Gastric Juice-Based Real-Time PCR for Tailored Helicobacter Pylori Treatment: A Practical Approach

A gastric juice-based real-time polymerase chain reaction (PCR) assay was established to identify Helicobacter pylori infection, clarithromycin susceptibility and human CYP2C19 genotypes and to guide the choice of proton pump inhibitor (PPI), clarithromycin and amoxicillin treatment for tailored H. pylori eradication therapy. From January 2013 to November 2014, 178 consecutive dyspeptic patients were enrolled for collection of gastric biopsy samples and gastric juice by endoscopy at the Peking University Third Hospital; 105 and 73 H. pylori-positive and -negative patients, respectively, were included in this study. H. pylori infection was defined as samples with both a strongly positive rapid urease test (RUT) and positive H. pylori histology. A series of primers and probes were distributed into four reactions for identifying the H. pylori cagH gene coupled with an internal control (Rnase P gene), A2142G and A2143G mutants of the H. pylori 23S rRNA gene, and single-nucleotide polymorphisms (SNPs) G681A of CYP2C19*2 and G636A of CYP2C19*3. The E-test and DNA sequencing were used to evaluate the H. pylori clarithromycin susceptibility phenotype and genotype. The SNPs CYP2C19*2 and CYP2C19*3 were also evaluated by nucleotide sequencing. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of this gastric juice-based real-time PCR assay were evaluated by comparing with the same measures obtained through gastric biopsy-based PCR and culture. The H. pylori diagnostic sensitivities of the culture, PCR, and gastric biopsy- and gastric juice-based real-time PCR assays were 90.48% (95/105), 92.38% (97/105), 97.14% (102/105) and 100% (105/105), respectively; the specificities of the above methods were all 100%. Higher false-negative rates were found among the gastric biopsy samples assessed by culture (10.48%, 11/105), PCR (7.62%, 8/105) and real-time PCR (2.86%, 3/105) than in gastric juice by real-time PCR. Regarding clarithromycin susceptibility, a concordance of 82.98% (78/94) and discordance of 17.02% (16/94) were observed among the different methods, discrepancies that mainly represent differences between the H. pylori clarithromycin susceptibility phenotype and genotype. Three coinfections of susceptible and resistant strains were detected, with resistant-to-susceptible ratios of 1.16, 3.44, and 8.26. The CYP2C19 genotyping results from gastric juice by real-time PCR were completely in accordance with those obtained from biopsy samples by conventional PCR. This gastric juice-based real-time PCR assay is a more accurate method for detecting H. pylori infection, clarithromycin susceptibility and CYP2C19 polymorphisms. The method may be employed to inform the choice of proton pump inhibitor (PPI), clarithromycin and amoxicillin treatment for tailored H. pylori eradication therapy.

The influence of emission control on particle number size distribution and new particle formation during China's V-Day parade in 2015

Temporary strict emission control strategies were conducted to ensure good air quality for China's V-Day parade (August 20-September 3, 2015) in Beijing and nearby cities. The influence of the emission control on particle number size distribution (PNSD) was evaluated based on the long-term measurements of PNSD at a rural site (Shangdianzi) located northeast of Beijing. This study also presented the comparison results of PNSD during the parade in 2015 and the Olympics in 2008 (August 8-23), as well as the same period without strict emission control in 2010-2013 (August 20-September 3). Compared with the same period in 2010-2013 and 2008 Olympics, the accumulation mode particle number concentration showed a significant reduction in 2015, and the PM₁ mass concentration decreased by approximately 60-90%. The alleviation of the PM₁ was also associated with the weather conditions. The back trajectories analysis results showed that the southerly air mass passing through the polluted areas accounted for 14% of the total back trajectories in 2015, which contributed to approximately 60% in the other years. During the control period in 2015, there were six new particle formation (NPF) events observed, with a higher frequency, but a lower formation rate and growth rate than the same period in 2010-2013. The comparison of the condensation sink (CS), sulfuric acid, solar radiation and relative humidity among the different years indicated that at Shangdianzi station, the first factor in determining the NPF occurrence was the CS, and the second factor could be the concentration level of precursor vapors participating in the NPF event (e.g., sulfuric acid).

Rabeprazole, Minocycline, Amoxicillin, and Bismuth as First-Line and Second-Line Regimens for Helicobacter pylori Eradication

BACKGROUND

Because of general unavailability of tetracycline, common adverse effects, and complicated administration, the clinical application of bismuth quadruple therapy often faces difficulties. Whether the combination of minocycline and amoxicillin can replace tetracycline and metronidazole for Helicobacter pylori eradication remains unclear. This study was to determine the efficacy, compliance, and safety of rabeprazole, minocycline, amoxicillin, and bismuth (RMAB) therapy as first-line and second-line regimens.

MATERIALS AND METHODS

Between July 2013 and December 2015, a total of 160 patients in first-line and 70 patients in second-line therapies received rabeprazole 10 mg, minocycline 100 mg, amoxicillin 1000 mg, and bismuth potassium citrate 220 mg twice daily for 14 days. Eradication status was assessed 6-12 weeks after treatment.

RESULTS

RMAB therapy achieved the eradication rates of 87.5% (95% confidence interval, 81.9-92.5%, intention-to-treat analysis), 90.9% (85.7-95.5%, modified intention-to-treat analysis), and 92.6% (88.5-96.6%, per-protocol analysis) in first-line therapy in a setting with high antibiotic resistance rates (amoxicillin 3.4%, clarithromycin 39.7%, metronidazole 60.3%, levofloxacin 36.2%, tetracycline 3.4%, and minocycline 6.9%). As for second-line therapy, the eradication rates were 82.9% (74.3-91.4%, intention-to-treat analysis), 86.6% (77.6-94.0%, modified intention-to-treat analysis), and 89.1% (81.3-95.3%, per-protocol analysis). Totally, 24.0% patients had adverse effects, 2.2% discontinued medications, and good compliance was achieved in 94.7%. Poor compliance and minocycline resistance were identified as the risk factors for treatment failure. Significant differences in efficacy existed among the groups of both sensitive (48/51 and 18/20), isolated amoxicillin resistance (1/1 and 0/0), isolated minocycline resistance (2/3 and 1/1), and dual resistance (0/1 and 0/1) in both first-line (p = .004) and second-line (p = .035) therapies.

CONCLUSIONS

The eradication efficacies of RMAB therapy as first-line and second-line regimens were satisfactory with good compliance and safety in a region with high antibiotic resistance.

[Study of abnormal iron metabolism parameters and iron overload in patients with myelodysplastic syndromes]

Objective: To investigate the abnormalities of iron metabolism parameters, the prevalence and risk factors of iron overload and clinical characteristics of patients with myelodysplastic syndromes(MDS). Methods: Retrospective investigation was used to observe abnormal iron metabolism parameters and clinical characteristics of newly diagnosed 94 MDS patients in our center from June 2015 to March 2016. Results: Of 94 patients, 71(75.53%)had a hemoglobin level of less than 100 g/L at diagnosis. Iron overload was observed in 52(55.32%)of 94 MDS patients, in which a higher prevalence of iron overload was observed in low risk groups(IPSS low/Int-1 risk groups)than higher risk groups(Int-2/high risk groups). Higher levels of serum iron(SI)[36.5(8.5-64.7)mmol/L vs 25.2(3.7-45.3)mmol/L, P<0.01], transferrin saturation(TSAT)[43.5(12.2-77.2)% vs 53.4(14.8-97.5)%, P <0.01]and serum ferritin(SF)were observed in iron overload group. No differences of labile cellular iron(LCI)and reactive oxygen species(ROS)were observed between two groups(P=0.88, P=0.06). As the results of clinical complication of iron overload, alanine aminotransferase(ALT)[25(3-158)U/L vs 16(5-80)U/L, P=0.03]and type B natriuretic peptide precursor(proBNP)[190(6-4281)ng/L vs 84(12-2 275)ng/L, P= 0.05]levels were increased in iron overload group. There was no significant difference in iron metabolism parameters between patients with refractory anemia(RARS)and non RARS patients(P>0.05). Both frequency and volume of RBC transfusion had a significant effect on all iron metabolism parameters(SI, TSAT and SF)(P <0.01)except LCI and ROS. Excluded the patients with history of blood transfusion and SF levels over 1 000 μg/L, higher levels of LCI were mainly observed in dysplastic erythropoiesis and increased bone marrow erythroblasts ratio groups(P<0.01, P<0.05). Conclusion: The main cause of iron overload in MDS is chronic transfusion therapy. Both frequency and intensity of transfusion regimen have a main effect on iron metabolism parameters. LCI levels are mainly increased in newly diagnosed patients with the abnormalities of iron metabolism and have a stronger association with dysplastic erythropoiesis and increased bone marrow erythroblasts ratio. As the toxic fraction of iron and its negative impact on MDS, iron overload monitoring and chelation treatment decision can also be supported by LCI.

Hybrid Therapy as First-Line Regimen for Helicobacter pylori Eradication in Populations with High Antibiotic Resistance Rates

BACKGROUND

Hybrid therapy has recently attracted widespread attention. However, many issues require further exploration. For example, research in regions with high antibiotic resistance rates is limited, and the correlation between eradication efficacy and antibiotic resistance remains unclear. The aim of this study was to determine the efficacy, compliance, safety, and risk factors of hybrid therapy as first-line regimen in a region with high antibiotic resistance rates.

MATERIALS AND METHODS

This prospective study was conducted in a tertiary hospital between January 2014 and June 2015. A total of 196 patients with dyspepsia but without prior eradication therapy received hybrid regimen (esomeprazole 20 mg and amoxicillin 1000 mg twice daily for 14 days with the addition of clarithromycin 500 mg and tinidazole 500 mg twice daily for the final 7 days). All patients underwent Helicobacter pylori culture, antibiotic susceptibility testing and cytochrome P450 isoenzyme 2C19 polymorphism testing.

RESULTS

Hybrid therapy achieved eradication rates of 77.0% (95% confidence interval (CI), 70.9-83.7%) in intention-to-treat (ITT), 83.9% (78.9-88.9%) in modified ITT and 86.0% (80.2-91.3%) in per-protocol analyses in a setting with high antibiotic resistance rates (amoxicillin 2.0%, clarithromycin 44.9%, metronidazole 67.3% and dual clarithromycin and metronidazole 33.3%). Adverse reactions occurred in 31.9% patients and 2.7% discontinued medications due to adverse reactions. Good compliance was achieved by 92.0%. Multivariate analyses identified clarithromycin resistance (odds ratio, 3.494; 95% CI, 1.237-9.869), metronidazole resistance (3.012; 1.013-12.054) and poor compliance (5.840; 1.126-30.296) as independent predictors of treatment failure. The eradication rate with dual clarithromycin and metronidazole resistance (70.2%) was markedly decreased compared to isolated clarithromycin resistance (87.5%), isolated metronidazole resistance (88.6%), or dual susceptibility (96.4%) (p = .014).

CONCLUSIONS

Despite good compliance and safety, hybrid therapy as first-line regimen in populations with high antibiotic resistance rates had unsatisfactory efficacy, primarily due to dual clarithromycin and metronidazole resistance.

Dual emission of Ce3+ ,Mn2+ -coactivated Ca3 YNa(PO4 )3 F via energy transfer: a single component white/yellow-emitting phosphor

A series of Ce³⁺ ,Mn²⁺ -coactivated Ca₃ YNa(PO₄ )₃ F phosphors were synthesized via a traditional solid-state reaction under a reductive atmosphere. X-Ray powder diffraction was used to confirm that the crystal structure and diffraction peaks of Ce³⁺ /Mn²⁺ -doped samples matched well with the standard data. A spectral overlap between the emission band of Ce³⁺ and the excitation band of Mn²⁺ suggested the occurrence of energy transfer from Ce³⁺ to Mn²⁺ . With increasing Mn²⁺ content, the emission intensities and lifetime values of the Ce³⁺ emission for Ca₃ YNa(PO₄ )₃ F:Ce³⁺ ,Mn²⁺ phosphors linearly decrease, whereas the energy transfer efficiencies gradually increase to 89.35%. By adjusting the relative concentrations of Ce³⁺ and Mn²⁺ , the emission hues are tuned from blue to white and eventually to yellow. These results suggest that Ca₃ YNa(PO₄ )₃ F:Ce³⁺ ,Mn²⁺ phosphors have promising application as white-emitting phosphors for near-ultraviolet light-emitting diodes.

Nocturnal Hypoxemia Causes Hyperglycemia in Patients With Obstructive Sleep Apnea and Type 2 Diabetes Mellitus

BACKGROUND

Our purpose was to investigate the relationship between oxygen saturation (SpO2) and dynamic interstitial glucose level (IGL) in patients with obstructive sleep apnea (OSA) along with type 2 diabetes mellitus (T2DM), and to investigate the potential mechanisms thereof.

MATERIALS AND METHODS

A total of 130 patients with OSA and T2DM underwent polysomnography and oral glucose tolerance tests at the Sleep Medicine Center. Using the lowest (L) SpO2% tested, patients were divided into mild, moderate and severe LSpO2 groups. Polysomnography and continuous glucose monitoring systems were used to analyze the altered pattern of SpO2 and dynamic IGL in the 3 groups.

RESULTS

LSpO2 during sleep in patients with OSA and T2DM stimulated an increase in IGL. The moderate and severe levels were represented by IGL45 and IGL30, respectively. The average nocturnal and peak IGL after LSpO2 in the severe group were significantly higher than in the mild and moderate groups. Stepwise multiple regression analysis showed that the body mass index (β = 0.301, P < 0.001), homeostatic model assessment of insulin resistance (β = 0.260, P < 0.001), apnea-hypopnea index (β = 0.309, P < 0.001), average SpO2 (β = -0.423, P = 0.008), LSpO2 (β = -0.369, P < 0.001) and microarousal index (β = 0.335, P = 0.044) were probably related to nocturnal IGL in patients with OSA along with T2DM.

CONCLUSIONS

Severe and moderate OSA with T2DM is marked by a delayed IGL peak following LSpO2. Nocturnal hypoxemia causes hyperglycemia in patients with OSA along with T2DM.

[The changes of main upper gastrointestinal diseases and Helicobacter pylori infection status in the past thirty five years]

OBJECTIVE

To study the spectrum of upper gastrointestinal diseases and infection rate of Helicobacter pylori(Hp)in our hospital during the past 35 years.

METHODS

Patients who were 16 or older with duodenal ulcer, gastric ulcer, reflux esophagitis, gastric cancer and esophageal cancer diagnosed by gastroscopy and pathology were retrospectively enrolled in our study from January 1980 to December 2014.Patients with chronic superficial gastritis, chronic atrophic gastritis or Hp infection from January 1989 to December 2014 were also included in our study according to the same diagnostic criteria.The incidences of diseases and the infection rates of Hp were studied.

RESULTS

A total of 213 495 patients underwent gastroscopy in our department during the past 35 years.The overall diagnostic rates of duodenal ulcer, gastric ulcer, reflux esophagitis, gastric cancer and esophageal cancer were 9.87%, 3.79%, 6.66%, 1.59% and 0.66% respectively.There were 183 426 patients receiving gastroscopy in our department from January 1989 to December 2014. The overall endoscopic diagnosis rates of chronic superficial gastritis and chronic atrophic gastritis were 49.83% and 22.43% respectively.The overall infection rate of Hp was 36.18%, which had a declining trend consistent with peptic ulcer (all P=0.000). Yet, the prevalence of reflux esophagitis, chronic superficial gastritis and chronic atrophic gastritis were increasing (all P=0.000). The diagnostic rates of gastric cancer and esophageal cancer were persistent (P=0.266, P=0.156).

CONCLUSIONS

The Hp infection during years has been decreasing, consistent with the declining tendency of peptic ulcer.On the other hand, reflux esophagitis, chronic superficial gastritis and chronic atrophic gastritis show an ascendant trend.The proportion of patients with gastric cancer and esophageal cancer is relatively stable.

ARF1 activation dissociates ADRP from lipid droplets to promote HCV assembly

Lipid droplets are the place for HCV assembly and ADRP is an abundant lipid droplets-associated protein. However, little is known about the mechanisms how ADRP is involved in HCV life cycle. Here we demonstrate that activation of ARF1 dissociates ADRP from lipid droplets. A constitute active form of ARF1 (ARF1Q71I) promotes HCV assembly. We found that ADRP plays a positive role in HCV replication and a negative role in HCV assembly. Overexpression of ADRP increases the size of lipid droplets, while silencing ADRP reduces the size of lipid droplets. These findings provide new insight into the role of lipid droplets proteins in life cycle of HCV.

Tailored versus Triple plus Bismuth or Concomitant Therapy as Initial Helicobacter pylori Treatment: A Randomized Trial

BACKGROUND

With markedly increased antibiotic resistance and unsatisfactory efficacies of common empiric eradication regimens in the mainland of China, tailored therapy may be the best choice to achieve good efficacy. This study compared the eradication rates, safety, and compliance of tailored therapy to those of triple therapy plus bismuth and concomitant therapy in the naïve patients with Helicobacter pylori infection.

MATERIALS AND METHODS

Between September 2013 and April 2014, 1050 patients with H. pylori infection at three tertiary hospitals were randomly assigned to 10-day treatment with tailored, triple plus bismuth, or concomitant regimens. In tailored therapy, medications were adjusted according to clarithromycin sensitivity and cytochrome P450 isoenzyme 2C19 genotype. The antimicrobial susceptibility testing (E test) was performed. Eradication status was assessed 4-12 weeks after treatment.

RESULTS

The eradication rate was significantly higher in tailored group than in triple plus bismuth and concomitant groups in both intention-to-treat (88.7 vs 77.4 vs 78.3%, p < .001) and per-protocol (93.3 vs 87.0 vs 87.4%, p = .021) analyses in a setting with high antibiotic resistance (clarithromycin 48.8%, metronidazole 65.7%, and dual resistance 35.3%). Significantly, fewer adverse effects occurred in tailored group than in concomitant group (22.0 vs 31.7%, p = .018). The eradication rates of dual clarithromycin and metronidazole resistance, isolated clarithromycin resistance, isolated metronidazole resistance, and dual susceptible were 78.7, 82.4, 94.8, and 94.4% in triple therapy plus bismuth and 75.9, 87.2, 92.9, and 95.2% in concomitant therapy, respectively.

CONCLUSIONS

First-line tailored therapy achieves significantly higher eradication rates and fewer side effects, compared to triple therapy plus bismuth and concomitant therapy in a setting with high rates of clarithromycin and metronidazole resistance.

Synthesis and Characterization of Eu3+-Doped CdS Quantum Dots by a Single-Step Aqueous Method

Eu3+-doped CdS quantum dots (QDs) are successfully synthesized through a straightforward single-pot process in aqueous solution using thioglycolic acid as the capping ligand. The structure, shape, and spectral properties of the QDs are investigated. The obtained CdS:Eu3+ QDs exhibit cubic structures with good crystallinity and approximately sphere-like shapes about 4 nm in diameter. The CdS QDs manifest a broadband emission peak at 600 nm and enhanced Photoluminescence (PL) emission intensity after doping with Eu3+ ions. Given the strong PL intensity and good chromaticity of the sulfide-based QDs, they have potential use in doping rare-earth ions.

[The clinical significance and changes of serum tumor necrosis factor and plasma endothelium in patients with OSAHS associated Type 2 diabetes mellites]

OBJECTIVE

To investigate the significance of tumor necrosis factor-alpha (TNF-α) and plasma endothelium (ET) in pathophysiologic process of patients with obstructive sleep apnea hypopnea syndrome(OSAHS) with type 2 diabetes mellitus (T2DM).

METHOD

All observed subjects were divided into 4 groups. A number of 80 patients with OSAHS, 65 cases of OSAHS with T2DM patients, 20 patients with T2DM, and 32 cases of healthy control group were observed in this study. The serum levels of TNF-α and ET were detected by double antibody sandwich ELISA, the content of TNF-α and ET were compared between OSAHS group and OSAHS + T2DM group. It were also compared before and after treatment of CPAP or surgery.

RESULT

TNF-α level is higher in OSAHS+T2DM group than that in the OSAHS group, T2DM group and the control group (P < 0.05); TNF-α level in OSAHS group and the T2DM group are higher than that in the control group (P < 0.05), but there was no difference in TNF-α level between the OSAHS group and the T2DM group. There was also no difference in ET level of the four groups. There were significant differences of TNF-α before and after treatment of CPAP or surgery in OSAHS group and OSAHS+T2DM group (P < 0.05). But there was no significant differences of ET before and after treatment of CPAP or surgery in the OSAHS+T2DM group (P > 0.05).

CONCLUSION

TNF-α may be involved in the development of OSAHS and T2DM, while ET may have little effect on the occurrence and development of OSAHS and T2DM.

Magnetic combined cross-linked enzyme aggregates of horseradish peroxidase and glucose oxidase: an efficient biocatalyst for dye decolourization

In this study, the magnetic combined cross-linked enzyme aggregates (combi-CLEAs) of glucose oxidase (GOD) and horseradish peroxidase (HRP) were designed and prepared successfully.

Changes of HMGB1 expression on angiogenesis of ovarian cancer and its mechanism

This study was designed to investigate the changes of high-mobility group box-1 (HMGB1) expression and its effects on regulating the angiogenesis of ovarian cancer. HMGB1 eukaryotic expression plasmid and artificially synthesized small interfering ribose nucleic acid (siRNA) were constructed to transfer SKOV3 cell, respectively. Western blot was adopted to investigate the changes of HMGB1, CXCL12 and vascular endothelial growth factor (VEGF) before and after the transfection and flow cytometry (FCM) was applied to detect SKOV3 apoptosis. Results revealed that the apoptosis rates of SKOV3 cell were 32.8±2.2%, 33.9±1.9% and 11.7±1%, respectively, in the control group, no-load group and transfection group after 2-d cisplatin treatment (10 μg/mL). The apoptosis rate in the transfection group was obviously lower than that in the control group and no-load group (p = 0.00) while no significant difference was found in the apoptosis rate in the other two groups (p = 0.75). Furthermore, the apoptosis rates of SKOV3 cell in the SKOV3 group, negative control group, SKOV3-ribose nucleic acid interfere (RNAi) group were 7.9±0.5%, 8.3±0.8% and 29.5±1.3% respectively. The apoptosis rate was notably higher in SKOV3-RNAi group than in the SKOV3 group and negative control group (p < 0.001) while no significant difference was found in the apoptosis rate in the other two groups (p = 0.89). Thus, it can be concluded that HMGB1 interference can reduce VEGF and CXCL12 expression in ovarian cancer cells, but increase the apoptosis of ovarian cancer cells. Moreover, HMGB1 is highly expressed in cytoplasm and karyon.

[Minocycline quadruple versus tailored therapy in retreatment of Helicobacter pylori infection]

OBJECTIVE

To compare eradication rates, safety and compliance of minocycline quadruple and tailored therapies in patients retreated for Helicobacter pylori (H.pylori) infection.

METHODS

Between January 2014 and June 2014, 135 patients with dyspepsia (18-70 years) and H. pylori infection after at least one previous eradication treatment at a tertiary hospital were randomly assigned to a 10-day treatment with minocycline quadruple therapy versus tailored triple regimen of PPI, amoxicillin and a third antibiotic. In the group of tailored therapy, medications were adjusted based on clarithromycin sensitivity and cytochrome P450 isoenzyme 2C19 genotype. Eradication status was assessed 4-12 weeks after treatment.

RESULTS

Although H. pylori eradication rates were higher in the minocycline therapy group than that in the tailored therapy group in intention-to-treat [84.1% (95%CI 75.0%-93.2%) vs 75.8%(95%CI 65.1%-86.5%), P=0.245] and per-protocol [88.3% (95%CI 80.3%-96.3%) vs 79.7%(95%CI 69.7%-89.7%), P=0.197] analyses, the differences between the two groups were not statistically significant.The incidence of adverse effects and compliance between the two groups were also comparable.

CONCLUSIONS

The tailored therapy in this study had a poor eradication efficacy in the retreated patients with H. pylori infection.Minocycline quadruple therapy achieved a relatively satisfactory eradication efficacy and may be an alternative choice for the retreatment of H. pylori infection.

CLINICAL TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR-TRC-13003975.