Breath Test Research Articles

Analysis of first responder-involved traffic incidents by mining news reports

Roadside service and incident response personnel face the risk of being killed or severely injured by passing vehicles when performing their duties on or along a road. This study investigated 5,113 responder-involved event news reports to understand the characteristics of first responder-involved incidents. Through text mining, this study examined and compared the characteristics of three types of responder-involved incidents: near-miss incidents, struck-by incidents, and line-of-duty-deaths (LODD). A higher proportion of struck-by and LODD incidents are associated with law enforcement agencies. In terms of the time of day, morning and night incidents are frequently reported in the news. Driving under the influence (DUI) or driving while intoxicated (DWI) is a major cause of LODD incidents. Compared to struck-by incidents, LODD incidents have a larger portion related to out-of-control vehicles. Further, this study built a logistic regression model to relate the incident characteristics to the odds of an incident being a LODD incident. The modeling result shows that tow truck drivers are associated with a greater likelihood of being involved in a news-reported LODD incident than other responders. LODD incidents are more likely to occur on early morning. Compare to entering/leaving/staying at the scene, responders are more likely to be involved in LODD event when assisting. The results offer insights into understanding the characteristics and possible reasons for first responder-involved incidents so that potential countermeasures could be developed to improve responder safety.

Efficacy and safety of vonoprazan-based dual therapy and esomeprazole-based dual therapy in eradicating primary Helicobacter pylori infection: A propensity score matching analysis.

According to the Maastricht VI/Florence consensus report, potassium-competitive acid blockers (P-CAB) may improve Helicobacter pylori eradication treatment. A total of 213 H. pylori treatment-naive patients aged between 18 and 70 years were treated with two regimens. The two regimens are VDT: 20 mg vonoprazan twice a day and 1 g amoxicillin three times daily and EDT: 20 mg esomeprazole four times a day and 750 mg amoxicillin four times daily. 13 C-urea breath tests were used to evaluate eradication rate 4-6 weeks after treatment. Based on propensity score matching (PSM), this retrospective study analyzed the eradication rates, adverse events (AEs), compliance, and antibiotic resistance rates in VDT and EDT groups. On intention-to-treat (ITT) analysis, the eradication rate in VDT group (89.0%; 95% CI 81.7-96.3) was non-inferior to that in EDT group (87.7%; 95% CI 80.1-95.3; p = 0.796). The corresponding per-protocol (PP) eradication rates were 94.1% (95% CI 88.4-99.8) and 92.8% (95% CI 86.7-98.9; p = 1.000), respectively. There were no significant between-group differences with respect to compliance or incidence of AEs. The efficacy and safety of 14-day VDT and EDT were comparable. Therefore, 14-day VDT or EDT may be recommended for the first-line treatment of H. pylori infection.

Usefulness of the aldehyde breath test for predicting metachronous recurrence in patients with esophageal squamous cell carcinoma and hypopharyngeal squamous cell carcinoma.

The rate of metachronous recurrence after endoscopic submucosal dissection for early-stage esophageal squamous cell carcinoma and hypopharynx squamous cell carcinoma is as high (10-15%). The acetaldehyde breath test may detect acetaldehyde dehydrogenase 2 gene polymorphisms. Therefore, we evaluated its usefulness in assessing metachronous recurrence in patients with esophageal squamous cell carcinoma and hypopharynx squamous cell carcinoma. A total of 76 patients underwent endoscopic submucosal dissection for esophageal squamous cell carcinoma and hypopharynx squamous cell carcinoma and were followed up for at least 3years (non-recurrence group: 52 patients; recurrence group: 24 patients). The risk factors for carcinogenesis were compared between the recurrence and non-recurrence groups, and the acetaldehyde-to-ethanol ratio was assessed. The cutoff acetaldehyde-to-ethanol ratio that correlated with recurrence was established, and the cumulative recurrence rate was evaluated. The recurrence group had a higher acetaldehyde-to-ethanol ratio, daily alcohol consumption, and Lugol-voiding lesion grade than the non-recurrence group in the univariate analysis. The cutoff acetaldehyde-to-ethanol ratio for recurrence was 28.1 based on the receiver operating characteristic curve. The multivariate analysis revealed an acetaldehyde-to-ethanol ratio of > 28.1 and a Lugol-voiding lesion grade associated with carcinogenesis. Patients with an acetaldehyde-to-ethanol ratio of ≥ 28.1 had a significantly high recurrence rate using the Kaplan-Meier method. The acetaldehyde-to-ethanol ratio detected using the acetaldehyde breath test could be a novel biomarker of metachronous recurrence after endoscopic submucosal dissection in patients with esophageal squamous cell carcinoma and hypopharynx squamous cell carcinoma. UMIN000040615.

The Relationship Between Helicobacter pylori Infection and Development of Rheumatoid Arthritis

Background : Helicobacter pylori is a spiro-helical, gram-negative & microaerophilic bacteria that particularly lives in the stomach. It has helix form is thought to have developed to puncture the mucoid lining of the stomach and transmit infection. Almost around world about half of population infected with these bacteria, which is broadly dispersed. The interplay of genetic predisposition and environmental exposures results in autoimmune disorders. Infectious triggers have been linked and thoroughly explored among environmental exposures.
 Purpose: To identify the frequency of peoples infected with Helicobacter pylori with autoimmune disorders like rheumatoid arthritis and to determine how this infection may affect the immune system and contribute to autoimmune disease.
 Methods: 100 Stool samples were collected from patients (50) & control group (50) having mild to severe abdominal symptoms also they have pain in joints and bones in order to detect H. pylori infection by stool antigen (Ag) test also urea breath test done to confirm the diagnosis , the patients also diagnosed for rheumatoid arthritis (RA) via anti -CCP test by blood samples collection .
 Results: 50 total patients were infected by H. pylori , Females have higher rate of infection with 60% and males 40% . (40-49) years old age patients have higher rate of infection . (30%) of patients with positive H. pylori and chronic gastritis suffered from Pain in bones and joints and diagnosed with RA , while only 6 % of controls without H. pylori infection diagnosed with RA and showed less gastrointestinal symptoms and no joints inflammation.
 Conclusions: In our study we can conclude that there is a strong association between gastritis in patients caused by helicobacter pylori and development of autoimmune diseases represented by rheumatoid arthritis .

Subsequent risky driving behaviors, recidivism and crashes among drivers with a traffic violation: A scoping review

PurposeDrivers who have committed a traffic violation are a particularly high-risk group, yet studies conducted among this group are scarce. We analyzed and synthesized the current literature concerning subsequent risky driving behaviors, recidivism, and crashes among drivers with a traffic violation. MethodsWe searched PubMed, Education Resources Information Center (ERIC), Academic Search Complete, Web of Science, and Scopus for articles published in English between January 1, 1999, and May 31, 2023. A total of 25 articles met the selection criteria and were included in the final analysis. Two coders independently extracted and analyzed the selected articles to identify common categories across the articles, including study design, study population, type of traffic violation, and study outcomes including subsequent driving behaviors, recidivism, and crash risks. ResultsOf the 25 selected articles, 19 (76%) involved both male and female participants. Fourteen (56%) studies were interventions/evaluation studies, with the other 11 (44%) being observational. Nineteen (76%) studies included alcohol-impaired driving violations, and 23 (92%) studies examined recidivism as an outcome measure. Over half of the observational studies demonstrated that traffic offenders were more likely to commit a subsequent traffic violation or had elevated risk of crashes. Most of the intervention/evaluation studies demonstrated a significant reduction in driving under the influence (DUI) of alcohol among the study participants. However, such positive effects observed during the active intervention period were not always sustained. ConclusionsTraffic offenders are a high-risk group for subsequent violations and crashes. Evidence from this review calls for more effective interventions implemented following a traffic violation to prevent recidivism, crashes, and crash-related injuries and deaths.

IL4 rs34142320 polymorphism is associated with susceptibility to Helicobacter pylori infection in Chinese Han population in northwestern China

Previous studies revealed that both Helicobacter pylori infection and some cytokine gene polymorphisms are risk factors for gastric diseases. The association between H. pylori and gene polymorphisms is worth exploring. Here we conducted a case–control study and systematically evaluate on association between H. pylori infection and IL4, TNFA, and IL10 polymorphisms in a Chinese Han population in northwestern China, where gastric cancer is the major burden on the health and the leading cause of death in local community. The Sequenom MassArray platform was used to screen the genotypes and 14C-urea breath test was employed to determine H. pylori infection status of 705 participants of the local rural residents. Significant association between H. pylori infection and the IL4 rs34142320 polymorphism was observed in the dominant model (OR = 0.57, 95% CI = 0.40–0.80, P = 0.030). No significant association was found between IL4 rs2243250, TNFA rs1800630, TNFA rs1800629, TNFA rs1799964, IL10 rs1800871, IL10 rs1800896 and H. pylori infection. Haplotype analysis showed that T-DEL and G-C haplotypes of the observed IL4 SNPs were significantly associated with H. pylori infection. Our analysis demonstrated that the IL4 rs34142320 polymorphism has a protective effect on H. pylori infection in Chinese Han population.

Injunctive Norms and Driving Under the Influence and Riding With an Impaired Driver Among Young Adults in Washington State

PurposeAlcohol- and cannabis-impaired driving behaviors remain a public health concern especially among young adults (i.e., ages 18–25). Limited updates to prevention efforts for these behaviors may be due, in part, to limited understanding of malleable psychosocial predictors. The current study assessed associations between perceived injunctive norms (i.e., acceptability) of driving under the influence of alcohol (DUI-A) and cannabis (DUI-C), and riding with a driver under the influence of alcohol (RWI-A) and cannabis (RWI-C) in Washington State young adults. MethodsParticipants included 1,941 young adults from the 2019 cohort of the Washington Young Adult Health Survey. Weighted logistic regressions assessed the associations between peer injunctive norms and impaired driving-related behaviors. ResultsA weighted total of 11.5% reported DUI-A, 12.4% DUI-C, 10.9% RWI-A, and 20.9% RWI-C at least once in the past 30 days. Overlap between the outcomes was observed, indicating some young adults had engaged in multiple impaired driving-related behaviors. After controlling for substance use frequency, weighted logistic regressions indicated more positive perceived injunctive norms were associated with nearly 2 ½ times higher odds of DUI-A, 8 times higher odds of DUI-C, 4 times higher odds of RWI-A and six and a half times higher odds of RWI-C. DiscussionResults increase the understanding of how injunctive norms–a potentially malleable psychosocial factor–are associated with four impaired driving-related outcomes. Prevention programs that focus on assessing and addressing the norms of these outcomes individually and collectively, such as normative feedback interventions and media campaigns, may be helpful in reducing these behaviors.

Medium-term repeatability for airwave oscillometry in patients with severe asthma taking benralizumab.

The effort-independent tidal breathing test used by oscillometry presents a viable alternative for following up patients whose condition is stable while they are receiving biologic therapy. We aimed to determine intrasession and intersession repeatability values for airwave oscillometry (AOS) and spirometry in patients who were already taking benralizumab. In all, 21 patients with severe eosinophilic asthma attended the Scottish Centre for Respiratory Research as partof a clinical trial (EudraCT identification number 2019-003763-22). Paired AOS and spirometry values were obtained at 3 separate visits (baseline and days 28 and 56) with no change in asthma therapy. Intrasession agreement between repeated measurements for AOS and spirometry was excellent (intraclass correlation coefficient≥ 0.90) at all 3 visits. Intersession agreement was also excellent (intraclass correlation coefficient≥ 0.80). In this study we report medium-term intrasession and intersession repeatability values for airwave oscillometry and spirometry in a cohort of severely asthmatic patients receiving benralizumab therapy. Oscillometry can be used to follow up patients with asthma who are taking biologics.

The impact ofvaping ethanol-containing electronic cigarette liquids onroadside impairment investigations.

Legal professionals and others have suggested that vaping electronic cigarettes (e-cigs) prior to or during ethanol breath testing may produce false positives. Preliminary breath tests (PBTs) and evidentiary breath tests (EBTs) measure ethanol in exhaled breath and standardized field sobriety tests (SFSTs) are used to assess impairment. Ethanol has been identified in e-cig liquids (e-liquids). Presented are a series of experiments designed to determine the mechanics of vaping ethanol using an e-cig and the effects of vaping ethanol on the SFSTs and breath tests used by law enforcement officers (LEO). Twelve participants (five females, age: 21-32 and seven males, age: 21-55), vaped either one or ten puffs of an e-liquid (0% or 20% ethanol). LEOs assessed impairment using SFSTs (12 and 42 min), PBTs (<1, 27, 32, 37 and 57 min) and EBTs (2, 29, 34, 39 and 59 min) post-vaping. A self-assessment test was administered post-vaping (22 and 52 min). Baseline responses for all measures were collected prior to vaping. Results demonstrated that ethanol in the e-liquids was aerosolized by e-cigs and produced particles that could reach the deep lung tissue based on mean-mass diameter. Ethanol was detected by PBT <3 min after participants vaped one (0.007-0.030 g/210 L) or ten puffs (013-0.074 g/210 L) of a 20% ethanol e-liquid. Ethanol was not detected by PBT at any subsequent time point. Ethanol was not detected by the EBT under any condition. Impairment was not indicated by the SFST. Some subjective effects were reported, but few statistically significant differences between conditions were indicated. A wait period prior to ethanol breath testing is not always mandated, depending on jurisdiction, or observed in all applications, such as workplace testing. The results demonstrate that a wait period must be employed to prevent vaping-related false-positive breath ethanol results.

A day-to-day management model improves patient compliance to treatment for Helicobacter pylori infection: a prospective, randomized controlled study

BackgroundThe day-to-day (DTD) management model encourages patients to actively participate in their healthcare by setting goals. We determined the effectiveness of the DTD model in the treatment of Helicobacter pylori (H. pylori) infection, as compared with conventional outpatient education (OE).MethodsWe randomized 254 H. pylori-positive patients into a DTD group (127 patients) and an OE group (127 patients) prior to primary treatment with 14-day bismuth-containing quadruple therapy, including esomeprazole, amoxicillin, and clarithromycin. Both groups received consistent medication instructions. Patients in the DTD group recorded daily attendance after completing their daily medication plan from day 1 to day 14. The medication compliance, follow-up compliance, H. pylori eradication rates, and adverse events (AEs) were evaluated.ResultsIn the modified intention-to-treat (MITT) and per-protocol (PP) analyses, the DTD group showed significantly higher medication compliance than the OE group (P = 0.001 and P = 0.031, respectively). Both the MITT and PP analyses showed significant differences in follow-up compliance (P < 0.001 and P = 0.003, respectively) and timing of the review urea breath test (P < 0.001 and P = 0.001, respectively) between the two groups. However, no significant differences were observed in the H. pylori eradication rates (95.8% vs. 93.8%, P = 0.529) in the PP analysis, or AEs incidence (25.4% vs. 28.3%, P = 0.603) between the two groups.ConclusionThis study demonstrated the novel application of the DTD model in the treatment of H. pylori infection, which enabled patients to develop habitual medication-taking behaviors without physician intervention.

Datasets of Simulated Exhaled Aerosol Images from Normal and Diseased Lungs with Multi-Level Similarities for Neural Network Training/Testing and Continuous Learning

Although exhaled aerosols and their patterns may seem chaotic in appearance, they inherently contain information related to the underlying respiratory physiology and anatomy. This study presented a multi-level database of simulated exhaled aerosol images from both normal and diseased lungs. An anatomically accurate mouth-lung geometry extending to G9 was modified to model two stages of obstructions in small airways and physiology-based simulations were utilized to capture the fluid-particle dynamics and exhaled aerosol images from varying breath tests. The dataset was designed to test two performance metrics of convolutional neural network (CNN) models when used for transfer learning: interpolation and extrapolation. To this aim, three testing datasets with decreasing image similarities were developed (i.e., level 1, inbox, and outbox). Four network models (AlexNet, ResNet-50, MobileNet, and EfficientNet) were tested and the performances of all models decreased for the outbox test images, which were outside the design space. The effect of continuous learning was also assessed for each model by adding new images into the training dataset and the newly trained network was tested at multiple levels. Among the four network models, ResNet-50 excelled in performance in both multi-level testing and continuous learning, the latter of which enhanced the accuracy of the most challenging classification task (i.e., 3-class with outbox test images) from 60.65% to 98.92%. The datasets can serve as a benchmark training/testing database for validating existent CNN models or quantifying the performance metrics of new CNN models.

Quantitative Polymerase Chain Reaction (qPCR)-Based Rapid Diagnosis of Helicobacter pylori Infection and Antibiotic Resistance.

Helicobacter pylori is a major human pathogen thatinfects approximately half of the global population and is becoming a serious health threat due to its increasing antibiotic resistance. It is the causative agent of chronic active gastritis, peptic ulcer disease, and gastric cancer and has been classified as a Group I Carcinogen by the International Agency for Research on Cancer. Therefore, the rapid and accurate diagnosis of H. pylori and the determination of its antibiotic resistance are important for the efficient eradication of this bacterial pathogen. Currently, H. pylori diagnosis methods mainly include the urea breath test (UBT), the antigen test, the serum antibody test, gastroscopy, the rapid urease test (RUT), and bacterial culture. Among them, the first three detection methods are noninvasive, meaning they are easy tests to conduct. However, bacteria cannot be retrieved through these techniques; thus, drug resistance testing cannot be performed. The last three are invasive examinations, but they are costly, require high skills, and have the potential to cause damage to patients. Therefore, a noninvasive, rapid, and simultaneous method for H. pylori detection and drug resistance testing is very important for efficiently eradicating H. pylori in clinical practice. This protocol aims to present a specific procedure involving the string test in combination with quantitative polymerase chain reaction (qPCR) for the rapid detection of H. pylori infection and antibiotic resistance. Unlike bacterial cultures, this method allows for easy, rapid, noninvasive diagnosis of H. pylori infection status and drug resistance. Specifically, we used qPCR to detect rea for H. pylori infection and mutations in the 23S rRNA and gyrA genes, which encode resistance against clarithromycin and levofloxacin, respectively. Compared to routinely used culturing techniques, this protocol provides a noninvasive, low-cost, and time-saving technique to detect H. pylori infection and determine its antibiotic resistance using qPCR.

Efficacy of a standardised herbal formulation in Helicobacter pylori positive patients with gastritis or peptic ulcer: a triple-blind randomised clinical trial

IntroductionPistacia atlantica subsp. kurdica and Quercus brantii are traditionally used for various gastrointestinal disorders. This study aimed to evaluate the effects of herbal formulation from these two herbs on Helicobacter pylori infection, as well as undertake phytochemical analysis. MethodsA total of 78 H pylori-infected patients were enroled in this triple-blind randomised clinical trial and divided into two equal groups. The intervention and control groups received herbal formulation and placebo capsules once a day besides conventional therapy for 2 weeks, respectively. Patients were asked regarding their clinical symptoms at baseline, 2 weeks, and 3 months after the start of treatment. Also, the urea breath test was applied to assess the effects of herbal formulation 3 months after the start of treatment, which showed a significantly higher rate of H pylori eradication in the intervention group. ResultsWe found that the frequency of clinical symptoms was significantly lower in the intervention group 2 weeks after the start of the study. As well, the standardisation of the herbal formulation was performed according to volatile and nonvolatile compounds by GCMS/FID (gas chromatography mass spectrometry/flame ionization detector) and HPLC-PDA (high pressure liquid chromatography/photodiode array). ConclusionsGenerally, our results confirm the beneficial effects of herbal formulation on H pylori infection in line with its local application. Trial registrationIRCT20120215009014N233.

Excessive bacterial growth syndrome in small intestine burdens the clinical picture of inflammatory bowel diseases

Research objective: to study the frequency of small intestinal bacterial overgrowth (SIBO) and factors associated with it in patients with inflammatory bowel diseases (IBD). Materials and methods of the study: 152 patients with IBD (Crohn’s disease and ulcerative colitis) a hydrogen breathing test (HBT) with lactulose, performed by the “Gastro+” monitor using lactulose. In all patients, the characteristics of the course of IBD were evaluated, including 60 parameters: the time of diagnosis of IBD, the existing symptoms assessed by a visually analog scale (VAS), extra-intestinal manifestations, current and previous treatment, severity of attack, extent of the lesion in UC, phenotypic variant in CD, the level of endoscopic activity, the presence or absence of surgical interventions, indicators of laboratory and instrumental methods of examination, etc. Results. The frequency of positive hydrogen breath test was 48%, in patients with CD - 50.7% (n=36), in patients with UC - 45.7% (n=37) (p= 0.626). The presence of SIBO in general in IBD patients was associated with the level of clinical and endoscopic activity and the form of the disease, the severity of the attack; as well as in UC patients - the extent of the colon lesion, in CD patients - the presence of penenting and stenosing phenotypes. Patients with IBD with the presence of SIBR complain of a greater number of defecations, a lower body mass index, the presence of a decrease in body weight within 1 month before the examination and more frequent complaints of bloating, flatulence, tearfulness and weakness. Thus, a hydrogen breath test can be used for differential diagnosis of exacerbation of IBD from clinical manifestations caused by SIBO.

Macronutrients effects on satiety and food intake in older and younger adults: A randomised controlled trial

Older adults are advised to increase their protein intake to maintain their muscle mass. However, protein is considered the most satiating macronutrient and this recommendation may cause a decrease in total energy intake. To date, satiety studies comparing all three macronutrients have been undertaken in young adults, and it is unclear if the same response is seen in older adults. The objective of this study was to compare the effect of preloads high in protein, fat, and carbohydrate but equal in energy (∼300 kcal) and volume (250 ml) on energy intake, perceived appetite, and gastric emptying in younger and older adults. Twenty older and 20 younger adults completed a single-blinded randomised crossover trial involving three study visits. Participants consumed a standard breakfast, followed by a preload milkshake high in either carbohydrate, fat, or protein. Three hours after the preload, participants were offered an ad libitum meal to assess food intake. Visual analogue scales were used to measure perceived appetite and gastric emptying was measured via the 13C-octanoic acid breath test. There was no significant effect of preload type or age on energy intake either at the ad libitum meal, self-recorded food intake for the rest of the test day or subjective appetite ratings. There was a significant effect of preload type on gastric emptying latency phase and ascension time, and an effect of age on gastric emptying latency and lag phase such that older adults had faster emptying. In conclusion, energy intake, and perceived appetite were not affected by macronutrient content of the preloads in both younger and older adults, but gastric emptying times differed.

Effectiveness of eradication therapy for Hp infection of residents of Perm and the Perm region

Purpose: to evaluate the effectiveness of eradication therapy for Hp infection in Perm and the Perm region. Materials and methods: a retrospective analysis of 88 case histories of patients who underwent eradication of Hp infection was carried out at the Perm Medical Center (GASTROCENTER). Primary infection with H. pylori was confirmed by: serological blood test or determination of Hp antigen in feces, rapid urease test, and C13 urease breath test. Hp eradication therapy regimens, depending on the source of prescription, included standard triple therapy with the addition of bismuth preparations for a period of 14 days (main group) or 7-10-day triple therapy (control group). Results and discussion: the main indications for Hp eradication were: chronic gastritis and gastroesophageal reflux disease. In the main group, all patients received Hp eradication therapy with the inclusion of: esomeprazole (emanera) 40 mg, amoxicillin 1000 mg, clarithromycin (fromilid) 50 mg and bismuth tripotassium dicitrate (ulcavis) 240 mg twice a day for 14 days. The control group included patients who received Hp eradication schemes with various proton pump inhibitors, amoxicillin and clarithromycin or metronidazole or levofloxacin or even rifaximin for 7 or 10 days. Adverse events: abdominal pain and diarrhea occurred in both groups. Patients of the main group complained about bitterness in the mouth, where all patients received clarithromycin. Approximately the same small number of patients complained of nausea. With a differentiated assessment by groups, in the main group, Hp eradication was highly effective and reached 93%, while in the control group it was significantly lower and did not exceed 48% (p=0,00087) Conclusions: modern detection of Hp infection and its eradication is an effective approach to the prevention of atrophic gastritis, gastric cancer and peptic ulcer of the stomach and duodenum. The “gold” standard for diagnosing Hp infection is the 13C-urease breath test. For residents of Perm and the Perm Territory, it is recommended to use Hp eradication with the appointment of a 14-day regimen with the inclusion of esomeprazole (Emaner), clarithromycin (Fromilide), amoxicillin and bismuth tripotassium dicitrate (Ulkavis) as the first line of therapy.

Ilaprazole-amoxicillin dual therapy at high dose as a first-line treatment for helicobacter pylori infection in Hainan: a single-center, open-label, noninferiority, randomized controlled trial

ObjectivesThis study aimed to evaluate the efficacy, adverse events, patient compliance, and cost of dual therapy with Ilaprazole-amoxicillin (IA) at high dose versus Ilaprazole-amoxicillin-furazolidone-bismuth (IAFB) quadruple therapy for the Helicobacter pylori (H.pylori) infection among Chinese patients.Methods200 patients who had tested positive for H. pylori and undergoing upper gastrointestinal endoscopy after being diagnosed with chronic gastritis participated in this open-label randomized controlled clinical trial. Patients were randomized to Group A and Group B: the 14-day IA dual treatment group (101) and IAFB quadruple treatment group (99). The 13 C urea breath test was conducted to determine whether H. pylori had been eliminated 4–6 weeks after the treatment. Eradication rates, drug-related adverse events, patient compliance, and drug costs were compared between the two treatment groups.ResultsEradication rates in group A were 92.1% and 94.9%, depending on the intention-to-treat (ITT), per-protocol (PP), respectively, which was similar to group B (91.9% and 93.6%). There was no significant difference observed in adverse events between the two groups (P = 0.518). Interestingly, compliance was significantly higher in group A compared to the group B (P = 0.031). In addition, drug costs were significantly lower for group A in comparison to the group B.ConclusionsIA dual therapy was found to be equally effective, safer and less costly than IAFB quadruple therapy. Therefore, these therapies can be potentially considered as first-line regimens for empirical treatment.

Establishing a cell-based screening workflow for determining the efficiency of CYP2C9 metabolism: moving towards the use of breath volatiles in personalised medicine

The use of volatile biomarkers in exhaled breath as predictors to individual drug response would advance the field of personalised medicine by providing direct information on enzyme activity. This would result in enormous benefits, both for patients and for the healthcare sector. Non-invasive breath tests would also gain a high acceptance by patients. Towards this goal, differences in metabolism resulting from extensive polymorphisms in a major group of drug-metabolizing enzymes, the cytochrome P450 (CYP) family, need to be determined and quantified. CYP2C9 is responsible for metabolising many crucial drugs (e.g., diclofenac) and food ingredients (e.g., limonene). In this paper, we provide a proof-of-concept study that illustrates the in vitro bioconversion of diclofenac in recombinant HEK293T cells overexpressing CYP2C9 to 4ʹ-hydroxydiclofenac. This in vitro approach is a necessary and important first step in the development of breath tests to determine and monitor metabolic processes in the human body. By focusing on the metabolic conversion of diclofenac, we have been able to establish a workflow using a cell-based system for CYP2C9 activity. Furthermore, we illustrate how the bioconversion of diclofenac is limited in the presence of limonene, which is another CYP2C9 metabolising substrate. We show that increasing limonene levels continuously reduce the production of 4ʹ-hydroxydiclofenac. Michaelis-Menten kinetics were performed for the diclofenac 4ʹ-hydroxylation with and without limonene, giving a kinetic constant of the reaction, K M, of 103 µM and 94.1 µM, respectively, and a maximum reaction rate, V max, of 46.8 pmol min−1 106 cells−1 and 56.0 pmol min−1 106 cells−1 with and without the inhibitor, respectively, suggesting a non-competitive or mixed inhibition type. The half-maximal inhibitory concentration value (IC50) for the inhibition of the formation of 4ʹ-hydroxydiclofenace by limonene is determined to be 1413 µM.

Estimation of exocrine pancreatic insufficiency in children with acute pancreatitis using the 13C mixed triglyceride breath test

Background/Objective: The extent of exocrine pancreatic insufficiency (EPI) in the paediatric population with acute pancreatitis (AP) is unknown. The primary objective was to use a 6 h stable-isotope breath test to determine the prevalence of EPI in children with AP. The secondary objective was to determine the diagnostic ability of a 4 h abbreviated breath test in the detection of EPI. Methods13C-mixed triglyceride (MTG) breath test was used to measure fat digestibility in 12 children with AP and 12 normal children. EPI was diagnosed based on a cumulative dose percentage recovery (cPDR) cut-off value < 26.8% present in literature. To reduce the test burden, the diagnostic accuracy of an abbreviated 4 h test was evaluated, using a cPDR cut-off that was the 2.5th percentile of its distribution in control children. ResultsThe cPDR of cases was significantly lower than that of controls (27.71 ± 7.88% vs 36.37 ± 4.70%, p = 0.005). The cPDR during acute illness was not significantly different to that at 1 month follow up (24.69 ± 6.83% vs 26.98 ± 11.10%, p = 0.52). The 4 h and 6 h breath test results correlated strongly (r = 0.93, p < 0.001) with each other. The new 4 h test had 87.5% sensitivity and 93.8% specificity for detecting EPI. ConclusionTwo-thirds (66.7%) of this sample of children with AP had EPI during admission, which persisted at 1 month follow up. The 4 h abbreviated 13C-MTG breath test has good diagnostic ability to detect EPI in children and may improve its clinical utility in this age group.

Helicobacter pylori-negative Gastric Adenocarcinoma Mimicking Verrucous Gastritis in the Antrum: A Case Report and Literature Review.

A 46-year-old man was referred to our hospital for the examination of a flat elevated lesion with an erosion-like depression, located on the greater curvature of the antrum. Endoscopic submucosal dissection was performed. Histological findings of the resected specimen demonstrated a well-differentiated tubular adenocarcinoma with a diameter of 12 mm. No atrophy was observed in the tumor-adjacent mucosa. Serum Helicobacter pylori antibody estimation and 13C-urea breath tests yielded negative results. Immunohistochemical staining was positive for both gastric mucin and intestinal mucin. The final diagnosis was well-differentiated tubular adenocarcinoma with a gastrointestinal phenotype that originated in mucosa uninfected by H. pylori.