Multiplex-PCR-based screening and computational modeling of virulence factors and t-cell mediated immunity in helicobacter pylori infections for accurate clinical diagnosis

The outcome of H. pylori infection is closely related with bacteria's virulence factors and host immune response. The association between T cells and H. pylori infection has been identified, but the effects of the nine major H. pylori specific virulence factors; cagA, vacA, oipA, babA, hpaA, napA, dupA, ureA, ureB on T cell response in H. pylori infected patients have not been fully elucidated. We developed a multiplex- PCR assay to detect nine H. pylori virulence genes with in a three PCR reactions. Also, the expression levels of Th1, Th17 and Treg cell specific cytokines and transcription factors were detected by using qRT-PCR assays. Furthermore, a novel expert derived model is developed to identify set of factors and rules that can distinguish the ulcer patients from gastritis patients. Within all virulence factors that we tested, we identified a correlation between the presence of napA virulence gene and ulcer disease as a first data. Additionally, a positive correlation between the H. pylori dupA virulence factor and IFN-γ, and H. pylori babA virulence factor and IL-17 was detected in gastritis and ulcer patients respectively. By using computer-based models, clinical outcomes of a patients infected with H. pylori can be predicted by screening the patient's H. pylori vacA m1/m2, ureA and cagA status and IFN-γ (Th1), IL-17 (Th17), and FOXP3 (Treg) expression levels. Herein, we report, for the first time, the relationship between H. pylori virulence factors and host immune responses for diagnostic prediction of gastric diseases using computer—based models

Diverticulum With Papillae: Does Position of Papilla Affect Technical Success?

Basis and Purpose:The presence of peripapillary diverticulum (PPD) can cause some biliary diseases, especially common bile duct stones, and also, literally, can change the technique of endoscopic retrograde cholangiopancreatography (ERCP) and affect the complication ratio of this procedure. In this study, we investigate the effect of localization and position of the papilla according to the diverticulum on the success of therapeutic ERCP procedures.Materials and Methods:The study was conducted prospectively in the patients with naive papillae, who underwent ERCP for a period of 16 months. In all patients, the position of papillae according to the diverticulum (the periphery of the diverticulum is thought as the clock circumference, and the position of papillae is defined as the dials of clock), the success rate of biliary cannulation, total procedure time, overall treatment success rate of ERCP, and the complications are investigated.Results:During this period, 222 (18.5%) of the 1205 enrolled patients who underwent ERCP had PPD. Of the patients with PPD, 123 (55.4%) were female and 99 (44.6%) were male, and the median age was 68.910.1 years. According to the position of the papilla by the diverticulum, 90 (40.5%) patients have it on 7 o'clock position, 64 (28.8%) patients have on 6 o'clock position, 63 (28.3%) patients have on 5 o'clock position, and 5 (2.3%) patients have on 1 o'clock position. In the cases of the papilla on 1 o'clock position according to the diverticulum, cannulation procedures were found to be more difficult than other patients (P<0.05). The presence of the diverticulum did not affect the success of therapeutic procedures and did not increase the ratio of complications.Conclusions:In the presence of PPD, additional cannulation techniques may be required for the procedure. Particularly, the aid of percutaneous techniques may be needed for the papilla on 1 o'clock position

Anomalous opening of the common bile duct into the duodenal bulb: endoscopic treatment-6

<p><b>Copyright information:</b></p><p>Taken from "Anomalous opening of the common bile duct into the duodenal bulb: endoscopic treatment"</p><p>http://www.biomedcentral.com/1471-230X/7/26</p><p>BMC Gastroenterology 2007;7():26-26.</p><p>Published online 5 Jul 2007</p><p>PMCID:PMC1933541.</p><p></p> stone next to the balloon

Anomalous opening of the common bile duct into the duodenal bulb: endoscopic treatment-2

<p><b>Copyright information:</b></p><p>Taken from "Anomalous opening of the common bile duct into the duodenal bulb: endoscopic treatment"</p><p>http://www.biomedcentral.com/1471-230X/7/26</p><p>BMC Gastroenterology 2007;7():26-26.</p><p>Published online 5 Jul 2007</p><p>PMCID:PMC1933541.</p><p></p>t with ectopic opening to the duodenal bulb. Note the dilation at CBD and intrahepatic bile ducts

Anomalous opening of the common bile duct into the duodenal bulb: endoscopic treatment-4

<p><b>Copyright information:</b></p><p>Taken from "Anomalous opening of the common bile duct into the duodenal bulb: endoscopic treatment"</p><p>http://www.biomedcentral.com/1471-230X/7/26</p><p>BMC Gastroenterology 2007;7():26-26.</p><p>Published online 5 Jul 2007</p><p>PMCID:PMC1933541.</p><p></p> CBD narrowed critically. Despite the absence of a stone, a 11.5 mm diameter inflated extraction balloon wasn't pulled-out.(real stricture)

Anomalous opening of the common bile duct into the duodenal bulb: endoscopic treatment-0

<p><b>Copyright information:</b></p><p>Taken from "Anomalous opening of the common bile duct into the duodenal bulb: endoscopic treatment"</p><p>http://www.biomedcentral.com/1471-230X/7/26</p><p>BMC Gastroenterology 2007;7():26-26.</p><p>Published online 5 Jul 2007</p><p>PMCID:PMC1933541.</p><p></p>wer hole) with guide-wires inserted for the better demonstration

Anomalous opening of the common bile duct into the duodenal bulb: endoscopic treatment-3

<p><b>Copyright information:</b></p><p>Taken from "Anomalous opening of the common bile duct into the duodenal bulb: endoscopic treatment"</p><p>http://www.biomedcentral.com/1471-230X/7/26</p><p>BMC Gastroenterology 2007;7():26-26.</p><p>Published online 5 Jul 2007</p><p>PMCID:PMC1933541.</p><p></p>ape and tapering of the distal end of the CBD is now slightly perceived when it's in normal diamete