Histopathology， bacterial culture or 13C/14C urea breath test are usually considered as the gold standards for diagnosis of Helicobacter pylori （H. pylori） infection. Histologic examination and bacterial culture are invasive， with high technical requirements and long process. Therefore， they are not applicable to children and elderly patients with underlying diseases. 13C urea breath test is expensive， 14C is radioactive and not recommended for children or pregnant women， urea breath test is easily interfered by drugs such as proton pump inhibitors， antibiotics and other drugs. Molecular tests have advantages on strain typing and antibiotic resistance screening， and can use different sample types from both invasive and non-invasive approaches.This article provides a review of the molecular detection techniques for H. pylori.
Piezo1 is a novel mechanosensitive ion channel protein （MSCP）， which was discovered in 2010 in the Neuro2A neuroblastoma cell line and encoded by the Fam38a gene. Piezo1 is widely expressed in various organs and cells， such as lung， skin， bladder， kidney， endothelial cells and red blood cells. It is activated by mechanical stimulation， regulating intracellular and extracellular Ca2+ concentration to modulate downstream intracellular signaling pathways. Recent studies have shown that Piezo1 plays an important role in the occurrence and development of infectious diseases. This article reviews the basic physiological functions and regulatory mechanisms of Piezo1， its functions in immune cells， and its relationship with infection-related diseases， which intended to provide new diagnostic and therapeutic strategies for the clinical prevention and treatment of infection-related diseases.
To investigate the clinical characteristics of patients with chronic hepatitis B（CHB） alone and those with different degrees of hepatic steatosis （HS）.
Methods
Clinical data of 1 393 patients with CHB attending Beijing You’an Hospital， Capital Medical University from February 2008 to January 2023 were collected. Patients were divided into four groups based on the controlled attenuation parameter （CAP） values of liver transient elastography：CHB alone group （740 cases）， mild HS-CHB group（201 cases）， moderate HS-CHB group （235 cases） and severe HS-CHB group （217 cases）. The hepatitis B virological and biochemical characteristics among the four groups were compared. Continuous variables were presented as median （interquartile range）， with overall group comparisons by Kruskal-Wallis test and pairwise comparisons by Mann-Whitney U test. Categorical variables are presented as number （%）， with comparisons performed by Pearson χ2 test.
Results
Age （Z =-4.086， -5.747， -6.958； all P ＜ 0.001）and proportion of males （χ2 = 22.370， 40.120， 37.777； all P ＜ 0.001） were significantly higher in patients with mild， moderate and severe HS-CHB compared to those with CHB alone. Hepatitis B virus surface antigen （HBsAg） （H = 21.532， P ＜ 0.001）， HBV DNA level （H = 28.227， P ＜ 0.001）， and hepatitis B virus e antigen （HBeAg） positivity rates （χ2 = 24.311， P ＜ 0.001） among CHB alone patients， and patients with mild，moderate and severe HS-CHB were statistically significant. HBsAg， HBV DNA level and HBeAg positivity rate were significantly lower of patients in moderate and severe HS-CHB groups compared to those with CHB alone （all P ＜ 0.05）. Regarding biochemical markers， the levels of alanine aminotransferase （ALT） and aspartate aminotransferase （AST） among patients with CHB alone and those with mild， moderate and severe HS-CHB were not significantly different （all P ＞ 0.05）. However， the levels of γ-glutamyl transferase （GGT）（H = 53.619， P ＜ 0.001）， alkaline phosphatase （ALP） （H = 53.619， P ＜ 0.001）， albumin （ALB） （H = 23.339，P ＜ 0.001）， total bilirubin （TBil） （H = 13.907， P = 0.003） and fasting blood glucose （FBG） （H = 84.403，P ＜ 0.001） were significantly different； GGT， ALP and FBG levels were significantly higher of patients with mild， moderate， and severe HS-CHB compared to those with CHB alone （all P ＜ 0.05）. The levels of low-density lipoprotein cholesterol （LDL-C） （H = 20.993， P ＜ 0.001）， high-density lipoprotein cholesterol（HDL-C） （H = 39.718， P ＜ 0.001）， small dense low-density lipoprotein cholesterol （sdLDL-C） （H = 76.613，P ＜ 0.001）， total cholesterol （TC） （H = 18.263， P ＜ 0.001） and triglycerides （TG） （H = 103.477， P ＜ 0.001）were statistically significant among the four groups； LDL-C， sdLDL-C， TC and TG levels were significantly higher in patients with moderate and severe HS-CHB compared to those with CHB alone， while HDL-C levels were significantly lower （all P ＜ 0.05）.
Conclusions
Patients with HS-CHB are generally older and predominantly male. Compared to those with CHB alone， patients with HS-CHB have lower HBV virological indicators and higher metabolic indicators.
To investigate the clinical features and prognostic trends of acquired immunodeficiency syndrome （AIDS）-related lymphoma （ARL）.
Methods
Total of 53 patients with ARL diagnosed and treated in Zhongnan Hospital of Wuhan University from January 2006 to December 2015 were selected as control group， due to the improvement of the anti-tumor regimen for ARL patients since 2016，97 patients with ARL diagnosed and treated in our hospital from January 2016 to December 2022 were selected as research group. Pearson Chi-square test or Fisher’s exact probability method were used to compare the clinical characteristics， including non-Hodgkin lymphoma （NHL） pathological classification， Ann Arbor stage， central involvement and bone marrow involvement， etc， and survival status between the two groups.
Results
Compared with control group， patients in research group were older ［（48.81 ± 12.50） years old vs. （43.13 ±12.75） years old：t = 2.65， P = 0.010］， and the proportion of patients with clinical stage Ⅲ-Ⅳ was higher （81.44%vs. 54.72%：χ2 = 13.722， P ＜ 0.001）， international prognostic index （IPI） score was poorer （proportion of 3-5 points：84.53% vs. 66.04%：χ2 = 7.495， P = 0.024）， proportion of bone marrow involvement was higher （46.39%vs. 28.30%：χ2 = 4.673， P = 0.031） and the pathological classification of lymphoma changed significantly （P = 0.003）［the proportion of Burkitt lymphoma （BL） patients increased significantly （37.11% vs. 9.43%）， the proportion of diffuse large B-cell lymphoma decreased （44.33% vs. 67.92%）］； There were no significant differences in gender， CD4+ T cell count， central nervous system involvement， ARL treatment and highly active antiretroviral therapy （HAART） between the two groups （all P ＞ 0.05）. Total of 93 ARL patients （55 cases in research group and 38 cases in control group） died during the follow-up period， and the follow-up time was 11.21（4.00， 29.25） months. The follow-up time of research group and control group were 10.0 （4.50， 24.50） months and 7.0 （2.0， 112.0） months， respectively （Z = 0.11， P = 0.910）. The one-year overall survival （OS） rates of research group and control group were 54.64% and 41.51%， respectively （χ2 = 2.363， P = 0.124）. The oneyear OS rates of patients who received oncotherapy were 69.33% and 60.0% （χ2 = 0.931， P = 0.335）， and the one-year OS rates of patients who did not receive oncotherapy were 4.55% and 5.56% （P ＞ 0.999）， all without significant differences. Tumor progression was the main cause of death in research group and control group，up to 81.82% （45/55） and 81.58% （31/38）， respectively.
Conclusions
In recent years， the onset age of ARL patients is delayed， the proportion of BL is significantly increased， the clinical stage of ARL is worse， and it is more urgent to explore more effective treatment methods.
To investigate the risk factors for infection in patients with hematological malignancies （HM） undergoing chemotherapy and neutropenia， and to construct and validate a column chart model for predicting the risk of infection.
Methods
A retrospective analysis was conducted on the clinical data of 120 patients admitted to Longhua District People’s Hospital in Shenzhen from January 2021 to January 2023 who underwent initial HM chemotherapy and had a neutropenia phase， all patients were divided into infected group （43 cases） and control group （77 cases） based on whether infection occurred. Independent risk factors for infection during the neutropenia phase after HM chemotherapy were analyzed through univariate and multivariate Logistic regression analysis， and a predictive model （R software） was constructed.The discrimination and accuracy of the predictive model on the risk of infection during the neutropenia phase after HM chemotherapy were evaluated by receiver operating characteristic （ROC） curves and calibration curves. Among the 120 patients with neutropenia after HM chemotherapy， 43 patients developed infection，with an infection rate of 35.83% （43/120）. Total of 47 strains of pathogenic bacteria were detected in 43 specimens of infected patients， including 33 strains （70.21%） of Gram negative bacteria， 12 strains （25.53%）of Gram positive bacteria， and 2 strains （4.26%） of fungi. Multivariate analysis showed that the frequency of chemotherapy ≥ 3 times （OR = 2.561， 95%CI：0.019-5.031， P ＜ 0.001）， cutaneous mucosal lesion （GradeⅠ：OR = 1.547， 95%CI：1.215-1.978， P ＜ 0.001； Grade Ⅱ：OR = 2.649， 95%CI：1.134-4.547， P ＜ 0.001；Grade Ⅲ：OR = 3.423， 95%CI：1.753-6.686， P ＜ 0.001）， and the improved infection likelihood score （mIPS）in the neutropenia phase ≥ 13 points （OR = 4.447， 95%CI：1.830-8.842， P ＜ 0.001） were all risk factors for infection of patients with HM. Patients with HM chemotherapy who have a neutropenia period ≥ 7 days （OR =5.571， 95%CI：1.842-9.421， P ＜ 0.001） and a hospital stay ≥ 14 days （OR = 2.213， 95%CI：1.264-4.431， P ＜0.001） were more likely to develop infections during the neutropenia phase. The area under the curve of the column chart model predicting infection in patients with granulocyte deficiency after HM chemotherapy was 0.846 （95%CI：0.809-0.884）， with the sensitivity of 87.15% and the specificity of 89.67%. The slope of the calibration curve for predicting infection was close to 1， and the goodness of fit test results showed that the difference between the predicted probability of infection risk in patients with granulocyte deficiency after HM chemotherapy and the actual probability was not statistically significant （χ2 = 0.169， P = 0.643）.
Conclusions
Patients with granulocyte deficiency stage after HM chemotherapy have a higher risk of infection. The number of chemotherapy cycles ≥ 3， skin and mucosal damage， mIPS score ≥ 13， granulocyte deficiency ≥ 7 days， and hospital stay ≥ 14 days are all high-risk factors for infection in patients with granulocyte deficiency stage after HM chemotherapy.
To interpret the phenotype， genotype and evolutionary model of Vibrio vulnificus （V. vulnificus） based on acute sepsis cases， and to improve the diagnosis and treatment of emerging zoonoses.
Methods
A 48-hour blood culture of a patient （male， 71 years old） with sepsis secondary to acute gastroenteritis admitted to the emergency department of Renji Hospital， Shanghai Jiao Tong University School of Medicine on June 21st， 2016 was isolated， the strain was identified by MALDI-TOF-MS， biochemical and drug resistance phenotype， and whole genome sequencing （WGS） was used to predict multi-site sequence type （MLST）， annotation of drug resistance genes， mobile elements and virulence factors. The phylogenetic tree of gene cluster （C1-C4） analysis was constructed based on single nucleotide polymorphism （SNPs）. The characteristics of V. vulnificus cases in different regions of China （including Hong Kong and Taiwan） from 2012 to 2023 were analyzed by literature， then characteristics of V. vulnificus cases in China， the United States and South Korea in different periods were compared.
Results
The patient had a history of seafood consumption and chronic renal insufficiency， and was clinically diagnosed with sepsis and acute gastroenteritis. The patient was cured through anti-infection and symptomatic treatment with levofloxacin and cefepime for 14 days. The isolated strain was identified as V. vulnificus biotype 1 by biochemical and MALDI-TOF-MS. It was sensitive to all drugs except polymyxin. WGS predicted a new sequence type ST14514， and the phylogenetic tree suggested cluster type 1 （clinical type C1）， carrying hypervirulence genes wza， vvhA， rtxA， vvp and luxS. The top five provinces among 15 provinces which reported 148 cases with V. vulnificus infection in China were Guangdong， Zhejiang， Fujian， Shanghai and Jiangsu， and the ratio of male to female was about 4∶1. Total of 132 cases and 16 cases were confirmed by culture and mNGS， respectively. Fifty-five cases （37.16%） died，and 99 cases （66.89%） were exposed to seawater， fish and shrimp injuries， or eating seafood. The mortality of V. vulnificus infection in China mainland was lower than that in the United States and South Korea. The main route of infection was direct or indirect contact with seawater （sea-products）. The high mortality was characterized by male liver disease （hepatitis， alcoholic liver disease， cirrhosis）.
Conclusions
ST14514 is a new C1 clinical strain type， with high toxicity and low resistance. Sepsis patients secondary to gastroenteritis caused by V. vulnificus are often occult， rare， and Propaganda and education of V. vulnificus diagnosis and ecotype and exposure risk to professional organizations and the mass should be strengthened， in order to enhance the capacity of treatment and reduce the mortality.
To explore the impact of human immunodeficiency virus （HIV） infection on the prognosis of anal fistula patients undergoing incision and thread drawing surgery， and to provide reference for the standardized clinical diagnosis and treatment of anal fistula patients with HIV infection.
Methods
Total of 85 patients with anal fistula who underwent incision and thread drawing surgery in Beijing Ditan Hospital， Capital Medical University from January 2014 to January 2019 were selected， including 40 HIV infected patients （HIV infected group） and 45 non-HIV infected patients （control group）， gender， age， anal fistula classification， thread hanging status， postoperative pain， healing status and recurrence rate within oneyear of surgery in two groups of patients were analyzed to evaluate the short-term and long-term efficacy. The quantitative data were analyzed by independent sample t-test and Mann Whitney U test； the counting data was analyzed by chi-square test. The risk factors for anal fistula recurrence were analyzed by univariate analysis and multivariate Logistic regression analysis.
Results
There was no difference in postoperative defecation recovery time ［2 （1， 2） d vs. 2 （1， 2） d：Z =-0.245， P = 0.806）］， VAS score on the first day after surgery ［3（2， 4） points vs. 3 （3， 5） points： Z =-0.862， P = 0.389）］， hanging line detachment time ［22 （19， 24.25） d vs. 24 （20， 28） d：Z =-1.938， P = 0.053］， and healing time ［（28.88 ± 3.41） d vs. （29.73 ± 2.45） d： t = 1.319， P =0.192）］ between HIV infected group and control group. The recurrence rate of anal fistula in HIV infected patients within one year was 32.5% （13/45）， significantly higher than that of control group （11.1%， 5/40）， with significant difference （χ2 = 5.80， P = 0.02）. Logistic regression analysis showed that HIV infection （OR = 4.756，95%CI：1.442-15.683， P = 0.010） and healing time （OR = 1.249， 95%CI：1.027-1.518， P = 0.026） were both influencing factors for recurrence within one year after undergoing anal fistula incision and thread drawing surgery.
Conclusions
HIV infection has no significant effect on short-term recovery of patients with anal fistula who undergo incision and thread drawing surgery. HIV infection and longer healing time significantly increase the recurrence rate of anal fistula in patients within one year.
To improve clinical understanding of reactive infectious skin and mucous membrane rash （RIME） caused by Mycoplasma pneumoniae infection， and to provide more accurate treatment and prognosis assessment for this disease.
Methods
A retrospective analysis was conducted on clinical data，treatment and prognosis of a patient with RIME caused by Mycoplasma pneumoniae infection， who was admitted to the Zhejiang University Sir Run Run Shaw Alaer Hospital， on April 11th， 2024.
Results
The 15-year-old female patient presented with symptoms indicative of fever， cough and mucosal ulceration.Subsequent laboratory investigations revealed the presence of positive serum IgM antibodies to Mycoplasma pneumoniae and a positive result for a Mycoplasma pneumoniae DNA amplification test conducted on throat swabs. Chest computed tomography （CT） scan revealed the presence of multiple patchy opacities， which were consistent with the imaging characteristics of Mycoplasma pneumoniae pneumonia. Throughout the clinical course， the patient exhibited a constellation of cutaneous lesions， including vesicular eruptions， targetoid lesions and mucocutaneous ulcerations. The diagnosis of RIME was supported by the combined evidence of laboratory findings indicative of a Mycoplasma pneumoniae infection. The patient was treated with doxycycline for its antibacterial properties， in conjunction with a brief course of moderate-dose corticosteroids and intravenous immunoglobulin therapy. This resulted in a complete recovery and subsequent discharge from the hospital.
Conclusions
RIME caused by Mycoplasma pneumoniae infection can be effectively managed with doxycycline， corticosteroids and immunoglobulin therapy， with a favorable prognosis.
To analyze the clinical features and surgical protocol of a patient with human immunodeficiency virus （HIV） infection and symptomatic chronic internal carotid artery occlusion （CICAO），and to improve the clinical attention of patients with CICAO complicated with HIV infection.
Methods
The clinical data and surgical procedures of a patient with HIV infection and complicated with CICAO admitted to Beijing Ditan Hospital， Capital Medical University in September 2020 were analyzed， retrospectively； and the relevant literatures were reviewed.
Results
A 41 year-old male， presented clinically with hemiplegia of the left limb， and lacunar cerebral infarction appeared intermittently after the onset. The patient had been infected with HIV for 12 years， and anti-retrovirus therapy （ART） therapy was started one year before the onset. Cervical ultrasound indicated right internal carotid artery occlusion. After admission to our hospital， magnetic resonance imaging （MRI）， computed tomography perfusion imaging （CTP）， and digital subtraction angiography （DSA）examinations were performed and “CICAO” was confirmed. Superficial temporal artery frontal branch-middle cerebral artery （STA-MCA） bypass combined with STA parietal branch application was performed. The patient’s neurological function was partially recovered after surgery without recurrence of cerebral infarction.
Conclusions
HIV infection may accelerate the process of intracranial atherosclerosis. For patients with symptomatic CICAO，STA-MCA bypass combined with STA parietal branch application can increase cerebral perfusion， improve nerve function and prevent recurrence of ipsilateral stroke， which is an effective treatment option.
