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Helicobacter pylori (H. pylori) infection is a crucial risk factor for chronic gastritis, peptic ulcer and gastric cancer. The presence of oral H. pylori might affect the efficiency of eradication therapy and act as a causal force for its recurrence. Bismuth-containing quadruple therapy has recently been the first-line treatment recommended widely but has limited efficacy in patients with periodontitis. This study aimed to evaluate efficacy of bismuth-containing quadruple therapy with different adjunctive periodontal therapies in gastric H. pylori eradication. We conducted a prospective randomized trial on 160 gastric H. pylori infected patients who also have periodontitis, of whom 65 received quadruple therapy plus supragingival scaling (Group A) and 95 received quadruple therapy plus adjunctive periodontal therapy contained scaling and root planing(SRP) (Group B). The presence of H. pylori was detected by 13C-urea breath test (UBT). The probe depth (PD), clinical attachment loss(CAL) and plaque index (PLI) in group A and group B both improved after treatment. The eradication rate in Group B (87.37%) is significantly higher than Group A (75.38%). However, the difference between the two groups decreased with time. The recurrence rates after one year in Group A and Group B were 12.31% and 10.53%. This study suggests that adjunctive periodontal therapy is an effective added treatment for H. pylori infection. In addition, as an adjuvant treatment of quadruple therapy, the effect of SRP is significantly higher than that of supragingival scaling only. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal (GI) complaints are frequently observed in patients who suffer from anorexia nervosa (AN). These symptoms may hamper treatment and weight regain and are often perceived as the cause, not the consequence, of the disease. Since carbohydrate malabsorption also produces these symptoms, this might underly or contribute to these complaints. So far, the role of carbohydrate malabsorption (fructose malabsorption and lactose intolerance) in AN has not yet been investigated. Methods: For this case series, inpatients with AN of restrictive type (n = 3), purging type (n = 3), and atypical AN (n = 1) conducted hydrogen breath tests with 25 g of fructose and 50 g of lactose to investigate carbohydrate malabsorption. Results were then analyzed in association with body mass index (BMI) and patient-reported outcomes (disordered eating, body image disturbances, anxiety, depressive symptoms, perceived stress, and GI complaints). Results: Based on the hydrogen breath test results, three of the seven female patients were classified as lactose intolerant and one presented fructose malabsorption. Both hydrogen curves for fructose (r = -0.632, p < 0.001) and lactose (r = -0.704, p < 0.001) showed a negative correlation with BMI. No association was observed between hydrogen values and patientreported outcomes. Conclusion: In patients with AN, GI symptoms caused by intolerance of common monosaccharides and disaccharides may be an underestimated burden and should be considered in the diagnosis and therapy of patients with AN. Due to the observed correlation with BMI, GI complaints after ingestion of fructose or lactose likely develop with decreasing body weight and are potentially reversible with weight regain. [ABSTRACT FROM AUTHOR]

Pulses are healthy and sustainable but induce gut symptoms in people with a sensitive gut. Oats, on the contrary, have no fermentable oligo- di-, monosaccharides and polyols compounds and are known for the health effects of their fibres. This 4-day cross-over trial investigated the effects of oat and rice flour ingested with pulses on gut symptoms and exhaled gases (4th day only) in subjects with a sensitive gut or IBS (n 21) and controls (n 21). The sensitive group perceived more symptoms after both meals than controls (P = 0·001, P = 0·001). Frequency, intensity or quality of the symptoms did not differ between meals during the first 3 d in either group. More breath hydrogen was produced after an oat than rice containing meal in both groups (AUC, P = 0·001, P = 0·001). No between-group difference was seen in breath gases. During day 4, both sensitive and control groups perceived more symptoms after the oat flour meal (P = 0·001, P = 0·0104, respectively) as mainly mild flatulence. No difference in moderate or severe symptoms was detected. Increased hydrogen production correlated to a higher amount of perceived flatulence after the oat flour meal in both the sensitive and the control groups (P = 0·042, P = 0·003, respectively). In summary, ingestion of oat flour with pulses increases breath hydrogen levels compared with rice flour, but gastrointestinal symptoms of subjects sensitive to pulses were not explained by breath hydrogen levels. Additionally, consumer mindsets towards pulse consumption and pulse-related gut symptoms were assessed by an online survey, which implied that perceived gut symptoms hinder the use of pulses in sensitive subjects. [ABSTRACT FROM AUTHOR]

Background: Hydrogen and methane breath tests (HMBT) are widely used clinical investigations but lack standardization. To address this, the North American Consensus (NAC) group published evidence-based recommendations for HMBT. Aims: To evaluate results obtained using NAC recommendations for HMBT, compared to retrospective data that utilized guidelines previously recommended. Methods: HMBT data from 725 patients referred for small intestinal bacterial overgrowth (SIBO) and/or carbohydrate malabsorption (CM) testing were analyzed. Data were compared regarding dose of substrate for SIBO testing (16 vs. 10 g lactulose, and 50 vs. 75 g glucose) and the effect of post-ingestion sampling period for malabsorption testing. The effect of different recommended cut-off values for SIBO were examined. Results: Substrate dose did not affect methane production. 10 g lactulose significantly reduced positive SIBO results compared to 16 g lactulose (42 vs. 53%, p = 0.04). 75 g glucose significantly increased positive results compared to 50 g glucose (36 vs. 22%, p = 0.04). Provoked symptoms were significantly more prevalent in patients testing positive by both North American Consensus and Ledochowski cut-off values. 34.5% of patients tested positive for CM at 180-min compared to 28% at 120-min (not significant, p = 0.19). Conclusions and Inferences: 10 g lactulose substrate produces fewer positive SIBO results than 16 g lactulose, while 75 g glucose dose produces more positive SIBO results than 50 g. Performing CM breath tests for 180 min increases number of positive results when compared to 120 min. SIBO cut-off timings require further investigation, but our findings broadly support the NAC recommendations for SIBO and CM testing. [ABSTRACT FROM AUTHOR]

Background /Aims: The serum pepsinogen (PG) assay is used to screen subjects at high risk for gastric cancer. Currently, there are few studies on the PG levels for the detection of Helicobacter pylori infection. This study aimed to determine the PG assay findings for detecting ongoing infection. Methods: Asymptomatic subjects who underwent a 13C-urea breath test (13C-UBT) on the day of gastroscopy and serum assay for cancer screening were included. Subjects with a recent intake of acid suppressants or antibiotics, gastrectomy, or renal failure were excluded. H. pylori infection was defined as a positive 13C-UBT result. Results: Among the 500 included subjects, 167 (33.4%) had current infection. The serum PG II levels of > 12.95 ng/mL (area under the curve [AUC] = 0.930, sensitivity 86.5%, specificity 90.7%) and PG I/II ratios of < 4.35 (AUC = 0.875, sensitivity 86.8%, specificity 79.6%) were related to infection. The PG I/II ratios were inversely correlated with age (r = -0.160, p = 0.039). The cutoff values of PG I/II ratios were lower in older subjects aged ≥ 50 years (< 4.05; AUC = 0.875, sensitivity 80.7%, specificity 88.2%) than in younger subjects aged < 50 years (< 4.35; AUC = 0.873, sensitivity 77.4%, specificity 88.9%). Conclusions: Serum PG II levels > 12.95 ng/mL and PG I/II ratios < 4.35 suggest ongoing infection in asymptomatic subjects; therefore, H. pylori confirmation tests (i.e., 13C-UBT) should be considered under these conditions. Stricter criteria are required in older subjects aged ≥ 50 years (PG I/II ratio < 4.05) to detect ongoing infection than younger subjects. [ABSTRACT FROM AUTHOR]

Objective: To explore the clinical research of compound glutamine combined with quadruple therapy in the treatment of peptic ulcer. Methods: A total of 80 patients with peptic ulcer treated in our hospital from March 2019 to March 2022 were selected as the research objects. The patients were divided into conventional group and combined group, 40 cases in each group. The routine group was treated with quadruple therapy, and the combination group was treated with compound glutamine on the basis of the control group. The clinical efficacy and clinical indicators, carbon-13 breath test, changes in inflammatory factor levels, quality of life and recurrence rate were compared between the two groups of patients. Results: In this study, 80 patients underwent carbon-13 breath test, and there was no difference in the positive rate of Hp between the two groups (P>0.05). <0.05); after treatment, the total effective rate of the combined group was 95%, and the total effective rate of the conventional group was 75%, which was better than that of the conventional group (P<0.05); before treatment, there was no difference in the levels of inflammatory factors between the two groups ( P>0.05), after treatment, the levels of hs-CRP, IL-6, and TNF-α in the two groups decreased, and the combination group was better than the routine group (P<0.05); before treatment, the quality of life in the two groups was different There was no significant difference in the dimension scores (P>0.05). After treatment, the scores of each dimension in the two groups were improved, and the combination group was higher than that in the routine group (P<0.05). After the treatment, the patients in the two groups were followed up. The recurrence rate was 5%, and the ulcer recurrence rate in the conventional group was 25%, which was lower in the combined group than in the conventional group (P<0.05). Conclusion: In clinical treatment, compound glutamine combined with quadruple therapy can reduce the positive rate of Hp in patients, effectively reduce the inflammatory response of the body, improve the quality of life of patients, the clinical effect is obvious, and the recurrence rate is low. [ABSTRACT FROM AUTHOR]

This review article focuses on the use of breath tests in the field of bariatrics and obesitology. The first part of the review is an introduction to breath test problematics with a focus on their use in bariatrics. The second part provides a brief history of breath testing. Part three describes how breath tests are used for monitoring certain processes in various organs and various substances in exhaled air and how the results are analyzed and evaluated. The last part covers studies that described the use of breath tests for monitoring patients that underwent bariatric treatments. Although the number of relevant studies is small, this review could promote the future use of breath testing in the context of bariatric treatments. [ABSTRACT FROM AUTHOR]

Background: The diagnosis of NASH needs a liver biopsy, an invasive procedure that is not frequently accepted by patients. The aim of our study was to evaluate the efficacy of the 13C-Octanoate breath test (OBT) as a non-invasive surrogate marker to differentiate patients with NASH from patients with simple steatosis (NAFL). Methods: We performed a prospective study on patients with histologically established non-alcoholic steatohepatitis and no other hepatic disease. Each patient underwent a testing protocol, which included a clinical exam, laboratory blood tests, standard abdominal ultrasound, and a 13C-Octanoate breath test. Results: The study group included: 82 patients with steatohepatitis, 64 patients with simple steatosis, and 21 healthy volunteers. The univariate and bivariate analysis identified that significant values were the percent dose recovery (PDR) at 15 min—r = 0.65 (AUROC = 0.902) and cumulative percent dose recovery (cPDR) at 120 min—r = 0.69 (AUROC = 0.899). Discussion: Our study showed that 13C-OBT had good efficacy for identifying patients with NASH from those with NAFL (steatosis alone) but not those with NAFL from healthy subjects. Considering all these pathogenic steps in NASH we considered that OBT could have the clinical utility to identify patients at risk for NASH, especially "fast progressors". [ABSTRACT FROM AUTHOR]

(1) Background: The treatment goal of ketogenic glycogen storage diseases (GSDs) is appropriate control of hypoglycemia and other disturbances such as dyslipidemia. Monitoring and treatment of ketosis are known to improve outcomes. We used breath analysis to identify volatile organic compounds (VOCs) that correlate with serum ketones in order to provide a non-invasive method of monitoring ketosis. (2) Methods: Consecutive children with ketogenic GSDs were recruited from a single center during routine admission to monitor serum glucose and ketone levels. Five breath samples were collected from every patient at the same time of blood draws. SIFT-mass spectrometry was used to analyze breath samples. Univariate linear mixed-effects regression models for 22 known VOCs and either serum ketones or glucose were performed. (3) Results: Our cohort included 20 patients aged 5–15 years with a mean BMI of 20 kg/m2 (72% tile). Most patients had GSD type 0 (35%), while 25% had type IX. VOCs that showed a significant correlation with serum ketone levels included acetone (p < 0.0001), trimethylamine (p < 0.0001), pentane (p = 0.0001), 3-methylhexane (p = 0.0047), and carbon disulfide (p = 0.0499). No correlation was found between serum glucose and any VOC. (4) Conclusions: Breath analysis is a promising noninvasive tool that can be used to predict ketone serum levels in patients with GSD. [ABSTRACT FROM AUTHOR]

Helicobacter pylori infection (H. pylori) is mainly managed at the primary care level. Our group previously performed a study demonstrating that providing specific counselling (SC) to primary care practitioners (PCPs) who requested a urea breath test (UBT) improved treatment management but not indications for H. pylori tests. SC was given in the form of a personal letter addressed to PCPs with UBT results which contained information about accepted UBT indications and a Helicobacter pylori treatment algorithm. The purpose of the present study was to evaluate the effect of training sessions (TS) on UBT indications, antibiotic prescriptions and eradication rates. This was a quasi-experimental study performed at primary care centres (PCCs). Phase I included 399 patients diagnosed with H. pylori infection after providing SC to PCPs. Phase II included 400 H. pylori-positive patients after giving TS to PCPs who had already received SC (100 from PCCs with TS and 300 from PCCs without TS). An improved trend in the appropriate indication of H. pylori diagnosis was observed between Phase I and PCCs with TS in Phase II (57.5% vs. 67%; p = 0.06). TS improved appropriate prescriptions in PCCs with TS compared to PCCs that only received SC in Phase I and II (94% vs. 75.3%, p = 0.01; 94% vs. 85.6%, p = 0.04, respectively). Eradication rates showed no differences between groups. In conclusion, training sessions after specific counselling improved antibiotic prescription appropriateness but not eradication rates. [ABSTRACT FROM AUTHOR]

The clinical application of lung cancer detection based on breath test is still challenging due to lack of predictive molecular markers in exhaled breath. This study explored potential lung cancer biomarkers and their related pathways using a typical process for metabolomics investigation. Breath samples from 60 lung cancer patients and 176 healthy people were analyzed by GC-MS. The original data were GC-MS peak intensity removing background signal. Differential metabolites were selected after univariate statistical analysis and multivariate statistical analysis based on OPLS-DA and Spearman rank correlation analysis. A multivariate PLS-DA model was established based on differential metabolites for pattern recognition. Subsequently, pathway enrichment analysis was performed on differential metabolites. The discriminant capability was assessed by ROC curve of whom the average AUC and average accuracy in 100-fold cross validations were 0.871 and 0.787, respectively. Eight potential biomarkers were involved in a total of 18 metabolic pathways. Among them, 11 metabolic pathways have p-value smaller than.1. Some pathways among them are related to risk factors or therapies of lung cancer. However, more of them are dysregulated pathways of lung cancer reported in studies based on genome or transcriptome data. We believe that it opens the possibility of using metabolomics methods to analyze data of exhaled breath and promotes involvement of knowledge dataset to cover more volatile metabolites. Although a series of related research reported diagnostic models with highly sensitive and specific prediction, the clinical application of lung cancer detection based on breath test is still challenging due to disease heterogeneity and lack of predictive molecular markers in exhaled breath. This study may promote the clinical application of this technique which is suitable for large-scale screening thanks to its low-cost and non-invasiveness. As a result, the mortality of lung cancer may be decreased in future. In the present study, 11 pathways involving 8 potential biomarkers were discovered to be dysregulated pathways of lung cancer. We found that it is possible to apply metabolomics methods in analysis of data from breath test, which is meaningful to discover convinced volatile markers with definite pathological and histological significance. [ABSTRACT FROM AUTHOR]

To evaluate the safety and efficacy of high-dose amoxicillin-proton pump inhibitor dual therapy, and to provide a new eradication regimen as a first-line option for patients with H. pylori infection. A total of 971 H. pylori positive patients who received initial treatment were recruited from March to August 2020, and randomly divided into treatment group and control group. The treatment group received of 20 mg esomeprazole four times daily and 750 mg amoxicillin four times daily for 14 days. Control group received of 220 mg bismuth potassium citrate twice daily, 20 mg esomeprazole twice daily, 1000 mg amoxicillin twice daily and 250 mg clarithromycin capsule twice daily for 14 days. Four weeks after the end of treatment, the urea breath test was reviewed to detect whether H. pylori was eradicated. There were no statistical differences in age, gender, the total clinical symptom scores before and after initial treatment, the compliance, and the degree of remission of symptoms before and after initial treatment between the two groups. The eradication rates of H. pylori between dual therapy and quadruple therapy were 88.31% and 85.26% (p=.158) by intention-to-treat (ITT) analysis, 88.66% and 85.44% (p=.186) by modified intention-to-treat (mITT) analysis, and 91.63% and 90.60% (p=.116) by PP analysis, respectively. Adverse events in dual therapy group were significantly lower than quadruple therapy group (13.3% vs. 28.2% (p<.01)). For the initial treatment of H. pylori infection, the high-dose dual therapy regimen has the same efficacy as the bismuth-containing quadruple therapy regimen, good compliance, less adverse reactions and high safety, so it can be recommended as the empirical first-line treatment regimen for the eradication of H. pylori (KY2019173). [ABSTRACT FROM AUTHOR]

Excess ammonia (NH 3) in human exhaled breath serves as a biomarker for renal disease and helicobacter pylori-related gastropathy. A highly sensitive and selective ammonia sensor enables early non-invasive diagnosis of such diseases. Herein, lithium-doped ZnO nanoparticles with varying doping content (1, 5, 10-wt%) were synthesized by reflux method which can detect trace ammonia very efficiently. Specially, the sensor with 5-wt % lithium-doped ZnO (LZ-5) demonstrates remarkable selective sensitivity (43 %) to 1 ppm ammonia, paired with ultrafast response(0.72s)/recovery(1s), stability, and resilience against moisture. Comprehensive structural, morphological, and chemical characterization indicates that significant enhancement in gas sensing of LZ-5 due to increased surface area, elevated oxygen defects and higher donor defects. Density functional theory reveals that Li-doping notably decrease the adsorption energy, thereby improving the ammonia sensing performance. The efficacy of the LZ-5 sensor was evaluated using both real and simulated breath demonstrating its potential for monitoring renal diseases. [Display omitted] • Li doped cauliflower-like ZnO was synthesized via reflux method. • 5-wt % Li doped ZnO based sensor showed remarkable sensitivity (400 % higher than pristine ZnO) towards ammonia. • Prepared sensor is ultrafast in nature with response and recovery times of 0.72 s and 1 s, respectively. • Real and simulated exhale breath test confirms the potential of device applicability. • DFT simulation was invoked to understand the influence of doping. [ABSTRACT FROM AUTHOR]

Household air pollution is estimated to be responsible for nearly three million premature deaths annually. Measuring fractional exhaled nitric oxide (FeNO) may improve the limited understanding of the association of household air pollution and airway inflammation. We evaluated the cross-sectional association of FeNO with exposure to household air pollution (24-h average kitchen and personal fine particulate matter and black carbon; stove type) among 139 women in rural Honduras using traditional stoves or cleaner-burning Justa stoves. We additionally evaluated interaction by age. Results were generally consistent with a null association; we did not observe a consistent pattern for interaction by age. Evidence from ambient and household air pollution regarding FeNO is inconsistent, and may be attributable to differing study populations, exposures, and FeNO measurement procedures (e.g., the flow rate used to measure FeNO).

ImportanceThe optimal temporal approach for reducing nicotine to minimally or nonaddictive levels in all cigarettes sold in the United States has not been determined.ObjectivesTo determine the effects of immediate vs gradual reduction in nicotine content to very low levels and as compared with usual nicotine level cigarettes on biomarkers of toxicant exposure.Design, setting, and participantsA double-blind, randomized, parallel-design study with 2 weeks of baseline smoking and 20 weeks of intervention was conducted at 10 US sites. A volunteer sample of daily smokers with no intention to quit within 30 days was recruited between July 2014 and September 2016, with the last follow-up completed in March 2017.Interventions(1) Immediate reduction to 0.4 mg of nicotine per gram of tobacco cigarettes; (2) gradual reduction from 15.5 mg to 0.4 mg of nicotine per gram of tobacco cigarettes with 5 monthly dose changes; or (3) maintenance on 15.5 mg of nicotine per gram of tobacco cigarettes.Main outcomes and measuresBetween-group differences in 3 co-primary biomarkers of smoke toxicant exposure: breath carbon monoxide (CO), urine 3-hydroxypropylmercapturic acid (3-HPMA, metabolite of acrolein), and urine phenanthrene tetraol (PheT, indicator of polycyclic aromatic hydrocarbons) calculated as area under the concentration-time curve over the 20 weeks of intervention.ResultsAmong 1250 randomized participants (mean age, 45 years; 549 women [44%]; 958 [77%] completed the trial), significantly lower levels of exposure were observed in the immediate vs gradual reduction group for CO (mean difference, -4.06 parts per million [ppm] [95% CI, -4.89 to -3.23]; P

The non-invasive, quick, and safe collection of exhaled breath condensate makes it a candidate as a diagnostic matrix in personalized health monitoring devices. The lack of standardization in collection methods and sample analysis is a persistent limitation preventing its practical use. The collection method and hardware design are recognized to significantly affect the metabolomic content of EBC samples, but this has not been systematically studied. Here, we completed a series of experiments to determine the sole effect of collection temperature on the metabolomic content of EBC. Temperature is a likely parameter that can be controlled to standardize among different devices. The study considered six temperature levels covering two physical phases of the sample; liquid and solid. The use of a single device in our study allowed keeping saliva filtering and collector surface effects as constant parameters and the temperature as a controlled variable; the physiological differences were minimized by averaging samples from a group of volunteers and a period of time. After EBC collection, we used an organic solvent rinse to collect the non-water-soluble compounds from the condenser surface. This additional matrix enhanced metabolites recovery, was less dependent on temperature changes, and may possibly serve as an additional pointer to standardize EBC sampling methodologies. The collected EBC samples were analyzed with a set of mass spectrometry methods to provide an overview of the compounds and their concentrations present at each temperature level. The total number of volatile and polar non-volatile compounds slightly increased in each physical phase as the collection temperature was lowered to minimum, 0 °C for liquid and -30, -56 °C for solid. The low-polarity non-volatile compounds showed a weak dependence on the collection temperature. The metabolomic content of EBC samples may not be solely dependent on temperature but may be influenced by other phenomena such as greater sample dilution due to condensation from the ambient air at colder temperatures, or due to adhesion properties of the collector surface and occurring chemical reactions. The relative importance of other design parameters such as condenser coating versus temperature requires further investigation.

Peak ratios of pulmonary gas-exchange to ventilation during exercise (V˙O2/V˙E and V˙CO2/V˙E, termed "circulatory equivalents") are sensitive to heart failure (HF) severity, likely reflecting low and/or poorly distributed pulmonary perfusion. We tested whether peak V˙O2/V˙E and V˙CO2/V˙E would: (1) distinguish HF patients from controls; (2) be independent of incremental exercise protocol; and (3) correlate with lactate threshold (LT) and ventilatory compensation point (VCP), respectively. Twenty-four HF patients (61±11 years) with reduced ejection fraction (31±8%) and 11 controls (63±7 years) performed ramp-incremental cycle ergometry. Eighteen HF patients also performed slow (5±1 W/min), medium (9±4 W/min), and fast (19±6 W/min) ramps. Peak V˙O2/V˙E and V˙CO2/V˙E from X-Y plot, and LT and VCP from 9-panel plot, were determined by 2 independent, blinded, assessors. Peak V˙O2/V˙E (31.2±4.4 versus 41.8±4.8 mL/L; P

BackgroundThe neural mechanisms of anorexia nervosa (AN), a severe and chronic psychiatric illness, are still poorly understood. Altered body state processing, or interoception, has been documented in AN, and disturbances in aversive interoception may contribute to distorted body perception, extreme dietary restriction, and anxiety. As prior data implicate a potential mismatch between interoceptive expectation and experience in AN, we examined whether AN is associated with altered brain activation before, during, and after an unpleasant interoceptive state change.MethodsAdult women remitted from AN (RAN; n = 17) and healthy control women (CW; n = 25) underwent functional magnetic resonance imaging during an inspiratory breathing load paradigm.ResultsDuring stimulus anticipation, the RAN group, relative to CW, showed reduced activation in right mid-insula. In contrast, during the aversive breathing load, the RAN group showed increased activation compared with CW in striatum and cingulate and prefrontal cortices (PFC). The RAN group also showed increased activation in PFC, bilateral insula, striatum, and amygdala after stimulus offset. Time course analyses indicated that RAN responses in interoceptive processing regions during breathing load increased more steeply than those of CW. Exploratory analyses revealed that hyperactivation after breathing load was associated with markers of past AN severity.ConclusionsAnticipatory deactivation with a subsequent exaggerated brain response during and after an aversive body state may contribute to difficulty predicting and adapting to internal state fluctuation. Because eating changes our interoceptive state, restriction may be one method of avoiding aversive, unpredictable internal change in AN.

In this work, we present a hydrophilic self-cleaning condenser surface for the collection of biological and environmental aerosol samples. The condenser is installed in a battery-operated hand-held breath sampling device. The device performance is characterized by the collection and analysis of exhaled breath samples from a group of volunteers. The exhaled breath condensate is collected on a subcooled condenser surface, transferred into a storage vial, and its chemical content is analyzed using mass spectrometric methods. The engineered surface supports upon it a continuous condensation cycle, and this allows the collection of liquid samples exceeding the saturation mass/area limit of a plain hydrophilic surface. The condenser surface employs two constituent parameters: a low surface energy barrier to enhance nucleation and condensation efficiency, and a network of surface microstructures to create a self-cleaning mechanism for fluid aggregation into a reservoir. Removal of the liquid condensate from the condenser surface prevents the formation of a thick liquid layer, and thus maintains a continuous condensation cycle with a minimum decrease in heat transfer efficiency as condensation occurs on the surface. The self-cleaning condenser surfaces may have a number of applications in the collection of biological, chemical, or environmental aerosol samples. Sample phase conversion to liquid can facilitate sample manipulation and chemical analysis of matrices with low concentrations. Here, we demonstrate the use of a self-cleaning microcondenser for the collection of exhaled breath condensate with a hand-held portable device. All breath collections with the two devices were performed with the same group of volunteers under UC Davis IRB protocol 63701-3.

Selenium-binding protein 1 (SELENBP1) has been associated with several cancers, although its exact role is unknown. We show that SELENBP1 is a methanethiol oxidase (MTO), related to the MTO in methylotrophic bacteria, that converts methanethiol to H2O2, formaldehyde, and H2S, an activity not previously known to exist in humans. We identified mutations in SELENBP1 in five patients with cabbage-like breath odor. The malodor was attributable to high levels of methanethiol and dimethylsulfide, the main odorous compounds in their breath. Elevated urinary excretion of dimethylsulfoxide was associated with MTO deficiency. Patient fibroblasts had low SELENBP1 protein levels and were deficient in MTO enzymatic activity; these effects were reversed by lentivirus-mediated expression of wild-type SELENBP1. Selenbp1-knockout mice showed biochemical characteristics similar to those in humans. Our data reveal a potentially frequent inborn error of metabolism that results from MTO deficiency and leads to a malodor syndrome.

Objective: To investigate the effect of iron overload (IO) on red blood cell (RBC) lifespan in MDS patients with the use of carbon monoxide breath test Methods: The red blood cell lifespan of 93 patients with myelodysplastic syndrome (MDS) and 22 healthy volunteers in the control group were measured by alveolar gas carbon monoxide (CO) assay, with the detection of liver iron concentration, iron metabolism index, erythropoietin (EPO) concentration, peripheral blood inflammatory cytokines, etc. The MDS patients were divided into the severe IO group, mild IO group and non IO group according to liver iron concentration. The effect of IO on RBC lifespan was analyzed in MDS patients. Results: The RBC lifespan of MDS patients in the severe IO group was significantly lower than that in the mild IO group (p<0.05), while the RBC life span in the mild IO group was significantly lower than that in the non IO group (p<0.05). The expression of inflammatory cytokines in the severe IO group was significantly higher than that of the mild and non IO groups. After receiving iron removal treatment(ICT), the expression of inflammatory cytokines was decreased significantly, and the RBC lifespan was significantly prolonged (p<0.05).Besides, liver iron concentration was significantly positively correlated with EPO concentration, while EPO concentration was significantly negatively correlated with RBC lifespan, especially in the MDSRS subgroup. The RBC lifespan in the EPO>1000 group was significantly lower than that in the EPO<1000 group. Conclusion: IO can shorten RBC lifespan in MDS patients, which may be result from the increase of endogenous EPO and the over-expression of inflammatory cytokines. After ICT, the ineffective hematopoiesis caused by increased EPO may reduced and the decrease of inflammatory cytokine may significantly prolong the RBC lifespan in MDS patients. [ABSTRACT FROM AUTHOR]

Introduction Breath tests utilising13 C-labelled substrates for the assessment of gastric emptying have been applied widely. Wagner-Nelson analysis is a pharmacokinetic model that can be utilised to generate a gastric emptying curve from the %13 CO2 measured in breath samples. We compared Wagner-Nelson analysis with (i) scintigraphy and (ii) conventional breath test modelling to quantify gastric emptying in type 2 diabetes. Methods Thirteen patients (age 68.1±1.5 years, body mass index 31.0±0.9 kg/m2 , HbA1c 6.3±0.2%) consumed a mashed potato meal comprising 65 g powdered potato, 20 g glucose, 250 ml water, an egg yolk labelled with 100 μL13 C-octanoic acid and 20MBq99m Tc-calcium phytate. Scintigraphic data were acquired and breath samples collected for 4 hours after the meal. Gastric emptying curves were derived based on each technique; the 50% emptying time and intragastric retention at 60 min were also calculated. Results With Wagner-Nelson analysis, a Kel =0.60 (the elimination constant) best approximated the scintigraphic gastric emptying curve. There was a relationship between the T50 calculated with scintigraphy and by both Wagner-Nelson Kel =0.60 (r2 =0.45, P<0.05) and conventional analysis (r2 =0.44, P<0.05). There was no significant difference in the 50% gastric emptying time for scintigraphy (68.5±4.8 min) and Wagner-Nelson Kel =0.60 (71.3±4.5 min), however, the 50% gastric emptying time calculated by conventional analysis was much greater at 164.7±6.0 min (P<0.001). Conclusion In type 2 diabetes, gastric emptying of a mashed potato meal measured using a13 C-octanoic acid breath test analysed with Wagner-Nelson Kel =0.60 closely reflects measurements obtained with scintigraphy, whereas, in absolute terms, the conventional breath test analysis does not. [ABSTRACT FROM AUTHOR]

Gastroparesis, once regarded as a rare disease, is difficult to diagnose and challenging to treat; there were many breakthrough advances in the 2010s, shifting the paradigm of the understanding of this complex entity and its management. Similar to diabetes, its increasing prevalence reflects increased accessibility to diagnostic modalities and suggests that gastroparesis was underacknowledged in the past. Major developments in the three main aspects of the disease include the discovery of smooth muscle cells, interstitial cells of Cajal, PDGFRα+ cells syncytium, rather than interstitial cells of Cajal alone, as the main gastric pacemaker unit; the development of validated point-of-care diagnostic modalities such as a wireless motility capsule, the carbon 13-labeled breath test, and impedance planimetry; and the introduction of novel minimally invasive therapeutic options such as newer pharmacologic agents and gastric peroral endoscopic pyloromyotomy. All aspects of these advances will be discussed further in this review. [ABSTRACT FROM AUTHOR]

Background Alcohol-induced hangover represents a significant, yet understudied, global hazard and a large socioeconomic burden. Objective The aim of this study was to investigate the effects of hydrogen on relieving drinking and hangover symptoms in 20 healthy volunteers. Methods In this pilot, randomized, double-blinded, placebo-controlled, matched, crossover interventional trial, participants were matched into pairs and randomly assigned. Study group 1 inhaled placebo air for 1 h, followed by drinking 100 mL liquor (40% alcohol) within 10 min, and then pure water. Study group 2 inhaled a mixture of hydrogen and oxygen gas for 1 h, followed by drinking 100 mL liquor within 10 min, and then hydrogen dissolved in water. On a second intervention day (crossover) ≥1 wk later, study-group subjects were switched to the opposite order. Breath alcohol concentration (BrAC), hangover severity, and cognitive scores were measured. Results The BrACs within the hydrogen group were significantly lower than those within the placebo group after 30 min, 60 min, and 90 min (P   <  0.05). The hydrogen group reported having fewer hangover symptoms compared with the placebo group (placebo: 77% of symptoms absent, 19.7% of mild symptoms, 2.7% of moderate symptoms, 0.7% of severe symptoms; hydrogen: 88.6% of symptoms absent, 10% of mild symptoms, 1.3% of moderate symptoms, 0% of severe symptoms; P   <  0.001). Hydrogen treatment improved cognitive testing scores (P   <  0.05), including attention and executive functions. Furthermore, consumption of hydrogen was negatively (β = −13.016; 95% CI: −17.726, −8.305; P   <  0.001) and female sex was positively (β = 22.611; 95% CI: 16.226, 28.997; P   <  0.001) correlated with increased BrACs. Likewise, the consumption of hydrogen was negatively (OR: 0.035; 95% CI: 0.007, 0.168; P   <  0.001) while female sex was positively (OR: 28.838; 95% CI: 5.961, 139.506; P   <  0.001) correlated with the severity of hangover symptoms. Conclusions Hydrogen decreases BrACs and relieves the symptoms of hangovers. This trial was registered at the China Clinical Trial Registry (http://www.chictr.org.cn/showproj.aspx?proj=58359) as ChiCTR2200059988. [ABSTRACT FROM AUTHOR]

Small Intestinal Bacterial Overgrowth (SIBO) is a form of dysbiosis that involves increased bacterial colonization of the small intestine with some of the bacteria more characteristic of the colon microbiota. The prevalence of SIBO over recent decades has been estimated to range from 2.5 to 22% (depending on the source) and to increase with age and among individuals with comorbidities. Recently, an increase in the number of diagnosed SIBO cases has been observed, which is primarily due to the availability of noninvasive breath tests that facilitate the diagnostic process. However, SIBO is still both a diagnostic and a therapeutic problem. This review presents the pathophysiology, manifestations, diagnostics, and recommended management of SIBO. [ABSTRACT FROM AUTHOR]

Background: Accurate breath detection is essential for the computation of outcomes in the multiple-breath washout (MBW) technique. This is particularly important in young children, where irregular breathing is common, and the designation of inspirations and expirations can be challenging. Aim: To investigate differences between a commercial and a novel breath-detection algorithm and to characterize effects on MBW outcomes in children. Methods: We replicated the signal processing and algorithms used in Spiroware software (v3.3.1, Eco Medics AG). We developed a novel breath detection algorithm (custom) and compared it to Spiroware using 2,455 nitrogen (N2) and 325 sulfur hexafluoride (SF6) trials collected in infants, children, and adolescents. Results: In 83% of N2 and 32% of SF6 trials, the Spiroware breath detection algorithm rejected breaths and did not use them for the calculation of MBW outcomes. Our custom breath detection algorithm determines inspirations and expirations based on flow reversal and corresponding CO2 elevations, and uses all breaths for data analysis. In trials with regular tidal breathing, there were no differences in outcomes between algorithms. However, in 10% of pre-school children tests the number of breaths detected differed by more than 10% and the commercial algorithm underestimated the lung clearance index by up to 21%. Conclusion: Accurate breath detection is challenging in young children. As the MBW technique relies on the cumulative analysis of all washout breaths, the rejection of breaths should be limited. We provide an improved algorithm that accurately detects breaths based on both flow reversal and CO2 concentration. [ABSTRACT FROM AUTHOR]

Although lactose-free dairy products for the clinical management of lactose intolerance (LI) are widely available, scientific evidence on their efficacy is still lacking. This study comparatively analyzed the efficacy of flavored lactose-free milk (LFM) and whole milk (WM) in reducing symptoms in South Korean adults with LI. This prospective study was conducted in adults suspected of LI. All screened participants underwent the hydrogen breath test (HBT) using 570 mL of chocolate-flavored WM (20 g of lactose) and responded to a symptom questionnaire. LI was confirmed when the ΔH2 peak exceeded 16 ppm above baseline values and with the occurrence of symptoms after WM consumption. The participants who were diagnosed with LI underwent the HBT again with 570 mL of chocolate-flavored LFM (0 g of lactose), followed by the symptom questionnaire survey after 1 week. After excluding 40 participants who did not meet the diagnostic criteria for LI and 2 who were lost to follow-up, a total of 28 lactose-intolerant individuals were enrolled in the study. The ΔH2 values in the first HBT were significantly higher than those in the second HBT (33.3 ± 21.6 ppm vs. 8.6 ± 6.3 ppm, P < .001). Similarly, there was a significant reduction in the total symptom score in the second HBT (4.18 ± 1.51 vs. 0.61 ± 0.98, P < .001). Flavored LFM is well tolerated in South Korean adults diagnosed with LI based on the HBT and symptom questionnaire results. Therefore, LFM may be a viable alternative to WM. [ABSTRACT FROM AUTHOR]

This study aimed to assess the accuracy and factors influencing blood alcohol concentration self-estimation during voluntary breath testing. It also aimed to assess whether intended drinking behaviour changed after reviewing blood alcohol concentration and factors influencing this. A total of 462 Australian music festival patrons aged 18–40 years completed a survey exploring factors likely to affect estimation accuracy and provided an estimation of their blood alcohol concentration. A breathalyser reading was taken and participants were asked whether reviewing this reading changed their drinking intentions. Most respondents (58.4%) were accurate within 0.02% range, while 11.4% underestimated and 29.1% overestimated. Machine-read blood alcohol concentration was the most significant estimation accuracy predictor. Reviewing their readings changed the intention to drink in one-third of participants, indicating that voluntary breath testing may influence future drinking behaviour. Underestimation was associated with intention to drink less, whilst completing the survey earlier and <1 h since last drink was associated with intention to drink more. [ABSTRACT FROM AUTHOR]

The objective of the current study is to prove a link between IL17 gene polymorphisms and H. pylori infection. We obtained Seventy-eight (78) cases with clinical symptoms associated with H. pylori infection. Two tests, fast Ab immunoassay and urea breath testing, located 45 patients with H. pylori infection. 45 individuals who appeared to be in good health were used as the control group, and their samples were taken. The urea breath test has been identified as the gold standard technique for non-invasive diagnosis. Additionally, ELISA, sequencing, and traditional PCR techniques were used to find the interleukin 17 gene. In patients compared to controls, the genotypes C/T and C/C were found to be more prevalent, with odd ratios (95% CI) of 2.75 (1.06-7.15) and 0.71 (0.22-2.36) and P = 0.05, respectively. This may suggest that these SNP variants are linked to greater H. pylori infection, in contrast to the T/T genotype, which showed no significant difference between patients and controls and may result in reduced H. pylori infection for carriers. With a mean concentration of 97.87 ± 39.56 pg/ml in the H. pylori infection group as opposed to 75.57 ± 22.75pg/ml in the control group, interleukin 17 levels were elevated. The results of the comparison between the level of IL-17 and the genotypes of the IL-17 gene revealed that the genotype C/T in IL-17 (rs 3748067) showed the highest concentration of IL-17 (119.79 pg/ml) in the serum of these studied groups, while the average serum level of C/C(78.65 pg/ml) and T/T groups (78.68pg/ml). [ABSTRACT FROM AUTHOR]

Background: Chronic intestinal pseudo-obstruction (CIP) is a rare motility disorder characterized by dilated small bowel in the absence of mechanical obstruction. CIP has a known association with small intestinal bacterial overgrowth (SIBO); however, data regarding association with specific subtypes such as methane-positive (M+) and hydrogen-positive (H+) SIBO are limited. Therefore, we conducted this study to characterize subtypes of SIBO in CIP and compare them with non-CIP patients.Aims: The aim is to explore the association and prevalence of hydrogen and methane subtypes of SIBO in patients with CIP.Methods: A retrospective chart review was conducted for 494 patients who underwent glucose breath tests (GBT) in 2019. CIP was diagnosed based on clinical suspicion and after ruling out mechanical obstruction. We also reviewed demographic data, including age, gender, body mass index, tobacco and alcohol history, medical comorbidities, use of proton pump inhibitors, and history of colectomy.Results: Among 494 patients, 7.7% (38) had CIP. The prevalence of M+ GBT in CIP patients was higher compared with non-CIP patients, and it was significant [52.6% (20/38) versus 11.8% (54/456), p < 0.001]. The prevalence of H+ GBT in our cohort of CIP patients was similar to that of non-CIP patients [23.7% (9/38) versus 25.7% (117/456), p = 0.941].Conclusion: The prevalence of methane-positive GBT was higher in CIP patients than in patients without CIP. This finding further strengthens the hypothesis that the relationship between motility disorders and methanogen overgrowth is facilitative. [ABSTRACT FROM AUTHOR]

Background and Aim: Symptoms of small intestinal bacterial overgrowth (SIBO) and celiac disease (CeD) often overlap, and studies suggest a link between SIBO and CeD. We thus conducted a systematic review and meta‐analysis to compare SIBO prevalence in CeD patients and controls and assessed effects of antimicrobial therapy on gastrointestinal symptoms in SIBO positive CeD patients. Methods: Electronic databases were searched until February 2022 for studies reporting SIBO prevalence in CeD. Prevalence rates, odds ratio (OR), and 95% confidence intervals (CI) of SIBO in CeD and controls were calculated. Results: We included 14 studies, with 742 CeD patients and 178 controls. The pooled prevalence of SIBO in CeD was 18.3% (95% CI: 11.4–28.1), with substantial heterogeneity. Including case–control studies with healthy controls, SIBO prevalence in CeD patients was significantly increased (OR 5.1, 95% CI: 2.1–12.4, P = 0.0001), with minimal heterogeneity. Utilizing breath tests, SIBO prevalence in CeD patients was 20.8% (95% CI: 11.9–33.7), almost two‐fold higher compared with culture‐based methods at 12.6% (95% CI: 5.1–28.0), with substantial heterogeneity in both analyses. SIBO prevalence in CeD patients nonresponsive to a gluten free diet (GFD) was not statistically higher as compared with those responsive to GFD (OR 1.5, 95% CI: 0.4–5.0, P = 0.511). Antibiotic therapy of SIBO positive CeD patients resulted in improvement in gastrointestinal symptoms in 95.6% (95% CI: 78.0–99.9) and normalization of breath tests. Conclusions: This study suggests a link between SIBO and CeD. While SIBO could explain nonresponse to a GFD in CeD, SIBO prevalence is not statistically higher in CeD patients non‐responsive to GFD. The overall quality of the evidence is low, mainly due to substantial "clinical heterogeneity" and the limited sensitivity/specificity of the available diagnostic tests. [ABSTRACT FROM AUTHOR]

Objectives Cardiopulmonary involvement is a major cause of death in patients with SSc. This study evaluated the clinical utility and reliability of breath-holding test (BHT) in evaluating cardiopulmonary function in patients with SSc. Methods Seventy-two prospectively enrolled patients with SSc underwent BHT and the 6 min walk test (6MWT), along with measurements of the Borg dyspnoea scale and Scleroderma Health Assessment Questionnaire (SHAQ). Data on pulmonary function test and echocardiography were also collected. Validity was assessed based on the correlations between the best BHT and relevant clinical parameters. To assess the reliability of BHT, an additional 31 patients with SSc underwent BHTs twice within 2 week intervals. Results Mean (s. d.) best BHT time was 38.4 (15.7) s, and 6MWT distance was 473.5 (95.5) m. BHT showed significant correlations with the Borg dyspnoea scale before (r  = −0.367, P  < 0.001) and after (r  = −0.285, P  = 0.016) testing, whereas 6MWT were correlated with the Borg dyspnoea scale after (r  = −0.351, P  = 0.002) but not before (r  = −0.113, P  = 0.343) testing. BHT time was correlated with diffusing capacity for carbon monoxide (%, r  = 0.426, P  < 0.001), forced vital capacity (litres, r  = 0.373, P  = 0.001), pulmonary arterial systolic pressure (mmHg, r  = −0.272, P  = 0.031) and SHAQ score (r  = −0.470, P  < 0.001), but not with left ventricular ejection fraction (%, r  = −0.135, P  = 0.263). BHT showed excellent reliability, with an intraclass correlation coefficient (2, 1) of 0.943 (95% CI: 0.88, 0.97). Conclusion BHT, a simple and less time-consuming test, shows excellent reliability and significant correlation with the Borg scale, SHAQ and pulmonary parameters. These results suggest that BHT might be a useful surrogate marker of pulmonary capacity in SSc patients. Trial registration number NCT04484948. [ABSTRACT FROM AUTHOR]

Breath analysis is a promising non-invasive method for the detection and management of lung cancer. Exhaled breath contains a complex mixture of volatile and non-volatile organic compounds that are produced as end-products of metabolism. Several studies have explored the patterns of these compounds and have postulated that a unique breath signature is emitted in the setting of lung cancer. Most studies have evaluated the use of gas chromatography and mass spectrometry to identify these unique breath signatures. With recent advances in the field of analytical chemistry and machine learning gaseous chemical sensing and identification devices have also been created to detect patterns of odorant molecules such as volatile organic compounds. These devices offer hope for a point-of-care test in the future. Several prospective studies have also explored the presence of specific genomic aberrations in the exhaled breath of patients with lung cancer as an alternative method for molecular analysis. Despite its potential, the use of breath analysis has largely been limited to translational research due to methodological issues, the lack of standardization or validation and the paucity of large multi-center studies. It is clear however that it offers a potentially non-invasive alternative to investigations such as tumor biopsy and blood sampling. [ABSTRACT FROM AUTHOR]

Background: We aimed to assess the latest prevalence and secular trend of Helicobacter pylori infection and its association with the incidence and mortality of gastric cancer in Taiwan. Materials and Methods: Adults naive to H. pylori eradication received 13C‐urea breath test (13C‐UBT), H. pylori stool antigen test, and serology test during 2019–2020 in this prospective screening program. Children and adolescent aged between 7 and 19 years received 13C‐UBT for H. pylori screening. We also conducted a systematic review and meta‐analysis to assess the secular trend of prevalence of H. pylori from 1990 to 2020 in Taiwan. The secular trends of age‐standardized incidence and mortality of gastric cancer were obtained from the Taiwan Cancer Registry. Results: A total of 1494 participants were enrolled, including 294 children or adolescents and 1200 adults. The overall prevalence of active H. pylori infection by 13C‐UBT was 26.6% (397/1494), which was 30.8% in adults and 9.5% in adolescents/children. The age‐standardized prevalence of active H. pylori infection was 32.3% in adults after adjustment of the population structure in Taiwan. Of the 29 studies including 38,597 subjects eligible for the meta‐analysis, the pooled prevalence of H. pylori infection decreased from 63.8% (95% CI: 55.9%–71%) in 1990–2000 to 28.2% (95% CI:21.8%–35.6%) in 2016–2020. The age‐standardized incidence and mortality of gastric cancer have also declined from 15.2 to 10.75 per 100,000, respectively, in 1999 to 9.29 and 5.4 per 100,000, respectively, in 2019. Conclusions: The prevalence of H. pylori infection has declined in Taiwan, which correlates with the declining trends of age‐standardized incidence and mortality of gastric cancer in Taiwan. [ABSTRACT FROM AUTHOR]

Background: The recent data on the prevalence of Helicobacter pylori (H. pylori) infection in Russia are limited. The aim of the study was to compare Helicobacter pylori infection prevalence in ambulatory settings in Russia in 2017 and 2019 years. Materials and Methods: Subjects visiting primary care centers were invited to take part in the study. H. pylori status was assessed by 13C‐urea breath test (UBT). Data on subjects' demography, previous treatment exposure, and place of residence were collected in all federal districts of Russia in 2017 and in 2019 calendar years and processed centrally. Results: The data of 19,875 subjects were available for analysis. The prevalence of H. pylori infection assessed by positive UBT in treatment‐naive subjects was highest in the Southern (54.9%) and the North Caucasian (45.1%) federal districts. A significant difference (p < 0.05) in H. pylori prevalence between two testing periods was found only in a half of federal districts: the Central (46.2% in 2017 vs. 36.2% in 2019), the Northwestern (38.6% vs. 35.5% accordingly), the Volga (40.6% vs. 33.0%, accordingly), and the Ural (40.4% vs. 32.7%, accordingly). The lowest prevalence of H. pylori infection was revealed in the age group <18 years old (20.2%), while the highest in the age group of 41–50 years old (43.9%). In 2017, the prevalence of H. pylori was significantly (p < 0.05) higher than in 2019 in all age groups but younger than 18 and older than 70 y.o., where similar rates were found during both study periods. Conclusions: The prevalence of H. pylori according to 13C‐UBT testing of primary care visitors in Russia is lower than expected (38.8%). The highest prevalence of H. pylori infection found in the Southern and the North Caucasian federal districts of Russia and in the age group of 41–50 years old. This study was registered at clinicaltrials.gov (NCT04892238). [ABSTRACT FROM AUTHOR]

Background: The currently recommended quadruple regimens as rescue therapy on Helicobacter pylori infection were not as effective as being supposed, especially in those who had failed two or more times. Dual regimen composed of vonoprazan (a potassium‐competitive acid blocker) and amoxicillin might be an option since it's effective in eradication therapy as first‐line treatment. Objective: As a real‐world retrospective study, data were collected to evaluate the efficacy and safety of vonoprazan and amoxicillin dual regimen as rescue therapy in Helicobacter pylori positive patients who had failed one or more times in their previous treatment. Methods: From May 2020 to June 2021, the clinical data of patients who had failed in Helicobacter pylori infection treatment were collected in GI department of Peking University First Hospital, Beijing, China. Patients were given vonoprazan 20 mg or 40 mg per day and amoxicillin 3000 mg per day (VA dual therapy) for 14 days as rescue treatment. Helicobacter pylori status was evaluated by 13C‐urease breath test 6 weeks after treatment. All adverse effects during treatment were recorded. Results: A total of 186 patients were enrolled, including 67 males and 119 females. All of them had failed for 1 ~ 7 times in their previous treatment. Successful eradication was achieved in 172 patients (92.5%, 172/186). The adverse effects (referring to skin rash, abdominal pain, diarrhea, and headache), mainly mild and did not cause quit of treatment, occurred in 14 patients (7.5%, 14/186) and all symptoms relieved spontaneously. Conclusions: Dual regimen composed of vonoprazan and amoxicillin for 14 days was effective and safe as rescue therapy in Helicobacter pylori infection treatment. It could be chosen as a "simplified rescue therapy" with relatively high eradication rate no matter how many times the patients had failed and what regimens they had used previously. [ABSTRACT FROM AUTHOR]

Helicobacter pylori (H. pylori) continues to be a major health problem worldwide, causing considerable morbidity and mortality due to peptic ulcer disease and gastric cancer. The aim of the present systematic review and meta-analysis was to determine the sensitivity and specificity of 13C/14C-urea breath tests in the diagnosis of H. pylori infection. A PRISMA systematic search appraisal and meta-analysis were conducted. A systematic literature search of PubMed, Web of Science, EMBASE, Scopus, and Google Scholar was conducted up to August 2022. Generic, methodological and statistical data were extracted from the eligible studies, which reported the sensitivity and specificity of 13C/14C-urea breath tests in the diagnosis of H. pylori infection. A random effect meta-analysis was conducted on crude sensitivity and specificity of 13C/14C-urea breath test rates. Heterogeneity was assessed by Cochran's Q and I2 tests. The literature search yielded a total of 5267 studies. Of them, 41 articles were included in the final analysis, with a sample size ranging from 50 to 21857. The sensitivity and specificity of 13C/14C-urea breath tests in the diagnosis of H. pylori infection ranged between 64–100% and 60.5–100%, respectively. The current meta-analysis showed that the sensitivity points of estimate were 92.5% and 87.6%, according to the fixed and random models, respectively. In addition, the specificity points of estimate were 89.9% and 84.8%, according to the fixed and random models, respectively. There was high heterogeneity among the studies (I2 = 98.128 and 98.516 for the sensitivity and specificity, respectively, p-value < 0.001). The 13C/14C-urea breath tests are highly sensitive and specific for the diagnosis of H. pylori infection. [ABSTRACT FROM AUTHOR]

Résumé: La majorité des patients souffrant d'un syndrome de l'intestin irritable présentent des symptômes digestifs liés à la consommation d'aliments. Ces symptômes ont un impact majeur, notamment sur la qualité de vie. Une alimentation thérapeutique peut être proposée dans leur prise en charge. Cette prise en charge nécessite un encadrement diététique, afin d'éviter des carences nutritionnelles. Il reste encore difficile de savoir comment sélectionner les patients pouvant bénéficier d'une telle prise en prise en charge diététique. Les tests respiratoires sont des examens non invasifs, facilement disponibles qui permettent de mesurer la malabsorption en carbohydrates (lactose et fructose) ainsi que l'intolérance ou la présence de symptômes. Les carbohydrates mal absorbés peuvent être responsables des symptômes digestifs. Ces tests peuvent être proposés après exclusion d'une maladie organique chez des patients chez qui une intolérance semble une cause plausible à leurs symptômes. Il est conseillé de suivre un régime pauvre en lactose (12 g/j) uniquement chez les patients avec malabsorption associée à une intolérance au lactose. La place du test respiratoire au fructose reste encore à définir. Les tests respiratoires au lactulose et au glucose permettent de poser le diagnostic de pullulation bactérienne endoluminale ou Small Intestinal Bacterial Overgrowth (SIBO). Ce test est communément utilisé bien qu'imparfait. En cas de positivité, si et seulement si le tableau clinique est évocateur, un traitement antibiotique séquentiel peut être prescrit afin d'améliorer les symptômes. Les tests respiratoires après la prise d'un repas test sont de plus en plus étudiés en recherche clinique et pourraient faire partis de la prise en charge dans le futur. Most of patients suffering of irritable bowel syndrome (IBS) have gastrointestinal symptoms associated with food intake. These food-related symptoms have a major impact on quality of life. The management of patients with IBS can include diet. Dietary treatments should always involve a dietician in order to avoid nutritional deficiency. Moreover, to select the good patients to a diet remains a challenge. Breath tests are non-invasive and widely available, assessing carbohydrates malabsorption (fructose and lactose), but also intolerance, or the presence of gastrointestinal symptoms. Malabsorbed carbohydrates can lead to gastrointestinal symptoms in IBS. If carbohydrate intolerance is suspected, and after exclusion of an organic disease, breath tests could be proposed. Only patients with lactose malabsorption associated with intolerance should follow a lactose-free diet (12 g/day). The role of fructose breath test need to be defined in the management of patients with IBS. Lactulose and glucose breath tests are useful to diagnose small intestinal bacterial overgrowth (SIBO). This test is imperfect but is commonly used and should be only propose in case of a compatible clinical picture. If positive, antibiotics can improve the symptoms of patients. Meal challenge test associated with breath test might be part of the management in the future, while there are more and more used in clinical research. [ABSTRACT FROM AUTHOR]

Background: Alcohol induced intoxication is responsible for altered behavior in individuals. Blood alcohol concentration (BAC) has been the key toxicology test, which is considered as the gold standard in medico-legal evidence. BAC can be assessed by determining blood ethanol or methanol concentration. It is expensive and timeconsuming procedure and so, it cannot be considered as primary choice for screening of alcohol consumption. At present breath analysis is the most common and accepted screening procedure but there are certain limitations to this procedure and hence assessment of other procedures for screening is also important. Aim and Objective: The primary aim of the study is to assess efficiency of salivary strip test vs breath alcohol analyzer in screening for alcohol consumption among the individuals who are suspected for drunken driving by the city traffic police of Kannur district. Setting and Design: It's a Prospective case control study were samples are collected from Traffic aid post in Kannur district of Kerala for screening of suspected drunken driving. Materials and Method: Individuals suspected of drunken driving by the city traffic police of Kannur district were included in the study. Subjects were screened by using alcohol breath alcohol analyzer and Alcohol salivary strip. Statistical Analysis: It was performed using SPSS 20.0. Chi square test was used for association between variables. Results: The result shows that both salivary alcohol strip test is as effective as breath alcohol analysis. Conclusion: Salivary alcohol test strip is rapid, economically feasible and can easily be performed. The result given by strip is easy to interpret and can easily indicate different BAC level as it is very much sensitive even at a BAC value of 0.02%. [ABSTRACT FROM AUTHOR]

Dyspnea is a disorder that occurs because of shortness of breath and may lead to multiple complications. Intoxicated dyspnea patients are those who are addicted to alcohol, as well as have breathing problems. Mostly, problems faced by dyspnea patients are inhalation, when they take alcohol with severe concentration. For intoxicated dyspnea patients, there is a continuous need for alcohol breath testing along with breath indicators, since, an individual is prone to alcohol addiction, and faces problems of breathing such as asthma, hypertension, etc. The severe outbreak of dyspnea in these individuals may be deadly. To handle this condition, an alcoholic meter along with an incentive spirometer is designed that helps in the assessment of breathing problems by measuring the alcohol concentration and inhaled air. Several parameters have opted for both inhalation detection and alcohol concentration which include the severity of health problems encompassing asthma, hypertension for the detection of inhaled air, and normal, moderate, severe alcohol concentration. The working of the proposed device is validated through the analysis of these parameters. The results are obtained on the graph as well as on display, which shows a variation in the range among every individual with respect to selected parameters either in incentive spirometer (inhalation detection) or alcoholic meter, and these ranges are also displayed in a numeric form on LCD. The idea is to design an economical and portable device for intoxicated dyspnea patients for emergency conditions which is a combination of an alcoholic meter with an incentive spirometer (IS) for the measurement of alcohol concentration along with breathing problems by making use of sensors. This unique idea of combining an alcoholic meter with an incentive spirometer will aid intoxicated dyspnea patients in case of emergency. [ABSTRACT FROM AUTHOR]

The PVF Tedlar is widely used for gas collection in clinical diagnostics and environmental research. However, sample collection is frequently associated with the degradation, adsorption, or transformation of sensitive chemicals. Here, we explore to what extent the Tedlar bag collection effects the composition of expired breath samples. Collected breath samples were analyzed using the EESI-MS technique after the storage time of 30 min, 1 h, 2 h, 3 h, 4 h, 5 h, and 6 h, respectively. Our results demonstrated the gradual MS signal decay after 3 h storage. The decay rate of 3 h is about 45% and 6 h is about 88%. Therefore, the Tedlar bag is suggested as a reliable breath holder on the time scale of <3 h. [ABSTRACT FROM AUTHOR]

Background. The beneficial effects of probiotic supplementation standard antibiotic therapies for Helicobacter pylori infection have been verified, but the ability of probiotic monotherapy to eradicate H. pylori remains unclear. Aim. To evaluate the accuracy and efficacy of specific Lactobacillus strains against H. pylori infection. Methods. Seventy-eight patients with H. pylori infection were treated with strain L. crispatus G14-5M (L. crispatus CCFM1118) or L. helveticus M2-09-R02-S146 (L. helveticus CCFM1121) or L. plantarum CCFM8610 at a dose of 2 g twice daily for one month. 14C-urea breath test, the gastrointestinal symptom rating scale, serum pepsinogen concentrations, and serum cytokine concentrations of patients were measured at baseline and end-of-trial to analyze the effect of the Lactobacillus strains in eradicating H. pylori infection and reducing gastrointestinal discomfort in patients. In addition, the composition and abundance of the intestinal microbiota of patients were also measured at end-of-trial. Results. The 14C-urea breath test value of the three Lactobacillus treatment groups had decreased significantly, and the eradication rate of H. pylori had increased by the end of the trial. In particular, the eradication rate in the G14-5M treatment group was significantly higher than the placebo group (70.59% vs. 15.38%, P = 0.0039), indicating that one-month administration of the G14-5M regimen was sufficient to eradicate H. pylori infection. The ingestion of Lactobacillus strains also ameliorated the gastrointestinal symptom rating scale scores, and the serum interleukin-8 concentrations of H. pylori-infected patients appeared to modulate the gut microbiota of patients. However, none of the Lactobacillus strains had a significant effect on general blood physiological characteristics, serum tumor necrosis factor α concentrations, or serum pepsinogen concentrations in the patients. Conclusion. Three Lactobacillus strains significantly alleviate the gastrointestinal discomfort and the gastric inflammatory response of H. pylori-infected patients. The activity of probiotics in eradicating H. pyloriinfection may be species/strain specific. [ABSTRACT FROM AUTHOR]

This article presents and illustrates a functional modeling-based representation of digital twinning (DT) architectures. We provide a detailed review of the existing architectures and frameworks intended for use on product digital twins. We identified gaps in the prior work on architectures and frameworks for DT of products, product families, and systems. We identified a need for robust representation schemes that enable product-specific synthesis and analysis of DTs, which the existing DT architecture representations do not offer. We integrated the efforts of the researchers on DT architectures in our functional modeling-based architecture representation approach. We included selected attributes of each reviewed framework and addressed the identified gaps through our functional modeling-based DT architecture representation. The proposed architecture representation approach opens up new avenues of research and can potentially help improve the design process for product DT. This paper illustrates our approach through an instructional example of a COVID-19 testing breathalyzer kiosk designed as a rapid response to the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Objectives: To study the correlation of eradication and recurrence with IL-1 β, IL-6 and TNF-α levels in children with Helicobacter pylori (Hp) infection. Methods: Children confirmed with Hp infection (n = 153) in our hospital from January to June 2019 and successfully followed up for one year were selected as the study subjects, and 73 healthy children of the same period were selected as the control group. The levels of IL-1 β, IL-6 and TNF-α in children confirmed with Hp infection and healthy children were detected, respectively. Results: Results of triple therapy: 113 cases (73.9%) reexamined with negative 13C-urea breath test were included in Group-A; and 40 cases (26.1%) reexamined with positive 13C-urea breath test were included in Group-B. Follow up results: 23 cases (20.4%) positive in 13C-urea breath test in one year follow-up were included in Group-C; and 90 cases (79.6%) negative in 13C-urea breath test in one year follow-up were included in Group-D. Group-B showed significantly higher levels of IL-1β, IL-6 and TNF-α when compared with the Group-A and the control group, respectively (P < 0.05). Obviously higher levels of IL-1β, IL-6 and TNF-α were observed in Group-C and Group-D in comparison with the control group (P < 0.05). There was no significant difference in IL-1 β level between Group-C and Group-D (P > 0.05). IL-6 and TNF-α levels in Group-C were remarkably higher than those in Group-D (P < 0.05). Conclusions: Higher levels of IL-1β, IL-6 and TNF-α may affect the eradication effect of triple therapy in Children with Hp infection, and increased levels of IL-6 and TNF-α may affect the recurrence rate of Hp infection in children. [ABSTRACT FROM AUTHOR]

Pulse rate variability is a physiological parameter that has been extensively studied and correlated with many physical ailments. However, the phase relationship between inter-beat interval, IBI, and breathing has very rarely been studied. Develop a technique by which the phase relationship between IBI and breathing can be accurately and efficiently extracted from photoplethysmography (PPG) data. A program based on Lock-in Amplifier technology was written in Python to implement a novel technique, Dynamic Phase Extraction. It was tested using a breath pacer and a PPG sensor on 6 subjects who followed a breath pacer at varied breathing rates. The data were then analyzed using both traditional methods and the novel technique (Dynamic Phase Extraction) utilizing a breath pacer. Pulse data was extracted using a PPG sensor. Dynamic Phase Extraction (DPE) gave the magnitudes of the variation in IBI associated with breathing (Δ I B I) measured with photoplethysmography during paced breathing (with premature ventricular contractions, abnormal arrhythmias, and other artifacts edited out). Δ I B I correlated well with two standard measures of pulse rate variability: the Standard Deviation of the inter-beat interval (SDNN) (ρ = 0.911) and with the integrated value of the Power Spectral Density between 0.04 and 0.15 Hz (Low Frequency Power or LF Power) (ρ = 0.885). These correlations were comparable to the correlation between the SDNN and the LF Power (ρ = 0.877). In addition to the magnitude Δ I B I , Dynamic Phase Extraction also gave the phase between the breath pacer and the changes in the inter-beat interval (IBI) due to respiratory sinus arrythmia (RSA), and correlated well with the phase extracted using a Fourier transform (ρ = 0.857). Dynamic Phase Extraction can extract both the phase between the breath pacer and the changes in IBI due to the respiratory sinus arrhythmia component of pulse rate variability ( Δ I B I) , but is limited by needing a breath pacer. [ABSTRACT FROM AUTHOR]

Background: Patients with sleep disturbances have gastrointestinal symptoms. Breath hydrogen (H2) and methane (CH4) indicating small intestinal bacterial overgrowth (SIBO) might be related with these symptoms. The study was conducted to assess the link between breath profiles and untreated obstructive sleep apnea (OSA). Methods: This prospective study enrolled consecutive patients with OSA using polysomnography. Heart rate variability (HRV) was used as a measurement for the balance of autonomic nervous system during polysomnography. Glucose breath test (GBT) to evaluate breath H2 and CH4 and bowel symptom questionnaire to investigate associated intestinal symptoms were performed. Results: Among 52 patients with OSA, 16 (30.8%) showed positivity to GBT. Although no significant difference was shown in GBT positivity between patients with healthy controls and patients with OSA (13.3% vs 30.8%, P = 0.109), breath H2 and CH4 levels in the OSA group were significantly higher than those in controls (P < 0.05). Flatulence was significantly common in OSA groups with GBT positivity than those without GBT positivity. Multivariate analysis demonstrated that waist-to-hip ratio (odds ratio = 12.889; 95% confidence interval (CI): 1.257–132.200; P = 0.031) and low-to-high-frequency ratio of HRV (odds ratio = 1.476; 95% CI: 1.013–2.151, P = 0.042) are independently related to GBT positivity in patients with OSA. Conclusion: Elevated breath H2 or CH4 after glucose load might not be an uncommon finding in patients with untreated OSA. Abdominal obesity and autonomic imbalance dysfunction are significantly associated with GBT positivity in OSA patients. SIBO could be considered as target for therapeutic management in OSA patients. [ABSTRACT FROM AUTHOR]

Background: The 13C-urea breath test (13C-UBT) is preferred for non-invasive detection of Helicobacter pylori (H. pylori); however, its accuracy drops when results fall between 2‰ and 6‰ (called the gray zone). This study aimed to evaluate the accuracy of 13C-UBT (cut-off point 4‰) between 2‰ and 6‰, find a more appropriate gray zone, and identify the factors influencing 13C-UBT. Methods: Patients with 13C-UBT results 2‰–6‰, over an eight-year period, were studied. H. pylori infection was diagnosed if patients were positive for either Warthin–Starry staining or quantitative real-time polymerase chain reaction (real-time PCR), and excluded if both were negative. Accuracy of 13C-UBT under different cut-off points was calculated, and the factors affecting 13C-UBT were analyzed. Results: A total of 208 patients were included, of whom 129 were H. pylori–positive. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of 13C-UBT were 71.32%, 83.54%, 64.08%, and 87.62%, respectively. When the cut-off point was changed to 2.15‰, the NPV of 13C-UBT reached a maximum (76.47%); when the cut-off point was changed to 4.95‰, PPV reached its maximum (93.22%). Therefore, the original gray zone (2‰–6‰) was adjusted to 2‰–4.95‰. Gastric antral intestinal metaplasia (OR = 3.055, 95% CI: 1.003–9.309) was an independent risk factor for false-negative 13C-UBT. Conclusions: Accuracy of 13C-UBT over 2‰–6‰ was poor, and the gray zone was changed to 2‰–4.95‰. 13C-UBT results over 2‰–4.95‰ should be interpreted with caution during mass screening of H. pylori, especially for patients with gastric antral intestinal metaplasia. [ABSTRACT FROM AUTHOR]