Efetividade e segurança do regime de tratamento contendo gemifloxacino no tratamento de primeira linha para Helicobacter pylori / Efficacy and safety of gemifloxacin containing treatment regimen in first-line treatment of helicobacter pylori

ABSTRACT Background: After eradication of Helicobacter pylori (H. pylori) chronic gastritis will resolve, complications due to H. pylori infection and recurrence of infection will be prevented. Objective: To determine efficacy and safety of gemifloxacin containing treatment regimen in first line treatment of H. pylori with comparison to bismuth containing quadruple therapy. Methods: This retrospective study was conducted in a tertiary care university hospital between January 2018 and January 2021 with 410 participants who were diagnosed to have H. pylori infection with biopsies obtained during upper gastrointestinal system endoscopy. Patients were distributed into two groups according to their first-line treatment regimens. First group patients were treated with amoxicillin, gemifloxacin and pantoprazole and second group patients were treated with amoxicillin, metronidazole, bismuth subcitrate and pantoprazole for seven days. Results: Intention to treat and per protocol ratios for gemifloxacin containing regimen were 90.0% and 91.2%, while quadruple treatment has these ratios as 91.7% and 93.8% respectively. Treatment success rate in both regimens were similar. But adverse effects were lower and patient compliance were better in patients who had gemifloxacin containing treatment (P<0.001). Conclusion: Gemifloxacin containing treatment regimen is as effective as bismuth containing quadruple treatment regimen for H. pylori infection and patient compliance is better in this group. Gemifloxacin containing treatment regimens may be novel and effective alternatives for eradication of H. pylori infection.

RESUMO Contexto: Após a erradicação do Helicobacter pylori (HP), a gastrite crônica será resolvida, as complicações devido à infecção por HP e a recorrência da infecção serão prevenidas. Objetivo: Determinar a eficácia e segurança do regime de tratamento contendo gemifloxacino no tratamento de primeira linha do HP, em comparação com a terapia quádrupla contendo bismuto. Métodos: Este estudo prospectivo foi conduzido em um hospital universitário de atendimento terciário entre janeiro de 2018 e janeiro de 2021, com 410 participantes diagnosticados com infecção por HP, obtidos por meio de biópsias durante a endoscopia do sistema gastrointestinal superior. Os pacientes foram divididos em dois grupos de acordo com seus regimes de tratamento de primeira linha. Os pacientes do primeiro grupo foram tratados com amoxicilina, gemifloxacino e pantoprazol, e os pacientes do segundo grupo foram tratados com amoxicilina, metronidazol, subcitrato de bismuto e pantoprazol por 7 dias. Resultados: As taxas de intenção de tratar e por protocolo para o regime contendo gemifloxacino foram de 90,0% e 91,2%, enquanto o tratamento quádruplo apresentou essas taxas como 91,7% e 93,8%, respectivamente. A taxa de sucesso do tratamento em ambos os regimes foi similar. No entanto, os efeitos adversos foram menores e a adesão dos pacientes foi melhor nos que receberam o tratamento contendo gemifloxacino (P<0,001). Conclusão: O regime de tratamento contendo gemifloxacino é tão eficaz quanto o regime de tratamento quádruplo contendo bismuto para a infecção por HP, e a adesão dos pacientes é melhor neste grupo. Os regimes de tratamento contendo gemifloxacino podem ser alternativas novas e eficazes para a erradicação da infecção por HP.

Clinical efficacy of laparoscopic radical resection of hilar cholangiocarcinoma / 中华消化外科杂志

Objective:To investigate the clinical efficacy of laparoscopic radical resection of hilar cholangiocarcinoma (LRHCCA).Methods:The retrospective and descriptive study was constructed. The clinicopathological data of 211 patients who under LRHCCA in the Second Hospital of Hebei Medical University from May 2014 to June 2022 were collected. There were 135 males and 76 females, aged (63±8)years. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( Q1, Q3) or M(range). Count data were described as absolute numbers or percentages. The Kaplan-Meier method was used to calculate survival rate and draw survival curve. Results:(1) Surgical situations. All 211 patients underwent LRHCCA successfully, with the operation time as 350 (300,390)minutes, volume of intraoperative blood loss as 400(200,800)mL, and intraoperative red blood cell transfusion as 2.0(range, 0-15.0)U, respectively. As partial portal vein invasion, 10 of 211 patients underwent portal vein resection and reconstruction. Results of intraoperative histopathology examination showed negative margin of portal vein. The operation time, volume of intraoperative blood loss, intraopera-tive red blood cell transfusion of the 10 patients was (400±53)minutes, 1 200(range, 800-3 000)mL, 5.5(range, 4.0-15.0)U, respectively. (2) Postoperative situations. Of the 211 patients, there were 63 cases of the Bismuth type Ⅰ, 65 cases of the Bismuth type Ⅱ, 22 cases of the Bismuth type Ⅲa, 26 cases of the Bismuth type Ⅲb, 35 cases of the Bismuth type Ⅳ. The R 0 resection rate was 95.73%(202/211). There were 202 patients identified as adenocarcinoma of the bile duct, including 7 cases with poorly differentiated tumor, 189 cases with moderate to poorly differentiated tumor, 3 cases with moderate to well differentiated tumor, 3 cases with well differentiated tumor. There were 8 patients with poorly differentiated biliary mucinous adenocarcinoma, 1 patient with intraductal papillary neoplasm with high-grade epithelial dysplasia. There were 24 cases of stage Ⅰ, 98 cases of stage Ⅱ, 30 cases of stage ⅢA, 34 cases of stage ⅢB, 19 cases of stage ⅢC, 6 cases of stage ⅣA. Of the 211 patients, there were 25 cases with postoperative biliary fistula, 11 cases with postoperative abdominal infection, 3 cases with postoperative bleeding as anastomotic bleeding after biliary fistula, 2 cases with postoperative gastric emptying disability, 1 case with postoperative acute liver failure. There were 7 patients undergoing postoperative unplanned reoperation, including 3 cases with emergency operation for hemostasis, 4 cases with abdominal exploration debridement and drainage for severe abdominal infection. There were 3 cases dead during perioperative period, including 1 case of acute liver failure, 1 case of systemic infection and multiple organ failure, 1 case of exfoliated deep venous thrombosis of lower extremities and acute pulmonary embolism. The postoperative duration of hospital stay was (15±5)days of the 211 patients and (17±4)days of patients undergoing portal vein resection and reconstruction. The cost of hospital stay of the 211 patients was (11.7±1.7)ten thousand yuan. (3) Follow-up. Of the 211 patients, 188 patients were followed up for 21(range, 4?36)months. The median survival time of 188 patients was 22 months, and the postoperative 1-, 2- and 3-year survival rate was 90.9%, 43.1% and 18.7%, respectively. Conclusion:LRHCCA is safe and feasible, with satisfactory short-term effect, under the coditions of clinicians with rich experience in laparoscopic surgery and patients with strict surgical evaluation.

Advance on anti-tumor theranostics and biosafety of bismuth-based nanomedicine / 药学学报

Nanomedicine is one of the most promising fields in biomedicine. Inorganic nanomaterials stand out among many nanomaterials due to their excellent physicochemical properties, stable chemical properties and high biocompatibility. As an inorganic nanomaterial, bismuth-based nanomaterials have the advantages of adjustable band gap, low toxicity, easy functionalization, large X-ray attenuation coefficient, high photothermal conversion efficiency and long cycle half-life, so they have good promising application in cancer diagnosis and treatment. This review summarizes the recent research progress of bismuth-based nanomaterials in tumor diagnosis, treatment and biosafety, which provides a theoretical basis for the design and exploitation of a new generation of bismuth-based nanomedicine systems.

Real-world research of vonoprazan and amoxicillin dual therapy for Helicobacter pylori eradication / 中国药房

OBJECTIVE To explore the efficacy， safety and economics of a dual therapy consisting of conventional dose of vonoprazan combined with conventional dose of amoxicillin in patients with primary treatment of Helicobacter pylori （HP） infection. METHODS Using a prospective cohort study， the patients diagnosed with HP infection and receiving initial treatment in Chengdu Xinhua Hospital from July 2021 to July 2022 were collected according to inclusion and exclusion criteria. The patients were given vonoprazan/amoxicillin dual therapy （i.e. VA group， Vonoprazan fumarate tablets 20 mg， once a day+Amoxicillin capsules 1.0 g， twice a day， 14 days） and bismuth-containing quadruple therapy （i.e. LJAF group， Rabeprazole sodium enteric- coated tablets 20 mg， twice a day+Colloidal bismuth pectin capsules 200 mg， twice a day+Amoxicillin capsules 1.0 g， twice a day+ Furazolidone tablets 100 mg， twice a day， for 14 days） according to the patient’s medication willingness. Four weeks after the end of the treatment， HP eradication rates of the two groups were compared by using intention-to-treat （ITT）， modified intention-to- treat （MITT） and per-protocol （PP） analysis. The occurrence of adverse drug reactions （ADR） was recorded， and an economic evaluation was performed for them. RESULTS Among the 58 patients in VA group， 55 completed the trial， 2 were lost to follow- up and one withdrew due to rash； among the 62 patients in LJAF group， 57 completed the trial， 3 were lost to follow-up and 2 withdrew due to rash. Results of ITT， MITT and PP analysis showed that HP eradication rates of VA group were 86.2%， 89.3% and 90.9%， and those of LJAF group were 87.1%，91.5% and 94.7%， respectively； there was no statistical significance among different groups （P＞0.05）. The incidences of ADR in VA group and LJAF group were 6.9% and 14.5%，which were not significantly different （P＞0.05）. The result of cost minimization analysis showed that the treatment cost of VA group was 340.9 yuan， which was lower than 373.5 yuan of LJAF group. CONCLUSIONS In patients with primary treatment of HP infection， the efficacy and safety of dual therapy of conventional dose of vonoprazan combined with conventional dose of amoxicillin is equivalent to the bismuth-containing quadruplex therapy with low cost.

A clinical study using a new approach for laparoscopic radical resection of Bismuth-Corlette Ⅲa hilar cholangiocarcinoma / 中华肝胆外科杂志

Objective:To study the safety and feasibility of laparosocpic left-liver-first anterior radical modular orthotopic right hemihepatectomy (Lap-Larmorh) in treatment of Bismuth-Corlette type Ⅲa hilar cholangiocarcinoma.Methods:From June 2020 to April 2022, 13 patients with Bismuth-Corlette type Ⅲa hilar cholangiocarcinoma underwent Lap-Larmorh at the Department of Hepatobiliary Surgery of the Second Hospital of Hebei Medical University. There were 8 males and 5 females, aged (60.9±8.4) years. The operation time, intraoperative blood loss, complications and postoperative survival were analyzed.Results:Five patients were treated with percutaneous transhepatic cholangial drainage to reduce jaundice before surgery. All 13 patients successfully underwent the Lap-Larmorh and there was no conversion to laparotomy. The operative time was [ M( Q1, Q3)] 390.0 (355.0, 435.0) minutes, and the intraoperative blood loss was [ M( Q1, Q3)] 800.0 (300.0, 1 100.0) ml. Postoperative complications occurred in 4 patients with pleural effusion, and 1 patient had portal vein thrombosis associated with pleural effusion, who was managed successfully using low molecular weight heparin sodium anticoagulation therapy and pleural effusion tapping. The postoperative hospital stay was (12.5±5.5) days, and there was no perioperative death. Intraoperative frozen pathology showed 12 patients with left hepatic duct with negative margins, and 1 patient with moderate dysplasia. Postoperative paraffin pathology showed 12 patients with bile duct adenocarcinoma, 1 patient with bile duct mucinous adenocarcinoma, 2 patients with tumors of high differentiation, 10 patients with moderate differentiation, and 1 patient with poor differentiative. The R 0 resection rate was 100.0% (13/13) and the tumor diameter was (2.9±0.9) cm. Follow-up by telephone or outpatient clinics after operation showed 1 patients to be lost to follow-up. The 1-year survival rate after operation was 66.7% (8/12). Conclusion:For Bismuth-Corlette type Ⅲa hilar cholangiocarcinoma, the new laparoscopic approach of Lap-Larmorh was safe and feasible.

Selection of surgical treatment for Bismuth-Corlette type III and IV hilar cholangiocarcinoma / 中华肝胆外科杂志

Objective:To analyze the efficacy and prognosis of different surgical treatments for Bismuth-Corlette type III and IV hilar cholangiocarcinoma (HCCA).Methods:The clinical data of 86 Bismuth-Corlette type III and IV HCCA patients treated at the First Affiliated Hospital of Anhui Medical University from January 2010 to December 2016 were retrospectively analyzed. There were 45 males and 41 females with age of (59.5±10.5) years old. According to the operative method, 57 patients were included into the extended hepatectomy group, and 29 patients into the perihilar hepatectomy group. The perioperative clinical data and survival rates were compared between the two groups. Through inpatient interviews, regular outpatient or telephone follow-up, factors affecting prognosis were analyzed by univariate and multifactorial Cox regression.Results:The operative time and intraoperative blood loss in the extended hepatectomy group were significantly higher than those in the perihilar hepatectomy group, [320(270, 380) min vs. 270(210, 300) min, P<0.001; 300(200, 400) ml vs. 100(100, 150) ml, respectively P<0.001]. The incidences of ≥ Clavien-Dindo grade III complications and ISGLS grade C liver failure in the extended hepatectomy group were significantly higher than those in the perihilar hepatectomy group [36.4%(20/57) vs. 13.8% (4/29), P=0.037; 13.8% (7/57) vs. 0(0/29), respectively P=0.047]. The cumulative 1-, 3- and 5-year survival rates of the extended hepatectomy group were 89.5%, 38.6% and 19.3%, respectively. The cumulative 1-, 3- and 5-year survival rates of perihilar hepatectomy group were 86.2%, 20.7% and 10.3%, respectively. The difference between the two groups was statistically significant ( P=0.048). Multivariate analysis showed that perihilar hepatectomy ( HR=1.958, 95% CI: 1.174-3.268, P=0.010), non-R 0 resection ( HR=6.040, 95% CI: 2.915-12.513, P<0.001) and TNM stage III/IV( HR=2.144, 95% CI: 1.257-3.654, P=0.005) were independent risk factors for overall survival after surgery for HCCA patients ( P<0.01). Conclusions:Patients with Bismuth-Corlette type III and IV HCCA who received extended hepatectomy had significantly better overall survival than those patients who underwent perihilar hepatectomy. However, the incidences of surgical complications and liver failure in the extended hepatectomy group were also significantly higher.

Effect of different courses of Bifidobacterium tetravaccine tablets (live) in the treatment of Helicobacter pylori positive gastric ulcer / 中国综合临床

Objective:To explore the effects of different courses of Bifidobacterium combined with bismuth on the eradication rate, ulcer healing rate and adverse reactions in the initial eradication treatment of Helicobacter pylori positive gastric ulcer patients.Methods:From September 2018 to September 2021, 219 patients with gastric ulcer were selected from the outpatient department of gastroenterology department of Kailuan General Hospital Affiliated,all of whom were positive for 13C or 14C-urea breath test and were not treated with Helicobacter pylori eradication. Group A, B and C were randomly divided by Excel, Group A was the control group (73 patients): 14-day bismuth quadruple therapy (Eprazole + colloidal bismuth pectin + amoxicillin + furazolidone); group B (73 patients): 7 days Bifidobacterium tetravaccine tablets (live) was given in the second week of treatment in group A; group C (73 patients): Bifidobacterium tetravaccine tablets (live) was given 14 days on the basis of treatment in group A. 13C or 14C-urea breath test and gastroscope were reexamined after all treatments, to compare the eradication rate, ulcer healing rate and the incidence of adverse reactions.Results:The eradication rates in three groups were 90.8%(59/65), 91.2% (62/68)and 91.0%(61/67) respectively, there was no significant difference among the three groups (χ 2=0.01, P=0.997). The ulcer healing rate in three groups were 93.8%(61/65), 94.1%(64/68) and 95.5%(64/67) respectively, group B and group C were compared with group A, and the difference was not statistically significant(group B: group A P=1.000, group C: group A P=0.716).The incidence of adverse reactions in three groups was 21.4%(15/70), 7.1%(5/70) and 7.0%(5/71) respectively, the difference was statistically significant (χ 2=9.21, P=0.010). The incidence of adverse reactions in group B and C was significantly lower than that in group A (group B: group A χ 2=5.83, P=0.016; group C: groups A χ 2=5.99, P=0.014). Compare means of measurement data among the three groups use analysis of variance. Chi square test, Fisher exact probability method and split chi square test were used to compare the three groups of counting data. Conclusion:14-day Bifidobacterium tetravaccine tablets (live) and the second half of the treatment lasted for 7-day Bifidobacterium Bifidobacterium tetravaccine tablets (live), they are combined separately with bismuth quadruple therapy in the first eradication of Helicobacter pylori positive gastric ulcer patients can significantly reduce adverse reactions, but Bifidobacterium tetravaccine tablets (live) could not significantly improve the eradication rate, and had no promoting effect on the healing of gastric ulcer.

Preparation and use of the 225Ac- 213Bi generator / 中华核医学与分子影像杂志

Objective:To develop radiopharmaceuticals for targeted alpha therapy (TAT), a simple and useful 225Ac- 213Bi generator was developed to provide a short half-life α-emitter 213Bi. Methods:DIPEX resin was used as the stationary phase of the generator, a Sep-Pak Alumina N Plus Light Cartridge column was utilized as the column to construct the generator, and hydrochloric acid was used as the eluent. The γ spectrometer was used to determine the purity of the eluted 213Bi and verify the method to measure the radioactivity of 225Ac and 213Bi by using radioisotope calibrators. The elution curves of the generator at various settings were analyzed to find the best elute and storage conditions. Results:Using commercial 225Ac, 100 mg DIPEX resin and a Sep-Pak Alumina N Plus Light Cartridge column, a 225Ac- 213Bi generator with a column volume of 0.35 ml was constructed, which could be eluted 213Bi with a syringe drenched with hydrochloric acid. The produced 213Bi was pure, and the measured half-life was (45.75±0.12) min, which was consistent with the theoretical value (45.6 min). CRC ? calibrators with setting numbers of #086 and #018 could measure the activity of 225Ac and 213Bi with the average errors of -2.6% and + 0.2% respectively. The eluent for the 225Ac- 213Bi generator was 2 mol/L hydrochloric acid, of which 320 μl was required only to get 90% elution yield. The generator was recommended to be stored directly in the eluent to avoid drying. Conclusion:The 225Ac- 213Bi generator can be constructed to obtain 213Bi for TAT.

The exposure of antibiotics on the eradication of bismuth quadruple therapy in H.pylori infection / 中华内科杂志

Objective:To analyze the impact of previous exposure to macrolide, quinolones and nitroimidazole antibiotics on eradication rate of bismuth quadruple therapy (BQT) in newly diagnosed patients with Helicobacter pylori( H. pylori). Methods:A total of 469 patients with H. pylori initially treated at the Third Hospital of Peking University from September 2017 to August 2020 were retrospectively recruited. The therapeutic regimens were BQT containing clarithromycin/levofloxacin/metronidazole recommended by Chinese guidelines. Clinical data were collected, including general demographic data, exposure history of antibiotics, CYP2C16 metabolic pattern, endoscopic diagnosis, bacterial density, H.pylori resistance, eradication results, etc. Univariate analysis, Chi-square test, Fisher exact probability test, Kruskal-Wallis H test and Logistic regression model were used as statistical methods. Results:Among different eradication therapies, univariate and multivariate analyses suggested that previous exposure to macrolides ( OR=3.37,95 %CI 1.04-10.98, P<0.05) was relevant to the decreased eradication rate of BQT containing clarithromycin. This may be due to increased resistance to clarithromycin ( OR=6.12,95 %CI 3.99-9.40, P<0.01).The previous exposure to quinolones ( OR=3.65, 95 %CI 1.27-10.49, P<0.05) was relevant to the decreased eradication rate of BQT containing levofloxacin, which was probably explained by the increased resistance to levofloxacin ( OR=2.50, 95 %CI 1.69-3.71, P<0.01). But the previous history of nitroimidazole did not impact the efficacy of BQT containing metronidazole. Conclusions:In patients newly diagnosed with H.pylori infection, the previous exposure to macrolide or quinolones antibiotics is related to lower eradiation rates of H. pylori. Although the exposure to nitroimidazole also indicates drug resistance to metronidazole, the clinical efficacy of BQT with metronidazole 400 mg four times a day is not affected.

Application of 210Bi removal by anion exchange resin in 90Sr analysis / 中华放射医学与防护杂志

Objective:To overcome the disadvantages of bismuth removal by bismuth sulfide precipitation method recommended by existing analytical standards and improve the quality of analytical result.Methods:Based on 201×7 anion exchange resin, the experimental process of bismuth removal was designed, and verified by using spiked samples and IAEA test samples.Results:Bismuth was removed by anion exchange resin. In the removal experiments of strontium, yttrium and bismuth, the chemical recovery rate of strontium and yttrium could reach (98.6 ± 0.8)% and (98.5 ± 0.7)%, respectively, with no Bi 2S 3 precipitation found. The relative standard deviation between analytical result and theoretical values was -2.97% to 5.94%, better than 3.96%-17.8% by the standard bismuth removal method. Through validation using IAEA test samples, the relative standard deviation between the reported value and the target value for 90Sr was between 3.40%-7.09%, and all the results were acceptable. Conclusions:Bismuth could be quantitatively removed using anion exchange resin without adsorption of strontium and yttrium. In addition, the bismuth removal solution system of anion exchange resin was the same as the elution system in 90Sr analysis, and the purpose of rapid bismuth removal could be achieved without conversion system. Compared with the current standard analytical method, it was feasible and better to quantitatively remove bismuth based on anion exchange resin, which could meet the needs of routine analysis of 90Sr.

The phantom study of bismuth shielding combined with organ tube current modulation in brain CT / 中华放射医学与防护杂志

Objective:To evaluate the application value of bismuth shielding combined with organ tube current modulation (X-care) in brain CT scanning by measuring the radiation dose of sensitive organs.Methods:The head and neck phantom was scanned with Siemens dual source CT at the same volume CT dose index (CTDI vol) by X-care, bismuth shielding and x-care combined with bismuth shielding, and by dual energy CT angiography (DE-CTA) with and without bismuth shielding. The CT values of cerebral vessels, adjacent brain tissues and cerebrospinal fluid and image noise were measured, and the contrast noise ratio of cerebral vessels and brain parenchyma was calculated. Organ dose equivalent ( HT) was calculated by placing thermoluminescent personal dosimeter (TLD), and CTDI vol and dose length product (DLP) were recorded after each scan. Results:Under the same CTDI vol, the mean values of HT, lens with X-care, Bi shielding and X-care combined with Bi shielding were(37.89 ± 2.00), (42.20 ± 2.96) and (28.21 ± 1.31) mSv, respectively, significantly lower than those of conventional sequence scanning( F=186.52, P<0.05). The values of HT, thyroid with Bi shielding and X-care combined with Bi shielding were (0.77 ± 0.07) and (0.89 ± 0.08) mSv, lower than those of routine brain scan and X-care( F=103.26, P<0.05). The values of HT, lens and HT, thyroidof DE-CTA with bismuth shielding were (11.56 ± 1.04) and (0.32 ± 0.03) mSv, respectively, significantly lower than those without bismuth shielding( t=5.07, P<0.05). There was no significant difference in noise and CNR in routine brain scan between with and without X-care, bismuth shielding and X-care combined with bismuth shielding. There was no significant difference in noise and CNR in dual energy CTA scanning between with and without Bi shielding. Conclusions:Using bismuth shielding and organ tube current modulation, we can significantly reduce organ dose of lens and thyroid during brain CT scanning without sacrificing the image quality.

Dental discoloration caused by Grey-MTAFlow cement: analysis of its physicochemical, biological and antimicrobial properties

Abstract Tricalcium silicate-based cement are materials used in reparative and regenerative procedures in endodontics. A recently proposed formulation aimed to enhance handling during clinical use with a versatile material applicable by syringe. Although, the use of bismuth oxide as radiopacifier and grey raw powder are drawbacks considering aesthetics. Objectives Evaluate physicochemical, biological, and antimicrobial properties of Grey-MTAFlow (Ultradent) and assess whether the addition of zinc oxide (ZnO) prevents dentinal discoloration caused by bismuth oxide. Methodology Grey-MTAFlow was manipulated in 'thin' consistency for all tests. Luminosity, color change, ion migration to dentine, radiopacity, setting time, ISO 6876:2012 linear flow, volumetric lateral flow and central filling of simulated grooves scanned using micro-computed tomography (μCT), pH, calcium release, volumetric change using μCT, chemical characterisation, cytotoxicity, and antimicrobial activity were assessed. Addition of 5% ZnO to Grey-MTAFlow and a bismuth-containing experimental composition were comparatively tested. Statistical analyses used Shapiro-Wilk, T-test, ANOVA, and Kolmogorov-Smirnov (p<0.05). Results The addition of ZnO to Grey-MTAFlow prevented dentine darkening after 90 days due to bismuth migration reduction, although no statistical difference was found (p=0.863). ZnO addition significantly enhanced Grey-MTAFlow radiopacity without differences in initial setting time. Grey-MTAFlow presented an ISO linear flow of 10.9 mm and a balanced volumetric lateral flow with central filling in μCT evaluation. All compositions presented an alkaline pH after immersion. Grey-MTAFlow had a significantly higher calcium ion release after 28 days in comparison to 24 hours (p=0.011) and volumetric expansion of 0.4±1.8% after immersion. ZnO addition altered the hydrated cement matrix once calcium hydroxide (portlandite) could not be detected in characterisation. Neither of the materials produced inhibition halos nor reduced bacterial turbidity, but all presented cytocompatibility above 100%. Conclusion Grey-MTAFlow expanded after immersion and exhibited higher luminosity values after the evaluation period when ZnO was added, but chemical modifications after this addition occurred.

Therapeutic effect of bismuth potassium citrate combined with famotidine on peptic ulcer and its effects on lipid peroxide,malondialdehyde and somatostatin levels / 中国医师进修杂志

Objective To explore the therapeutic effect of bismuth potassium citrate combined with famotidine on peptic ulcer and its effects on the levels of lipid peroxide (LPO),malondialdehyde (MDA) and somatostatin (SS).Methods One hundred and fifty patients with peptic ulcer who were treated in Cixi Cilin Hospital from January 2018 to May 2019 were randomly divided into famotidine group and combined treatment group,with 75 cases in each group.Famotidine group was treated with famotidine,while bismuth potassium citrate combined with famotidine was used in combined treatment group.H+-K+-ATP ase activity,gastric acid-base value and gastric acid secretion function were detected in two groups.The levels of tumor necrosis factor-ot (TNF-α),interleukin-7 (IL-7),hypersensitive C-reactive protein (hs-CRP) were detected by ELISA,T lymphocyte subsets were detected by flow cytometry,and the levels of T lymphocyte subsets were detected by immunotransmission turbidimetry.The levels of LPO,MDA and SS were measured,and the therapeutic effect,ulcer healing and adverse reactions were compared between two groups.Results After treatment,the activity of H+-K+-ATP ase in the combined treatment group was lower than that in the famotidine group [(2.54 ± 0.41) μmol/min vs.(2.87 ± 0.50) μmol/min],the acid-base value in stomach was higher than that in the famotidine group (5.56 ± 1.19 vs.4.77 ± 0.89),and there were significant differences (P ＜ 0.05).After treatment,the levels of maximum gastric acid excretion after pentagastrin stimulation (MAO),peak gastric acid output (PAO),basal acid output (BAO),TNF-α,IL-17,hs-CRP,CD8+,LPO and MDA in combined treatment group were lower than those in famotidine group [(8.22 ± 1.76) mmol/h vs.(10.53 ± 2.21) mmol/h,(11.88 ± 2.51)mmol/h vs.(14.79 ± 2.76) mmol/h,(4.11 ± 1.32) mmol/h vs.(5.54 ± 1.49) mmol/h,(4.76 ± 1.52) ng/L vs.(6.91 ± 1.61) ng/L,(18.37 ± 3.25) ng/L vs.(22.83 ± 3.62) ng/L,(6.41 ± 1.81) mg/L vs.(8.67 ± 2.15) mg/L,0.287 6 ± 0.030 5 vs.0.325 5 ± 0.032 4,(0.06 ± 0.02) U/mg vs.(0.09 ± 0.03) U/mg,(10.19 ± 1.86) μmol/L vs.(13.25 ± 2.03) μmol/L],while the levels of CD3+,CD4+,SS were higher than those in the famotidine group [0.523 6 ± 0.040 9 vs.0.476 3 ± 0.039 5,0.356 6 ± 0.035 2 vs.0.315 8 ± 0.033 9,(14.59 ± 2.67)ng/L vs.(10.36 ± 2.31) ng/L],and there were significant differences (P＜0.05).The total effective rate and ulcer healing rate in combined treatment group were higher than those in famotidine group [93.33％ (70/75) vs.80.00％ (60/75),94.67％ (71/75) vs.82.67％ (62/75)] (P＜ 0.05).The incidence of adverse reactions in combined treatment group was slightly higher than that in famotidine group [16.00％(12/75)vs.13.33％ (10/75)],but there was no significant difference between the two groups (P＞0.05).Conclusions Bismuth potassium citrate combined with famotidine in the treatment of peptic ulcer patients can improve gastric acid secretion function,regulate gastric acid-base value,inhibit inflammatory response,improve immune function,and reduce oxidative stress injury.

Strive to Improve the Eradication Rate of Helicobacter pylori / 胃肠病学

As the awareness of the harmfulness of Helicobacter pylori (Hp) infection increases, the indications for Hp eradication continue to expand. "Kyoto Global Consensus Report on Helicobacter pylori Gastritis" puts forward "Hp infected individuals should be offered eradication therapy, unless there are competing considerations" and the statement has been accepted by more and more scholars. In our country, "the confirmed Hp infection" has been listed as an indication for eradication. However, as the antibiotic resistance rate of Hp increases, the eradication rate of Hp is gradually decreasing, and the proportion of people who has failed multiple treatments is increasing. This article was specially written for helping the clinicians to improve the eradication rate of Hp infection.

Therapeutic effect of bismuth potassium citrate combined with famotidine on peptic ulcer and its effects on lipid peroxide,malondialdehyde and somatostatin levels / 中国医师进修杂志

Objective@#To explore the therapeutic effect of bismuth potassium citrate combined with famotidine on peptic ulcer and its effects on the levels of lipid peroxide (LPO), malondialdehyde (MDA) and somatostatin (SS).@*Methods@#One hundred and fifty patients with peptic ulcer who were treated in Cixi Cilin Hospital from January 2018 to May 2019 were randomly divided into famotidine group and combined treatment group, with 75 cases in each group. Famotidine group was treated with famotidine, while bismuth potassium citrate combined with famotidine was used in combined treatment group. H+-K+-ATP ase activity, gastric acid-base value and gastric acid secretion function were detected in two groups. The levels of tumor necrosis factor-α (TNF-α), interleukin-7 (IL-7), hypersensitive C-reactive protein (hs-CRP) were detected by ELISA, T lymphocyte subsets were detected by flow cytometry, and the levels of T lymphocyte subsets were detected by immunotransmission turbidimetry. The levels of LPO, MDA and SS were measured, and the therapeutic effect, ulcer healing and adverse reactions were compared between two groups.@*Results@#After treatment, the activity of H+-K+-ATP ase in the combined treatment group was lower than that in the famotidine group [(2.54 ± 0.41) μmol/min vs. (2.87 ± 0.50) μmol/min], the acid-base value in stomach was higher than that in the famotidine group(5.56 ± 1.19 vs. 4.77 ± 0.89), and there were significant differences (P<0.05). After treatment, the levels of maximum gastric acid excretion after pentagastrin stimulation (MAO), peak gastric acid output (PAO), basal acid output (BAO), TNF-α, IL-17, hs-CRP, CD8+, LPO and MDA in combined treatment group were lower than those in famotidine group [(8.22 ± 1.76) mmol/h vs. (10.53 ± 2.21) mmol/h, (11.88 ± 2.51)mmol/h vs. (14.79 ± 2.76) mmol/h, (4.11 ± 1.32) mmol/h vs. (5.54 ± 1.49) mmol/h, (4.76 ± 1.52) ng/L vs.(6.91 ± 1.61) ng/L, (18.37 ± 3.25) ng/L vs. (22.83 ± 3.62) ng/L, (6.41 ± 1.81) mg/L vs. (8.67 ± 2.15) mg/L, 0.287 6 ± 0.030 5 vs. 0.325 5 ± 0.032 4, (0.06 ± 0.02) U/mg vs. (0.09 ± 0.03) U/mg, (10.19 ± 1.86) μmol/L vs. (13.25 ± 2.03) μmol/L], while the levels of CD3+, CD4+, SS were higher than those in the famotidine group [0.523 6 ± 0.040 9 vs. 0.476 3 ± 0.039 5, 0.356 6 ± 0.035 2 vs. 0.315 8 ± 0.033 9, (14.59 ± 2.67) ng/L vs. (10.36 ± 2.31) ng/L], and there were significant differences (P<0.05). The total effective rate and ulcer healing rate in combined treatment group were higher than those in famotidine group [93.33%(70/75) vs. 80.00%(60/75), 94.67%(71/75) vs. 82.67%(62/75)] (P<0.05). The incidence of adverse reactions in combined treatment group was slightly higher than that in famotidine group [16.00%(12/75) vs. 13.33%(10/75)], but there was no significant difference between the two groups (P>0.05).@*Conclusions@#Bismuth potassium citrate combined with famotidine in the treatment of peptic ulcer patients can improve gastric acid secretion function, regulate gastric acid-base value, inhibit inflammatory response, improve immune function, and reduce oxidative stress injury.

Effect of 7-day Bismuth Quadruple Therapy versus 14-day Moxifloxacin Triple Therapy for Second-line Helicobacter pylori Eradication Therapy / 대한소화기학회지

BACKGROUND/AIMS: Both bismuth-containing quadruple therapy and moxifloxacin-containing triple therapy have been suggested as second-line eradication therapy for Helicobacter pylori (H. pylori) infection. We aimed to evaluate the efficacy of 14-day moxifloxacin-containing triple therapy (14-EAM) in second-line H. pylori eradication in comparison to 7-day bismuth-containing quadruple therapy (7-RBMT). METHODS: From January 2011 to December 2015, a total of 569 patients who failed to respond to first-line triple therapy and who subsequently received second-line 7-RBMT or 14-EAM were retrospectively enrolled. The eradication rates were identified using per-protocol (PP) analysis. H. pylori eradication was confirmed by a 13C-urea breath test (UBiT-IR300®; Otsuka Electronics, Co., Ltd., Osaka, Japan) or a rapid urease test (CLOtest®; Delta West, Bentley, Australia) at least 4 weeks after completion of eradication therapy. RESULTS: A total of 487 and 82 patients received 7-RBMT and 14-EAM, respectively. PP eradication rates were 93.6% (366/391; 95% CI, 91.0–95.9%) with 7-RBMT and 73.8% (48/65; 95% CI, 63.1–84.6%) with14-EAM (p < 0.001). Therefore, the eradication rates with 7-RBMT were significantly higher than with 14-EAM according to the PP analysis. The adverse event rate was 17.1% (67/391) with 7-RBMT and 7.7% (5/65) with 14-EAM (p=0.065). In terms of risk factors, multivariate analysis revealed that 14-EAM (OR, 5.47; 95% CI, 2.74–10.93) was related to H. pylori eradication failure. CONCLUSIONS: 7-RBMT may be an effective second-line therapy in patients who failed to respond to first-line triple therapy in Korea, where there is a high prevalence of H. pylori infection.

Preparation of folate-targeted phase-transition nanoparticles carrying bismuth sulfide and application in CT/ultrasound imaging in vitro / 中国介入影像与治疗学

Objective To prepare folate-targeted phase-transition nanoparticles carrying bismuth sulfide (FBS-PFH-NPs), in order to use for targeting performance and CT/ultrasound (US) imaging in vitro. Methods Rotary evaporator and probe-type sonication methods were used to prepare FBS-PFH-NPs. Basic characteristics of FBS-PFH-NPs were detected using several analytical methods. The targeting performance of FBS-PFH-NPs was verified through incubation with cervical cancer Hela cells in vitro. The echo intensity and temperature variation of FBS-PFH-NPs were observed after irradiating with HIFU using different acoustic powers (60, 90, 120, 150 and 180 W), respectively. The effects of FBS-PFH-NPs with different Bi2S3 concentrations (1.0, 2.0, 3.0, 4.0 and 5.0 mg/ml) for enhancing CT/US imaging were investigated. Results FBS-PFH-NPs were prepared with diameter (458.50±69.22)nm, which showed regular spherical morphology and uniform size under microscope. Bi2S3 nanoparticles randomly distributed in the lipid shell, and the concentration of Bi2S3 was 1.0 mg/ml. A mass of FBS-PFH-NPs was bond to Hela cells. The phase-transition of FBS-PFH-NPs occurred after irradiation with HIFU. The echo intensities and temperature of FBS-PFH-NPs gradually enhanced with increased HIFU powers (F=110.09, 440.69, both P<0.01). The echo intensities and CT value of FBS-PFH-NPs gradually enhanced with increased Bi2S3 concentrations (F=146.14, 16.74, both P<0.01). Conclusion FBS-PFH-NPs can not only target to Hela cell specifically, but also be applied in CT/US dual-modal imaging in vitro.

Evaluation of different staging methods on radical resection rate and prognosis of patients with hilar cholangiocarcinoma / 中华肝胆外科杂志

Objective@#To compare the Bismuth-Corlette typing, modified T-staging and Mayo staging system in predicting the radical resection rates and prognosis of patients with hilar cholangiocarcinoma (HCC).@*Methods@#The clinical data of 138 patients with hilar cholangiocarcinoma treated in the First Bethune Hospital of Jilin University were retrospectively analyzed. Three different staging methods were used.@*Results@#With increase in the classification level of the Bismuth-Corlette classification, the radical resection rate did not significantly decrease (P>0.05). The radical resection rates of stage T1, T2 and T3 in the modified T-staging system were 60.0% (27/45), 36.0% (10/28) and 14.0% (9/65) respectively (all P<0.05). The radical resection rates of patients in the stages I, II, III, IV of the Mayo Staging System were 86.0% (12/14), 50.0% (14/28), 29.0% (19/66) and 3/0% (1/30) respectively (all P<0.05). The overall survival time were no significant differences between the different Bismuth-Corlette and the modified T-staging system patients (P>0.05). However, there were significant differences among the survival rates in the various tumor staging levels using the Mayo Staging System.@*Conclusions@#The modified T-staging system and the Mayo staging system were more accurate than the Bismuth-Corlette typing system in predicting radical resection rates in patients with hilar cholangiocarcinoma. The Mayo staging system was superior to the Bismuth-Corlette typing system and the modified T-staging system in predicting prognosis of patients with hilar cholangiocarcinoma.

Curative effect of teprenone capsule combined with quadruple therapy in the treatment of chronic atrophic gastritis / 中国基层医药

Objective To analyze the curative effect of teprenone capsule combined with quadruple therapy in the treatment of chronic atrophic gastritis.Methods From June 2013 to June 2017,one hundred and fifty patients with chronic atrophic gastritis admitted to the First Hospital of Ninghai County were retrospectively selected.According to different treatment schemes,they were divided into control group and observation group,with 75 patients in each group.The control group was treated with routine quadruple therapy, and the observation group was treated with teprenone capsule combined with quadruple therapy.The effective rate of the two groups was compared.Results The total effective rate of the observation group was 97.33% ,which was higher than 85.33% of the control group,the difference between the two groups was statistically significant(χ2 =3.197,P<0.05).After treatment,the levels of interleukin-8 and tumor necrosis factor - alpha in the observation group were ( 7.04 ± 1.03 ) ng/L, ( 41.02 ± 1.72)ng/L,respectively,which in the control group were (10.81 ± 1.63)ng/L,(57.35 ± 2.95) ng/L,respectively, the differences between the two groups were statistically significant (t=6.028,7.281,all P <0.05).The gastric mucosa score and the gastrin concentration in the observation group were (1.13 ± 0.32)points,(8.97 ± 2.33)pmol/L, respectively,which in the control group were ( 1. 82 ± 0. 61 ) points, ( 5. 36 ± 1. 52 ) pmol/L, respectively, the differences between the two groups were statistically significant ( t =5. 661, 6. 024, all P <0. 05 ). Conclusion Teprenone capsule combined with quadruple therapy can improve the clinical efficacy and reduce the degree of inflammation in patients with chronic atrophic gastritis,which is worthy of clinical application.

Efficacy and Safety of AlbisD Compared With Omeprazole 20 mg in Patients With Non-erosive Reflux Disease: A Randomized, Open-label, Active-controlled, Pilot Study

BACKGROUND/AIMS: Proton pump inhibitors (PPIs) are frequently used to treat non-erosive reflux disease (NERD), but their effect is limited. It is not known whether a potential alternative, AlbisD, containing ranitidine hydrochloride, sucralfate hydrate, and tripotassium dicitrato bismuthate, is effective and safe in treating NERD. The aim of the study is to evaluate the efficacy and safety of AlbisD compared with omperazole in patients with NERD. METHODS: This was a multicenter, randomized, open-label, parallel-group, non-inferiority comparative study. A total of 126 patients with NERD were randomly allocated to either AlbisD twice daily or omeprazole 20 mg once daily for 4 weeks from February 2016 to August 2016. The study patients had histories of heartburn or regurgitation of moderate severity (> score 2) and a frequency of at least 2 episodes per week, and had no mucosal breaks of the esophagus on endoscopy. The primary efficacy variable was complete cure of heartburn at week 4. Secondary efficacy variables evaluating symptoms of heartburn and acid reflux as well as safety profiles were compared in the 2 groups at week 2 and 4 after treatment. RESULTS: A total of 113 patients completed the study (57 and 56 in AlbisD and omeprazole groups, respectively). The proportion of patients with complete cure of heartburn at week 4 was not significantly different between the AlbisD and omeprazole groups (35.1% vs 32.1% respectively, P = 0.740). There were no significant differences between the 2 groups in the any secondary variables including proportions of days without heartburn or acid reflux over 4 weeks (including daytime and nighttime). Adverse events were similarly reported in the 2 groups (7 [12.3%] vs 6 [10.7%]), and there were no serious adverse events. CONCLUSIONS: The efficacy and safety of AlibsD in treating NERD patients are not inferior to those of omeprazole. Therefore, AlbisD can be an alternative to PPIs for NERD.