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Background: Gastric mucosal atrophy and intestinal metaplasia (IM) are precancerous conditions of gastric cancer. Although Moluodan has been used in the treatment of chronic atrophic gastritis (CAG), there is little study on efficacy evaluation of Moluodan based on pathological stages. Aims: To assess the efficacy of Moluodan on reversal of gastric mucosal atrophy and IM based on OLGA and OLGIM staging systems, and to analyze the related factors. Methods: A total of 104 patients with CAG and IM from October 2019 to January 2022 at Xijing Hospital of Air Force Medical University were enrolled retrospectively in this study. All the patients received Moluodan treatment (one bag each time, three times daily) for 6 months. Changes of OLGA and OLGIM stages before and after treatment, and the related factors affecting the efficacy were analyzed. Results: After treatment with Moluodan for 6 months, the reversal rates for gastric mucosal atrophy and IM were 47.1% (49/104) and 51.0% (53/104), respectively, and the overall efficacy was 65.4% (68/104). There were 49.3% (34/69) and 52.4% (22/42) of patients with higher OLGA and OLGIM stages (III-) reversed to lower stages (0-Ⅱ), respectively. In addition, patients with OLGA and OLGIM stage III- showed a higher reversal rate than those with stage -Ⅱ (all P0.05). Conclusions: Moluodan could reverse gastric mucosal atrophy and IM effectively in patients with CAG, which suggests that Moluodan has good potential in prevention of gastric cancer.
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Objective:To investigate the efficacy and related factors of lamb′s tripe extract and vitamin B12 capsule (LTEVB12) in the treatment of chronic atrophic gastritis.Methods:From October 1st 2016 to April 30th 2021, 240 patients with chronic atrophic gastritis visited the Department of Gastroenterology at Xijing Hospital, Air Force Medical University were retrospectively analyzed. All patients regularly took LTEVB12 (110 U/day, 3 times/day) for six months. At the end of treatment, endoscopy and gastric mucosal biopsy were conducted. The therapeutic effects were evaluated by comparing the changes of operative link on gastritis assessment (OLGA) and operative link on gastritis assessment based on intestinal metaplasia (OLGIM) staging before and after treatment. The related factors affecting the efficacy of the drug were analyzed. Multivariate logistic regression analysis was used for statistical analysis.Results:After half a year of treatment, the reversal efficiency of atrophy and intestinal metaplasia was 45.4% (109/240) and 37.9% (91/240), respectively, and the total efficiency was 62.9% (151/240). The reversal efficiency of OLGA and OLGIM staging reversed from high stage (stage Ⅲ to Ⅳ) to low stage (stage 0 to Ⅱ) was 53.4% (63/118) and 54.5% (36/66), respectively. The results of multivariate analysis showed that female, vitamin supplementation (≥3 times/week), negative or successful eradication of Helicobacter pylori and mild inflammatory status (inflammation score: 1 to 2) were associated with improving the efficacy of LTEVB12 (odds ratio=1.798, 3.730, 2.817 and 4.631, 95% confidence interval 1.055 to 3.064, 1.197 to 11.627, 1.171 to 6.779, 1.480 to 14.493; all P<0.05). High consumption of pickled food (≥3 times/week) was associated with reducing efficacy of LTEVB12 (odds ratio=0.384, 95%confidence interval 0.200 to 0.740). Conclusion:LTEVB12 has better reversal therapeutic effect on atrophy and intestinal metaplasia, and may reduce the risk of gastric cancer in patients with chronic atrophic gastritis.
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Sclerosing cholangitis can be divided into primary sclerosing cholangitis (PSC) and secondary sclerosing cholangitis according to the etiology and pathogenesis, and the pathogenesis of PSC may be associated with immunity. In recent years, a new type of sclerosing cholangitis has been found, which is characteristic of elevated levels of IgG4 in serum and tissue and good response to steroid therapy. PSC and IgG4-related sclerosing cholangitis can be collectively referred to as autoimmune sclerosing cholangitis. This article explores the similarities and differences between various diseases with manifestations of sclerosing cholangitis in the new concept, which will provide new ideas and directions for immune-related diseases.
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Primary biliary cirrhosis (PBC) is a chronic progressive cholestatic liver disease associated with immunity, with unknown etiology and pathogenesis. This article reviews the origin of its name, recent advances in research on PBC, and the prospect of treatment. Ursodeoxycholic acid is considered to be effective in improving cholestasis among PBC patients, but its naming and risk factors, as well as the response criteria and treatment, still need further research.
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<p><b>OBJECTIVE</b>To perform a preliminarily study on the relationship between the duration and dosage of ribavirin treatment and its antiviral effect against chronic hepatitis C.</p><p><b>METHODS</b>A total of 69 patients with chronic hepatitis C whose hemogloblin (HGB) level had decreased to 100 g/L were divided into two groups for receiving a reduced dosage of ribavirin when their HGB level fell to less than or equal to 100 g/L or for withdrawal of the ribavirin treatment when their HGB level fell to less than or equal to 80 g/L (restricted group), or for receiving a reduced dosage when the HGB level fell to less than or equal to 80 g/L or for withdrawal of the ribavirin treatment when the HGB level fell below less than or equal to 60 g/L (adjusted group).The rates of sustained virological response (SVR), relapse, and incidence of adverse effects were statistically compared between the two groups.</p><p><b>RESULTS</b>The adjusted group had a significantly higher SVR rate than the restricted group (91.17% vs.74.29%, P = 0.049). At the 2-year follow-up after treatment withdrawal, there were significantly less cases of relapse in the adjusted group than in the restricted group (23.07% vs.6.45%, P = 0.038).The adjusted group had lower incidence rates of severe anemia and cardiovascular events but there was no significant difference from these rates in the restricted group (P more than 0.05).Subgroup analysis of the adjusted group showed that the patients with HCV-RNA baseline level of less than 5 lg copy/ml had a significantly higher SVR rate than the patients with HCV-RNA baseline level of more than 5 lg copy/ml (100% vs.76.92%, P = 0.021), and that the patients infected with non genotype-1 had a significantly higher SVR rate than patients infected with genotype-1 (100% vs.70.00%, P = 0.005).</p><p><b>CONCLUSION</b>When patients with chronic hepatitis C develop anemia during the course of anti-HCV ribavirin therapy with Peg-IFNat2a, adjustment of the ribavirin treatment duration and dosage can increase the likelihood of achieving and sustaining SVR and decrease the rate of relapse; these treatment adjustments are not associated with changes in severe adverse effects.The adjustment approach, however, shows more benefit for patients with lower viral load and non genotype-1 infection.</p>
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Female , Humans , Male , Antiviral Agents , Therapeutic Uses , Genotype , Hepatitis C Antibodies , Hepatitis C, Chronic , Drug Therapy , Interferon-alpha , Ribavirin , Therapeutic Uses , Treatment Outcome , Viral LoadABSTRACT
Because of insufficient intake,synthesis disorder,metabolic disorder and excessive consumption,patients with cirrhosis often lead to malnutrition. Providing scientific nutritional support and guiding the patients to a reasonable diet can effectively improve the liver metabolism and reduce the complication of cirrhosis such as hepatic encephalopathy,and improve the quality of life and survival rate. This article described the nutritional metabolism disorder in patients with cirrhosis and nutritional treatment in hepatic encephalopathy.
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Objective To evaluate the feasibility of active breathing control (ABC) in conformal radiotherapy (CRT) for patients with non-small cell lung cancer (NSCLC). Methods From Feb 2005 to Mar 2008, 29 patients with inoperable NSCLC (stage Ⅱ-Ⅳ) were evaluated. For each patient, two series of CT scans were obtained with free breathing (FB) and ABC system during simulation, respectively. Then two confonnal radiotherapy (CRT) plans were finished based on the two sets of reconstructed images. The pattern of post-inspiratory breath-hold was triggered at 80% of the peak of inspiration curve. The margin of clinical target volume (CTV) to planning target volume (PTV) was 0. 6 cm for lesions of the superior lobe, and 1.0 cm for the lesions of middle and inferior lobes. Three to five coplanar fields were performed in conformal radiotherapy. The gross tumor volume (GTV), CTV, PTV, volume of the bilateral lungs (Volume_(lung)), V_(20) and mean lung dose (MLD) of two plans were evaluated by dose-volume histogram (DVH). The World Health Organization criteria and National Cancer Institute Common Toxicity Criteria 3.0 (NCI-CTC3.0) scale were used to assess the immediate response and acute side-effect, respectively. Results Significant differences of GTV, CTV, FIN, Volum_(lung), V_(20) and MDL were observed between the two plans (36. 35 cm~3 vs. 31.40 cm~3, t = 9. 70, P <0. 001 ;82. 33 cm~3 vs. 70. 83 cm~3, t = 8. 19, P < 0. 001 ; 230. 73 cm~3 vs. 197.59 cm~3 ,t=5.72,P <0. 001 ;21.66% vs. 18. 76% ,t = 11.16,P <0. 001 ;1329. 07 Gy vs. 1143. 14 Gy, t = 13. 24, P < 0. 001). With ABC, all patients completed their treatment successfully except one patient for financial problems. The median radiation dose to the GTV was 64 Gy (60 -64 Gy). The overall immediate response rate was 64% (18/28). According to the NCI-CTC 3.0, grade 1 and 2 acute radiation-related toxicities occurred in 68% (19/28) and 18% (5/28) of patients for esophagitis, 82% (23/28) and 7% (2/28) for pneumonitis, respectively. Grade 1, 2 and 3 bone marrow suppression occurred in 57% (16/28), 25% (7/28) and 14% (4/28) of patients, respectively. Grade 1 and 2 acute cardiac injuries occurred in 86% (24/28) and 14% (4/28) of patients. Conclusions During CRT for patients with NSCLC, the use of ABC can decrease the radiation dose and acute complications of normal tissues.