Clinical Focus

Relationship between Helicobacter pylori infection and chronic gastritis

Liu Xina, Shi Yanyanb, Ding Shiganga

2019, 34(5): 389-393. doi:10.3969/j.issn.1004-583X.2019.05.001

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Helicobacter pylori(H.pylori) is a microaerobic, spirally curved gramnegative bacillus, which is easy to be colonized in the stomach and is an important etiology of chronic gastritis. Cytotoxic factors such as cytotoxin associated protein A, acuolating cytotoxin (VacA) and thioredoxin play an important role in the pathogenesis of H.pylori. In the early stage of inflammation, there may be significant accumulation of neutrophils in the mucosal lamina propria, and then the majority of patients will progress to chronic gastritis with lymphocyte infiltration. H.pylori infection can be manifested as diffuse redness, gastric nodule and gastric plica thickening under white light endoscopy. The absence of collecting vein, the enlargement of gastric fovea and the unclear display of subepithelial capillary network are the diagnostic indicators of H.pylori infection under image enhancement endoscopy. For H.pylori positive patients with atrophic gastritis, it is strongly recommended to select H.pylori treatment antibiotic regimen for eradication in the early stage to prevent the occurrence of gastric cancer.

Endoscopic performance of chronic gastritis

Yu Yanan, Tian Zibin

2019, 34(5): 394-398. doi:10.3969/j.issn.1004-583X.2019.05.002

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With the continuous improvement of endoscopic equipment, the diagnosis of chronic gastritis and the detection rate of early gastric cancer have been effectively improved. At present, the main point for the endoscopic diagnosis is to determine whether there is Helicobacter pylori (H.pylori) infection and evaluate the risk of gastric cancer through endoscopic manifestations. Since most patients with chronic gastritis have no obvious clinical symptoms, it is particularly important to understand the endoscopic performance of chronic gastritis fully and accurately. Here, we reviewed endoscopic performance according to the presence or absence of H.pylori infection, drug induced gastritis and high risk mucosa.It is expected to improve the ability of endoscopic diagnosis and classification of H.pylori infection status and risk of gastric cancer, so as to be beneficial to the clinical diagnosis and treatment.

Pathologic diagnosis of chronic gastritis

Cui Yun, Lu Shiyuan, Chen Yingxuan, Chen Xiaoyu, Fang Jingyuan

2019, 34(5): 399-402. doi:10.3969/j.issn.1004-583X.2019.05.003

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The pathologic diagnosis of chronic gastritis referred to the updated Sydney system and Chinese consensus on chronic gastritis (2017, Shanghai) which included the semiquantitative evaluation of inflammation, activity, atrophy, intestinal metaplasia, H.pylori infection and gave the related classification. Although H.pylori infection is the most common cause, other types of chronic gastritis should not be ignored. Furthermore， the pathologic assessment should try to provide evidences or clues pointing to the etiology. OLGA and OLGIM were two effective systems to evaluate the risk to gastric cancer that were recommended as a part in the pathologic assessment. Complete pathologic diagnosis system could not only guide the clinical treatment, but also facilitate the management of the chronic gastritis patients, development of the followup strategy and early gastric cancer screening.

Value of serum pepsinogens and gastrin 17 for diagnosis of atrophic gastritis

Ying Xiao, Lv Bin

2019, 34(5): 403-406. doi:10.3969/j.issn.1004-583X.2019.05.004

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Pepsinogens (PGs) which consists of two types: pepsinogen I (PGI) andpepsinogen Ⅱ (PGⅡ) are the precursors of pepsin. In patients with gastric mucosal atrophy,the serum concentrations of PGI and PGⅡ decrease with the development of atrophy. PGI has a more obvious decrease than PGⅡ, so the PGI/Ⅱ ratio is lower. Low PGI, low PGI/Ⅱ ratio, or low values of both are good serological indicators of atrophic gastritis. Gastrin 17 (G17) is produced by G cells in the antrum. Serum G17 concentration depends on the intragastric acidity and the number of G cells. G17 can detect atrophic gastritis limited to the antrum (low G17 concentration) or the corpus (high G17 concentration). The combination of PG and G 17 is a useful tool for the diagnosis of atrophic gastritis, applied to the gastric cancer risk stratification and screening of high risk populations, with the higher sensitivity, specificity and negative predictive value(74.7%, 95.6% and 91%, respectively). But, serum PG and G17 concentrations are affected by Hp, PPI use, age, gender and other factors.

Early warning, early diagnosis and prevention of carcinogenesis of chronic atrophic gastritis

Zou Tianhui1, Liao Xiaohong2, Chen Yingxuan1

2019, 34(5): 407-411. doi:10.3969/j.issn.1004-583X.2019.05.005

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Gastric cancer is one of the most common gastrointestinal tumors. The developmental model of intestinal type gastric cancer is “Glandatrophyintestinalmetaplasiadysplasiagastric cancer”, which is a multifactor, multistep process. Therefore, screening and followup management in high risk populations, early detection and treatment of precancerous changes，are the main strategies for prevention of gastric cancer. This review summarizes the early warning, early diagnosis and prevention of carcinogenesis of chronic atrophic gastritis.

Treatment strategies for chronic gastritis

Niu Weiwei, Zhang Xiaolan

2019, 34(5): 412-415. doi:10.3969/j.issn.1004-583X.2019.05.006

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Chronic gastritis is one of the most common diseases in the clinic. With advancing age, the incidence rate of the disease increases year by year. It not only affects people's quality of life, but also poses a serious threat to human health. Therefore, the treatment of chronic gastritis is particularly important. According to the classification of chronic gastritis in etiology, clinical symptoms and other aspects, this article will elaborate the treatment strategies of various types of chronic gastritis for the standardization of chronic gastritis treatment.

Correlation study of serum uric acid on shortterm outcome in acute ischemic stroke patients treated with intravenous recombinant tissue plasminogen activator

Guo Zhengliang, Xin Xiaoyu, Zeng Lili, Fu Yi

2019, 34(5): 416-419. doi:10.3969/j.issn.1004-583X.2019.05.007

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Objective To investigate the changes of serum uric acid on shortterm outcome in acute ischemic stroke patients treated with intravenous recombinant tissue plasminogen activator. Methods A total of 122 acute ischemic stroke patients treated with thrombolysis in our stroke unit from 2015 to 2018 was included. At 90 days, the scores of the modified Rankin Scale（mRS）>2 was defined as poor prognosis and the scores of mRS≤2 was defined as excellent outcome. The demographic data, clinical data, and laboratory parameters on adimission were prospectively collected. Stepwise Logistic regression moedels were used to analyze potential factors affecting the prognosis. The demographic data (age, sex, hypertension, diabetes mellitus, atrial fibrillation, drinking, smoking), clinical data (NIHSS, modified Rankin Scale, the time between onset and thrombolysis) and laboratory indicators (uric acid, cholesterol, triglyceride, low density lipoprotein cholesterol, high density lipoprotein cholesterol) were compared between the two groups. Results The demographic data (age, sex, hypertension, diabetes mellitus, drinking, smoking) and laboratory indexes (cholesterol, triglyceride, low density lipoprotein, high density lipoprotein) were not significantly different between the two groups. Atrial fibrillation, the scale of NIHSS before thrombolysis, time from onset to thrombolysis and the level of serum uric acid were significantly different between the two groups. Logistic regression analysis revealed that high level of serum uric acid was related to excellent outcome. Conclusion Increased serum uric level was associated with better prognosis in acute ischemic stroke patients treated with intravenous recombinant tissue plasminogen activator.

Clinical study of tirofiban in acute stage of reocclusion after intravenous thrombolysis in perforating arterial cerebral infarction

Li Jiuquan

2019, 34(5): 420-422. doi:10.3969/j.issn.1004-583X.2019.05.008

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Objective To investigate the efficacy and safety of tirofiban in acute stage of reocclusion after intravenous thrombolysis in perforating arterial cerebral infarction.Methods Totally 21 patients with reocclusion after intravenous thrombolysis in perforating arterial cerebral infarction in our department from May 2016 to March 2018 were selected as study group and treated with tirofiban during acute phase. Besides, 32 patients with reocclusion after intravenous thrombolysis in perforating arterial cerebral infarction in our department from January 2011 to April 2016 were collected as control group. There were no significant differences in gender, age, ratio of complicated hypertension and diabetes mellitus, NIHSS score at onset and NIHSS score at reocclusion between the study group and the control group.Results The improvement of NIHSS score in study group at discharge was significantly better than that in control group(P<0.05). After 3 months of treatment, the clinical prognosis in study group was significantly better than that in control group(P<0.05). In addition, there were no adverse events such as symptomatic intracranial hemorrhage, hemorrhage in other parts and death in both groups.Conclusion Early treatment of tirofiban can effectively improve the shortterm clinical symptoms of patients with intravenous thrombolysisin perforating arterial cerebral infarction, which is conducive to improve the longterm clinical prognosis of patients.

Analysis of seasonal differences and influencing factors of nosocomial infection in neurology department of a hospital in Beijing

Li Haiying1, Sun Zhenping2, Feng Kai1

2019, 34(5): 423-425. doi:10.3969/j.issn.1004-583X.2019.05.009

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Objective To explore the influence of seasonal changes on the incidence of nosocomial infection in inpatients of neurology department in Beijing, and to provide scientific basis for formulating effective measures for prevention and control of nosocomial infection. Methods The incidence rate of nosocomial infection in neurological patients admitted to Shunyi District Hospital of Beijing from October 2015 to September 2018 was retrospectively analyzed. The monthly patient admissions and nosocomial infection during a year were compared. The influencing factors that might cause seasonal differences of nosocomial infections were compared and analyzed. Results In 11 922 patients, 225 cases of nosocomial infection occurred within 117 229 days of total hospitalization. The incidence rate of nosocomial infection was 1.89%, and the daily rate of nosocomial infection was 1.92‰. February, March and November were the periods of high incidence of nosocomial infection, mainly respiratory infections. The average hospitalization days and the proportion of cerebral hemorrhage in patients with high incidence of nosocomial infection were higher than those in other months, with statistically significant difference(P<0.05). Conclusion Early winter and early spring are the periods of high incidence of nosocomial infection in neurology patients in Beijing. The prevention, control and surveillance of nosocomial infection should be strengthened during the periods.

Six1 was highly expressed in colon carcinoma patients and enhanced the invasive ability of colon cancer cells

Ma Xiaofeng1, Ma Li1, Wei Xiaoguo2

2019, 34(5): 426-430. doi:10.3969/j.issn.1004-583X.2019.05.010

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Objective To investigate the expression of sine oculis homeobox homolog1 (Six1) in colon cancer tissues and its effect on cell invasion of colon cancer cells. Methods The positive expression rate of Six1 in 90 cases of colon cancer and adjacent normal tissues were detected by immunohistochemistry method. Six 1 small interfering RNA (SiRNA) was applied to suppress Six1. The invasion ability of colon cancer cells was detected by Transwell chamber test. Results The positive rate of Six1 protein in colon cancer tissue was higher than that of normal tissues adjacent to cancer. After suppressing Six1, Six1 mRNA and protein expression levels of Six1 were significantly decreased, and the invasion cell number of HT29 cells was significantly decreased. Conclusion The expression of Six1 is closely related to the development of colon cancer, and inhibition of Six1 expression can prevent the invasion of colon cancer cells.

Relationship between nephrin and prognosis of diabetic nephropathy

Wang Rongzhen1, Yao Can1, Liu Feng2

2019, 34(5): 431-435. doi:10.3969/j.issn.1004-583X.2019.05.011

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Objective To investigate the correlation between nephrin and prognosis of patients with diabetic nephropathy(DN). Methods Thirtytwo patients with DN underwent renal biopsy and were diagnosed. Their nephrin in kidney was detected by direct immunofluorescence assay, nephrin in urine was detected by ELISA. The relationship of renal nephrin and urine nephrin and clinical prognosis were analyzed. Results The expression of nephrin in the kidney of DN group was significantly lower than that of normal group. The urinary nephrin/creatinine ratio in DN group was higher than that of normal group. According to the level of nephrin in the kidney, the patients were divided into two groups: high nephrin group and low nephrin group. The low nephrine group suffered longer duration of diabetes mellitus, a higher level of glycosylated hemoglobin, lower level of albumin and eGFR, a higher level of urinary protein, serum creatinine and urinary nephrin/creatinine excretion ratio (all P<0.01). The low nephrin group showed more significant interstitial fibrosis, tubular atrophy, interstitial inflammation, and arteriosclerosis(P<0.01). The increase of HbA1c was correlated with nephrin injury, whereas the nephrin injury significantly correlated with the increase of urine protein and the decrease of eGFR.There was a significant difference in renal survival between the two groups (P<0.01). COX proportional hazards regression analysis showed that decreased nephrin expression in the kidney and increased nephrin excretion in urine significantly influence renal survival. Conclusion The detection of nephrin in the kidney and urine of DN patients helps to judge the condition and prognosis of DN.

Effect of Helicobacter pylori infection on chronic complications in patients with type 2 diabetes

Tian Lihua1, Xue Yanan2, Tu Qiang2, Xu Xiuying3

2019, 34(5): 436-440. doi:10.3969/j.issn.1004-583X.2019.05.012

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Objective To evaluate the association between Helicobacter pylori (H. pylori) infection and type 2 diabetes mellitus (T2DM). Methods A total of 179 T2DM patients from our hospital were divided into H. pylori positive(n=108) and H. pylori negative(n=71) groups according to 13Curea breath test. At baseline, we performed blood tests including fasting glucose, fasting insulin, glycated haemoglobin A1c (HbA1c) and other biochemical measurements. Results The prevalence of H. pylori infection was 60.3% in diabetic patients. There was no significant difference between two groups in age, body mass index, the duration of diabetes, SBP, DBP, fasting glucose, HbA1c, fasting insulin, fasting C peptide, ALT, AST, TG, HDLC, UA, CRE, Whether or not insulin used (P>0.05). In T2DM patients, the males and those who had the family history of diabetes had a higher rate of H. pylori infection (P<0.01). There were significant differences in TC and LDLC (P<0.05). T2DM patients with H. pylori infection had a higher risk of the occurrence of diabetic chronic complications including, coronary atherosclerotic cardiopathy，cerebrovascular disease than those without H. pylori infection （P<0.01）. And the rate of nonalcoholic fatty liver disease was higher in the patients with H. pylori infection (P<0.05). Conclusion This study showed a higher prevalence of H. pylori infection in diabetic patients, and H. pylori infection may affect the development of diabetes chronic complications.Proper screening for H. pylori infection and H. pylori eradication therapies in diabetes patients should be recommended.

Coronary artery spontaneous dissection: a case report and literature review

Chen Pei, Zhan Hongji, Yin Chune, Wang Fujun

2019, 34(5): 441-446. doi:10.3969/j.issn.1004-583X.2019.05.013

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Objective To summarize the pathogenesis, etiology and inducement, clinical manifestation, diagnosis, treatment and related research progress of spontaneous coronary artery dissection, and to improve its recognition and diagnostic detection rate. Methods A case of acute myocardial ischemic infarction caused by spontaneous coronary dissection was retrospectively analyzed, and relevant literature was reviewed.Results The patient admitted to the hospital with chest pain, and electrocardiogram showed acute inferior wall ST elevation myocardial infarction with increased myocardial enzyme and troponin I, which was diagnosed as acute myocardial infarction. The reexamination of electrocardiogram immediately returned to normal. Coronary angiography showed that the stenosis of the right coronary opening was about 70%, and spontaneous dissection of the proximal middle segment was performed. Percutaneous coronary balloon dilatation (PTCA) + coronary stent implantation was performed. No stenosis was observed postoperatively, and the stent completely covered the dissection, and TIMI blood flow was level 3. Conclusion Acute spontaneous coronary artery dissection is characterized by rapid disease progression and high early mortality. Therefore, rapid diagnosis and avoidance of misdiagnosis are of great significance. Relevant imaging examinations should be improved as soon as possible in early diagnosis.

Systematic review and metaanalysis：clinical effect of cognitive behavioral therapy on chronic insomnia

Shao Xiangyun, Zhao Min, An Ruili, Guo Jiao, Qu Nan, Li Dan

2019, 34(5): 447-454. doi:10.3969/j.issn.1004-583X.2019.05.014

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Objective To systematically evaluate the clinical effect of cognitive behavioral therapy on chronic insomnia. Methods Chinese literature sources were explored for computer retrieval: CNKI，Chongqing Weipu Chinese Database, Wanfang Database, Chinese Biomedical Literature Database, and foreign literature retrieval databases include PubMed and The Cochrane Library. The randomized controlled trials(RCTs) of cognitive behavioral therapy for chronic insomnia were searched, and all literatures were included in the retrieval scope within the selfbuilt database until the time limit of November 8, 2018. References included in the literature were searched manually. Metaanalysis was conducted by RevMan 5.3 software after RCT screening, data extraction and quality evaluation independently by two individuals according to inclusion and exclusion criteria. Results A total of 17 studies were included, involving 1 131 patients with chronic insomnia, and the methodological quality of the trial was partially low. Compared with the control group, the sleep latency MD=-8.01, 95%CI was (-10.96,-5.06); the number of awakenings MD=-0.43, and the 95%CI was(-0.70,-0.16); the total sleep time MD=39.51, 95%CI (27.09, 51.93); the sleep efficiency MD=7.85, 95%CI (1.90, 13.80); and Pittsburgh sleep quality index MD=-2.44, 95%CI (-3.32,-1.56); the treatment efficiency OR=3.18, 95%CI (1.81, 5.61; and the insomnia severity index MD=-1.30, 95%CI (-2.06, -0.54). Conclusion According to current clinical evidence, cognitive behavioral therapy for chronic insomnia is clinically reliable.

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