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Sm-Co bulk alloys are well-known permanent magnets having large remanent magnetizations and coercive forces and are widely used in many industrial products. Recently, a large transverse thermoelectric conversion was observed for SmCo5 over a wide temperature range in the absence of magnetic fields. The large thermoelectric conductivity tensors (αxy) was also confirmed by the first-principles density functional theory (DFT) calculations. In this study, we predicted further enhancement of the αxy by including Ni in Co site of SmCo5. We showed that the αxy of Sm(Co1−xNix)5 increases with increasing the Ni ratio and takes the maximum value αxy = 11.3 A K−1 m−1 around x = 0.08 at 300 K, which is about 77% enhancement of αxy = 6.4 A K−1 m−1 in SmCo5. We clarified that the band proximity points near the nodal line of Sm(Co0.92Ni0.08)5 are the main contributing factor to the large Berry curvature, providing the steep slope of the energy dependence in the anomalous Hall conductivity around the Fermi energy. [ABSTRACT FROM AUTHOR]

We demonstrated the effectiveness of the machine learning method combined with first-principles calculations for the enhancement of the anomalous Nernst effect (ANE) of multilayers. The composition ratio of CoNi homogeneous alloy superlattices was optimized by Bayesian optimization so as to maximize the transverse thermoelectric conductivity (αxy). The nonintuitive optimal composition with a large αxy of ∼10 A K−1 m−1 was identified through the two-step Bayesian optimization using rough and fine candidate pools. The Berry curvature and band dispersion analyses revealed that αxy is enhanced by the appearance of the flat band near the Fermi level due to the multilayer formation. The magnitude of the energy derivative of the anomalous Hall conductivity increases owing to the large Berry curvature near the flat band along the R-M high symmetry line, which emerges only in the optimized superlattice, leading to the αxy enhancement. The effective method verified here will broaden the choices of ANE materials to more complex systems and, therefore, lead to the development of transverse thermoelectric conversion technologies. [ABSTRACT FROM AUTHOR]

We demonstrated the effectiveness of the machine learning method combined with first-principles calculations for the enhancement of the anomalous Nernst effect (ANE) of multilayers. The composition ratio of CoNi homogeneous alloy superlattices was optimized by Bayesian optimization so as to maximize the transverse thermoelectric conductivity (αxy). The nonintuitive optimal composition with a large αxy of ∼10 A K−1 m−1 was identified through the two-step Bayesian optimization using rough and fine candidate pools. The Berry curvature and band dispersion analyses revealed that αxy is enhanced by the appearance of the flat band near the Fermi level due to the multilayer formation. The magnitude of the energy derivative of the anomalous Hall conductivity increases owing to the large Berry curvature near the flat band along the R-M high symmetry line, which emerges only in the optimized superlattice, leading to the αxy enhancement. The effective method verified here will broaden the choices of ANE materials to more complex systems and, therefore, lead to the development of transverse thermoelectric conversion technologies. [ABSTRACT FROM AUTHOR]

Syrphid larvae are well-known predators of aphids; however, we sometimes observed them on onion plants with thrips and without any aphids, which intercropped with barley in our previous study. Therefore, we hypothesized that syrphid larvae fed on thrips in the onion field in the absence of aphids, their main prey. This hypothesis was tested by analyzing the prey DNA from syrphid larvae collected from onion plants intercropped with barley. We found that they preyed on three thrips species: Thrips tabaci (Lindeman), Frankliniella occidentalis (Pergande), and Anaphothrips obscurus (Müller). Moreover, we observed that syrphid larvae collected from onion plants fed on larval T. tabaci in a laboratory setting. According to COI sequencing of their genomes, the syrphid species occurred from the onion plants were Sphaerophoria macrogaster (Thomson), Melanostoma scalare (Fabricius), Melanostoma mellinum (L.), and Platycheirus pennipes (Ohara); all of them were found to prey on thrips in the prey DNA analyses. These results and observations supported the hypothesis and suggested that intercropping barley as a living mulch may become an option for enhancing the potential of native syrphid species as generalist predators in the onion fields. [ABSTRACT FROM AUTHOR]

We report a proof-of-concept demonstration of the anomalous Nernst thermopile driven by solar heating and radiative cooling. The anomalous Nernst thermopile proposed here consists of a zigzag-shaped single magnetic material without any junction structures and black ink-coated alternately on the wires arranged in the zigzag configuration. The voltage generated from this structure increases by an order of magnitude compared to an uncoated structure under the condition with solar heating and radiative cooling, which can further be enhanced by increasing the number of wires. This device concept paves the way for outdoor thermoelectric applications based on the anomalous Nernst effect. [ABSTRACT FROM AUTHOR]

Chrysanthemum stunt viroid (CSVd) is a disease agent caused by a viroid from the genus Pospiviroid. The CSVd pathogen infects chrysanthemum plants and causes severe symptoms of stunting and significant yield loss in cultivation. Although many studies have focussed on this issue, the mechanism of CSVd‐infection remains to be clarified. In particular, the effects of CSVd on the underground parts of infected plants are not yet fully understood in Chrysanthemum. Here, we investigated whether the effects of CSVd on the root formation of infected plants varies among cultivars and wild Chrysanthemum species, C. morifolium and C. seticuspe, using transcribed RNA and in vitro assays. Furthermore, to compare infected plants with uninoculated plants, we assessed the symptoms and measured the CSVd RNA accumulation levels in several tissues using RT‐qPCR. Our findings indicated that CSVd‐infected plants exhibited severe root formation symptoms in both C. morifolium and C. seticuspe. RT‐qPCR revealed CSVd accumulation in the root tips and similar patterns of CSVd accumulation in each organ of C. morifolium and C. seticuspe. We propose that in vitro assays are useful for determining root formation in CSVd‐infected chrysanthemum plants. Such investigations are necessary to better understand CSVd infection in Chrysanthemum species and plant defences against such diseases. [ABSTRACT FROM AUTHOR]

Text recognition in natural scene images is a challenging task that has recently been garnering increased research attention. In this paper, we propose a method for recognizing text by utilizing the layout consistency of a text string. We estimate the layout (four lines of a text string) using initial character extraction and recognition result. On the basis of the layout consistency across a word, we perform character extraction and recognition again using four lines, which is more accurate than the first process. Our layout estimation method is different from previous methods in terms of exploiting character recognition results and its use of a class-conditional layout model. More accurate and robust estimation is achieved, and it can be used to refine character extraction and recognition. We call this two-way process-from extraction and recognition to layout, and from layout to extraction and recognition-'bidirectional' to discriminate it from previous feedback refinement approaches. Experimental results demonstrate that our bidirectional processes provide a boost to the performance of word recognition. [ABSTRACT FROM AUTHOR]

Purpose: To determine the incidence of difficulty in inserting a 25- and 23-gauge trocar cannula (DITC) during 25- or 23-gauge micro-incision vitrectomy surgery (MIVS). Methods: Retrospective, consecutive, interventional case series performed by a single surgeon at a single centre. We defined a DITC as the condition where at least 1 trocar cannula could not be inserted into the vitreous at the beginning of MIVS. The incidence of DITC was calculated from 1,525 eyes, and the pre-operative demographics of the DITC cases were compared to those of the non-DITC cases. Results: The incidence of DITC for all cases was 0.6% (9 of 1,525 eyes). Overall, there were 242 eyes with a retinal detachment (RD), and 8 of the 9 eyes with DITC had an RD with an incidence of 3.3% (8 of 242 RD eyes). Seven of these 8 eyes had a total RD, 4 also had a choroidal detachment, 4 eyes were also myopic (>-8.0 dpt, high myopia), and 6 of the 8 eyes were hypotonic (<8 mm Hg). The DITC cases had larger RDs (p < 0.0001), a higher incidence of choroidal detachment (p < 0.0001), higher myopia (p = 0.0204) and hypotony (p = 0.0003) than the non-DITC eyes with an RD. Conclusions: A large RD, a choroidal detachment, high myopia and hypotony are significant risk factors for DITC. We recommend that MIVS should be performed cautiously for eyes with these risk factors. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: A validated productivity questionnaire, the Work Productivity and Activity Impairment questionnaire for Gastroesophageal Reflux Disease (WPAI-GERD), exists for Swedish patients with GERD.Objective: To assess responsiveness to change of the WPAI-GERD and construct validity of the English language version.Methods: We used the WPAI-GERD in a before-after treatment clinical study of Canadian GERD patients with moderate or severe symptoms treated with esomeprazole 40 mg once daily for 4 weeks. We measured productivity variables including GERD-specific absence from work, reduced productivity while at work and reduced productivity while carrying out regular daily activities other than work during the preceding week.Results: The analysis included 217 patients, of whom 71% (n = 153) were employed. Before treatment, employed patients reported an average 0.9 hours of absence from work due to GERD and 14.0% reduced work productivity (5.8 hours equivalent) in the previous week, as well as 21.0% reduced productivity in daily activities (all patients). After treatment, the corresponding figures decreased to 0.3 hours, 3.0% (1.1 hours equivalent) and 4.9%, respectively. Thus, the improvement (difference from start of treatment) in productivity was 0.6 hours (p = 0.011) for absence from work and 11.0% units (p < 0.001) for reduced work productivity (4.7 hours equivalent, p < 0.001). This translated into an avoided loss of work productivity of 5.3 hours in total on a weekly basis per employed patient. In addition, a 16.1% unit (p < 0.001) improvement for reduced productivity in activities was observed. Cross-sectional correlation coefficients of WPAI variables with symptoms (range 0.04-0.63) and health-related quality of life (HR-QOL; range 0.02-0.65) supported cross-sectional construct validity. Corresponding change score correlations between WPAI variables and HR-QOL (range 0.05-0.56) supported longitudinal construct validity of the WPAI-GERD while low change score correlations between productivity variables and relevant symptoms (range 0.06-0.34) did not.Conclusion: The English version of the WPAI-GERD showed good cross-sectional construct validity, and results indicated that the WPAI-GERD is responsive to change. Although the results also indicated that longitudinal construct validity may be poor, the overall findings suggest that further study of the instrument remains warranted. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The etiologies of functional dyspepsia (FD) are unclear, but in some studies, treatment with a proton pump inhibitor has been beneficial. The objective of this study was to evaluate the efficacy of esomeprazole 40 mg once a day compared to placebo in achieving symptom relief in primary care patients with FD. METHODS: This was a randomized, placebo-controlled trial in adult FD patients, who had at least moderate severity of symptoms, defined as a score of ≥4 on a 7-point Global Overall Symptom (GOS) scale. Patients were excluded if they had predominant symptoms of heartburn or regurgitation; after a normal baseline endoscopy, patients were randomized to esomeprazole 40 mg once daily or placebo for 8 wk. The primary outcome measure was symptom relief (GOS ≤2) at 8 wk. RESULTS: Of the 502 enrolled patients, 224 were randomized. The main reasons for exclusion were abnormal endoscopic findings, especially esophagitis. A significantly greater proportion of patients in the esomeprazole group achieved symptom relief at 4 but not at 8 wk compared to placebo: 4 wk esomeprazole 50.5% versus placebo 32.2%, p= 0.009; 8 wk esomeprazole 55.1% versus placebo 46.1%, p= 0.16. A similar relationship at 4 and 8 wk was seen for symptom resolution (GOS = 1) and improvement (ΔGOS ≥2). CONCLUSION: For the primary outcome measure of symptom relief at 8 wk, there was no statistically significant difference between esomeprazole 40 mg once a day and placebo. However, at 4 wk, esomeprazole was significantly more effective than placebo for symptom relief. The difference in therapeutic gain between 4 and 8 wk was largely due to a higher placebo response rate at 8 wk. [ABSTRACT FROM AUTHOR]

BACKGROUND : The management of Helicobactor pylori negative patients with dyspepsia in primary care has not been studied in placebo-controlled studies. METHODS : H. pylori negative patients with dyspepsia symptoms of at least moderate severity (≥4 on a seven-point Likert scale) were recruited from 35 centers. Patients were randomized to a 4-wk treatment of omeprazole 20 mg od, ranitidine 150 mg bid, cisapride 20 mg bid, or placebo, followed by on-demand therapy for an additional 5 months. Treatment success was defined as no or minimal symptoms (score ≤ 2 out of 7), and was assessed after 4 wk and at 6 months. RESULTS : Five hundred and twelve patients were randomized and included in the intention-to-treat (ITT) analysis. At 4 wk, success rates (95% CI) were: omeprazole 51% (69/135; 43–60%), ranitidine 36% (50/139, 28–44%), cisapride 31% (32/105, 22–39%), and placebo 23% (31/133, 16–31%). Omeprazole was significantly better than all other treatments ( p < 0.05). The proportion of patients who were responders at 4 wk and at 6 months was significantly greater for those receiving omeprazole 31% (42/135, 23–39%) compared with cisapride 13% (14/105, 7–20%), and placebo 14% (18/133, 8–20%) ( p= 0.001), but not ranitidine 21% (29/139, 14–27%) ( p= 0.053). The mean number of on-demand study tablets consumed and rescue antacid used was comparable across groups. Economic analysis showed a trade-off between superior efficacy and increased cost between omeprazole and ranitidine. CONCLUSION : Treatment with omeprazole provides superior symptom relief compared to ranitidine, cisapride, and placebo in the treatment of H. pylori negative primary care dyspepsia patients. (Am J Gastroenterol 2005;100:1–12) [ABSTRACT FROM AUTHOR]

Background: The correlation between treatment satisfaction and demographic characteristics, symptoms, or healthrelated quality of life (HRQL) in patients with gastroesophageal reflux disease (GERD) is unknown. The objective of this study was to assess correlates of treatment satisfaction in patients with GERD receiving a proton pump inhibitor, esomeprazole. Methods: Adult GERD patients (n = 217) completed demography, symptom, HRQL, and treatment satisfaction questionnaires at baseline and/or after treatment with esomeprazole 40 mg once daily for 4 weeks. We used multiple linear regressions with treatment satisfaction as the dependent variable and demographic characteristics, baseline symptoms, baseline HRQL, and change scores in HRQL as independent variables. Results: Among the demographic variables only Caucasian ethnicity was positively associated with treatment satisfaction. Greater vitality assessed by the Quality of Life in Reflux and Dyspepsia (QOLRAD) and worse heartburn assessed by a four-symptom scale at baseline, were associated with greater treatment satisfaction. The greater the improvement on the QOLRAD vitality (change score), the more likely the patient is to be satisfied with the treatment. Conclusions: Ethnicity, baseline vitality, baseline heartburn severity, and change in QOLRAD vitality correlate with treatment satisfaction in patients with GERD. [ABSTRACT FROM AUTHOR]

Background: Gastro-esophageal reflux disease (GERD) is a common disease. It impairs health related quality of life (HRQL). However, the impact on utility scores and work productivity in patients with moderate to severe GERD is not well known. Methods: We analyzed data from 217 patients with moderate to severe GERD (mean age 50, SD 13.7)across 17 Canadian centers. Patients completed three utility instruments - the standard gamble (SG), the feeling thermometer (FT), and the Health Utilities Index 3 (HUI 3) - and several HRQL instruments, including Quality of Life in Reflux and Dyspepsia (QOLRAD) and the Medical Outcomes Short Form-36 (SF-36). All patients received a proton pump inhibitor, esomeprazole 40 mg daily, for four to six weeks. Results: The mean scores on a scale from 0 (dead) to 1 (full health) obtained for the FT, SG, and HUI 3 were 0.67 (95% CI, 0.64 to 0.70), 0.76 (95% CI, 0.75 to 0.80), and 0.80 (95% CI, 0.77 to 0.82) respectively. The mean scores on the SF-36 were lower than the previously reported Canadian and US general population mean scores and work productivity was impaired. Conclusion: GERD has significant impact on utility scores, HRQL, and work productivity in patients with moderate to severe disease. Furthermore, the FT and HUI 3 provide more valid measurements of HRQL in GERD than the SG. After treatment with esomeprazole, patients showed improved HRQL. [ABSTRACT FROM AUTHOR]

OBJECTIVES: From the Canadian Registry of patients with Upper Gastrointestinal Bleeding and Endoscopy (RUGBE), we determined clinical outcomes and explored the roles of endoscopic and pharmacologic therapies in a contemporary real-life setting.METHODS: Analysis of randomly selected patients endoscoped for nonvariceal upper gastrointestinal bleeding at 18 community and tertiary care institutions between 1999 and 2002. Covariates and outcomes were defineda prioriand 30-day follow-up obtained. Logistic regression models identified predictors of outcomes.RESULTS: One thousand eight-hundred and sixty-nine patients were included (66± 17 yr, 38% female, 2.5± 1.6 comorbid conditions, hemoglobin, 96± 27 g/L, 54% received a mean of 2.9± 1.7 units of blood). Endoscopy was performed within 24 h in 76%, with ulcers (55%) most commonly noted. High-risk endoscopic stigmata and endoscopic therapy were reported in 37%. Rebleeding, surgery, and mortality rates were 14.1%, 6.5%, and 5.4%, respectively. Decreased rebleeding was significantly and independently associated with PPI use (85% of patients, mean daily dose 56± 53 mg) in all patients regardless of endoscopic stigmata, (odds ratio (OR):0.53, 95% confidence interval, 95% CI:0.37–0.77) and endoscopic hemostasis in patients with high-risk stigmata (OR:0.39, 95% CI:0.25–0.61). PPI use (OR:0.18, 95% CI:0.04–0.80) and endoscopic therapy (OR:0.31, 95% CI:0.11–0.91) were also each independently associated with decreased mortality in patients with high-risk stigmata.CONCLUSIONS: These results appear to confirm the protective role of endoscopic therapy in patients with high-risk stigmata, and suggest that acute use of PPIs may be associated with a reduction of rebleeding in all patients, and lower mortality in patients with high-risk stigmata. Independent prospective validation of these observational findings is now required. [ABSTRACT FROM AUTHOR]

This pragmatic, primary care study by Meineche-Schmidt in patients with presumed acid-related uninvestigated dyspepsia showed that a standard dose of omeprazole 20 mg daily was significantly more effective than a placebo in treating their self-worded main dyspepsia complaint. As a higher dose of omeprazole 40 mg daily was not more effective, the standard dose should be used. In this study, 9% of the patients had sole reflux-like symptoms while the rest had other accompanying symptoms and would be considered to have dyspepsia. In fact, patients had on average more than five symptoms. Patients do not know that there is a controversy about whether to call their symptoms GERD or dyspepsia; they just know that they want to feel better. As no initial investigations were made, patients could have a variety of possible diagnoses such as gastroesophageal reflux disease, ulcer disease, or functional dyspepsia. The recent CADET-PE study showed that if patients had endoscopic abnormalities, these were findings such as esophagitis that would be appropriately treated with acid suppression. That study also reconfirmed that symptoms do not predict endoscopic findings and do not make a diagnosis. Thus, the approach suggested in this study to treat patients based on their main symptom complaint is practical and effective. [ABSTRACT FROM AUTHOR]

This article examines the context and process of sports migration among the professional baseball leagues in the Pacific region and the United States from 1995 to 1999. During this 5-year period, the number of foreign players in every league increased. Findings indicate that although some 90% of foreign- born players in US. Major League Baseball originate from Latin America, more than 50% of foreigners are Americans in the four Asian leagues. Furthermore, with respect to baseball migration patterns among the Pacific nations, it seems that economic and athletic factors are very important with a geographic dimension being particularly significant in US. Major League Baseball. Overall, the study found evidence supporting the increasing influence of globalization based on the relationships of interdependency in professional baseball. [ABSTRACT FROM AUTHOR]

Abstract Objective: To determine whether a "test for Helicobacter pylori and treat" strategy improves symptoms in patients with uninvestigated dyspepsia in primary care. Design: Randomised placebo controlled trial. Setting: 36 family practices in Canada. Participants: 294 patients positive for Hpylori ([sup 13]Curea breath test) with symptoms of dyspepsia of at least moderate severity in the preceding month. Intervention: Participants were randomised to twice daily treatment for 7 days with omeprazole 20 mg, metronidazole 500 mg, and clarithromycin 250 mg or omeprazole 20 mg, placebo metronidazole, and placebo clarithromycin. Patients were then managed by their family physicians according to their usual care. Main outcome measures: Treatment success defined as no symptoms or minimal symptoms of dyspepsia at the end of one year. Societal healthcare costs collected prospectively for a secondary evaluation of actual mean costs. Results: In the intention to treat population (n=294), eradication treatment was significantly more effective than placebo in achieving treatment success (50% v 36%; P=0.02; absolute risk reduction=14%; number needed to treat=7, 95% confidence interval 4 to 63). Eradication treatment cured Hpylori infection in 80% of evaluable patients. Treatment success at one year was greater in patients negative for Hpylori than in those positive for Hpylori (54% v 39%; P=0.02). Eradication treatment reduced mean annual cost by $C53 (-86 to 180) per patient. Conclusions: A "test for Hpylori with [sup 13]C-urea breath test and eradicate" strategy shows significant symptomatic benefit at 12 months in the management of primary care patients with uninvestigated dyspepsia. [ABSTRACT FROM AUTHOR]

This article seeks to draw attention to the phenomenon of the so-called 'borderless athletes' who transcend ethnicity or national borders in the sporting world. This approach applies Fukuoka's (1993) conceptual framework to clarify how the identities of these 'global' athletes are defined and accepted within Japan. In general, the article focuses on the naturalization of 'sports stars' in Japan in terms of governing bodies and sports associations. In particular the study examines the case of Canadian-born players in Japanese ice hockey, the strengthening of nationalism in the case of soccer star Waguner Lopes and the role of the media. Overall, the article addresses the assimilation of particular foreign athletes as a result of globalization into the Japanese sporting world and their sub-sequent transformation within local Japanese culture. [ABSTRACT FROM AUTHOR]

Objective: Sinus rhythm gained after the Cox/maze procedure concomitant with mitral valve operation has demonstrated long-term attrition during the follow-up, no information exists on whether the type of mitral valve operation—(repair vs. replacement)—affects this sinus rhythm maintenance rate. We retrospectively studied patients undergoing concomitant mitral valve operation and Cox/maze procedure to answer this question. Methods: Between April 1993 and August 1995, 87 consecutive patients—35 men and 52 women (mean age: 59.3 years)—with chronic atrial fibrillation and mitral valve disease underwent the modified Cox/maze procedure and concomitant mitral valve operation, with 56 having mitral valve repair (repair group) and 31 mitral valve replacement (replacement group). Patients were followed up and changes in rhythm studied retrospectively. Results: Follow-up for a mean 51.3±11.6 months was completed in 82 of 83 long-term survivors (99%). Repair group surgery survival was 98.1±1.9% at 1 year and 94.2±3.2% at 5 based on the Kaplan-Meier method. Replacement group surgery survival was 85.7±5.9% at 1 year and 82.9 ±6.4% at 5. Probability in sinus rhythm maintenance for the repair group at 1 year was 88.6±5.4% and at 5 years was 67.6±9.1%. Probability in sinus rhythm maintenance for the replacement group at 1 year was 95.7±4.3% and at 5 years was 65.0±11.1%. Conclusions: Medium-term results after the Cox/maze III procedure concomitant with mitral valve operation are good. The attrition of sinus rhythm maintenance appears similar by the completion of 5-year follw-up. [ABSTRACT FROM AUTHOR]

AbstractObjectives: To provide Canadian primary care physicians with an evidence-based clinical management tool, including diagnostic and treatment recommendations, for patients who present with uninvestigated dyspepsia.Recommendations: The management tool has 5 key decision steps addressing the following: (1) evidence that symptoms originate in the upper gastrointestinal tract, (2) presence of alarm features, (3) use of nonsteroidal anti-inflammatory drugs (NSAIDs), (4) dominant reflux symptoms and (5) evidence of Helicobacter pylori infection. All patients over 50 years of age who present with new-onset dyspepsia and patients who present with alarm features should receive prompt investigation, preferably by endoscopy. The management options for patients with uninvestigated dyspepsia who use NSAIDs regularly are: (1) to stop NSAID therapy and assess symptomatic response, (2) to treat with NSAID prophylaxis if NSAID therapy cannot be stopped or (3) to refer for investigation. Gastroesophageal reflux disease can be diagnosed clinically if the patient's dominant symptoms are heartburn or acid regurgitation, or both; these patients should be treated with acid suppressive therapy. The remaining patients should be tested for H. pylori infection, and those with a positive result should be treated with H. pylori-eradication therapy. Those with a negative result should have their symptoms treated with optimal antisecretory therapy or a prokinetic agent.Validation and evidence: Evidence for resolution of the dyspepsia symptoms was the main outcome measure. Supporting evidence for the 5 steps in the management tool and the recommendations for treatment were graded according to the strength of the evidence and were endorsed by consensus of committee members. If no randomized controlled clinical trials were available, the recommendations were based on the best available evidence.Literature review: Evidence was obtained from MEDLINE searches for pertinent articles published ... [ABSTRACT FROM AUTHOR]

Objectives: To provide Canadian primary care physicians with an evidence-based clinical management tool, including diagnostic and treatment recommendations, for patients who present with uninvestigated dyspepsia. Recommendations: The management tool has 5 key decision steps addressing the following: (1) evidence that symptoms originate in the upper gastrointestinal tract, (2) presence of alarm features, (3) use of nonsteroidal anti-inflammatory drugs (NSAIDs), (4) dominant reflux symptoms and (5) evidence of Helicobacter pylori infection. All patients over 50 years of age who present with new-onset dyspepsia and patients who present with alarm features should receive prompt investigation, preferably by endoscopy. The management options for patients with uninvestigated dyspepsia who use NSAIDs regularly are: (1) to stop NSAID therapy and assess symptomatic response, (2) to treat with NSAID prophylaxis if NSAID therapy cannot be stopped or (3) to refer for investigation. Gastroesophageal reflux disease can be diagnosed clinically if the patient's dominant symptoms are heartburn or acid regurgitation, or both; these patients should be treated with acid suppressive therapy. The remaining patients should be tested for H. pylori infection, and those with a positive result should be treated with H. pylori-eradication therapy. Those with a negative result should have their symptoms treated with optimal antisecretory therapy or a prokinetic agent. Validation and evidence: Evidence for resolution of the dyspepsia symptoms was the main outcome measure. Supporting evidence for the 5 steps in the management tool and the recommendations for treatment were graded according to the strength of the evidence and were endorsed by consensus of committee members. If no randomized controlled clinical trials were available, the recommendations were based on the best available evidence. Literature review: Evidence was obtained from MEDLINE searches for pertinent articles published from 1966 to October 1999. The searches focused on dyspepsia, diagnosis and treatment. Additional articles were retrieved through a manual search of bibliographies and abstracts from international gastroenterology conferences. Sponsors: Supported by unrestricted educational grants from AstraZeneca Canada Inc., Isotechnika Inc. and Integrated Healthcare Communications Inc. [ABSTRACT FROM AUTHOR]

Background: The pathogenesis of the occurrence of late potentials (LP) has not been fully elucidated. Deletion polymorphism in the Angiotensin I-converting enzyme (ACE) gene may relate the myocarclial remodeling after the myocardial infarction (Ml). The purpose of this study was to evaluate the significance of ACE gene polymorphism for the occurrence of LPs after Ml. Methods: A 287 base pair (bp) insertion/deletion polymorphism in intron 16 of the ACE gene was determined by polymerase chain reaction and LPs were also examined by signal-averaged EGC in 136 patients with Ml. Polymorphism of the ACE gene was characterized by three genotypes: II, ID, and DD. Signal-averaged ECG were recorded using X, Y, Z leads and LP were defined by time-domain analysis as low amplitude potentials exceeding 20 ms after the QRS-end and filtered QRS >115 ms. Results: Positive LPs were noted in 40 of 136 patients with Ml. No differences could be detected between patients with LP-positive and LP-negative for the location of Ml, the success rate of reperfusion therapy, and left ventricular end-diastolic volume (126 ± 40 vs 113 ± 43 mL/m2). In patients with LP-positive compared with those in LP-negative, filtered QRS was significantly higher (135 ± 8 vs 107 ± 8 ms), left ventricular ejection fraction was lower (47 ± 12 vs 54%± 11 %), and peak was higher (3602 ± 2928 vs 2614 ± 2360 IU/L). The frequency of ACE/DD genotype was associated with patients with LP-positive (18 of DD, 18 of ID, and 4 of II for patients with LP-positive, while 25 of DD, 42 of ID, and 29 of II for patients with LP-negative). In the study population, the ACE / DD genotype was associated with patients with LP-positive when compared with the ACE ID & II genotype (x2= 4.7, P = 0.03). Conclusion: ACE/DD genotype of the ACE gene may be associated with the occurrence of LP after Ml. [ABSTRACT FROM AUTHOR]

While many definitions exist, dyspepsia is best considered a symptom complex (not a diagnosis) thought to arise in the upper gastrointestinal tract, unrelated to defecation. The symptom complex includes: upper abdominal/ epigastric pain or discomfort, postprandial fullness, bloating, belching, early satiety, anorexia, nausea, retching, vomiting, heartburn and regurgitation. Patients with typical gastroesophageal reflux, biliary colic and irritable bowel syndrome should not be considered to have dyspepsia. After investigations, if a cause of dyspepsia is found, this is `organic or structural' dyspepsia. If no structural cause is found, this is best called 'functional dyspepsia', subclassified into a) ulcer-like b) dysmotility-like c) reflux-like and d) unspecified dyspepsia. This symptom guided classification should be shifted to the first presentation with uninvestigated dyspepsia, prior to any investigations, to define a clinically useful guide to patient care. As there is considerable symptom overlap, it may be useful to combine together the ulcer and reflux-like groups into an acid-related dyspepsia group. In 1998, another approach would be to screen dyspeptic patients with an H. pylori test and classify them as H. pylori positive and negative dyspepsia. [ABSTRACT FROM AUTHOR]

Objective. To develop a disease-specific QOL instrument (QOLRAD) addressing patient concerns in gastroesophageal reflux disease (GERD) and dyspepsia. Patients. 759 male (45%) and female (55%) patients with a mean age of 48.4 years (sd 15.2) were used in the psychometric evaluation. Main outcome measures. A pilot version of QOLRAD, the Gastrointestinal Symptoms Rating Scale (GSRS) and the SF-36 were completed prior to endoscopy. Items with a high ceiling effect, items measuring a different construct, i.e. with a low squared multiple correlation (R < 0.5) with the other items, items that showed redundancy by a high correlation (>0.80) with another item were removed. A confirmatory factor analysis was also performed. Results. The final questionnaire included 25 items depicting problems with emotions, vitality, sleep, eating/drinking, and physical/social functioning. The internal consistency reliability was high (alpha value overall 0.97, dimensions 0.89-94). Construct validity, i.e. the associations between similar constructs in the QOLRAD, the SF-36 and the GSRS scores was confirmed. Pain and symptom severity were markers of impaired QOL. The impact on health-related QOL was similar across the functional gastrointestinal disorders with the exception of patients with a normal endoscopy, who did slightly worse. Conclusion. The QOLRAD is a short and user-friendly instrument with excellent psychometric properties. Its responsiveness to change in (AVMC1)clinical trials is currently being explored. [ABSTRACT FROM AUTHOR]

Objectives: To treat previously untreated adult patients infected with Helicobacter pylori with one of two regimens in an ambulatory community setting to assess the efficacy and safety of these regimens. Methods: Sixty five adult patients with histologically confirmed H. pylori infection were randomly assigned in this open cohort study to 2 wk, low dose, twice daily treatment with omeprazole 20 mg and clarithromycin 250 mg (OC) (n = 31) or OC plus metronidazole 500 mg (OCM) (n = 34). At least 4 wk after treatment, H. pylori status was assessed by histology (four gastric biopsies, two each from antrum and body). Results: Triple therapy with OCM was significantly better than dual therapy with OC in intent-to-treat (82.4 vs 58.1%,p = 0.03) and per protocol analysis (93.3 vs 62.1%, p = 0.004). Although there were frequent side effects (OC 19/31 61.3%; OCM 22/34 64.7% with at least one side effect), these were generally mild, and patients were able to complete nearly all of their medications (OC 97.2%, OCM 96.7% of pills taken). The only patient withdrawn due to medication side effects was in the OC arm. Conclusions: Triple therapy with OCM in a community setting eradicates H. pylori more effectively than dual therapy with OC. OCM is tolerated with high compliance despite frequent minor side effects and appears safe without the development of serious adverse events. [ABSTRACT FROM AUTHOR]

Despite numerous Helicobacter pylori treatment studies, the optimum regimen(s) for its eradication remain unclear. Our objective was to determine systematically which regimen(s) gave the best pooled eradication rates, by using meta-analysis methodology. A total of 27 studies were identified. Pooled eradication rates for single (18.6%), double (48.2%), and triple therapy (82.3%) were statistically highly different (p < 0.0005). Eradication rates with amoxicillin (23.0%) and bismuth compounds (19.6%) were equivalent. Combined treatment with bismuth + metronidazole was better than bismuth + amoxicillin (55.1% vs. 43.7%, p = 0.049). Triple therapy with bismuth + metronidazole + tetracycline gave a statistically higher eradication rate (94.1%) than bismuth + metronidazole + amoxicillin (73.1%, p < 0.0005). Despite increased side effects with multiple antibiotic regimens, patients tolerated these well, without significant drop-out. The combination of bismuth, metronidazole, and tetracycline gives the best eradication rate, but the optimal doses and duration of treatment have yet to be determined. Further studies are necessary to explore factors such as antibiotic resistance and drug compliance as important factors affecting antibiotic efficacy. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Development of guidelines for recently arrived immigrants and refugees to Canada: Delphi consensus on selecting preventable and treatable conditions," by H. Swinkels and colleagues in the 2011 issue.

The author reflects on the management of uninvestigated dyspepsia in primary care with a test and treat method for helicobacter pylori. He suggests that research has indicated that testing and treating and the use of proton pump based on the predominant symptoms which are seen. He argues that in uninvestigated patients without alarming symptoms the initial choice of treatment depends on considerations of each patient.

Both 2-(2'-hydroxyphenyl)-1,3-dimethylbenzimidazoline and 2-(4'-hydroxyphenyl)-1,3-dimethylbenzimidazoline were found to act as formal two hydrogen atom-donors for photoinduced electron transfer reactions of epoxy ketones and other carbonyl compounds. [ABSTRACT FROM AUTHOR]

The article shares the author's remarks concerning the efficacy of first-line therapies for Helicobacter pylori (H pylori). He mentions the meta-analysis of the study by L. Fischbach which affirms the deleterious effect of clarithromycin (CTM) resistance on CTM-containing triple therapies and helps explain their declining efficacy. He added that metronidazole (MTN) resistance seems to be less important than CTM resistance because it can be overcome to some extent.

The author comments on the study which examines the effect of antibiotic resistance status on the efficacy of triple and quadruple therapies for Helicobacter pylori. According to the author, metronidazole (MTN) resistance seems to be less important than clarithromycin (CTM) resistance because it can be overcome to some extent. With the amoxicillin-nitroimidazole-bismuth triple therapy, a larger daily close of nitroimidazole can eradicate resistant strains.

This article focuses on a clinical study according to which Helicobacter pylori remains an important cause of ulcer disease, mucosa-associated lymphoid tissue lymphoma, and gastric adenocarcinoma. In the study, an impressive eradication rate of 94% was seen with the 10-day sequential therapy regimen compared with 80% with the gold-standard triple therapy regimen. Excellent compliance and minimal side effects were also observed. The study appropriately documented Helicobacter pylori status both before and after eradication treatment. The study included older patients in 3 Italian centers.

The article reports that esomeprazole was not better than omeprazole for resolving heartburn in endoscopy-negative reflux disease. If heartburn is predominant, these patients are considered to have gastroesophageal reflux disease (GERD). After endoscopy, these patients can be divided into those with erosive disease and those without. Patients in these studies may have a milder form of GERD or they may have had functional dyspepsia, in which rates of symptom relief with PPIs are known to be lower.

An abstract of the article "The cost-effectiveness of alternative strategies to manage patients with uninvestigated dyspepsia: Comparing the CanDys approach to antisecretory therapy and prompt endoscopy," by Alan N. Barkun and colleagues is presented.