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BACKGROUND: Small intestinal bacterial overgrowth (SIBO) is a common, yet underdiagnosed, gut condition caused by gut dysbiosis. A previous study has shown the potential of herbal therapy, providing equivalent results to rifaximin. OBJECTIVES: The objective of this study was to assess how the use of an oral botanical regimen may modulate the gut microbiome, facial erythema, and intestinal permeability in those with SIBO. METHODS: This was an open-label prospective study of adults that had lactulose breath test-confirmed SIBO. Participants received a 10-week oral supplementation of a Biocidin liquid tincture and GI Detox+. If participants were found to be non-responsive to treatment after 10 weeks with a persistently positive lactulose breath test, a third oral supplement, Olivirex, was administered for an additional 4 weeks. Lactulose breath tests were administered at baseline, weeks 6, 10, and 14 to assess for SIBO status. A high-resolution photographic analysis system was utilized to analyze changes in facial erythema. Stool sample collections and venipuncture were performed to analyze the gut microbiome and intestinal permeability. RESULTS: A total of 33 subjects were screened with breath testing, and 19 subjects were found to have SIBO. Three of the subjects withdrew during the screening period prior to baseline, and sixteen subjects enrolled. Four subjects dropped out after baseline. Hydrogen-dominant SIBO was the most common subtype of SIBO, followed by methane and hydrogen sulfide. The botanical regimen was most effective for hydrogen- and hydrogen sulfide-dominant SIBO, leading to negative breath test results at week 10 in 42.8% and 66.7% of participants, respectively. Compared to baseline, supplementation with the botanical regimen led to positive shifts in short-chain fatty acid-producing bacteria such as A. muciniphila, F. prausnitzii, C. eutectus, and R. faecis by 31.4%, 35.4%, 24.8%, and 48.7% percent at week 10, respectively. The mean abundance of Firmicutes decreased by 20.2%, Bacteroides increased by 30%, and the F/B ratio decreased by 25.4% at week 10 compared to baseline. At week 10, there was a trending 116% increase in plasma LPS/IgG (p = 0.08). There were no significant changes in plasma zonulin, DAO, histamine, DAO/histamine, LPS/IgG, LPS/IgA, or LPS/IgM. Facial erythema was not statistically different at week 6, but at week 10, there was a 20% decrease (p = 0.001) in redness intensity. Among the patients that extended to week 14, there was no statistical change in erythema. CONCLUSIONS: Supplementation with an antimicrobial botanical supplemental regimen may have therapeutic potential in hydrogen and hydrogen-sulfide subtypes of SIBO. Furthermore, the botanical supplemental regimen may reduce facial erythema, increase SCFA-producing bacteria, decrease the F/B ratio, and modulate markers of intestinal permeability.

Recent respiratory outbreaks have garnered substantial attention, yet most respiratory monitoring remains confined to physical signals. Exhaled breath condensate (EBC) harbors rich molecular information that could unveil diverse insights into an individual's health. Unfortunately, challenges related to sample collection and the lack of on-site analytical tools impede the widespread adoption of EBC analysis. Here, we introduce EBCare, a mask-based device for real-time in situ monitoring of EBC biomarkers. Using a tandem cooling strategy, automated microfluidics, highly selective electrochemical biosensors, and a wireless reading circuit, EBCare enables continuous multimodal monitoring of EBC analytes across real-life indoor and outdoor activities. We validated EBCare's usability in assessing metabolic conditions and respiratory airway inflammation in healthy participants, patients with chronic obstructive pulmonary disease or asthma, and patients after COVID-19 infection.

Electronic cigarette smoking (or vaping) is on the rise, presenting questions about the effects of secondhand exposure. The chemical composition of vape emissions was examined in the exhaled breath of eight human volunteers with the high chemical specificity of complementary online and offline techniques. Our study is the first to take multiple exhaled puff measurements from human participants and compare volatile organic compound (VOC) concentrations between two commonly used methods, proton-transfer-reaction time-of-flight mass spectrometry (PTR-ToF-MS) and gas chromatography (GC). Five flavor profile groups were selected for this study, but flavor compounds were not observed as the main contributors to the PTR-ToF-MS signal. Instead, the PTR-ToF-MS mass spectra were overwhelmed by e-liquid thermal decomposition and fragmentation products, which masked other observations regarding flavorings and other potentially toxic species associated with secondhand vape exposure. Compared to the PTR-ToF-MS, GC measurements reported significantly different VOC concentrations, usually below those from PTR-ToF-MS. Consequently, PTR-ToF-MS mass spectra should be interpreted with caution when reporting quantitative results in vaping studies, such as doses of inhaled VOCs. Nevertheless, the online PTR-ToF-MS analysis can provide valuable qualitative information by comparing relative VOCs in back-to-back trials. For example, by comparing the mass spectra of exhaled air with those of direct puffs, we can conclude that harmful VOCs present in the vape emissions are largely absorbed by the participants, including large fractions of nicotine.

Across the United States, there is increased use of cannabis products and electronic delivery systems for cannabis products and nicotine, yet little is known about their impacts on lung health. We analyzed exhaled breath condensate of 254 participants who were non-users and users who used cannabis and tobacco products. The 132 participants reported using a product ("users") were distributed into cohorts of tobacco products and cannabis products, with some participants following into multiple cohorts. Targeted analysis of inflammatory oxylipins found up-regulation among persons using tobacco products, while cannabis users had concentrations closer to nonusers, and often down-regulated. Untargeted screening of 403 significant metabolites found tobacco users had similar breath profiles, and that cannabis users had a similar profile that was closer to the profile of nonusers. Metabolites were significantly higher in breath of people using combustion products (tobacco and cannabis) relative to nonusers, and significantly lower in e-device users (nicotine and THC). Our work demonstrates the relative impact of e-delivery systems and cannabis products compared to traditional cigarette smoking on lung metabolic profiles. [ABSTRACT FROM AUTHOR]

Introduction: Pancreatic exocrine insufficiency (PEI) is a condition defined by a reduction in pancreatic exocrine activity that impairs normal digestion. Despite established guidelines recommendations, precise diagnosis of PEI after pancreatic resection are infrequently achieved. This review aims to provide a comprehensive overview of the methodology and accuracy of diagnostic tools available for evaluating PEI after pancreatic resection. Methods: A review of PEI diagnostic tests was conducted using a combined text and MeSH search strategy to identify relevant articles focused on post-pancreatectomy PEI diagnosis. Results: The literature search yielded 4,874 records, and 30 studies were included in the analysis, with a total of 2,305 patients. The reported frequency of PEI across the included studies varied widely, though more than two-thirds of included papers reported an incidence of PEI above 65% in patients who underwent pancreatoduodenectomy or distal pancreatectomy. The faecal elastase-1 (FE-1) test was the most frequently used test for diagnosing post-pancreatectomy PEI. Six studies compared the diagnostic accuracy of FE-1 with faecal fat tests or 13 C breath tests, finding no significant differences. Five studies reported on micronutrient deficiencies. Conclusion: The FE-1 test is the most commonly used diagnostic tool for post-pancreatectomy PEI; however, well-designed studies comparing the diagnostic accuracy of various tests for PEI are lacking. Additionally, few studies report on micronutrient deficiencies, variations in anthropometric data or PEI-related patient-reported outcomes. Future studies should aim to establish a gold standard for diagnosis and severity assessment of post-pancreatectomy PEI and provide guidance for tailored pancreatic enzyme replacement therapy. [ABSTRACT FROM AUTHOR]

The article examines the MunichBREW II study, which investigated the effects of acute alcohol consumption on heart rhythms in young adults. Topics discussed include the increase in heart rate and premature beats during alcohol consumption, the occurrence of significant arrhythmias like atrial fibrillation during the recovery period, and the role of alcohol-induced changes in sympathetic nervous system activity.

Objective This study investigated whether the delta-over-baseline of exhaled 13CO2 (Δ13CO2), generated from a 13C glucose breath test (13C-GBT), measured insulin resistance (IR) in people with type 1 diabetes, using the hyperinsulinemic-euglycemic clamp (HEC) as a reference method. The secondary objective was to compare the 13C-GBT with the estimated glucose disposal rate (eGDR). Methods A 40 mU/m2/min HEC and 2 separate 13C-GBTs (euglycemic with insulin bolus and hyperglycemic without bolus) were consecutively performed in 44 adults with type 1 diabetes with varying body compositions. eGDR was calculated based on hemoglobin A1c (HbA1c), presence of hypertension, and waist circumference. Results The mean glucose disposal rate (M-value) was 5.9 ± 3.1 mg/kg/min and mean euglycemic Δ13CO2 was 6.4 ± 2.1 δ‰, while median eGDR was 5.9 [4.3-9.8] mg/kg/min. The hyperglycemic Δ13CO2 did not correlate with the M-value, while the euglycemic Δ13CO2 and the M-value correlated strongly (r = 0.74, P <.001). The correlation between M-value and eGDR was more moderate (Spearman's rho = 0.63, P <.001). Linear regression showed an association between Δ13CO2 and M-value, adjusted for age, sex, and HbA1c ]adjusted R² = 0.52, B = 1.16, 95% confidence interval (CI).80-1.52, P <.001]. The area under the receiver-operator characteristics curve for Δ13CO2 to identify subjects with IR (M-value < 4.9 mg/kg/min) was 0.81 (95% CI.68-.94, P <.001). The optimal cut-off for Δ13CO2 to identify subjects with IR was ≤ 5.8 δ‰. Conclusion Under euglycemic conditions, the 13C-GBT accurately identified individuals with type 1 diabetes and concurrent IR, suggesting its potential as a valuable noninvasive index. Clinical Trial Identifier: NCT04623320 [ABSTRACT FROM AUTHOR]

(1) Background: Colorectal cancer is one of the leading causes of cancer-related death, while early detection decreases incidence and mortality. Current screening programs involving fecal immunological testing and colonoscopy commonly bring about unnecessary colonoscopies, which adds burden to healthcare systems. The objective of this study was to provide an assessment of the diagnostic performance of an electronic nose serving as a complementary screening tool to improve current screening programs in clinical settings. (2) Methods: We conducted a case–control study that included patients from a medical center with colorectal cancer and non-colorectal cancer controls. We analyzed the composition of volatile organic compounds in their exhaled breath using the electronic nose. We then used machine learning algorithms to develop predictive models and provided the estimated accuracy and reliability of the breath testing. (3) Results: We enrolled 77 patients, with 40 cases and 37 controls. The area under the curve, Kappa coefficient, sensitivity, and specificity of the selected model were 0.87 (95% CI 0.76–0.95), 0.66 (95% CI 0.49–0.83), 0.81, and 0.85. For subjects at an early stage of disease, the sensitivity and specificity were 0.90 and 0.85. Excluding smokers, the sensitivity and specificity were 0.88 and 0.92. (4) Conclusions: This study highlights the promising potential of breath testing using an electronic nose for enabling early detection and reducing unnecessary treatments. However, more independent data for external validation are required to ensure applicability and generalizability. [ABSTRACT FROM AUTHOR]

Aims: This study aims to assess the serum levels of pepsinogen (PG)I, PG II, and gastrin (G17) in patients with gastric intestinal metaplasia (GIM) and evaluate their correlation with demographic characteristics. Methods: A total of 247 normal controls (NC) and 240 patients diagnosed with GIM were enrolled in this study. All participants underwent a gastroscopy procedure followed by pathological examination for diagnosis confirmation. The expression level of PGI, PG II, and G 17 was detected by fluorescence immunochromatography and Hp infection was detected by 13-carbon breath test. The demographic characteristics of the subjects were obtained through questionnaires. Results: Compared to the NC group, the GIM group showed a reduction in PG II expression level [10.71(6.40,16.89) VS 9.21(6.14,14.55), p = 0.010]. GIM patients had a higher prevalence of previous Hp eradication history (14.98% VS 23.75%, p = 0.014). The low PG II group exhibited a higher incidence rate of GIM compared to the high PG II group (54.10% VS 44.44%, p = 0 0.020). In the Hp-negative(Hp-) group, there was a decrease in both PGI and PG II expression levels when compared to the Hp-positive(Hp+) group [146.73 ± 78.53 VS 125.61 ± 68.75 and 10.19(7.27, 16.58) VS 7.36(5.62,12.53), p = 0.036 and p < 0.001]. Among patients without Hp eradication history, those with low PG II levels had a higher proportion of individuals with a history of Hp eradication than those with high PG II levels (29.31% VS 3.13%, p = 0.003). Additionally, within the subgroup that underwent Hp eradication, there was a decrease in PG II expression level compared to the subgroup without Hp eradication (6.16(5.13, 7.52) VS 8.73(5.67, 13.35), p = 0.041). Conclusion: The prevalence of GIM was significantly associated with low levels of PG II. There was a significant association between HP eradication history and the prevalence of GIM. Hp eradication history resulted in reduced expression levels of PG II in Hp- GIM patients. [ABSTRACT FROM AUTHOR]

Background: Irritable bowel syndrome symptoms are associated with diverse pathophysiological mechanisms including small intestinal bacterial overgrowth and food intolerance. Small intestinal bacterial overgrowth leads to the decreased activity of several digestive enzymes, including lactase. Aims: To assess the efficacy of rifaximin-alpha on the symptoms and lactase activity of patients with irritable bowel syndrome without constipation. Methods: This was a prospective, pilot study. The recruited patients had irritable bowel syndrome without constipation (Rome IV criteria), a positive lactulose-Hydrogen Breath Test for small intestinal bacterial overgrowth, low urinary D-Xylose levels measured using the Lactest® test, and self-reported lactose intolerance. In addition, lactose HBT was performed. All patients received 400 mg rifaximin-alpha every 8 h for 2 weeks. Four weeks after the intervention, lactose and lactulose HBT were performed, and the symptoms and urinary D-Xylose levels were evaluated. Results: After treatment with rifaximin-alpha, 60% of the patients reported improvement in abdominal pain, 44% in bloating, 36% in flatulence, 60% in borborygmi, and 72% in stool consistency. A negative lactulose-Hydrogen Breath Test result for SIBO was documented in 32% of patients, and lactose maldigestion by lactose-Hydrogen Breath Test was reduced from 88 to 52% of the studied subjects. The median D-Xylose levels before and after treatment were 7.6 (IQR 4.34–13.7) mg/dL vs. 10.4 (IQR 7.1–17.3) mg/dL, p = 0.002. Conclusions: Rifaximin-alpha caused symptomatic improvement, reduced lactose maldigestion, and reduced positive Hydrogen Breath Test results for small intestinal bacterial overgrowth in patients with irritable bowel syndrome without constipation. [ABSTRACT FROM AUTHOR]

This article traces the development and present status of legislation pertaining to driving under the influence of alcohol (DUI) and other drugs (DUID) in the United Kingdom (UK). The Road Safety Act of 1967 represented a paradigm shift in the way that traffic offenders were prosecuted for driving after consumption of alcohol. This new legislation defined punishable concentrations of alcohol (ethanol) in samples of the driver's blood (80 mg%) or urine (107 mg%). The creation of these statutory concentration limits meant that it was no longer necessary to prove that a suspect was under the influence or impaired by alcohol at the time of driving. Also in 1967, a police officer in uniform was permitted to administer a roadside breath alcohol screening test to help make a decision whether a suspect should be arrested for further investigation. In 1983, the British government introduced a statutory breath alcohol concentration limit of 35 µg/100 mL and evidential quality breath analyzers were approved for use by the police as an alternative to sampling blood or urine for analysis. Evidence of driving under the influence of drugs other than alcohol depended on the results of a clinical examination and questionnaire done by a police surgeon. This was supported by evidence presented by the arresting police officers or other witnesses. In 2015, a radical change occurred in the legislation pertaining to drug-impaired driving where instead of relying on clinical evidence of impairment, concentration limits in blood for 17 psychoactive substances were defined by statute. These consisted of eight commonly encountered recreational drugs of abuse and nine prescription medications (opiates and benzodiazepines), all classified as controlled substances. [ABSTRACT FROM AUTHOR]

Small intestinal bacterial overgrowth (SIBO) is a disorder characterized by the excessive growth of bacteria in the small intestine. Bacterial overgrowth disrupts the bacterial balance and can lead to abdominal pain, weight loss, and gastrointestinal symptoms, including bloating, diarrhea, and malabsorption. SIBO is widespread in the population. There are two main methods for diagnosing SIBO: breath tests and bacterial culture. The most commonly used method is a breath test, which enables the division of SIBO into the following three types: hydrogen-dominant (H-SIBO), methane-dominant (CH4-SIBO), and hydrogen/methane-dominant (H/CH4-SIBO). This comprehensive review aims to present the current knowledge on the use of prebiotics, probiotics, and postbiotics in the context of SIBO. For this purpose, medical databases such as MEDLINE (PubMed) and Scopus were analyzed using specific keywords and their combinations. This review is based on research studies no older than 10 years old and those using only human models. In summary, clinical studies have shown that the efficacy of SIBO therapy can be increased by combining antibiotics with probiotics, especially in vulnerable patients such as children and pregnant women. The further development of diagnostic methods, such as point of care testing (POCT) and portable devices, and a better understanding of the mechanisms of biotics action are needed to treat SIBO more effectively and improve the quality of life of patients. [ABSTRACT FROM AUTHOR]

Background/Aims: Bismuth-based quadruple therapy (BQT) is a treatment option for clarithromycin-resistant Helicobacter pylori (HP) infection. The aim of this study was to compare the efficacy of 7-day BQT with that of 14-day BQT as first-line treatment for clarithromycin-resistant HP infection. Methods: A total of 162 treatment-naïve patients with peptic ulcer disease and clarithromycin-resistant HP infection confirmed by real-time polymerase chain reaction (RT-PCR) were enrolled. The enrolled patients were prospectively randomized to receive BQT for either 7 or 14 days of treatment. Eradication of HP infection was assessed using a 13C-urea breath test. Eradication and adverse event rates of the two groups were assessed. Results: The overall eradication rates in the intention-to-treat (ITT) and per-protocol (PP) analyses were 83.0% (95% confidence interval [CI], 77.2% to 88.9%; 132/159) and 89.8% (95% CI, 84.9% to 94.7%; 132/147), respectively. The eradication rates in the ITT analysis were 79.0% (64/81) in the 7-day group and 87.2% (68/78) in the 14-day group (p=0.170). The eradication rates in the PP analysis were 86.5% (64/74) in the 7-day group and 93.2% (68/73) in the 14-day group (p=0.182). Clinically significant adverse events occurred in 18.2% of patients. There was no statistically significant difference in the rates of individual or all adverse events between the two groups. Conclusions: Both 7-day and 14-day BQT were effective and safe as first-line therapy for HP infections identified as resistant to clarithromycin by RT-PCR. For clarithromycin-resistant HP infections, 7-day BQT may be sufficient as first-line therapy.

Introduction: The correlation between alcohol consumption and injury is undeniable. However, past research relying on self‐reporting alcohol use likely resulted in underreporting and emphasizing the need to increase alcohol testing, especially in resource‐limited settings where the burden of injuries is highest. Methods: This is a prospective analysis of injured patients presenting to the trauma center at Kamuzu Central Hospital in Lilongwe, Malawi. We collected information including patient age, sex, admission date, mechanism of injury, breathalyzer test and Rapid ResponseTM Alcohol Saliva Test Strips (AST) result, and survival. Results: A total of 805 trauma patients were included. The overall prevalence of alcohol consumption in this trauma cohort is 18.3%. There was a 95.5% agreement between the AST and breathalyzer test with a Kappa coefficient of 0.83. The sensitivity and specificity of the AST were determined to be 78.5% (CI 75.7–81.2) and 99.3% (CI 98.7–99.9), respectively. ROC analyses showed the AST to have excellent discrimination with an area under the curve of 0.88 (95% CI 0.85–0.92). Conclusion: The prevalence of alcohol‐related injury is high in Malawi and the use of the Alcohol Saliva Test Strips is feasible and correlated with results derived from the breathalyzer. Routine alcohol testing for trauma patients presenting to a resource‐limited setting is imperative and should be implemented. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to improve the health of peri-implant tissues through continuous intake of Lactobacillus salivarius WB21 (LSWB21) tablets. Methods: A double-blind, randomized controlled trial was conducted with 23 maintenance patients who had generally healthy oral peri-implant tissues. Participants were divided into a test group (n = 12) receiving LSWB21 tablets and a control group (n = 11) receiving placebos. All patients took one tablet three times daily for 2 months. Evaluation measures included modified Gingival Index (mGI), modified Plaque Index (mPI), modified Bleeding Index (mBI), salivary secretory IgA, and oral symptoms assessed at baseline, 1 month, and 2 months. Results: After 2 months, significant improvements in the mGI, mPI, and mBI were observed in the test group; significant improvement in the mPI was observed in the control group. Changes in the mGI over 2 months significantly differed between the groups (p = 0.038), and multiple regression analysis confirmed the effectiveness of LSWB21 in reducing the mGI (p = 0.034). Subjective symptoms such as bad breath in the test group and tongue symptoms in the control group also significantly improved. Conclusion: Continuous intake of LSWB21 may be beneficial for stabilizing peri-implant tissue. Trial registration: UMIN000039392 (UMIN-CTR). [ABSTRACT FROM AUTHOR]

Background: With the prevalence of small intestinal bacterial overgrowth (SIBO) on the rise, treatment has become of paramount importance for patients suffering from this disease. Antibiotics used to treat SIBO include rifaximin, ciprofloxacin, metronidazole, and neomycin. Probiotics reinforce the small intestine's internal microbiota and help cure many diseases. Aim: In this study, we aimed to evaluate the efficacy of rifaximin together with a multi-strain probiotic in patients with SIBO. In a multi-center open-labeled prospective study, recruited patients were randomized into two groups treated with rifaximin as a base and probiotics that varied in the timing of initiation (concomitantly; group A or sequentially; group B) for treating the clinical manifestations of the disease. The primary endpoint evaluated the clinical response to treatment, and the secondary endpoint evaluated the eradication rates. Results: Eradication rates revealed that 69.8% of the patients in group A and 74.8% of the patients in group B were successfully treated and returned with negative lactulose hydrogen breath test results. Clinical response rates were divided into partial and complete responders; partial responders were reported in 23.3% and 26.6% of patients in groups A and B, respectively, and complete responders were reported in 62.7% and 59.5% of patients in groups A and B, respectively. Overall, partial or complete responders' combined rate comprised 86% and 86.2% in groups A and B, respectively. There were no reported side effects by patients treated with rifaximin and the multi-strain probiotic for both protocols. Conclusion: The addition of probiotics, both concomitantly or sequentially, to the treatment regimen acts synergistically with rifaximin to improve outcomes. According to our study, there were no statistical differences between the two regimens. In conclusion, the extension of probiotics in the sequential regimen provided a more prolonged clinical response rate. [ABSTRACT FROM AUTHOR]

Background: Breath testing for small intestinal bacterial overgrowth (SIBO) is typically performed using clinic-based equipment or single-use test kits. Aims: This study aimed to evaluate the utility of a portable, point-of-care breath analysis device (AIRE®, FoodMarble) in patients suspected to have SIBO. A technical assessment including a comparison to existing mail-in kits was first performed. Then, postprandial breath hydrogen levels of patients before and after antibiotic treatment were gathered and compared to levels seen in a healthy cohort. Methods: For the comparison, 50 patients suspected of having SIBO were provided with an AIRE device and performed concurrent LHBTs at-home with a mail-in breath test kit. For the postprandial analysis, twenty-four patients with chronic GI symptoms measured their postprandial hydrogen for 7 days prior to antibiotic treatment and for 7 days after treatment. 10 healthy controls also measured their postprandial hydrogen for 7 days. Results: Substantial agreement was demonstrated between AIRE and the mail-in kits for the performance of lactulose hydrogen breath tests (κ = 0.8). Prior to treatment, patients had significantly greater daily postprandial hydrogen than healthy controls (p < 0.001). The mean postprandial hydrogen of patients reduced significantly after treatment (p < 0.001). Conclusions: Measuring postprandial hydrogen shows potential as a means of differentiating patients with chronic GI symptoms from healthy controls and may be useful in monitoring patients before, during, and after treatment. Future studies could help determine if pre-treatment breath gas levels are predictive of response to antibiotic treatment. [ABSTRACT FROM AUTHOR]

Copyright of Andes Pediatrica is the property of Revista Chilena de Pediatria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Bozok Veterinary Sciences is the property of Bozok Veterinary Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

ABSTRACT Background Methods Key Results Conclusions and Inferences There is a large unmet need for alternative, non‐invasive, and accurate diagnosis of small intestinal bacterial overgrowth (SIBO). The smart capsule bacterial detection system (SCBDS) device contains a targeted sampling technology and an onboard SCBDS assay to detect metabolically active bacteria in the small intestine. Here, we evaluated the agreement of SCBDS assay with duodenal aspiration/culture ex vivo in a multicenter clinical study.Duodenal aspiration was performed in subjects with gastrointestinal symptoms suggestive of SIBO. Aspirated fluid was sent to local and central microbiology labs to evaluate the agreement for detecting bacteria with SCBDS assay compared to the total bacterial count (TBC) reference standard. The performance of SCBDS assay was evaluated using a receiver operator curve, sensitivities, and specificities.Aspirates from 66 patients were collected and analyzed for TBC and SCDBS assay. The overall agreement between the two assays was 82%–92% across 3 clinical sites. The SCBDS assay had a sensitivity of 67%–100% and a specificity of 90%–97% using either ≥ 103 or 105 CFU mL−1 cutoff. Additionally, there was a good correlation (r = 0.82) for the TBC culture between the local and central labs.The SCBDS assay showed a high level of agreement with TBC and improved performance compared to other non‐invasive tests. These results demonstrate the potential utility of SCBDS device to aid SIBO diagnosis as a simple and non‐invasive tool that merits further clinical validation. [ABSTRACT FROM AUTHOR]

Background: Current eradication regimens are not ideal for Helicobacter pylori infected patients who have difficulty choosing antibiotics due to penicillin allergy or antibiotic resistance. Objective: To explore the efficacy and safety of a simple vonoprazan-minocycline dual therapy (VM dual therapy) in H. pylori eradication. Design: Clinical data of patients who were prescribed 14-day VM dual therapy were retrospectively collected. The included patients were 18–70 years old and positive for 13C urea breath test (13C-UBT). They were allergic to penicillin or had a history of repeated antibiotic exposure or had failed eradication with multiple regimens containing amoxicillin. VM dual therapy consists of vonoprazan 20 mg twice daily and minocycline 100 mg twice daily. 13C-UBT was repeated 4–6 weeks after treatment to evaluate the therapeutic outcome. Results: Of the 88 enrolled patients, 54 were treatment naïve, 13 had one prior eradication failure, and 21 had multiple eradication failures. The overall intention to treat (ITT) and per-protocol (PP) eradication rates were 90.9% (95% CI: 82.4–95.7) and 95.2% (95% CI: 87.6–98.5). The ITT eradication rates were 90.7% (95% CI: 78.9–96.5) in treatment-naïve patients, 84.6% (95% CI: 53.7–97.3) in patients with one prior treatment failure, and 95.2% (95% CI: 74.1–99.8) in patients with multiple failures. The PP eradication rates were 94.2% (95% CI: 83.1–98.5), 91.7% (95% CI: 59.8–99.6), and 100%, respectively. The overall incidence of adverse events was 23.0%. The common adverse reactions were nausea and mild dizziness, which could be resolved without intervention. Conclusion: Simple VM dual therapy exhibited a good eradication rate, low incidence of adverse effects, and good adherence. It is a potential new regimen for both first-line and rescue therapy. Plain language summary: The simple 14-day vonoprazan-minocycline dual therapy is a promising new regimen for Helicobacter pylori eradication Current eradication regimens are not ideal for Helicobacter pylori infected patients who have difficulty choosing antibiotics due to penicillin allergy or antibiotic resistance. We explored a simple vonoprazan-minocycline dual therapy for these patients. We retrospectively collected 88 Helicobacter pylori infected patients' clinical data. They were allergic to penicillin or had a history of repeated antibiotic exposure, or had failed eradication with multiple regimens containing amoxicillin. VM dual therapy consists of Vonoprazan 20mg twice daily and minocycline 100mg twice daily. In the 54 treatment naïve patients, the eradication rate was 90.7%. In the 13 patients with on prior failure and the 21 patients with multiple failures, the eradication rates was 84.6% and 95.2%. 23% of the patients reported adverse events, which was mailnly nausea and mild dizziness. Our study suggested that the simple VM dual therapy exhibited a good eradication rate, low incidence of adverse effects, and good adherence. It is a promising new regimen. [ABSTRACT FROM AUTHOR]

Objectives: Patients with metabolic dysfunction‐associated steatotic liver disease (MASLD) exhibit varying degrees of halitosis. The author speculated that small intestinal bacterial overgrowth (SIBO) might lead to MASLD and subsequent extra‐oral halitosis and aimed to test this hypothesis. Methods: This retrospective cross‐sectional study reviewed 885 extra‐oral halitosis patients. Halitosis and exhaled dimethyl sulfide (DMS) were measured by organoleptic score (OLS) (0–5) and OralChroma, respectively. SIBO and MASLD were diagnosed by hydrogen breath test and Fibroscan combined with cardiometabolic criteria. Results: In this study, 133/885 (15.05%) of the halitosis patients otherwise healthy had MASLD, while 87/133 (65.41%) of the MASLD patients were SIBO‐positive. No significant differences were observed in physical parameters such as age, serum biochemical parameters such as lipids, or Fibroscan parameters between the SIBO‐positive and SIBO‐negative patients. However, the OLS was 4 (interquartile range: 3–4) and exhaled DMS level was 56 (43–75) parts per billion (ppb) in the SIBO‐positive patients, significantly greater than 2 (2–3) and 43 (25–51) ppb in the SIBO‐negative patients (both p < 0.001). Exhaled hydrogen levels positively correlated with the OLS and exhaled DMS levels (r = 0.774, r = 0.740, both p < 0.001). Conclusion: MASLD can cause halitosis by SIBO. [ABSTRACT FROM AUTHOR]

Background: Mobile health (mHealth) technology use may reduce alcohol use and related negative consequences; however, little is known about its efficacy without prompting from researchers or pay‐per‐use. This exploratory analysis assessed relationships between mHealth technology use frequency and alcohol‐use outcomes. Methods: Young adults who drink heavily (N = 97, Mage = 23, 51% male, 64% non‐Hispanic White, Mdrinks/week = 21) had the option to use three mHealth technologies (breathalyzer device/app, blood alcohol content estimator app, drink counting via text message) while drinking for 2 weeks. Relationships between alcohol‐related outcomes and any, multiple, and specific mHealth technology use across study days and drinking days were evaluated via bivariate correlations and multiple regressions. Results: Participants used one or more mHealth technologies on approximately 68% of drinking days (33% of field days), with multiple technologies used on 34% of drinking days. Bivariate correlations revealed that a higher percentage of study days with any mHealth technology use was related to higher mean weekly drinks. However, a higher percentage of drinking days with any mHealth technology use was related to lower mean weekly drinks, percent of heavy and high‐intensity drinking days, and negative consequences. There were several significant, inverse correlations between alcohol variables and using the mHealth technologies that provided personalized feedback. Multiple regression analyses (holding sex and baseline alcohol variables constant) indicated that a higher percentage of drinking days with any mHealth technology use was related to lower mean weekly drinks and lower percentage of heavy drinking days. Conclusions: Using mHealth technologies to moderate drinking without direct prompting from the research team or per‐use incentives was related to less overall alcohol use and heavy drinking. This indicates potential real‐world engagement with mHealth apps to assist with in‐the‐moment drinking. Normalizing mHealth technology use during drinking could help curb the public health crisis around harmful alcohol use in young adult populations. [ABSTRACT FROM AUTHOR]

Background and Aim: Patients with intestinal failure (IF) have abnormal intestinal anatomy, secretion, and dysmotility, which impairs intestinal homeostatic mechanisms and may lead to small intestinal bacterial overgrowth (SIBO). We conducted a systematic review and meta‐analysis to determine the prevalence of SIBO in patients with IF and to identify risk factors for SIBO. Methods: MEDLINE (PubMed) and Embase electronic databases were searched from inception to December 2023 for studies that reported the prevalence of SIBO in IF. The prevalence rates, odds ratio (OR), and 95% confidence intervals of SIBO in IF and the risk factors for SIBO in IF were calculated using random effects model. Results: Final dataset included nine studies reporting on 407 patients with IF. The prevalence of SIBO in IF was 57.5% (95% CI 44.6–69.4), with substantial heterogeneity in this analysis (I2 = 80.9, P = 0.0001). SIBO prevalence was sixfold higher in patients with IF who received parenteral nutrition (PN) compared with IF patients not on PN (OR = 6.0, 95% CI 3.0–11.9, P = 0.0001). Overall, the prevalence of SIBO in patients with IF using PPI/acid‐suppressing agents (72.0%, 95% CI 57.5–83.8) was numerically higher compared with IF patients not using these agents (47.6%, 95% CI 25.7–70.2). Conclusions: This systematic review and meta‐analysis suggests that there is an increased risk of SIBO in patients with IF and that PN, and potentially, the use of PPI/acid‐suppressing agents is risk factors for SIBO development in patients with IF. However, the quality of evidence is low and can be attributed to lack of case–control studies and clinical heterogeneity seen in the studies. [ABSTRACT FROM AUTHOR]

• Drivers with a previous DUI experience are more likely to refuse a breath test when caught. • A higher degree of probability to refuse a breath test occurs when the penalty of test refusal rises. • Drivers refusing a breath test are more likely to violate DUI rules than heavy drinking drivers. • Refusers are more likely to cause incidents than drunk drivers who comply with the breath test. • The mild punishment of breath test refusal may lead to more DUI cases and incidents among refusers. Driving under the influence of alcohol (DUI) is a major concern of road safety, as it not only leads to many people killed and injured, but also induces a significant loss of labor productivities. Taiwan is no exception to this problem, because drunk driving is one of the primary causes of severe traffic crashes nationwide. To prevent DUI, the authorities have revised laws many times to increase the penalties for drunk driving, including revocation or suspension of license, greater fines, detaining vehicles, and lengthening incarceration times. However, under the current system, suspected drivers are only subject to an administrative punishment if they refuse the request of a sobriety test. By doing so, heavy drinkers could avoid a possible criminal accusation of drunk driving, a potential incarceration penalty, and a lifetime criminal record. This research investigates the opportunistic behavior of drunk drivers against DUI policies in Taiwan. First, we find that drivers with a previous DUI experience are more likely to refuse a breath test when caught. Second, the degree of probability to refuse a breath test increases as the punishment to drivers failing a breath test rises, while it drops as the punishment to refusers increases. Third, breath test refusers have a greater likelihood to be caught again for DUI violations in one year than heavy drinking drivers with a BrAC (breath alcohol concentration) level of 0.55 mg/L. Fourth, breath test refusers are somewhat more likely to cause a DUI incident in two years than drunk drivers who comply with the request to carry out a breath test. These findings suggest that the allowance of breath test refusal with a mild administrative punishment may be a loophole that limits the deterrent effect and consequently leads to more drunk driving cases and incidents among refusers. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper was to assess the prevalence and association between H. pylori infection and alcohol, or cigarette use among Iraqi patients. Methods: 115 individuals needed upper gastrointestinal endoscopies in total. Reverse transcription polymerase chain reaction (RT-PCR), urea breath test, rapid urease test, CagA-IgG, and culture were all used to confirm H. pylori infection. The information on alcohol consumption, smoking, sex, and age was collected using a standard questionnaire. Results: The gold standard test, RT-PCR, was used to detect H. pylori infection in 81 (70.4%) of patients. H. pylori infection was not affected by age (OR: 0.976; CI: 95% (0.944-1.009; P > 0.05), sex (OR: 1.26, 95% CI: 0.57-2.75; P > 0.05), or alcohol intake (OR: 0.293; CI: 95% (0.081-1.058; P > 0.05) according to the binary logistic regression analysis. Additionally, there was a considerable inverse association between smoking and H pylori infection (OR: 0.094; CI: 95% (0.025-0.352; P < 0.05). According to binary logistic regression analysis, both smoking (OR: 0.036; CI: 95% (0.007-0.182; P < 0.05) and alcohol intake (OR: 0.179; CI: 95% (0.041-0.988; P < 0.05) were inversely and significantly related with H. pylori illness whereas H. pylori infection did not alter with age (OR: 1.001; CI 95% (0.959-1.044; P > 0.05) in the male subgroup. Conclusions: According to the study, males who smoke and drink are more likely to have H. pylori infections. Furthermore, there was no positive association between age and H. pylori infection. [ABSTRACT FROM AUTHOR]

Background: Halitosis in children implies psychosocial repercussions. Risk factors associated with this condition are unclear, and detection methods are inaccurate. Aim: To quantify the levels of sulfur‐like compounds in children with asthma and healthy children from a novel validated assay, and to establish the risk factors related to halitosis. Design: One hundred and twenty‐eight individuals (63 healthy and 65 asthmatic) from 3 to 17 years of age were tested using a passive colorimetric sensor to measure the levels of sulfur‐like compounds in breath and saliva. Information was collected on oral hygiene habits, gingival and dental health, breathing type, and dental malocclusion. Results: The mean values of hydrogen sulfide were 4.0 ± 6.8 and 19.7 ± 12.2 ppbv (parts per billion in volume) in the control and asthmatic groups, respectively (p <.001). The presence of higher concentrations of sulfur compounds was significantly associated (p <.05) with the presence of gingival inflammation, tongue coating, dental plaque, mouth breathing, hypomineralization, age, tongue brushing, and the use of dental floss. Conclusion: The level of sulfur in breath and saliva was significantly higher in patients with asthma. These results can serve as a precedent to raise awareness among paediatricians and parents about oral hygiene care in children and adolescents. [ABSTRACT FROM AUTHOR]

Rationale: The early identification of children with poorly controlled asthma is imperative for optimizing treatment strategies. The analysis of exhaled volatile organic compounds (VOCs) is an emerging approach to identify prognostic and diagnostic biomarkers in pediatric asthma. Objectives: To assess the accuracy of gas chromatography–mass spectrometry–based exhaled metabolite analysis to differentiate between controlled and uncontrolled pediatric asthma. Methods: This study encompassed discovery (SysPharmPediA [Systems Pharmacology Approach to Uncontrolled Paediatric Asthma]) and validation (U-BIOPRED [Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes] and PANDA [Paediatric-Asthma-Non-Invasive-Diagnostic-Approaches]) phases. First, exhaled VOCs that discriminated degrees of asthma control were identified. Subsequently, outcomes were validated in two independent cohorts. Patients were classified as controlled or uncontrolled on the basis of asthma control test scores and the number of severe attacks in the past year. In addition, the potential of VOCs to predict two or more future severe asthma attacks in SysPharmPediA was evaluated. Measurements and Main Results: Complete data were available for 196 children (SysPharmPediA, n = 100; U-BIOPRED, n = 49; PANDA, n = 47). In SysPharmPediA, after randomly splitting the population into training (n = 51) and test (n = 49) sets, three compounds (acetophenone, ethylbenzene, and styrene) distinguished between patients with uncontrolled and controlled asthma. The areas under the receiver operating characteristic curves (AUROCCs) for training and test sets were, respectively, 0.83 (95% confidence interval [CI], 0.65–1.00) and 0.77 (95% CI, 0.58–0.96). Combinations of these VOCs resulted in AUROCCs of 0.74 ± 0.06 (U-BIOPRED) and 0.68 ± 0.05 (PANDA). Attack prediction tests resulted in AUROCCs of 0.71 (95% CI, 0.51–0.91) and 0.71 (95% CI, 0.52–0.90) for the training and test sets. Conclusions: Exhaled metabolite analysis might enable asthma control classification in children. This should stimulate the further development of exhaled metabolite–based point-of-care tests in asthma. [ABSTRACT FROM AUTHOR]

The exhaled breath represents an ideal matrix for noninvasive biomarker discovery, and exhaled metabolomics have the potential to be clinically useful in the era of precision medicine. In this concise translational review, we specifically address volatile organic compounds in the breath, with a view toward fulfilling the promise of these as actionable biomarkers, in particular, for lung diseases. We review the literature paying attention to seminal work linked to key milestones in breath research; discuss potential applications for breath biomarkers across disease areas and healthcare systems, including the perspectives of industry; and outline critical aspects of study design that will need to be considered for any pivotal research going forward if breath analysis is to provide robust validated biomarkers that meet the requirements for future clinical implementation. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Methods Results Conclusions Reports on stress‐associated halitosis are scarce and have only focused on intraoral halitosis. This work aimed to study stress‐associated extraoral halitosis (EOH) and further investigate its potential association with stress‐induced intestinal inflammation.This retrospective study included 664 white‐collar employees with self‐reported stress‐associated halitosis. They underwent the organoleptic score (OLS) to assess halitosis, modified Brief Job Stress Questionnaire (BJSQ) score to assess job stress, OralChroma breath test to measure volatile sulfur compounds (VSCs) in breath, and hydrogen/methane breath test (HMBT) and nitric oxide breath test (NOBT) to detect intestinal inflammation. They were classified into high‐stress and low‐stress groups based on their modified BJSQ score.Totally, 106 eligible patients were identified as having stress‐associated EOH, and 61 of them had high stress. Additionally, 70 (66.04%) and 73 (68.87%) of them tested positive for HMB and NOBT, respectively. Dimethyl sulfide (DMS) was found to be the predominant VSC in breath. High‐stress patients had significantly higher positivity rates for HMBT and NOBT, OLS, and exhaled DMS levels compared to low‐stress patients. HMBT‐positive patients and NOBT‐positive patients had significantly higher OLS and exhaled DMS levels compared to their respective negative counterparts.Job stress can lead to intestinal inflammation and subsequent gut‐originated EOH. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: Confirming the eradication of Helicobacter pylori is essential due to increasing antimicrobial resistance to various treatment regimens. The primary objective of this study is to determine the eradication rate of H. pylori using the carbon-14 (14C) urea breath test. Materials and Methods: A cross-sectional study with an analytical component was conducted by retrospectively reviewing medical records of patients who received eradication treatment for H. pylori and subsequent confirmation of eradication through the 14C urea breath test. The study was carried out at Hospital Universitario Fundación Valle del Lili between January 2019 and June 2022. Results: A total of 360 patients met the inclusion criteria. Women represented 66.9% of the sample, with a median age of 51 years (interquartile range [IQR]: 39-61). A negative 14C urea breath test result was obtained in 84.4% of cases, with a median interval of eight weeks (IQR: 5-12) between the end of treatment and test performance. Almost all patients received 14 days of treatment. Conclusions: An acceptable eradication rate was observed in our setting, even with the standard triple therapy, which remains the most commonly used regimen. Antimicrobial susceptibility studies are needed to guide treatments based on local epidemiology. [ABSTRACT FROM AUTHOR]

This is the first registered intervention study for vonoprazan, high-dose amoxicillin, clarithromycin, and metronidazole 14-day concomitant therapy based on a susceptibility test of Helicobacter pylori. We conducted this study as a fourth-line rescue regimen in Japan. Methods: Twenty patients who underwent three rounds of eradication therapies (first- or second-line 7-day triple therapy consisting of amoxicillin and clarithromycin, or metronidazole- and sitafloxacin-based third-line therapy) and had failed eradication based on a urea breath test or fecal antigen test were recruited. All patients underwent endoscopic examination and culture tests before starting eradication therapy. The intervention was concomitant therapy consisting of vonoprazan 20 mg bid, amoxicillin 500 mg qid, clarithromycin 400 mg bid, and metronidazole 250 mg bid for 14 days, which were modified based on the susceptibility test, and the resistant drugs were removed from the regimen. Patients with negative culture results were treated with quadruple therapy. The primary outcome was the eradication rate (UMIN000025765, jRCTs 031180208). Results: The eradication rate of susceptibility-testing-based fourth-line eradication therapy was 63.2% (95%CI: 38.4–83.7%) in intent-to-treat analysis and 70.6% (95%CI: 44.0–89.7%) in per-protocol analysis. Thirteen patients received quadruple therapy, with eradication rates of 61.5% and 75.0%, respectively. No serious adverse events were reported. Conclusions: This vonoprazan-based concomitant therapy modified by the susceptibility test is a potential option as fourth-line eradication after first-line clarithromycin-based 7-day triple, second-line metronidazole-based 7-day triple, and third-line sitafloxacin-based 7-day triple therapy failure. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effects of different amoxicillin (AMX) dosing schedules on bismuth quadruple therapy in Helicobacter pylori treatment-naïve patients. A total of 139 H. pylori-infected patients received a 2-week eradication regimen consisting of 50 mg tegoprazan, 500 mg clarithromycin, and 300 mg bismuth tripotassium dicitrate twice daily, 1000 mg AMX twice daily (BID group), or 500 mg AMX four times daily (QID group). We performed a urea breath test to evaluate H. pylori eradication eight weeks after treatment and compared the H. pylori eradication rate, patient compliance, and adverse drug events between the BID and QID groups. Based on propensity score matching, 114 and 100 patients were included in intention-to-treat (ITT) and per-protocol (PP) analyses, respectively. The H. pylori eradication rate did not differ significantly according to the ITT (82.5% vs. 87.7%, p = 0.429) and PP (95.9% vs. 98.0%, p = 0.536) analyses between the BID and QID groups. No significant differences were found in treatment compliance or adverse drug event rates between the two groups. In conclusion, the eradication rate of first-line H. pylori therapy containing tegoprazan, clarithromycin, and bismuth was not affected by AMX dosing schedules administered twice and four times daily. [ABSTRACT FROM AUTHOR]

Introduction: There has been an increasing interest in using exhaled breath condensate (EBC) as a non-invasive method of detecting parameters of the airway, including oxidative stress biomarkers. Aim: Our aim was to estimate the oxidative stress in EBC in patients with moderate uncontrolled asthma (allergic and non-allergic) and to assess whether the intensity of that process may reflect the differentiation of asthma phenotypes. Material and methods: Forty-four patients (9 males, 35 females, age range: 35–59 years) with chronic moderate asthma were included in the study. The diagnosis was based on clinical history, physical findings and lung function tests. Thirty-one patients suffered from allergic asthma and 13 patients from non-allergic. In blood serum, erythrocyte hemolysate and in EBC the following oxidative stress parameters were estimated: superoxide dismutase (SOD), protein sulfhydryl groups (SH), catalase activity (CAT), glutathione reductase (GR), glutathione S-transferase (GST), glutathione peroxidase (GPx), malondialdehyde (MDA), total oxidation status (TOS), total antioxidant capacity (TAC), lipofuscin, ceruloplasmin, lipid peroxide concentration (LPH). Results: The oxidative stress markers were assessed both in peripheral blood and in EBC. In contrast to peripheral blood, only 4 markers (TAC, TOS, CAT and GST) were detectable in EBC. There were no significant differences in levels of those markers in EBC in patients with allergic and non-allergic asthma. Significantly higher oxidative stress parameter levels were detected in blood of non-allergic asthma patients with regards to CER (p = 0.008) and MDA (p = 0.014). Blood levels of LPS (p = 0.04) and SH (p = 0.014) were higher in allergic asthmatics. Conclusions: The inflammatory markers were elevated among non-allergic asthma patients. EBC is only partially useful to assess airway inflammation. [ABSTRACT FROM AUTHOR]

Women physicians and nurses are health professionals with significant differences in their role, but they share common social and occupational stressors. This study compares the outcomes of female physicians and nurses in treatment in a highly specialized program for health professionals with substance use disorders. This was a 9-year, survival, observational, cohort study, conducted with data from medical e-records of female nurses (n = 58) and physicians (n = 50) in treatment for addictions. The most common drug of abuse was alcohol (62% of physicians and 75.9% of nurses) followed by sedatives (16%vs. 12.1%). Themedian time in treatment was similar (49.1 and 46.4 months for physicians and nurses, respectively). Abstinence rates of physicians (76%) were higher than those of nurses (61.4%) as well as their median time to first lapse (15.5 and 7.6 months, respectively). However, after multivariate analyses, differences did not remain statistically significant neither for their abstinence rates nor for their survival time. To have an alcohol use disorder emerged as a risk factor of relapse for all (Hazard Ratio = 3.41, p = .03). More knowledge is needed to ascertain the common and differential factors related to the treatment response of women physicians and nurses with addictions and particularly to improve alcohol use disorder outcomes in these populations. [ABSTRACT FROM AUTHOR]

Background: The global prevalence of obesity is increasing and represents a major public health challenge. However, there is a paucity of data regarding Helicobacter pylori (H pylori) eradication in people with obesity. The aim of the study is to examine the influence of obesity degree on H. pylori eradication in patients undergoing bariatric and metabolic surgery. Methods: A post hoc analysis was conducted in a cohort of 204 adults patients (129 individuals diagnosed with obesity, 75 normal weight) H. pylori positive, included in two multicenter, prospective studies. Patients underwent a 14-day quadruple concomitant treatment, and H. pylori eradication was assessed using the 13C-urea breath test. The cohort was stratified according to body mass index (BMI), and statistical analyses were performed using chi-squared test, Kruskal–Wallis test, and logistic regression. Results: Eradication rates were significantly lower in patients with obesity compared with normal weight individuals (68.2% vs. 88.0%, OR 0.29, 95% CI 0.13–0.63, p < 0.01). Furthermore, within the population diagnosed with obesity, the degree of obesity correlated with decreased eradication rates, with class 3 (BMI 40.0–49.9) and class 4 (BMI ≥ 50.0) obesity showing the lowest rates (67% and 51%, with an OR 0.28 and 0.15 respectively, p < 0.01). Conclusions: Our results indicate that obesity may influence H. pylori eradication, especially among severe obesity patients undergoing bariatric surgery, which could have implications for the development of ulcers and gastritis as well as the risk of gastric cancer. Tailored eradication strategies may be necessary to improve treatment efficacy in this population. [ABSTRACT FROM AUTHOR]

Identification of the breathing cycle forms the basis of any breath-by-breath gas exchange analysis. Classically, the breathing cycle is defined as the time interval between the beginning of two consecutive inspiration phases. Based on this definition, several research groups have developed algorithms designed to estimate the volume and rate of gas transferred across the alveolar membrane ("alveolar gas exchange"); however, most algorithms require measurement of lung volume at the beginning of the ith breath (VLi-1; i.e., the end-expiratory lung volume of the preceding ith breath). The main limitation of these algorithms is that direct measurement of VLi-1 is challenging and often unavailable. Two solutions avoid the requirement to measure VLi-1 by redefining the breathing cycle. One method defines the breathing cycle as the time between two equal fractional concentrations of lung expired oxygen (Fo2) (or carbon dioxide; Fco2), typically in the alveolar phase, whereas the other uses the time between equal values of the Fo2/Fn2 (or Fco2/Fn2) ratios [i.e., the ratio of fractional concentrations of lung expired O2 (or CO2) and nitrogen (N2)]. Thus, these methods identify the breathing cycle by analyzing the gas fraction traces rather than the gas flow signal. In this review, we define the traditional approach and two alternative definitions of the human breathing cycle and present the rationale for redefining this term. We also explore the strengths and limitations of the available approaches and provide implications for future studies.

Infection of airway epithelial cells with severe acute respiratory coronavirus 2 (SARS-CoV-2) can lead to severe respiratory tract damage and lung injury with hypoxia. It is challenging to sample the lower airways non-invasively and the capability to identify a highly representative specimen that can be collected in a non-invasive way would provide opportunities to investigate metabolomic consequences of COVID-19 disease. In the present study, we performed a targeted metabolomic approach using liquid chromatography coupled with high resolution chromatography (LC-MS) on exhaled breath condensate (EBC) collected from hospitalized COVID-19 patients (COVID+) and negative controls, both non-hospitalized and hospitalized for other reasons (COVID-). We were able to noninvasively identify and quantify inflammatory oxylipin shifts and dysregulation that may ultimately be used to monitor COVID-19 disease progression or severity and response to therapy. We also expected EBC-based biochemical oxylipin changes associated with COVID-19 host response to infection. The results indicated ten targeted oxylipins showing significative differences between SAR-CoV-2 infected EBC samples and negative control subjects. These compounds were prostaglandins A2 and D2, LXA4, 5-HETE, 12-HETE, 15-HETE, 5-HEPE, 9-HODE, 13-oxoODE and 19(20)-EpDPA, which are associated with specific pathways (i.e. P450, COX, 15-LOX) related to inflammatory and oxidative stress processes. Moreover, all these compounds were up-regulated by COVID+, meaning their concentrations were higher in subjects with SAR-CoV-2 infection. Given that many COVID-19 symptoms are inflammatory in nature, this is interesting insight into the pathophysiology of the disease. Breath monitoring of these and other EBC metabolites presents an interesting opportunity to monitor key indicators of disease progression and severity.

Summary: Background: Small Intestinal Bacterial Overgrowth (SIBO) has been implicated in the pathophysiology of chronic liver disease (CLD). We conducted a systematic review and meta-analysis to assess and compare the prevalence of SIBO among CLD patients (with and without with complications of end stage liver disease) and healthy controls. Methods: Electronic databases were searched from inception up to July-2024 for case–control studies reporting SIBO in CLD. Prevalence rates, odds ratios (ORs), and 95% confidence intervals (CIs) of SIBO in patients with CLD and controls were calculated utilizing a random-effects model. The protocol was prospectively registered with PROSPERO (CRD42022379578). Findings: The final dataset included 34 case–control studies with 2130 CLD patients and 1222 controls. Overall, the odds for SIBO prevalence in CLD patients compared to controls was 6.7 (95% CI 4.6–9.7, p

Prolonged exposure to hyperbaric hyperoxia can lead to pulmonary oxygen toxicity (PO2tox). PO2tox is a mission limiting factor for special operations forces divers using closed-circuit rebreathing apparatus and a potential side effect for patients undergoing hyperbaric oxygen (HBO) treatment. In this study, we aim to determine if there is a specific breath profile of compounds in exhaled breath condensate (EBC) that is indicative of the early stages of pulmonary hyperoxic stress/PO2tox. Using a double-blind, randomized 'sham' controlled, cross-over design 14 U.S. Navy trained diver volunteers breathed two different gas mixtures at an ambient pressure of 2 ATA (33 fsw, 10 msw) for 6.5 h. One test gas consisted of 100% O2(HBO) and the other was a gas mixture containing 30.6% O2with the balance N2(Nitrox). The high O2stress dive (HBO) and low O2stress dive (Nitrox) were separated by at least seven days and were conducted dry and at rest inside a hyperbaric chamber. EBC samples were taken immediately before and after each dive and subsequently underwent a targeted and untargeted metabolomics analysis using liquid chromatography coupled to mass spectrometry (LC-MS). Following the HBO dive, 10 out of 14 subjects reported symptoms of the early stages of PO2tox and one subject terminated the dive early due to severe symptoms of PO2tox. No symptoms of PO2tox were reported following the nitrox dive. A partial least-squares discriminant analysis of the normalized (relative to pre-dive) untargeted data gave good classification abilities between the HBO and nitrox EBC with an AUC of 0.99 (±2%) and sensitivity and specificity of 0.93 (±10%) and 0.94 (±10%), respectively. The resulting classifications identified specific biomarkers that included human metabolites and lipids and their derivatives from different metabolic pathways that may explain metabolomic changes resulting from prolonged HBO exposure.

BackgroundSeveral studies suggest that far-field transmission (>6 ft) explains a significant number of COVID-19 superspreading outbreaks.ObjectiveTherefore, quantifying the ratio of near- and far-field exposure to emissions from a source is key to better understanding human-to-human airborne infectious disease transmission and associated risks.MethodsIn this study, we used an environmentally-controlled chamber to measure volatile organic compounds (VOCs) released from a healthy participant who consumed breath mints, which contained unique tracer compounds. Tracer measurements were made at 0.76 m (2.5 ft), 1.52 m (5 ft), 2.28 m (7.5 ft) from the participant, as well as in the exhaust plenum of the chamber.ResultsWe observed that 0.76 m (2.5 ft) trials had ~36-44% higher concentrations than other distances during the first 20 minutes of experiments, highlighting the importance of the near-field exposure relative to the far-field before virus-laden respiratory aerosol plumes are continuously mixed into the far-field. However, for the conditions studied, the concentrations of human-sourced tracers after 20 minutes and approaching the end of the 60-minute trials at 0.76 m, 1.52 m, and 2.28 m were only ~18%, ~11%, and ~7.5% higher than volume-averaged concentrations, respectively.SignificanceThis study suggests that for rooms with similar airflow parameters disease transmission risk is dominated by near-field exposures for shorter event durations (e.g., initial 20-25-minutes of event) whereas far-field exposures are critical throughout the entire event and are increasingly more important for longer event durations.Impact statementWe offer a novel methodology for studying the fate and transport of airborne bioaerosols in indoor spaces using VOCs as unique proxies for bioaerosols. We provide evidence that real-time measurement of VOCs can be applied in settings with human subjects to estimate the concentration of bioaerosol at different distances from the emitter. We also improve upon the conventional assumption that a well-mixed room exhibits instantaneous and perfect mixing by addressing spatial distances and mixing over time. We quantitatively assessed the exposure levels to breath tracers at alternate distances and provided more insights into the changes on "near-field to far-field" ratios over time. This method can be used in future to estimate the benefits of alternate environmental conditions and occupant behaviors.

Aim: A clinical study was performed to test the usability of a smartphone eyescanning app at a needle exchange facility to detect drug use to support therapy. Methods: The study recruited 24 subjects who visited the facility one to three times, making a total of 40 visits. During each visit the subjects underwent testing for non-convergence (NC), nystagmus (NY), and pupillary light reflex (PLR) using a smartphone-based eHealth system. The collected eye data were transformed into key features that represent eye characteristics. During each visit, a time-line follow-back interview on recent drug use and a usability questionnaire were completed. Results: Technical usability of the smartphone eye-scanning app was good for PLR and NC, where key features were generated in 82%-91% of the cases. For NY, only 60% succeeded due to cognitive problems to follow instructions. In most cases, subjects were under the influence of drugs when participating in the tests, with an average of 2.4 different drugs ingested within the last 24 h. The key features from PLR could distinguish use of opioids from central stimulants. The usability questionnaire results indicate that 23 of the 24 subjects could perform the eye-scanning by themselves after a short training, even when under severe influence of drugs. The caregiver assessed that 20 out of the 24 challenging subjects could potentially perform these tests in an indoors, home-like environment. Conclusions: Smartphone-based eye-scanning is functional in a patient population with heavy drug use, also when under the influence of drugs. The use of central stimulants can be distinguished from the use of opioids. [ABSTRACT FROM AUTHOR]

Introduction: The analysis of chemoreflex and baroreflex sensitivity may contribute to optimizing patient care and athletic performance. Breathholding tests, such as the Body Oxygen Level Test (BOLT), have gained popularity as a feasible way to evaluate the reflex control over the cardiorespiratory system. According to its proponents, the BOLT score reflects the body's sensitivity to carbon dioxide and homeostasis disturbances, providing feedback on exercise tolerance. However, it has not yet been scientifically validated or linked with exercise performance in highly-trained individuals. Therefore, we investigated the association of BOLT scores with the results of standard performance tests in elite athletes. Methods: A group of 49 speedskaters performed BOLT, Wingate Anaerobic Test (WAnT), and cardiopulmonary exercise test (CPET) on a cycle ergometer. Peak power, total work, and power drop were measured during WAnT. Time to exhaustion and maximum oxygen uptake were measured during CPET. Spearman's rank correlation and multiple linear regression were performed to analyze the association of BOLT scores with parameters obtained during the tests, age, somatic indices, and training experience. Results: No significant correlations between BOLT scores and parameters obtained during WAnT and CPET were found, r(47) = -0.172-0.013, p = 0.248-0.984. The parameters obtained during the tests, age, somatic indices, and training experience were not significant in multiple linear regression (p = 0.38-0.85). The preliminary regression model showed an R2 of 0.08 and RMSE of 9.78 sec. Conclusions: Our findings did not demonstrate a significant relationship between BOLT scores and exercise performance. Age, somatic indices, and training experience were not significant in our analysis. It is recommended to interpret BOLT concerning exercise performance in highly-trained populations with a great degree of caution. [ABSTRACT FROM AUTHOR]

Background: Clarithromycin plays an important role in eradicating Helicobacter pylori (H. pylori) through quadruple therapy. However, there is limited research on whether different forms of clarithromycin dosage have similar efficacies against H. pylori. Objective: We aimed to evaluate the efficacy of different forms of clarithromycin dosage in bismuth-containing quadruple therapy for eradicating H. pylori. Design: A single-center retrospective analysis comparing the efficacy of different forms of clarithromycin dosage in eradicating H. pylori. Methods: An analysis was conducted on patients diagnosed with H. pylori infection through the 13C-urea breath test (13C-UBT) at Henan Provincial People's Hospital, China from 2020 to 2022 who were treated with either a dispersible or sustained-release clarithromycin tablet (500 mg each), alongside amoxicillin (1000 mg), a standard dose of proton pump inhibitors (PPIs), and bismuth citrate (220 mg), administered twice daily as part of bismuth-containing quadruple therapy. Treatment efficacy was assessed using 13C-UBT at least 4 weeks after treatment completion. The H. pylori eradication rate was the primary outcome of this study, and factors influencing it were analyzed. Results: Among 2094 screened patients, 307 with H. pylori infection (mean age, 41.8 ± 0.7 years; 43% men) received bismuth-containing quadruple therapy. Univariate analysis of the dispersible and sustained-release tablet groups revealed a lower eradication rate with the sustained-release tablet compared with the dispersible clarithromycin tablet regimen (75.26% (73/97) vs 95.26% (200/210), respectively; p < 0.05). Other factors, such as smoking, age, and PPI type, were not significantly associated with the cure rate. Multivariate analysis identified the form of clarithromycin dosage (dispersible vs sustained-release) to be an independent risk factor for eradication failure using the bismuth-containing quadruple therapy (odds ratio = 0.145, 95% confidence interval: (0.065–0.323); p < 0.05). Conclusion: The clarithromycin dispersible tablet demonstrated a higher H. pylori eradication rate, and the sustained-release clarithromycin tablet may be inappropriate for H. pylori eradication. Plain language summary: Clarithromycin sustained-release tablet may be an improper therapy for the eradication of Helicobacter pylori The clarithromycin dispersible tablet therapy demonstrated a higher eradication rate for H. pylori infection, and clarithromycin sustained-release tablets may be inappropriate for the eradication of H. pylori. [ABSTRACT FROM AUTHOR]

Background: The optimal dosage of minocycline remains unclear for Helicobacter pylori (H. pylori) eradication. We aimed to evaluate the efficacy and safety of four different regimens with minocycline and metronidazole compared to classical bismuth quadruple therapy for H. pylori rescue treatment. Materials and Methods: From March 2021 to March 2024, refractory H. pylori‐infected patients with at least two previous treatment failures who received 14‐day therapy with b.i.d. proton pump inhibitor 20 mg and bismuth 220 mg, plus tetracycline 400 mg q.i.d and metronidazole 400 mg q.i.d (BQT), or minocycline 50 mg q.i.d and metronidazole 400 mg q.i.d (PBMn4M4), or minocycline 50 mg t.i.d and metronidazole 400 mg t.i.d (PBMn3M3), or minocycline 50 mg b.i.d and metronidazole 400 mg q.i.d (PBMn2M4), or minocycline 50 mg b.i.d and metronidazole 400 mg t.i.d (PBMn2M3) were included in this retrospective study. H. pylori eradication was assessed by 13C‐urea breath test at least 6 weeks after treatment. All adverse effects during treatment were recorded. Results: Totally, 823 patients were enrolled: 251 with BQT, 97 with PBMn4M4, 191 with PBMn3M3, 108 with PBMn2M4, and 176 with PBMn2M3. The eradication rates of BQT, PBMn4M4, PBMn3M3, PBMn2M4, and PBMn2M3 were 89.2%, 87.6%, 91.6%, 88.0%, and 91.5%, respectively, by intention‐to‐treat analysis; 96.1%, 97.7%, 97.8%, 96.9%, and 97.6%, respectively, by modified intention‐to‐treat analysis; 97.1%, 97.5%, 97.7%, 96.8%, and 97.6%, respectively, by per‐protocol analysis. Metronidazole resistance did not affect the efficacy of all groups. PBMn2M3 group achieved the greatest compliance and the fewest moderate and severe adverse events. Conclusions: The novel bismuth‐containing quadruple therapy with a low dose of minocycline and metronidazole is an alternative to classical bismuth quadruple therapy for H. pylori rescue treatment with superior safety and compliance. Trial Registration: ClinicalTrials.gov identifier: NCT06332599 [ABSTRACT FROM AUTHOR]