Association between methylenetetrahydrofolate reductase polymorphisms and non-syndromic cleft lip with or without palate susceptibility: an updated systematic review and meta-analysis

Methylenetetrahydrofolate reductase (MTHFR) polymorphisms are thought to be involved in the development of cleft lip with or without cleft palate (NSCL/P), but published results are contradictory. We therefore designed an updated meta-analysis to pool eligible studies and to evaluate further the possible relations between MTHFR polymorphisms (c.677C>T and c.1298A>C) and susceptibility to NSCL/P. A comprehensive search based on PubMed, Medline, Web of Science, and Embase databases was made up to February 2018. Twenty-three case-control and 10 case-parent trio studies (including 1149 cases and 1161 controls) were retrieved. Odds ratio (OR) with 95% CI were used to estimate the pooled strength of association under different genetic models. The Q test and I² test were used to estimate heterogeneity among studies, the quality of which was assessed using the Newcastle-Ottawa scale. In the MTHFR c.677C>T polymorphism group, there were significant overall results for the recessive (OR 1.231, 95%CI 1.092 to 1.387) and homozygote (OR 1.252, 95%CI 1.078 to 1.456) models. Subgroup analysis by subjects and ethnicity identified only associations in European mothers for the recessive model and the homozygote model. For the c.1298A>C group, there were no significant results for either European or Asian patients for all genetic models. The MTHFR c.677C>T polymorphism might increase susceptibility to NSCL/P in European mothers, but was negatively associated in Asian patients, and the MTHFR c.1298A>C polymorphism is not involved in the development of NSCL/P in either European or Asian patients.

P6501Recurrent genetic aberrations in bicuspid aortic valve disease patients with isolated severe aortic regurgitation

Background

The etiology of bicuspid aortic valve disease (BAVD) is still unclear. Recent studies have demonstrated elevated prevalence of genetic defects in BAV patients with root phenotype, which includes aortic regurgitation and root-predominant dilatation.

Purpose

The present study intended to illustrate the feature of genetic defects among early-onset BAV patients with isolated severe aortic regurgitation.

Methods

From June 2015 to December 2017, whole exome sequencing was performed upon 27 BAVD patients with isolated severe aortic regurgitation under 45 years in our institution. Patients were categorized into right-left (R-L, n=16) and non-RL (n=11) cusp fusion types, and those with complex cardiac defects were excluded from the present study.

Results

Among 27 patients with a median age of 30.5 (18–44) years, only one was female with a rare left-non-coronary cusp fusion type. The prevalence of root phenotype was markedly higher in RL patients (56.3% vs 9.1%, p=0.018). In RL patients, the numbers of rare genetic variants (RGVs) were 15 in extracellular matrix genes, 8 in TGF-β signaling pathway genes, 2 in smooth muscle cell contraction apparatus genes, and 3 in familiar BAV related genes. In non-RL patients, the number of RGVs were 15, 3, 4, and 5, respectively. On the other hand, the number of RGVs in above gene clusters were 9, 6, 3, 2 in patients with a root phenotype, and 21, 5, 3, 6 in those without. Eight recurrent genetic variants were identified in 6 genes (see Table). An interesting observation was that ADAMTS2 variants were exclusively found among non-RL patients without root phenotype, as FBN2 variants among RL patients with root phenoype.

Recurrent Rare Genetic Variants Gene Reference sequence Variant 1000G 1000G-East Asia Patients TGFBR2 NM_001024847.2 p.Val216Ile/c.646G>A 0.004 0.018 A16, A23 TGFBR2 NM_001024847.2 p.Thr340Met/c.1019C>T 0.003 0.015 A03, A05, A07 ADAMTS2 NM_014244.4 p.Gly1169Val/c.3506G>T 0.0044 0.021 A03, A15 FBN2 NM_001999.3 p.Gly475Val/c.1424G>T 0.0004 0.002 A19, A24 ELN NM_001278939.1 p.Pro93Leu/c.278C>T 0.0014 0.0069 A22, A26 COL4A5 NM_033380.2 p.Gly953Val/c.2858G>T 0.0079 0.03 A11, A17 MYLK NM_053025.3 p.Ser243Trp/c.728C>G 0.0002 0.001 A01, A02 MYLK NM_053025.3 p.Asp717Tyr/c.2149G>T 0.0024 0.011 A04, A21

Conclusion

Recurrent genetic variants could be identified in a cohort of early-onset BAVD patients with isolated severe aortic regurgitation and staggering male predominance. The incidence and clinical relevance of these variants should be validated in an extended real-world BAV cohort.

P916The effect of a novel, user-friendly, transcatheter edge-to-edge mitral valve repair device in a porcine model of mitral regurgitation

Objective

A new technique has been devised to treat mitral regurgitation (MR) through the transapical route by replicating the edge-to-edge repair surgery. This system encompasses an easy-to-use leaflet clamp and a smaller-sized delivery system (14F–16F). We aimed to evaluate the effectiveness of this device in a porcine model of acute MR.

Methods

Acute MR was induced in 36 anesthetized porcine subjects by severing the major chordae supporting the corresponding segment of the leaflet. This device was then transapically implanted on the prolapsing segment under 3D epicardial echocardiographic guidance. All of the animals were killed 30 days after the procedure to verify the proper location of the implanted devices.

Results

Cutting the major chordae induced an eccentric MR jet (MR grade: 3+, 27.8%/4+, 72.2%) in all of the animals. Every single pig was then successfully implanted with one clamp. The duration of catheterization ranged from 18 to 40 minutes. Overt MR reduction was observed following the procedure through echocardiography; residual MR was mild in 8 cases, trivial in 19 cases, and absent in 9 cases. In terms of hemodynamic parameters, the mean and maximum mitral valve pressure gradients were increased significantly (p<0.01), but these values were less than 4 mmHg in all of the cases. Autopsy demonstrated that all but one device were precisely placed to clip the prolapsing segment of the mitral valve, and there was no evidence of thrombosis, thromboembolism or impairment of the cardiac structure.

Table 1. Changes in hemodynamic parameters, cardiac size, and functional parameters after the procedure Preoperation Postoperation P value MR-maxA (mm2) 7.27±2.13 1.54±1.29 0.000 MVPG-max (mmHg) 1.95±0.47 3.66±0.62 0.000 MVPG-mean (mmHg) 0.87±0.31 1.7±0.28 0.000 LVEDD (mm) 46.08±2.85 46.44±3.53 0.239 LVESD (mm) 29.11±3.44 29.08±3.62 0.940 LVEF (%) 66.53±6.4 67.14±4.93 0.256 LAD (mm) 35.75±2.24 36.42±1.99 0.057 LAA (mm2) 12.95±2.22 12.64±1.55 0.301

Figure 1

Conclusions

Transapical implantation of the novel mitral valve repair device is effective and safe in reducing acutely induced MR in pigs; thus, suggesting that it has great potential for clinical benefit in patients with MR.

Acknowledgement/Funding

Shanghai Science and Technology Committee

The eradication of Helicobacter pylori restores rather than disturbs the gastrointestinal microbiota in asymptomatic young adults

BACKGROUND

The eradication of Helicobacter pylori (H pylori) has been suggested to reduce the risk of gastric cancer, but its impact on the gut microbiota has attracted public attention. This study aimed to investigate the short-term and long-term effects of bismuth quadruple therapy on both gastric and fecal microbiota.

METHODS

Ten asymptomatic young adults with H pylori-related gastritis were treated with bismuth quadruple therapy for 14 days, and 7 age-matched adults without H pylori infection were enrolled as healthy controls. Both fecal and gastric mucosa samples were collected from H pylori-positive patients at weeks 0, 6, and 26, while fecal samples were collected from healthy controls. The gastric and gut microbiota were analyzed by 16S rRNA gene sequencing.

RESULTS

The structure of the gastric microbiota was significantly changed after the eradication of H pylori with increased alpha diversity over time. The relative abundance of H pylori sharply decreased from more than 70% to nearly 0% after treatment, while some beneficial bacteria, such as Lactobacillus and Bifidobacterium, were increased. The microbial diversity of gut microbiota was higher in H pylori-infected patients than in healthy controls, which tended to decrease after eradication. The potentially beneficial gut bacteria Blautia and Lachnoclostridium were enriched at week 26 compared to week 0, while the pathogenic Alistipes were depleted to a level close to that of the healthy controls.

CONCLUSIONS

Bismuth quadruple therapy for H pylori eradication can restore the diversity of gastric microbiota with enrichment of beneficial bacteria. The composition of gut microbiota after H pylori eradication trends toward healthy status instead of becoming dysbiotic.

Effectiveness and safety of furazolidone-containing quadruple regimens in patients with Helicobacter pylori infection in real-world practice

BACKGROUND & AIMS

The eradication rate of Helicobacter pylori (H pylori) has decreased largely because of the antibiotic resistance. We aimed to evaluate the effectiveness and safety of furazolidone-containing quadruple regimens for H pylori eradication.

METHODS

This was an observational study of furazolidone-containing quadruple regimens for H pylori infection in real-world settings. Data sets were collected from the medical records and telephone interviews of patients referred to a specialist clinic for suspected H pylori reinfection from January 1, 2015, to January 1, 2018, at the First Affiliated Hospital of Nanchang University. Main outcome measures were the eradication rate and adverse reactions during medication.

RESULTS

Among 584 patients with H pylori infection that met the inclusion criteria, 561 (96.1%) were treated for the first time, 19 (3.3%) had one, and 4 (0.5%) had two or more prior to furazolidone-containing quadruple regimens. The eradication rates for 10-day and 14-day regimens were 93.7% (95% CI: 91.5%-95.9%) vs 98.2% (95% CI: 95.6%-99.3%), respectively (P = 0.098). Adverse drug reactions occurred in 8.2% (48/584) with abdominal discomfort being the most common symptom. Overall adverse events with 10-day regimens were lower than 14-day regimens (6.1% vs 17.4%, P < 0.001). Logistic regression analysis indicated that poor adherence (adjusted odds ratio [AOR] = 46.5, 95% CI: 9.7-222.4) was correlated with failed eradication. Adverse drug reactions during medication were related to smoking and tobacco status, alcohol intake history, regimens combined with tetracycline, and poor adherence (all P < 0.05).

CONCLUSIONS

Furazolidone-containing quadruple regimens proved both safe and highly effective in a real-world setting.

Characteristics of mucosa-associated gut microbiota during treatment in Crohn’s disease

BACKGROUND

The dysbiosis of the gut microbiome is evident in Crohn’s disease (CD) compared with healthy controls (HC), although the alterations from active CD to remission after treatment are unclear.

AIM

To characterize the mucosa-associated gut microbiota in patients with CD before and after the induction therapy.

METHODS

The basic information was collected from the subjects and the CD activity index (CDAI) was calculated in patients. A 16S rRNA sequencing approach was applied to determine the structures of microbial communities in mucosal samples including the terminal ileal, ascending colon, descending colon and rectum. The composition and function of mucosa-associated gut microbiota were compared between samples from the same cohort of patients before and after treatment. Differential taxa were identified to calculate the microbial dysbiosis index (MDI) and the correlation between MDI and CDAI was analyzed using Pearson correlation test. Predictive functional profiling of microbial communities was obtained with PICRUSt.

RESULTS

There were no significant differences in microbial richness among the four anatomical sites in individuals. Compared to active disease, the alpha diversity of CD in remission was increased towards the level of HC compared to the active stage. The principal coordinate analysis revealed that samples of active CD were clearly separated from those in remission, which clustered close to HC. Sixty-five genera were identified as differentially abundant between active and quiescent CD, with a loss of Fusobacterium and a gain of potential beneficial bacteria including Lactobacillus, Akkermansia, Roseburia, Ruminococcus and Lachnospira after the induction of remission. The combination of these taxa into a MDI showed a positive correlation with clinical disease severity and a negative correlation with species richness. The increased capacity for the inferred pathways including Lipopolysaccharide biosynthesis and Lipopolysaccharide biosynthesis proteins in patients before treatment negatively correlated with the abundance of Roseburia, Ruminococcus and Lachnospira.

CONCLUSION

The dysbiosis of mucosa-associated microbiota was associated with the disease phenotype and may become a potential diagnostic tool for the recurrence of disease.

The Value of Confocal Laser Endoscopy in Assessing the Quality of Duodenal Ulcer Healing

BACKGROUND AND OBJECTIVE

Confocal laser endomicroscopy (CLE) is a novel endoscopic technique that can image cells and subcellular layers of the gastric mucosa in vivo. We aimed to investigate the value of CLE in assessing the quality of ulcer healing (QOUH) and preliminarily establish evaluation criteria.

MATERIALS AND METHODS

Patients with duodenal ulcers were enrolled. After duodenal ulcer healing, we compared the value of CLE and white light endoscopy (WLE) in assessing the QOUH by using the histopathological diagnosis as the gold standard. At the same time, immunohistochemistry was performed to examine the expressions of transforming growth factor β1 (TGF-β1) and fibroblast growth factor 2 (FGF-2) in normal and scar tissues.

RESULTS

In assessing the QOUH classified as poor, good, and excellent by the pathological classification, the sensitivity of WLE was 57.14%, 50%, and 47.06%, the specificity was 87.80%, 52.38%, and 81.58%, and the accuracy was 80.00%, 50.91%, and 70.91%, respectively. Meanwhile, the sensitivity of CLE was 73.33%, 85.19%, and 92.31%, the specificity was 95%, 85.71%, and 92.86%, and the accuracy was 89.09%, 85.45%, and 92.73%, respectively. The κ value for the correlation with pathological diagnosis grade was 0.38 for WLE vs. 0.74 for CLE. The assessment of the QOUH in the CLE image classification showed great improvement compared with that in the WLE image classification. The image classification of CLE was not associated with the immunohistochemical expression of TGF-β1 or FGF-2 according the Spearman rank correlation (P > 0.05).

CONCLUSION

Compared with WLE, CLE has a higher value in assessing the QOUH. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Vitamin B6 catabolism and lung cancer risk: results from the Lung Cancer Cohort Consortium (LC3)

BACKGROUND

Increased vitamin B6 catabolism related to inflammation, as measured by the PAr index (the ratio of 4-pyridoxic acid over the sum of pyridoxal and pyridoxal-5'-phosphate), has been positively associated with lung cancer risk in two prospective European studies. However, the extent to which this association translates to more diverse populations is not known.

MATERIALS AND METHODS

For this study, we included 5323 incident lung cancer cases and 5323 controls individually matched by age, sex, and smoking status within each of 20 prospective cohorts from the Lung Cancer Cohort Consortium. Cohort-specific odds ratios (ORs) and 95% confidence intervals (CIs) for the association between PAr and lung cancer risk were calculated using conditional logistic regression and pooled using random-effects models.

RESULTS

PAr was positively associated with lung cancer risk in a dose-response fashion. Comparing the fourth versus first quartiles of PAr resulted in an OR of 1.38 (95% CI: 1.19-1.59) for overall lung cancer risk. The association between PAr and lung cancer risk was most prominent in former smokers (OR: 1.69, 95% CI: 1.36-2.10), men (OR: 1.60, 95% CI: 1.28-2.00), and for cancers diagnosed within 3 years of blood draw (OR: 1.73, 95% CI: 1.34-2.23).

CONCLUSION

Based on pre-diagnostic data from 20 cohorts across 4 continents, this study confirms that increased vitamin B6 catabolism related to inflammation and immune activation is associated with a higher risk of developing lung cancer. Moreover, PAr may be a pre-diagnostic marker of lung cancer rather than a causal factor.

Furazolidone-containing triple and quadruple eradication therapy for initial treatment for Helicobacter pylori infection: A multicenter randomized controlled trial in China

BACKGROUND

The efficacy of Helicobacter pylori (H. pylori) eradication has steadily declined, primarily because of antibiotic resistance. This study aimed to evaluate the efficacy and safety of furazolidone eradication therapies as initial treatments for H. pylori infection.

METHODS

A national, multicenter, open-label, randomized controlled trial was performed at 16 sites across 13 provinces in China to evaluate the efficacy and safety of furazolidone-containing therapies for H. pylori infection. Treatment naïve patients were randomly assigned to: esomeprazole 20 mg, bismuth 220 mg, amoxicillin 1000 mg, and furazolidone 100 mg twice daily for 10 and 7 days (FAB 10 and FAB 7; the same therapy without bismuth (FA 10 and FA 7). The primary and secondary outcomes were the eradication rate and regimen safety, respectively. Treatment success was assessed by the ¹³ C urea breath test at least 4 weeks after treatment completion.

RESULTS

Overall, according to intention-to-treat (ITT) analysis, the eradication rates for FAB 10 and FAB 7 were 86.6% (95% confidence interval [CI], 79.9%-93.2%) and 83.6% (95% CI, 76.3%-90.9%) and for FA 10 and FA 7 were 82.4% (95% CI, 74.9%-89.8%) and 77.6% (95% CI, 69.4%-85.8%), respectively. According to per-protocol analysis, the overall eradication rates for FAB 10 and FAB 7 were 94.7% (95% CI, 90.3%-99.1%) and 90.8% (95% CI, 85.1%-96.5%) and for FA 10 and FA 7 were 90.6% (95% CI, 84.9%-96.3%) and 85.1% (95% CI, 78.2%-92.1%), respectively. The overall prevalence of side effects was 8.1%.

CONCLUSIONS

Furazolidone-containing therapies, particularly the tested 10-day quadruple therapy, exhibited satisfactory efficacy and safety. This 10-day quadruple therapy represents a promising initial treatment strategy for Chinese patients.

Helicobacter pylori promotes gastric epithelial cell survival through the PLK1/PI3K/Akt pathway

Purpose

Helicobacter pylori (H. pylori) infection plays a critical role in the process of gastric carcinogenesis. However, the complicated pathogenic mechanism is still unclear. Polo-like kinase 1 (PLK1) is involved in the development of multiple human malignancies, including gastric cancer. Therefore, this study aimed to elucidate the role of PLK1 in H. pylori-induced gastric carcinogenesis and the underlying signaling mechanism.

Materials and methods

We detected the expression of PLK1 in 166 patients in different stages of gastric carcinogenesis as well as the established Mongolian gerbil model with H. pylori infection by immunohistochemistry. Cell Counting Kit-8 was used to estimate the survival of gastric cancer cells.

Results

We found that PLK1 expression in gastric cancer tissues was significantly higher than that of paired adjacent mucosa. PLK1 expression was increased in intestinal metaplasia, dysplasia, and gastric cancer tissues compared to chronic non-atrophic gastritis tissues. Notably, PLK1 expression was much lower in H. pylori-negative tissues than in H. pylori-positive tissues at intestinal metaplasia stage. In addition, H. pylori infection increased PLK1 expression in the gastric epithelial cells of the Mongolian gerbil model, which was positively related to the duration of H. pylori infection. Inhibition of PLK1 significantly reduced H. pylori-induced cell proliferation. Furthermore, incubation of MKN-28 cells with H. pylori resulted in a significant increase in PLK1, p-PTEN, and the downstream PI3K/Akt pathway, and pretreatment with a PLK1 inhibitor reversed these molecular changes.

Conclusion

PLK1 is involved in H. pylori-induced gastric carcinogenesis at the early stage by activating the PI3K/Akt signaling pathway. These results may contribute to the development of new control strategies for H. pylori infection-related gastric cancer.

PTEN lipid phosphatase inactivation links the hippo and PI3K/Akt pathways to induce gastric tumorigenesis

Background

Phosphatase and tensin homolog (PTEN) is an important tumor suppressor gene, and its encoded protein has activities of both a protein phosphatase and a lipid phosphatase. However, the substitution effect of protein phosphatase activity remains unclear. PI3K/Akt is the most common pathway negatively regulated by PTEN. The Hippo and PI3K/Akt pathways have a joint effect in regulating cell proliferation and apoptosis. Therefore, how PTEN lipid phosphatase inactivation contributes to the occurrence and development of gastric cancer and the potential role of the Hippo and PI3K/Akt pathways in PTEN lipid phosphatase inactivation mediated gastric tumorigenesis remain to be explored.

Methods

Immunohistochemical staining was performed to detect the expression of p-PTEN and YAP in a gastric cancer tissue microarray. Stable cell lines expressing a wild-type or dominant-negative mutant PTEN were established. The proliferation and migration of stable cells were detected by MTT, BrdU, and colony-formation, transwell assay and high content analysis in vitro, and tumor growth differences were observed in xenograft nude mice. Changes in the expression of key molecules in the Hippo and Akt signaling pathways were detected by western blot. Nuclear-cytoplasm separation, immunofluorescence and coimmunoprecipitation analyses were conducted to explore the dysregulation of Hippo in the stable cell lines.

Results

PTEN lipid phosphatase inactivation strongly promoted the proliferation and migration of gastric cancer cells in vitro and tumor growth in vivo. A immunohistochemical analysis of gastric cancer tissues revealed a significant correlation between phosphorylated PTEN and nuclear YAP expression, and both were determined to be independent prognostic factors for gastric cancer. Mechanistically, PTEN lipid phosphatase inactivation abolished the MOB1-LATS1/2 interaction, decreased YAP phosphorylation and finally promoted YAP nuclear translocation, which enhanced the synergistic effect of YAP-TEAD, thus inducing cell proliferation and migration. Moreover, PTEN lipid phosphatase inactivation promoted the PI3K/Akt pathway, and disruption of YAP-TEAD-driven transcription decreased the activation of Akt in a dose-dependent manner.

Conclusions

Taken together, our findings indicate that PTEN lipid phosphatase inactivation links the Hippo and PI3K/Akt pathways to promote gastric tumorigenesis and cancer development.

Electronic supplementary material

The online version of this article (10.1186/s13046-018-0795-2) contains supplementary material, which is available to authorized users.

Ulcerative colitis followed by the development of typical intestinal Behçet disease: A case report

RATIONALE

Intestinal Behçet disease (intestinal BD) and inflammatory bowel disease (IBD) share a lot of characteristics, including genetic background, clinical manifestations, and therapeutic strategies, especially the extraintestinal manifestations, such as oral ulcers, arthralgia, eye lesions, skin lesions, etc, but the coexistence of these 2 diseases are uncommon. Behçet disease with gastrointestinal involvement in ulcerative colitis (UC) patient has been reported in just 1 previous case report, but, which can not be diagnosed as definite intestinal BD based on Korean novel diagnositic criteria due to lacking the typical ileocecal ulcer.

PATIENT CONCERNS

We present a 23-year-old woman with ulcerative disease who developed typical intestinal BD, which is the first case report of patient with coexisting UC and typical intestinal BD.

DIAGNOSES

This patient was diagnosed as coexistence of intestinal BD and UC base on the clinical manifestations, extra intestinal manifestations and typical colonoscopic findings.

INTERVENTIONS

Steroid and methotrexate were administered.

OUTCOMES

This patient achieved clinical remission and mucosal healing.

LESSONS

Coexistence of intestinal BD and UC is uncommon, and the combination with steroid, methotrexate, and 5-aminosalicylic acids is an effective therapy.

Comparison of two kinds of skin imaging analysis software: VISIA® from Canfield and IPP® from Media Cybernetics

BACKGROUND

Skin imaging analysis, acting as a supplement to noninvasive bioengineering devices, has been widely used in medical cosmetology and cosmetic product evaluation. The main aim of this study is to assess the differences and correlations in measuring skin spots, wrinkles, vascular features, porphyrin, and pore between two commercially available image analysis software.

MATERIALS AND METHODS

Seventy healthy women were included in the study. Before taking pictures, the dermatologist evaluated subjects' skin conditions. Test sites included the forehead, cheek, and periorbital skin. A 2 × 2 cm cardboard was used to make a mark on the skin surface. Pictures were taken using VISIA^® under three kinds light conditions and analyzed using VISIA^® and IPP^® respectively.

RESULTS

(1) Skin pore, red area, ultraviolet spot, brown spot, porphyrin, and wrinkle measured with VISIA^® were correlated with those measured with IPP^® (P < .01). (2) Spot, wrinkle, fine line, brown spot, and red area analyzed with VISIA^® were correlated with age on the forehead and periorbital skin (P < .05). L-value, Crow's feet, ultraviolet spot, brown spot, and red area analyzed with IPP^® were correlated with age on the periorbital skin (P < .05). (3) L-value, spot, wrinkle, fine line, porphyrin, red area, and pore analyzed with VISIA^® and IPP^® showed correlations with the subjective evaluation scores (P < .05).

CONCLUSIONS

VISIA^® and IPP^® showed acceptable correlation in measuring various skin conditions. VISIA^® showed a high sensibility when measured on the forehead skin. IPP^® is available as an alternative software program to evaluate skin features.

Methods for Contrasting Gap Time Hazard Functions: Application to Repeat Liver Transplantation

In studies featuring a sequence of ordered events, gap times between successive events are often of interest. Despite the rich literature in this area, very few methods for comparing gap times have been developed. We propose methods for estimating a hazard ratio connecting the first and second gap times. Specifically, a two-stage procedure is developed based on estimating equations. At the first stage, a proportional hazards model is fitted for the first gap time. Weighted estimating equations are then solved at the second stage to estimate the hazard ratio between the first and second gap times. The proposed estimator has a closed form and, being analogous to a standardized mortality ratio, is easy to interpret. Large sample properties of the proposed estimators are derived, with simulation studies used to evaluate finite sample characteristics. Extension of the approach to accommodate a piecewise constant hazard ratio is considered. The proposed methods are applied to contrast repeat (second) versus primary (first) liver transplants with respect to graft failure, based on national registry data.

Macrophage immunomodulatory activity of the polysaccharide isolated from Collybia radicata mushroom

Polysaccharides from Collybia radicata mushroom (CRP) possess many functions, such as antiviral, anti-aging and hypolipidemic activities. However, little is known about their immunomodulatory activity. To address this issue, we did a thorough research into their immune effects on murine macrophages. The results showed that the 14942Da polysaccharide not only obviously improved the proliferation and phagocytosis of macrophages, but also induced the secretion of nitric oxide (NO), inducible nitric oxide synthase (iNOS) and cytokines, such as tumor necrosis factor-α (TNF-α) and interleukin factors (IL-1β, IL-6 and IL-10). At a concentration of 850.0μgmL^-1, the polysaccharide stimulated their proliferation and phagocytosis to 2.1 and 3.4 times, respectively, as compared to the negative group. Meanwhile, it raised the production of NO by inducing iNOS in a concentration-dependent manner. Furthermore, it enhanced the release of these cytokines to multiples from 2.3 to 3.6 times. As an inhibitor of TLR4 (Toll-like Receptor 4), TAK242 suppressed the secretion of NO, iNOS and cytokines above 51%, and ORP acted on the cells mainly via TLR4. Consequently, the polysaccharide has a potent immunomodulatory activity by stimulating macrophages and can be considered as a novel potential immunopotentiator in medical and food industries.

Evaluation of first-line bismuth-containing 7-day concomitant quintuple therapy for Helicobacter pylori eradication

OBJECTIVE

Helicobacter pylori (H. pylori) infection is difficult to cure, mainly due to antibiotic resistance. This study aimed to determine the efficacy and safety of 7-day bismuth-containing concomitant quintuple regimen for H. pylori eradication.

METHODS

Conducted from August 2015 to February 2016 at the First Affiliated Hospital of Nanchang University, this prospective trial enrolled 70 untreated patients who were positive for H. pylori. The patients received 7-day quintuple therapy consisting of bismuth subcitrate 220 mg, esomeprazole 20 mg, clarithromycin 500 mg, amoxicillin 1 g and metronidazole 400 mg, each was given twice daily. All patients underwent a ¹³ C-urea breath test at 4 weeks after treatment.

RESULTS

A total of 70 patients at a mean age of 43.5 years, including 36 men, were included in this trial. One person who violated the protocol was further excluded. The treatment compliance rate was 99.6%. The overall eradication rates of the 7-day bismuth-containing concomitant quintuple therapy were 75.4% (intention-to-treat analysis) and 86.7% (per-protocol analysis). The prevalence of side effects was 31.9%, including a bitter taste (23.2%), nausea (4.3%), dizziness (2.9%), diarrhea (2.9%), limb asthenia (2.9%), skin rash (1.4%), numbness of the tip of the tongue (1.4%) and insomnia (1.4%).

CONCLUSIONS

The 7-day bismuth-containing concomitant quintuple therapy may not be superior to traditionally widely accepted therapy due to its lack of acceptable efficacy and high rate of side effects.

Primary antibiotic resistance of Helicobacter pylori in Chinese patients: a multiregion prospective 7-year study

OBJECTIVES

To explore the characteristics of Helicobacter pylori resistance in China and the association between antibiotic resistance and several clinical factors.

METHODS

H. pylori strains were collected from patients in 13 provinces or cities in China between 2010 and 2016. Demographic data including type of disease, geographic area, age, gender and isolation year were collected to analyse their association with antibiotic resistance. Antibiotic resistance was detected using the Etest test and the Kirby-Bauer disc diffusion method.

RESULTS

H. pylori were successfully cultured from 1117 patients. The prevalence of metronidazole, clarithromycin (CLA), azithromycin, levofloxacin (LEV), moxifloxacin, amoxicillin (AMO), tetracycline and rifampicin resistance was 78.2, 22.1, 23.3, 19.2, 17.2, 3.4, 1.9 and 1.5%, respectively. No resistance to furazolidone was observed. The resistance rates to LEV and moxifloxacin were higher in strains isolated from patients with gastritis compared to those with duodenal ulcer and among women. Compared to patients ≥40 years old, younger patients exhibited lower resistance rates to CLA, azithromycin, LEV and moxifloxacin. The resistance rates to CLA and AMO were higher in strains isolated more recently, and we also found that the prevalence of resistance to metronidazole, CLA, azithromycin and AMO were significantly different among different regions of China.

CONCLUSIONS

The resistance rates to metronidazole, CLA and LEV were high in China. Patient age, gender, disease and location were associated with the resistance of H. pylori to some antibiotics. Furazolidone, AMO and tetracycline are better choices for H. pylori treatment in China.

Superior mesenteric arteriovenous fistula presenting as gastrointestinal bleeding: case report and literature review

Superior mesenteric arteriovenous fistula (SMAVF) is a rare vascular disorder usually following penetrating abdominal trauma or gastrointestinal surgery. Percutaneous endovascular treatment such as embolization, has been widely used to treat this disease. We report a patient, who was presented with melena at the onset of his symptoms, then an acute hematemesis in shock. A SMAVF was diagnosed on an angiogram after a large mesenteric vein was seen on CT. The patient had a successful emergency endoscopic variceal ligation (EVL) to stop bleeding. Then the patient received fistula embolization with covered stent.

Esophageal Adenocarcinoma-Derived Extracellular Vesicle MicroRNAs Induce a Neoplastic Phenotype in Gastric Organoids

There have been no reports describing the effects of cancer cell-derived extracellular vesicles (EVs) on three-dimensional organoids. In this study, we delineated the proneoplastic effects of esophageal adenocarcinoma (EAC)-derived EVs on gastric organoids (gastroids) and elucidated molecular mechanisms underlying these effects. EVs were identified using PKH-67 staining. Morphologic changes, Ki-67 immunochemistry, cell viability, growth rates, and expression levels of miR-25 and miR-210, as well as of their target mRNAs, were determined in gastroids co-cultured with EAC-derived extracellular vesicles (c-EVs). C-EVs were efficiently taken up by gastroids. Notably, c-EV-treated gastroids were more crowded, compact, and multilayered and contained smaller lumens than did those cultured in organoid medium alone or in EAC-conditioned medium that had been depleted of EVs. Moreover, c-EV-treated gastroids manifested increased proliferation and cellular viability relative to medium-only or EV-depleted controls. Expression levels of miR-25 and miR-210 were significantly higher, and those of PTEN and AIFM3 significantly lower, in c-EV-treated versus medium-only or EV-depleted control groups. Inhibitors of miR-25 and miR-210 reversed the increased cell proliferation induced by c-exosomes in co-cultured gastroids by lowering miR-25 and miR-210 levels. In conclusion, we have constructed a novel model system featuring the co-culture of c-EVs with three-dimensional gastroids. Using this model, we discovered that cancer-derived EVs induce a neoplastic phenotype in gastroids. These changes are due, at least in part, to EV transfer of miR-25 and miR-210.

The outcomes of initial endoscopic transluminal drainage are superior to percutaneous drainage for patients with infected pancreatic necrosis: a prospective cohort study

BACKGROUND AND STUDY AIM

The commonly used minimally invasive methods for patients with infected pancreatic necrosis (IPN) are initial endoscopic transluminal drainage (ETD) and percutaneous catheter drainage (PCD), which are followed, if necessary, by endoscopic or surgical necrosectomy. This study intends to explore which of the two minimally invasive treatments leads to a better prognosis.

PATIENTS AND METHODS

Patients with IPN and an indication for intervention were prospectively enrolled and underwent either initial ETD or PCD followed, if necessary, by endoscopic or surgical necrosectomy.

RESULTS

Initial treatment success occurred in 8 of 11 patients after ETD (72.7%) and in 3 of 13 patients after PCD (30.8%) (risk ratio [RR] with ETD, 2.36; 95% CI 0.97-5.77; P = 0.04). After 1 year of follow-up, 72.7% of patients survived with ETD, and 69.2% survived with PCD (RR 1.05; 95% CI 0.63-1.75; P = 0.85). Intestinal fistula seems to have occurred less in the patients who received initial ETD rather than PCD therapy (9.1 vs. 38.5%; RR 0.24; 95% CI 0.03-1.73; P = 0.098). Fewer patients who underwent an initial ETD were transferred to surgery (9.1 vs. 46.2%; RR 0.20; 95% CI 0.03-1.40; P = 0.047). A higher rate of new-onset diabetes (3 cases) or impaired glucose tolerance (1 case) occurred in initial PCD compared to ETD (40 vs. 0%, P = 0.042).

CONCLUSION

The outcomes of initial endoscopic transluminal drainage are superior to percutaneous drainage for patients with infected pancreatic necrosis (ChiCTR-ONRC-13003653).