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Emerging technologies such as virtual reality and mixed reality are an educational resource that attracts students' attention and increases their interest in the content presented. The application of this technology to a MOOC course makes the proposal to motivate students really interesting. This paper presents the proposal and design of a MOOC course on social entrepreneurship that integrates virtual reality and open educational resources. Furthermore, the methodology used in the course is based on the Learning Environment Modeling Language (LEML). This makes it really attractive to the public, while improving the traditional content of a training course. Finally, the main findings and implications of the training course on competence in social entrepreneurship and its relation to the development of Sustainable Development Objectives are discussed.

Context: The recent increase in accidents, mishaps or road accidents in urban systems with metropolitan characteristics has caused concern in the authorities responsible for planning the issue of mobility and transport subsystems. Indeed, there is convergence that the occurrence of this type of events is away from purely stochastic factors, but are the result of anomalies associated with the intrasystemic interaction of the vehicle, the user and the road. In this sense, the objective of this work is to determine through systemic analysis the components that are causing entropy in the second most important metropolis in Mexico. Method: In this analysis the precepts of systems theory are used; in such a way that through the tringulation of data obtained in situ and solved documentarily the causal components of intrasystemic entropy are determined. To do this, a modified derivation of the Pressure-State-Response model that identifies homeostasis in the urban system is elaborated. Results: The high exposure rates force the user to occupy the road subsystem for long periods of time, which triggers voluntary and involuntary human errors complemented by the lax requirements for obtaining driving licenses. From here, the components that produce accidents include in the road part the pavements in poor condition, absence of signaling, poor design of intersections, among others; in the vehicle part, mechanical failures due to the useful life of the internal components, flexible regulatory frameworks, and other; in the part of the user for breach of the regulations, physiological factors among others. Conclusions: From the systemic analysis, mobility is a subject of valuable study to detect the imbalances in the trinomial Vehicle-User-Road (V-C-U), which lead us to generate preventive and corrective measures that suppress metropolitan accidents, morbidity and mortality in the metropolis; or in our terms to reduce entropy levels in the system.

Introduction The only curative treatment for severe aplastic anemia in children is allogenic stem cell transplantation, but only few patients have a matched related or unrelated donor. Haploidentical stem cell transplantation (haplo-SCT) using bone marrow (BM) and peripheral blood stem cells (PBSC) has been recently described as effective and safe. In this study, we retrospectively describe the outcome of nine pediatric patients who underwent haplo-SCT using only PBSC. Patients and methods The father was the selected donor for seven of the nine patients. Donor specific anti-HLA antibodies were ruled out. Stem cells mobilization was performed with filgrastim 10 mcg/kg/d for five days, and CD34+ were recollected by peripheral blood apheresis on day 0. The conditioning regimen consisted on rabbit anti-thymocyte globulin 2.5 mg/kg/d on days -7, -6, -5, and -4, and cyclophosphamide 50 mg/kg/d on days -3 and -2. We used cyclophosphamide 50 mg/kg/d on days +3 and +4, tacrolimus and mycophenolic acid as graft versus host disease prophylaxis. Results The median follow up was 253 days (range 45-765 days). The median infused CD34+ was 10 × 10^6/kg (range 2.7 to 43 × 10^6/kg). The median myeloid engraftment was day +15 (range 11-30 days), and median platelet engraftment was day +16 (range 12-30 days). In eight of the nine patients, a sustained graft was achieved. One patient never achieved platelet engraftment and died because of cytomegalovirus infection. There was not treatment related toxicity reported. None of the patients had GVHD. The overall survival up to date is 88.8%. The eight surviving patients remain free of transfusions. Conclusions Haplo-SCT could be established as first line treatment when there is no matched related or unrelated donor. According to this short sample and previous reports, PBSC is a feasible option to be effectively used as only source of stem cells.

Recent data indicate that up-to 30–40% of cancers can be prevented by dietary and lifestyle measures alone. Herein, we introduce a unique network-based machine learning platform to identify putative food-based cancer-beating molecules. These have been identified through their molecular biological network commonality with clinically approved anti-cancer therapies. A machine-learning algorithm of random walks on graphs (operating within the supercomputing DreamLab platform) was used to simulate drug actions on human interactome networks to obtain genome-wide activity profiles of 1962 approved drugs (199 of which were classified as “anti-cancer” with their primary indications). A supervised approach was employed to predict cancer-beating molecules using these ‘learned’ interactome activity profiles. The validated model performance predicted anti-cancer therapeutics with classification accuracy of 84–90%. A comprehensive database of 7962 bioactive molecules within foods was fed into the model, which predicted 110 cancer-beating molecules (defined by anti-cancer drug likeness threshold of >70%) with expected capacity comparable to clinically approved anti-cancer drugs from a variety of chemical classes including flavonoids, terpenoids, and polyphenols. This in turn was used to construct a ‘food map’ with anti-cancer potential of each ingredient defined by the number of cancer-beating molecules found therein. Our analysis underpins the design of next-generation cancer preventative and therapeutic nutrition strategies.

El manejo eficiente de carga es un elemento clave para un puerto marítimo pueda competir y proveer adecuados niveles de servicio a sus usuarios. El desempeño de un puerto depende del tiempo de permanencia de la nave, que está condicionado por la eficiencia en las operaciones de carga y descarga de las naves. En el patio, los contenedores son almacenados temporalmente para ser cargados a la nave o despachados a los usuarios externos con un alto impacto en los tiempos de atención de las naves. Este artículo propone una política para stacking de contenedores, considerando las características particulares de un terminal de contenedores en Chile. Para medir el desempeño de este procedimiento, se propone una cota superior para el número de despejes de un contenedor en función de la capacidad de los bloques. Se presentan resultados numéricos en comparación con la cota superior, mostrando un buen desempeño del procedimiento propuesto. Efficient cargo handling is a key element for a maritime port to compete and provide good service levels to its users. The performance of a port is related to ship-turnaround, which is conditioned by the ships loading and unloading operational efficiency. At the yard, containers are temporarily stacked in order to later either load them onto a ship or dispatch them to external users. Stacking has a strong impact on ships’ service times. This paper proposes a container stacking policy, considering the particular characteristics of a container terminal in Chile. In order to measure the performance of the procedure, an upper bound for the number of re-handles of containers is estimated as a function of the block’s capacity. Numerical results are provided in comparison to an upper bound, and a good performance by the proposed procedure is demonstrated.

El uso de medios electrónicos en casi todas las esferas de la vida, ha llevado a los individuos a cambiar la percepción de la realidad, lo que implica la creación de nuevos conceptos y formas de explicar los procesos de comunicación y su impacto en las organizaciones. La presente investigación explora el uso racional y ético del Internet y cómo impacta en la competitividad de las organizaciones, utilizando cuestionarios aplicados a universitarios. Esta investigación arroja una ligera correlación entre el uso racional y la ética con respecto a la competitividad, por lo que no se descarta realizar una investigación posterior que dé continuidad para saber concluyentemente si existe tal correlación.

Background The aim of this study was to evaluate the results of video-assisted mediastinoscopic lymphadenectomy (VAMLA) for staging of non-small cell lung cancer (NSCLC). Methods This was a prospective observational study of all consecutive VAMLAs performed from January 2010 to April 2015 for staging NSCLC. For left lung cancers, extended cervical videomediastinoscopy was added to explore the subaortic and paraaortic nodes. Patients with negative VAMLA results underwent tumor resection and lymphadenectomy of the remaining nodes. Those with N2–3 disease underwent chemoradiation. The rate of unsuspected pathologic (p)N2–3 was analyzed in the global series and in the subgroups of patients according to their nodal status diagnosed by imaging and metabolic techniques. Results One hundred sixty VAMLAs were performed for staging NSCLC (138 tumors were clinical (c)N0-1 based on imaging techniques). The rate of unsuspected N2–3 disease was 18% for the whole series: 40.7% for cN1, 22.2% for cN0 and tumor size greater than or equal to 3 cm, and 6.4% for cN0 and tumor size less than 3 cm. Staging values were sensitivity, 0.96 (95% confidence interval [CI], 0.81–99.3); specificity, 1 (95% CI, 0.97–1); positive predictive value, 1 (95% CI, 0.87–1); negative predictive value, 0.99 (95% CI, 0.95–0.99); and diagnostic accuracy, 0.99 (95% CI, 0.96–0.99). The complication rate was 5.9%. Conclusions VAMLA is a feasible and highly accurate technique. The high rate of unsuspected mediastinal node disease diagnosed by VAMLA in patients with cN1 or cN0 disease and tumor size larger than 3 cm suggests that preresection lymphadenectomies should be included in the current staging algorithms.

Melting gels are hybrid gels that have the ability to soften and flow at around 100°C for some combinations of mono- and di-substituted alkoxysiloxanes, where substitutions are either all aromatic or all aliphatic. In this study, melting gels were prepared using phenyltriethoxysilane (PhTES) and dimethyldiethoxysilane (DMDES), meaning both an aromatic and aliphatic substitution. Differential scanning calorimetry was performed to identify glass-transition temperatures, and thermal gravimetric analysis coupled with differential thermal analysis (TGA-DTA) was performed to measure weight loss. The glass-transition temperatures (Tg) ranged from −61°C to +5.6°C, which are between the values in the methyl only system, where all Tg values are less than 0°C, and those values in the phenyl only system, where Tg values are greater than 0°C. The Tg decreased with an increase in the DMDES fraction. Below 450°C, the gels lost little weight, but around 600°C there was a drop in weight. This temperature is lower than the temperature for gels prepared with only aromatic substitutions, but higher than that for gels prepared with only aliphatic substitutions. Final heat treatment was carried out at 150°C for the gel with 80%PhTES-20%DMDES (in mol%), and the consolidation temperature increased with increasing DMDES content to 205°C for the gel with 50%PhTES-50%DMDES. After this heat treatment, the melting gels no longer soften.

Bone disease in rheumatoid arthritis (RA) is a complex phenomenon where genetic risk factors have been partially evaluated. The system formed by receptor activator for nuclear factor-κB (RANK), receptor activator for nuclear factor-κB ligand (RANKL), and osteoprotegerin (OPG): RANK/RANKL/OPG is a crucial molecular pathway for coupling between osteoblasts and osteoclasts, since OPG is able to inhibit osteoclast differentiation and activation. We aim to evaluate the association between SNPs C950T (rs2073617), C209T (rs3134069), T245G (rs3134070) in theTNFRSF11B(OPG) gene, and osteoporosis in RA. We included 81 women with RA and 52 healthy subjects in a cross-sectional study, genotyped them, and measured bone mineral density (BMD) at the lumbar spine and the femoral neck. Mean age in RA was50±12with disease duration of12±8years. According to BMD results, 23 (33.3%) were normal and 46 (66.7%) had osteopenia/osteoporosis. We found a higher prevalence of C allele for C950T SNP in RA. Polymorphisms C209T and T245G did not reach statistical significance in allele distribution. Further studies including patients from other regions of Latin America with a multicenter design to increase the sample size are required to confirm our findings and elucidate if C950T SNP could be associated with osteoporosis in RA.

Objectives The objectives of this study were to analyse the frequency of gene mutations associated with antitubercular drug resistance in clinical samples from the population of Jalisco State (Mexico) and to evaluate the genetic variability of Mycobacterium tuberculosis and multidrug-resistant (MDR) M. tuberculosis strains to describe the frequency of various families. Methods Clinical isolates of M. tuberculosis obtained from Jalisco State were analysed. Isolates were subjected to drug susceptibility testing, and mutations were characterised by sequencing, followed by genotyping using spoligotyping and mycobacterial interspersed repetitive units–variable-number of tandem repeats (MIRU-VNTR). Moreover, the prevalence of mutations was analysed by phylogenetic lineages. Results Resistant strains were analysed by sequencing of katG , inhA and rpoB genes to determine the presence of mutations associated with isoniazid and rifampicin resistance. In MDR, monoresistant and polyresistant isolates, mutations were found in 17 (54.84%) of 31 strains. Spoligotyping identified six different strain lineages [T1 (25.40%), H3 (7.94%), MANU (4.76%), X1 (3.17%), EAI5 (1.59%) and LAM1 (1.59%)], with the remaining strains identified as orphans. In additional tree-based identification, a dendrogram of spoligotype patterns generated five different similarity clusters. When combining 24-loci MIRU-VNTR and spoligotyping approaches, the results shows that there is no cluster formation, indicating low transmission of the samples. Conclusions This study using spoligotyping and MIRU-VNTR showed that the analysed strains were not related to each other since no two identical strains were found. Families with the highest prevalence in the study were orphans followed by T family.

Objective. There is a lack of information about the genotype frequencies of IL-6 −174G/C and −572G/C polymorphisms in Mexicans with rheumatoid arthritis (RA). Therefore, the aim of this study was to evaluate the association of the IL-6 −174G/C and −572G/C polymorphisms in Mexican mestizo with RA.Methods. We included 137 patients with RA and 102 healthy controls. Patients were assessed for clinical characteristics. IL-6 −174G/C and −572G/C polymorphisms were genotyped using PCR-RFLP analysis. Allele and genotype frequencies and the Hardy-Weinberg equilibrium were computed. Odds ratios (ORs) were computed to identify the risk for RA associated with the presence of GG genotype in comparison with the GC or CC genotypes.Results. The genotype −174GG occurred at a higher frequency in cases and controls (77.4% versus 78.4%,P=0.845). We found similar results for the genotype −572GG (54% in patients versus 60.8% in controls,P=0.295).Conclusions. This is the first study to evaluate the association of −174G/C and −572G/C polymorphisms of the IL-6 gene with RA in Mexican mestizo patients. These two polymorphisms were not associated with RA in the studied sample. Additional studies are required to evaluate if these IL-6 polymorphisms have relevance to the development of more severe disease.

The increase in the number of renewable energy generating facilities has transformed the electricity distribution network into a Distributed Generation (DG) system. This has given rise to a new monitoring scenario for protective devices already installed across radial distribution networks, which may execute unexpected and inappropriate protective actions that cause loss of supply to consumers. These devices are affected by the new condition of the electricity distribution network, as network currents vary. A common practice is to use electrical impedance-based fault localizers. This work describes a novel method for fault detection in radial networks with DG, which does not require knowing the electrical impedances of the lines that compose the network. The method only requires input data regarding the short circuit currents provided by the main feeder and the DG units in the area in which a fault has occurred. This information is sufficient to allow the area where the fault lies to be identified. The underlying idea is that the measurement of the current at two points provides a binocular view of the fault, thus allowing its location to be pinpointed. The method was tested using the IEEE 13-node test feeder system, locating different types of faults in different areas of a simulated radial network. DOI: http://dx.doi.org/10.5755/j01.eie.22.2.7226

Glucocorticoids are frequently used in rheumatoid arthritis (RA) in order to alleviate symptoms of joint inflammation, retard erosions and to treat extra-articular manifestations, although these drugs may increase the risk of bone mineral loss and osteoporotic fractures. To date, in Mexico there are no studies that identify the frequency of patients with RA with corticosteroids, receiving therapy for osteoporosis. Therefore, we evaluated the prevalence and factors related to the prescription of antiresorptives in 520 Mexican patients with RA. We used a multivariate model to identify variables associated with antiresorptives prescription. We identified that although 79% of patients were under treatment with glucocorticoids, only 13% received antiresorptive agents as preventive therapy for osteoporosis. The multivariate analysis identified that higher proportions of antiresorptive drugs prescriptions were associated with female patients (OR 11.40, 95% CI: 1.5-84.3, P = 0.02), an age of 40 years or more (OR 3.22, 95% CI: 1.3-8.3, P = 0.02) and to consume a lower number of cointerventions with other drugs (OR 1.09, 95% CI: 1.0-1.2, P = 0.03). Corticosteroid treatment was not associated with the prescription of antiresorptives (P = 0.31). In conclusion, a low proportion of Mexicans with RA receive antiresorptive therapy independently regardless of whether they consume or not chronically corticosteroids. Additional strategies should be evaluated to encourage the prevention and early treatment for osteoporosis in patients with RA.

Objective: To evaluate the accuracy of repeat mediastinoscopy (reMS) in all its indications, and to analyse survival in the group of patients who underwent induction chemotherapy or chemoradiotherapy for pathologically proven stage III-N2 non-small-cell lung cancer (NSCLC). Methods: From July 1992 to February 2009, 96 patients (87 men; median age: 61.3 years), underwent 101 reMSs (five patients required a second reMS) for the following indications: restaging after induction therapy for pathologically proven N2 disease (84 cases), inadequate first mediastinoscopy (five), metachronous second primary (six) and recurrent lung cancer (six). Patients with N2-NSCLC, who had received induction therapy and had positive reMS, underwent definitive chemotherapy or chemoradiotherapy. Patients in whom reMS was negative underwent thoracotomy for lung resection and systematic nodal dissection (SND). SND was considered the gold standard to compare the negative results of reMS. Pathologic findings were reviewed and staging values were calculated using the standard formulas. Follow-up data were completed in January 2010, and survival analysis was performed by the Kaplan—Meier method.Results:InthegroupofreMSforrestagingafterinductiontherapy,thestagingvalues were:sensitivity0.74,specificity1,positivepredictivevalue1,negativepredictivevalue0.79anddiagnosticaccuracy0.87.Wealsodeterminedthe diagnostic value of this technique according to the type of induction treatment. In terms of accuracy, no statistically significant differences were found.Mediansurvival timeinpatientswithtruenegativereMSwas51.5months(95%confidenceinterval(CI) 0—112), and inthe combinedgroup of patients with positive and false-negative reMS, median survival time was 11 months (95% CI 7.6—14.1) ( p = 0.0001). In the group of miscellaneous indications,allstagingvalueswere1.Conclusion:ReMSisfeasibleinalltheindicationsdescribed.Afterinductiontherapy,itisausefulprocedureto selectpatientsforlungresectionwithhighaccuracy,independentlyoftheinductiontreatmentusedortheintensityofthefirstmediastinoscopy.The persistence of lymph node involvement after induction therapy has a poor prognosis. Therefore, techniques providing cytohistological evidence of nodal downstaging are advisable to avoid unnecessary thoracotomies. # 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

This text is limited to the reflection made by the authors in order to contribute to the debate on how to develop the entrepreneurial university, in a process in which plays a key role in the transfer of technology and knowledge. It is intended that this work will contribute to the consolidation of the university as a trainer of entrepreneurs able to respond in a timely manner, the legitimate aspirations of the modern society that is transforming knowledge into wealth. Freedom to undertake ventures should also be one because people with knowledge equals more wealth generation. The ability to carry out projects is essential for the prosperity of mankind. It’s not greed that drives successful societies.

Objective: To evaluate the technical feasibility and the sensitivity, specificity and accuracy of extended cervical mediastinoscopy (ECM) in the staging of bronchogenic carcinoma (BC) of the left lung. Methods: From 1998 to 2003, 89 patients underwent routine ECM for staging of BC of the left lung. In 2004, positron emission tomography (PET) was included in our staging protocol and ECM was reserved for those with positive mediastinal or hilar PET images, large lymph nodes on computed tomography (CT) scan or central tumours. From 2004 to 2007 we performed selective ECM in 67 patients. ECM was considered positive when metastatic nodes or tumour involvement directly in the subaortic or para-aortic regions was confirmed pathologically. One hundred and forty-three patients with negative ECM underwent subsequent thoracotomy for tumour resection and systematic nodal dissection. Pathological findings were reviewed and staging values were calculated. Results: One hundred and fifty-six patients underwent ECM (89 routine and 67 selective). In 13, ECM was positive and thoracotomy was contraindicated. The rest of the patients were operated. We performed 88 lobectomies, 34 pneumonectomies, 6 wedge resections, 13 exploratory thoracotomies and 2 parasternal mediastinotomies. Lymphadenectomy specimens showed tumour involvement of subaortic lymph nodes in 8 patients. Complication rate was 2%: two cases of mediastinitis, one ventricular fibrillation, and one superficial surgical wound infection. Sensitivity, specificity, positive predictivevalue,negativepredictivevalueandaccuracyofroutine/selectiveECMwere:0.45/0.75,1/1,1/1,0.94/0.95,0.94/0.95,respectively. Conclusion:ECMis a feasiblestagingtechnique thatallowsruling outsubaorticandpara-aorticnodaldiseasewith highnegativepredictivevalue, accuracyandsensitivity.ItsindicationbasedontheCTandPETfindingsseemsmoreadvisablethatitsroutineusetostagebronchogeniccarcinoma of the left lung. # 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

This study explored how Latinas diagnosed with a breast abnormality suspicious for cancer define and use social support while undergoing diagnostic follow-up and/or awaiting a definitive diagnosis. Qualitative data was collected and analyzed from 15 telephone interviews with Spanish-speaking women diagnosed with a breast abnormality suspicious for cancer. Findings indicated that social support was perceived as the comfort, caring, and esteem a person receives from others. With respect to family support, half of the participants felt female family members (e.g., daughters, mothers) were more supportive than male family members (e.g., fathers, sons) when discussing their illness. Many participants felt that asking for help from family members, friends, and health professionals was acceptable under medical circumstances and less justifiable under non-medical circumstances. In conclusion, our findings suggest that Latinas diagnosed with a breast abnormality suspicious for breast cancer are more likely to seek support from family members, friends and health professional after a definitive diagnosis has been given. Additional research is needed to assess the impact of social support in increasing adherence to diagnostic follow-up procedures for a breast abnormality.

Fuente TESIUNAM

Hematopoietic SCT (HSCT) has become an established therapy for numerous disorders of the hematopoietic system and for some solid tumors.1 However, owing to the high cost of the procedure, and the need for a multidisciplinary team, few centers in developing countries provide this treatment modality. In Mexico, the history of HSCT began in 1980, when the first transplant took place at the National Institute of Nutrition in Mexico City. After this, there were a few other procedures in the National Medical Center of the University Hospital of Monterrey, with poor results. This resulted in the suspension of the HSCT program at these institutions. As a result, the practice of HSCT in Mexico was almost anecdotal until 1995.2 As there has been no national report, we consider it important to evaluate the current activity, needs and perspectives in the field of HSCT.

The role of physical activity in the prevention of chronic illness is recognized. Latinos have higher than average rates for several chronic illnesses and lower than average rates for participation in leisure time physical activity. A community-based physical activity intervention that was designed by and for Latino families residing in rural cities located in the San Joaquin Valley of Central California is described in this article. Walking clubs were designed to provide skill-building opportunities and a flexible structure to accommodate fluctuating periods of participant availability. Walking clubs also provided low-impact, low-cost activities that were self-paced and included all family members. In this article we consider (1) whether participation in physical activity increases over time and (2) whether perceived barriers to physical activity decrease over time. A cohort of 202 was surveyed at baseline, 6 months, and 1 year. Information on type and frequency of physical activity and barriers...

The growth and survival of the blue abalone Haliotis fulgens was followed for 11 months in barrel culture in the sea at Cedros Island, Baja California. The mean growth rate was 49.4 μm day −1 for individuals whose initial mean lengths were 12–15 mm at the ages of 6–7.6 months. The abalone were fed Macrocystis pyrifera and Eisenia arborea and other algae as available. Mean survival was 87%. Growth rates are compared with those in barrel culture elsewhere in the world.

Peptidyl arginine deiminase IV (PAD 4) is the responsible enzyme for a posttranslational modification called citrullination, originating the antigenic determinant recognized by anti-cyclic citrullinated peptide antibodies (ACPA). Four SNPs (single nucleotide polymorphisms) have been described inPADI4gene to form a susceptibility haplotype for rheumatoid arthritis (RA); nevertheless, results in association studies appear contradictory in different populations. The aim of the study was to analyze if the presence of three SNPs inPADI4gene susceptibility haplotype (GTG) is associated with ACPA positivity in patients with RA. This was a cross-sectional study that included 86 RA patients and 98 healthy controls. Polymorphisms PADI4_89, PADI4_90, and PADI4_92 in thePADI4gene were genotyped. The susceptibility haplotype (GTG) was more frequent in RA patients; interestingly, we found a new haplotype associated with RA with a higher frequency (GTC). There were no associations between polymorphisms and high scores in Spanish HAQ-DI and DAS-28, but we did find an association between RARBIS index and PADI4_89, PADI4_90 polymorphisms. We could not confirm an association between susceptibility haplotype presence and ACPA positivity. Further evidence about proteomic expression of this gene will determine its participation in antigenic generation and autoimmunity.

Medir la concentración de suero de un grupo de proteínas inflamatorias, de remodelación de tejido y asociadas a tumor e identificar biomarcadores candidatos sistémicos de la EPOC

Using quadruple clarithromycin-containing regimens for Helicobacter pylori eradication is controversial with high rates of macrolide resistance.To evaluate antibiotic resistance rates and the efficacy of empirical and tailored nonbismuth quadruple (concomitant) therapy in a setting with cure rates80% for triple and sequential therapies.209 consecutive naive H. pylori-positive patients without susceptibility testing were empirically treated with 10-day concomitant therapy (proton pump inhibitors (PPI), amoxicillin 1 g, clarithromycin 500 mg, and metronidazole 500 mg; all drugs b.i.d.). Simultaneously, 89 patients with positive H. pylori culture were randomized to receive triple versus concomitant therapy for clarithromycin-susceptible H. pylori, and sequential versus concomitant therapy for clarithromycin-resistant strains. Eradication was confirmed with ¹³C-urea breath test or histology 8 weeks after completion of treatment.Per-protocol (PP) and intention-to-treat eradication rates after empirical concomitant therapy without susceptibility testing were 89% (95%CI:84-93%) and 87% (83-92%). Antibiotic resistance rates were: clarithromycin, 20%; metronidazole, 34%; and both clarithromycin and metronidazole, 10%. Regarding clarithromycin-susceptible H. pylori, concomitant therapy was significantly better than triple therapy by per protocol [92% (82-100%) vs 74% (58-91%), p = 0.05] and by intention to treat [92% (82-100%) vs 70% (57-90%), p = 0.02]. As for antibiotic-resistant strains, eradication rates for concomitant and sequential therapies were 100% (5/5) vs 75% (3/4), for clarithromycin-resistant/metronidazole-susceptible strains and 75% (3/4) vs 60% (3/5) for dual-resistant strains.Empirical 10-day concomitant therapy achieves good eradication rates, close to 90%, in settings with multiresistant H. pylori strains. Tailored concomitant therapy is significantly superior to triple therapy for clarithromycin-susceptible H. pylori and at least as effective as sequential therapy for resistant strains.