A multicentre study on eradication of Helicobacter pylori using four 1-week triple therapies in China

BACKGROUND

Short-term proton pump inhibitor-based triple therapies for the eradication of Helicobacter pylori are used widely. The eradication rates vary greatly from country to country and from region to region.

AIM

To assess the efficacy at eradicating H. pylori of 1-week regimens containing three medications: omeprazole (O) or colloidal bismuth subcitrate (B), furazolidone (F) or metronidazole (M), and amoxicillin (A) or clarithromycin (C).

METHODS

A multicentre study involving 20 hospitals in different regions of China. A total of 892 patients with H. pylori-positive non-ulcer dyspepsia or healed duodenal ulcer confirmed by endoscopy were recruited to receive, randomly, one of four regimens: OMC, OFC, OFA, and BFC, b.d. for 7 days. 13C-urea breath test was performed 4-8 weeks after completion of treatment.

RESULTS

The eradication rates with per protocol/intention-to-treat analyses were: OMC (n=217/219) 66%/65%; OFC (n=227/229) 69%/69%; OFA (n=223/225) 87%/86%; and BFC (n=214/219) 80%/78%. The eradication rate (per protocol analysis) in duodenal ulcer (79%) was higher than that in non-ulcer dyspepsia (73%, P=0.033). Patient compliance was good. The adverse events of the four regimens were mild, and mainly gastrointestinal.

CONCLUSIONS

The omeprazole, furazolidine and amoxicillin regimen achieves a high H. pylori eradication rate in different geographical regions of China.

[The long-term effect of augmentation rhinoplasty with silicone]

OBJECTIVE

To evaluate the long-term effect of augmentation rhinoplasty with silicone.

METHOD

360 patients underwent augmentation rhinoplasty with silicone. Improved "L" shaped implants were used in 343 patients.

RESULT

Among 360 patients, 334 cases were successful enough (92.83%).

CONCLUSION

The key to the maintenance of the long-term effect is to use properly improved "L"-shaped implant, to choose a suitable tunnel, to prevent various complications and to ask patient's opinions for implant design.

A new quadruple therapy for Helicobacter pylori using tripotassium dicitrato bismuthate, furazolidone, josamycin and famotidine

BACKGROUND

In our previous study, a triple therapy using tripotassium dicitrato bismuthate (TDB), josamycin and furazolidone achieved a suboptimal cure rate of Helicobacter pylori infection.

AIM

To investigate whether the addition of an antisecretory agent raises the cure rate using this regimen.

METHODS

One hundred and twenty H. pylori positive patients with peptic ulcer disease or functional dyspepsia were randomly assigned to receive 1-week quadruple therapy of TDB 240 mg b.d., furazolidone 100 mg b.d., josamycin 1000 mg b.d. and famotidine 20 mg b.d. (BFJF group), or triple therapy of TDB 240 mg b.d., furazolidone 100 mg b.d. and clarithromycin 250 mg b.d. (BFC group). H. pylori status was assessed by histology and culture of gastric biopsy specimens before and at least 4 weeks after completion of therapy.

RESULTS

Seven patients (three in the BFJF group and four in the BFC group) dropped out. Eradication rates (intention-to-treat/per protocol) were 90%/95% in the BFJF group and 82%/88% in the BFC group, respectively (P > 0.05). Duodenal ulcer healing rates were 94% (16/17) in the BFJF group and 80% (20/25) in the BFC group, respectively (P > 0.05). Mild side-effects occurred in 11 (18%) patients in the BFJF group and 10 (17%) in the BFC group (P > 0.05).

CONCLUSIONS

One-week quadruple therapy consisting of TDB, furazolidone, josamycin and famotidine achieves a high cure rate of H. pylori infection.

[A recombinant fowlpox virus expressing the fusion protein of Newcastle disease virus strain F48E8 and its protective efficacy]

The transfer vector pFGF1175-1 was constructed by insertion the fusion protein gene of Newcastle disease virus (NDV) F48E8 strain into the insertion vector pFG1175-1, downstream of P7.5 promotor, and then transfected chicken embryo fibroblast (CEF) cell cultures which had been infected with fowlpox virus (FPV) Chinese vaccine strain 282E4 for 3-4 hours. Recombinant FPV with blue plaques were selected and purified in CEF cell culture laid agar containing X-gal. The recombinant FPV named rFPV-NDF was confirmed expressing NDV fusion protein by indirect immunofluorescence assay, and could protect chickens against virulent NDV challenge, The protective rate was 96.7%.

Furazolidone-containing short-term triple therapies are effective in the treatment of Helicobacter pylori infection

BACKGROUND

A furazolidone-containing therapeutic regimen for Helicobacter pylori infection has attracted special interest in the face of a rising world-wide metronidazole resistant H. pylori, and the expense of currently used antimicrobial regimens.

AIM

To evaluate the efficacy of furazolidone-containing regimens in eradicating H. pylori.

METHODS

One-hundred and forty H. pylori positive patients with endoscopically confirmed duodenal ulcer or functional dyspepsia received one of four different regimens to eradicate H. pylori. In the first trial, the patients were randomly assigned to receive a 1-week course of furazolidone 100 mg b.d. and clarithromycin 250 mg b.d., with either tripotassium dicitrato bismuthate (TDB) 240 mg b.d. (FCB group) or lansoprazole 30 mg daily (FCL group). In the second trial, the patients were randomly assigned to receive a 1-week course of clarithromycin 250 mg b.d. and omeprazole 20 mg daily, with either furazolidone 100 mg b.d. (FCO group) or metronidazole 400 mg b.d. (MCO group). Endoscopy was repeated 4 weeks following completion of therapy with re-assessment of H. pylori status on gastric biopsies by histology and culture.

RESULTS

Four patients (1 in FCB, 1 in FCO and 2 in MCO groups) dropped out because they refused a follow-up endoscopy. Eradication rates of H. pylori on an intention-to-treat basis in the FCB, FCL, FCO and MCO groups were 91% (32/35, 95% CI: 82-99%), 91% (32/35, CI: 82-99%), 86% (30/35, CI: 74-97%) and 74% (26/35, CI: 60-89%) (all P > 0.05), respectively. Mild side-effects occurred in 15% of the 140 patients. In MCO group, the eradication rate in the patients infected with metronidazole-sensitive isolates of H. pylori was 86%, but dropped to 67% in those with metronidazole-resistance strains (P = 0.198).

CONCLUSION

One-week regimens containing furazolidone and clarithromycin in combination with TDB or a proton pump inhibitor fulfil the criteria for successful H. pylori therapy.

High cure rate of Helicobacter pylori infection using tripotassium dicitrato bismuthate, furazolidone and clarithromycin triple therapy for 1 week

BACKGROUND

When metronidazole is used in bismuth-based or proton pump inhibitor-based triple therapy, the cure rate of Helicobacter pylori is usually high. However, metronidazole-resistant H. pylori strains, which are increasing in frequency, are a major cause of failed H. pylori eradication.

AIM

To evaluate the efficacy of non-metronidazole containing bismuth-based triple therapy for H. pylori infection.

METHODS

One-hundred and eighty H. pylori-positive patients with endoscopically documented peptic ulcer disease or functional dyspepsia were randomly assigned to one of three 1-week regimens containing tripotassium dicitrato bismuthate (also called colloidal bismuth subcitrate) 240 mg b.d. and two antibiotics: furazolidone 100 mg b.d. plus clarithromycin 250 mg b.d. (Group A); or clarithromycin 250 mg b.d. plus amoxycillin 1000 mg b.d. (Group B); or furazolidone 100 mg b.d. plus josamycin 1000 mg b.d. (Group C). H. pylori status was assessed by rapid urease test, histology and culture of gastric biopsy specimens taken from both the antrum and corpus, both before and at least 4 weeks after completion of therapy.

RESULTS

Thirteen patients dropped out (3 in group A, 5 in group B and 5 in group C). Based on an intention-to-treat analysis, the eradication rates achieved in groups A, B and C were 88% (53/60), 58% (35/60) and 77% (46/60), respectively. These differences were significant between groups A and B (P < 0.001), as well as between groups B and C (P < 0.05). Side-effects occurred in 7 (12%) patients in group A, 3 (5%) in group B and 8 (13%) in group C, and were mild, with the exception of vomiting in one patient (group C) that resulted in withdrawal from the study.

CONCLUSION

One-week triple therapy, consisting of tripotassium dicitrato bismuthate, low-dose furazolidone and low-dose clarithromycin, achieves a high cure rate of H. pylori.

Modulation of hepatitis C virus quasispecies heterogeneity by interferon-alpha and ribavirin therapy

To determine the effects of interferon-alpha (IFN-alpha) and ribavirin therapy on hepatitis C virus (HCV) quasispecies heterogeneity, 29 patients with chronic HCV infection treated with either IFN-alpha (n = 15), ribavirin (n = 7) or placebo (n = 7) were studied. HCV quasispecies heterogeneity was determined by single-strand conformational polymorphism (SSCP) analysis of the HCV E2 hypervariable region 1 (HVR1). For patients receiving IFN-alpha, HVR1 was amplified in 14 of 15 patients before, and in six of seven patients after therapy. After controlling the amount of amplicon loaded, a reduction in the number of SSCP bands was observed with IFN-alpha therapy (median number of SSCP bands per patient was eight before therapy and two after therapy). In the seven patients within each of the ribavirin- and placebo-treated groups, there was no significant difference in the viraemia level, number of SSCP bands per patient or the SSCP band pattern, before and after therapy. These findings suggest that at the doses given, IFN-alpha, but not ribavirin, exerts a selective pressure on HCV quasispecies heterogeneity.

Seroprevalence of Helicobacter pylori infection in medical staff in Shanghai

BACKGROUND

The epidemiology of Helicobacter pylori is still under investigation. It is postulated that the human stomach is the natural reservoir and that spread occurs by oral-oral or fecal-oral transmission. The aim of this study was to determine whether medical staff, especially endoscopy unit personnel, are at an increased risk of acquiring H. pylori infection.

METHODS

An enzyme-linked immunosorbent assay technique was used to detect circulating H. pylori IgG antibodies in 1050 medical staff from 16 hospitals in Shanghai, including 125 GI endoscopists, 45 endoscopy unit nurses, 71 gastroenterologists not doing endoscopy, 105 nurses working in gastroenterology wards, 417 internists, and 287 general nurses. This group was compared with an age-matched population obtained from the same urban area of the city.

RESULTS

The overall prevalence of H. pylori infection in total medical staff was 70.0%, compared to 44.6% in general population (P < 0.0001). Age-adjusted comparisons between subgroups of medical staff were made. The prevalence of H. pylori in GI endoscopists was 82.4%, which is significantly higher than 66.4% in internists and 65.8% in general nurses (all, P < 0.01) but not significantly different from 77.7% in endoscopy unit nurses or from 74.2% in nurses working in gastroenterology wards (all, P > 0.05). Further analysis did not show any significant difference in the prevalence of H. pylori between other subgroups. The prevalence of H. pylori infection in GI endoscopists increased with the number of years of practice.

CONCLUSIONS

Medical staff, especially endoscopy unit personnel, are at increased risk of infection with H. pylori. These findings strongly suggest the medical practice and endoscopy procedures are risk factors for H. pylori infection and support person-to-person transmission in this setting, probably from patients to medical staff.

Machine learning techniques in early screening for gastric and oesophageal cancer

A database on 2692 dyspeptic patients over the age of 40 was established, consisting of 73 epidemiological and clinical variables. A tree-based machine learning algorithm (PREDICTOR) was applied to this database, in order to attempt to find rules which would classify patients into 2 groups, i.e., those suffering from gastric or oesophageal cancer, and the remainder. The results were encouraging. The cross-validated classification performance figure showed that by classifying 61.3% of the patients as high risk, a sensitivity of 94.9% and a specificity of 39.8% could be achieved. It is planned to construct an expert system based on the rules produced by the machine learning algorithm, in order to provide preliminary screening for cancer in dyspeptic patients.

A single amino acid change in Escherichia coli glycerol kinase abolishes glucose control of glycerol utilization in vivo

Escherichia coli glycerol kinase (EC 2.7.1.30; ATP:glycerol 3-phosphotransferase) is a key element in glucose control of glycerol metabolism. Its catalytic activity is inhibited allosterically by the glycolytic intermediate, fructose 1,6-biphosphate, and by the phosphotransferase system phosphocarrier protein, IIIGlc (also known as IIAGlc). These inhibitors provide mechanisms by which glucose blocks glycerol utilization in vivo. We report here the cloning and sequencing of the glpK22 gene isolated from E. C. C. Lin strain 43, a strain that shows the loss of glucose control of glycerol utilization. DNA sequencing shows a single missense mutation that translates to the amino acid change Gly-304 to Ser (G-304-S) in glycerol kinase. The effects of this substitution on the functional and physical properties of the purified mutant enzyme were determined. Neither of the allosteric ligands inhibits it under conditions that produce strong inhibition of the wild-type enzyme, which is sufficient to explain the phenotype of strain 43. However, IIIGlc activates the mutant enzyme, which could not be predicted from the phenotype. In the wild-type enzyme, G-304 is located 1.3 nm from the active site and 2.5 nm from the IIIGlc binding site (M. Feese, D. W. Pettigrew, N. D. Meadow, S. Roseman, and S. J. Remington, Proc. Natl. Acad. Sci. USA 91:3544-3548, 1994). It is located in the same region as amino acid substitutions in the related protein DnaK which alter its catalytic and regulatory properties and which are postulated to interfere with a domain closure motion (A. S. Kamath-Loeb, C. Z. Lu, W.-C. Suh, M. A. Lonetto, and C. A. Gross, J. Biol. Chem. 270:30051-30059, 1995). The global effect of the G-304-S substitution on the conformation and catalytic and regulatory properties of glycerol kinase is consistent with a role for the domain closure motion in the molecular mechanism for glucose control of glycerol utilization.

The mode of action of hirsutellin A on eukaryotic cells

A 16-kDa protein toxin was purified from Hirsutella thompsonii var thompsonii and named hirsutellin A (HtA). At 0.5 and 5.0 microM concentrations, HtA caused detectable cytopathic effects on Spodoptera frugiperda cells (Sf-9) within 2-4 hr and completely inhibited Sf-9 cell growth at 4 days posttreatment. Electron microscope data showed that the HtA treated Sf-9 cells became hypotrophied and internal organelles and cell membranes were disrupted. At the same concentration, HtA effectively inhibited Brome mosaic virus protein synthesis of both rabbit reticulocyte and wheat germ in vitro translation system. The ribosomal RNA extracted from HtA treated Sf-9 cells produced a smaller RNA (approximately 528 bases) than untreated Sf-9 cells. In summary, HtA is the first mycotoxin of a invertebrate mycopathogen determined to possess ribosomal inhibiting activity and appears to possess some specificity to invertebrate cells.

Extraction and characterization of the insecticidal toxin hirsutellin A produced by Hirsutella thompsonii var. thompsonii

Hirsutellin A (HtA) produced by Hirsutella thompsonii var. thompsonii (strain JAB-04) was extracted and purified using a combination of ion-exchange, gel-permeation, and immunoaffinity chromatography. The identity of the purified HtA was confirmed by amino acid analysis and N-terminal sequencing. Monoclonal antibodies prepared against HtA were capable of detecting 25-50 ng of HtA by direct sandwich ELISA. In addition, utilizing Western blot methods, the antibodies were shown to be specific to HtA. The production of HtA was monitored during submerged fermentation. The peak level of exocellular HtA (13-14 micrograms/ml) was during the late exponential growth phase (39-45 h), determined by utilizing a combination of densitometric analysis of the 16.3-kDa bands on SDS-PAGE gels and ELISA. HtA production was directly correlated with mycelial growth. Twenty-one-hour culture filtrates were highly toxic to larvae of the greater wax moth. Pure HtA at a final concentration of 40 pmol was highly toxic to Galleria mellonella larvae.

An adoption study comparing the prevalence of psychiatric illness in women who have adoptive and natural children compared with women who have adoptive children only

The current study compares the current and lifetime prevalence of affective disorder in women who have adopted and have natural children (n = 110) with women who only have adopted children (n = 176). There was no difference in lifetime prevalence of psychiatric disorder between the two groups and a nonsignificant trend for women who had born children to have had a major depressive episode during their lifetime 48 (44%) cf 62 (35%). The increased prevalence of psychiatric illness in married women with children cannot be explained by the biological fact of bearing children. None of the social variables related to child-rearing which were examined influenced the lifetime prevalence of psychiatric disorder.

Localization of a cycloheximide-sensitivity response element in the human thymidine kinase gene promoter

In order to localize the segment of the human thymidine kinase (TK) gene promoter that mediates sensitivity of TK mRNA expression to the presence of cycloheximide (CX), a series of promoter truncation mutants was prepared between the 460-base pair (bp) promoter that was demonstrated previously to be sensitive to CX and the 83-bp promoter that was demonstrated previously to be insensitive to CX. TK promoters containing 370, 300, 160, or 130 bp of 5'-flanking sequence were all sensitive to inhibition by CX. Further truncation to 100 bp of 5'-flanking sequence eliminated CX sensitivity. Electrophoretic mobility shift assays using a probe containing most of this region (but omitting the SP1 binding site at the 5'-end of the 130-bp promoter) identified some complexes whose formation was sensitive to the presence of CX. Comparison of the sequences of oligonucleotides that were able to compete for formation of mobility shift complexes identified the sequence GCGGCC as a putative CX-sensitivity response element. Two such sequences are found between 83 and 130 bp 5' of the TK capsite. Mutation of the distal sequence attenuated sensitivity of TK mRNA expression to CX, while mutation of the proximal sequence had minimal effect on CX sensitivity. Thus, these data have localized a CX-sensitivity response element to a segment of TK promoter about 120 bp 5' of the capsite that includes the hexamer GCGGCC.

Escherichia coli glycerol kinase: role of a tetramer interface in regulation by fructose 1,6-bisphosphate and phosphotransferase system regulatory protein IIIglc

Escherichia coli glycerol kinase (EC 2.7.1.30; ATP:glycerol 3-phosphotransferase) is a key element in a signal transduction pathway that couples expression of genes required for glycerol metabolism to the relative availability of glycerol and glucose. Its catalytic activity is inhibited by protein-protein interactions with IIIglc, a phosphotransferase system protein, and by fructose 1,6-bisphosphate (FBP); each of these allosteric effectors constitutes a positive signal that glucose is available. Loss of glucose inhibition of glycerol metabolism was used to screen for regulatory mutants of glycerol kinase after hydroxylamine mutagenesis of the cloned glpK gene. Two mutant enzymes were identified and shown by DNA sequencing to contain the mutations alanine 65 to threonine (A65T) and aspartate 72 to asparagine (D72N). Initial velocity studies show the mutations do not significantly affect the catalytic properties, hence active-site structures, of the enzymes. Both mutations decrease inhibition by FBP; A65T eliminates the inhibition while D72N appears to decrease the affinity for FBP and the extent of the inhibition. However, neither mutation significantly affects inhibition by IIIglc. Gel-permeation chromatography studies show that both of the mutations alter the dimer-tetramer assembly reaction of the enzyme and the effect of FBP in increasing the molecular weight. The effects of the mutations on the assembly reaction are consistent with the locations of these two amino acid residues in the X-ray structure, which shows them to be associated with an alpha-helix that constitutes one of the two subunit-subunit interfaces within the tetramer.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of Equisetum hyemale on experimental hyperlipemia in rats and its toxic test]

The results of an experimental study in rats fed with Equisetum hyemale and hyperlipid food have proved that inhibiting effects on the elevation of triglyceride and cholesterol can be obviously observed in both high and low doses of Equisetum. The study also shows that Equisetum hyemale can antagonize the hyperlipemia in rats. The acute toxic test has proved its low toxicity.

[A study on motility of sphincter of Oddi in postcholecystectomy syndrome]

Endoscopic manometry of sphincter of Oddi (SO) and serum levels of gastrin, glucagon, and somatostatin were measured in patients with postcholecystectomy syndrome (n = 12), asymptomatic cholecystectomy patients (n = 6), and controlled subjects (n = 14). Pentagastrin-stimulated gastric acid secretion test was also performed in part of patients who had symptoms or no symptoms after the removal of gallbladder. The results showed that the patients of symptomatic group had hypertonic dyskinesia of SO as shown by deep and wide waves superimposed on high basal pressure plateau of SO. The symptomatic group also had a higher serum level of gastrin and a greater BAO than those of other two groups. No difference of serum levels of glucagon and somatostatin was found among these three groups. The hypertonic dyskinesia of SO and hypergastrinemia are possibly important factors in the pathogenesis of postcholecystectomy syndrome.

Mucosal wound and cicatricial stricture formation in the dog trachea: an experimental study

Complete healing of full-thickness tracheal mucosal wounds of different sizes was studied in three groups of dogs. No stricture was observed when the mucosal wounds were less than 20 x 15 mm. Obvious stricture, however, occurred when the wounds were 20 x 25 mm. Normal epithelium regenerated on the wounded areas in all of the three groups within seven weeks.

Cytophotometric DNA analysis on canine stomach carcinogenesis induced by ENNG

DNA content and nuclear area were measured by microspectrophotometry in gastric carcinogenesis of three adult wolfdogs induced by N-ethyl-N'-nitro-N-nitrosoguanidine (ENNG). The mean values and standard deviations of DNA content and nuclear area in normal gastric mucosa were 10.03 +/- 2.30 AU and 28.76 +/- 5.85/microns2; those in atrophic gastritis were 12.04 +/- 3.34 AU and 28.69 +/- 8.02/microns2; in mild dysplasia 13.52 +/- 3.73 AU and 28.23 +/- 8.12/microns2; in moderate dysplasia 20.88 +/- 4.57 AU and 47.58 +/- 10.74/microns2; in severe dysplasia 24.01 +/- 4.48 AU and 56.64 +/- 12.53/microns2; in well-differentiated adenocarcinoma 33.07 +/- 9.38 AU and 72.99 +/- 15.57/microns. These figures were different (P less than 0.01). The nuclear area of gastric carcinoma increased with DNA content (r = 0.73, P less than 0.01). The distribution patterns of DNA content in the histogram showed that diploidy was decreased and polyploidy increased in cancer cells. These findings indicate that DNA ploidy patterns and nuclear area can be useful indices for differentiating carcinoma from precancerous lesions.

The efficacy of furazolidone and metronidazole in the treatment of chronic gastritis associated with Helicobacter (Campylobacter) pylori--a randomized double-blind placebo-controlled clinical trial

Seventy-two patients with Helicobacter pylori-associated chronic gastritis were randomized to a 3-week oral treatment with furazolidone 0.1g t.i.d. or metronidazole 0.2g t.i.d. or placebo. Endoscopy was performed before and after treatment, and biopsy specimens were taken from the antrum of the stomach for histological examination and culture of Helicobacter pylori. Disappearance rates of Helicobacter pylori in furazolidone, metronidazole and the control groups were 74% (20/27) if considering completion of therapy, the 20/25 or 80%, 33.3% (8/24) and 14.3% (3/21) respectively. There was a significant difference in the disappearance rate of Helicobacter pylori between furazolidone and metronidazole, and between furazolidone and the placebo group (p less than 0.01), but there was no such difference between metronidazole and the placebo group (p greater than 0.05). In the patients receiving furazolidone, the eradication of Helicobacter pylori was accompanied by marked improvement in both inflammatory infiltration in the gastric mucosa and symptoms. These results reasonably suggest that Helicobacter pylori may play an etiological role in the pathogenesis of chronic gastritis, and that furazolidone is effective in the treatment of Helicobacter pylori-associated chronic gastritis.