A randomized, multicenter and noninferiority study of amoxicillin plus berberine vs tetracycline plus furazolidone in quadruple therapy for Helicobacter pylori rescue treatment.

OBJECTIVE: Helicobacter pylori (H. pylori) infection is closely associated with gastric ulcers and gastric adenocarcinomas. We aimed to assess the efficacy and safety of a quadruple regimen with amoxicillin plus berberine vs tetracycline plus furazolidone in rescue therapy for H. pylori eradication. METHODS: We conducted a randomized, open-label, multicenter, noninferiority trial. Patients with previous treatment failures recruited from five centers were randomized (1:1) to receive a regimen with esomeprazole and bismuth plus either berberine and amoxicillin (the BA group) or tetracycline and furazolidone (the TF group) for 14 days. Their H. pylori infection status was confirmed 4-8 weeks after treatment. The primary outcome was the eradication rate. The secondary outcomes included the rates of symptom improvement, compliance, and adverse events. This study was registered at ClinicalTrials.gov (NCT03609892). RESULTS: Altogether 658 participants were consecutively enrolled. An intention-to-treat analysis demonstrated that the two regimens achieved a similar eradication rate (76.3% vs 77.5%; P = 0.781). The per-protocol analysis reached a similar result (81.5% vs 85.0%; P = 0.278). The eradication rate reached in the BA group was greater than the pre-established margin of noninferiority, at -10% (the lower bounds of the 95% CI were -7.66% and -9.43%, respectively). The rate of adverse events was lower for the BA group than the TF group (18.5% vs 26.1%, P = 0.024). Rates of compliance and symptom improvement were similar for the two therapies. CONCLUSION: The efficacy of both regimens in rescue treatment for H. pylori eradication was satisfactory, 14-day BA-based quadruple therapy is noninferior to the TF-based therapy.

[Anti-arrhythmic research situation and thinking of traditional Chinese medicine monomer].

The basic physiological function of anti-arrhythmic drugs is affects myocardial cell membrane ion channels. Change the ion flow and affect cell electrophysiological properties, change the conduction velocity, eliminate retrace, inhibit autorhythmicity and trigger events, inhibit the occurrence of arrhythmia, but will trigger a new activities, new retrace, produce new arrhythmia. In recent years, with the improvement of the theoretical system of traditional Chinese medicine and the production of new research methods, Chinese medicine treatment of arrhythmia has a new development. This article summarized the recent decades of which Chinese medicine monomer anti-arrhythmic drugs that had been proved by the influence of monomer anti-arrhythmic drugs, lists the differents traditional Chinese medicinal materials which chemical composition and the effective of the anti-arrhythmic effects, shows the unique advantages of Chinese medicine in the aspect of anti-arrhythmic, and points out that the current Chinese medicine in anti-arrhythmic (monomer) existing problems and solutions.

[Study of correlation between Helicobacter pylori infection and hyperammonemia and hepatic encephalopathy in cirrhotic patients].

OBJECTIVE: To evaluate the relationship among helicobacter pylori (HP) infection, blood ammonia concentrations, and hepatic encephalopathy (HE) status, and to investigate the effect of HP eradication on blood ammonia levels and HE status in cirrhotic patients. METHODS: Three hundred and sixty-eight cirrhotic patients were enrolled. Patients were evaluated for the demographic profile, number connection test (NCT), HP infection, Child-Pugh degree of liver dysfunction, blood ammonia concentration and status of mentation. Patients with HP infection were given one week therapy with omeprazole plus clarithromycin and amoxicillin. (13)C urea breath test was performed, and the mental symptoms and blood ammonia levels were reassessed after the eradication therapy. RESULTS: (1) The overall HP infection rate was 70.1% (258/368 cases), and HE positive in 51.4%(189/368 cases). Subclinical hepatic encephalopathy (SHE) was diagnosed in 85 out of 19(47.5%) cirrhotics patients. (2) Blood ammonia concentrations in HP negative and HP positive cirrhotics were (52.7+/-49.8)micromol/L and (79.3+/-61.8)micromol/L, respectively (P<0.01), and it was significantly reduced to (52.6+/-36.5) micromol/L after HP eradication therapy (P<0.01). HE was more frequently found in patients with HP infection than without it (59.6% vs. 31.8%, P<0.01). HE rate were significantly dropped to 32.8% after HP eradication (P<0.01). (3)HP prevalence rate was significantly different among cirrhotics with HE (81.5%),those with SHE (68.5%), or without HE (53.9%)(P<0.05). The level of blood ammonia had significantly difference among the cirrhotics with HE [(96.6+/-78.2)micromol/L], those with SHE [(60.5+/-50.4)micromol/L], or without HE[(46.8+/-36.4)micromol/L, both P<0.05]. CONCLUSION: HP infection aggravates elevated blood ammonia concentration and hepatic encephalopathy in cirrhotic patients. HP eradication may be helpful in the treatment and prevention of HE in cirrhotic patients.