Amoxicillin-Clarithromycin-Containing Bismuth Quadruple Therapy for Primary Eradication of Helicobacter pylori / 中国医学科学院学报

Objective To evaluate the efficacy and safety of amoxicillin-clarithromycin-containing bismuth quadruple regimen as a primary therapy for Helicobacter pylori (Hp) eradication.Methods A total of 102 Hp-infected outpatients diagnosed by C-or C-urea breath test from December 2015 to June 2017 were enrolled and received 14-day bismuth quadruple therapy (esomeprazole 20 mg bid,bismuth potassium citrate 220 mg bid,amoxicillin 1000 mg bid,and clarithromycin 500 mg bid for 14 days). Hp status was assessed by C-or C-urea breath test 4 weeks,8 weeks,6 months,and 12 months after the treatment. The primary outcome was Hp eradication rate,which was analyzed by intention-to-treat (ITT) and per-protocol (PP) analyses. The second outcomes were Hp infection recurrence,symptomatic benefit from Hp eradication,and safety. Results A total of 101 patients,of which 65 patients had dyspeptic symptoms before eradication,completed the study. Hp eradication rates by ITT analysis and by PP analysis were 88.2% and 89.1%,respectively. Only in two of 84 patients,who were followed for 8 weeks after eradication,Hp became positive. No Hp recurrence happened at the 6-month and 12-month follow-up and the annual recurrence rate was 2.4%. The symptomatic relief rates at the 4-week,8-week,6-month and 12-month follow-up were 81.5%,75.4%,71.2%,and 70.2% respectively. Eleven of 101 patients had mild and similar side-effects,which were well tolerated.Conclusion Amoxicillin-clarithromycin-containing bismuth quadruple regimen can be used as the standard therapy for Hp eradication.

Values of Different Laboratory Diagnostic Approaches for Tuberculous Peritonitis / 中国医学科学院学报

Objective To evaluate the diagnostic accuracy of different laboratory approaches for tuberculous peritonitis(TP).Methods The clinical data of patients with suspected TP who were mainly manifested as ascites in Peking Union Medical College Hospital from January 2014 to June 2017 were retrospectively analyzed. Ascites samples were tested with different diagnostic approaches,including acid fast stain,culture for mycobacterium,real-time polymerase chain reaction for identifying DNA of mycobacterium tuberculosis,and T-cell spot of tuberculosis test(T-SPOT.TB). Results Totally 163 cases aged 15-84 years [mean±SD:(50±17)years] with complete data were enrolled,among whom 82(50.3%) were males and 81(49.7%) were females. Finally,27 patients were confirmed as TP,which was excluded in the other 136 cases. The sensitivity and specificity of ascites acid fast stain were 0% and 100%,respectively,followed by ascites culture for mycobacterium(21.74% and 100%),real-time polymerase chain reaction for DNA of mycobacterium tuberculosis in ascites(18.52% and 100%),T-SPOT.TB on ascites(95.42% and 61.90%),and T-SPOT.TB on peripheral blood(76.19% and 80.18%). Conclusion The diagnosis of tuberculous peritonitis remains challenging because of the limitations of the currently available diagnostic tests. Diagnosis should also be based on clinical manifestations and auxiliary examinations.

Clinical and Laboratory Diagnosis of Intestinal Tuberculosis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Tuberculosis (TB) remains a worldwide problem. Intestinal TB (ITB) constitutes a major public health problem in developing countries and has been associated with significant morbidity and mortality. The aim of this study was to characterize the clinical, radiological, endoscopic, and pathological features of ITB and to define the strategy for establishing the diagnosis.</p><p><b>METHODS</b>A retrospective study (from January 2000 to June 2015) was carried out in Peking Union Medical College Hospital and all hospitalized cases were diagnosed as ITB during the study period were included. The relevant clinical information, laboratory results, microbiological, and radiological investigations were recorded.</p><p><b>RESULTS</b>Of the 85 cases, 61 cases (71.8%) were ranged from 20 to 50 years. The ileocecal region was involved in about 83.5% (71/85) of patients. About 41.2% (35/85) of patients had co-existing extra ITB, especially active pulmonary TB. Abdominal pain (82.4%) was the most common presenting symptom followed by weight loss (72.9%) and fever (64.7%). Both T-cell spot of TB test (T-SPOT.TB) and purified protein derivatives (PPD) tests were performed in 26 patients: 20 (76.9%) positive T-SPOT.TB and 13 (50.0%) positive PPD were detected, with a statistical significant difference (P = 0.046). Twenty cases (23.5%) were histopathology and/or pathogen confirmed TB; 27 cases (31.8%) were diagnosed by clinical manifestation consistent with ITB and evidence of active extra ITB; 38 cases (44.7%) were diagnosed by good response to diagnostic anti-TB therapy.</p><p><b>CONCLUSIONS</b>ITB is difficult to diagnose even with modern medical techniques due to its nonspecific clinical and laboratory features. At present, combination of clinical, endoscopic, radiological, and pathological features continues to be the key to the diagnosis of ITB.</p>

Whole genome expression profiling of gastric high-grade intraepithelial neoplasia with or without cancer / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the whole genome expression profiles between gastric high-grade intraepithelial neoplasia (HGIN) tissues with cancer and HGIN tissues without cancer.</p><p><b>METHODS</b>Gastric specimens from an upper magnifying chromoendoscopic targeted biopsy were collected at Peking Union Medical College Hospital from March 2010 to May 2013. Each of the forceps biopsies from the 21 patients was HGIN,but there were 10 HGIN and 11 HGIN with cancer after the endoscopic submucosal dissection. The whole genome expression profiling was performed on 10 HGIN samples and 11 HGIN with cancer samples using Agilent 4 × 44K Whole Human Genome microarrays. Differentially expressed genes between different types of lesions were identified using an unpaired t-test and corrected with the Benjamini and Hochberg false discovery rate algorithm. A gene ontology(GO)enrichment analysis was performed using the GeneSpring software GX 12.6.</p><p><b>RESULTS</b>The gene expression patterns were different between HGIN tissues with cancer and HGIN tissues without cancer. There were 470 significantly differentially expressed transcripts between them (P<0.05,Fold Change>2), with 180 up-regulated genes and 290 down-regulated genes in HGIN tissues with cancer. A GO enrichment analysis demonstrated that the most striking over-expressed transcripts in HGIN with cancer were in the category of triglyceride biosynthetic process,acylglycerol biosynthetic process,neutral lipid biosynthetic process,glycerol ether metabolic process,organic ether metabolic process,and glycerolipid metabolic process.</p><p><b>CONCLUSION</b>The change of lipid metabolism may contribute to the pathogenesis of gastric cancer at an early stage.</p>