Nonbismuth concomitant quadruple therapy for Helicobacter pylori eradication in Chinese regions: A meta-analysis of randomized controlled trials

AIM: To evaluate the applicability of nonbismuth concomitant quadruple therapy for Helicobacter pylori(H. pylori) eradication in Chinese regions.METHODS: A systematic review and meta-analysis of randomized controlled trials was performed to evaluate the efficacy of nonbismuth concomitant quadruple therapy between sequential therapy or triple therapy for H. pylori eradication in Chinese regions. The defined Chinese regions include China, Hong Kong, Taiwan, and Singapore. The primary outcome was the H. pylori eradication rate; the secondary outcome was the compliance with therapy. The Pub Med, Embase, Scopus, and Cochrane databases were searched for studies published in the period up to March 2016 with no language restriction.RESULTS: We reviewed six randomized controlled trials and 1616 patients. In 3 trials comparing concomitant quadruple therapy with triple therapy, the H. pylori eradication rate was significantly higher for 7-d nonbismuth concomitant quadruple therapy than for 7-d triple therapy(91.2% vs 77.9%, risk ratio = 1.17, 95%CI: 1.09-1.25). In 3 trials comparing quadruple therapy with sequential therapy, the eradication rate was not significant between groups(86.9% vs 86.0%). However, higher compliance was achieved with concomitant therapy than with sequential therapy.CONCLUSION: The H. pylori eradication rate was higher for nonbismuth concomitant quadruple therapy than for triple therapy. Moreover, higher compliance was achieved with nonbismuth concomitant quadruple therapy than with sequential therapy. Thus, nonbismuth concomitant quadruple therapy should be the first-line treatment in Chinese regions.

Hybrid, sequential and concomitant therapies for Helicobacter pylori eradication: A systematic review and meta-analysis

AIM: To compare hybrid therapy(HT) with traditional sequential therapy(ST) and concomitant therapy(CT) for Helicobacter pylori(H. pylori) eradication.METHODS: We performed an electronic search of Pub Med, Embase, and the CENTRAL database. Randomized controlled trials(RCTs) of HT were included in the meta-analysis. The primary outcome was the eradication rate of H. pylori. The secondary outcomes included the compliance rate and adverse event rate. Effect estimates were pooled using the random-effects model.RESULTS: Twelve studies were included. Pooled results showed no significant differences in eradication rate between HT and ST in per-protocol(PP) analysis(RR = 1.03, 95%CI: 0.94-1.12, P = 0.59) or in intention-totreat(ITT) analysis(RR = 1.00, 95%CI: 0.89-1.12, P = 0.94). HT and ST showed similarly high compliance rate(96% vs 98%, P = 0.55) and acceptable adverse event rate(30.3% vs 28.2%, P = 0.63). No significant results were seen in the eradication rate between HT and CT in PP analysis(RR = 1.01, 95%CI: 0.96-1.05, P = 0.76) or in ITT analysis(RR = 0.99, 95%CI: 0.95-1.03, P = 0.47). HT displayed a slightly higher compliance rate than CT(95.8% vs 93.2%, P < 0.05). The adverse event rates of HT and CT were similar(39.5% vs 44.2%, P = 0.24).CONCLUSION: Compared with ST or CT, HT yields a similar eradication rate, high compliance rate, and acceptable safety profiles.

Two-week bismuth-containing quadruple therapy and concomitant therapy are effective first-line treatments for Helicobacter pylori eradication: A prospective open-label randomized trial

BACKGROUND Increasing levels of antibiotic resistance have reduced the Helicobacter pylori(H.pylori)eradication rates afforded by the standard triple therapy.Thus,2-wk firstline four-drug regimens must be considered.AIM To analyze the eradication rates of modified bismuth-containing quadruple therapy(mBCQT)and concomitant therapy(CT),the associated adverse events,and compliance.METHODS Patients infected with H.pylori were prospectively randomized to receive mBCQT or CT for 2 wk.mBCQT featured a proton pump inhibitor(PPI),bismuth,metronidazole,and tetracycline,taken twice daily.CT included a PPI,clarithromycin,metronidazole,and amoxicillin,taken twice daily.The 13C-urea breath test was performed no earlier than 4 wk after therapy concluded to confirm eradication.If either the histological or rapid urease test was positive,H.pylori infection was diagnosed.RESULTS The demographic characteristics of 68 patients who received mBCQT and 68 who received CT did not differ significantly.On intention-to-treat analysis,the eradication rate was 88.2%(60/68)in the mBCQT group and 79.4%(54/68)in the CT group(P=0.162).By per-protocol analysis,the respective eradication rates were 98.4%(60/61)and 93.1%(54/58)(P=0.199).More CT than mBCQT patients experienced adverse events[33.8%(23/68)mBCQT vs 51.5%(35/58)CT patients,respectively,P=0.037].All patients showed good compliance[85.3%(58/68)mBCQT vs 82.4%(56/68)CT patients,P=0.641].CONCLUSION The H.pylori eradication rates of the 2-wk mBCQT and CT regimens are high.Most patients show good compliance,and more CT than mBCQT patients experience adverse events.

Role of concomitant therapy for Helicobacter pylori eradication: A technical note

We read with interest the recent meta-analysis by Lin et al who evaluated the effectiveness of concomitant regimen for Helicobacter pylori(H. pylori) in Chinese regions. They found that 7-d concomitant regimen is undoubtedly superior to 7-d triple therapy(91.2% vs 77.9%, P < 0.0001). However, it is a common belief that a triple therapy lasting 7 d should be definitively removed from the clinical practice for its ineffectiveness. Only its prolongation to 14 d may give satisfactory success rate. Thus, the assessment of an old and outdated treatment versus a more recent and successful one does not seem to bring novel and useful information. Moreover, a 7-d duration has not been ascertained for concomitant regimen, as main guidelines recommend a 10-d schedule for this scheme. Therefore, only studies comparing 10-d concomitant versus 14-d triple seem to be appropriate according to current Guidelines and would clarify which regimen is the most suitable worldwide. Additionally, in this metaanalysis concomitant and sequential therapy showed similar performances, despite it is common opinion that sequential is more prone than concomitant therapy to fail when metronidazole resistance occurs, and China is characterized by high rate of resistance to this antibiotic. None of the included studies evaluated a priori antibiotic resistances, and the lack of this detail hampers the unveiling of this apparent contradiction. In conclusion, the lack of the evaluation of the quality of included trials as well as their high heterogeneity constitute a burdensome limit to draw solid conclusions in this meta-analysis. On the bases of these considerations and the low number of examined trials, we believe that further studies and the knowledge of antibiotic resistances will support with high quality evidence which is the best regimen and its optimal duration.

Research progress on dynamic monitoring of ctDNA and drug resistance related concomitant mutations in non-small cell lung cancer

Owing to significantly prolonged survival,targeted therapy has become standardized recommendation for advanced non-small cell lung cancer patients with mutated driver genes.However,the genetic status of lung cancer patients is dynamic.By dynamically monitoring the evolution of genes status,differential genes and concomitant genes related to progressive disease could be confirmed early,so as to achieve a more accurate and comprehensive insight of the whole process management of targeted therapy for lung cancer patients.Under the guidance of accurate genetic testing results,it is helpful to provide patients with more effective,long-term,and stable individualized targeted therapy.

Sequential and concomitant non-bismuth quadruple therapies are ineffective for <i>H. pylori</i>eradication in Palestine. A randomized trial

Background: Increasing clarithromycin resistance has undermined the effectiveness of traditional clarithromycin-containing triple eradication therapy of Helicobacter pylori infections. Sequential and concomitant therapies show improved outcome with clarithromycin resistance. Aim: To evaluate the effectiveness of sequential and concomitant 4-drug non-bismuth therapies for eradication of Helicobacter pylori in a prospective, randomized, clinical trial conducted in Palestine. Patients and Methods: Patients who underwent upper endoscopy for a clinical indication and tested positive for rapid urease test were included. Subjects randomly allocated into two groups: One received a modified sequential therapy: esomeprazole 40 mg OD and amoxicillin 1 g BID for 5 days then esomeprazole 40 mg OD, clarithromycin 500 mg BID and tinidazole 500 mg BID for another 5 days. The other group received concomitant therapy in which the same 4 drugs and doses were all given daily for 10 days. Stool antigen was tested 4 weeks after completion of treatment. Results: Five hundred thirty three (533) patients were tested for H. pylori and 180 (34%) were positive;141 patients were included in the study and 112 patients completed. The overall per protocol eradication rate was (74%;95% CI = 65.9% - 82.1%). The eradication rates for sequential therapy was, (70.9%;95% CI = 58.9% - 82.9%) and for concomitant therapy (77.2%;95% CI = 66.3% - 88.1%). The results intention-to-treat were: sequential 61%, concomitant 57%. Conclusion: Neither sequential nor concomitant therapy achieved an acceptable H. pylori eradiation rate in Palestine.

Efficacy Differences of First-line EGFR-TKIs Alone vs in Combination with Chemotherapy in Advanced Lung Adenocarcinoma Patients with Sensitive EGFR Mutation and Concomitant Non-EGFR Genetic Alterations

Background and objective:Epidermal growth factor receptor(EGFR)mutations are often associated with non-EGFR genetic alterations,which maybe a reason for the poor efficacy of EGFR tyrosine kinase inhibitors(TKIs).Here we conducted this study to explore whether EGFR-TKIs combined with chemotherapy would benefit advanced lung adenocarcinoma patients with both sensitive EGFR mutation and concomitant non-EGFR genetic alterations.Materials and methods:Cases of advanced lung adenocarcinoma with EGFR mutation combined with concomitant nonEGFR genetic alterations were retrospectively collected.And the patients were required to receive first-line EGFR-TKIs and chemotherapy combination or EGFR-TKIs monotherapy.Demographic,clinical and pathological data were collected,and the electronic imaging data were retrieved to evaluate the efficacy and time of disease progression.Survival data were obtained through face-to-face or telephone follow-up.The differences between the two groups in objective response rate(ORR),disease control rate(DCR),progression-free survival(PFS)and overall survival(OS)were investigated.Results:107 patients were included,including 63 cases in the combination group and 44 cases in the monotherapy group.The ORR were 78%and 50%(P=0.003),and DCR were 97%and 77%(P=0.002),respectively.At a median follow-up of 13.7 mon,a PFS event occurred in 38.1%and 81.8%of patients in the two groups,with median PFS of18.8 mon and 5.3 mon,respectively(P<0.000,1).Median OS was unreached in the combination group,and 27.8 mon in the monotherapy group(P=0.31).According to the Cox multivariate regression analysis,combination therapy was an independent prognostic factor of PFS.Conclusion:In patients with EGFR-mutant advanced lung adenocarcinoma with concomitant non-EGFR genetic alterations,combination of TKIs and chemotherapy was significantly superior to EGFR-TKIs monotherapy,which should be the preferred treatment option.

Long-term outcomes of a phase Ⅱ randomized controlled trial comparing intensity-modulated radiotherapy with or without weekly cisplatin for the treatment of locally recurrent nasopharyngeal carcinoma

Background:Salvage treatment for locally recurrent nasopharyngeal carcinoma(NPC) is complicated and relatively limited.Radiotherapy,combined with effective concomitant chemotherapy,may improve clinical treatment outcomes.We conducted a phase Ⅱ randomized controlled trial to evaluate the efficacy of intensity-modulated radiotherapy with concomitant weekly cisplatin on locally recurrent NPC.Methods:Between April 2002 and January 2008,69 patients diagnosed with non-metastatic locally recurrent NPC were randomly assigned to either concomitant chemoradiotherapy group(n = 34) or radiotherapy alone group(n = 35).All patients received intensity-modulated radiotherapy.The radiotherapy dose for both groups was 60 Gy in 27 fractions for 37 days(range 23-53 days).The concomitant chemotherapy schedule was cisplatin 30 mg/m^2 by intravenous infusion weekly during radiotherapy.Results:The median follow-up period of all patients was 35 months(range 2-112 months).Between concomitant chemoradiotherapy and radiotherapy groups,there was only significant difference in the 3-year and 5-year overall survival(OS) rates(68.7%vs.42.2%,P = 0.016 and 41.8%vs.27.5%,P = 0.049,respectively).Subgroup analysis showed that concomitant chemoradiotherapy significantly improved the 5-year OS rate especially for patients in stage rT3-4(33.0%vs.13.2%,P = 0.009),stages Ⅲ-Ⅳ(34.3%vs.13.2%,P = 0.006),recurrence interval >30 months(49.0%vs.20.6%,P = 0.017),and tumor volume >26 cm^3(37.6%vs.0%,P = 0.006).Conclusion:Compared with radiotherapy alone,concomitant chemoradiotherapy can improve OS of the patients with locally recurrent NPC,especially those with advanced T category(rT3-4) and stage(lll-IV) diseases,recurrence intervals >30 months,and tumor volume >26 cm^3.

Hybrid therapy for Helicobacter pylori infection:A systemic review and meta-analysis

AIM: To compare the effectiveness of hybrid therapy with other recommended regimens using metaanalysis.METHODS: Bibliographical searches for randomized trials comparing hybrid and other therapies were performed in Pubmed, the Cochrane Library and relevant congresses up to February 2015 using the following keywords(all fields and/or me SH):("Helicobacter pylori " or "H. pylori") and("hybrid therapy" or "sequential-concomitant therapy"). metaanalyses were performed with Cochrane Review manager 5.1. The random effect model proposed by Der Simonian and Laird and the mantel-Haenszel method were used to estimate the pooled relative risk and 95%CI of the efficacy outcomes between hybrid therapy and other eradication therapies. RESULTS: Eight studies(2516 subjects) met entry criteria. The antimicrobial resistance in the study groups ranged from 6.9% to 23.5%. The mean cure rates of hybrid therapy by intention-to-treat(ITT) and perprotocol analyses were 88.5%(n = 1207; range: 80.0% to 97.4%) and 93.3%(n = 1109; range: 85.7% to99.1%), respectively. meta-analysis showed there was no significant difference in ITT eradication rate between hybrid and sequential therapy(relative risk: 1.01; 95%CI: 0.92-1.11). Subgroup analysis revealed hybrid therapy was more effective than sequential therapy in the non-Italian populations(95%CI: 1.01-1.18) and was only less effective in one, Italian population(95%CI: 0.83-0.98). There was no significant difference in eradication rate between hybrid therapy and concomitant therapy(95%CI: 0.93-1.02). No head-tohead comparisons of hybrid therapy and standard triple therapy or bismuth quadruple therapy were found. However, a multicenter, randomized trial showed that reverse hybrid therapy was superior to standard triple therapy(95.5% vs 88.6% ITT; P = 0.011).CONCLUSION: Hybrid therapy appears to be an effective, safe, and well-tolerated treatment for H. pylori infection in the era of increasing antibiotic resistance.

A new look at anti-Helicobacter pylori therapy

With the rising prevalence of antimicrobial resistance,the treatment success of standard triple therapy has recently declined to unacceptable levels (i.e.,80% or less) in most countries.Therefore,several treatment regimens have emerged to cure Helicobacter pylori (H.pylori) infection.Novel first-line anti-H.pylori therapies in 2011 include sequential therapy,concomitant quadruple therapy,hybrid (dual-concomitant) therapy and bismuth-containing quadruple therapy.After the failure of standard triple therapy,a bismuth-containing quadruple therapy comprising a proton pump inhibitor (PPI),bismuth,tetracycline and metronidazole can be employed as rescue treatment.Recently,triple therapy combining a PPI,levofloxacin and amoxicillin has been proposed as an alternative to the standard rescue therapy.This salvage regimen can achieve a higher eradication rate than bismuth-containing quadruple therapy in some regions and has less adverse effects.The best second-line therapy for patients who fail to eradicate H.pylori with first-line therapies containing clarithromycin,amoxicillin and metronidazole is unclear.However,a levofloxacin-based triple therapy is an accepted rescue treatment.Most guidelines suggest that patients requiring third-line therapy should be referred to a medical center and treated according to the antibiotic susceptibility test.Nonetheless,an empirical therapy (such as levofloxacin-based or furazolidone-based therapies) can be employed to terminate H.pylori infection if antimicrobial sensitivity data are unavailable.

Helicobacter pylori:Future perspectives in therapy reflecting three decades of experience

The rising prevalence of antibiotic resistance has created a need to reassess the established Helicobacter pylori(H.pylori)eradication protocols,and to develop new ones.Various bacterial and host factors are evaluated,and their contribution to eradication failure is estimated.For a long time being considered the cornerstone eradication scheme,the standard triple therapy has been replaced with novel,more efficient regimens,namely sequential and concomitant,along with the emergence of a new design of bismuth quadruple therapy.A rescue levofloxacin based regimen has overcome the fear of therapy failure due to higher prevalence of dual resistant(clarithromycin and metronidazole)H.pylori.Culture-free and efficient susceptibility test are reestablishing the concept of tailored therapy,making eradication success close to originally desirable rates.Alleviating therapy side effects and improving patient compliance are as important as choosing appropriate eradication schemes,so various probiotic compound supplements are taken into consideration.Finally,we summarize the emerging efforts and obstacles in creating efficientH.pylori vaccine.

A Clinic-Epidemilogical Study of Cases of Locally Advanced Non Small Cell Lung Cancer (NSCLC) That Received Radiotherapy at NCI Cairo in the Period from 2001-2010

Purpose: This work was to study the clinic-epidemiological characteristics of patients with locally advanced NCSLC and to analyze their prognostic factors and also the results of different treatment modalities for local control and their effect on overall survival (OAS). Materials and Methods: This is a retrospective study including 121 patients with primary locally advanced NSCLC diagnosed between 2001 and 2010 at the radiotherapy department , National Cancer Institute, Cairo University, Egypt. Results: The study showed significant correlation between the tumor size 60, moderately differentiated tumors G2 and treatment outcomes;better locoregional control and better survival rates. On the opposite side poorly differentiated tumors G3, tumor size > 7 cm had the worst locoregional control and survival rates. The study also showed significant statistical correlation between treatment modality, locoregional control and survival rates. Patients who were treated by either concommitent chemo-radiotherapy or sequential chemo-radiotherapy had better local control compared to other patients who were treated by radical radiotherapy, and they also had the best survival rates among all the other treatment groups. The average 6 months OAS rates for all studied patients were 60.3% while 12 months survival rates were 38.8%. The median OAS was 7 months. Conclusions: From the present study, we concluded that concomitant chemo-radiotherapy is the treatment of choice for locally advanced non small cell lung cancer;also we concluded that better performance status and higher hemoglobin levels have better treatment outcome in these cases.

非小细胞肺癌ctDNA监测耐药相关伴随基因研究进展

肺癌靶向治疗显著延长了患者的生存时间,已成为晚期驱动基因阳性非小细胞肺癌患者标准治疗。但肺癌患者的基因状态是动态变化的,通过动态监测基因状态的变化,可早期发现与肺癌疾病进展相关差异基因和伴随基因,从而更加精准地实现对肺癌靶向治疗全程管理的全方位掌握。根据精确基因检测指导下的靶向药应用,有助于为患者提供更切实有效、更长期稳定的个体化靶向治疗指导,达到最佳临床获益。

不同疗程铋剂四联疗法在中国根治幽门螺杆菌感染疗效的Meta分析

目的评价不同疗程(10 d或14 d)铋剂四联疗法在中国幽门螺杆菌感染的根除疗效及安全性。方法计算机检索2005年1月至2016年11月Pubmed、EMBASE、the Cochrane Central Register of Controlled Trials、中国知网、中国生物医学文献数据库、维普等数据库关于10 d或14 d铋剂四联疗法在中国根除幽门螺杆菌感染的随机对照试验,提取受试者的基本资料、观察指标(根除率及不良反应发生率)、研究质量等相关数据,使用Rev Man 5.3软件分析相关指标,计算RR及95%CI,使用漏斗图行发表偏倚评价。结果纳入43篇文献,共7 686例患者。合并结果显示:据意向性分析,10 d或14 d铋剂四联疗法和三联疗法根除率分别是88.96%(95%CI:87.73%~90.19%)和74.11%(95%CI:72.53%~75.69%),差异有统计学意义(RR=1.20,95%CI:1.16%~1.25%);10 d或14 d铋剂四联疗法和7 d铋剂四联疗法相比,根除率分别是87.34%(95%CI:84.87%~89.80%)、81.65%(95%CI:78.76%~84.54%)(意向性分析),差异有统计学意义(RR=1.07,95%CI:1.02%~1.12%);10 d或14 d铋剂四联联疗法与序贯疗法(RR=1.02,95%CI:0.97%~1.07%)及与伴随疗法(RR=1.01,95%CI:0.95%~1.07%)差异无统计学意义。结论 10 d或14 d铋剂四联疗法与序贯疗法及伴随疗法疗效相当,三联疗法及7 d铋剂四联疗法不作为首选治疗方案。

尼妥珠单抗和顺铂同步全盆腔调强放疗治疗无法手术切除宫颈癌的初步研究

目的探讨每周尼妥珠单抗和顺铂同步全盆腔调强放疗治疗无法手术切除宫颈癌的安全性和有效性。方法2013年12月~2015年7月24例FIGO分期为Ⅰ_(B1)~Ⅳ_A期、活检组织病理学证实为鳞癌的无法手术切除宫颈癌接受全盆腔调强放射治疗(50.4 Gy/28次)和5~6次(30~36 Gy/5~6次)的后装近距离治疗,化疗方案为每周尼妥珠单抗200 mg和顺铂40 mg/m^2,共6周期。急性反应评价按照CTCAE 4.03标准,晚期反应评价按照RTOG/EORTC标准。结果所有患者完成6周期化疗并在7~8周内完成盆腔放疗。3级白细胞减少、中性粒细胞减少和血小板减少的发生率分别为33.3%(8/24)、8.3%(2/24)和8.3%(2/24),经对症支持治疗后恢复至正常继续化疗。未出现4级血液学毒性。24例中位随访12个月(5~24个月)。治疗后4个月22例完全缓解,2例部分缓解。2例部分缓解中,1例在治疗后8个月出现局部复发。1年总生存率、无进展生存率和局部控制率分别为100%(24/24)、95.8%(23/24)和95.8%(23/24)。1例治疗后7个月出现1级出血性放射性直肠炎。结论 6周期的每周尼妥珠单抗200 mg和顺铂40 mg/m^2同步全盆腔调强放疗治疗无法手术切除的宫颈癌安全、可行,显示较好的临床疗效。

化、放同步治疗ⅢA/ⅢB期非小细胞肺癌的初步临床研究

目的 评价化、放同步治疗与单纯放射治疗ⅢA/ⅢB期非小细胞肺癌 (NSCLC)的疗效及毒副反应。方法 5 6例ⅢA/ⅢB期NSCLC患者被随机分成同步放化疗组 (同步组 )和单纯放疗组 (单放组 ) ,单放组为原发灶和区域淋巴结前程超分割照射 ,每次 1.2Gy ,每天 2次 ,总量 45 .6Gy ;后程加速超分割照射 ,每次1.6Gy ,每天 2次 ,肿瘤灶总量为 68Gy。同步组在放疗同时给予足叶乙甙 5 0mg/m2 ,顺铂 2 0mg/m2 ,第 1～ 3、15～ 17、2 9～ 3 1天。结果 同步组有效率为 78.6% (2 2 /2 8) ,其中完全缓解 (CR) 10例 ,部分缓解 (PR) 12例。单放组有效率为 3 9.3 % (11/2 8) ,均为PR。同步组的有效率明显高于单放组 (P =0 .0 0 3 )。同步组和单放组的中位生存时间分别为 16和 13个月 (P =0 .0 0 0 3 )。同步组的远处转移率 (5 7.1% )明显低于单放组 (85 .7% ) (P =0 .0 18)。同步组Ⅲ～Ⅳ度放射性食管炎、中性粒细胞减少发生率分别为 3 9.3 % (11/2 8)、17.9% (5 /2 8) ,高于单放组的 17.9% (5 /2 8)和 3 .6% (1/2 8) ,但均无统计学差异 (P =0 .0 76和 0 .0 84)。结论 化、放同步治疗是ⅢA/ⅢB期非小细胞肺癌安全有效的治疗手段 ,值得进一步临床研究。

不同疗程伴同疗法与含铋剂四联疗法根除幽门螺杆菌的疗效

目的:观察不同疗程的伴同疗法与含铋剂四联疗法根除幽门螺杆菌(Helicobacter pylori,H.pylori)的疗效和安全性.方法:随机选取2014-07-01/2015-07-01郑州大学第一附属医院消化内科门诊就诊,行胃镜检查明确胃部疾病(慢性糜烂性胃炎或消化性溃疡)并行13C呼气试验检测阳性的282例患者,按照就诊顺序,分别采用4组治疗方案:A组:埃索美拉唑镁肠溶片20 mg bid+克拉霉素片500 mg bid+阿莫西林胶囊1000 mg bid+甲硝唑片400 mg bid,7 d;B组:埃索美拉唑镁肠溶片20 mg bid+克拉霉素片500 mg bid+阿莫西林胶囊1000 mg bid+枸橼酸铋钾胶囊220 mg bid,7 d;C组:埃索美拉唑镁肠溶片20 mg bid+克拉霉素片500 mg bid+阿莫西林胶囊1000 mg bid+甲硝唑片400 mg bid,14 d;D组:埃索美拉唑镁肠溶片20 mg bid+克拉霉素片500 mg bid+阿莫西林胶囊1000mg bid+枸橼酸铋钾胶囊220 mg bid,14 d.根除治疗结束后4 wk复查13C呼气试验.结果:本研究共纳入患者282例,按符合方案(per-protocol,PP)分析A组H.pylori根除率为84.06%,B组为83.33%,C组为94.12%,D组为97.91%;按意向性(intention to treat,ITT)分析A组为80.56%,B组为78.57%,C组为92.96%,D组为91.55%,其中A组与B组、C组与D组的H.pylori根除率,经PP分析及ITT分析差异均无统计学意义;A组与C组、B组与D组的H.pylori根除率,经PP分析及ITT分析差异均有统计学意义(P<0.05);各组不良反应发生率及症状缓解率差异均无统计学意义.结论:伴同疗法和含铋剂四联疗法2 wk方案H.pylori根除率高、安全性良好且症状缓解率高,可推荐为临床根除H.pylori的一线治疗方案.

心房颤动患者临床现状分析

目的分析医院就诊心房颤动(AF)患者的临床现状。方法收集2016年1月至2018年1月在山西医科大学第二医院就诊的1 326例心房颤动患者病历资料,包括人口学资料、伴随疾病和心血管危险因素、治疗方案选择以及抗栓治疗情况,进行统计学分析。结果本组患者平均年龄(68±13)岁,70～79岁者占比最高,为31. 4%(416/1 326)。男712例,女614例,性别构成比之间差异无统计学意义(P> 0. 05)。伴随疾病和心血管危险因素中,合并高血压536例(40. 4%),睡眠呼吸暂停综合征107例(8. 1%)。心力衰竭和脑卒中/短暂性脑缺血发作人群中持续性心房颤动占比明显高于阵发性心房颤动,冠状动脉粥样硬化性心脏病(冠心病)人群阵发性心房颤动占比明显高于持续性心房颤动(均P <0. 01)。选择射频消融治疗141例(10. 6%),左心耳封堵2例(0. 2%),其余均选择药物治疗。未接受抗栓治疗243例(18. 3%),接受抗血小板治疗717例(54. 1%),华法林治疗280例(21. 2%),接受华法林治疗患者中国际标准化比值达标率为47. 1%(132/280)。结论本院就诊心房颤动患者以70～79岁为主,性别之间无明显差异;高血压、心力衰竭、冠心病仍为心房颤动主要伴随疾病或心血管危险因素;合并睡眠呼吸暂停综合征需引起关注;接受射频消融治疗比例较低,大多患者选择药物治疗;未接受抗栓治疗比例较高,抗栓治疗及抗栓强度均低于目前指南建议。

长春瑞滨联合参芪扶正注射液同步放疗治疗老年食管癌30例临床观察

目的观察长春瑞滨联合参芪扶正注射液同步治疗老年食管癌的疗效及其不良反应。方法 60例老年食管鳞状细胞癌患者随机分为单纯放疗组(简称RT组)30例和长春瑞滨联合参芪扶正注射液同步放疗组(简称CRT组)30例,CRT组放疗剂量每28～30次(50.4～54.0)Gy;RT组放疗剂量每35～37次(63.0～66.6)Gy。结果 CRT组和RT组患者的有效率分别为96.67%和80.00%,差异有统计学意义(P=0.044)。CRT组患者的中位生存期为23.0月,RT组患者的中位生存期为16.5月。CRT组和RT组患者的3年生存率分别为33.33%和10.00%,差异有统计学意义(P=0.028)。CRT组和RT组患者的不良反应发生率无显著差异。结论 CRT组较RT组有更好的有效率和长期生存率,且不良反应并未增加。对于老年食管癌患者,可采用长春瑞滨联合参芪扶正注射液同步放疗的治疗方法,以期获得更好的疗效及长期生存。

同步放、化疗治疗Ⅲ期非小细胞肺癌的前瞻性随机研究

目的 研究同步放、化疗对不能手术的Ⅲ期非小细胞肺癌的疗效及毒副反应。方法 72例不能手术的Ⅲ期非小细胞肺癌患者被随机分成同步放化疗组 (同步组 )和单纯放疗组 (单放组 ) ,两组放疗方法相同 ,均采用常规分割放疗 ,每次2 0Gy ,每周 5次 ,肿瘤灶总剂量为 6 0～ 70Gy ,同步组在放疗同时给予足叶乙甙、顺铂化疗。结果 同步组和单放组的有效率分别是 77 8%和 5 8 3% ,经统计学处理无显著性差异 (P >0 0 5 ) ,两组的完全缓解率分别是 2 7 8%和 8 3% ,同步组明显高于单放组 (P <0 0 5 )。同步组和单放组的中位生存时间分别为 14个月和 9个月 (P <0 0 5 ) ,1年生存率分别为 5 5 1%和 30 1% ,同步组优于单放组 (P <0 0 5 )。同步组的远处转移率 (5 2 8% )明显低于单放组 (83 3% ) (P <0 0 5 )。两组间毒副反应差异无明著性(P >0 0 5 )。结论 同步放、化疗对不能手术的Ⅲ期非小细胞肺癌有较好的疗效 ,值得进一步临床研究。