奥美拉唑联合抗生素治疗萎缩性胃炎102例临床疗效观察

目的探讨奥美拉唑联合抗生素治疗萎缩性胃炎的临床疗效。方法选取我院2013年6月-2015年5月收治的102例萎缩性胃炎患者,采用随机数字表法分为观察组与对照组,每组各51例,观察组患者给予奥美拉唑联合抗生素治疗,对照组患者只给予奥美拉唑治疗,观察组两组患者治疗的临床疗效。结果观察组治疗后疗效明显优于对照组,两组对比差异显著（P〈0.05）,有统计学意义,同时观察组治疗后出现不良反应的机率也明显小于对照组,两组对比差异显著（P〈0.05）,有统计学意义。讨论：采用奥美拉唑联合抗生素治疗萎缩性胃炎具有良好的疗效,且可有效的将患者的临床症状予以改善,同时提高生活质量。

奥美拉唑联合抗生素治疗萎缩性胃炎102例临床疗效观察

目的：探讨奥美拉唑联合抗生素治疗萎缩性胃炎的临床疗效。方法选取我院2013年7月～2014年7月收治的102例萎缩性胃炎患者，采用随机数字表法分为观察组与对照组各51例，观察组患者给予奥美拉唑联合抗生素治疗，对照组患者只给予奥美拉唑治疗，观察组两组患者治疗的临床疗效。结果观察组治疗后疗效明显优于对照组，两组对比差异显著（ P＜0．05），有统计学意义，同时观察组治疗后出现不良反应的机率也明显小于对照组，两组对比差异显著（ P＜0．05），有统计学意义。结论采用奥美拉唑联合抗生素治疗萎缩性胃炎具有良好的疗效，且可有效的将患者的临床症状予以改善，同时提高生活质量。

抗生素降阶梯方案治疗ICU重症肺炎的临床疗效及对肺功能的影响

对ICU重症肺炎患者实施抗生素降阶梯方案治疗,其对患者疾病改善有一定价值,本次主要探究实验组治疗对临床效果的影响,同时掌握其对ICU重症肺炎患者肺功能的应用效果。方法 本次对收治的患者使用两组差异较大的治疗手段,判断其各项指标变化。结果 实验组的临床总有效率、肺功能以及生化指标较之对照组,差异显著(p<0.05);实验组的临床症状消失时间短于对照组(p<0.05).结论 与对照组的常规治疗手段进行比较,发现实验组实施的治疗对患者的治疗效果以及肺功能改善效果更好,且可以对患者的生化指标科学调整,缩短临床症状消失时间,对患者术后能够快速康复提供有效帮助。

Diagnosis and Treatment of Yeast Mastitis in Dairy Cattle

[Objective] Study on the yeast mastitis in dairy cattle cases which have been ineffectively treated by multiple antibiotics through traditional Chinese medicine prescription. [ Method] The isolated pathogenic fungi from milk were used for drug sensitivity testing and the ones proved were clinically treated by self-made traditional Chinese medicine prescription ＂Ruxiaotang＂. [ Result] 19 cases of 20 selected dairy cattle cases were diagnosed as yeast mastitis and cured with the except of a Candida tropicalis case. [ Conclusion] The results provide a new reference for curing yeast mastitis.

In vitro activity of moxifloxacin and piperacillin/sulbactam against pathogens of acute cholangitis

AIM：To analyze the in vitro activity of moxifloxacin and piperacillin/sulbactam against pathogens isolated from patients with acute cholangitis. METHODS： In this prospective study a total of 65 patients with acute cholangitis due to biliary stone obstruction （n = 7）, benign biliary stricture （n = 16）, and malignant biliary stricture （n = 42） were investigated with regard to spectrum of bacterial infection and antibiotic resistance. Pathogens were isolated from bile cultures in all study patients. In 22 febrile patients, blood cultures were also obtained. In vitro activity of moxifloxacin and piperacillin/ sulbactam was determined by agar diffusion. RESULTS： Thirty-one out of 65 patients had positive bile and/or blood cultures. In 31 patients, 63 isolates with 17 different species were identified. The predominant strains were Enterococcus species （26/63）, Ecoli （13/63） and Klebsiella species （8/63）. A comparable in vitro activity of moxifloxacin and piperacillin/sulbactam was observed for E.coli and Klebsiella species. In contrast, Enterococcus species had higher resistances towards moxifloxacin. Overall bacteria showed antibiotic resistances in vitro of 34.9% for piperacillin/sulbactam and 36.5% for moxifioxacin.CONCLUSION： Enterococcus species, E.co/i and Klebsiella species were the most common bacteria isolated from bile and/or blood from patients with acute cholangitis. Overall, a mixed infection with several species was observed, and bacteria showed a comparable in vitro activity for piperacillin/sulbactam and moxifloxacin.

Diagnosis and therapy of ascites in liver cirrhosis

Ascites is one of the major complications of liver cirrhosis and is associated with a poor prognosis. It is important to distinguish noncirrhotic from cirrhotic causes of ascites to guide therapy in patients with noncirrhotic ascites. Mild to moderate ascites is treated by salt restriction and diuretic therapy. The diuretic of choice is spironolactone. A combination treatment with furosemide might be necessary in patients who do not respond to spironolactone alone. Tense ascites is treated by paracentesis, followed by albumin infusion and diuretic therapy. Treatment options for refractory ascites include repeated paracentesis and transjugular intrahepatic portosystemic shunt placement in patients with a preserved liver function. Potential complications of ascites are spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS). SBP is diagnosed by an ascitic neutrophil count > 250 cells/mm3 and is treated with antibiotics. Patients who survive a first episode of SBP or with a low protein concentration in the ascitic fluid require an antibiotic prophylaxis. The prognosis of untreated HRS type 1 is grave. Treatment consists of a combination of terlipressin and albumin. Hemodialysis might serve in selected patients as a bridging therapy to liver transplantation. Liver transplantation should be considered in all patients with ascites and liver cirrhosis.

Small intestine bacterial overgrowth and irritable bowel syndrome-related symptoms:Experience with Rifaximin

AIM： TO estimate the prevalence of small intestinal bacterial overgrowth （SIBO） in our geographical area （Western Sicily, Italy） by means of an observational study, and to gather information on the use of locally active, non-absorbable antibiotics for treatment of SIBO.METHODS： Our survey included 115 patients fulfilling the Rome II criteria for diagnosis of irritable bowel syndrome （IBS）; a total of 97 patients accepted to perform a breath test with lactulose （BTLact）, and those who had a positive test, received Rifaximin （Normix , Alfa Wassermann） 1200 mg/d for 7 d; 3 wk after the end of treatment, the BTLact was repeated.RESULTS： Based on the BTLact results, SIBO was present in about 56% of IBS patients, and it was responsible for some IBS-related symptoms, such as abdominal bloating and discomfort, and diarrhoea. 1-wk treatment with Rifaximin turned the BTLact to negative in about 50% of patients and significantly reduced the symptoms, especially in those patients with an alternated constipation/diarrhoea-variant IBS. CONCLUSION： SIBO should be always suspected in patients with IBS, and a differential diagnosis is done by means of a ＂breath test＂. Rifaximin may represent a valid approach to the treatment of SIBO.

Septic thrombophlebitis of the porto-mesenteric veins as a complication of acute appendicitis

Pylephlebitis, a rare complication of acute appendicitis, is defined as thrombophlebitis of the portal venous system. Pylephlebitis usually occurs due to secondary infection in the region drained into the portal system. We report a case of pylephlebitis caused by acute appendicitis. The patient was transferred from a private clinic 1 wk after appendectomy with the chief complaints of high fever and abdominal pain. He was diagnosed with pylephlebitis of the portal vein and superior mesenteric vein by CT-scan. The patient was treated with antibiotics and anticoagulation therapy, and discharged on the 25th day and follow-up CT scan showed a cavernous transformation of portal thrombosis.

Antibiotics and probiotics in treatment of inflammatory bowel disease

Many experimental and clinical observations suggest that intestinal microflora plays a potential role in the pathogenesis of inflammatory bowel disease （IBD）. Manipulation of the luminal content using antibiotics or probiotics represents a potentially effective therapeutic option. The available studies do not support the use of antibiotics in ulcerative colitis （UC）. Antibiotics are effective in treating septic complications of Crohn＇s disease （CD） but their use as a primary therapy is more controversial, although this approach is frequently and successfully adopted in clinical practice.There is evidence that probiotic therapy may be effective in the prevention and treatment of mild to moderate UC. In contrast, a lack of successful study data at present precludes the widespread use of probiotics in the treatment of CD. Both antibiotics and probiotics appear to play a beneficial role in the treatment and prevention of pouchitis and further trials are warranted to fully quantify their clinical efficacy.

Post-gastrectomy acute pancreatitis in a patient with gastric carcinoma and pancreas divisum

Gastrectomy is commonly performed for both benign and malignant lesions.Although the incidence of post-gastrectomy acute pancreatitis(PGAP)is low compared to other well-recognized post-operative complications,it has been reported to be associated with a high mortality rate.In this article,we describe a 70-year-old man with asymptomatic pancreatic divisum who underwent palliative subtotal gastrectomy for an advanced gastric cancer with liver metastasis.His postoperative course was complicated by acute pancreatitis and intra-abdominal sepsis.The patient eventually succumbed to multiple organ failure despite surgical debridement and drainage,together with aggressive antibiotic therapy and nutritional support.For patients with pancreas divisum or dominant duct of Santorini who fail to follow the normal post-operative course after gastrectomy,clinicians should be alert to the possibility of PGAP as one of the potential diagnoses. Early detection and aggressive treatment of PGAP might improve the prognosis.

Rifaximin vs conventional oral therapy for hepatic encephalopathy:A meta-analysis

AIM: To characterize the efficacy of rifaximin in the management of hepatic encephalopathy (HE) as several randomized controlled studies have shown contradictory results on its effectiveness in comparison to other oral agents. METHODS: We performed a systematic review and random effects meta-analysis of all eligible trials identifi ed through electronic and manual searches. Twelve randomized controlled trials met the inclusion criteria with a total of 565 patients. RESULTS: The clinical effectiveness of rifaximin was equivalent to disaccharides or other oral antibiotics[odds ratio (OR) 0.96; 95% CI: 0.94-4.08] but with a better safety profi le (OR 0.27; 95% CI: 0.12-0.59). At the completion of treatment protocols, patients receiving rifaximin showed lower serum ammonia levels [weighted mean difference (WMD) = -10.65; 95% CI: -23.4-2.1; P = 0.10], better mental status (WMD = -0.24; 95% CI: -0.57-0.08; P = 0.15) and less asterixis (WMD -0.1; 95% CI -0.26-0.07; P = 0.25) without reaching statistical signifi cance. On the other hand, other psychometric outcomes such as electroencephalographic response and grades of portosystemic encephalopathy were superior in patients treated with rifaximin in comparison to the control group (WMD = 0.21, 95% CI: -0.33-0.09, P = 0.0004; and WMD = -2.33, 95% CI: -2.68-1.98, P = 0.00001, respectively). Subgroup and sensitivity analysis did not show any signifi cant difference in the above fi ndings. CONCLUSION: Rifaximin appears to be at least as effective as other conventional oral agents for the treatment of HE with a better safety profi le.

Optimal length of triple therapy for H pylori eradication in a population with high prevalence of infection in Chile

AIM:To compare the efficacy of 7-d versus 14-d triple therapy for the treatment of H pylori infection in Chile,with a prevalence of 73% in general population. METHODS:H pylori-infected patients diagnosed by rapid urease test,with non-ulcer dyspepsia or peptic ulcer disease were randomized to receive omeprazole 20 mg bid,amoxicillin 1 g bid,and clarithromycin 500 mg bid for 7 (OAC7) or 14 (OAC14) d. Primary outcome was eradication rate 6 wk after the treatment. Subgroup analysis was carried out considering the eradication rate among patients with or without peptic ulcer disease and eradication rate among smokers or non-smokers. RESULTS:One hundred and thirty-one patients were randomized to OAC7 (n = 69) or OAC14 (n = 62). The overall eradication rate (intention-to-treat) was 78.3% in OAC7 and 85.5% in OAC14 groups,without a significant difference (P =0.37). No significant difference in the eradication rate was found among the patients with peptic ulcer disease (n = 31) between the OAC7 group (85.7%) and OAC14 group (87.5%). However,smokers had an obviously lower eradication rate compared to non-smokers,particularly in the OAC7 group (57.1% in smokers vs 83.6% in non-smokers; P = 0.06). Adverse effects rate were similar between both groups. CONCLUSION:Short-term efficacy of triple therapy with OAC for 7 d is comparable to 14 d in this high-prevalence population. Longer follow-up,and studies focused to some subgroups of patients (smokers and non-ulcerpatients) are necessary to support widespread use of 7-d instead of 10-14-d triple therapy in a developing country like Chile.

Tropheryma whipplei infection

Whipple's disease was initially described in 1907. Over the next century, the clinical and pathological features of this disorder have been better appreciated. Most often, weight loss, diarrhea, abdominal and joint pain occur. Occasionally, other sites of involvement have been documented, including isolated neurological disease, changes in the eyes and culture-negative endocarditis. In the past decade, the responsible organism Tropheryma whipplei has been cultivated, its genome sequenced and its antibiotic susceptibility defined. Although rare, it is a systemic infection that may mimic a wide spectrum of clinical disorders and may have a fatal outcome. If recognized, prolonged antibiotic therapy may be a very successful form of treatment.

Clostridium perfringens bacteremia caused by choledocholithiasis in the absence of gallbladder stones

A 67-years-old male presented with periumbilical abdominal pain, fever and jaundice. His anaerobic blood culture was positive for clostridium perfringens. Computed tomogram scan of the abdomen and abdominal ultrasound showed normal gallbladder and common bile duct (CBD). Subsequently magnetic resonance cholangiopancreaticogram showed choledocholithiasis. Endoscopic retrograde cholangiopancreaticogram-with sphincterotomy and CBD stone extraction was performed. The patient progressively improved with antibiotic therapy Choledocholithiasis should be considered as a source of clostridium perfringens bacteremia especially in the setting of elevated liver enzymes with cholestatic pattern.

Helicobacter pylori eradication: Sequential therapy and Lactobacillus reuteri supplementation

AIM:To evaluate the role of sequential therapy and Lactobacillus reuteri (L. reuteri ) supplementation, in the eradication treatment of Helicobacter pylori (H. pylori ). METHODS:H. pylori infection was diagnosed in 90 adult dyspeptic patients. Patients were excluded if previously treated for H. pylori infection or if they were taking a proton pump inhibitor (PPI), H2-receptor antagonist or antibiotics. Patients were assigned to receive one of the following therapies:(1) 7-d triple therapy (PPI plus clarithromycin and amoxicillin or metronidazole) plus L. reuteri supplementation dur- ing antibiotic treatment; (2) 7-d triple therapy plus L. reuteri supplementation after antibiotic treatment; (3) sequential regimen (5-d PPI plus amoxicillin therapy followed by a 5-d PPI, clarithromycin and tinidazole) plus L. reuteri supplementation during antibiotic treatment; and (4) sequential regimen plus L. reuteri supplementation after antibiotic treatment. Successful eradication therapy was defined as a negative urea breath test at least 4 wk following treatment. RESULTS:Ninety adult dyspeptic patients were en- rolled, and 83 (30 male, 53 female; mean age 57 ± 13 years) completed the study. Nineteen patients were administered a 7-d triple treatment:11 with L. reuteri supplementation during and 8 after therapy. Sixty-four patients were administered a sequential regimen:32 with L. reuteri supplementation during and 32 after therapy. The eradication rate was significantly higher in the sequential group compared with the 7-d triple regimen (88% vs 63%, P = 0.01). No difference was found between two types of PPI. No difference in erad- ication rates was observed between patients submitted to L. reuteri supplementation during or after antibiotic treatment. Compliance with therapy was excellent in all patients. No difference in adverse effects was observed between the different antibiotic treatments and between patients submitted to L. reuteri supplementation during and after antibiotic treatment. There was a low incidence of adverse effects in all groups of patients with sequential therapy, probably due to the presence of the L. reuteri supplementation. CONCLUSION:The sequential treatment regimen achieved a significantly higher eradication rate of H. pylori compared with standard 7-d regimen. L. reuteri supplementation could reduce the frequency and the intensity of antibiotic-associated side-effects.

Rifaximin in the treatment of inflammatory bowel disease

The gut microbiota plays a role in promoting and maintaining inflammation in inflammatory bowel diseases （IBD）, hence the rationale for the use of antibiotics in the treatment of those disorders. Antibiotics, however, may induce untoward effects, especially during longterm therapy. Rifaximin α polymer is an antibacterial agent that is virtually unabsorbed after oral administration and is devoid of systemic side effects. Rifaximin has provided promising results in inducing remission of Crohn＇s disease （up to 69% in open studies and significantly higher rates than placebo in double blind trials） and ulcerative colitis （76% in open studies and significantly higher rates than placebo in controlled studies） and might also have a role in maintaining remission of ulcerative colitis and pouchitis. The potential therapeutic activity of rifaximin in IBD deserves to be further investigated and confirmed in larger, controlled studies. The optimal dosage still needs to be better defined.

Diagnosis and Treatment of Infective Endocarditis in Chronic Hemodialysis Patients

Objective To analyze the clinical features of hemodialysis patients complicated by infective endo carditis. Methods The clinical features of six such patients admitted to Peking Union Medical College Hospital during the year 1990 to 2009 were analyzed. All of them were diagnosed based on Chinese Children Diagnostic Criteria for Infective Endocarditis. Results The average age of the six patients was 52.3±19.3 years old. Four were males. Vascular accesses at the onset of infective endocarditis were as follows： permanent catheters in three, temporary catheters in two, and arteriovenous fistula in one. Three were fbund with mitral valve involvement, two with aor tic valve involvement, and one with both. Five vegetations were found by transthoracic echocardiography, and one by transesophageal echocardiography. Four had positive blood culture results. The catheters were all removed. Four of the patients were improved by antibiotics treatment, in which two were still on hemodialy sis in the following 14-24 months and the other two were lost to follow-up. One patient received surgery, but died of heart failure alter further hemodialysis for three months. One was well on maintenance hemodi alvsis for three months after surgery. Conclusions Infective endocarditis should be suspected when hemodialysis patients suffer from long-term fever, for which prompt blood culture and transthoracic echocardiography confirmation could be performed. Transesophageal echocardiography could be considered even when transthoracic echocardiography produces negative findings. With catheters removed, lull course of appropriate sensitive antibiotics and surgery if indicated could improve the outcome of chronic hemodialysis patients complicated by infective cndocarditis.

Effects of anaerobic composting on tetracycline degradation in swine manure

Oxytetracycline(OTC) and tetracycline(TC) are the most common TC antibiotics used in human and veterinary medicine.Residual amounts of these antibiotics in manure pose a potential threat to public and ecological health as a result of the potential for them to be released to the environment following land application of manure from animals treated with antibiotics.We investigated the degradation of OTC and TC during anaerobic composting.We tested the effects of temperature and antibiotic concentration on degradation rates in a control and in manure spiked with TCs.We examined changes in p H,biological degradation material(BDM),and moisture corresponding with antibiotic degradation of TCs in the swine manure.Results showed that the OTC and TC concentrations decreased by between 68.54% and 95.50% in all nine treatments following 14 days of anaerobic composting,and the highest removal ef ficiencies were observed at an incubation temperature of 55°C and initial concentrations of 10.36 μg·g^(-1),and 5.96 μg·g^(-1) of OTC and TC,respectively,which were degraded by 95.50%,and 90.06%.During composting at 55 °C and at added concentrations of 5 μg·g^(-1),OTC decreased rapidly,and the time required for50% and 90% degradation was 4.1 and 9.8 days,respectively;for TC,these values were 4.4 and 14.0 days,respectively.Removal ef ficiencies for all TCs correlated well with moisture content of the manure.These results show that composting may be a practical and useful means to reduce concentrations of OTC and TC in swine manure prior to its land application.

A case of gas gangrene in an immunosuppressed Crohn's patient

Clostridium septicum(C.septicum)gas gangrene is well documented in the literature,typically in the setting of trauma or immunosuppression.In this paper,we report a unique case of spontaneous clostridial myonecrosis in a patient with Crohn's disease and sulfasalazineinduced neutropenia.The patient presented with left thigh pain,vomiting and diarrhea.Blood tests demonstrated a profound neutropenia,and magnetic resonance imaging of the thigh confirmed extensive myonecrosis.The patient underwent emergency hip disarticulation,followed by hemicolectomy.C.septicum was cultured from the blood.Following completion of antibiotic therapy,the patient developed myonecrosis of the right pectoral muscle necessitating further debridement,and remains on lifelong prophylactic antibiotic therapy.