[Efficacy of alternate mucosa-submucosa clip closure in preventing postoperative complications for patients with gastric mucosal lesions after endoscopic submucosal dissection].

Objective: To analyze the efficacy of alternate titanium clip closure in preventing postoperative complications for patients with gastric mucosal lesions after endoscopic submucosal dissection (ESD). Methods: Clinical data of patients with gastric mucosal lesions who underwent ESD in the Department of Gastroenterology, Zhongda Hospital, Southeast University, were retrospectively collected from January 1, 2013 to August 31, 2023. According to the postoperative wound closure status, the patients were divided into completely closed group (complete closure of ESD wounds using alternate titanium clip closure), partially closed group (partial closure of ESD wounds), and unclosed group (without use of clips for treatment of ESD wounds). The incidence of postoperative complications as well as wound healing at 1 month and 3 months after surgery were compared among three groups, and the factors related to delayed bleeding after ESD for gastric mucosal lesions were analyzed through multiple logistic regression analysis. Results: A total of 846 patients were included, 430 cases in the completely closed group, including 300 males and 130 females, age [M (Q1, Q3)] was 65(56, 72) years old; one hundred and nine cases in unclosed group, including 78 males and 31 females, aged 66 (60, 71) years; and 307 cases in the partially closed group, including 214 males and 93 females, aged 66 (59, 71) years. The difference in the rate of delayed postoperative bleeding between the completely closed group [2.1% (9/430)] and the unclosed group [5.5% (6/109)] was not statistically significant (P=0.072), but both were lower than that of the partially closed group [9.4% (29/307), P<0.05)]. Further stratified analysis showed that, for the lesions located in the lower 1/3 of the stomach, the rate of postoperative bleeding was lower in the completely closed group than in the partially closed and unclosed groups [0.9% (2/222) vs 11.4% (4/35) vs 9.5% (7/74), respectively, P<0.001]. For lesions≥50 mm in length, the rate of postoperative bleeding was lower in the completely closed group than that in the partially closed and unclosed group[0 vs 11.8% (2/17) vs 20.5% (15/73), respectively, P=0.004]. The incidence of postoperative abdominal pain in the completely closed group [84.2% (363/430)] was lower than that in the unclosed group [97.2% (106/109)] and the partially closed group [95.4% (293/307), both P<0.001)]. The score of postoperative abdominal pain in the completely closed group [0 (0, 1)], was lower than that in the unclosed group [3 (2, 3)], and that in the partially closed group [2 (1, 3)] (both P<0.001). The wound healing rate of the completely closed group [80% (176/220)] was higher than that of the unclosed group [52.3% (33/63)] and the partially closed group [52.2% (83/159)] at 1 month postoperatively (both P<0.001); the healing rate of all three groups reached 100% at 3 months postoperatively. Multiple logistic regression analysis showed that the presence of ulcers or scars on the surface of the lesion (OR=2.930, 95%CI:1.503-5.712, P=0.002), and the diameter (OR=1.031, 95%CI:1.015-1.047,P<0.001) were related factors for postoperative bleeding. Conclusions: The alternate titanium clip closure surgery can reduce postoperative abdominal pain and shorten wound healing time in patients with gastric mucosal lesions after ESD surgery. The risk of postoperative bleeding can be reduced for lesions with a diameter≥50 mm and located in the lower 1/3 of the stomach.

[Construction of a prediction model for predicting rebleeding in patients with obscure gastrointestinal bleeding after capsule endoscopy].

Objective: To explore the risk factors of rebleeding in patients with obscure gastrointestinal bleeding (OGIB) after capsule endoscopy (CE), and construct a model to predict rebleeding. Methods: The data of patients with OGIB who underwent CE in Zhongda Hospital Affiliated to Southeast University from July 2018 to September 2021 were retrospectively analyzed. Follow-up data were obtained via electronic medical records or telephone interviews. Univariate and multivariate Cox regression models were performed to figure out the risk factors of rebleeding in OGIB patients. Then the optimal prediction model was determined and presented as a nomogram. The model was evaluated by C statistic, calibration curve and decision curve analysis. Results: One hundred and thirty patients with OGIB were included, including 64 females and 66 males, aged (55.8±17.2) years (18-87 years), and 39 (30.0%) cases developed rebleeding during follow-up. Univariate and multivariate Cox regression model analysis showed the duration of more than 2 weeks OGIB (HR=3.70, 95%CI: 1.85-7.42, P<0.001), a history of previous gastrointestinal bleeding (HR=5.25, 95%CI: 2.00-13.81, P<0.001), positive CE findings (HR=3.72, 95%CI: 1.66-8.33, P=0.001), and the lowest hemoglobin level before CE<80 g/L (HR=2.00, 95%CI: 1.02-3.84, P=0.044) were risk factors for rebleeding, while specific treatment (HR=0.25, 95%CI: 0.11-0.54, P<0.001) was a protective factor. The corresponding scores of the above five predictive factors were: OGIB duration>2 weeks: 79 points; Previous history of gastrointestinal bleeding: 100 points; The result of CE was positive: 79 points; Specific treatment:-85 points; Minimum hemoglobin before CE<80 g/L: 41 points. The prediction model constructed from the above five variables had good discriminative capability (concordance index=0.798, 95%CI: 0.732-0.865). The calibration curves showed high consistency between nomogram-predicted probabilities and actual observations. The decision curves showed that when the threshold probability was above 0.04, the use of the nomogram to predict rebleeding provided a greater net benefit than the assumption of "all patients rebleeding or no patients rebleeding". Conclusion: The prediction model established in this study has a good ability to predic rebleeding in patients with OGIB after CE examination.

[Efficacy of stent placement in treatment of malignant tracheoesophageal fistula and relevant factors of fistula closure].

Objective: To investigate the efficacy of stent placement in the treatment of malignant tracheoesophageal fistula (MTEF) and the factors affecting the closure of the fistula. Methods: Clinical, pathological, laboratory, and imaging data of 288 patients with MTEF admitted to Zhongda Hospital, Southeast University from 2015 to 2021were retrospectively analyzed. Among them, there were 208 males; the age was (63.6±10.5) years. A total of 94 patients received conservative treatment (conservative group), and 194 in the stent group (170 cases with esophageal stents and 24 cases with tracheal stents). Patients were followed-up at 2 weeks, 1 month, 3 months, and 6 months to evaluate the effect of stent implantation. Multivariable logistic regression was used to analyze factors affecting fistula closure. Results: Age, fistula size, leukocyte count before treatment, and fistula location were significantly different between the conservative group and the stent group (P<0.05). The Karnofsky functional status (KPS) score before treatment in the conservative group was lower than the stent group, (45.1±1.0) vs (51.8±0.7) scores, respectively (P<0.001). After 2 weeks and 1 month of treatment, improvement in KPS scores was significantly better in the stent group than in the conservative group (P<0.05). At 1 month, the pulmonary infection rate in the stent group was 33.5% (58/173), significantly lower than that in the conservative group [77.0% (47/61); P<0.001]. Among the 288 patients, the fistula was closed in 196 patients and unclosed in 92 patients. Fistula size (OR=3.429, 95%CI: 1.623-7.829, P=0.001), leukocyte count before treatment (OR=1.160, 95%CI: 1.027-1.317, P=0.018), KPS score before treatment (OR=0.898, 95%CI: 0.848-0.945, P<0.001) and the treatment method (conservative treatment as reference, esophageal stent OR=0.010, 95%CI: 0.004-0.030, P<0.001; tracheal stent OR=0.003, 95%CI: 0.000-0.042, P<0.001) were factors affecting fistula closure. In the 170 patients in the esophageal stent group, early complications (≤24 h) occurred in 71 patients, and late (>24 h) complications occurred in 11 patients. While in the 24 patients in the tracheal stent group, 9 had early complications and 2 had late complications. Conclusions: Stent placement is an effective treatment for MTEF compared to conservative treatment. Stent treatment, small fistula size, low pre-treatment leukocyte count, and high pre-treatment KPS score are beneficial to fistula closure.

[Safety and efficacy analysis of the removal of refractory esophageal self-expandable metal stents by stent-in-stent technique].

To evaluate the safety and efficacy of esophageal stent-in-stent (SIS) in patients with refractory esophageal self-expandable metal stents (SEMS). Case series study. Retrospective analysis was made on the patients with refractory esophageal SEMS treated with SIS technology in Zhongda Hospital Affiliated to Southeast University from June 2015 to June 2021. The success rate of stent removal and the incidence of adverse events were analyzed. A total of 12 patients were included, including 7 males and 5 females, aged 50-73 (62.7±8.5) years. The clinical success rate of the internal stents was 12/12, with the median retention time of [M(Q1, Q3), 64.5 (52.0, 90.8)] days. The postoperative displacement rate and severe stenosis incidence were 1/12 and 3/12, respectively. The esophageal stents were successfully removed in one endoscopic session in all patients. A small amount of mucous membrane extravasation occurred in all patients after SIS, and no patients died after 90 days of follow-up.

[Efficacy and safety of endoscopic submucosal dissection with additional radiotherapy for T1a-MM/T1b-SM esophageal squamous cell carcinoma].

Objective: To clarify the efficacy and safety of endoscopic submucosal dissection (ESD) with additional radiotherapy in T1a-MM/T1b-SM esophageal squamous cell carcinoma (ESCC). Methods: A retrospective analysis was conducted on 71 patients with T1a-MM/T1b-SM ESCC admitted to Southeast University Affiliated Zhongda Hospital from January 2015 to December 2019. The patients were divided into two groups based on the treatment method: the ESD group (ESD therapy alone) and the ESD-radiotherapy group (ESD combined radiotherapy). The follow-up duration after ESD was (44±17) months. The difference of disease-free survival (DFS) rate and overall survival (OS) rate between the two groups was compared by survival analysis, and the occurrence of complications was compared. Baseline variables of the two groups were compared and the influencing factors of DFS rate were analyzed by Cox proportional risk regression model. Results: There were 44 patients in the ESD-radiotherapy group [28 males, 16 females, aged (65±7) years] and 27 patients in the ESD group [18 males, 9 females, aged (67±9) years]. The results of survival analysis show that the 1, 3 and 5-year DFS rates of ESD-radiotherapy group were 95.5%, 92.9% and 77.4%, respectively, which were higher than those of ESD group 85.2%, 73.2% and 62.7% (all P<0.05). The 1, 3 and 5-year OS rates of the ESD-radiotherapy group were 100%, 94.7% and 94.7%, while those of the ESD group were 96.3%, 96.3% and 79.4%, respectively. The difference was not statistically significant (all P>0.05). Cox proportional hazard regression model analysis showed that ESD combined with radiotherapy (HR=0.19, 95%CI: 0.04-0.90, P=0.037), complete tumor resection (HR=0.25, 95%CI: 0.07-0.86, P=0.027), and vascular invasion (HR=12.06, 95%CI: 1.61-90.26, P=0.015) were the influencing factors of DFS rates. The most common complication of ESD was esophageal stenosis, and no grade 3 or higher radiation adverse reactions occurred after combined radiotherapy. Conclusion: ESD combined radiotherapy is an effective and safe therapeutic strategy for patients with T1a-MM/T1b-SM ESCC.

[Safety and efficacy of yellow zebra guide wire exchange system in the treatment of complete upper digestive stenosis].

To investigate the efficacy and safety of yellow zebra guide wire exchange system in the treatment of complete upper digestive stenosis. To analyze the success rate and adverse events, a retrospective analysis was conducted on patients with complete digestive stenosis in Zhongda Hospital Affiliated to Southeast University from May 2019 to April 2023 and the First Affiliated Hospital of Nanjing Medical University from August 2011 to March 2015. A total of 41 patients were included, including 25 males and 16 females, aged (65±12) years (28-94 years). Among them, 40 patients were successfully inserted with yellow zebra guide wire and underwent endoscopic treatment using the outer tube replacement with hard steel wire, with 97.6% (40/41) effective rate. Eleven patients (27.5%) were accompanied by varying degrees of retrosternal pain, without complications such as bleeding or perforation.

[Effect and mechanism of glucocorticoids in preventing stenosis after esophageal endoscopic submucosal dissection].

Objective: To explore the role and specific mechanism of glucocorticoids in preventing stenosis after esophageal endoscopic submucosal dissection (ESD). Methods: Data of 81 patients [51 cases were male and 30 cases were female, aged (62.09±7.95) years] undergoing early esophageal cancer or precancerous lesions with a stripping range ≥3/4 circle hospitalized from January 2019 to February 2021 in Department of Gastroenterology, Zhongda Hospital, Southeast University. They were randomly divided into the control group (n=23), oral prednisone acetate group (n=28) and/or combined with local injection Triamcinolone acetonide group (n=30). Analysis the stenosis rates, endoscopic stent dilatation times, the scores of the Atkinson classification and QLQ-OES18 after 12 weeks. Also the expression of carbohydrate sulfotransferase15 (CHST15) mRNA, TGF-ß1 and Collagen-Ⅰ protein were compared by real-time PCR or immunohistochemistry. Results: The stenosis rates of the control group, oral prednisone acetate group and/or combined with local injection Triamcinolone acetonide group were 82.6% (19/23), 46.4% (13/28) and 20.0% (6/30) (P<0.001); endoscopic stent dilatation times [M (Q1,Q3)] in these three groups were 2 (1, 3), 0 (0, 0) and 0 (0, 0) (P<0.001). After ESD, the scores of the Atkinson classification and QLQ-OES18 in the three groups were lower than before (P<0.001); and the expression of CHST15 mRNA in the three groups were 4.31±0.13, 3.44±0.07 and 2.84±0.21 respectively (P<0.001). Compared with the control group, the expression of CHST15 mRNA in oral prednisone acetate group was down-regulated (P<0.001), and was the lowest in oral prednisone acetate combined with local injection Triamcinolone acetonide group (P<0.001). As CHST15 mRNA was down-regulated, the expression of TGF-ß1 and Collagen-I protein was also down-regulated (P<0.05). Conclusions: Oral prednisone alone or combined with local injection of triamcinolone acetonide both can prevent esophageal stenosis effectively. Oral combined with local injection of glucocorticoid is particularly more effective. Glucocorticoid can reduce the expression of CHST15 mRNA, thereby inhibiting the expression of TGF-ß1 and Collagen-I protein.

SIRT3 Promotes the Development of Esophageal Squamous Cell Carcinoma by Regulating Hexokinase 2 through the AKT Signaling Pathway.

In the present study, we explored whether sirtuin-3 (SIRT3) regulates the proliferation and migration of esophageal squamous cell carcinoma (ESCC) and investigated the mechanisms underlying the oncogene role of SIRT3. siRNA was used to transfect Eca109 cells and downregulate SIRT3. The proliferation and migration of Eca109 cells were examined by the CCK-8 assay, colony formation assay, Transwell assay, and scratch test. Quantitative real-time PCR and Western blotting were used to detect SIRT3, hexokinase 2, AKT, and p-AKT in Eca109 cells. Functional assays showed that downregulation of SIRT3 could inhibit the proliferation and migration of ESCC cells. Reduced SIRT3 expression downregulated hexokinase 2 expression and inhibited AKT activation in ESCC. These results indicated that SIRT3 promote ESCC development and progression by regulating hexokinase 2 through the AKT signaling pathway. SIRT3 promote ESCC proliferation and migration by regulating HK-2 through the AKT signaling pathway.

Association between XRCC3 Thr241Met polymorphism and risk of osteosarcoma in a Chinese population.

Osteosarcoma is one of the most common bone malignancies in adolescents, and hereditary factors may influence its susceptibility. We assessed the association between XRCC3 Thr241Met polymorphism and susceptibility to osteosarcoma in a Chinese population. Between May 2012 and May 2014, a total of 136 osteosarcoma patients and 136 healthy control subjects were included in our study. The XRCC3 Thr241Met polymorphism was analyzed using a polymerase chain reaction restriction fragment length polymorphism assay. By multiple logistic regression analysis, individuals carrying the Met/Met genotype of XRCC3 Thr241Met were at significantly increased risk of osteosarcoma when compared with the Thr/Thr (OR = 2.50, 95%CI = 1.13-5.66). The Thr/Met+Met/Met genotype of XRCC3 Thr241Met was furthermore found to be correlated with an elevated increased risk of osteosarcoma when compared with the Thr/Thr genotype (OR = 1.71, 95%CI = 1.03-2.87), and Met/Met genotype of XRCC3 Thr241Met was associated with an increased risk of osteosarcoma compared to the Thr/Thr (OR = 3.50, 95%CI = 1.51-8.79). In conclusion, our study firstly reports that XRCC3 Thr241Met gene polymorphism is associated with an elavated risk of osteosarcoma.

MicroRNA-183 promotes proliferation and invasion in oesophageal squamous cell carcinoma by targeting programmed cell death 4.

BACKGROUND: Dysregulated microRNAs (miRNAs) can serve as oncogenes or suppressors and are associated with many cancers, including oesophageal squamous cell carcinoma (ESCC). METHODS: An alignment miRNA array was used to identify differentially expressed miRNAs in ESCC tissues. The expression of miR-183 and programmed cell death 4 (PDCD4) in oesophageal tissues from ESCC and early oesophageal carcinoma patients was examined by quantitative reverse transcriptase PCR and western blotting. A luciferase assay was performed to confirm miR-183 target genes. The effects of miR-183 on ESCC cells and the associated mechanisms were established by in vitro experiments. RESULTS: We identified 51 upregulated miRNAs and 17 downregulated miRNAs in our array, and miR-183 was one of the most upregulated miRNAs. An inverse correlation between miR-183 and PDCD4 levels was found in ESCC tissues. Upregulated expression of miR-183 was not correlated with tumour stage or lymphatic metastasis in ESCC patients. The luciferase assay confirmed that miR-183 directly interacted with the PDCD4 mRNA 3'-untranslated region in ESCC cells. Overexpression of miR-183 led to decreased PDCD4 protein levels and promoted ESCC cell proliferation and invasion. Inhibition of the PI3K/Akt signalling pathway increased PDCD4 protein levels and decreased miR-183 expression in ESCC cells. CONCLUSIONS: MiR-183 promotes ESCC cell proliferation and invasion by directly targeting PDCD4, which suggests that it is involved in the pathogenesis of ESCC.

Role of interferon alpha-inducible protein 6 in modulating the proliferation, apoptosis and senescence of oesophageal squamous cell carcinoma cells.

Oesophageal cancer is one of the most malignant tumors worldwide. Dysfunction of interferon alpha-inducible protein 6 (IFI6) has been implicated in numerous human diseases, including cancer. We performed the study to investigate the function and potential molecular pathways of IFI6 in oesophageal squamous cell carcinoma (ESCC) cells. IFI6 expression was analysed using databases-derived data and paraffin-embedded tissue samples. CCK-8-based analyses and EdU staining, colony formation, ß-galactosidase staining and Annexin V/PI double-staining assays were used to determine the influence of IFI6 on cell growth, senescence and apoptosis. Tumor growth in vivo was investigated in mouse xenograft models. RNA sequencing (RNA-seq) was performed to identify the transcripts and pathways affected by IFI6. The results showed that IFI6 expression was elevated in ESCC and correlated with poor clinical prognosis (P<0.05). IFI6 was overexpressed and silenced in TE-1 and TE-10 cells using lentiviruses. Upregulation of IFI6 promoted cell growth both in vitro and in vivo, whereas downregulation induced opposite effects. IFI6 overexpression inhibited cell senescence and apoptosis but did not influence cell cycle progression, while IFI6 downregulation increased cell senescence and apoptosis. RNA-seq revealed that 3 mRNAs (EPHA5, CLIP1 and GTF2F2) were consistently associated with both IFI6 overexpression and silencing. IFI6 appeared to modulate TE-1 cells via complex mechanisms. In conclusion, IFI6 plays a positive role in the proliferation of ESCC cells both in vitro and in vivo, which could be a novel therapeutic target for treating ESCC.

Purine analogues compared with mesalamine or 5-ASA for the prevention of postoperative recurrence in Crohn's disease: a meta-analysis.

Objective: To use a meta-analysis approach to evaluate the efficacy and safety of purine analogues, azathioprine (AZA) and 6-mercaptopurine (6-MP), in the prevention of postoperative recurrence of Crohn's disease (CD), as compared with mesalamine or 5-aminosalicylic acid (5-ASA). Methods: The Pubmed, Cochrane Library, and Embase literature databases were searched for relevant studies with the key words "azathioprine", "6-mercaptopurine", "purine analogue", "mesalamine", or "5-ASA". The efficacy and safety of purine analogues in the retrieved randomized controlled trials (RCTs) were evaluated with RevMan 5.0.25 (The Cochrane Collaboration, Oxford, England) and STATA 12.0 (Stata Corporation, College Station, TX, USA). The outcome measures of AZA and 6-MP, compared to mesalamine and 5-ASA (control arms), were: clinical recurrence, endoscopic recurrence, and adverse event rates. Results: Five RCTs, comprised of 429 patients, were analyzed. The effect of purine analogues for preventing clinical recurrence for year 1 and 2 were similar to controls (year 1: n = 390; recurrence rate: 18.6% vs. 20.9%; RR: 0.88, 95% CI: 0.60-1.30, p = 0.53; year 2: n = 270; recurrence rate: 29.9% vs. 38.2%; RR: 0.76, 95% CI: 0.55-1.05, p = 0.10). In contrast, purine analogues were more effective than controls in preventing severe endoscopic recurrence (i2-4) for year 1 (n = 289; 32.4% vs. 46.1%; RR: 0.71, 95% CI: 0.53-0.94, p = 0.02). However, purine analogues were associated with more adverse events leading to drug withdrawal than the controls (20.1% vs. 7.9%; RR: 2.57, 95% CI: 1.47-4.51, p = 0.0010). Conclusion: Purine analogues are more effective than controls in preventing endoscopic postoperative recurrence in CD, but are associated with more adverse events.

Inhibition of microRNA-184 reduces H2O2-mediated cardiomyocyte injury via targeting FBXO28.

OBJECTIVE: Cardiovascular disease, especially coronary heart disease, is one of the diseases with the highest mortality. A large number of studies have found that microRNAs (miRNAs) are closely related to the occurrence and development of myocardial ischemia. This article mainly focused on the regulation of miR-184 on oxidative stress, inflammation, and apoptosis in myocardial infarction (MI). MATERIALS AND METHODS: MiR-184 inhibitor or negative control (NC) were transfected into H9c2 cells. Then, H9c2 cells were treated with H2O2 to construct a cardiomyocyte injury model. H9c2 cells were divided into 4 groups: control group, H22O2 treatment group, H2O2 + NC group, and H2O2 + miR-184 inhibitor group. The oxidative stress of H9c2 cells was observed by the expression levels of SOD, ROS, and MDA in each group. The inflammatory response of H9c2 cells was reflected by the expression of TNF-α, IL-6, and IL-1ß detected by ELISA kits. Western blot was used to detect the expression of cleaved Caspase-3, Bcl-2, Bax and F-box protein 28 (FBXO28). Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was utilized to detect miR-184 expression. TdT-mediated dUTP Nick-End Labeling (TUNEL) staining and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay were used to observe the apoptosis and cell viability. The Luciferase reporter experiment was used to prove whether miR-184 could target FBXO28. RESULTS: MiR-184 expression was significantly increased in H2O2-induced H9c2 cell injury model. After H9c2 cells were transfected with miR-184 inhibitor to silence miR-184, the levels of ROS and MDA were markedly reduced, while the expression of SOD was greatly increased. At the same time, the expression of inflammatory factors was greatly reduced. Silencing miR-184 also increased Bcl-2 expression, and reduced the expression of cleaved Caspase-3 and Bax. In addition, compared with the H2O2 + NC group, the number of TUNEL positive cells in the H2O2 + miR-184 inhibitor group was also significantly reduced, and the cell viability was remarkably increased. The Luciferase reporter experiment proved that FBXO28 is a target gene of miR-184. CONCLUSIONS: MiR-184 expression was increased in H2O2-treated H9c2 cells. Inhibition of miR-184 markedly inhibited oxidative stress and inflammation in cardiomyocytes, thereby inhibiting cardiomyocyte apoptosis, through the regulation of FBXO28.

[Drug susceptibility test guided therapy and novel empirical quadruple therapy for Helicobacter pylori infection: a network Meta-analysis].

Objective: To compare the efficacy and the risk of adverse effect of drug susceptibility test guided therapy and novel empirical quadruple therapy for Helicobacter (H.) pylori infection. Methods: Literature retrieval was conducted by using major databases. Related papers published up to June 2015 were considered eligible if they were randomized control trials comparing different pharmacological formulations for H. pylori infection and used in a network Meta-analysis and a single rate Meta-analysis to evaluate the relative and absolute rates of H. pylori eradication and the risk of adverse effect. The Jadad score was used to evaluate the methodological quality. Funnel plot was constructed to evaluate the risk of publication bias. Begg's rank correlation test or Egger's regression intercept test was done for the asymmetry of funnel plot. Results: Twenty randomized control trials for the treatment of 6 753 initial treated patients with H. pylori infection were included. Drug susceptibility test guided therapy was significantly superior to concomitant therapy, hybrid therapy, sequential therapy and bismuth quadruple therapy. The culture-based therapy had the highest likelihood of improving clinical efficacy, with lowest risk of adverse effect. Concomitant therapy had the highest probability of causing adverse effect despite its effectiveness. Hybrid therapy and bismuth quadruple therapy were associated with lower risk of adverse effect and higher effectiveness. Conclusion: Drug susceptibility test guided therapy showed superiority to other 4 interventions for H. pylori eradication mentioned above. Hybrid therapy and bismuth quadruple therapy might be applied in the settings where the culture-based strategy is not available.

Analysis of 13 cases of venous compromise in 178 radial forearm free flaps for intraoral reconstruction.

The purpose of this study was to analyse the causes of venous compromise and flap failure in radial forearm free flap (RFFF) surgery for intraoral reconstruction. One hundred seventy-eight RFFF reconstructions were reviewed retrospectively for intraoral defects. Of the 13 flaps with venous obstruction, 9 flaps were salvaged, and 4 were lost, with a salvage rate of 69.2%. Eleven venous occlusions occurred within the first 72h. The main reasons for venous failure were mechanical obstruction or technical errors due to inadequate pedicle length and geometry, inadequate venous drainage, compression and kinking of the vein. The main cause of failure for oropharynx reconstruction was unrecognized vascular events due to the lack of reliable monitoring for buried flap. Oozing of dusky blood from the flap margin may be directly related to venous congestion in the early postoperative period and a late indication of a change in skin colour. In conclusion, a thorough operative plan, including carefully selected drainage vein for the flap and recipient vessels, adequate pedicle length and geometry, precise surgical technique, avoidance of haematoma, and expert monitoring of buried flaps may improve the success rate of RFFF transfer in intraoral reconstruction.

A rare case of a glass fragment impacted in the parapharyngeal space associated with neurovascular compromise.

It is rare for foreign bodies to be found in the parapharyngeal space due to the protection of the mandibular ramus and zygomatic bone. The authors describe a rare case of a patient with an unusual penetrating neck injury caused by broken windshield glass in a traffic accident, which lodged in the parapharyngeal space and punctured the internal jugular vein and cranial nerves. 3 weeks later, a delayed exploration was performed on the patient after detailed evaluation of the relationship between the foreign body and the great vessels. The authors removed the glass fragment easily with no active bleeding because it had been surrounded by a fibrous envelope. This experience indicates that increasing the duration of foreign body retention in the parapharyngeal space may be helpful, allowing fibrosis to surround the foreign body, reducing the risk of active bleeding when it is removed.

The longitudinal observation of the effect of antibiotics on human tear lysozyme activity.

It is well known that lysozyme, which catalyzes the hydrolysis of bacterial cell walls, is one of the important substances protecting the eye surface from bacterial infections. It was reported that the aminoglycoside antibiotics strongly inhibited the tear lysozyme activity. The lysozyme activity of tears which were added to different concentrations of two aminoglycoside antibiotics and three other antibiotics was determined longitudinally. No influence of any antibiotics on tear lysozyme activity was found. Therefore it is unnecessary to worry about that the use of aminoglycoside antibiotics may weaken the defence function of the eye.