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OBJECTIVE To systematically evaluate the efficacy and safety of vonoprazan （VPZ） for Helicobacter pylori （Hp） eradication therapy. METHODS Retrieved from The Cochrane Library， Embase， PubMed， CNKI， VIP and Wanfang database， randomized controlled trials about VPZ for Hp eradication therapy （trial group） versus proton pump inhibitor （PPI） （control group） were collected during the inception to July 2022. After data extraction and quality evaluation with bias risk assessment tool recommended by Cochrane System Evaluation Manual 5.1.0， meta-analysis was performed by using RevMan5.3 software. RESULTS Nine studies with 2 134 patients were included. Compared with control group， the overall Hp eradication rate of trial group increased significantly in either the ITT analysis or PP analysis， being 87.5% vs. 76.2% [RR＝1.14， 95%CI （1.06，1.21）， P＜0.001] and 92.4% vs. 80.5% [RR＝1.11， 95%CI （1.03，1.21）， P＜0.01]， respectively. According to ITT and PP analysis of primary treatment subgroup， compared with control group， the overall Hp eradication rate of trial group increased significantly， being 88.4% vs. 76.5% [RR＝1.15， 95%CI （1.09，1.22）， P＜0.000 01] and 92.8% vs. 80.9% [RR＝1.12， 95%CI（1.03，1.23）， P＜ 0.05]； according to ITT and PP analysis of rescue therapy subgroup， there was no significant difference in the overall Hp eradication rate between control group and trial group （P＞0.05）. According to ITT and PP analysis of triple therapy subgroup， compared with control group， overall Hp eradication rate of trial group increased significantly， being 88.3% vs. 75.6% [RR＝1.16， 95%CI （1.08， 1.25）， P＜0.000 1] and 92.6% vs. 77.6% [RR=1.15， 95%CI （1.04， 1.28）， P＜0.01]； according to ITT and PP analysis of quadruple therapy subgroup， there was no significant difference in the overall Hp eradication rate between control group and trial group （P＞0.05）. Compared with control group， the incidence of adverse events in trial group decreased significantly， being 34.2% vs. 40.9% [RR＝0.84， 95%CI（0.70，0.99）， P＜ 0.05]. There was no statistical significance in the incidence of serious adverse events between 2 groups （P＞0.05）. CONCLUSIONS Compared with PPI therapy， the efficacy of VPZ-based triple therapy is better， particularly in primary treatment patients. However， VPZ has no significant advantage in rescue treatment and bismuth-containing quadruple regimen. And the safety and tolerance of VPZ for Hp eradication therapy are well， even better than PPI.
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Objective:To investigate the effect of ionizing radiation on the N 6-methyladenine (m 6A) modification profile of circular RNA (circRNA) in mouse bone marrow cells and provide scientific basis for revealing the relationship between RNA epigenetic modification and hematopoietic radiation injury. Methods:A total of twenty four C57BL/6 J mice were randomly divided into two groups: the healthy control group ( n=12), and ionizing radiation group ( n=12) irradiated in total body with 4 Gy of 137Cs γ-rays. At 5 min after irradiation, mice were killed and bone marrow cells were collected from the femur. Total RNAs were extracted and the changes in circRNA m6A modification profiles were investigated by RNA immunoprecipitation-high-throughput sequencing (MeRIP-Seq) technology and bioinformatics analysis. The representative alterations of m 6A peaks were validated by MeRIP-PCR assay. Results:325 and 455 m 6A sites were identified on circRNAs in the healthy control group and ionizing radiation group (178 common sites, 147 specific sites in the healthy control group and 277 specific sites in ionizing radiation group), respectively. 1 275 and 1 017 deriving genes of m 6A-circRNAs were identified in the healthy control group and ionizing radiation group (767 common genes, 508 specific genes in the healthy control group and 250 specific genes in ionizing radiation group), respectively. Compared with the control healthy group, 414 (178) m 6A peaks was significantly up- (down-) regulated in the ionizing radiation group( P < 10 -10; fold-change cut-off > 5). Moreover, Gene Ontology (GO) assay revealed that the deriving genes of circRNAs with differentially methylated m 6A sites between two groups involves various functions including chromatin regulation, ciliary transition fiber and poly (A)-specific ribonuclease activity. Kyoto Encyclopedia of Genes and Genomes (KEGG) assay revealed that the deriving genes of circRNAs with differentially methylated m 6A sites between two groups included numerous pathways such as platelet activation, Fc γ R-mediated phagocytosis and B cell receptor signaling pathway. Conclusions:Ionizing radiation triggers rapid alterations in the m 6A modification profile of circRNA in mouse bone marrow cells. The deriving genes of differentially methylated circRNAs are associated with a variety of functions and signaling pathways of hematopoietic radiobiology.
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OBJECTIVE：To study the mode of regional volume-based proc urement of injection ，design complete and effective volume-based procurement plan of injection ，and to provide decision-making basis for government departments. METHODS ：The official documents of all provinces/provincial-level alliances that carried out injection volume-based procurement were retrieved as of Feb. 8th，2021. Content analysis method was used to sort out and compare volume-based procurement types ，grouping methods ， product selection methods and other information of injection. Combined with the existing information ，the suggestions were put forward for improving volume-based procurement mode and the improved volume-based procurement mode framework. RESULTS & CONCLUSIONS ：By Feb. 8th，2021，a total of 13 provinces/provincial-level alliances have launched volume-based procurement of injections ，mainly involving antibiotics and proton pump inhibitors ；a comprehensive evaluation system was used for evaluation for many provinces/provincial-level alliances. Comprehensive evaluation system involves the price and quality of injection ，and enterprise credit ，etc.，and include a variety of factors other than price into evaluation scope. But the comprehensive evaluation system is still in its preliminary application stage ，and has differences in each province/provincial-level. Its details need to be perfected and it has not yet formed a unified standard. In the future，the way of product quality inspection needs to be refined. On the existing basis ，it has been constructed and improved that comprehensive evaluation system framework include efficacy ，safety，economy and other indicators. It is suggested to promote the comprehensive clinical evaluation of com drugs and apply more re al world data for product review ，so as to further reduce drug price，and promote the hea lthy development of the pharmaceutical industry.
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Objective To evaluate the therapy effect and clinical value of non-invasive positive-pressure ventilation (NPPV) treatment in acute respiratory distress syndrome (ARDS) caused by severe acute pancreatitis. Methods Data of 22 cases of AP with ARDS who were treated with NPPV were retrospectively analyzed. The oxygenation index (OI), PaO2, PaCO2, respiratory rate (RR) and heart rate (HR) were measured and analyzed before and after NPPV treatment. Results All of cases recovered from ARDS. The PaO2, SpO2 and RR decreased 2 h after NPPV treatment [(81.60 ± 12.56) mmHg (1 mmHg=0.133 kPa) vs. (61.50 ± 5.71) mmHg, (95.66 ± 5.13)% vs. (88.52 ± 4.41)% and (24.49 ± 2.01) times/min vs. (33.37 ± 2.96) times/min] (P<0.05). The OI, PaO2, SpO2 and RR further decreased 12 h after NPPV treatment [(367.89 ± 49.58) mmHg vs. (214.64 ± 20.93) mmHg, (105.19 ± 17.60) mmHg vs. (61.50 ± 5.71) mmHg; 0.991 ± 0.026 vs. 0.885 ± 0.044] (P < 0.05). The OI, PaO2, PaCO2 and SpO2 increased significantly, in contrast, RR and HR descended 24 h after NPPV treatment (P < 0.05). Conclusions NPPV treatment can effectively improve oxygenation of patients with ARDS caused by SAP. NPPV has a good value of clinical application and is worth spreading.
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Objective:To investigate the potential correlation between miR-223 level in leukocytes and platelet responses to clopidogrel in patients with coronary artery disease.Methods:A cohort of 188 outpatients,who conducted percutaneous coronary intervention (PCI) and received dual antiplatelet therapy,were recruited.The patient's electronic health data were collected,and their blood samples were obtained for measurement of adenosine diphosphate (ADP)-induced whole-blood platelet aggregation.Extreme cases ofplatelet responses to clopidogrel (ultra-vs.non-responder) were measured with miR-223-3p levels in leukocytes.Results:Both groups had similar miR-223-3p levels in leukocytes.There were no significant differences in other demographic and clinical data except for metrics of ADP-induced whole-blood platelet aggregation between the 2 group.Conclusion:MiR-223-3p in peripheral leukocytes is not associated with the altered platelet responses to clopidogrel in PCI outpatients.
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Objective To investigate the possible role of mean platelet volume and its value as a therapeutic effect in acute pancreatitis (AP).Methods Data of 78 cases of AP and 40 cases of negative control were retrospectively analyzed.Mean platelet volume (MPV),platelet counts (PLT),platelet distribution width (PDW),leucocyte count (WBC),C reactive protein (CRP) and serum level of calcium (Ca2+) were measured and analyzed on the admission day,3th,5th and 7th day.Results The MPV values were elevated obviously in AP group on the admission day.Moreover,the MPV values of SAP group were significantly higher than those of MAP group on the admission day.The MPV values were decreased at 5 days and 7 days after admission followed by a increasing at 3 days in SAP group.Furthermore,the MPV value of SAP group at every time point was significantly higher than those of MAP group.The MPV values of AP patients showed a significant reduce after treatment.Conclusion MPV was associated with the severity and the treatment effect of acute pancreatitis.
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Objective To investigate the clinical features and prognosis of adult dermatomyositis with gastrointestinal bleeding and perforation. Methods The clinical data of a adult dermatomyositis with gastrointestinal bleeding and perforation were retrospectively analyzed. And the clinical characteristics of this patient were analyzed, combined with 7 cases reported in the literature. Results Among the 8 cases, 6 cases were females and 2 cases were males, aged 18 to 63 years. The 5 cases had melena, 3 cases had hematemesis, 3 cases had hematochezia and 1 case had hemoptysis. The main treatment was glucocorticoids, immunosuppressive agent, intravenous immune globulin (IVIG), endoscopic hemostasis and angiographic embolization. Four of the 8 cases died. Conclusions Adult dermatomyositis with gastrointestinal bleeding and perforation is rare, but the condition is dangerous and the mortality is high. Dermatomyositis with early onset of abdominal pain, vomiting, melena should be alert to serious complications such as gastrointestinal bleeding and perforation.