Objective:Reflux esophagitis (RE) may be negatively correlated with Helicobacter pylori ( H. pylori) infection, but the conclusion and relevant mechanism is still controversial. This study proposed to explore the correlation between RE and H. pylori infection based on natural population. Methods:From July 2013 to December 2014, 3 940 residents aged 40-69 years were recruited in Linqu County of Shandong Province and Hua County of Henan Province by the whole sampling method. All the subjects underwent gastroscopy, and gastric mucosa biopsy specimens were collected for pathological diagnosis and Warthin-Starry (WS) staining to identify H. pylori infection. Venous blood samples of some subjects were collected for H. pylori immunoglobulin G ( H. pylori-IgG) detection. Also, demographic and sociological data were collected. Chi-square test and logistic regression were used to analyze the correlation between RE and H. pylori infection. Results:A total of 359 cases of RE were detected. Excluding RE and other upper gastrointestinal organic diseases, 3 382 cases were considered as controls. Chi-square test showed that WS staining positive rate in RE group was significantly lower than that in control group ( P=0.023), but there was no significant difference in the positive rate of H. pylori-IgG between the two groups ( P=0.281). There were significant differences between RE group and control group in gender composition, age, body mass index (BMI), smoking, alcohol consumption, education level and mucosal active inflammation. Multivariate regression analysis showed that RE was negatively correlated with gastric mucosa active inflammation [ OR=0.754 (95% CI 0.600-0.949), P=0.016], and positively correlated with male [ OR=4.231 (95% CI 3.263-5.486), P<0.001], age ≥60 years, BMI≥24 kg/m 2 [ OR=1.540 (95% CI 1.220-1.945), P<0.001]. Compared to those aged 40-49 years and 50-59 years, the odds ratio ( OR) of RE in these aged ≥60 years were 1.566 (95% CI 1.144-2.143, P=0.005) and 1.405 (95% CI 1.093-1.805, P=0.008). Conclusion:RE is more closely related to H. pylori present infection. Multivariate analysis showed that RE is negatively correlated with active inflammation of gastric mucosa caused by H. pylori infection, and positively correlated with male, overweight and aged ≥60 years.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can cause acute respiratory distress syndrome, hypercoagulability, hypertension, and multiorgan dysfunction. Effective antivirals with safe clinical profile are urgently needed to improve the overall prognosis. In an analysis of a randomly collected cohort of 124 patients with COVID-19, we found that hypercoagulability as indicated by elevated concentrations of D-dimers was associated with disease severity. By virtual screening of a U.S. FDA approved drug library, we identified an anticoagulation agent dipyridamole (DIP) , which suppressed SARS-CoV-2 replication . In a proof-of-concept trial involving 31 patients with COVID-19, DIP supplementation was associated with significantly decreased concentrations of D-dimers ( < 0.05), increased lymphocyte and platelet recovery in the circulation, and markedly improved clinical outcomes in comparison to the control patients. In particular, all 8 of the DIP-treated severely ill patients showed remarkable improvement: 7 patients (87.5%) achieved clinical cure and were discharged from the hospitals while the remaining 1 patient (12.5%) was in clinical remission.

OBJECTIVETo compare the outcomes of adult patients with acute lymphoblastic leukemia (ALL) who underwent autologous hematopoietic stem cell transplantation (auto-HSCT) and allogeneic hematopoietic stem cell transplantation (allo-HSCT).

METHODSFrom Jan 2007 to Dec 2010, 106 adult ALL patients were retrospectively divided into two groups, 50 in auto-HSCT group and 56 in allo-HSCT group. Auto-HSCT group included 21 patients with high-risk, 46 patients in CR1 and 4 cases in CR2. All the 50 patients had negative minimal residual disease (MRD) prior to HSCT. Allo-HSCT group included 44 patients with high risk, 51 patients in CR1 and 5 cases in CR2, 15 patients with positive MRD before allo-HSCT. response, regulatory T cells (Treg), cytokines levels and treatment-related adverse effects were observed.

RESULTSOf the total 106 patients, 29 patients relapsed at a medium follow-up of 22.9(0.8-63.3) months. The 3-year cumulative relapse rate (RR) was (29.9±8.0) % in auto-HSCT group and (32.7±6.8) % in allo-HSCT group. There were no significant differences in RR and overall survival (OS) between auto-HSCT and allo-HSCT groups, even of stratified risk groups. In standard risk group, 3-year OS was (77.1±13.2) % in auto-HSCT group and (90.9±8.7) % in allo-HSCT group (P=0.739). In high-risk group, 3-year OS was (68.7±10.8) % after auto-HSCT and (45.2±8.5) % after allo-HSCT (P=0.094).

CONCLUSIONDue to acceptable RR and OS, adult ALL patients with no MRD before HSCT showed favorable survival. Auto-HSCT may be a considerable choice for adult ALL patients with negative MRD when lacking of donors for allo-HSCT.

Adult ; Allografts ; Hematopoietic Stem Cell Transplantation ; Humans ; Neoplasm, Residual ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Recurrence ; Retrospective Studies ; Transplantation, Homologous

The self-microemulsion formulation of potassium dehydroandrographolidi succinas (PDS) has been optimized and the performance in vitro has been evaluated preliminary. Kinds of prescription accessories were screened by solubility based on the emulsifying result and efficiency, particle size of emulsions. The optimal formulation composition and compatibility proportion were determined by orthogonal design and pseudo-ternary phase diagrams. The appearance, particle size, Zeta potential and stability of this formulation were also investigated. The optimized prescription of PDS was 10% MCT, 40% Tween-20 and 50% glycerol. It can spontaneously form a transparent pale blue opalescent emulsion with emulsification time 31.27 s, particle size 37.1 nm, Zata potential -17.4 mV and good stability.

OBJECTIVEThis article aimed to review the incidence of Helicobacter pylori (H. pylori) infection and its therapy.

DATA SOURCESRelevant articles published in English were identified by searching in PubMed from 2000 to 2013, with keywords "H. pylori". Important references from selected articles were also retrieved from Elsevier, Wiley, EBSCO, and SPRINGER. The Chinese articles published were searched from China National Knowledge Infrastructure (CNKI).

STUDY SELECTIONArticles about "prevalence", "gastric carcinoma", "peptic ulcer", "gastroesophageal reflux disease", "functional dyspepsia", "pathogenic mechanism", "therapy", "eradication rate", "antibiotic resistance", and "gene polymorphisms" were selected.

RESULTSThe decreased infection rates of H. pylori could also be linked to the changed disease spectrum, such as the decreased morbidity and recurrence rate of H. pylori-related peptic ulcer, and the increased morbidity of gastroesophageal reflux. Although different treatment regimens have been used for H. pylori infection, the H. pylori eradication rate declined gradually. Due to primary resistance to antibiotics, the gene polymorphism of host and infected strain, and the therapy regimes, H. pylori eradication became even more difficult.

CONCLUSIONSThe prevalence of H. pylori infection had been decreasing, but the rate of eradication failure has dramatically risen in many countries due to resistance to antibiotic. H. pylori therapy in clinical practice is becoming progressively more difficult.

Drug Resistance, Bacterial ; genetics ; Helicobacter Infections ; drug therapy ; epidemiology ; Helicobacter pylori ; drug effects ; genetics ; pathogenicity ; Humans

BACKGROUNDHelicobacter pylori (Hp) is a common and potentially curable cause of gastric mucosa lesion. This study investigated the relationship of Hp infection with histological changes in gastric mucosa and gastric cancer in Hp-positive patients compared with Hp-eradication patients followed up for ten years.

METHODSFrom an initial group of 1 006 adults, 552 Hp-positive subjects were randomly assigned to a treatment group (T; n = 276) or a placebo group (P; n = 276). In the randomized, double-blind, placebo-controlled, parallel trial, T group subjects received oral doses of omeprazole, amoxicillin and clarithromycin for 1 week; those in the P group received a placebo. One month after treatment ended, a 13C urea breath test was performed, and Hp was undetectable in 88.89% of the T group. All subjects were followed at 1, 5, 8, and 10 years after treatment, with endoscopy and biopsies for histological examination.

RESULTSGastric mucosa inflammation was significantly milder in the T group than that in the P group one year after Hp eradication and this persisted for 10 years. Glandular atrophy and intestinal metaplasia (IM) had deteriorated in both groups during ten years. However, the increased score of glandular atrophy at both the gastric antrum and corpus, and IM only at the gastric antrum, in the P group was more obvious than that in the T group. During the 10 years, 9 patients were diagnosed with gastric cancer (2 in the T group; 7 in the P group; P = 0.176). When mucosal atrophy was absent at the gastric antrum and corpus when entering the study, the incidence of gastric cancer in the P group (n = 6) was much higher than that in the T group (n = 0, P = 0.013).

CONCLUSIONSHp eradication may significantly diminish and help halt progression of gastric mucosal inflammation and delay the development of IM and atrophy gastritis. Hp eradication is helpful for reducing the risk for gastric cancer, especially in the early stage of Hp infection.

Adult ; Aged ; Amoxicillin ; therapeutic use ; Anti-Bacterial Agents ; therapeutic use ; Clarithromycin ; therapeutic use ; Double-Blind Method ; Female ; Follow-Up Studies ; Gastric Mucosa ; drug effects ; pathology ; Gastritis, Atrophic ; diagnosis ; drug therapy ; Helicobacter Infections ; drug therapy ; Helicobacter pylori ; pathogenicity ; Humans ; Male ; Middle Aged ; Omeprazole ; therapeutic use ; Stomach Neoplasms ; diagnosis ; prevention & control

Objective To evaluate the clinical value of OLGA (Operative Link on Gastritis Assessment) system in pathological assessment of gastric mucosa from Chinese patients.Methods Endoscopic and pathological data of patients,who underwent the endoscopic examination of upper gastrointestinal tract from 2007 to 2012,were analyzed.Using the Sydney protocol,we graded atrophy and staged the Helicobacter pylori infection status in gastric biopsies from 108 patients with dyspepsia.We applied the OLGA system to assess the relationship between OLGA staging and grading and dysplasia/cancer,and the relationship between OLGA grading and Helicobacter pylori infection.Results Two cases of early gastric adenocarcinoma were detected at stage Ⅱ and Ⅳ,respectively.The detection rates of precancerous lesions (including intestinal metaplasia and dysplasia) in cases clustered in stages Ⅲ-Ⅳ were significantly higher than those in stages 0-Ⅱ (intestinal metaplasia:100.0％ VS 65.3％,P ＜0.001 ;dysplasia:77.8％ VS 13.9％,P ＜0.001,respectively),and there were significant differences between OLGA staging and the degree of dysplasia (r =0.671,P ＜0.001).In the subjects at stage 0-Ⅱ,we observed only 10 cases (13.9％) of mild dysplasia.The difference in rate of Helicobacter pylori infection was significant at different OLGA grade (P ＜ 0.001),and the correlation between OLGA grading and infection degree of Helicobacter pylori was significant (r =0.586,P ＜ 0.001).Conclusion Precancerous lesions and gastric adenocarcinoma tend to be discovered in patients clustered at high-risk (Ⅲ-Ⅳ) OLGA stages.OLGA staging of dysplasia can effectively differentiate the risks of gastric cancer.The OLGA grading system is consistently associated with the Helicobacter pylori infection.

Objective To evaluate the clinical significance of intercellular space diameters (ISD)of squamous epithelium by light microscopy (LM) in lower esophagus of erosive reflux esophagitis (ERD),non-erosive reflux disease ( NERD), Barrett esophagus (BE) and healthy controls. Methods A total of 21 ERD and 21 NERD patients with reflux symptoms and confirmed with 24-hour esophageal pH monitoring, 13 BE patients diagnosed by gastroscopy and biopsy, and 20 other healthy controls were enrolled in the study.Samples of ERD, NERD and control group were collected at 2 cm above dentate line, and made HE slides in the conventional way. Images for measurement of ICS were acquired with oil lens ( × 1000). ICS of squamous epithelium was quantitatively measured by computer-assisted morphometry. Ten cells were taken for each sample, 10 consecutive ISD for each cell, i.e. 100 ISD for each subject. Mean ISD was calculated.Results Mean ISDs by LM in control, BE, ERD, and NERD groups were 0. 59, 0. 99, 1.29 and 1.06 μm, respectively. The mean ISDs in BE, ERD, and NERD group were much greater than that in control (P＜0. 05). The mean, maximal and minimal ISDs of group ERD were greater than those of NERD and BE (P = 0. 000). However, the ISDs of NERD and BE are of no significant difference ( P ＞ 0. 05 ). The cut-off value of mean ISD for diagnosis of gastro-esophageal reflux disease (GERD) was 0. 85 μm. Diagnostic sensitivity and specificity for ERD, NERD and BE were 89. 1% and 100. 0%, with reference to clinical symptoms, endoscopy and ISDs above the cut-off value. Conclusion Larger ISDs in lower esophagus by using LM will be found in all subgroups of GERD, including ERD, NERD and BE. Increased ISDs may be one of the markers for diagnosis of ERD, NERD and BE.

ObjectiveTo investigate the endoscopic and clinical characteristics of gastrointestinal Behcet's disease (BD). MethodsWe analyzed the clinical and follow-up data of 27 patients with gastrointestinal BD retrospectively.Results Most common locations involved were esophagus and ileocecum,74. 1％ (20/27) and 59. 3％ (16/27), respectively. The most common parenteral symptoms were oral ulcers (85.2％), genital ulcers (25.9％), ophthalmitis (7. 4％ ) and skin damage (7. 4％ ). The most common gastrointestinal symptom was chest pain (48. 1％, 13/27). Ulcer was the basic endoscopic feature,most of which were with uneven bottom and peripheral inflammatory response. There was no difference in endoscopic features between typical BD and atypical BD. Pathology showed typical small vasculitis (44. 4％,12/27). ConclusionClinical manifestations of intestinal BD vary. Symptoms are not necessarily consistent with the involved locations. A small number of patients with BD present with gastrointestinal symptoms as the first and only symptom, with serious complications in some patients. Physicians need to be fully aware of the disease.

Objective To investigate the potential mechanism for symptoms related to epigastric discomfort in patients without Helicobacter pylori (H.pylori) infection.Methods Patients who underwent gastric endoscopy and conformed H.pylori negative by histologic examination were enrolled.Among them,232 adult patients were collected between August 2006 and November 2006 and 31 children were collected between September 2005 and August 2009.All patients showed no apparent abnormality by endoscopic examination.The endoscopic biopsy was examined with HE or Warthin-Starry staining.Results In adult group,arteriole obstruction was found in 16 (8.8%) cases and focal haemorrhage in 82 (45.6%) cases.Both were existed in 82 (45.6%) cases.The histopathologic findings showed that arteriole obstruction in transition zone (65.2 %,P = 0.159) was common,whereas the focal haemorrhage in gastric fundus and corpus (65.6%,P=0.001) was in predominance.The symptom of heartburn was less in patients with arteriole obstruction and/or focal haemorrhage in comparison with those without these changes (x2 =8.564,P=0.003).In adolescent group,arteriole obstruction and/or focal haemorrhage accounted for 96.8% (30/31).Conclusion Gastric mucosa ischemic resulted from arteriole obstruction are commonly seen in both adult and adolescent patients,which is an important reason for epigastric discomfort in H.pylori negative patients.