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The spatial distributions of single‐frequency and dual‐frequency Electromagnetic ion cyclotron (EMIC) waves in the subauroral ionosphere are investigated under varying geomagnetic activities, using high‐resolution magnetic field data from dual Swarm satellites spanning from 2015 to 2017. Single‐frequency EMIC waves predominantly occur in the dawn sector, whereas dual‐frequency waves exhibit peaks around both dawn and dusk. The occurrence rate of dual‐frequency waves shows a more pronounced increase with increasing geomagnetic activity. As magnetic storms evolve, both types of EMIC waves shift from dusk to dawn. The South Atlantic Anomaly (SAA) emerges as a high‐incidence region for ionospheric EMIC waves. Dual‐frequency EMIC waves display lower frequencies compared to other regions. Additionally, the low‐frequency components of dual‐frequency waves observed at higher latitudes demonstrate greater power density and longer durations than their high‐frequency counterparts. This suggests that higher frequency waves experience more significant damping during propagation. Most dual‐frequency EMIC waves observed in the ionosphere belong to the O‐band and He‐band waves, indicating that magnetospheric bands below the cyclotron frequency of H+ are more likely to propagate into the ionosphere. Key Points: Single‐frequency ionospheric electromagnetic ion cyclotron (EMIC) waves mainly occur in the dawn sector while dual‐frequency EMIC waves peak around dawn and duskThe occurrence rate of dual‐frequency waves increases more significantly with enhanced geomagnetic activity than single‐frequency wavesLow‐frequency components of dual‐frequency waves observed at higher latitudes exhibit greater power density and extended duration [ABSTRACT FROM AUTHOR]

In the neighbour joining phylogenetic trees of amplified sequences, both FS-1 and FS-2 clustered with I F. solani i species complex strains, clearly separating them from other I Fusarium i spp. (Fig. Keywords: Prunus avium; Rosaceae EN Prunus avium Rosaceae 1 4 4 09/30/22 20220701 NES 220701 Sweet cherry ( I Prunus avium i ) is an important fruit crop in China with a cultivation area of more than 13,000 km SP 2 sp (Sun I et al. i , 2017). [Extracted from the article]

Objective: To examine the longitudinal associations of fetal growth with adverse child growth outcomes and to assess whether maternal metabolic factors modify the associations. Design: Prospective cohort study. Setting: Born in Guangzhou Cohort Study, China. Population: A total of 4818 mother–child pairs. Methods: Fetal growth was assessed according to estimated fetal weight (EFW) from 22 weeks of gestation until birth and the measurement of the birthweight. Fetal growth Z‐scores were computed from random effects in the multilevel linear spline models to represent fetal size in early pregnancy (22 weeks of gestation) and growth in mid‐pregnancy (22–27 weeks of gestation), early third trimester (28–36 weeks of gestation) and late third trimester (≥37 weeks of gestation). Main outcome measures: Z‐scores for childhood stunting, low weight, overweight or obesity, length/height for age (LAZ/HAZ), weight for age (WAZ) and body mass index for age (BMIZ) at the age of 3 years. Adjusted associations were examined using multiple Poisson or linear regression models. Results: Increased Z‐scores of fetal size in early pregnancy and growth in mid‐pregnancy and early third trimester were associated with a higher risk of childhood overweight or obesity (risk ratios 1.25–1.45). Fetal growth in each period was negatively associated with stunting and low weight, with the strongest associations observed for fetal size in early pregnancy and growth in mid‐pregnancy. The results for continuous outcomes (LAZ/HAZ, WAZ and BMIZ) were similar. The associations of fetal growth with overweight or obesity in childhood were stronger among mothers who were underweight and who were overweight or obese than among mothers of normal weight. Conclusions: Accelerated fetal growth before 37 weeks of gestation is associated with children who are overweight or obese, whereas the critical period for stunting and low weight occurs before 28 weeks of gestation. Fetal growth during different periods is differentially associated with childhood stunting, underweight and overweight or obesity. Fetal growth during different periods is differentially associated with childhood stunting, underweight and overweight or obesity. [ABSTRACT FROM AUTHOR]

Objective: To estimate a stillbirth rate at 24 or more gestational weeks in 2015–2016 and to explore potentially preventable causes in China. Design: A multi‐centre cross‐sectional study. Setting: Ninety‐six hospitals distributed in 24 (of 34) provinces in China. Population: A total of 75 132 births at 24 completed weeks of gestation or more. Methods: COX Proportional Hazard Models were performed to examine risk factors for antepartum and intrapartum stillbirths. Population attributable risk percentage was calculated for major risk factors. Correspondence analysis was used to explore region‐specific risk factors for stillbirths. Main outcome measures: Stillbirth rate and risk factors for stillbirth. Results: A total of 75 132 births including 949 stillbirths were used for the final analysis, giving a weighted stillbirth rate of 13.2 per 1000 births (95% CI 7.9–18.5). Small for gestational age (SGA) and pre‐eclampsia/eclampsia increased antepartum stillbirths by 26.2% and 11.7%, respectively. Fetal anomalies increased antepartum and intrapartum stillbirths by 17.9% and 7.4%, respectively. Overall, 31.4% of all stillbirths were potentially preventable. Advanced maternal age, pre‐pregnant obesity, chronic hypertension and diabetes mellitus were important risk factors in East China; low education and SGA were major risk factors in Northwest, Southwest, Northeast and South China; and pre‐eclampsia/eclampsia and intrapartum complications were significant risk factors in Central China. Conclusions: The prevalence of stillbirth was 13.2 per 1000 births in China in 2015–2016. Nearly one‐third of all stillbirths may be preventable. Strategies based on regional characteristics should be considered to reduce further the burden of stillbirths in China. The stillbirth rate was 13.2 per 1000 births in China in 2015–2016 and nearly one‐third of all stillbirths may be preventable. The stillbirth rate was 13.2 per 1000 births in China in 2015–2016 and nearly one‐third of all stillbirths may be preventable. [ABSTRACT FROM AUTHOR]

Vacuolar protein sorting 4 (Vps4) not only functions with its positive regulator vacuolar protein sorting 20‐associated 1 (Vta1) in the multivesicular body (MVB) pathway but also participates alone in MVB‐unrelated cellular processes. However, its physiological roles at the organism level remain rarely explored. We previously identified their respective homologues Bombyx mori Vps4 (BmVps4) and BmVta1 from the silkworm, a model organism for insect research. In this study, we performed fluorescence quantitative real‐time PCR and Western blot to globally characterize the transcription and protein expression profiles of BmVps4 and BmVta1 during silkworm development and in different silkworm tissues and organs. The results showed that they were significantly up‐regulated in metamorphosis, adulthood and embryogenesis relative to larval stages, and displayed a roughly similar tissue‐and‐organ specificity for transcriptions in silkworm larvae. Importantly, BmVps4 was down‐regulated during the early period of the fifth instar, reaching the lowest level of transcription on Day 6, then up‐regulated from Day 7 to the wandering, spinning and pupal stages, and down‐regulated again in adulthood. Moreover, knocking down BmVps4 by RNA interference significantly inhibited silk gland growth, shortened spinning time, prolonged pupation, reduced pupal size and weight, and increased moth wing defects. Together, our data demonstrate the critical and broad requirements for BmVps4 in silkworm metamorphosis. [ABSTRACT FROM AUTHOR]

Thellungiella salsuginea is highly tolerant to abiotic stress, while its a close relative Arabidopsis thaliana is sensitive to stress. This characteristic makes T. salsuginea an excellent model for uncovering the mechanisms of abiotic stress tolerance. Abscisic acid (ABA) plays essential roles in plant abiotic and biotic stress tolerance.To test the changes in gene expression of T. salsuginea under ABA treatment, in this study, the transcriptomes of T. salsuginea roots and leaves were compared in response to exogenously application of ABA.The results showed that ABA treatment caused different expression of 2,200 and 3,305 genes in leaves and roots, respectively, compared with the untreated control. In particular, genes encoding transcription factors such as WRKY, MYB, NAC, GATA, ethylene‐responsive factors (ERFs), heat stress transcription factors, basic helix‐loop‐helix, PLATZ and B3 domain‐containing family members were enriched. In addition, 49 and 114 differentially expressed genes were identified as ABA‐regulated genes, separately in leaves and roots, respectively, which were related to biotic and abiotic stresses. The expression levels of some genes were validated by qRT‐PCR. Different responses of genes to ABA treatment were discovered in T. salsuginea and A. thaliana.This transcriptome analysis expands our understanding of the role of ABA in stress tolerance in T. salsuginea. Our study provides a wealth of information for improving stress tolerance in crop plants. [ABSTRACT FROM AUTHOR]

A series of chemically treated graphene oxide (GO) samples, destined for the preparation of several composite materials, was studied by X‐ray photoelectron spectroscopy (XPS). From their comparison, the 3‐mercaptopropyl trimethoxysilane was identified as the most effective reducing agent among the used procedures. The influence of ultrahigh vacuum annealing up to 600°C on the chemical composition and carbon electronic configuration in reduced GO samples was further investigated by XPS and Auger electron spectroscopy. All the samples before and after thermal treatments were analyzed in situ by XPS and Auger electron spectroscopy, paying a particular attention to the shape of C KVV spectra described by the values of D parameter. The changes of chemical composition and carbon configuration reflected in the D parameter revealed the full reduction of GO to graphene after annealing in ultrahigh vacuum at 600°C. The successful reduction of GO to graphene was also confirmed by Raman spectroscopy. Obtained bulk samples of graphene aggregates remained stable in air, testifying the irreversibility of this reduction. [ABSTRACT FROM AUTHOR]

Background: The present study aimed to report our clinical experience with intraluminal calculated distance for endobronchial blocker placement (ICEB) and to find out whether ICEB could reduce the number of hypoxemia episodes during blocker placement compared with extraluminal blocker placement for one-lung ventilation in children under the age of 2 years.Methods: The medical records of all children under the age of 2 years with a 5 French (F) or 4F WeiLi (WeiLi medical Inc, Guangzhou, China) endobronchial blocker for one-lung ventilation in thoracic surgery from July 2015 through July 2016 were retrospectively reviewed. After November 2015, one-lung ventilation was achieved using the ICEB technique, while before November 2015, extraluminal blocker placement was used. The success rate of blocker placement, quality of lung deflation, number of hypoxemia episodes, blocker dislodgement, and successful reposition after dislodgement were compared between the two groups.Result: The incidence of hypoxemia episodes during blocker placement was lower in the ICEB group compared to the extraluminal placement group. Moreover, the success rate of blocker reposition during the operation was higher in the ICEB group than the extraluminal placement group. The success rate of endobronchial blocker placement was similar between the two groups.Conclusions: Intraluminal calculated distance for endobronchial blocker placement is a feasible method to achieve lung isolation and could reduce hypoxemia episodes during blocker placement in children under the age of 2 years. [ABSTRACT FROM AUTHOR]

Background and Objectives: Infusion of by‐products of red blood cell (RBC) storage‐induced degradation as well as of the residual plasma proteins and the anticoagulant‐preservative solution contained in units of stored blood serve no therapeutic purpose and may be harmful to some patients. Here, we describe a prototype of a gravity‐driven system for bedside washing of stored RBCs. Materials and Methods: Stored RBCs were diluted to 10% haematocrit (Hct) with normal saline, matching the conventional washing procedure. The dilute RBC suspensions were passed through a column of coiled tubing to allow RBC sedimentation in normal gravity, thus separating them from the washing solution. Washed RBCs were collected using bifurcations located along the tubing. Washing efficiency was quantified by measuring Hct, morphology, deformability, free haemoglobin and total‐free protein. Results: The gravity‐driven washing system operating at 0·5 ml/min produced washed RBCs with final Hct of 36·7 ± 3·4% (32·3–41·2%, n = 10) and waste Hct of 3·4 ± 0·7% (2·4–4·3%, n = 10), while removing 80% of free haemoglobin and 90% of total‐free protein. Washing improved the ability of stored RBCs to perfuse an artificial microvascular network by 20%. The efficiency of washing performed using the gravity‐driven system was not significantly different than that of conventional centrifugation. Conclusions: This proof‐of‐concept study demonstrates the feasibility of washing stored RBCs using a simple, disposable system with efficiency comparable to that of conventional centrifugation, and thus represents a significant first step towards enabling low‐cost washing of stored blood at bedside. [ABSTRACT FROM AUTHOR]

Children represent a large underserved population of 'therapeutic orphans,' as an estimated 80% of children are treated off-label. However, pediatric drug development often faces substantial challenges, including economic, logistical, technical, and ethical barriers, among others. Among many efforts trying to remove these barriers, increased recent attention has been paid to extrapolation; that is, the leveraging of available data from adults or older age groups to draw conclusions for the pediatric population. The Bayesian statistical paradigm is natural in this setting, as it permits the combining (or 'borrowing') of information across disparate sources, such as the adult and pediatric data. In this paper, authored by the pediatric subteam of the Drug Information Association Bayesian Scientific Working Group and Adaptive Design Working Group, we develop, illustrate, and provide suggestions on Bayesian statistical methods that could be used to design improved pediatric development programs that use all available information in the most efficient manner. A variety of relevant Bayesian approaches are described, several of which are illustrated through 2 case studies: extrapolating adult efficacy data to expand the labeling for Remicade to include pediatric ulcerative colitis and extrapolating adult exposure-response information for antiepileptic drugs to pediatrics. [ABSTRACT FROM AUTHOR]

The combination of aztreonam-avibactam is active against multidrug-resistant Enterobacteriaceae that express metallo-β-lactamases. A complex synergistic interaction exists between aztreonam and avibactam bactericidal activities that have not been quantitatively explored. A two-state semimechanistic pharmacokinetic/pharmacodynamic (PK/PD) logistic growth model was developed to account for antimicrobial activities in the combination of bacteria-mediated degradation of aztreonam and the inhibition of aztreonam degradation by avibactam. The model predicted that changing regimens of 2 g aztreonam plus 0.375 and 0.6 g avibactam as a 1-hour infusion were qualitatively similar to that observed from in vivo murine thigh infection and hollow-fiber infection models previously reported in the literature with 24-hour log kill ≥1. The current approach to characterize the effect of avibactam in enhancing aztreonam activity from time-kill study was accomplished by shifting the half-maximal effective concentration (EC50) of aztreonam in increasing avibactam concentration using a nonlinear equation as a function of avibactam concentration, providing a framework for translational predictions. [ABSTRACT FROM AUTHOR]

Background Interleukin ( IL)-10 is a pleiotropic cytokine with anti-inflammatory and immunosuppressive properties in liver failure. Biomarkers are urgently needed to predict prognosis of acute-on-chronic hepatitis B liver failure ( ACHBLF). Aim To investigate the potential diagnostic value of plasma IL-10 as a biomarker for predicting the mortality of ACHBLF. Methods This prospective study consisted of 115 newly diagnosed ACHBLF patients from May 2009 to October 2013 as a training cohort and 54 ACHBLF patients from November 2013 to March 2015 as a validating cohort. Plasma IL-10 level was measured using enzyme-linked immunosorbent assay. Results In the training cohort, the plasma IL-10 level of nonsurvivals [median (centile25; centile75): 12.38 (8.76; 15.52) pg/mL] was significantly higher than that in survivals [6.55 (5.43; 7.65) pg/mL, P < 0.001]. Plasma IL-10 (hazard ratio = 1.205, 95% confidence interval: 1.145-1.267, P < 0.001) was identified as an independent risk factor for mortality of ACHBLF patients. Furthermore, plasma IL-10 showed higher area under the curve of receiver operating characteristic ( AUROC) than model for end-stage liver diseases ( MELD) for predicting 1-month (0.887 vs. 0.779, P < 0.05), 2-month (0.878 vs. 0.779, P < 0.05) and 3-month (0.917 vs. 0.776, P < 0.001) mortality. However, we did not find significant differences in AUROC between IL-10 and IL-10 plus MELD for 1-, 2- and 3-month mortality. ACHBLF patients with plasma IL-10 > 9.6 pg/mL showed poor survival time than patients with plasma IL-10 ≤ 9.6 pg/mL at the end of 1 month in the training and validation cohorts. Conclusions Plasma IL-10 performed better than MELD in predicting the prognosis of acute-on-chronic hepatitis B liver failure. Furthermore, plasma IL-10 > 9.6 pg/mL predicts a poor 1-month mortality. [ABSTRACT FROM AUTHOR]

Recently, the Center for Drug Evaluation and Research at the Food and Drug Administration released a guidance that makes recommendations about how to demonstrate that a new antidiabetic therapy to treat type 2 diabetes is not associated with an unacceptable increase in cardiovascular risk. One of the recommendations from the guidance is that phases II and III trials should be appropriately designed and conducted so that a meta-analysis can be performed. In addition, the guidance implies that a sequential meta-analysis strategy could be adopted. That is, the initial meta-analysis could aim at demonstrating the upper bound of a 95% confidence interval (CI) for the estimated hazard ratio to be < 1.8 for the purpose of enabling a new drug application or a biologics license application. Subsequently after the marketing authorization, a final meta-analysis would need to show the upper bound to be < 1.3. In this context, we develop a new Bayesian sequential meta-analysis approach using survival regression models to assess whether the size of a clinical development program is adequate to evaluate a particular safety endpoint. We propose a Bayesian sample size determination methodology for sequential meta-analysis clinical trial design with a focus on controlling the familywise type I error rate and power. We use the partial borrowing power prior to incorporate the historical survival meta-data into the Bayesian design. We examine various properties of the proposed methodology, and simulation-based computational algorithms are developed to generate predictive data at various interim analyses, sample from the posterior distributions, and compute various quantities such as the power and the type I error in the Bayesian sequential meta-analysis trial design. We apply the proposed methodology to the design of a hypothetical antidiabetic drug development program for evaluating cardiovascular risk. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Safety assessment is essential throughout medical product development. There has been increased awareness of the importance of safety trials recently, in part due to recent US Food and Drug Administration guidance related to thorough assessment of cardiovascular risk in the treatment of type 2 diabetes. Bayesian methods provide great promise for improving the conduct of safety trials. In this paper, the safety subteam of the Drug Information Association Bayesian Scientific Working Group evaluates challenges associated with current methods for designing and analyzing safety trials and provides an overview of several suggested Bayesian opportunities that may increase efficiency of safety trials along with relevant case examples. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The Drug Information Association Bayesian Scientific Working Group (BSWG) was formed in 2011 with a vision to ensure that Bayesian methods are well understood and broadly utilized for design and analysis and throughout the medical product development process, and to improve industrial, regulatory, and economic decision making. The group, composed of individuals from academia, industry, and regulatory, has as its mission to facilitate the appropriate use and contribute to the progress of Bayesian methodology. In this paper, the safety sub-team of the BSWG explores the use of Bayesian methods when applied to drug safety meta-analysis and network meta-analysis. Guidance is presented on the conduct and reporting of such analyses. We also discuss different structural model assumptions and provide discussion on prior specification. The work is illustrated through a case study involving a network meta-analysis related to the cardiovascular safety of non-steroidal anti-inflammatory drugs. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Allograft inflammatory factor-1 (AIF-1) was originally cloned from a rat heart allograft under chronic rejection. Data from many studies suggested an important role of AIF-1 in several inflammatory processes. The aim of this study was to examine the dynamic expression of AIF-1 and its association with the pathogenesis of hepatic schistosomiasis in BALB/c mice infected with S. japonicum. The expression of AIF-1 and tumour necrosis factor-alpha (TNF-α) was determined by enzyme-linked immunosorbent assay, western blot and immunohistochemistry. AIF-1 and TNF-α were overexpressed in hepatic tissues at the early stage of infection, and then diminished with the length of infection. On culturing splenocytes stimulated by soluble egg antigen for 72 h, the expression of AIF-1 in infected mice was suppressed, but TNF-α increased gradually. Our results showed that AIF-1 was overexpressed in the liver of BALB/c mice infected with S. japonicum, and the interaction between AIF-1 and TNF-α or other cytokines played an important role in the pathogenesis and progression of hepatic schistosomiasis. [ABSTRACT FROM AUTHOR]

The probability that an earthquake occurs when a train is running over a bridge in earthquake-prone regions is much higher than before, for high-speed railway lines are rapidly developed to connect major cities worldwide. This paper presents a finite element method-based framework for dynamic analysis of coupled bridge-train systems under non-uniform seismic ground motion, in which rail-wheel interactions and possible separations between wheels and rails are taken into consideration. The governing equations of motion of the coupled bridge-train system are established in an absolute coordinate system. Without considering the decomposition of seismic responses into pseudo-static and inertia-dynamic components, the equations of motion of the coupled system are formed in terms of displacement seismic ground motions. The mode superposition method is applied to the bridge structure to make the problem manageable while the Newmark-β method with an iterative computation scheme is used to find the best solution for the problem concerned. Eight high-speed trains running over a multi-span steel truss-arch bridge subject to earthquakes are taken as a case study. The results from the case study demonstrate that the spatial variation of seismic ground motion affects dynamic responses of the bridge-train system. The ignorance of pseudo-static component when using acceleration seismic ground motions as input may underestimate seismic responses of the bridge-train system. The probability of separation between wheels and rails becomes higher with increasing train speed. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to test community-based nursing education about breast self-examination to see whether self-examination frequency could be increased. Background: Breast cancer rates in China are rising rapidly, especially in cities. The majority of Chinese women does not know about breast self-examination, and the Chinese health care system cannot provide mammograms for the millions of at-risk women throughout China. Method: This study was a randomized clinical trial of nurse-provided, community-based teaching of breast self-examination in the urban and rural areas of Tianjin and urban and suburban areas of Shanghai. Women ( n = 1510) never diagnosed with breast cancer and 40 years and older were randomized by community and stratified by urban vs. other residences. Results: At baseline, 9% of the intervention and 6% of the control groups did breast self-examination at least every other month. After 12 months, 34% of the intervention, but only 11% of the control, group did breast self-examination that often ( P < 0.001). There was a significant impact in urban, suburban and rural areas, and intervention effects were stronger than any of the other influences tested. Conclusion: The clinical trial showed a statistically significant increase in breast self-examination after the nursing education intervention. As no other breast cancer screening method is available in most of China, this method is best suited for the masses of people currently at risk in China. [ABSTRACT FROM AUTHOR]

Oral Diseases (2010) 16, 198–203 Purpose: As a review and clinical analysis of primary oral leiomyosarcoma (LMS) cases in West China stomatology Hospital in the past 37 years, this study provides demographic, therapeutic and prognostic information of this rare tumor. Patients and methods: In our study, 20 cases of primary oral LMS treated between 1972 and 2008 in West China Stomatology Hospital were analyzed retrospectively. A thorough review of clinical records was carried out and potential indicators of survival were analyzed. Results: The most common symptom of oral LMS presented as a painless mass. The median age of patients was 37 years, and the peak incidence age of this tumor was in the 2nd and 5th decades. There was no predilection of gender, and the male-to-female ratio was 11:9. The most frequently occurring site of oral leiomysarcoma was the jawbones. The prognosis of this tumor was poor as a result of the high local recurrence and the estimated 2 year survival was 17.6%. The bony involvement and method of therapy was observed to have an influence on the prognosis and survival of this tumor ( P < 0.05). Conclusion: There was a predilection site of jawbones for oral LMS, and bony involvement was a potential indicator suggesting a poorer prognosis. The recommended method of therapy on this tumor was aggressive, radical surgical resection; however, adjuvant radiotherapy and chemotherapy may also have a beneficial effect. [ABSTRACT FROM AUTHOR]

Interferon (IFN) has been used in the treatment of chronic hepatitis B for decades. Beneficial effects including hepatitis B e antigen/HBV DNA seroclearance have been documented. However, the effect of treatment on the prevention of cirrhosis and hepatocellular carcinoma (HCC) development remains controversial. We conducted a meta-analysis of available literature to evaluate whether IFN reduces the incidence of liver cirrhosis and HCC in patients with chronic hepatitis B. Twelve clinical controlled trials, including 2082 patients and comparing IFN with no treatment, were selected. Data on the incidence of liver cirrhosis and HCC in IFN treated and untreated patients were extracted from each study. The evaluation of preventive effectiveness was performed with an intention-to-treat method. The relative risk (RR) and 95% confidence interval (CI) of the main outcomes as a measure of efficacy were used. Meta-analysis was performed using fixed-effect or random-effect methods, depending on absence or presence of significant heterogeneity. Analyses were performed withstata version 9.0 and Review Manager Version 4.2. Five studies including the data on development of liver cirrhosis, and eleven studies including the data on development of HCC were analyzed. There was no evidence for publication bias on the funnel plot or by Egger’s test, and the heterogeneity test indicated that the variation of trial-specific RR was not statistically significant. A different incidence of liver cirrhosis and HCC was observed between treated and untreated patients. The RR of liver cirrhosis and HCC was 0.65 (95% CI: 0.47, 0.91) and 0.59 (95% CI: 0.43, 0.81), respectively. In conclusion, the results of this meta-analysis indicate that IFN prevents or delays the development of liver cirrhosis and HCC in patients with chronic hepatitis B. [ABSTRACT FROM AUTHOR]

Background The incidence of ‘true’ re-infection with Helicobacter pylori after successful eradication remains uncertain. Aim To determine the worldwide rates, risk factors and clinical implications of ‘true’ re-infection of Helicobacter pylori. ‘True’ re-infection of H. pylori is defined as the situation where tests for H. pylori infection, which were negative for 12 months after eradication, become positive again at a later stage. Results Thirty six studies were identified through a literature search to be able to produce annual rates of ‘true’ re-infection, and data from 33 original articles were considered reliable and adequate in the further review. Generally, the reported rates varied from 0% to 23.4% in adults and from 1.9% to 9.6% in children. Most studies from developed countries reported rates of less than 1%, whereas relatively higher rates were reported in most of the developing countries. Small sample sizes included in the studies appeared to be associated with increased re-infection rates. Interfamilial transmission is the major cause of re-infection, although iatrogenic re-infection through contaminated endoscopic equipment has been reported. Conclusion Helicobacter pylori re-infection is not a concern in a clinical setting, especially in the developed world; however, caution must be exercised in most developing countries. [ABSTRACT FROM AUTHOR]

A large Er3+–Yb3+ co-doped yttrium calcium oxoborate [Er3+:Yb3+:Ca4YO(BO3)3, abbreviated as Er:Yb:YCOB] single crystal, with dimensions of 2.5 cm in diameter and 9.0 cm in length, has been grown along the crystallographic b axis by the Czochralski method. X-ray powder diffraction results show that the as-grown Er:Yb:YCOB crystal belongs to the monoclinic system with space group Cm; the unit-cell constants are a = 8.085, b = 16.048, c = 3.528 Å and β = 101.11°. The high crystalline quality of the as-grown single crystal was confirmed by high-resolution X-ray diffraction, which showed the full width at half-maximum of the rocking curves to be less than 20 arcseconds on the (060) and (201) diffraction planes. The measurement and calculation of the symmetrical second-rank tensor for the monoclinic crystal are described in detail in this paper. The principal coefficients of thermal expansion of the as-grown Er:Yb:YCOB crystal are αI = 11.95 × 10−6 K−1, αII = 9.20 × 10−6 K−1 and αIII = 18.93 × 10−6 K−1 over the temperature range 303.15–873.15 K. The specific heat of the crystal is 725.6 J kg−1 K−1 at 328.15 K. The principal thermal conductivity parameters are KI = 2.882 W m−1 K−1, KII = 2.687 W m−1 K−1 and KIII = 2.692 W m−1 K−1 at 328.15 K. [ABSTRACT FROM AUTHOR]

Peptic ulcer disease is mainly caused by Helicobacter pylori infection and the use of non-steroidal anti-inflammatory drugs. To investigate the trends in the prevalence of peptic ulcer disease, H. pylori infection and non-steroidal anti-inflammatory drug use in uninvestigated dyspeptic patients over recent years in Hong Kong. Data from consecutive patients with uninvestigated dyspeptic symptoms referred by family physicians for open access upper endoscopy during 1997 and 2003 were analysed in relation to peptic ulcer disease, H. pylori infection and non-steroidal anti-inflammatory drug use. Among 2700 patients included, 405 (15%) had peptic ulcer disease and 14 (0.5%) had gastric cancer. There was a reduced trend from 1997 to 2003 in the prevalence of peptic ulcer disease (17, 20, 14, 16, 13, 14 and 14%, respectively, χ2 = 5.80, P = 0.016) (mainly because of decrease in duodenal ulcers), H. pylori infection (44, 50, 49, 44, 40, 40, 36 and 43%, respectively, χ2 = 13.55, P < 0.001) and non-steroidal anti-inflammatory drug use (13, 5, 5, 6, 3, 4, 4 and 5% respectively, χ2 = 13.61, P < 0.001). The prevalence of peptic ulcer disease, H. pylori infection and non-steroidal anti-inflammatory drug use between 2001 and 2003 were significantly lower than that between 1997 and 2000 (17% vs. 13%, OR = 0.78, 95% CI: 0.63–0.96, P = 0.020 for peptic ulcer disease; 47% vs. 39%, OR =0.72, 95% CI: 0.60–0.86, P < 0.001 for H. pylori infection; and 6% vs. 4%, OR = 0.56, 95% CI: 0.39–0.82, P = 0.002 for non-steroidal anti-inflammatory drug use). H. pylori infection was associated with both duodenal ulcer (OR = 15.87, 95% CI: 10.60–23.76, P < 0.001) and gastric ulcer (OR = 3.12, 95% CI: 2.15–4.53, P < 0.001) whereas non-steroidal anti-inflammatory drug use was only associated with gastric ulcer (OR = 2.97, 95% CI: 1.70–5.20, P < 0.001). The prevalence of peptic ulcer disease, mainly duodenal ulcers, was reduced in association with a decreasing trend in the prevalence of H. pylori infection and non-steroidal anti-inflammatory drug use from 1997 to 2003. [ABSTRACT FROM AUTHOR]

: Recent studies suggest that theHelicobacter pylorieradication rate in patients with non-ulcer dyspepsia is lower when compared to patients with peptic ulcer diseases.: The aim of this study was to study the efficacy of triple therapy forH. pyloriinfection in patients with duodenal ulcer vs. patients with non-ulcer dyspepsia.: A total of 582 Chinese patients with provenH. pyloriinfection were recruited to receive: omeprazole 20 mg, amoxicillin 1000 mg and clarithromycin 500 mg all given twice daily for 7 days (OCA regime). Endoscopy with rapid urease test, histology and culture were performed before treatment. Post-treatmentH. pyloristatus was determined by13C-urea breath test. Metronidazole, clarithromycin and amoxicillin resistance was defined as minimum inhibitory concentration (MIC) of>8 μg/mL,>1 μg/mL and>1 μg/mL, respectively.: A significantly higher (intention-to-treat/per-protocol) eradication rate was found in patients with duodenal ulcer than those with non-ulcer dyspepsia (91/94% vs. 84/88% respectively,P = 0.011 andP = 0.016). Clarithromycin resistance rate was higher in patients with non-ulcer dyspepsia than those with duodenal ulcer (14% vs. 6%,P = 0.015). Clarithromycin resistance (40% vs. 5%,P < 0.001, OR 12, 95% CI: 5.7–24.3) and the diagnosis of non-ulcer dyspepsia (91% vs. 84%,P = 0.011, OR 2.0, 95% CI: 1.2–3.3) significantly affected the success ofH. pylorieradication.: Clarithromycin resistance accounts for the significantly lower and suboptimalH. pylorieradication rate of OCA regimen in Chinese patients with non-ulcer dyspepsia compared to those with duodenal ulcer. [ABSTRACT FROM AUTHOR]

: The performance of commercialHelicobacter pyloridiagnostic kits developed for particular geographic regions has often been found to be of poor diagnostic value when applied to other regions, possibly because of infections being caused by differentH. pyloristrains in different regions.: To evaluate the performance of an IgG2 anti-H. pylorienzyme-linked immunoassay test (Helirad Alert) for detection ofH. pyloriinfection in both Australian and Hong Kong (Chinese) subjects.: Serum samples were tested forH. pylorispecific IgG2 and IgG antibodies by enzyme-linked immunoassay kits using identical antigen preparation in 168 Australian and 160 Hong Kong (Chinese) subjects diagnosed with dyspepsia.: Using a cut-off value determined by analysis ofH. pylori-negative Australian samples, the sensitivity, specificity and accuracy of the IgG2 assay were 77.8, 97.4 and 91.1%, respectively, for the Australian samples and 96.3, 83.8 and 90% for Hong Kong samples. For the IgG assay, sensitivity, specificity and accuracy were 87.0, 99.1 and 95.2% for Australian samples and 97.5, 75 and 86.3% for Hong Kong samples respectively. Receiver-operating characteristic analysis showed better discrimination ofH. pyloristatus when the IgG2 assay was applied to Hong Kong samples, while the IgG assay was better in the Australian samples.: These data demonstrate that the Helirad Alert enzyme-linked immunoassay could provide a reliable method for screeningH. pyloriinfection in both western and Chinese populations. [ABSTRACT FROM AUTHOR]

: The natural history of gastro-oesophageal reflux disease in Asian population has not been studied before.: To study the onset and disappearances of reflux symptoms over a 1-year period in the Chinese population.: A population-based telephone survey was performed in 2002 and repeated 1 year later. The change in prevalence rate, onset and disappearance of gastro-oesophageal reflux disease, and the change in diagnoses were assessed. Factors associated with the onset and disappearance of gastro-oesophageal reflux disease were studied.: A total of 712 subjects completed the first and second survey. The annual, monthly and weekly prevalence of gastro-oesophageal reflux disease were 34.1%, 10.1% and 2.7% respectively. The onset rate (per 1000 person-year) and disappearance rate of any gastro-oesophageal reflux disease and frequent gastro-oesophageal reflux disease (≥ monthly symptoms) were 209, 40; and 395, 243 respectively. Forty-four percentage of gastro-oesophageal reflux disease subjects changed their diagnoses in 2003. By multiple logistic regression analysis, high anxiety score (OR: 1.2, 95% CI: 1.1–1.2) and higher educational level (OR: 2.7, 95% CI: 1.3–6.3) were associated with the onset of gastro-oesophageal reflux disease; while the frequency of acid regurgitation (OR: 0.35, 95% CI: 0.17–0.70) and use of antisecretory therapy (OR: 0.50, 95% CI: 0.28–0.89) were associated with the disappearance of gastro-oesophageal reflux disease.: The prevalence of gastro-oesophageal reflux disease is stable over 1 year. Higher anxiety score and higher educational level were associated with the onset of gastro-oesophageal reflux disease, while lower frequency of reflux symptoms and infrequent use of antisecretory therapy were associated with the disappearance of gastro-oesophageal reflux disease in a Chinese population. [ABSTRACT FROM AUTHOR]

: We previously reported that aspirin inhibitedHelicobacter pylorigrowth and suppressed the mutagenic effect of metronidazole.: To determine the effects of a cyclo-oxygenase (COX)-2-specific inhibitor, SC-236, and a non-selective COX inhibitor, indometacin, on the growth, urease activity and antimicrobial susceptibility ofH. pylori.: ThreeH. pylorireference strains, and 18 clinical isolates were treated with SC-236 or indometacin for 24 and 48 h. Growth, urease activity and susceptibility to clarithromycin and metronidazole of the bacteria were assessed by viable colony counting, spectrophotometry andE-test respectively.: SC-236 and indometacin inhibitedH. pylorigrowth in a dose-dependent manner with the lowest inhibitory concentrations of 0.03 and 0.1 mm, and the lethal concentrations of 0.09 and 0.3 mm, respectively. The numbers of CFU/mL inBrucellabroth containing 0.09 mmSC-236 were 2 log lower at 24 h, and even 3 log lower at 48 h than that at 0 h (P = 0.035, compared with the vehicle control). Treatment of 0.3 mmindometacin reduced the number of CFU/mL by 1 log at 24 h compared with that at 0 h (P = 0.037 compared with the vehicle control).Helicobacter pyloriurease activity began to decrease with 0.06 mmSC-236 at 24 h (P = 0.016), and 0.3 mmindometacin at 48 h (P = 0.025). MICs of metronidazole and clarithromycin againstH. pyloriwere decreased significantly in the presence of 0.03 mmSC-236 or 0.1 mmindometacin (allP < 0.001).: Both SC-236 and indometacin suppressed the growth and urease activity ofH. pyloriin a dose-dependent manner, and increased its susceptibility to the antibiotics. [ABSTRACT FROM AUTHOR]

: Previous studies have suggested that the acid secretory capacity of the Chinese population is lower than that of the Western population. : To compare the effect of lansoprazole 30 mg and 15 mg once daily on the 24-h oesophageal and intragastric pH profiles in Chinese patients with gastro-oesophageal reflux disease. : Forty-four patients (male to female ratio, 27 : 17; mean age, 53 years; 55% with oesophagitis) with gastro-oesophageal reflux disease were randomized to receive lansoprazole 30 mg or 15 mg once daily for 4 weeks. Measurement of the 24-h oesophageal and intragastric pH, gastro-oesophageal reflux disease symptoms and quality of life was performed at baseline and during the last week of each dosing period. : Lansoprazole 30 mg maintained an intragastric pH > 4 for 10.5 h vs. 9.6 h for lansoprazole 15 mg ( P = 0.44). The percentage total time at oesophageal pH < 4 was similar for lansoprazole 30 mg and 15 mg (2.0% vs. 2.3%, P = 0.30). The proportion of patients with complete cure of heartburn and acid regurgitation and the quality of life assessment were similar for lansoprazole 30 mg and 15 mg. Both dosages of lansoprazole were well tolerated and the compliance was 100% in both groups. : Lansoprazole dosages of 30 mg and 15 mg once daily provide a satisfactory decrease for oesophageal acid exposure and are equally effective for the treatment of gastro-oesophageal reflux disease in the Chinese population. [ABSTRACT FROM AUTHOR]

Cyclodextrins are cyclic oligosaccharides which are able to form complexes with a wide range of organic compounds, including fragrance oils. As a result of the complexation, the vapour pressure of the volatile substance is reduced and its release is better controlled. To achieve this, β-cyclodextrin can be anchored to cellulose by means of a chemical linkage provided by heterobifunctional reactive dyes. [ABSTRACT FROM AUTHOR]

Summary Background : Population-based data on gastro-oesophageal reflux disease in Chinese are lacking. The prevalence, clinical spectrum and health care-seeking behaviour of subjects with gastro-oesophageal reflux disease were studied. Methods : Ethnic Chinese (3605) were invited to participate in a telephone survey using a validated gastro-oesophageal reflux disease questionnaire and the Hospital Anxiety and Depression Scale. Results : A total of 2209 subjects (58% female; mean age, 40.3 years) completed the interview. The annual, monthly and weekly prevalence rates of gastro-oesophageal reflux disease were 29.8%, 8.9% and 2.5%, respectively. Gastro-oesophageal reflux disease symptoms were associated with non-cardiac chest pain [odds ratio (OR), 2.3; 95% confidence interval (95% CI), 1.7–3.1], dyspepsia (OR, 1.9; 95% CI, 1.4–2.5), globus (OR, 1.8; 95% CI, 1.2–2.7), acid feeling in the stomach (OR, 5.8; 95% CI, 4.5–7.5) and the use of non-steroidal anti-inflammatory drugs (OR, 2.3; 95% CI, 1.5–3.6), but not with dysphagia, bronchitis, asthma, hoarseness and pneumonia. Patients with gastro-oesophageal reflux disease had a significantly higher anxiety and depression score and required more days off work when compared with subjects without. The frequency of heartburn (P = 0.032), female gender (P < 0.001), degree of depression (P = 0.004) and social morbidity (P < 0.001) were independent factors associated with health care-seeking behaviour. Conclusion : The prevalence of gastro-oesophageal reflux disease was lower than that in Western populations, but carried a significant socio-economic burden in the studied Chinese population. The frequency of heartburn, female gender and psychosocial factors were associated with health care utilization in gastro-oesophageal reflux disease. [ABSTRACT FROM AUTHOR]

Summary Background and aims: To develop a validated gastro-oesophageal disease (GERD) symptom questionnaire for the Chinese population. Methods: One hundred Chinese patients with GERD and 101 healthy Chinese controls were presented with a 20-item GERD questionnaire in the Chinese language (Chinese GERDQ). Quality of life in GERD patients was assessed by SF-36. A standard dose of proton pump inhibitors for 4 weeks was prescribed to 35 patients with newly diagnosed GERD. The Chinese GERDQ was performed before, 4 weeks and 8 weeks after treatment. Concept, content, construct, discriminant validity and reliability of the questionnaire were assessed. Results: Seven items were selected by logistic regression to account for most of the differences between controls and GERD patients with a good reproducibility and internal consistency. A cut-off score of equal or greater than 12 was determined to discriminate between controls and GERD patients with a sensitivity of 82% and a specificity of 84%. The Chinese GERDQ correlated negatively with five domains of the SF-36 and discriminated between GERD patients who reported symptomatic improvement during proton pump inhibitor treatment and symptoms deterioration upon withdrawal of proton pump inhibitor treatment. Conclusions: The Chinese GERDQ could be used in epidemiological studies to assess the frequency and severity of GERD in patient populations and in interventional studies of GERD. [ABSTRACT FROM AUTHOR]

Summary Aim : To determine whether pre-treatment antibody response to Helicobacter pylori virulence factors predicts eradication success and symptom relief 12 months after triple therapy in non-ulcer dyspepsia. Methods : H. pylori -positive patients with non-ulcer dyspepsia received 1-week omeprazole-based triple therapy, or omeprazole plus placebos. Symptoms were assessed using a validated Likert scale. Gastric biopsies taken before and 12 months after treatment were used for histological examination. Pre-treatment blood samples were used for the detection of anti-H. pylori immunoglobulin G (IgG) antibodies, and specific IgG antibodies to 19.5-, 26.5-, 30-, 35-, 89- (VacA) and 116-kDa (CagA) antigens of H. pylori . Results : IgG antibodies to the six antigens were detected in 62%, 96%, 88%, 47%, 54% and 78% of patients, respectively. The presence of antibody to 19.5-, 26.5- or 30-kDa antigen was associated with an increased anti-H. pylori IgG absorbance index. IgG absorbance indices were greater in those with H. pylori eradication (vs. persistent infection). The prevalence of antibodies to the six antigens was not significantly different between those with symptom relief vs. those without. The 19.5-kDa antigen (P = 0.018) and VacA (P = 0.001) were independent risk factors for body gastritis. Conclusions : An increased pre-treatment anti-H. pylori IgG absorbance index may be a useful predictor of the success of eradication therapy. Although the 19.5-kDa antigen and VacA were associated with body gastritis, none of the six antigens tested predicted symptom relief after triple therapy. [ABSTRACT FROM AUTHOR]

Summary Aim : To test the efficacy of rabeprazole, levofloxacin and rifabutin triple therapy vs. quadruple therapy for the second-line treatment of Helicobacter pylori infection. Methods : One hundred and nine patients who had failed previous H. pylori eradication were randomized to receive: (i) rabeprazole, 20 mg b.d., rifabutin, 300 mg once daily, and levofloxacin, 500 mg once daily, for 7 days (triple therapy); or (ii) rabeprazole, 20 mg b.d., metronidazole, 400 mg t.d.s., bismuth subcitrate, 120 mg q.d.s., and tetracycline, 500 mg q.d.s., for 7 days (quadruple therapy). Endoscopy and culture were performed before treatment. Results : The clarithromycin (79% vs. 21%, P < 0.001) and metronidazole (89% vs. 40%, P < 0.001) resistance rates were significantly higher in patients with previous exposure than in those with no previous exposure. The intention-to-treat and per protocol eradication rates were 91%/91% for the triple therapy group and 91%/92% for the quadruple therapy group. For patients with double resistance to metronidazole and clarithromycin, the eradication rates were 85% (17/20) in the triple therapy group and 87% (13/15) in the quadruple therapy group. Compliance was greater than 95% for both regimens. Conclusion : Rabeprazole, levofloxacin and rifabutin-based triple therapy and quadruple therapy were equally effective as second-line treatments for H. pylori infection. [ABSTRACT FROM AUTHOR]

Summary Aim : To determine whether symptomatic response to lansoprazole predicts abnormal acid reflux in endoscopy-negative patients with non-cardiac chest pain. Methods : Patients who complained of chest pain, but had normal coronary angiography, were asked to undergo upper endoscopy. Those without gastric and oesophageal lesions were recruited for 24-h ambulatory oesophageal pH monitoring, and were randomly given lansoprazole 30 mg or placebo, both daily for 4 weeks. Chest pain symptoms were recorded before and 1 month after treatment on a locally validated questionnaire. The symptom score was calculated by multiplying the severity and frequency of the symptom, and symptom improvement was defined as > 50% reduction in symptom score. Results : Overall, 68 patients, 36 on lansoprazole and 32 on placebo, completed the trial. The symptom score was reduced significantly in both groups (P < 0.001). In the lansoprazole group, more patients with than without abnormal reflux showed symptom improvement (92% vs. 33%; odds ratio = 22; 95% confidence interval, 2.3–201.8; χ 2 = 10.9; P = 0.001), giving a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 92%, 67%, 58%, 94% and 75%, respectively. In the placebo group, the rates of symptom improvement were similar between those with and without abnormal reflux (33% vs. 35%, P = N.S.). Conclusions : Treatment with lansoprazole is a useful test in diagnosing endoscopy-negative gastro-oesophageal reflux disease in Chinese patients with non-cardiac chest pain. [ABSTRACT FROM AUTHOR]

Summary Background : Recently, a rapid-release 100-mg 13 C-urea tablet with citrate supplement (Diabact UBT) showed excellent performance in a European population. Aim : To investigate the accuracy of a 50-mg tablet-based 13 C-urea breath test protocol. Methods : Consecutive dyspeptic patients referred for upper endoscopy were recruited. 13 C-Urea breath test was performed using a 50-mg 13 C-urea tablet (Diabact UBT) and compared with the gold standard (rapid urease test and histology). Baseline, 10-min, 20-min and 30-min breath samples were collected in all cases. The cut-off values at each measurement interval were determined by three standard deviations above the mean excess δ 13 CO2 excretion of Helicobacter pylori -negative patients. Results : Two hundred patients (150 before therapy and 50 after therapy) were available for analysis, with a mean age of 48.4 years, and 99 patients (50%) were H. pylori positive. The sensitivity and specificity of the 50-mg tablet-based 13 C-urea breath test at 10 min, 20 min and 30 min were 100% and 98%, 100% and 100%, and 100% and 98%, respectively. Conclusion : A 20-min, 50-mg tablet-based 13 C-urea breath test (Diabact UBT) protocol is highly accurate for the diagnosis of H. pylori infection. [ABSTRACT FROM AUTHOR]

Summary Aims : To study the prevalence of dyspepsia and irritable bowel syndrome and the effects of co-existing anxiety and depression on health care utilization by a population survey in Chinese. Methods : Ethnic Chinese households were invited to participate in a telephone survey using a validated bowel symptom questionnaire and the hospital anxiety and depression scale. Gastrointestinal symptoms were classified as dyspepsia and irritable bowel syndrome according to the Rome I criteria and gastro-oesophageal reflux disease by the presence of weekly heartburn or acid regurgitation. The anxiety and depression scores were compared between patients who sought medical attention and those who did not, using multiple logistic regression analysis. Results : One thousand, six hundred and forty-nine subjects completed the interview (response rate, 62%). The population prevalences of dyspepsia, irritable bowel syndrome and gastro-oesophageal reflux disease were 18.4%, 4.1% and 4.8%, respectively. Dyspepsia and irritable bowel syndrome were associated with anxiety, depression, medical consultation, sick leave and adverse effects on social life. The degree of anxiety was an independent factor associated with health care-seeking behaviour in both dyspeptics (P =0.003) and irritable bowel syndrome patients ( P =0.036). Conclusions : Irritable bowel syndrome and dyspepsia are associated with anxiety, depression, significant social morbidity, health care utilization and days off work. Anxiety is an independent factor in determining health care utilization in patients with dyspepsia and irritable bowel syndrome. [ABSTRACT FROM AUTHOR]

Summary Aims : To study the prevalence, clinical characteristics and long-term outcome of oesophagitis in Chinese patients. Methods : Clinical and endoscopic data were collected prospectively from consecutive patients who underwent upper endoscopy between 1997 and 2001. Patients with endoscopic oesophagitis were graded according to the Los Angeles system and analysed according to their clinical presentation, endoscopic details, Helicobacter pylori status, non-steroidal anti-inflammatory drug history, co-morbidity and mortality. Results : A total of 22 628 upper endoscopies were performed in 16 606 patients. Of these, 631 (3.8%) had endoscopic oesophagitis, 14 had benign oesophageal stricture (0.08%) and 10 had Barrett's oesophagus (0.06%). Most patients (94%) had either Los Angeles grade A or grade B oesophagitis. Patients who died during follow-up had a significantly higher incidence of co-morbid illness (100% vs. 63%, P < 0.001). By Cox regression analysis, the presence of gastrointestinal bleeding ( P = 0.008), advanced age ( P = 0.004) and the use of Ryle's tube ( P = 0.043) were identified to be independent factors associated with mortality. Conclusions : Complicated gastro-oesophageal reflux disease is uncommon in the Asian population. Advanced age, use of Ryle's tube and the presence of gastrointestinal bleeding are associated with a poor long-term outcome, which is a reflection of the severe underlying co-morbidity. [ABSTRACT FROM AUTHOR]

Summary Background : We have previously shown that ranitidine bismuth citrate-based, clarithromycin-containing triple therapy achieves a higher eradication rate than proton pump inhibitor-based regimens in areas with a high prevalence of metronidazole resistance. Aim : To evaluate whether this higher efficacy of ranitidine bismuth citrate over proton pump inhibitor can be extended to non-clarithromycin-containing regimens. Methods : Helicobacter pylori -positive dyspeptic patients were randomized to receive either ranitidine bismuth citrate, 400 mg, amoxicillin, 1000 mg, and metronidazole, 400 mg, or omeprazole, 20 mg, amoxicillin, 1000 mg, and metronidazole, 400 mg, each given twice daily for 1 week. H. pylori eradication was confirmed by 13 C-urea breath test 5 weeks later. The side-effects of the treatments were documented. Results : Two hundred and twenty-nine patients were eligible for analysis. By intention-to-treat and per protocol analysis, the eradication rates were 77% and 79%, respectively, in the ranitidine bismuth citrate–amoxicillin–metronidazole group and 77% and 82%, respectively, in the omeprazole–amoxicillin–metronidazole group (P = 0.58 and P = 0.65). However, patients in the omeprazole–amoxicillin–metronidazole group reported a significantly higher incidence of minor side-effects when compared to those in the ranitidine bismuth citrate–amoxicillin–metronidazole group ( P = 0.001). Conclusions : Ranitidine bismuth citrate–amoxicillin–metronidazole was equally as effective as omeprazole–amoxicillin–metronidazole triple therapy, and may be considered as an alternative non-clarithromycin-based regimen in the Chinese population. [ABSTRACT FROM AUTHOR]

SUMMARY Background : Helicobacter pylori infection has been associated with growth restriction in young children. Aim : To determine whether there is an association between H. pylori infection and intrauterine growth restriction. Methods : Four hundred and forty-eight consecutive pregnant women (aged 15–44 years), attending for routine examinations in the third trimester, were enrolled. Clinical, demographic and previous obstetric data, as well as smoking history, were collected. At delivery, the weight, height, gender and status of the neonate were recorded; intrauterine growth restriction was defined if the birth weight was below the 10th percentile according to the gestational age for infants born in Australia. Results : Eighty-nine (20%) women were seropositive for H. pylori . The prevalence of H. pylori was significantly lower in Caucasians (17%) vs. non-Caucasians (42%, P < 0.0001). There were 34 (7.5%) cases of intrauterine growth restriction (7% Caucasians, 16% Asians, 12% Aborigines and 0% Pacific Islanders). Intrauterine growth restriction was more common in H. pylori -seropositive women than in H. pylori -seronegative women [13.5% vs. 6%; odds ratio (OR)=2.41; 95% confidence interval (CI), 1.14–5.08; P =0.018]. A multiple logistic regression model revealed that smoking (OR=3.55; 95% CI, 1.62–7.79; P =0.002), maternal height (OR=0.48; 95% CI, 0.28–0.80; P =0.005) and H. pylori seropositivity (OR=2.59; 95% CI, 1.12–5.95; P =0.025) were all independent risk factors for intrauterine growth restriction. Conclusions : H. pylori infection in pregnant women may affect foetal intrauterine growth. [ABSTRACT FROM AUTHOR]

Aim: To test the efficacy of omeprazole, furazolidone and amoxicillin triple therapy for the treatment of Helicobacter pylori infection after failure of standard first-line therapy recommended by the Asia-Pacific Consensus on the management of H. pylori infection. Methods: Patients with failed H. pylori eradication received omeprazole, 20 mg, furazolidone, 100 mg, and amoxicillin, 1 g, all twice daily for 1 week. Endoscopy (CLO test, histology and culture) was performed before treatment. Post-treatment H. pylori status was determined by 13 C-urea breath test 6 weeks later. Results: Fifty patients were recruited. Resistance to metronidazole, clarithromycin and both drugs was in the range of 50–64%, 60–75% and 40–50%, respectively, after failure of first-line therapy. Amoxicillin resistance was not found. The intention-to-treat and per protocol H. pylori eradication rates were 52% and 53%, respectively. Patients with double resistance to metronidazole and clarithromycin showed the lowest eradication rate (38%), which was significantly lower than that of patients with sensitive strains (88%). Side-effects were minimal and compliance was excellent (98%). Conclusions: One-week omeprazole, furazolidone and amoxicillin rescue therapy achieved a high eradication rate in strains sensitive to metronidazole and clarithromycin. This is a cheap and safe rescue regimen when guided by pre-treatment sensitivity testing. [ABSTRACT FROM AUTHOR]

Background: A new rapid urine test was developed to detect anti-Helicobacter pylori antibody in urine using the principle of immunochromatography. The accuracy of this test in the Chinese population remains to be defined. Aim: To evaluate a new rapid urine test for the diagnosis of H. pylori infection in the Chinese population. Methods: Eligible patients without previous treatment of H. pylori were recruited. In-house rapid urease test and histology were used as the gold standard. The rapid urine test (RAPIRUN H. pylori antibody) was performed and the results were compared with the gold standard. Results: One hundred and twenty-three patients were eligible for analysis and 61 (50%) were H. pylori positive by the gold standard. The rapid urine test showed a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 96.7%, 95.2%, 95.2%, 96.7% and 95.9%, respectively. Results were obtained within 20 min and no special laboratory support was required. Conclusions: The rapid urine test by immunochromatography is highly accurate for the diagnosis of H. pylori infection in untreated Chinese patients. [ABSTRACT FROM AUTHOR]

Background: Numerous serological tests for the detection of Helicobacter pylori infection have been developed. However, many perform poorly when evaluated in the Chinese population. Aim: To search for optimal serological tests for the detection of H. pylori infection in Chinese patients. Methods: Consecutive dyspeptic patients referred for upper endoscopy were recruited. During endoscopy, gastric biopsies were taken for the CLOtest™ and histological examination. Patients were then given a 13 C-urea breath test. Sera were used to test for H. pylori infection, employing three commercial enzyme-linked immunosorbent assay kits (pylori DTect, HP IgG and GAP IgG). Results were compared with the gold standard defined by the CLOtest™, histology and 13 C-urea breath test. Results: Among the 142 patients (47 male, 95 female; mean age, 49 years) recruited, 81 (57%) were H. pylori -positive, 57 (40%) were H. pylori -negative and four (3%) were defined to be indeterminate. Using a self-defined cut-off value after calculation, the best accuracies for the pylori DTect, HP IgG and GAP IgG tests were 97%, 91% and 80%, respectively. Conclusions: The pylori DTect test is an optimal serological test for the detection of H. pylori infection in Hong Kong Chinese patients. The HP IgG test may be used as an alternative. [ABSTRACT FROM AUTHOR]

Aims: To test the usefulness of upper gastrointestinal investigations and quality of life assessment in Chinese patients with non-cardiac chest pain. Methods: Seventy-eight consecutive patients with non-cardiac chest pain underwent upper endoscopy. Eight patients had upper gastrointestinal pathology (10%). The remaining 70 patients received acid perfusion test, oesophageal manometry and 24-h ambulatory oesophageal pH (n =65)/manometry (n =61), and the results were compared with those of healthy controls (n =20). Symptoms and quality of life (SF-36) were assessed by standard validated questionnaire. Results: Significant acid reflux symptoms were present in five (5/70, 7%) patients. Abnormal 24-h oesophageal pH, indicating gastro-oesophageal reflux, was found in 19 (19/65, 29%) patients. The percentage of simultaneous contractions was higher and the percentage peristalsis was lower in patients with non-cardiac chest pain when compared with normal subjects by 24-h ambulatory manometry. Patients with non-cardiac chest pain had a lower SF-36 score when compared to controls. Conclusions: Typical acid reflux symptoms are uncommon in Chinese patients with non-cardiac chest pain, but abnormal 24-h pH results, indicating gastro-oesophageal reflux, were found in 29% of patients. Ineffective contractions were more frequently found in patients with non-cardiac chest pain by 24-h ambulatory manometry, which may have a bearing on the impaired quality of life in such patients. Upper gastrointestinal investigations are useful for the evaluation of Chinese patients with non-cardiac chest pain. [ABSTRACT FROM AUTHOR]

Background: The proportion of duodenal ulcers not associated with Helicobacter pylori infection or the use of non-steroidal anti-inflammatory drugs (NSAIDs) is increasing. Aim: To identify the clinical and endoscopic characteristics of non-H. pylori, non-NSAID duodenal ulcers. Methods: Clinical and endoscopic data and H. pylori status were prospectively collected from consecutive patients who underwent upper endoscopy from 1997 to 1999. Patients with duodenal ulcers were identified, and those with non-H. pylori, non-NSAID duodenal ulcers were analysed further. Results: A total of 11 717 upper endoscopies were performed in 8344 patients. Of these, 1153 (14%) had duodenal ulcers. Of 599 patients with active ulcers and known H. pylori status, 104 (17%) had ulcers not associated with H. pylori or the use of NSAIDs, 393 (66%) had ulcers associated with H. pylori alone, 51 (8.5%) had ulcers associated with the use of NSAIDs alone and 51 (8.5%) had ulcers associated with both. Multivariate logistic regression analysis revealed that the presence of concomitant diseases (odds ratio=15.0; 95% confidence interval, 8.64–25.9; P < 0.001) and the absence of epigastric pain/discomfort (odds ratio=0.52; 95% confidence interval, 0.29–0.91; P=0.022) were independent predictors for non-H. pylori, non-NSAID duodenal ulcers. Conclusions: Non-H. pylori, non-NSAID duodenal ulcers exhibit certain distinct clinical and endoscopic characteristics. The presence of concomitant diseases is an important predictive factor. [ABSTRACT FROM AUTHOR]

Background: We have previously shown that the 75 mg 13C-urea breath test without citrate test meal is highly accurate for the diagnosis of Helicobacter pylori infection in Chinese subjects. A lower dose 50 mg 13C-urea breath test protocol with a sampling time at 20 min has not been validated previously. Aim: To investigate the accuracy of a 20-min 50 mg 13C-urea breath test protocol in Chinese subjects. Methods: Consecutive dyspeptic patients referred for upper endoscopy were recruited. 13C-urea breath test was performed using (a) 75 mg and 50 mg of 13C-urea on two separate days without a test meal, and (b) 50 mg of 13C-urea with 2.4 g citrate as test meal, and compared with the gold standard [rapid urease test (CLO test) and histology]. Baseline, 20-min and 30-min breath samples were collected in all cases. Results: Two hundred and six patients were tested. The accuracy of the 50 mg 13C-urea breath test (no citrate) at 20 min and 30 min was 98%, comparable to that of the 50 mg 13C-urea breath test with citrate (99.1%) and the 75 mg 13C-urea breath test without citrate (100%). Conclusions: A 20-min 50 mg 13C-urea breath test without citrate produced highly accurate results for the diagnosis of Helicobacter pylori infection and is more economical and convenient for the Chinese population. [ABSTRACT FROM AUTHOR]