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Susceptibility-guided bismuth quadruple therapies for resistant Helicobacter pylori infections

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Precision Clinical Medicine 2020年第2期3卷 127-135页

作者： Tiankuo Yang Renwei Hu Xiaoqiong Tang Yalin Shen Alfred Tay Xuenan Pi Gang Wang Aleksandra WDebowski Keith AStubbs Mohammed Benghezal Barry JMarshall Hong Li Hong Tang West China Marshall Research Center for Infectious Diseases Center of Infectious DiseasesDivision of Infectious DiseasesState Key Laboratory of BiotherapyWest China HospitalSichuan UniversityChengdu 610041China Department of Gastroenterology West China HospitalSichuan UniversityChengdu 610041China Helicobacter pylori Research Laboratory School of Biomedical SciencesMarshall Centre for Infectious Disease Research and TrainingUniversity of Western AustraliaNedlands 6009Australia Precision Medicine Key Laboratory of Sichuan Province&Precision Medicine Center West China HospitalChengdu 610041China School of Molecular Sciences University of Western AustraliaNedlands 6009Australia

Increasing Helicobacter pylori resistance to antibiotics has ledthat molecular testing is appropriate as a sub to adoption of seven different bismuth quadruple therapies(BQT)in China without differentiation of first-line or second-line regimens.The objective of this study was to evaluate the efficacy of susceptibility-guided BQT for patients who had experienced previous treatment failures.A total of 133 patients was included and H.pylori was successfully cultured from 101 patients(75.9%)for subsequent antimicrobial susceptibility testing(AST).Based on the AST results,88 patients completed one of five AST-guided 14-day BQT regimens:esomeprazole and bismuth colloidal pectin,along with either,amoxicillin and clarithromycin(EBAC),amoxicillin and levofloxacin(EBAL),amoxicillin and furazolidone(EBAF),amoxicillin and tetracycline(EBAT),or tetracycline and furazolidone(EBTF).H.pylori eradication rateswere 100%for EBAC(5/5),EBAL(13/13),EBAF(14/14),and EBTF(43/43),but 76.9%for EBAT(10/13).The three patients that failed the EBAT regimenwere all cured after subsequent treatment with the EBTF regimen.Our study demonstrates the excellent efficacy of the AST-guided BQT for referred H.pylori patients,and that the current EBAT regimen,used in clinics,needs to be optimized.In addition,57 of the isolates were subjected to whole-genome sequencing.Analysis of the sequences revealed that point mutations in 23S rRNA correlated well with the phenotypic clarithromycin resistance with a concordance of 91.2%,while the concordance between phenotypic levofloxacin resistance and gyrA point mutations was 82.3%.This suggests that molecular testing is appropriate as a substitute for AST as a more rapid and cost-effective method for determining clarithromycin and levofloxacin resistance in Chinese patients.

关键词： Helicobacter pylori antibiotic resistance rescue therapy antimicrobial susceptibility testing whole-genome sequencing

深圳地区幽门螺杆菌临床分离菌株的耐药性分析

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新发传染病电子杂志 2021年第2期6卷 79-83页

作者：张淑贞李雪宏黄海燕陈海婷王湘雨 Barry Marshall Alfred Tay 深圳市大鹏新区葵涌人民医院检验科广东深圳518119 深圳市第二人民医院消化内科广东深圳518000 西澳大学生物医学院幽门螺杆菌研究实验室澳大利亚珀斯6009

目的探讨深圳地区幽门螺杆菌(Helicobacter pylori,Hp)临床分离菌株的耐药情况,为临床抗生素的合理选用提供实验室依据。方法2017年1月至2019年1月,对深圳市大鹏新区葵涌人民医院消化内科381例13C尿素呼气试验阳性的胃病患者行胃镜检查... 详细信息

目的探讨深圳地区幽门螺杆菌(Helicobacter pylori,Hp)临床分离菌株的耐药情况,为临床抗生素的合理选用提供实验室依据。方法2017年1月至2019年1月,对深圳市大鹏新区葵涌人民医院消化内科381例13C尿素呼气试验阳性的胃病患者行胃镜检查,采集胃窦及胃体部黏膜进行Hp培养和药物敏感试验,并对培养情况及药物敏感结果进行统计分析。结果381例患者分离培养到Hp 315株,阳性率为82.68%(315/381)。Hp对抗生素的耐药率分别为阿莫西林0(0/231)、利福平2.22%(7/315)、环丙沙星23.81%(75/315)、克拉霉素32.69%(103/315)、甲硝唑83.17%(262/315)。Hp对上述5种抗生素均敏感者有46株,敏感率14.60%(46/315),发生耐药269株,耐药率85.40%(269/315),其中单一耐药率51.43%(162/315),二重耐药率26.35%(83/315),三重耐药率7.62%(24/315)。Hp耐药率与性别、年龄有一定的关系,主要表现为男性人群Hp多重耐药率随年龄增长而增长,且老年男性人群多重耐药率明显高于老年女性人群(P<0.05)。结论深圳地区幽门螺杆菌甲硝唑耐药率极高,不适宜做为一线治疗用药;阿莫西林耐药率极低,若患者对青霉素不过敏,应当作为首选用药;男性特别是老年男性是Hp耐药及多重耐药更为严重的人群,治疗选用药物时须注意过往服药史。

关键词：幽门螺杆菌药物敏感试验耐药性抗菌药物

Liver resection versus liver transplantation for hepatocellular carcinoma within Milan criteria:a meta-analysis of 18,421 patients

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Hepatobiliary Surgery and Nutrition 2022年第1期11卷 78-93,I0009-I0013页

作者： Jin Hean Koh Darren Jun Hao Tan Yuki Ong Wen Hui Lim Cheng Han Ng Phoebe Wen Lin tay Jie Ning Yong Mark D.Muthiah Eunice X.Tan Ning Qi Pang Beom Kyung Kim Nicholas Syn alfred Kow Brian K.P.Goh Daniel Q.Huang Yong Loo Lin School of Medicine National University of SingaporeSingaporeSingapore Division of Gastroenterology and Hepatology Department of MedicineNational University HospitalSingaporeSingapore National University Centre for Organ Transplantation National University Health SystemSingaporeSingapore Division of Hepatobiliary&Pancreatic Surgery Department of SurgeryNational University HospitalSingaporeSingapore Department of Internal Medicine Yonsei University College of MedicineSeoulRepublic of Korea Yonsei Liver Center Severance HospitalYonsei University Health SystemSeoulRepublic of Korea Biostatistics and Modelling Domain Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingaporeSingapore Department of Hepato-Pancreato-Biliary and Transplant Surgery Division of SurgerySingapore General HospitalSingaporeSingapore Liver Transplant Service SingHealth Duke-NUS Transplant CentreSingaporeSingapore

Background:Outcomes after liver resection(LR)and liver transplantation(LT)for hepatocellular carcinoma(HCC)are heterogenous and may vary by region,over time periods and disease burden.We aimed to compare overall survival(OS)and disease-free survival(DFS)between LT versus LR for HCC within the Milan criteria.Methods:Two authors independently searched Medline and Embase databases for studies comparing survival after LT and LR for patients with HCC meeting the Milan criteria.Meta-analyses and meta-regression were conducted using random-effects models.Results:We screened 2,278 studies and included 35 studies with 18,421 patients.LR was associated with poorer OS[hazard ratio(HR)=1.44;95%confidence interval(CI):1.14-1.81;P<0.01]and DFS(HR=2.71;95%CI:2.23-3.28;P<0.01)compared to LT,with similar findings among intention-to-treat(ITT)studies.In uninodular disease,OS in LR was comparable to LT(P=0.13)but DFS remained poorer(HR=2.95;95%CI:2.30-3.79;P<0.01).By region,LR had poorer OS versus LT in North America and Europe(P≤0.01),but not Asia(P=0.25).LR had inferior survival versus LT in studies completed before 2010(P=0.01),but not after 2010(P=0.12).Cohorts that underwent enhanced surveillance had comparable OS after LT and LR(P=0.33),but cohorts undergoing usual surveillance had worse OS after LR(HR=1.95;95%CI:1.24-3.07;P<0.01).Conclusions:Mortality after LR for HCC is nearly 50%higher compared to LT.Survival between LR and LT were similar in uninodular disease.The risk of recurrence after LR is threefold that of LT.

关键词： Hepatocellular carcinoma(HCC) liver resection(LR) liver transplant survival recurrence

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胃癌预防主要策略:根除幽门螺杆菌

新发传染病电子杂志 2018年第4期3卷 193-194页

作者： Barry J Marshall alfred Chin-Yen tay The University of Western Australia M504Perth WA 6009 Australia

迄今为止,胃癌仍然是全球最常见的三大癌症之一。据报道,中国每年就有大约400 000例的新发胃癌病例报告[1]。在一些地区,虽然胃癌的发病率和死亡率已大幅下降,但胃癌的5年生存率仍低于25%。自Robin Warren教授和笔者于1984年发现幽门螺... 详细信息

迄今为止,胃癌仍然是全球最常见的三大癌症之一。据报道,中国每年就有大约400 000例的新发胃癌病例报告[1]。在一些地区,虽然胃癌的发病率和死亡率已大幅下降,但胃癌的5年生存率仍低于25%。自Robin Warren教授和笔者于1984年发现幽门螺杆菌以来,1994年世界卫生组织认定其为Ⅰ类致癌物。经过多年对全世界幽门螺杆菌感染者的治疗,已经证明根除幽门螺杆菌有助于改善个体的生活质量,预防消化性溃疡病并减少胃癌[2]。

关键词：根除幽门螺杆菌胃癌预防世界卫生组织消化性溃疡病 5年生存率病例报告生活质量死亡率

Long Survival (Cure) to Cisplatin/Infusional 5-Flurouracil in Metastatic Squamous Cell Anal Cancer with Extensive Liver and Lung Metastases

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Case Reports in Clinical Medicine 2015年第3期4卷 73-76页

作者： Andrew Haydon Rebecca tay Gabriel Mak Jeremy Shapiro Department of Medical Oncology Alfred Hospital Melbourne Australia Monash University Melbourne Australia

Background: Metastatic anal Squamous Cell Carcinoma (SCC) is a relatively uncommon malignancy that is usually treated with palliative platinum based chemotherapy. Response rates are modest and complete responses are rare. Case Report: Here we report on a case of advanced SCC with the extensive visceral metastatic disease that has possibly been cured with chemotherapy alone. The patient has received 6 cycles of Cisplatin and 5FU and has remained in complete remission for over 7 years. Conclusion: This is the first report of a case of metastatic anal SCC that has been cured with chemotherapy and highlights the need to remain optimistic when treating patients with “palliative” chemotherapy.

关键词： Metastatic Anal Squamous Cell carcinoma Chemotherapy Cure

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根除幽门螺杆菌，从合理使用抗生素做起

新发传染病电子杂志 2020年第1期5卷 38-42页

作者：任小英李雪宏张淑贞王湘雨 Sylvia Young Barry Marshall alfred Chin Yen tay 深圳市大鹏新区葵涌人民医院检验科广东深圳518119 深圳大学第一附属医院深圳市第二人民医院消化内科广东深圳518020 Harry Perkins Institute of Medical Research University of Western AustraliaNedlandsWA 6009Australia University of Western Australia Marshall CentreHelicobacter Research LaboratoryCrawleyWA 6009Australia

幽门螺杆菌根除失败的主要原因是对抗生素产生耐药。由于目前我国对治疗幽门螺杆菌的认识不统一、治疗不规范,随着抗生素的广泛使用,导致幽门螺杆菌对多种抗生素耐药率呈上升趋势,根除率下降。为了提高幽门螺杆菌的根除率,减少抗生素耐... 详细信息

幽门螺杆菌根除失败的主要原因是对抗生素产生耐药。由于目前我国对治疗幽门螺杆菌的认识不统一、治疗不规范,随着抗生素的广泛使用,导致幽门螺杆菌对多种抗生素耐药率呈上升趋势,根除率下降。为了提高幽门螺杆菌的根除率,减少抗生素耐药,本文对治疗幽门螺杆菌的七种抗生素的药理机制和幽门螺杆菌对抗生素的耐药机制进行了概述,从而加深临床医生对治疗幽门螺杆菌的抗生素的认识,促使其治疗规范化。同时呼吁临床医生在治疗前进行胃黏膜细菌培养和药敏试验,从而科学规范用药,减少耐药菌株的出现,缩短治疗进程,避免资源浪费,提高幽门螺杆菌的根除率,降低消化性溃疡的复发率,延缓胃黏膜相关淋巴组织(MALT)淋巴瘤的进程,预防胃癌的产生,造福患者。

关键词：幽门螺杆菌抗生素耐药