Analysis of the detection rate and clinical characteristics of early gastric cancer by painless gastroscopy and ordinary gastroscopy.

OBJECTIVE: To investigate the difference of early gastric cancer (EGC) detection rate and endoscopic characteristics between painless and ordinary electronic gastroscopy, and summarize the clinical data of gastric cancer (GC) patients. METHODS: Clinical data of 72,000 patients who underwent gastroscopy in the First People Hospital of Huzhou (Zhejiang, China) from January 2016 to December 2021 were retrospectively analyzed. The patients were divided into painless gastroscopy group (observation group, 36,000 cases) and ordinary gastroscopy group (control group, 36,000 cases) according to the examination methods. The detection rate of EGC between the 2 groups and the endoscopic characteristics of EGC lesions between the 2 groups were compared, and the clinical data of GC were summarized. RESULTS: Painless gastroscopy is safer than ordinary gastroscopy. The detection rate of GC and EGC in the observation group was significantly higher than that in the control group (P < .05); the difference between the 2 groups in the detection rate of advanced GC was not statistically significant. The average length of EGC lesions in the observation group was significantly shorter than that in the control group (P < .05). The proportion of EGC with lesion length <2.0 cm in the observation group was significantly higher than that in the control group (P < .05). The proportion of EGC lesions with type II morphology, normal or pallor mucosal color, and no rupture in mucosa in the control group were significantly lower than that in the observation group, respectively (P < .05). The proportion of EGC distributed in the cardia, fundus and corpus was higher in the observation group than in the control group (P < .05). The incidence of helicobacter pylori (HP) infection, precancerous diseases, first-degree relatives of GC patients, and risk factors in patients with GC was significantly higher than that in non-GC patients (P < .05), multivariate logistic regression analysis showed that these were independent influencing factors for the occurrence of GC. CONCLUSION: Painless gastroscopy can effectively improve the screening and diagnostic efficiency of EGC, especially for EGC lesions that are not easy to expose the site, small in size, superficial, without obvious mucosal color change or without mucosal breakage. Therefore, the value of painless gastroscopy in EGC screening is worth further promotion and research.

Postoperative encapsulated hemoperitoneum in a patient with gastric stromal tumor treated by exposed endoscopic full-thickness resection: A case report.

BACKGROUND: Gastric stromal tumors, originating from mesenchymal tissues, are one of the most common tumors of the digestive tract. For stromal tumors originating from the muscularis propria, compared with conventional endoscopic submucosal dissection (ESD), endoscopic full-thickness resection (EFTR) can remove deep lesions and digestive tract wall tumors completely. However, this technique has major limitations such as perforation, postoperative bleeding, and post-polypectomy syndrome. Herein, we report a case of postoperative serous surface bleeding which formed an encapsulated hemoperitoneum in a patient with gastric stromal tumor that was treated with exposed EFTR. Feasible treatment options to address this complication are described. CASE SUMMARY: A 47-year-old male patient had a hemispherical protrusion found during gastric endoscopic ultrasonography, located at the upper gastric curvature adjacent to the stomach fundus, with a smooth surface mucosa and poor mobility. The lesion was 19.3 mm × 16.1 mm in size and originated from the fourth ultrasound layer. Computed tomography (CT) revealed no significant evidence of lymph node enlargement or distant metastasis. Using conventional ESD technology for mucosal pre-resection, exposed EFTR was performed to resect the intact tumor in order to achieve a definitive histopathological diagnosis. Based on its morphology and immunohistochemical expression of CD117 and DOG-1, the lesion was proven to be consistent with a gastric stromal tumor. Six days after exposed EFTR, CT showed a large amount of encapsulated fluid and gas accumulation around the stomach. In addition, gastroscopy suggested intracavitary bleeding and abdominal puncture drainage indicated serosal bleeding. Based on these findings, the patient was diagnosed with serosal bleeding resulting in encapsulated abdominal hemorrhage after exposed EFTR for a gastric stromal tumor. The patient received combined treatments, such as hemostasis under gastroscopy, gastrointestinal decompression, and abdominal drainage. All examinations were normal within six months of follow-up. CONCLUSION: This patient developed serous surface bleeding in the gastric cavity following exposed EFTR. Serosal bleeding resulting in an encapsulated hemoperitoneum is rare in clinical practice. The combined treatment may replace certain surgical techniques.

ABLIM1, a novel ubiquitin E3 ligase, promotes growth and metastasis of colorectal cancer through targeting IĸBα ubiquitination and activating NF-ĸB signaling.

Actin-binding LIM protein 1 (ABLIM1), a member of the LIM-domain protein family, has been reported as a suppressor in several tumors whereas its role in colorectal cancer (CRC) remains unknown. In this study, we find that ABLIM1 is up-regulated in CRC patients and high levels of ABLIM1 predict short disease-free survival time. Knock-down of ABLIM1 in CRC cell lines by lenti-virus leads to inhibited cell proliferation, migration, and invasion capabilities in vitro and impaired growth of tumor xenografts and liver metastasis lesions in vivo, while ABLIM1 overexpression accelerates tumor growth and invasion in vitro. Mechanistically, we uncover that ABLIM1 activates the NF-ĸB/CCL-20 signaling through modulating IĸBα ubiquitination and proteasomal-mediated degradation. Further co-immunoprecipitation, in vivo and in vitro ubiquitination assays reveal ABLIM1 as a novel ubiquitin E3 ligase binding to IĸBα. Interestingly, The E3 ligase catalysis activity of ABLIM1 depends on its 402-778aa rather than its LIM domains and its interaction with IĸBα relies on the HP domain. Our findings delineate the oncogenic role of ABLIM1 in CRC progression and reveal it as a novel E3 ligase targeting IĸBα, providing new insights into the regulation of NF-ĸB signaling in tumors.

Factors influencing age at onset of colorectal polyps and benefit-finding after polypectomy.

Screening, followed by colonoscopic polypectomy, has been widely performed in China. However, factors influencing age at onset of colorectal polyps and benefit-finding after polypectomy have been insufficiently studied or ignored. A total of 152 patients with colorectal polyps first detected in First Affiliated Hospital of Huzhou University from July to September 2022 were enrolled in this study. We selected 11 factors associated with the risk of colorectal polyps, including gender, body mass index, occupational stress, education level, income satisfaction, smoking, alcohol consumption, exercise frequency, diet, family history and polyp characteristics. Benefit-finding after polypectomy was obtained by follow-up for 142 of these patients. Multivariate linear regression analysis showed that being overweight (i.e., body mass index ≥25 kg/m2), higher education level, lower exercise frequency, and refrigerated food preference were associated with early-onset colorectal polyps. Patients with a preference for pickled food and age ≥50 years at first colorectal polyp detection had lower benefit findings after colonoscopic polypectomy. Colorectal polyps may develop earlier in people who are overweight, well-educated, exercise less, and prefer refrigerated food. In addition, patients who prefer pickled food and age at onset ≥50 years have lower benefit-finding requiring more attention in future colonoscopy follow-ups.

Competition mechanism of exciton decay channels in the stacked multilayer tungsten sulfide.

The competition mechanism of exciton decay channels in the multilayer TMDs remains poorly understood. Here, the exciton dynamics in the stacked WS2 was studied. The exciton decay processes are divided into the fast and slow decay processes, which are dominated by the exciton-exciton annihilation (EEA) and defect-assisted recombination (DAR), respectively. The lifetime of EEA is on the order of hundreds of femtoseconds (400∼1100 fs). It is decreased initially, followed by an increase with adding layer thickness, which can be attributed to the competition between phonon-assisted effect and defect effect. The lifetime of DAR is on the timescale of hundreds of picoseconds (200∼800 ps), which is determined by the defect density especially in a high injected carrier density.

An unexpected complication of prophylactic esophageal stenting: esophageal stent impaction after thread dislocation

A 47-year-old woman was referred to our department with opportunistic endoscopic findings of two submucosal esophageal bulges, approximately half the circumference of the esophagus, both nearly 2.0 cm in size, and 24-27 cm from the incisors. Ultrasound endoscopy diagnosed smooth muscle tumors originating from the muscularis propria layer and she next underwent submucosal tunneling endoscopic resection. Intraoperatively, part of the tumor could not be separated from the muscularis propria layer and a U-shaped tumor was finally resected. A fully covered self-expanding esophageal nitinol stent was then inserted, covering the full circumference esophageal mucosa. The stent was fixed by ears with knotted thread and proton pump inhibitors were given for 1 week. (AU)

An unexpected complication of prophylactic esophageal stenting: esophageal stent impaction after thread dislocation.

A 47-year-old woman was referred to our department with opportunistic endoscopic findings of two submucosal esophageal bulges, approximately half the circumference of the esophagus, both nearly 2.0 cm in size, and 24-27 cm from the incisors. Ultrasound endoscopy diagnosed smooth muscle tumors originating from the muscularis propria layer and she next underwent submucosal tunneling endoscopic resection. Intraoperatively, part of the tumor could not be separated from the muscularis propria layer and a U-shaped tumor was finally resected. A fully covered self-expanding esophageal nitinol stent was then inserted, covering the full circumference esophageal mucosa. The stent was fixed by ears with knotted thread and proton pump inhibitors were given for 1 week.

A Single-Center Retrospective Study to Compare the Efficacy and Safety of Modified FOLFIRINOX with S-1 as Adjuvant Chemotherapy in 71 Patients with Resected Pancreatic Carcinoma.

BACKGROUND Studies are ongoing to determine the optimal adjuvant chemotherapy (ACT) for resected pancreatic carcinoma (PC). FOLFIRINOX is a chemotherapy regimen including oxaliplatin, irinotecan, leucovorin, and 5-fluorouracil (5-FU). S-1 is a fluoropyrimidine derivative widely used as ACT for gastrointestinal malignancy. This single-center retrospective study aimed to compare the efficacy and safety of modified FOLFIRINOX (mFOLFIRINOX) with S-1 as ACT for resected PC. MATERIAL AND METHODS A total of 71 patients with PC who accepted ACT after R0 resection between February 2016 and January 2019 were enrolled in this retrospective study. Among these patients, 34 received mFOLFIRINOX regimen chemotherapy (mFFX group), while 37 received S-1 monochemotherapy (S-1 group). The mFOLFIRINOX regimen included oxaliplatin 65 mg/m², leucovorin 400 mg/m², irinotecan 150 mg/m², 5-FU 400 mg/m², and continuous 5-FU 2400 mg/m² (for 46 h), in a 2-week schedule. The S-1 monochemotherapy (80-120 mg/day according to body surface area [BSA], in 2 divided doses for 2 week) was administrated every 3 weeks. We followed up these patients and analyzed the relapse-free survival (RFS), overall survival (OS), and chemotherapy-induced adverse events (AEs). RESULTS The mFFX group demonstrated a markedly higher 3-year RFS (P=0.0332) and OS (P=0.0346) than the S-1 group. Patients in the mFFX group experienced significantly more common and severe thrombocytopenia (P=0.0372), fatigue (P=0.0226), nausea/vomiting (P=0.0337), and diarrhea (P=0.0018). No chemotherapy-induced death was documented. CONCLUSIONS This retrospective study indicated that if dose adjustment and adverse events management are properly administrated, mFOLFIRINOX regimen chemotherapy could result in an improved survival compared with S-1 monochemotherapy for resected PC.

Effect of Shengbai Decoction on Chemotherapy-Induced Myelosuppression and Survival of Gastric Cancer Patients After Radical Resection: A Retrospective Study.

BACKGROUND Myelosuppression is one of the most common chemotherapy-induced adverse events and results in a series of clinical symptoms. This study aimed to evaluate the effect of Shengbai decoction (SD) on chemotherapy-induced myelosuppression and survival of gastric cancer (GC) patients after radical resection. MATERIAL AND METHODS We retrospectively analyzed data from 115 patients with stage II-III GC who underwent adjuvant chemotherapy after radical resection between May 2015 and June 2017 in our hospital. Among these patients, 57 received Shengbai decoction along with adjuvant chemotherapy (SD group), while 58 received adjuvant chemotherapy alone (control group). Medical records, including adverse events, the treatment completion rate of adjuvant chemotherapy, 3-year overall survival (OS), and 3-year recurrence-free survival (RFS), were compared. RESULTS Patient characteristics did not differ significantly between the 2 groups. No adverse events related to Shengbai decoction were reported in the SD group. Patients in the SD group had less neutropenia (P=0.0430), thrombocytopenia (P=0.0323), and anemia (P=0.0497). The SD group had a significantly lower probability of dose reduction (P=0.0448). The completion rate of adjuvant chemotherapy of the SD group was considerably higher than that of the control group (P=0.0398). The SD group had a significantly better 3-year RFS (P=0.0369) and 3-year OS (P=0.0455) than the control group. CONCLUSIONS Shengbai decoction effectively improved postoperative survival of patients with GC by alleviating chemotherapy-induced myelosuppression and improving the completion rate of adjuvant chemotherapy.

Gap-Induced Giant Third-Order Optical Nonlinearity and Long Electron Relaxation Time in Random-Distributed Gold Nanorod Arrays.

The third-order optical nonlinearities and the hot electron relaxation time (τ) of random-distributed gold nanorods arrays on glass (R-GNRA) have been investigated by using Z-scan and optical Kerr effect (OKE) techniques. Large third-order optical susceptibility (χ(3)) with the value of 2.5 × 10-6 esu has been obtained around the plamsonic resonance peak under the excitation power intensity of 0.1 GW/cm2. Further decrease of the excitation power intensity down to 0.3 MW/cm2 will lead to the significant increase of χ(3) up to 6.4 × 10-4 esu. The OKE results show that the relaxation time of R-GNRA around the plasmonic peak is 13.9 ± 0.4 ps, which is more than 4 times longer than those of the individual gold nanostructures distributed in water solutions. The Finite-difference time domain simulations demonstrate that this large enhancement of χ(3) and slow down of τ are caused by the gap-induced large local field enhancement of GNRs dimers in R-GNRA. These significant results offer great opportunities for plasmonic nanostructures in applications of photonic and photocatalytic devices.

Gastric cancer may share genetic predisposition with esophageal squamous cell carcinoma in Chinese populations.

Many features are shared between esophageal cancer (EC) and gastric cancer (GC). This study aimed to explore whether known EC susceptibility loci are also important in the development of GC. A total of 21 genetic variants associated with EC in genome-wide association studies were evaluated with association of GC risk in 2631 cases and 4373 controls of Chinese ancestry. Single variant and weighted genetic scores (WGS) for esophageal squamous cell carcinoma (ESCC), esophageal adenocarcinoma (EAC), and overall EC were analyzed with GC risk, respectively. Genetic variants of rs2274223 in PLCE1 at 10q23.33 (per G allele: odds ratio (OR) = 1.26, 95% confidence interval (CI): 1.16-1.38, P = 6.51 × 10-8), rs10052657 in PDE4D at 5q11.2 (per C allele: OR = 1.12, 95% CI: 1.01-1.25, P = 3.28 × 10-2) and rs671 in ALDH2 at 12q24.12 (per A-allele: OR = 0.83, 95% CI: 0.75-0.91, P = 1.14 × 10-4) were significantly associated with GC risk. The combined effect of those three variants had stronger influence on GC risk (OR = 1.31, 95% CI: 1.19-1.44, P = 2.34 × 10-8). High WGS of ESCC was also associated with increased risk of GC (P = 5.52 × 10-4 as a continuous variable) (trend test P = 2.71 × 10-4), whereas no statistically significant associations were observed between the WGS of EAC and GC risk (P = 0.66 as a continuous variable) (trend test P = 0.70). ESCC rather than EAC may share genetic susceptibility with GC. Genetic variants at 10q23.33, 5q11.2, and 12q24.12 may be useful as biomarkers to identify individuals with high risk for both ESCC and GC.

A positive feedback loop between miR-181b and STAT3 that affects Warburg effect in colon cancer via regulating PIAS3 expression.

This study aimed to investigate the relationship between the expression of microRNA (miR)-181b, protein inhibitor of activated STAT3 (PIAS3) and STAT3, and to examine the function of the miR-181b/PIAS3/STAT3 axis on the Warburg effect and xenograft tumour growth of colon cancer. Moreover, a positive feedback loop between miR-181b and STAT3 that regulated the Warburg effect in colon cancer was explored. A luciferase reporter assay was used to identify whether PIAS3 was a direct target of miR-181b. The gain-of-function and loss-of-function experiments were performed on HCT 116 cells to investigate the effect of miR-181b/PIAS3/STAT3 on the Warburg effect and xenograft tumour growth of colon cancer, as determined by commercial kits and xenograft experiments. The relationship between the expression of miR-181b, PIAS3 and STAT3 in HCT 116 and HT-29 cells was determined using RT-qPCR and Western blot. We found miR-181b was a direct regulator of PIAS3. miR-181b promoted the Warburg effect and the growth of colon cancer xenografts; however, these effects could be reversed by PIAS3. miR-181b expression interacted with STAT3 phosphorylation in a positive feedback loop in colon cancer cells via regulating PIAS3 expression. In conclusion, this study for the first time demonstrated that miR-181b contributed to the Warburg effect and xenograft tumour growth of colon cancer by targeting PIAS3. Moreover, a positive feedback loop between miR-181b and STAT3 that regulated the Warburg effect in colon cancer was also demonstrated. This study suggested miR-181b/PIAS3/STAT3 axis as a novel target for colon cancer treatment.

Plasmon-enhanced versatile optical nonlinearities in a Au-Ag-Au multi-segmental hybrid structure.

A Au-Ag-Au multi-segmental hybrid structure has been synthesized by using an electrodeposition method based on an anodic aluminum oxide (AAO) membrane. The third-order optical nonlinearities, second harmonic generation (SHG) and photoluminescence (PL) properties containing ultrafast supercontinuum generation and plasmon mediated thermal emission have been investigated. Significant optical enhancements have been obtained near surface plasmon resonance wavelength in all the abovementioned nonlinear processes. Comparative studies between the Au-Ag-Au multi-segmental hybrid structure and the corresponding single-component Au and Ag hybrid structures demonstrate that the Au-Ag-Au multi-segmental hybrid structure has much larger optical nonlinearities than its counterparts. These results demonstrate that the Au-Ag-Au hybrid structure is a promising candidate for applications in plasmonic devices and enhancement substrates.

Origin of the Avalanche-Like Photoluminescence from Metallic Nanowires.

Surface plasmonic systems provide extremely efficient ways to modulate light-matter interaction in photon emission, light harvesting, energy conversion and transferring, etc. Various surface plasmon enhanced luminescent behaviors have been observed and investigated in these systems. But the origin of an avalanche-like photoluminescence, which was firstly reported in 2007 from Au and subsequently from Ag nanowire arrays/monomers, is still not clear. Here we show, based on systematic investigations including the excitation power/time related photoluminescent measurements as well as calculations, that this avalanche-like photoluminescence is in fact a result of surface plasmon assisted thermal radiation. Nearly all of the related observations could be perfectly interpreted with this concept. Our finding is crucial for understanding the surface plasmon mediated thermal and photoemission behaviors in plasmonic structures, which is of great importance in designing functional plasmonic devices.

Near-UV-enhanced broad-band large third-order optical nonlinearity in aluminum nanorod array film with sub-10 nm gaps.

Plasmonic nanostructures with sub-10 nm gaps possess intense electric field enhancements, leading to their high reputation for exploring various functional applications at nanoscale. Till now, although large amounts of efforts have been devoted into investigation of such structures, few works were emphased on the nonlinear optical properties in near-ultraviolet (UV) region. Here, by combining sputtering technique and an optimized anodic aluminum oxide (AAO) template growing method, we obtain aluminum (Al) nanorod array film (NRAF) with average rod diameter and gap size of 50 and 7 nm, respectively. The Al-NRAF exhibits large third-order optical nonlinear susceptibility (χ(3)) and high figure of merit (χ(3)/α) over a broad wavelength range from 360 to 900 nm, and reaches their maximums at the shortest measured wavelength. In addition, comparisons with Au-NRAF and Ag-NRAF samples further confirm that Al-NRAF has better nonlinear optical properties in the blue and near-UV wavelength regions. These results indicate that Al nanostructures are promising candidates for nonlinear plasmonic applications at blue and near-UV wavelengths.

Survivin -31 G/C polymorphism might contribute to colorectal cancer (CRC) risk: a meta-analysis.

Published data has shown inconsistent findings about the association of survivin -31 G/C polymorphism with the risk of colorectal cancer (CRC). This meta-analysis quantitatively assesses the results from published studies to provide a more precise estimate of the association between survivin -31 G/C polymorphism as a possible predictor of the risk of CRC. We conducted a literature search in the PubMed, Web of Science, and Cochrane Library databases. Stata 12 software was used to calculate the pooled odds ratios (ORs) with 95% confidence intervals (CIs) based on the available data from each article. Six studies including 1840 cases with CRC and 1804 controls were included in this study. Survivin -31 G/C polymorphism was associated with a significantly increased risk of CRC (OR = 1.78; 95% CI, 1.53-2.07; I(2) = 0%). In the race subgroup analysis, both Asians (OR = 1.72; 95% CI, 1.44-2.05; I(2) = 0%) and Caucasians (OR = 1.93; 95% CI, 1.46-2.55; I(2) = 0%) with survivin -31 G/C polymorphism had increased CRC risk. In the subgroup analysis according to site of CRC, survivin -31 G/C polymorphism was not associated with colon cancer risk (OR = 2.02; 95% CI, 0.79-5.22; I(2) = 82%). However, this polymorphism was significantly associated with rectum cancer risk (OR = 1.98; 95% CI, 1.42-2.74; I(2) = 0%). In the subgroup analysis by clinical stage, both early stage (I+II) and advanced stage (III+IV) were associated with survivin -31 G/C polymorphism (OR = 1.61; 95% CI, 1.20-2.16; I(2) = 0% and OR = 2.30; 95% CI, 1.70-3.13; I(2) = 0%, respectively). In the subgroup analysis by smoke status, both smokers and non-smokers with survivin -31 G/C polymorphism showed increased CRC risk (OR = 1.47; 95% CI, 1.01-2.13; I(2) = 60% and OR = 1.71; 95% CI, 1.28-2.30; I(2) = 0%, respectively). In the subgroup analysis by drink status, both drinkers and non-drinkers with survivin -31 G/C polymorphism showed increased CRC risk (OR = 1.58; 95% CI, 1.06-2.37; I(2) = 8% and OR = 1.61; 95% CI, 1.23-2.11; I(2) = 0%, respectively). In conclusion, this meta-analysis suggested that survivin -31 G/C polymorphism may be associated with the risk of CRC.

Efficacy and tolerability of first-line triple therapy with levofloxacin and amoxicillin plus esomeprazole or rabeprazole for the eradication of Helicobacter pylori infection and the effect of CYP2C19 genotype: a 1-week, randomized, open-label study in Chinese adults.

BACKGROUND: First-line triple therapy with levofloxa- cin and amoxicillin plus a proton pump inhibitor has been reported to be effective and well tolerated in the eradication of Helicobacter pylori infection. Studies have reported that cytochrome P450 (CYP) 2C19 genotypes may affect the clinical efficacy of clarithromycinbased triple therapies, although there is only one report of such an effect with levofloxacin-based triple therapies. OBJECTIVES: This study evaluated the clinical efficacy and tolerability of a 1-week course of triple therapy with levofloxacin and amoxicillin plus esomeprazole or rabeprazole as first-line treatment for H pylori infection in Chinese adults. It also investigated whether CYP2C19 genotype status affected rates of H pylori eradication with these regimens. METHODS: Consecutive patients undergoing upper endoscopy at the First Affiliated Hospital of Nanjing Medical University between May 2008 and January 2009 were evaluated for inclusion. Eligible patients were those who tested positive for H pylori infection on biopsy-based testing (ie, histology and an in-house rapid urease test) or a validated (13)C-urea breath test. Patients were randomized in an open-label fashion to receive levofloxacin 500 mg/d and amoxicillin 1000 mg BID plus either esomeprazole 20 mg BID (group A), esomeprazole 40 mg BID (group B), or rabeprazole 10 mg BID (group C) for 1 week. Patients were asked to record adverse events in a diary. Trained study assistants contacted patients by telephone within the first week after completion of therapy to collect data on drug compliance and adverse events. H pylori status was determined 4 weeks after the end of therapy using a (13)C-urea breath test. Rates of H pylori eradication were calculated in the intent-to-treat (ITT) and per-protocol (PP) populations. CYP2C19 genotype was determined by the polymerase chain reaction-restriction fragment-length polymorphism method. RESULTS: Of 199 consecutive patients screened for eligibility, 184 H pylori-positive patients were enrolled in the study (61 in group A, 62 in group B, and 61 in group C). The overall sample was balanced in terms of age, sex, endoscopic diagnosis, and history of smoking. Rates of H pylori eradication in the ITT and PP populations were as follows: group A-85.2% (52/61) and 86.7% (52/60), respectively; group B-87.1% (54/62) and 90.0% (54/60); and group C-75.4% (46/61) and 75.4% (46/61). There were no significant differences in eradication rates among groups, nor were there any differences in rates of compliance (98.4%, 96.8%, and 100% in groups A, B, and C, respectively) or adverseevent profiles. Fifteen patients (7.6%) reported adverse events during the study (5 [8.2%] in group A, 6 [9.7%] in group B, and 4 [6.6%] in group C). The adverse events included diarrhea (6 patients), dizziness (5), abdominal pain (2), nausea (1), and skin rash (1). Three patients discontinued treatment because of adverse events ( 1 due to skin rash in group A and 2 due to dizziness in group B). In the 147 patients included in the PP analysis of the effect of CYP2C19 genotype, eradication rates were 88.9% (32/36) in poor metabolizers, 82.0% (50/61) in heterozygous extensive metabolizers, and 82.0% (41/50) in homozygous extensive metabolizers. Eradication rates did not differ significantly among genotype groups. CONCLUSIONS: One week of first-line triple therapy with levofloxacin and amoxicillin plus esomeprazole 20 or 40 mg BID or rabeprazole 10 mg BID was associated with H pylori eradication rates of 85.2%, 87.1%, and 75.4%, respectively, with no significant differences between treatment groups. There were no significant differences in eradication of H pylori by CYP2C19 genotype in this small population of Chinese adults.

Prophylactic antibiotics reduce pancreatic necrosis in acute necrotizing pancreatitis: a meta-analysis of randomized trials.

BACKGROUND AND AIM: The use of prophylactic antibiotics to prevent infection and reduce mortality in patients with acute necrotizing pancreatitis (ANP) remains controversial. The aim of this study is to perform a systematic review of the data from randomized controlled trials to compare prophylactic antibiotic treatment of patients with ANP versus placebo. METHODS: A computerized literature search was conducted using Medline, PubMed, EMBase and Cochrane Central Register of Controlled Trials (CENTRAL) for relevant articles published in English from January 1990 to March 2010. MeSH terms and keywords used to identify articles included 'antibiotic', 'pancreatitis', and 'randomized'. Outcome measures were infected pancreatic necrosis (IPN), mortality, nonpancreatic infection (NPN) and need for surgical intervention. RESULTS: Nine trials involving 564 patients were included. Analysis suggested that IPN was significantly reduced by treatment with antibiotics (RR 0.73, 95% CI 0.54-0.98, p = 0.04). Mortality (p = 0.1), NPN (p = 0.07), and need for surgical intervention (p = 0.17) were not significantly reduced by antibiotic treatment. Subsequent subgroup analysis confirmed that antibiotics were statistically superior to controls in reducing of infected necrosis (p = 0.003) and also mortality (p = 0.02) in single-blinded randomized controlled trials. CONCLUSION: Prophylactic antibiotic treatment reduced occurrence of IPN, but did not affect mortality, NPN, or surgical intervention in patients with ANP.

Advantages of Moxifloxacin and Levofloxacin-based triple therapy for second-line treatments of persistent Helicobacter pylori infection: a meta analysis.

OBJECTIVE: The main aim of this meta-analysis was to compare the efficacy and safety of clarithromycin and second-generation fluoroquinolone-based triple therapy vs. bismuth-based quadruple therapy for the treatment of persistent Helicobacter pylori infection. METHODS: A systematic literature search was conducted for articles and abstracts from 1981 to March 2009 using Medline, PubMed, EMBase, Google Scholar and CNKI (Chinese), Wanfang (Chinese) digital database and recent Digestive Disease Week, United European Gastroenterology Week, and European Helicobacter Study Group conferences were also performed. Boolean operators (NOT, AND, OR) were used in succession to narrow and widen the search. Sixteen articles and four abstracts met the inclusion criteria, and were included in the meta-analysis by using Review Manager 4.2.8. RESULTS: The eradication rates demonstrated that clarithromycin-based triple therapy is inferior to bismuth-based quadruple therapy (OR = 0.53, 95% CI: 0.35-0.80, P = 0.002). Thirteen RCTs compared levofloxacin-based triple therapy vs. bismuth-based quadruple therapy, the eradication rates of the two regimens were shown to have no significant difference (OR = 1.43, 95% CI: 0.82-2.51, P = 0.21). But the eradication rates demonstrated superiority of the 10-day levofloxacin-based triple therapy over 7-day bismuth-based quadruple therapy (OR = 4.79, 95% CI: 2.95-7.79, P < 0.00001). Levofloxacin-based triple therapy was better tolerated than bismuth-based quadruple therapy with lower rates of side effects (OR = 0.41, 95% CI: 0.27-0.61, P < 0.0001), and lower rates of discontinuation of therapy due to adverse events (OR = 0.13, 95% CI: 0.06-0.33, P < 0.0001). Furthermore, our meta-analysis suggested that the eradication rates of the moxifloxacin-based triple therapy has a slight superiority to bismuth-based quadruple therapy, but there was no significant difference between them. CONCLUSION: Second-generation fluoroquinolone-based triple therapy can be suggested as the regimen of choice for rescue therapy in the eradication of persistent H. pylori infection especially 10-day levofloxacin-based triple therapy.