Conclusion:Cefuroxime and clarithromycin containing bismuth quadruplex regimen failed to achieve a satisfactory eradication rate in patients with H. pylori infection and penicillin allergy.

Enzyme-driven micro/nanomotors consuming in situ chemical fuels have attracted lots of attention for biomedical applications. However, motor systems composed by organism-derived organics that maximize the therapeutic efficacy of enzymatic products remain challenging. Herein, swimming proteomotors based on biocompatible urease and human serum albumin are constructed for enhanced antitumor therapy via active motion and ammonia amplification. By decomposing urea into carbon dioxide and ammonia, the designed proteomotors are endowed with self-propulsive capability, which leads to improved internalization and enhanced penetration in vitro. As a glutamine synthetase inhibitor, the loaded l-methionine sulfoximine further prevents the conversion of toxic ammonia into non-toxic glutamine in both tumor and stromal cells, resulting in local ammonia amplification. After intravesical instillation, the proteomotors achieve longer bladder retention and thus significantly inhibit the growth of orthotopic bladder tumor in vivo without adverse effects. We envision that the as-developed swimming proteomotors with amplification of the product toxicity may be a potential platform for active cancer treatment.

Colonoscopy with polypectomy significantly reduces the incidence of colorectal cancer and cancer - related mortality. However, a pooled miss rate of 22% for polyps was documented. Aims: To explore the clinical application value of an artificial intelligence (AI)-based colorectal polyp diagnostic system for polyp detection. Methods: A total of 400 patients who underwent colonoscopy in the First Affiliated Hospital of Soochow University from September to November 2021 were selected according to the inclusion and exclusion criteria and were randomly divided into two groups: one group received routine colonoscopy, and the other group received AI system assisted colonoscopy. There were 200 cases in each group. The Boston Bowel Preparation Scale (BBPS) was used to evaluate bowel preparation quality. The primary outcome was polyp detection rate (PDR), and the secondary outcome was polyps per colonoscopy (PPC). Results: AI system significantly increased PDR and PPC (37.0% vs. 23.0%, 0.775 vs. 0.495, all P<0.05), especially for diminutive and small polyps (diminutive polyps: 23.0% vs. 13.0%, 0.410 vs. 0.295; small polyps: 16.0% vs. 8.0%, 0.255 vs. 0.095; all P<0.05). No significant difference in large polyp detection was observed between the two groups (all P>0.05). The bowel preparation quality was classified as“poor”(BBPS 0-5 points),“qualified”(BBPS 6-7 points) and“excellent”(BBPS 8-9 points). There were no significant differences in polyp detection between the two groups when the bowel preparation quality was“poor”or “excellent”(all P>0.05). PDR and PPC were significantly increased in AI group when the bowel preparation quality was “qualified”(33.0% vs. 20.0%, 0.670 vs. 0.450, all P<0.05). Conclusions: AI-based colorectal polyp diagnostic system can significantly improve PDR and PPC because of the significant increase in the number of diminutive and small polyps detected. In addition, when the bowel preparation is qualified, the AI system can play better for polyp detection.

Background: Helicobacter pylori (Hp) is closely associated with peptic ulcer, gastric cancer and other gastrointestinal diseases. Eradication therapy is the main approach to prevent and treat Hp-associated diseases, and patient management is crucial for improving the efficacy of eradication therapy. Aims: To explore the effect of whole-course management on medication adherence and reexamination rate of Hp eradication therapy. Methods: Patients who received Hp eradication therapy in the Hp Specialist Clinic of the First Affiliated Hospital of Soochow University from June 2020 to November 2020 were recruited consecutively. One hundred and twelve patients who received eradication therapy between June 2020 and August 2020 were served as the control group, and 112 patients who received eradication therapy between September 2020 and November 2020 were served as the observation group. Patients in control group were informed only the medication method and reexamination time, while patients in observation group were given the whole-course management composed of informing medication method and reexamination time plus following up online by WeChat and reminding the reexamination by WeChat and by phone. Patients in both groups received a 14-day bismuth quadruple therapy, and were told to undergo

Background: Gastric cancer is one of the common gastrointestinal malignancies. Early diagnosis can reduce the mortality rate significantly. In the Chinese consensus published in 2017, the New Gastric Cancer Screening Scoring System was recommended to be used for risk stratification of gastric cancer. Aims: To preliminarily explore the value of the New Gastric Cancer Screening Scoring System in early gastric cancer screening in asymptomatic community population. Methods: At several communities in Suzhou City Xiangcheng District, a questionnaire survey was conducted in asymptomatic community residents willing to accept voluntary serum tests to collect information on high risk factors of gastric cancer. Serum pepsinogen (PG), PGⅡ, gastrin 17 (G-17) and Helicobacter pylori (Hp) IgG were tested simultaneously. Risk stratification of gastric cancer was carried out in accordance with the New Gastric Cancer Screening Scoring System. Gastroscopy was recommended for moderate to high risk individuals. Results: A total of 540 asymptomatic individuals completed the study, of which 11 were categorized as high risk (2.0%), 168 as moderate risk (31.1%), and 361 as low risk (66.9%). Sixty-four moderate to high risk individuals completed the gastroscopy with a response rate of 35.8%. Four precancerous lesions were detected (6.2%), including 3 gastric low-grade intraepithelial neoplasia and 1 duodenal adenoma. No gastric cancer was detected. Conclusions: The New Gastric Cancer Screening Scoring System is useful for risk stratification of gastric cancer in asymptomatic population and may provide a basis for further endoscopic examination. However, the value of this scoring system in low risk areas of gastric cancer needs to be further verified.

Objective To evaluate the effectiveness and safety of transarterial ehemoembolization(TACE) combined with radiofrequency ablation(RFA) and surgical resection(SR) in the treatment of early stage hepatocellular carcinoma(HCC).Methods PubMed,Medline,Embase,China biomedical database,Wanfang database,CQVIP database and Chinese Journal Full-text database were retrieved by computer.Prospective or retrospective studies of TACE combined with RFA and SR for treating early HCC published from January 2000 to March 2016 were collected.Results Four randomized or non-randomized concurrent controlled trials were included,involving 697 patients.The 1-year and 3-year overall survival(OS) rates in the TACE-RFA group were[94.40％(337/357) and 59.94％(214/357),which in the SR group were 92.35％(314/340) and 68.24％ (232/340),the difference between the two groups was not statistically significant(OR=1.43,95％CI:0.79-2.60,P=0.24,I2 =0％;OR=0.77,95％CI:0.56-1.07,P=0.12,I2 =45％).The 1-year relapse-free survival(RFS) rate of the TACE-RFA group and the SR group was similar [81.5％(291/357) vs.80.3％(273/340),OR=1.07,95％CI:0.73-1.57,P=0.74,I2=0％],while the 3-year RFSrate of the TACE-RFA group was obviously lower than that of the SR group(29.97％ vs.44.41％,OR=0.56,95％CI:0.40-0.77,P=0.000 5,I2 =0％).The incidence rate of severe complications in the TACE-RFA group was evidently lower than that in the SR group(1.43％ vs.5.07％,OR=0.23,95％CI:0.10-0.54,P=0.000 7,I2 =10％).Conclusion Compared with TACE-RFA,SR can significantly reduce the long term recurrence rate of early stage HCC,but the occurrence rate of severe complications in SR is higher than that in TACE-RFA.

Objective To investigate the protective effects of irbesartan against cardiac inflammation associated with diabetes and obesity in the db/db mouse model of type 2 diabetes and explore the underlying mechanisms. Methods Twenty- four 10-week-old diabetic db/db mice were equally randomized into irbesartan treatment (50 mg/kg per day) group and model group, using 12 nondiabetic littermates (db/+) as the controls, The mice were treated with irbesartan or saline vehicle for 16 consecutive weeks, after which the heart pathology was observed and the heart weight, body weight, and serum levels of fasting blood glucose (FBG), total cholesterol(TC), and triglycerides(TG) were measured. The expression of nuclear factor-kappaB (NF-κB) p65 in the myocardium was assessed with immunohistochemistry, the protein levels of P-IкBα ,IкBαandβ-actin were analyzed with Western blotting, and the pro-inflammatory cytokines IL-6 and TNF-αmRNA were detected using quantitative real-time PCR (qPCR). Results Compared with db/+mice, the saline-treated db/db mice developed obesity, hyperglycemia and hyperlipidemia (P<0.01). Histopathological examination of the heart tissue revealed inflammatory cell infiltration, increased myocardial interstitium and disorders of myocardial fiber arrangement. The diabetic mice showed increased P-IкBα and decreased IκBα protein levels, enhanced activity and expression of NF-κB in the hearts, and increased mRNA expression of IL-6 and TNF-αin the myocardium. These abnormalities were all associated with increased inflammatory response. Treatment with irbesartan improved the heart architecture and attenuated high glucose-induced inflammation in the diabetic mice. Conclusion Treatment with irbesartan attenuates cardiac inflammation in type 2 diabetic db/db mice, and this effect was probably associated with the suppression of cardiac angiotensin Ⅱ and NF-κB signaling pathway.

Objective To investigate the protective effects of irbesartan against cardiac inflammation associated with diabetes and obesity in the db/db mouse model of type 2 diabetes and explore the underlying mechanisms. Methods Twenty- four 10-week-old diabetic db/db mice were equally randomized into irbesartan treatment (50 mg/kg per day) group and model group, using 12 nondiabetic littermates (db/+) as the controls, The mice were treated with irbesartan or saline vehicle for 16 consecutive weeks, after which the heart pathology was observed and the heart weight, body weight, and serum levels of fasting blood glucose (FBG), total cholesterol(TC), and triglycerides(TG) were measured. The expression of nuclear factor-kappaB (NF-κB) p65 in the myocardium was assessed with immunohistochemistry, the protein levels of P-IкBα ,IкBαandβ-actin were analyzed with Western blotting, and the pro-inflammatory cytokines IL-6 and TNF-αmRNA were detected using quantitative real-time PCR (qPCR). Results Compared with db/+mice, the saline-treated db/db mice developed obesity, hyperglycemia and hyperlipidemia (P<0.01). Histopathological examination of the heart tissue revealed inflammatory cell infiltration, increased myocardial interstitium and disorders of myocardial fiber arrangement. The diabetic mice showed increased P-IкBα and decreased IκBα protein levels, enhanced activity and expression of NF-κB in the hearts, and increased mRNA expression of IL-6 and TNF-αin the myocardium. These abnormalities were all associated with increased inflammatory response. Treatment with irbesartan improved the heart architecture and attenuated high glucose-induced inflammation in the diabetic mice. Conclusion Treatment with irbesartan attenuates cardiac inflammation in type 2 diabetic db/db mice, and this effect was probably associated with the suppression of cardiac angiotensin Ⅱ and NF-κB signaling pathway.

Objective To explore the effect of the family-centered prenatal maternal health education on delivery modes and breastfeeding.Methods Two hundred and thirty pregnant women who accepted prenatal maternal health education were divided into the observation group and the control group according to whether their families involved in the prenatal education.There were 108 cases in the observation group and 122 in the control group.The observation group was given prenatal health education involving the pregnant women and their caregivers or their husbands.The control group was given prenatal health education according to the previously-designed course without presence of their families.The two groups were compared in delivery mode,extent of pain during production and breast feeding.Results The rates of vaginal delivery and the breast feeding at discharge in the observation group were higher than the control group(P<0.05 for both).The rate of breast swelling in 72 hours was significantly lower than the control group(P<0.01). Conclusion Family-centered prenatal maternmal health education is good for the natural birth rate,improvement of breastfeeding rate and reduction the breast swelling.

Objective To compare imaging quality and radiation dose on DR and dual-sided reading of CR system.Methods The TRG of ALVIM statistics phantom was exposed by DR and dual-sided reading of CR with the same radiation dose,then the exposure factor and the entrance surface dose (ESD) were recorded.After that,the phantom was exposed by dual-sided reading of CR with various mAs ( 3.2,4.0,4.3,4.8 and 5.2 mAs) and the same kV,and the ESD was recorded,too.The acquired images were read by three radiologists on the monitor of diagnosis work station with the same window width and window level,then the total points of the images were given with the method of a five-level confidence scale.ROC curves were drawn and probability Pdet was calculated.Then the data was analyzed statistically by analysis of variance (ANOVA).Results The ROC analysis of bone substitute with diameter from 0.5 to 1.0 mm and muscle substitute with diameter from 0.9 to 2.0 mm showed A (z) values of 0.742 to 0.923 and 0.635 to 0.900 for DR system when the radiation dose was 137.5 μGy.The ROC analysis of bone substitute and muscle substitute showed A(z) values of 0.526 to 0.586 and 0.473 to 0.560 for dual-sided reading of CR at the same radiation dose.The probability Pdet discrepancy of bone substitute in two systems was from 0.216 to 0.337,with the highest of 0.337 in the diameter of 1.0 mm.The probability Pdet discrepancy by muscle substitute in two systems was from 0.075 to 0.342,with the highest of 0.342 in the diameter of 2.0 mm.There was significant statistical difference between the two groups ( F =35.30,P ＜ 0.01 ).When the exposure factor of dual-sided reading of CR system was 75 kV,4.8 mAs,the ESD was 180.4 μ Gy,the ROC analysis in the bone substitute with diameter from 0.5 to 1.0 mm and muscle substitute with diameter from 0.9 to 2.0 mm showed A(z) values was the same.The probability Pdet discrepancy of bone substitute in two systems was from - 0.003 to 0.009.The probability Pdet discrepancy of muscle substitute in two systems was from -0.005 to 0.008,and there was no statistical difference between the two groups ( F =5.23,P ＞0.05).When the probability Pdet of two systems was the same,the ESD was 180.4 μGy by dual-sided reading of CR system,and the ESD was 137.5 μGy by DR system.Conclusion Detection with DR system was proved to be superior to dual-sided reading of CR system at the same radiation dose.When the image quality was similar,the radiation dose of DR system was less than the dual-sided reading of CR system.