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.

Humans ; Esophageal Squamous Cell Carcinoma ; Esophageal Neoplasms/pathology* ; Carcinoma, Squamous Cell ; Microbiota

Objective:To establish and evaluate a rapid nucleic acid detection method for SARS-CoV-2 based on COYOTE ? Flash20 real-time fluorescent quantitative PCR instrument. Methods:A rapid reaction system was constructed by using specific primer and probe sets targeting ORF1ab and N gene of SARS-CoV-2, and the sensitivity and specificity of the system were verified. At the same time, 108 clinical samples of COVID-19 were used to evaluate the application of this method.Results:The detection method did not require nucleic acid extraction, and the manual operation time was only one minute. After the sample was sent to the system, the test could be completed in 30 minutes. The detection limit of this method was 4×10 2 copies/ml. It had no cross-reactivity with other human coronaviruses (including HCoV-229E, HCoV-NL63, HCoV-OC43, HCoV-HKU1, SARS-CoV and MERS-CoV) and other respiratory viruses. The evaluation of clinical sample application showed that the total coincidence rate with the conventional RT-qPCR which required nucleic acid extraction was 98.15%. Conclusions:Through the application evaluation of the rapid fluorescent quantitative PCR method of SARS-CoV-2, it was found that the method was simple, fast, specific and sensitive, and it was suitable for real-time and rapid detection needs in varieties of situations.

Objective To explore the feasibility of electrocardiogram (ECG)-gated coronary artery calcium scoring (CACS) CT scan for attenuation correction of 9gTcm-methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging (MPI) based on a hybrid SPECT/CT scanner.Methods From January 2017 to October 2017,a total of 110 subjects (61 males,49 females;age:(68.4±9.4) years) underwent ECG-gated MPI,ECG-gated CACS CT scan and conventional non-gated cardiac CT scan.The gated and non-gated CT scans were used for attenuation correction of MPI separately,then the relative percentage of radioactive distribution of left ventricular (LV) walls (anterior,lateral,inferior,septal and apex) based on different correction methods were compared,and the influences of CACS CT scan and conventional CT scan on visual assessment for myocardial ischemia were also compared.Paired t test and Kappa test were used to analyze the data.Results The relative radioactive distribution percentages of all LV walls in CACS CT corrected MPI and those in conventional CT corrected MPI were not statistically significant (t values:from-0.782 to 0.456,all P＞0.05).The weighted Kappa values of LV anterior,lateral,inferior,septal and apex from 2 types of corrected images between 2 physicians were 0.864 (95％ CI:0.749-0.979),0.795 (95％ CI:0.717-0.874),0.494(95％ CI:0.076-0.912),0.724(95％ CI:0.321-1.000),0.873 (95％ CI:0.764-0.982),respectively (all P＜0.01).Conclusion ECG-gated CACS CT scan can be used for attenuation correction of 99Tcm-MIBI MPI based on a hybrid SPECT/CT scanner.

Objective To investigate the value of CT in detecting incidental extracardiac findings (IEFs) when used for attenuation correction during SPECT/CT myocardial perfusion imaging (MPI).Methods A total of 520 patients (288 males,232 females,average age 65.8 years) who underwent SPECT/CT MPI between July 2014 and February 2016 were retrospectively analyzed.Low dose CT attenuation correction was used during MPI.IEFs of lung,mediastinum and chest wall,large blood vessels,spine,and part of upper abdomen were recorded independently.All findings were divided into three categories:IEFs requiting further examination and treatment measures taken immediately (group A),IEFs requiring follow-up or further examination (group B),IEFs need no further treatment (group C).Results IEFs (n =356) were observed in 52.31％ (272/520) of the patients,with 24 cases in group A (4.62％,24/520),105 cases in group B (20.19％,105/520) and 143 cases in group C (27.50％,143/520).There were 158 clinically significant IEFs in 129 patients (24.81％,129/520),including 5(0.96％,5/520) with newly diagnosed malignancy.Conclusion IEFs detected by CT used for attenuation correction during SPECT/CT MPI are not uncommon,including a few cases with clinically significant findings.

Objective To investigate a real-time imaging guided percutaneous transthoracic needle biopsy (PTNB) for thoracic masses with SPECT/CT.Methods From March to June 2016,a total of 12 patients (7 males,5 females;average age:(59.2± 13.2) years) with thoracic lesions suspicious for malignancy underwent 99Tcm-methoxyisobutylisonitrile (MIBI) SPECT/CT-guided PTNB.The hot spot areas were chosen from the thorax 99Tcm-MIBI SPECT/CT images as the sampling targets.Subsequent guiding CT scans were repeatedly fused with the prior SPECT images to realize the real-time guiding of the biopsy needle puncture step by step,until reaching to the target margin.Masses were sampled after confirming that the needle tips reached planned areas.Pathological results,total time of examination,time of PTNB procedure,complication,CT radiation dosage were recorded.Results Based on 99Tcm-MIBI SPECT/CT results,biopsies targeted the most suspicious areas within lesions.All biopsy procedures yielded diagnostic results.Eleven patients had positive results of malignancy,and 1 patient with inflammation.There were no severe complications.Total time of examination was (74.3±10.4) min,and (33.5±9.1) min for PTNB.Radiation dosage of CT was (6.1±1.7) mSv,36％ of which was caused by CT-guiding ((2.2±1.0) mSv).Conclusion Multimodal of SPECT/CT fusion imaging is useful for thorax biopsy planning and guiding,and can increase overall performance of safety and feasibility.

Objective To compare the diagnostic efficiencies of different scanning schemes of dualphase 99Tcm-methoxyisobutylisonitrile (MIBI) planar imaging with or without SPECT/CT in the preoperative localization of parathyroid lesions.Methods Forty-two patients (20 males,22 females;average age (53.1 ± 14.8) years) with primary or secondary hyperparathyroidism who underwent parathyroidectomy from June 2011 to June 2016 were analyzed retrospectively.All patients underwent dual-phase 99Tcm-MIBI planar scan and dual-phase SPECT/CT scan.The images were collected according to the following 4 procedures:dualphase planar imaging (S1),dual-phase planar imaging+early-phase SPECT/CT (S2),dual-phase planar imaging+delayed-phase SPECT/CT (S3),dual-phase planar imaging+dual-phase SPECT/CT (S4).Pathological results were considered as the gold standard.A total of 168 parathyroid glands in 42 patients were evaluated by the 4 imaging procedures respectively.The diagnostic efficiencies were calculated and compared by x2 test.Results Seventy-eight abnormal parathyroid lesions were found.The diagnostic sensitivities of S1,S2,S3,S4 were 66.7％ (52/78),89.7％(70/78),69.2％(54/78),89.7％(70/78),and the accuracies were 78.6％ (132/168),94.0％ (158/168),85.1％ (143/168),94.0％ (158/168),respectively.The diagnostic accuracies of S2 and S4 were significantly higher than those of S1 and S3 (x2 values:17.027 and 7.176,both P＜0.01).Condusions The dual-phase planar imaging together with early-phase and dualphase SPECT/CT imaging have high diagnostic efficiencies in the preoperative localization of parathyroid lesions.Considering reducing radiation dose and examine time,the dual-phase planar imaging together with early-phase SPECT/CT is a better choice.

Objective To evaluate the prevalence of extraosseous findings on integrated CT images of routine SPECT/CT bone imaging and its clinical incremental values. Methods A total of 843 patients (470 males, 373 females, age range: 26-92 years) who underwent SPECT/CT bone imaging during May 2013 to December 2015 were enrolled in this retrospective study. A modified C-RADS was used to classify the extraosseous findings to E1, E2, E3 and E4. χ2 test was used for data analysis. Results The CT images in 78.6%(663/843) of patients were normal or with no additional clinical significance (E1 and E2), and those in 21.4%(180/843) of patients might need further assessment (E3 and E4). The rate of E4 extraosseous findings in patients with malignancy was higher than that in patients without malignancy: 9.5%(59/622) vs 5.0%(11/221); χ2=4.352, P<0.05. There was no significant difference of the rate between genders: 8.5%(40/470) in males vs 8.0%(30/373) in females; χ2=0.510, P>0.05. With age increasing, the prevalence of E4 finding increased and the rate was the highest in the patients over 80 years old (125%, 16/128). Seventy patients had E4 findings and chest masses and nodules were the most common, followed by the abdominal or pelvis lymph node enlargements. Conclusions Potentially important extraosseous findings are common on SPECT/CT. Systematic reviewing CT images and communicating the important unexpected findings to clinical physicians could enhance its clinical incremental values.

Objective To evaluate the diagnostic value of 99Tcm-MDP SPECT/CT in the diagnosis of lumbar spondylolysis.Methods A total of 58 patients (28 males,30 females,average age 61.3 years) who underwent bone scan and SPECT/CT because of low back pain from January 2012 to May 2014 were retrospectively evaluated.The final diagnosis was based on comprehensive results of SPECT/CT and followup.The diagnostic sensitivity and accuracy of SPECT,CT and SPECT/CT images were calculated and x2 test was performed to analyze the data.Results Twenty-eight patients were diagnosed as lumbar spondylolysis.The diagnostic sensitivities of SPECT,CT and SPECT/CT were 53.6％ (15/28),78.6％ (22/28) and 100％(28/28).The diagnostic accuracies of SPECT,CT and SPECT/CT were 48.3％ (28/58),89.7％ (52/58) and 93.1％(54/58).SPECT/CT was proved to be more accurate than SPECT(x2=28.13,P＜ 0.05).Conclusion SPECT/CT bone scan may detect lumbar spondylolysis in early stage.