Tetracoordinate Fe3+ Activated Li2ZnAO4 (A = Si, Ge) Near-Infrared Luminescent Phosphors

Fe3+-doped near-infrared (NIR) phosphors have received a lot of interest because they are nontoxic, inexpensive, and ecologically benign. In this work, Fe3+-activated Li2ZnAO4 (A = Si, Ge) phosphors were synthesized by solid-phase reactions, in which Fe3+ entered the Zn2+ tetrahedral site. When excited by 300 nm UV light, broad NIR emission bands at 750 nm (Li2ZnSiO4: Fe3+) and 777 nm (Li2ZnGeO4: Fe3+) were observed, with internal quantum efficiencies (IQE) of 62.70% (Li2ZnSiO4: Fe3+) and 30.57% (Li2ZnGeO4: Fe3+). The thermal stability was increased from 35.43 to 49.79% at 373 K via cationic regulation. The combination of activation energy, electron-phonon coupling, and Debye temperature explained the improved thermal stability of Li2ZnGeO4: Fe3+ phosphor. Besides, the as-synthesized phosphor demonstrated sensitive and selective Cu2+ ion detection.

Prognostic prediction of thrombolytic therapy with rt-PA in acute ischemic stroke patients using an artificial intelligence model

OBJECTIVE

Through the comparison of different prediction models, we hope to find a promising statistical method to evaluate the prognosis of patients with acute ischemic stroke (AIS) after thrombolytic therapy.

METHODS

Data of 518 patients who received thrombolytic therapy were retrospectively collected in this study. Among them, 362 patients met the eligibility criteria, so their data such as age, sex, smoking history, previous medical history, clinical and laboratory indicators were analyzed. According to the 3 month follow-up results, 266 patients were included in a good prognosis group (modified Rankin Scale (mRS) score ≤2) and 96 in a poor prognosis group (3≤mRS≤6). All variables with P<0.05 in univariant and multivariant analyses were assigned in logistic regression model and artificial neural network (ANN) model to predict neurological prognosis, and the performance of the two models were compared.

RESULTS

Age, NIHSS scores, the serum concentration of immediate glucose, APTT and MBP at admission were found to be the predictive factors through ANN and logistic regression analysis. The binary logistic regression model revealed that the percentage correction, the precision, recall and F1 score of the regression model were 79%, 69.23%, 37.50% and 48.65%, respectively. While those of ANN were 79.98%, 69.70%, 37.25%, and 49.66%, correspondingly.

CONCLUSIONS

ANN model is as effective as a logistic regression model in predicting the prognosis of AIS after thrombolytic therapy with rt-PA. Moreover, ANN is slightly superior to logistic regression in accuracy, precision and F1 score.

Metal Halide Perovskite Nanocrystals for Near-Infrared Circularly Polarized Luminescence with High Photoluminescence Quantum Yield via Chiral Ligand Exchange

Using ligand exchange on FAPbI₃ perovskite nanocrystals (PNCs) surface with chiral tridentate l-cysteine (l-cys) ligand, we successfully prepared chiral FAPbI₃ PNCs that show circularly polarized luminescence (CPL) (dissymmetry factor; g_lum = 2.1 × 10^-3) in the near-infrared (NIR) region from 700 to 850 nm and a photoluminescence quantum yield (PLQY) of 81%. The chiral characteristics of FAPbI₃ PNCs are ascribed to induction by chiral l/d-cys, and the high PLQY is attributed to the passivation of the PNCs defects with l-cys. Also, effective passivation of defects on the surface of FAPbI₃ PNCs by l-cys results in excellent stability toward atmospheric water and oxygen. The conductivity of the l-cys treated FAPbI₃ NC films is improved, which is attributed to the partial substitution of l-cys for the insulating long oleyl ligand. The CPL of the l-cys ligand treated FAPbI₃ PNCs film retains a g_lum of -2.7 × 10^-4. This study demonstrates a facile yet effective approach to generating chiral PNCs with CPL for NIR photonics applications.

Bismuth, esomeprazole, metronidazole, and minocycline or tetracycline as a first-line regimen for Helicobacter pylori eradication: A randomized controlled trial

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.

New regimens as first-line eradication therapy for Helicobacter pylori infection in patients allergic to penicillin: A randomized controlled trial

BACKGROUND

Helicobacter pylori eradication in penicillin-allergic patients is challenging. The effective regimen is lacking in areas with high antibiotic resistance and tetracycline unavailable. Minocycline, cefuroxime, and full-dose metronidazole are promising drugs.

AIMS

To compare the eradication rate, safety, and compliance among three new bismuth quadruple therapies for first-line H. pylori eradication in penicillin-allergic patients.

METHODS

This randomized trial was conducted on 450 naive patients with H. pylori infection and penicillin allergy. The 14-day minocycline-metronidazole-containing (minocycline 100 mg twice daily and metronidazole 400 mg four times/day), minocycline-cefuroxime-containing (minocycline 100 mg twice daily and cefuroxime 500 mg twice daily), and cefuroxime-metronidazole-containing (cefuroxime 500 mg twice daily and metronidazole 400 mg four times/day) bismuth quadruple therapies were randomly assigned to the participants. Safety and compliance were assessed within 3 days after eradication. Urea breath test was performed 4-8 weeks after eradication to evaluate outcome.

RESULTS

The differences of eradication rates in either intention-to-treat (84.0%, 82.7%, and 23 82.0%, p = .896) or per-protocol (91.7%, 90.9%, and 88.2%, p = .599) analysis among minocycline-metronidazole, minocycline-cefuroxime, and cefuroxime-metronidazole-containing bismuth quadruple therapies were statistically insignificant. The incidence of adverse events (35.1%, 22.6%, and 28.9%) and compliance (90.5%, 91.8%, and 91.9%) were similar. Taste distortion, nausea, and anorexia were more common in metronidazole-containing regimens, and dizziness was more common in minocycline-containing regimens. The allergy was rare (~3%).

CONCLUSIONS

The efficacies of three bismuth quadruple therapies containing minocycline, cefuroxime, and full-dose metronidazole (pairwise) for first-line H. pylori eradication in penicillin-allergic patients were similarly satisfactory with relatively good safety and compliance. The study was registered in the Chinese Clinical Trials Registration (ChiCTR1900023702).

Ultra-Broadband Near-Infrared Phosphors Realized by the Heterovalent Substitution Strategy

Near-infrared (NIR) phosphor-converted light-emitting diodes with broadband emission have received considerable interest. However, there remains a challenge in the construction of ultra-broadband NIR phosphors, hindering their further application. In this work, a heterovalent substitution strategy is proposed to construct a novel ultra-broadband NIR-emitting LaTiTaO₆:Cr³⁺ phosphor with a full width at half maximum of ∼300 nm. Crystal structure, time-resolved emission spectroscopy, and electron paramagnetic resonance analyses confirm that only one crystallographic site of Cr³⁺ with separated ions exists. Electron and phonon coupling (EPC) evaluated by the Huang-Rhys factor (S) reveals that the heterovalent substitution strategy contributes to strong EPC with S = 9.185, resulting in ultra-broadband emission. Interestingly, a remarkable blue shift of emission from 1050 to 922 nm with increasing temperature is observed. Moreover, the application of LaTiTaO₆:Cr³⁺ phosphor is demonstrated in the qualitative analysis of ethanol/water mixtures. The work will enrich the toolbox for designing broadband NIR-emitting materials.

rFGF4 alleviates lipopolysaccharide-induced acute lung injury by inhibiting the TLR4/NF-κB signaling pathway

Acute lung injury (ALI) is a serious and common clinical disease. Despite significant progress in ALI treatment, the morbidity and mortality rates remain high. However, no effective drug has been discovered for ALI. FGF4, a member of the FGF family, plays an important role in the regulation of various physiological and pathological processes. Therefore, in the present study, we aimed to study the protective effects of FGF4 against LPS-induced lung injury in vivo and in vitro. We found that rFGF4 treatment improved the lung W/D weight ratio, the survival rate, immune cell infiltration and protein concentrations in mice with LPS-induced ALI. Histological analysis revealed that rFGF4 significantly attenuated lung tissue injury and cell apoptosis. Furthermore, rFGF4 inhibited the activation of the TLR4/NF-κB signaling pathway and the production of pro-inflammatory mediators in LPS-injured lung tissues, murine alveolar macrophages (MH-S) and murine pulmonary epithelial (MLE-12) cells. The results of cell experiments further verified that rFGF4 inhibited the production of inflammatory mediators in MH-S cells and MLE-12 cells by regulating the TLR4/NF-κB signaling pathway. These results revealed that rFGF4 protected lung tissues and inhibited inflammatory mediators in mice with LPS-induced ALI by inhibiting the TLR4/NF-κB signaling pathway in MH-S and MLE-12 cells.

Individualized diagnosis and eradication therapy for Helicobacter pylori infection based on gene detection of clarithromycin resistance in stool specimens: A systematic review and meta-analysis

BACKGROUND

Empiric therapy for Helicobacter pylori infection results in significantly increased antibiotic resistance and decreased eradication efficacy. The genotypic testing of clarithromycin resistance from stool specimens is a promising method for individualized diagnosis and treatment. This study aimed to determine the status of research and application on this method through a systematic review and meta-analysis.

METHODS

PubMed, Embase, MEDLINE, and WAN FANG database were searched for relevant literature. The quality of included diagnostic articles was evaluated using the quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate random-effect model was conducted to calculate the diagnostic accuracy of genotypic testing of clarithromycin resistance.

RESULTS

A total of 16 diagnostic-related were included and analyzed after exclusions. The pooled sensitivity and specificity of diagnostic meta-analysis were 0.93 (95% confidence interval [CI]: 0.90-0.96) and 0.98 (95% CI: 0.93-1.00), respectively. The area under the curve (AUC) of the summary receiver operating characteristic was 0.97 (95% CI: 0.95-0.98). The genotypic testing in stool samples had heterogeneous sensitivity (Q = 37.82, p < .01, I²  = 37.82) and specificity (Q = 60.34, p < .01, I²  = 93.72) in detecting clarithromycin resistance. Purification method, stool sample weight, real-time PCR, and antimicrobial susceptibility testing as reference accounted for the heterogeneity of pooled sensitivity, while patient age, purification method, stool sample weight, and real-time PCR for the heterogeneity of pooled specificity.

CONCLUSION

The genotypic testing of clarithromycin resistance from stool specimens is an accurate, convenient, noninvasive, and rapid detection technology, providing a definitive diagnosis of clarithromycin resistance and guiding the rational antibiotic selection.

Broadband-excited and green-red tunable emission in Eu2+-sensitized Ca8MnTb(PO4)7 phosphors induced by structural-confined cascade energy transfer

Novel green-red color-tunable Ca₈(Mg,Mn)Tb(PO₄)₇:Eu²⁺ phosphors have been synthesized via the traditional solid-state method. Since Tb³⁺/Mn²⁺ ions are the parent ions in the lattice, the structural confinement occurs when the sensitizer Eu²⁺ is introduced into the Ca₈(Mg,Mn)Tb(PO₄)₇:Eu²⁺ structure. The distance from Eu²⁺ to Tb³⁺/Mn²⁺ is confined in the 5 Å range, which induces a highly efficient energy transfer process. At Eu²⁺ 350 nm excitation, Ca₈MgTb(PO₄)₇:Eu²⁺ shows dominant Tb³⁺ green emission with almost-vanished Eu²⁺ emission. Red emission is clearly observed as Mn²⁺ ions doping into Ca₈MgTb(PO₄)₇:Eu²⁺, and color-tuning from green to red is realized by varying the Mn²⁺ contents. Eu²⁺-Tb³⁺-Mn²⁺ cascade energy transfer process is in effect due to short Eu²⁺-Tb³⁺/Mn²⁺ and Tb³⁺-Mn²⁺ distances, which is verified by PL and decay variations. Meanwhile, the Ca₈(Mg,Mn)Tb(PO₄)₇:Eu²⁺ phosphor indicates good thermal stability and maintained the 45% emission level at 150 °C, which demonstrates their potential applications in white light LEDs.

Immobilization of Enzymes on Cyclodextrin-Anchored Dehiscent Mesoporous TiO2 for Efficient Photoenzymatic Hydroxylation

A three-in-one heterogeneous catalyst (UPO@dTiO₂-CD) was fabricated by grafting cyclodextrins (CDs) on the dehiscent TiO₂ (dTiO₂) surface and subsequently immobilizing unspecific peroxygenase (rAaeUPO), which exhibited double enhanced electron/mass transfer in photo-enzymatic enantioselective hydroxylation of the C-H bond. The tunable anatase/rutile phase ratio and dehiscent mesoporous architectures of dTiO₂ and the electron donor feature and hydrophobic inner cavity of the CDs are independently responsible for accelerating both electron and mass transfer. The coordination of the photocatalytic and enzymatic steps was achieved by structural and compositional regulation. The optimized UPO@dTiO₂-CD not only displayed high catalytic efficiency (turnover number and turnover frequency of rAaeUPO up to >65,000 and 91 min^-1, respectively) but also exhibited high stability and reusability.

Tailored triple plus bismuth therapy based on previous antibiotic medication history for first-line Helicobacter pylori eradication: A randomized trial

INTRODUCTION

There are no randomized controlled trials that demonstrate the role of tailored therapy based on past medication history in improving efficacy of H. pylori eradication compared to empiric therapies. The objective of this study was to determine whether tailored triple plus bismuth therapy (TBT) can achieve higher eradication rates based on previous antibiotic history than empiric TBTs.

METHODS

800 treatment-naïve patients were randomly assigned to four groups receiving clarithromycin-, levofloxacin- or metronidazole-containing empiric TBT and tailored TBT (clarithromycin and levofloxacin chosen based on previous macrolides and quinolones medication history). Correlation analyses were performed between past medication history and resistance or eradication rate.

RESULTS

The eradication rates of tailored TBT were significantly higher than clarithromycin-, levofloxacin- and metronidazole-containing empiric TBT in both intention-to-treat (89.5%, 80.8%, 81.5% and 81.5%) and per-protocol (95.1%, 86.7%, 86.5% and 87.8%) analyses (P<0.05). In patients with previous macrolides, quinolones or nitroimidazoles medication history, the resistance rates of corresponding clarithromycin, levofloxacin or metronidazole were significantly higher than patients without past medication history, and the eradication rates of corresponding clarithromycin- or levofloxacin-containing empiric TBT were significantly lower.

CONCLUSION

Tailored TBT based on previous antibiotic history can achieve higher eradication rates than empiric TBT for first-line H. pylori eradication.

2022 Chinese national clinical practice guideline on Helicobacter pylori eradication treatment

BACKGROUND

Helicobacter pylori ( H. pylori ) infection is an infectious disease with a prevalence rate of up to 50% worldwide. It can cause indigestion, gastritis, peptic ulcer, and gastric cancer. H. pylori eradication treatment can effectively control disease progression and reduce the risk of the above conditions. However, the escalating trend of antibiotic resistance presents a global challenge for H. pylori eradication. We aim to provide guidance on pharmacological treatment of H. pylori infection.

METHODS

This clinical practice guideline is developed following the World Health Organization's recommended process, adopting Grading of Recommendations Assessment, Development and Evaluation in assessing evidence quality, and utilizing Evidence to Decision framework to formulate clinical recommendations, minimizing bias and increasing transparency of the clinical practice guideline development process. We used the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement and The Appraisal of Guidelines for Research and Evaluation II (AGREE II) as reporting and conduct guides to ensure the guideline's completeness and transparency.

RESULTS

Though decreasing in developed countries, the prevalence of H. pylori remains high in developing countries, causing a major public health burden. This clinical practice guideline contains 12 recommendations concerning pharmacological treatment for H. pylori eradication. Among them, it is worth highlighting that bismuth preparations are inexpensive, safe, and effective, consequently making bismuth quadruple therapy a preferred choice for initial and rescue treatment. In empirical treatment, high-dose dual therapy is equally effective compared with bismuth quadruple therapy.

CONCLUSIONS

The 12 recommendations in this clinical practice guideline are formed with consideration for stakeholders' values and preferences, resource use, feasibility, and acceptability. Recommendations are generalizable to resource limited settings with similar antibiotic resistance pattern as China, and lower middle-income countries facing comparable sociological and technical challenges.

REGISTRATION

Guidelines International Network (GIN) website, https://guidelines.ebmportal.com/node/69996 .

Improved Energy Transfer in Mn-Doped Cs3Cu2I5 Microcrystals Induced by Localized Lattice Distortion

With nontoxicity and high emission efficiency, luminescent copper(I)-based halides have attracted much attention as alternatives for lead-based perovskites in photoelectric domains. However, extending the emission wavelength by doping with Mn²⁺ in a facile way is still a challenge. In this work, Mn²⁺-doped Cs₃Cu₂I₅ microcrystals were synthesized by a mild solution method, and double emission bands from self-trapped excitons (STEs) and Mn²⁺ peaking at 445 and 560 nm, respectively, were observed. More importantly, further introduction of alkali metal ions (Rb⁺, K⁺, Na⁺) considerably promoted the luminescence performance of the Cs₃Cu₂I₅-Mn microcrystals. The STE → Mn²⁺ energy transfer efficiency of the typical sample doped with Na⁺ increased from ∼0 to 21.30%, and the photoluminescence quantum yield (PLQY) increased from 47.32% to 62.06%. The detailed structural and optical characterizations combined with DFT calculations proved that the doping with alkali metal ions causes lattice distortion and enhances the coupling between [MnI₄] and [CuI₄] tetrahedra, thus promoting the energy transfer efficiency and the PLQY.

Epigenetic modification facilitates proline synthase PYCR1 aberrant expression in gastric cancer

BACKGROUND & AIMS

Pyrroline-5-carboxylate reductase 1 (PYCR1) upregulation contributes to the progression of gastric cancer (GC) and indicates poor survival. However, PYCR1 expression profile in GC subtypes and the mechanism behind its upregulation are not well-studied.

METHODS

PYCR1 expression profiles in GC subtypes and different stages of gastric carcinogenesis were assessed in different GC cohorts. Genetic alterations and epigenetic modulation in PYCR1 regulation were further investigated using bioinformatics analysis and in vitro experiments.

RESULTS

PYCR1 expression was significantly higher in intestinal-type GC and associated molecular subtypes in TCGA and ACRG GC cohorts. During the cascade of intestinal-type GC, PYCR1 was continuously increased from normal gastric tissues through to atrophic gastritis, to intraepithelial neoplasia, and to GC. Copy number alterations in PYCR1 were associated with PYCR1 transcript expression. One CpG island was observed in PYCR1 promoter region, and the hypomethylation occurred at this region could contribute to PYCR1 transcriptional activation in GC. Besides, H3K27ac combination was found in PYCR1 promoter, and acetyltransferase p300 induced H3K27ac could promote PYCR1 expression in GC.

CONCLUSIONS

PYCR1 expression varies across GC subtypes, with intestinal-type GC and associated molecular subtypes having the highest expression. Hypomethylation at CpG sites and p300-induced H3K27ac modification within PYCR1 promoter could contribute to maintaining PYCR1 overexpression in GC. These results provide us with a new insight into epigenetic modulation in mitochondrial proline metabolism.

Asymmetric Hydrogenation of C = C Bonds in a SpinChem Reactor by Immobilized Old Yellow Enzyme and Glucose Dehydrogenase

The application of immobilized enzymes in pharmaceutical and bulk chemical production has been shown to be economically viable. We demonstrate the exceptional performance of a method that immobilizes the old yellow enzyme YqjM and glucose dehydrogenase (GDH) on resin for the asymmetric hydrogenation (AH) of C = C bonds in a SpinChem reactor. When immobilized YqjM and GDH are reused 10 times, the conversion of 2-methylcyclopentenone could reach 78%. Which is because the rotor of the SpinChem reactor effectively reduces catalyst damage caused by shear force in the reaction system. When the substrate concentration is 175 mM, an 87% conversion of 2-methylcyclopentenone is obtained. The method is also observed to perform well for the AH of C = C bonds in other unsaturated carbonyl compounds with the SpinChem reactor. Thus, this method has great potential for application in the enzymatic production of chiral compounds.

Diagnosis and treatment of Helicobacter pylori infection by physicians in China: A nationwide cross-sectional study

BACKGROUND

To investigate the current state of knowledge and practice of Helicobacter pylori (H. pylori) infection management in China.

MATERIALS AND METHODS

This nationwide, multicenter, cross-sectional questionnaire survey was conducted between March and April 2021 with respect to the diagnosis and treatment of H. pylori infection in 31 provinces, encompassing over 1000 hospitals in mainland China. General physician information, diagnostic and detection status, eradication treatment, reexamination and follow-up after treatment, and basic knowledge of physicians were collected and compared with the Fifth Chinese National Consensus Report on Management of H. pylori infection and the 2016 Maastricht V/Florence guidelines. The subgroup analysis was also performed.

RESULTS

Of the 6873 questionnaire respondents, 48.8% were males, and 51.2% were females. Approximately, 26.5% of respondents indicated that their hospitals had dedicated clinics for managing H. pylori infection. Moreover, 88.0% of respondents prescribed a bismuth-containing quadruple regimen as the initial eradication treatment, and 92.7% deemed the gastric acid suppression critical. Furthermore, 91.0% of respondents routinely recommended a reexamination 1-2 months after eradication therapy, and 95.1% advised patients to stop PPI treatment at least 2 weeks before reexamination. The detail of following (the choice of target population/methods; the choice/availability of drugs/regimens, indications for eradication, factors influencing eradication efficacy/improvement methods and factors influencing adherence, management options/factors influencing relapse; the timing and methods, awareness of reinfection rates/prevention measures, and the approach to continuing education, awareness of guidelines, and acceptance of current core concepts of management) was also described. Subgroup analysis further revealed that significant differences were existed in being gastroenterologist or not, different education level, professional title, years of working, and provincial administrative regions.

CONCLUSIONS

Chinese physicians' skills and knowledge about the diagnosis and treatment of H. pylori infection could be improved. More works on education are needed in future.

Long-Term Outcome of Gastric Mild-Moderate Dysplasia: A Real-World Clinical Experience

BACKGROUND & AIMS

The natural course of gastric mild-moderate dysplasia in a country with high incidence of gastric cancer (GC) is relatively unknown. We aimed to determine the long-term cumulative incidence of and risk factors for advanced neoplasia in patients with gastric dysplasia.

METHODS

This was a single-center observational study including all consecutive patients diagnosed with gastric mild-moderate dysplasia between 2000 and 2017. Follow-up data were collected until December 2019. We determined the cumulative incidence of advanced neoplasia and identified risk factors with Cox regression.

RESULTS

A total of 3489 consecutive participants were followed for a median of 4.19 years from initial mild-moderate dysplasia diagnosis. The median surveillance interval between index endoscopy and next follow-up endoscopy was 1.08 years, and more than half of patients had at least 3 surveillance gastroscopies. During the study period, the majority of participants did not show disease progression, either with dysplasia not detected (51.4%) or with persistent dysplasia (46.1%). There were 88 (2.9%) patients (5.13 per 1000 patient-years) who progressed to advanced neoplasia within a median of 4.3 years. The annual incidence of advanced neoplasia and GC were 0.43% and 0.26%, respectively, within 5 years of mild-moderate dysplasia diagnosis. Increasing age, male sex, moderate dysplasia, dysplasia detected in fundus or cardia at index endoscopy, and persistent Helicobacter pylori infection during follow-up were independent risk factors for developing advanced neoplasia.

CONCLUSIONS

Even in a country with high incidence of GC, the majority of patients with gastric mild-moderate dysplasia did not experience disease progression in the long term. Intensified surveillance during the first 5 years after mild-moderate dysplasia detection is suggested.

The necessity and appropriate range of the diagnostic "gray zone" of 13C-urea breath test

BACKGROUND

The ¹³C-urea breath test (¹³C-UBT) is preferred for non-invasive detection of Helicobacter pylori (H. pylori); however, its accuracy drops when results fall between 2‰ and 6‰ (called the gray zone). This study aimed to evaluate the accuracy of ¹³C-UBT (cut-off point 4‰) between 2‰ and 6‰, find a more appropriate gray zone, and identify the factors influencing ¹³C-UBT.

METHODS

Patients with ¹³C-UBT results 2‰-6‰, over an eight-year period, were studied. H. pylori infection was diagnosed if patients were positive for either Warthin-Starry staining or quantitative real-time polymerase chain reaction (real-time PCR), and excluded if both were negative. Accuracy of ¹³C-UBT under different cut-off points was calculated, and the factors affecting ¹³C-UBT were analyzed.

RESULTS

A total of 208 patients were included, of whom 129 were H. pylori-positive. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of ¹³C-UBT were 71.32%, 83.54%, 64.08%, and 87.62%, respectively. When the cut-off point was changed to 2.15‰, the NPV of ¹³C-UBT reached a maximum (76.47%); when the cut-off point was changed to 4.95‰, PPV reached its maximum (93.22%). Therefore, the original gray zone (2‰-6‰) was adjusted to 2‰-4.95‰. Gastric antral intestinal metaplasia (OR = 3.055, 95% CI: 1.003-9.309) was an independent risk factor for false-negative ¹³C-UBT.

CONCLUSIONS

Accuracy of ¹³C-UBT over 2‰-6‰ was poor, and the gray zone was changed to 2‰-4.95‰. ¹³C-UBT results over 2‰-4.95‰ should be interpreted with caution during mass screening of H. pylori, especially for patients with gastric antral intestinal metaplasia.