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Levofloxacin-based therapy or bismuth-based quadruple therapy are the recommended second-line regimens for Helicobacter pylori eradication after failure of clarithromycin-based therapy. However, resistance to levofloxacin has increased in the past decade. Furthermore, little is known about the long-term effects of H pylori eradication on the antibiotic resistome. In this study, we compared these second-line eradication therapies for efficacy, tolerability, and short-term and long-term effects on the gut microbiota, antibiotic resistome, and metabolic parameters.We did a multicentre, open-label, parallel group, randomised controlled trial at eight hospitals in Taiwan. Adult patients (age ≥20 years) with persistent H pylori infection after first-line clarithromycin-based therapy were randomly assigned (1:1, permuted block sizes of four) to receive levofloxacin-based sequential quadruple therapy for 14 days (EAML14; esomeprazole 40 mg and amoxicillin 1 g for 7 days, followed by esomeprazole 40 mg, metronidazole 500 mg, and levofloxacin 250 mg for 7 days, all twice-daily) or bismuth-based quadruple therapy for 10 days (BQ10; esomeprazole 40 mg twice daily, bismuth tripotassium dicitrate 300 mg four times a day, tetracycline 500 mg four times a day, and metronidazole 500 mg three times a day). All investigators were masked to the randomisation sequence. The primary endpoint was H pylori eradication rate measured byBetween Feb 25, 2015, and Dec 11, 2020, 560 patients were randomly assigned to receive EAML14 or BQ10 (n=280 per group; 261 [47%] men and 299 [53%] women). Mean age was 55·9 years (SD 12·7) in the EAML14 group and 54·9 years (12·3) in the BQ10 group. Eradication of H pylori was achieved in 246 (88%) of 280 participants in the EAML14 group and 245 (88%) of 280 in the BQ10 group according to ITT analysis (risk difference -0·4%, 95% CI -5·8 to 5·1; p=0·90). In the per-protocol analysis, 246 (90%) of 273 participants in the EAML14 group and 245 (93%) of 264 participants in the BQ10 group achieved H pylori eradication (risk difference 2·7%, 95% CI -0·2 to 7·4; p=0·27). Transient perturbation of faecal microbiota diversity at week 2 was largely restored to basal state 1 year after EAML14 or BQ10. Diversity recovery was slower with BQ10, and recovery in species abundance was partial after both therapies. On shotgun sequencing, we observed significant increases in total resistome after EAML14 (p=0·0002) and BQ10 (p=4·3 × 10We found no evidence of superiority between levofloxacin-based quadruple therapy and bismuth-based quadruple therapy in the second-line treatment of H pylori infection. The transient increase in the antibiotic resistome and perturbation of faecal microbiota diversity were largely restored to pretreatment state from 2 months to 1 year after eradication therapy.The Ministry of Science and Technology of Taiwan, the Ministry of Health and Welfare of Taiwan, National Taiwan University Hospital, Taipei Veteran General Hospital, and the Australian Federal Government through the St George and Sutherland Medical Research Foundation.For the Chinese translation of the abstract see Supplementary Materials section.

Background The updated prevalence of Helicobacter pylori (H. pylori) is lacking in Taiwan. We aimed to assess the accuracy of Vstrip® H. pylori Stool Antigen Rapid Test (Vstrip®HpSA) in the detection and surveillance of the updated prevalence of H. pylori in Taiwan. Methods A total of 347 adult subjects including 152 volunteers and 195 symptomatic patients were recruited. Stool samples were collected for detection of H. pylori using Vstrip® HpSA, ImmunoCard STAT!® HpSA and Premier Platinum HpSA® PLUS. All subjects who have completed the stool sample collections were included in the ITT analysis. The sensitivity, specificity, and accuracy of Vstrip® HpSA were calculated compared to gold standard test with 13C-Urea breath test. Results The un-adjusted prevalence of H. pylori infection was 22.5% (95% CI: 18.3–27%) in 2018. The age-standardized prevalence of H. pylori was 21.8% in asymptomatic adults in Taiwan. The sensitivity, specificity, and accuracy of the Vstrip® HpSA, and ImmunoCard STAT!® HpSA tests were 91% (95% CI: 82–96%) versus 76.9% (95% CI: 66–86%), 97% (95% CI: 94.1–98.6%) versus 97% (95% CI: 94.1–98.6%), and 95.7% (95% CI: 92–97%) versus 92.5% (95% CI: 89–95%), respectively. Conclusion The age-standardized prevalence of H. pylori infection in Taiwan was 21.8% in asymptomatic adults in 2018. The Vstrip® HpSA had equivalent performance as the ImmunoCard STAT!® HpSA, and can be used in future mass screening of H. pylori infection for gastric cancer prevention.

The aim of this study was to explore the behavior of online fitness users by using an integrated technology acceptance model. We also discussed the significant impact of fitness live streaming users on the integrated technology acceptance model. A cross-sectional study was carried out on a sample of 150 users who used Facebook fitness live streaming platform to watch fitness live streaming videos and usedthe live message reply, like and tracking functions. TheUnified Theory of Acceptance and Use of Technology (UTAUT) model was utilized to examine the behavior of users of Facebook fitness live streaming platform. The results showedthat there are statistically significant impacts in each structure of UTAUT,and the users of fitness live streaming have positive effects in UTAUT. In addition, the convenience and the infinityofInternet allows the social media users to obtain effective information through fast and real-time communication media and most users have the resources and knowledge required for live streaming. El objetivo de este estudio fue explorar el comportamiento de los usuarios de fitness en línea mediante el uso de un modelo integrado de aceptación de tecnología. También discutimos el impacto significativo de los usuarios de transmisión en vivo de fitnessen el modelo integrado de aceptación de tecnología. Se llevó a cabo un estudio transversal en una muestra de 150 usuarios que usaron la plataforma de transmisión en vivo de fitness de Facebook para ver videos de transmisión en vivo de fitness y usaron lasfunciones de respuesta de mensajes en vivo, me gusta y seguimiento. El modelo de Teoría Unificada de Aceptación y Uso de Tecnología (UTAUT) se utilizó para examinar el comportamiento de los usuarios de la plataforma de transmisión en vivo de fitness de Facebook. Los resultados mostraron que hay impactos estadísticamente significativos en cada estructura de UTAUT, y los usuarios de transmisión en vivo de fitness tienen efectos positivos en UTAUT. Además, la conveniencia y la infinidad de Internet permite a los usuarios de las redes sociales obtener información efectiva a través de medios de comunicación rápidos y en tiempo real y la mayoría de los usuarios tienen los recursos y conocimientos necesarios para la transmisión en vivo.

BACKGROUND AND AIM The reported prevalence of Helicobacter pylori infection in Taiwan was 54.4% in 1992. An updated prevalence of H. pylori infection in asymptomatic adults is lacking in Taiwan. We aimed to assess the updated age-standardized prevalence of H. pylori infection in asymptomatic subjects and in patients with dyspepsia and to assess the accuracy of H. pylori stool antigen (HpSA) test for screening of H. pylori in Chinese population. METHODS Asymptomatic adult subjects (N = 189) were screened for H. pylori infection using HpSA, serology, and 13 C-urea breath test (13 C-UBT) in 2016-2017. Adult patients with dyspepsia (N = 145) were screened for H. pylori using 13 C-UBT, HpSA, serology, rapid urease test, and histology during 2016-2018. Two types of HpSA, including the Diagnostec HpSA ELISA Kit (HpSA ELISA) and Rapid Test Kit (HpSA Rapid), were used in this study. Sensitivity, specificity, and accuracy of the HpSA tests were calculated using the 13 C-UBT as golden standard test. RESULTS The unadjusted prevalence of H. pylori was 21.2% in asymptomatic adults and 37.9% in patients with dyspepsia (P

Background & Aims We aimed to compare the efficacy of genotypic resistance–guided therapy vs empirical therapy for eradication of refractory Helicobacter pylori infection in randomized controlled trials. Methods We performed 2 multicenter, open-label trials of patients with H pylori infection (20 years or older) failed by 2 or more previous treatment regimens, from October 2012 through September 2017 in Taiwan. The patients were randomly assigned to groups given genotypic resistance–guided therapy for 14 days (n = 21 in trial 1, n = 205 in trial 2) or empirical therapy according to medication history for 14 days (n = 20 in trial 1, n = 205 in trial 2). Patients received sequential therapy containing esomeprazole and amoxicillin for the first 7 days, followed by esomeprazole and metronidazole, with levofloxacin, clarithromycin, or tetracycline (doxycycline in trial 1, tetracycline in trial 2) for another 7 days (all given twice daily) based on genotype markers of resistance determined from gastric biopsy specimens (group A) or empirical therapy according to medication history. Resistance-associated mutations in 23S ribosomal RNA or gyrase A were identified by polymerase chain reaction with direct sequencing. Eradication status was determined by 13C-urea breath test. The primary outcome was eradication rate. Results H pylori infection was eradicated in 17 of 21 (81%) patients receiving genotype resistance–guided therapy and 12 of 20 (60%) patients receiving empirical therapy (P = .181) in trial 1. This trial was terminated ahead of schedule due to the low rate of eradication in patients given doxycycline sequential therapy (15 of 26 [57.7%]). In trial 2, H pylori infection was eradicated in 160 of 205 (78%) patients receiving genotype resistance–guided therapy and 148 of 205 (72.2%) patients receiving empirical therapy (P = .170), according to intent to treat analysis. The frequencies of adverse effects and compliance did not differ significantly between groups. Conclusions Properly designed empirical therapy, based on medication history, is an acceptable alternative to genotypic resistance–guided therapy for eradication of refractory H pylori infection after consideration of accessibility, cost, and patient preference. ClinicalTrials.gov ID: NCT01725906.

The present practice of managing reticle haze defectivity involves reticle inspection at regular intervals, coupled with inspection of print-down wafers in between reticle inspections. The sensitivity of the reticle inspection tool allows it to detect haze defects before they are large enough to print on the wafer. Cleaning the reticle as soon as the reticle inspector detects haze defects could result in a shorter reticle lifetime. Thus there is strong motivation to develop a methodology to determine what size defect on the reticle results in a printable defect on the wafer. Printability depends upon several variables in the litho process as well as whether the defect resides in a high-MEEF (Mask Error Enhancement Factor) or low-MEEF area of the die.1 Trying to use wafer inspection to identify the first appearance of haze defects may require inspector recipe settings that are not suited to a practical wafer scan. A novel method of managing such defects is to map the coordinates of the defects from the reticle onto the wafer, and apply a separate, hyper-sensitive threshold to a small area surrounding the given coordinates. With this method, one can start to correlate the size of the defects printed on the wafer to the light transmission rate from the corresponding site on the reticle scan, and thus can predict the starting point at which the haze defects on the reticle are likely to print on the wafer. The experiment described in this paper is a first step in exploring the feasibility of this method to help track the growth of nascent haze defects and optimize the timing to rework the reticles. The methodology may have extendibility to other applications in which hyper-sensitive wafer inspection at localized areas within the die would be beneficial, such as monitoring weak spots found by Optical Rule Check, Process Window Qualification, electrical test or failure analysis.

The needs of the organic eggs are increasing; therefore, the farmers of chicken-egg (FCE) provide the best eggs to their consumers to satisfy their needs and wants. Because the FCE cannot satisfy every consumer' needs, FCE has to focus on some specific groups to satisfy their needs and wants. This paper is to clarify the segmentation of the customers in middle Taiwan and build the empirical model via Cluster Analysis. The 460 samples are taken randomly without some adjustment, but only 341 samples are used. As the results, this paper gets the segmentations of product oriented, economic oriented, and production oriented, and which would be the target markets that the FCE should focus on.