Tailored therapy guided by genotypic resistance of clarithromycin and levofloxacin detected by polymerase chain reaction in the first-line treatment of Helicobacter pylori infection.

OBJECTIVES: We aimed to explore the efficacy and safety of tailored therapy guided by genotypic resistance in the first-line treatment of Helicobacter pylori (H. pylori) infection in treatment-naive patients. METHODS: Gastric mucosal specimens were taken during gastroscopy, and main mutations of clarithromycin- and levofloxacin-resistant genes were detected by polymerase chain reaction (PCR). Sensitive antibiotics were selected individually for treating H. pylori infection with tailored bismuth-containing quadruple therapy (BQT) consisting of esomeprazole 20 mg twice daily, bismuth potassium citrate 220 mg twice daily, amoxicillin 1 g twice daily, and clarithromycin 500 mg twice daily, or levofloxacin 500 mg once daily, or metronidazole 400 mg four times daily. Safety and patient compliance were assessed 1-3 days after eradication. Treatment outcome was evaluated by urea breath test 4-8 weeks after eradication. RESULTS: One hundred and thirty-two treatment-naive patients with H. pylori infection were included. PCR results suggested resistance rates of 47.7% and 34.9% for clarithromycin and levofloxacin, respectively, and a dual resistance rate of 18.2%. Eradication rates of tailored BQT were 87.1% and 95.8% by intention-to-treat (ITT) analysis and per-protocol (PP) analysis, respectively. There was no statistically significant difference in the efficacy of 7-day clarithromycin-containing, 7-day levofloxacin-containing, and 14-day full-dose metronidazole-containing BQT (ITT analysis: P = 0.488; PP analysis: P = 0.833). The incidence of adverse events was 19.7%, and patient compliance was 97.7%. CONCLUSION: Tailored BQT guided by genotypic resistance can achieve satisfactory efficacy, safety, and patient compliance in the first-line treatment of H. pylori infection.

Primary antibiotic resistance of Helicobacter pylori strains isolated from patients with dyspeptic symptoms in Beijing: a prospective serial study.

AIM: To determine the resistance patterns of Helicobacter pylori (H. pylori) strains isolated from patients in Beijing and monitor the change of antibiotic resistance over time. METHODS: In this prospective, serial and cross-sectional study, H. pylori cultures were successfully obtained from 371 and 950 patients (never receiving eradication) during 2009-2010 and 2013-2014, respectively. Resistance to amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, and rifampicin was determined by Epsilometer test. RESULTS: The resistance rates of isolates obtained during 2009-2010 were 66.8%, 39.9%, 34.5%, 15.4%, 6.7%, and 4.9% to metronidazole, clarithromycin, levofloxacin, rifampicin, amoxicillin and tetracycline, respectively; and the corresponding rates for isolates during 2013-2014 were 63.4%, 52.6%, 54.8%, 18.2%, 4.4% and 7.3%, respectively. The resistance rates to clarithromycin and levofloxacin were significantly increased after four years. In 2009-2010, 14.6% of H. pylori isolates were susceptible to all tested antibiotics, with mono (33.7%), double (28.3%), triple (16.7%), quadruple (6.2%), quintuple (0.3%) and sextuple resistance (0.3%) also being detected. In 2013-2014, 9.4% were susceptible to all tested antibiotics, and mono (27.6%), double (28.4%), triple (24.9%), quadruple (7.3%), quintuple (2.3%) and sextuple resistance (0.1%) was also observed. More multiple resistant H. pylori isolates were found during 2013-2014. Gender (to levofloxacin and metronidazole), age (to levofloxacin) and endoscopic findings (to clarithromycin) were independent factors influencing antibiotic resistance. CONCLUSION: H. pylori resistance to commonly used antibiotics in Beijing is high with increased multiple antibiotic resistance.

[Comparison between laparoscopic and open surgical high ligation of the internal spermatic vein].

OBJECTIVE: To compare the effects of laparoscope-guided high ligation of the internal spermatic vein and open surgery in the treatment of varicocele. METHODS: We collected the clinical data of 85 cases of varicocele treated by laparoscope-guided high ligation of the internal spermatic vein (the laparoscopic group) and another 47 that underwent open surgery (the open group) , and compared the results of treatment between the 2 groups. RESULTS: The operations were successful in all the cases. In the laparoscopic group, the mean operation time was (32.0 +/- 5.9) minutes, with little bleeding, and the mean postoperative hospital stay was (3.0 +/- 1.6) days, with 3 cases (3.5%) of recurrence during the 3-12 months follow-up. In the open group, the mean operation time was (46.0 +/-7.2) minutes and the mean postoperative hospital stay was (7.0 +/- 3.7) days, with 5 cases (10.6%) of recurrence during the same length of follow-up. CONCLUSION: Laparoscopic method for the treatment of varicocele is obviously superior to open surgery for its advantages of minimal invasiveness, fast recovery, sure effectiveness, few complications and low recurrence, particularly for those with bilateral varicocele who experienced recurrence after open surgery.

[Shengjing granule: an effective Chinese medicine for spermatogenic disturbance in mice].

OBJECTIVE: To observe the effect of the Chinese medicine Shengjing Granule on spermatogenic disturbance in mice. METHODS: Forty-six male Kunming mice were randomly divided into a normal (n = 10), a model (n = 12), a control (n = 12) and a Shengjing group (n = 12), and models of spermatogenic disturbance were established by intraperitoneal injection of cyclophosphamide in the latter three. Then the first two groups received intragastric administration of physiological saline and the second two that of clomiphene (21.6 mg/kg x d) and Shengjing Granule (16 g/kg x d), respectively, all for 15 days. On the following day, the testis weight was measured, the levels of the follicle stimulating hormone (FSH), the luteinizing hormone (LH) and testosterone (T) determined by radioimmunoassay. Histological observations were made of the testis tissues under the microscope. RESULTS: The testis index and T level were (3.958 +/- 0.342) g/kg and (7.046 +/- 0.291) nmo/L, obviously increased, while the levels of FSH and LH were (2.947 +/- 0.587) mIU/ml and (3.254 +/- 0.492) mIU/ml, significantly decreased, in the Shengjing group, as compared with (3.525 +/- 0.462) g/kg, (6.231 +/- 0.317) nmol/L, (5.428 +/- 0.719) mIU/ml and (5.155 +/- 0.460) mIU/ml in the model group (P < 0.05). The number of spermatogenic cells on the seminiferous tubules and that of sperm in the lumina of the tubules were markedly increased in the Shenginjg group, compared with the models. CoCONCLUSIONShenginjg Granule is effective for spermatogenic disturbance in mice.

[Relation of risk factors to coronary artery stenosis severity in coronary atherosclerotic heart disease].

OBJECTIVE: To study the relationship of the risk factors to the coronary artery stenosis severity in coronary atherosclerotic heart disease (CAD). METHODS: 286 CAD patients, 206 males and 80 females, aged 61.6, underwent coronary angiography and then were divided into 3 groups according to its results: Group A with single vessel lesion, Group B with double vessel lesions, and Group C with triple/left main vessel lesions. Peripheral blood samples were collected to measure the levels of uric acid, C reactive protein, cholesterol, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol, and triglyceride. Spearman correlation analysis and multiple linear regression were used to analyze the relationship between the risk factors including age, bodyweight, and blood lipids and uric acid. RESULTS: There was significant difference among the three groups at age and LDL-C (both P < 0.05). Age and LDL-C of Group C [(62 +/- 10), (3.0 +/- 0.7) mmol/L] were significantly higher than those of Group A [(59 +/- 11), (2.8 +/- 0.6) mmol/L, both P < 0.05]. Age (r = 0.163) and LDL-C (r = 0.149) were significantly associated with coronary artery stenosis severity (both P < 0. 05). CONCLUSION: The severity of coronary artery stenosis is affected by age and LDL-C. Triple/left main vessel lesions are likely to be seen in the patients with older age and higher blood level of LDL-C.

[Shengjing Granule for varicocele in rats].

OBJECTIVE: To study the influence and therapeutic effect of the Chinese herbal drug Shengjing Granule on varicocele in rats. METHODS: A total of 80 male Sprague-Dawley rats were equally randomized into a sham operation group and 3 varicocele model groups, and the latter 3 again subdivided into a model, a Shengjing and a Clomifene group. Fifteen days after the modeling, the Shengjing and the Clomifene groups were intragastrically given Shengling Granule and Clomifene at the dose of 4 g/(kg x d) and 20 mg/(kg x d), respectively, while the model and sham operation groups were on normal diet. Thirty days later, the effects of Shengjing Granule were assessed by determining such serum sexual hormones as FSH, LH and T and observing the morphological changes of the testes of different groups of rats under the light microscope. RESULTS: The testis constitution was better and the levels of FSH and LH were significantly lower in the Shengjing group than in the model and Clomifene groups (P<0.05) but markedly higher in the Clomifene group than in the other three. The T level showed no obvious difference among the Shengjing, Clomifene and sham operation groups but was significantly higher in the three groups than in the model group (P<0.05). CONCLUSION: Shengjing Granule can not only protect the testis from but also repair varicocele-induced injury, probably with a better efficacy than Clomifene.