Bismuth, esomeprazole, metronidazole, and minocycline or tetracycline as a first-line regimen for Helicobacter pylori eradication: A randomized controlled trial / 中华医学杂志(英文版)

BACKGROUND@#Given the general unavailability, common adverse effects, and complicated administration of tetracycline, the clinical application of classic bismuth quadruple therapy (BQT) is greatly limited. Whether minocycline can replace tetracycline for Helicobacter pylori ( H . pylori ) eradication is unknown. We aimed to compare the eradication rate, safety, and compliance between minocycline- and tetracycline-containing BQT as first-line regimens.@*METHODS@#This randomized controlled trial was conducted on 434 naïve patients with H . pylori infection. The participants were randomly assigned to 14-day minocycline-containing BQT group (bismuth potassium citrate 110 mg q.i.d., esomeprazole 20 mg b.i.d., metronidazole 400 mg q.i.d., and minocycline 100 mg b.i.d.) and tetracycline-containing BQT group (bismuth potassium citrate/esomeprazole/metronidazole with doses same as above and tetracycline 500 mg q.i.d.). Safety and compliance were assessed within 3 days after eradication. Urea breath test was performed at 4-8 weeks after eradication to evaluate outcome. We used a noninferiority test to compare the eradication rates of the two groups. The intergroup differences were evaluated using Pearson chi-squared or Fisher's exact test for categorical variables and Student's t -test for continuous variables.@*RESULTS@#As for the eradication rates of minocycline- and tetracycline-containing BQT, the results of both intention-to-treat (ITT) and per-protocol (PP) analyses showed that the difference rate of lower limit of 95% confidence interval (CI) was >-10.0% (ITT analysis: 181/217 [83.4%] vs . 180/217 [82.9%], with a rate difference of 0.5% [-6.9% to 7.9%]; PP analysis: 177/193 [91.7%] vs . 176/191 [92.1%], with a rate difference of -0.4% [-5.6% to 6.4%]). Except for dizziness more common (35/215 [16.3%] vs . 13/214 [6.1%], P = 0.001) in minocycline-containing therapy groups, the incidences of adverse events (75/215 [34.9%] vs . 88/214 [41.1%]) and compliance (195/215 [90.7%] vs . 192/214 [89.7%]) were similar between the two groups.@*CONCLUSION@#The eradication efficacy of minocycline-containing BQT was noninferior to tetracycline-containing BQT as first-line regimen for H . pylori eradication with similar safety and compliance.@*TRIAL REGISTRATION@#ClinicalTrials.gov, ChiCTR 1900023646.

Research on labial and lingual alveolar bone plate thickness of the mandibular anterior teeth by CBCT / 实用放射学杂志

Objective To investigate labial and lingual alveolar bone plate thickness of the mandibular anterior teeth by using cone-beam computed tomography (CBCT),in order to provide a reference for immediate implantation.Methods 132 individuals with normal occlusion were examined with CBCT,and their mandibular anterior teeth were analyzed.The labial and lingual alveolar bone plate thickness at the level of the apical,1/4 of the apical,1/2 of the middle and 1/4 of the cervical were measured.The differences of the thickness were compared among the side and gender.Results There were no significant differences between the left and right sides. Except on the 1/4 of the cervical,the thickness of lingual bone plate was thicker than that of labial bone plate.The frequency of the thickness of the labial bone larger than 2 mm on the 1/4 of the cervical of the center incisor,lateral incisor,and canine were 0,0 and 1.5 1%,respectively,and on 1/4 of the middle were 0.76%,1.44% and 3.79%,respectively.The lingual bone plate thickness showed significant difference between genders.Conclusion Reference values of alveolar bone plate thickness in anterior teeth of normal occlusion were established by using CBCT,which can provide clinical instruction for immediate implant.

Measurement of mandibular incisive canal by cone beam CT / 中华放射学杂志

Objective This study was conducted to measure the mandibular incisive canal (MIC) by cone beam computed tomography(CBCT)and to assess 3?dimensional structure, course and adjacent structure of the MIC , in order to ensure safe region for surgery of the mandibular interforaminal area. Methods A total of the CBCT images from 83 patients were studied and measured. The detection rates of MIC were calculated The diameter of the MIC and the distances from MIC to the labial and lingual cortices and the inferior border of the mandible and tooth tips were measured at canines and lateral incisors. Results MIC was found in 67.8%of the patients. In the position of canine, the diameter of MIC, the mean distance of the MIC to the tips of the teeth, to the buccal border of the mandible , to the lingual border of the mandible and the inferior border of the mandible were (1.3±0.4), (8.9±2.9), (4.3±0.9), (5.2±1.1) and (8.6± 1.5) mm, respectively. In the position of the incisor, the distance of MIC, the mean distance of the MIC to the tips of the teeth, to the buccal border of the mandible , to the lingual border of the mandible and the inferior border of the mandible were (1.0 ± 0.3), (13.3 ± 4.0), (4.2 ± 0.9), (5.9 ± 0.9) and (8.9 ± 1.8) mm, respectively. Conclusion CBCT clearly show three dimensional structure, course and adjacent structure of the MIC. Preoperative CBCT can provide vital information for surgery of the mandibular interforaminal area.

The effects of pronase on drugs concentrations for treatment of Helicobacter pylori infection in gastric tissue / 中华内科杂志

Objective To evaluate the effect of pronase on amoxicillin and metronidazole concentrations in gastric tissue. Methods C57BL/6 mice were randomly divided into experimental group ( n = 70 ) and control group ( n = 70 ) . Amoxicillin ( 28. 6 mg/kg ) , metronidazole ( 22. 5 mg/kg) and omeprazole (138.2 mg/kg) were administered orally to C57BL/6 mice, combined with pronase (110 mg/kg) or same amount of sterile PBS. Gastric tissue and blood plasma samples were taken at 10 point-in time (7 mice/time) from 15 min up to 360 min after administration. Concentrations of amoxicillin and metronidazole were detected by high performance liquid chromatography. Gastritis index of gastric mucosa ( hematoxylin-eosin staining) and the gastric tissue expressions of mucin 5 AC (Western blot) were detected at 120 min and 360 min after administration. Results The time to peak concentration of amoxicillin and metronidazole in gastric tissue appeared earlier than that in blood plasma (15 min vs 60 min). Tissue concentrations of amoxicillin and metronidazole of experimental group were significantly higher than those of control, and they were mainly at 15 min to 90 min (P ＜0. 05). Plasma concentrations of amoxicillin and metronidazole of experimental group at 15 min and 30 min were higher than those of control ( P ＜ 0. 05 ). There was no difference in gastritis index between experimental group and control at 120 min and 360 min after administration (0.28±0. 18 vs 0. 14 ±0. 14,P＞0.05; 0. 43 ±0. 20 vs 0. 28 ±0. 18,P ＞0. 05). The expressions of mucin 5 AC in experimental group were lower than those of control ( 0. 036 ± 0. 006 vs 0. 197 ± 0. 058; P ＜0. 05; 0. 039 ± 0. 008 vs 0. 208 ± 0. 072, P ＜ 0. 05 ). Conclusions Pronase can significantly enhance the drugs penetration from mucus into gastric tissue. Concentrations of amoxicillin and metronidazole of experimental group in local gastric tissue and plasma are higher than those of control, especially in improving concentrations of gastric tissue and prolongation of exposed time.