BACKGROUND Antibiotic resistance significantly impacts the treatment failure rates of Helicobacter pylori(H.pylori)infections.AIM To investigate the trends in primary antibiotic resistance of H.pylori in Taiwan of Chi...BACKGROUND Antibiotic resistance significantly impacts the treatment failure rates of Helicobacter pylori(H.pylori)infections.AIM To investigate the trends in primary antibiotic resistance of H.pylori in Taiwan of China over the past six years.METHODS We conducted a retrospective analysis of H.pylori isolates from Taiwan residents,China who had not undergone previous treatments(n=1408),collected between January 1,2019 and December 31,2024.Susceptibility of these strains to amoxicillin,clarithromycin,levofloxacin,metronidazole,and tetracycline was tested using the Epsilometer test.We analyzed the trends in single and dual resistance profiles over the study period,and compared antibiotic resistance across different regions(northern,southern and eastern areas)of Taiwan of China.RESULTS The overall resistance rates for H.pylori to amoxicillin,clarithromycin,metronidazole,tetracycline,and levofloxacin in Taiwan of China were 1.3%,18.0%,31.0%,0.8%,and 28.7%,respectively.Tetracycline resistance increased significantly from 0%in 2019 to 3.5%in 2024(P value inχ^(2)test for linear trend:<0.001),while metronidazole resistance declined from 35.5%to 13.0%(P value inχ^(2)test for linear trend:<0.001).No significant changes of amoxicillin,clarithromycin and levofloxacin resistances were observed.The dual resistances to clarithromycin plus tetracycline,and metronidazole plus tetracycline both increased significantly from 0%to 1.7%from 2019 to 2024(P value inχ^(2)test for linear trend:<0.05).Furthermore,no significant regional differences in resistance frequencies except for levofloxacin were detected.CONCLUSION Primary antibiotic resistance to tetracycline in H.pylori has increased in Taiwan of China from 2019 to 2024,while resistance to metronidazole has decreased during the same period.The dual resistance to clarithromycin plus tetracycline and metronidazole plus tetracycline both increased significantly.展开更多
BACKGROUND Although important for determining long-term outcome, pathologic stage of hepatocellular carcinoma (HCC) is difficult to predict before surgery. Current state-of-the-art magnetic resonance imaging (MRI) usi...BACKGROUND Although important for determining long-term outcome, pathologic stage of hepatocellular carcinoma (HCC) is difficult to predict before surgery. Current state-of-the-art magnetic resonance imaging (MRI) using gadoxetic acid provides many imaging features that could potentially be used to classify single HCC as pT1 or pT2. AIM To determine which gadoxetic acid-enhanced MRI (EOB-MRI) findings predict pathologic stage T2 in patients with solitary HCC (cT1). METHODS Pre-operative EOB-MRI findings were reviewed in a retrospective cohort of patients with solitary HCC. The following imaging features were examined: Hyperintensity in unenhanced T2-weighted images, hypointensity in unenhanced T1-weighted images, arterial enhancement, corona enhancement, washout appearance, capsular appearance, hypointensity in the tumor tissue during the hepatobiliary (HB) phase, peritumoral hypointensity in the HB phase, hypointense rim in the HB phase, intratumoral fat, hyperintensity on diffusionweighted imaging, hypointensity on apparent diffusion coefficient map, mosaic appearance, nodule-in-nodule appearance, and the margin (smooth or irregular). Surgical pathology was used as the reference method for tumor staging. Univariate and multivariate analyses were performed to identify predictors of microvascular invasion or satellite nodules. RESULTS There were 39 (34.2%;39 of 114) and 75 (65.8%;75 of 114) pathological stage T2 and T1 HCCs, respectively. Large tumor size (≥ 2.3 cm) and two MRI findings, i.e., corona enhancement [odds ratio = 2.67;95% confidence interval: 1.101-6.480] and peritumoral hypointensity in HB phase images (odds ratio = 2.203;95% confidence interval: 0.961-5.049) were associated with high risk of pT2 HCC. The positive likelihood ratio was 6.25 (95% confidence interval: 1.788-21.845), and sensitivity of EOB-MRI for detecting pT2 HCC was 86.2% when two or three of these MRI features were present. Small tumor size and hypointense rim in the HB phase were regarded as benign features. Small HCCs with hypointense rim but not associated with aggressive features were mostly pT1 lesions (specificity, 100%). CONCLUSION Imaging features on EOB-MRI could potentially be used to predict the pathologic stage of solitary HCC (cT1) as pT1 or pT2.展开更多
基金Supported by the An Nan Hospital,China Medical University,No.ANHRF114-20 and No.ANHRF114-21.
文摘BACKGROUND Antibiotic resistance significantly impacts the treatment failure rates of Helicobacter pylori(H.pylori)infections.AIM To investigate the trends in primary antibiotic resistance of H.pylori in Taiwan of China over the past six years.METHODS We conducted a retrospective analysis of H.pylori isolates from Taiwan residents,China who had not undergone previous treatments(n=1408),collected between January 1,2019 and December 31,2024.Susceptibility of these strains to amoxicillin,clarithromycin,levofloxacin,metronidazole,and tetracycline was tested using the Epsilometer test.We analyzed the trends in single and dual resistance profiles over the study period,and compared antibiotic resistance across different regions(northern,southern and eastern areas)of Taiwan of China.RESULTS The overall resistance rates for H.pylori to amoxicillin,clarithromycin,metronidazole,tetracycline,and levofloxacin in Taiwan of China were 1.3%,18.0%,31.0%,0.8%,and 28.7%,respectively.Tetracycline resistance increased significantly from 0%in 2019 to 3.5%in 2024(P value inχ^(2)test for linear trend:<0.001),while metronidazole resistance declined from 35.5%to 13.0%(P value inχ^(2)test for linear trend:<0.001).No significant changes of amoxicillin,clarithromycin and levofloxacin resistances were observed.The dual resistances to clarithromycin plus tetracycline,and metronidazole plus tetracycline both increased significantly from 0%to 1.7%from 2019 to 2024(P value inχ^(2)test for linear trend:<0.05).Furthermore,no significant regional differences in resistance frequencies except for levofloxacin were detected.CONCLUSION Primary antibiotic resistance to tetracycline in H.pylori has increased in Taiwan of China from 2019 to 2024,while resistance to metronidazole has decreased during the same period.The dual resistance to clarithromycin plus tetracycline and metronidazole plus tetracycline both increased significantly.
文摘BACKGROUND Although important for determining long-term outcome, pathologic stage of hepatocellular carcinoma (HCC) is difficult to predict before surgery. Current state-of-the-art magnetic resonance imaging (MRI) using gadoxetic acid provides many imaging features that could potentially be used to classify single HCC as pT1 or pT2. AIM To determine which gadoxetic acid-enhanced MRI (EOB-MRI) findings predict pathologic stage T2 in patients with solitary HCC (cT1). METHODS Pre-operative EOB-MRI findings were reviewed in a retrospective cohort of patients with solitary HCC. The following imaging features were examined: Hyperintensity in unenhanced T2-weighted images, hypointensity in unenhanced T1-weighted images, arterial enhancement, corona enhancement, washout appearance, capsular appearance, hypointensity in the tumor tissue during the hepatobiliary (HB) phase, peritumoral hypointensity in the HB phase, hypointense rim in the HB phase, intratumoral fat, hyperintensity on diffusionweighted imaging, hypointensity on apparent diffusion coefficient map, mosaic appearance, nodule-in-nodule appearance, and the margin (smooth or irregular). Surgical pathology was used as the reference method for tumor staging. Univariate and multivariate analyses were performed to identify predictors of microvascular invasion or satellite nodules. RESULTS There were 39 (34.2%;39 of 114) and 75 (65.8%;75 of 114) pathological stage T2 and T1 HCCs, respectively. Large tumor size (≥ 2.3 cm) and two MRI findings, i.e., corona enhancement [odds ratio = 2.67;95% confidence interval: 1.101-6.480] and peritumoral hypointensity in HB phase images (odds ratio = 2.203;95% confidence interval: 0.961-5.049) were associated with high risk of pT2 HCC. The positive likelihood ratio was 6.25 (95% confidence interval: 1.788-21.845), and sensitivity of EOB-MRI for detecting pT2 HCC was 86.2% when two or three of these MRI features were present. Small tumor size and hypointense rim in the HB phase were regarded as benign features. Small HCCs with hypointense rim but not associated with aggressive features were mostly pT1 lesions (specificity, 100%). CONCLUSION Imaging features on EOB-MRI could potentially be used to predict the pathologic stage of solitary HCC (cT1) as pT1 or pT2.
