ObjectiveAlthough mass eradication of Helicobacter pylori has been proposed as a means to eliminate gastric cancer, its long-term effects remain unclear.DesignMass eradication of H. pylori infection was launched in 2004 and continued until 2018 for a high-risk Taiwanese population aged 30 years or older dwelling on Matsu Islands with prevalent H. pylori infection. Test positives for the 13C-urea breath test underwent eradication therapy. We evaluated the effectiveness of the mass eradication in reducing two main outcomes, incidence and mortality rates of gastric cancer, until the end of 2016 and 2018, respectively.ResultsAfter six rounds of mass screening and eradication, the coverage rate reached 85.5% (6512/7616). The referral rate for treatment was 93.5% (4286/4584). The prevalence rates of H. pylori fell from 64.2% to 15.0% with reinfection rates of less than 1% per person-year. The presence and severity of atrophic gastritis and intestinal metaplasia also decreased with time. Compared with the historical control period from 1995 to 2003, the effectiveness in reducing gastric cancer incidence and mortality during the chemoprevention period was 53% (95% CI 30% to 69%, p<0.001) and 25% (95% CI −14% to 51%, p=0.18), respectively. No significant changes were noted in the incidence rates of other digestive tract cancers or the antibiotic resistance rate of H. pylori.ConclusionPopulation-based eradication of H. pylori has significantly reduced gastric cancer incidence with no increase in the likelihood of adverse consequences. A significant reduction in mortality is likely to be achieved with a longer follow-up period.Trial registration numberNCT00155389

Background and Aim The reliable method to stratify the gastric cancer risk after Helicobacter pylori eradication remains an elusive goal. Methods Mass eradication of H. pylori began in 2004 in a high‐risk population. After eradication, a screening program involving first‐stage serological tests (pepsinogen‐I, pepsinogen‐II, H. pylori immunoglobin G, and gastrin‐17) and second‐stage endoscopic examination was launched in 2015–2018. Index lesions included gastric cancer or extensive premalignant lesions. We evaluated the performance of the serological tests to “rule in” and “rule out” the risk based on positive and negative likelihood ratios, respectively. The methylation levels of microRNA‐124a‐3 in the stomach were measured to indicate genetic damage. Results Among 6512 invited subjects, 3895 (59.6%) participated. Both gastrin‐17 and pepsinogen tests were normal in 3560 (91.4%) subjects; 206 (5.3%) gastrin‐17 and 129 (3.3%) pepsinogen tests were abnormal. Years after eradication, the severity of gastritis had fallen greatly, and extensive premalignant lesions or gastric cancer frequently occurred in newly non‐atrophic‐appearing mucosa. Pepsinogen testing could moderately predict atrophic gastritis (positive likelihood ratio: 4.11 [95% confidence interval: 2.92–5.77]; negative likelihood ratio: 0.14 [0.10–0.19]). Gastrin‐17 was not useful (0.66 and 1.20, respectively). However, pepsinogen testing poorly predicted the index lesions (2.04 [1.21–3.42] and 0.57 [0.34–0.95]). DNA methylation levels in the post‐eradication mucosa were more discriminative for predicting index lesions (3.89 [2.32–6.54] and 0.25 [0.15–0.42]). Conclusions After eradication, pepsinogen false‐negative results become more frequent because histology is improved but genetic damage may persist. Direct testing for genetic damage offers better discrimination.

This long-term cohort study shows the usefulness of PG measurement as a biomarker that is specific to the risk of gastric cancer death.

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the security of database system as the core component of data storage has been increasingly important. Effective audit of the database system can reduce the potential security risk. Practical database audit system should not affect the operation of the existing system which uses audited database. This paper presents and implements a multi-protocol database audit system based on bypass mode, and has a detailed description of the function of each module and the interface between them. This paper designs a detailed database audit policy to achieve effective audit. In the second half of this paper, we focus on the implementation of the key technologies which contain Zero-copy and flow table. Keywords-database;zero-copy;flow-table;policy;audit