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The impact of a carbohydrate-electrolyte solution with sodium alginate and pectin for hydrogel formation (CES-HGel), was compared to a standard CES with otherwisematched ingredients (CES-Std), for blood glucose, substrate oxidation, gastrointestinal symptoms (GIS; nausea, belching, bloating, pain, regurgitation, flatulence, urge to defecate, and diarrhea), and exercise performance. Nine trained male endurance runners completed 3 hr of steady-state running (SS) at 60% ...O2max, consuming 90 g/hr of carbohydrate from CES-HGel or CES-Std (53 g/hr maltodextrin, 37 g/hr fructose, 16% w/v solution) in a randomized crossover design, followed by an incremental time to exhaustion (TTE) test. Blood glucose and substrate oxidation were measured every 30 min during SS and oxidation throughout TTE. Breath hydrogen (H2) was measured every 30 min during exercise and every 15 min for 2 hr postexercise. GIS were recorded every 15 min throughout SS, immediately after and every 15-min post-TTE. No differences in blood glucose (incremental area under the curve [mean ± SD]: CES-HGel 1,100 ± 96 mmol⋅L-1⋅150 min-1 and CES-Std 1,076 ± 58 mmol⋅L-1⋅150 min-1; p = .266) were observed during SS. There were no differences in substrate oxidation during SS (carbohydrate: p = .650; fat: p = .765) or TTE (carbohydrate: p = .466; fat: p = .633) and no effect of trial on GIS incidence (100% in both trials) or severity (summative rating score: CES-HGel 29.1 ± 32.6 and CES-Std 34.8 ± 34.8; p = .262). Breath hydrogen was not different between trials (p = .347), nor was TTE performance (CES-HGel 722 ± 182 s and CES-Std: 756 ± 187 s; p = .08). In conclusion, sodium alginate and pectin added to a CES consumed during endurance running does not alter the blood glucose responses, carbohydrate malabsorption, substrate oxidation, GIS, or TTE beyond those of a CES with otherwise matched ingredients. [ABSTRACT FROM AUTHOR]

Background: MBOAT7 rs641738 variant is a risk factor for nonalcoholic fatty liver disease (NAFLD) and liver fibrosis, but the relationship between this polymorphism and early liver dysfunction remains uncertain. Methods: Eighty outpatients underwent blood analyses, liver imaging by ultrasound and acoustic radiation force impulse shear wave elastography and were genotyped for MBOAT7 (wild‐type [WT], rs641738 heterozygous or homozygous) polymorphism using TaqMan assays. Results: NAFLD was confirmed in 53 patients. Portal uptake and hepatocyte microsomal metabolization of (13C)‐methacetin were explored by measuring 13CO2 appearance in exhaled air. The distribution of the MBOAT7 genotypes was comparable in subjects with or without NAFLD. The majority of subjects with or without NAFLD had fibrosis ≤ F1 but decreased portal extraction of (13C)‐methacetin, i.e. 78.6% in homozygous, 45.0% in heterozygous and 46.2% in WT for the MBOAT7 variant. Both substrate extraction and microsomal metabolization were mostly defective in the homozygous carriers. The extraction efficiency from portal blood flow was minimal in subjects with both homozygous rs641738 polymorphism and NAFLD, as compared to those with WT/heterozygous polymorphism, with or without NAFLD. Conclusions: The homozygous MBOAT7 rs641738 polymorphism per se is associated with a reduced extraction efficiency of (13C)‐methacetin from the portal flow pointing to subclinical liver dysfunction independently from liver fibrosis. Liver steatosis worsens (13C)‐methacetin extraction efficiency. We urge to better explore the mechanisms of interaction between external factors and multiple gene polymorphisms (including MBOAT7), paving the road to primary prevention and novel therapeutic strategies. [ABSTRACT FROM AUTHOR]

Background: Exercise‐induced bronchoconstriction (EIB) and exercise‐induced laryngeal obstruction (EILO) are common in elite athletes. Knowledge of which factors are related to incident EIB and EILO is limited. The aim of this study was to explore the course of EIB and EILO in adolescent athletes over a 2 years period and baseline characteristics related to incident EIB. Methods: Questionnaire data on respiratory symptoms, asthma, and aeroallergy and results of objective EIB and EILO tests were collected from 58 participants (27 tested for EILO) at baseline and after 2 years (follow‐up). Associations between incident EIB and baseline asthma‐like symptoms, exercise‐induced symptoms, fractional exhaled nitric oxide (FeNO), aeroallergy, and sex were assessed using logistic regression models. Results: Ten participants had incident EIB, and eight participants had persistent EIB. Five were EIB positive at baseline but negative at follow‐up, while 35 participants were EIB negative at both time points. Having incident EIB was associated with reporting waking up with chest tightness (OR = 4.38; 95% CI: 1.06, 22.09). Reporting an increased number of asthma‐like symptoms increased the likelihood of incident EIB (OR = 2.78; 95% CI: 1.16, 6.58). No associations were found between exercise‐induced symptoms, FeNO, aeroallergy, or sex and incident EIB. Incident EILO was found in three and persistent EILO in two of the 27 participants tested. Conclusion: Two in nine had incident EIB and one eighth had incident EILO, suggesting that recurrent testing for EIB and EILO may be relevant in young athletes. Particularly, EIB‐negative athletes reporting multiple asthma‐like symptoms could benefit from recurrent EIB testing. [ABSTRACT FROM AUTHOR]

Gastroparesis (GP) is a chronic disease characterized by upper gastrointestinal symptoms, primarily nausea and vomiting, and delayed gastric emptying (GE), in the absence of mechanical GI obstruction. The underlying pathophysiology of GP remains unclear, but factors contributing to the condition include vagal nerve dysfunction, impaired gastric fundic accommodation, antral hypomotility, gastric dysrhythmias, and pyloric dysfunction. Currently, gastric emptying scintigraphy (GES) is considered the gold standard for GP diagnosis. However, the overall delay in GE weakly correlates with GP symptoms and their severity. Recent research efforts have focused on developing treatments that address the presumed underlying pathophysiological mechanisms of GP, such as pyloric hypertonicity, with Gastric Peroral Endoscopic Myotomy (G-POEM) one of these procedures. New promising diagnostic tools for gastroparesis include wireless motility capsule (WMC), the 13 carbon-GE breath test, high-resolution electrogastrography, and the Endoluminal Functional Lumen Imaging Probe (EndoFLIP). Some of these tools assess alterations beyond GE, such as muscular electrical activity and pyloric tone. These modalities have the potential to characterize the pathophysiology of gastroparesis, identifying patients who may benefit from targeted therapies. The aim of this review is to provide an overview of the current knowledge on diagnostic pathways in GP, with a focus on the association between diagnosis, symptoms, and treatment. [ABSTRACT FROM AUTHOR]

In the 1970s, 1% of the UK population consulted with dyspepsia; fiberoptic gastroscopy allowed biopsy specimens under direct vision enabling systematic histopathology. Steer et al described clusters of flagellated bacteria closely apposed to the gastric epithelium associated with chronic active gastritis. The first UK series of Helicobacter pylori following Marshall's 1983 visit to Worcester confirmed the association of H. pylori with gastritis. UK researchers completed much early helicobacter research as there were many UK campylobacteriologists. Steer and Newell proved the Campylobacter‐like organisms grown on culture were the same as those seen in the gastric mucosa using antiserum raised by inoculating rabbits with H. pylori from cultures. Wyatt, Rathbone, and others showed a strong correlation between the number of organisms, type and severity of acute gastritis, immunological response, and bacterial adhesion similar to enteropathogenic E coli. Seroprevalence studies indicated H. pylori increased with age. Histopathologists also showed peptic duodenitis was in effect "gastritis in the duodenum" caused by H. pylori, unifying its role in the pathogenesis of both gastritis and duodenal ulceration. These bacteria were initially called Campylobacter pyloridis and then C. pylori. However, electron microscopy suggested that the bacteria were not campylobacters, and this was supported by differences in fatty acid and polyacrylamide electrophoresis profiles. In‐vitro tests indicated that H. pylori was susceptible to penicillins, erythromycin, and quinolones, but not trimethoprim or cefsulodin allowing development of selective media for culture. Monotherapy with erythromycin ethylsuccinate was ineffective, and patients treated with bismuth subsalicylate initially responded with clearance of H. pylori and the associated gastritis, but then many relapsed. Thus, pharmacokinetic and treatment studies were important to direct suitable dual and triple treatments. Work optimized serology, and the rapid biopsy urease and urea breath tests. The link between H.pylori and gastric cancer was established in large seroprevalence studies, and H. pylori test and treat for dyspepsia became routine. [ABSTRACT FROM AUTHOR]

Background/Aims: In areas with >15% clarithromycin resistance, bismuth‐based quadruple therapy is recommended for first‐line Helicobacter pylori eradication. This study aimed to determine the efficacy of the twice‐daily intake of bismuth‐based quadruple therapy among 10‐day, 14‐day, and half‐dose antibiotic regimens. Methods: From May 2021 to March 2023, H. pylori‐infected Korean adults were administered tetracycline (1 g), metronidazole (750 mg), bismuth potassium citrate (300 mg), and lansoprazole (30 mg) twice daily, after breakfast and dinner, for 10 days. The regimen was administered for 14 days if the body weight was ≥70 kg or if the patient had reinfection. Half doses of antibiotics were administered for 14 days if there was a risk of drug interactions or if the patient was aged ≥75 years. The 13C‐urea breath test was performed after 6 weeks. Results: Among the 1258 infected Koreans, 85.1% (412/484) in the 10‐day, 84.3% (498/591) in the 14‐day, and 86.3% (158/183) in the half‐dose antibiotic groups followed the instructions. In the per‐protocol (PP) analysis, eradication rates were higher in the 10‐day (90.5%, p = 0.019) and 14‐day (90.2%, p = 0.023) groups than in the half‐dose group (83.5%). In the intention‐to‐treat (ITT) analysis, eradication rates were higher in the 10‐day group (80.6%) than in the half‐dose group (73.2%, p = 0.039). In the half‐dose group, the eradication rate was lower in patients aged ≥75 years (PP: 74.6%, ITT: 66.2%) than in those with a risk of drug interactions (PP: 89.7% [p = 0.017], ITT: 82.4% [p = 0.019]). Conclusions: Twice‐daily intake of bismuth‐based quadruple therapy for 10–14 days showed an eradication rate of >90% in the PP analysis. A 10‐day regimen could be administered to eradication‐naive patients with a body weight below 70 kg. A half‐dose antibiotic regimen might be recommended to patients with a risk of drug interactions but not to those aged ≥75 years simply due to old age. [ABSTRACT FROM AUTHOR]

Background: As the reduced eradication rate of Helicobacter pylori (H. pylori), we introduced string‐test and quantitative PCR (qPCR) for susceptibility‐guided therapy innovatively. The practicality of the string test was evaluated. Methods: It was an open‐label, non‐randomized, parallel, single‐center study, in which subjects tested by 13C‐ urea breath test (UBT) and string‐qPCR were enrolled. Based on the results of string‐qPCR, we calculated clarithromycin and levofloxacin resistance rates and gave 13C‐UBT positive patients 14 days susceptibility‐guided bismuth quadruple therapy. In the empirical therapy group, we retrospectively analyzed the treatment results of 13C‐UBT positive patients also treated with bismuth quadruple at Shenzhen Luohu People's Hospital from January 2021 to May 2022. The eradication rate was compared between susceptibility‐guided therapy and empirical therapy groups. Results: The diagnosis of H. pylori infection using the string‐qPCR had an overall concordance rate of 95.9% with the 13C‐UBT results. Based on the results of string‐qPCR, the clarithromycin and levofloxacin resistance rates were 26.1% and 31.8%, respectively. The patients who were given 14 days susceptibility‐guided bismuth‐based quadruple therapy achieved a high H. pylori eradication rate of 91.8%. Retrospective analysis of patient treatment data from January 2021 to May 2022 available in the hospital database revealed an overall success rate of 82.3% for those who received empirical bismuth‐based quadruple therapies, which is marginally significantly lower than that of the string‐qPCR susceptibility‐guided group (p = 0.084). Conclusion: The high treatment success rate of 91.8% indicates that the string‐qPCR test is a valuable and feasible approach for clinical practice to help improve H. pylori treatment success rate. [ABSTRACT FROM AUTHOR]

Background: Potassium‐competitive acid blockers (P‐CAB) are recommended for the treatment of Helicobacter pylori infections, but dual therapy of P‐CAB with amoxicillin has been poorly studied. The current study compared the efficacy, adverse reactions, compliance, and effects on gut microbiota of 14‐day vonoprazan‐amoxicillin (VA) dual therapy with esomeprazole, bismuth potassium citrate, amoxicillin, and metronidazole (EBAM) quadruple therapy in treatment‐naive patients with H. pylori. Materials and Methods: This was a multicenter, open‐label, randomized, and controlled, non‐inferiority study. Patients (n = 194) enrolled from six centers were randomly divided into either the VA or EBAM group. H. pylori eradication was determined using 13C urea breath tests (UBT) 4–6 weeks post‐treatment. Fecal samples were collected, and gut microbial populations were analyzed by 16S rDNA and metagenomic sequencing technology. Results: Eradication rates of H. pylori in the VA and EBAM groups were 88.7% and 91.8%, respectively, according to intention‐to‐treat (ITT) analysis; 95.6% and 96.7% with per‐protocol (PP) analysis; and 94.5% and 96.7% with modified ITT (mITT) analysis (all p > 0.05). The incidence of adverse reactions in the VA group was significantly lower compared to the EBAM group, and compliance within both groups was good. There was no difference in α‐diversity or microbial composition in the VA and EBAM groups at one‐month post‐treatment compared to baseline, except for a markedly reduced abundance of Bacteroides in the EBAM group. Conclusion: VA therapy achieved excellent eradication rates with low adverse reactions, good compliance, and little impact on gut microbiota. VA therapy should be recommended as a first‐line treatment against H. pylori. [ABSTRACT FROM AUTHOR]

Background: An adequate diagnostic and therapeutic approach to Helicobacter pylori (H. pylori) infection is the cornerstone to avoid overdiagnosis, overuse of health resources, and increase in antibiotic resistances. The aim of the study was to evaluate the most common errors in clinical practice and the associated risk factors. Materials and Methods: This is a retrospective observational study including patients with H. pylori infection and no previous treatment belonging to two defined areas of the National Health System in Spain; some of them were enrolled in the European Registry on H. pylori management (Hp‐EuReg). Patients were attended by gastroenterologists between 2010 and 2019. According to current guidelines, we evaluated indications for H. pylori investigation, appropriateness of diagnostic test used in dyspeptic patients and discontinuation of surveillance after treatment. Results: A total of 1730 patients were included, receiving 2260 eradication regimens. H. pylori infection was investigated in 1.7% cases in absence of a formal indication. Oral endoscopy was incorrectly used in 56% of patients with dyspepsia under 55 years without alarm signs, and urea breath test (UBT) was incorrectly used in 22.4% of patients with dyspepsia ≥55 years or red flags. Levofloxacin containing regimens were used as first‐line therapy in 7.5% of non‐allergic to penicillin patients. After first‐line failure, clarithromycin was repeated in 2.6% of the patients who received second‐line therapy. Confirmatory test of H. pylori status was absent in 2.5% cases. Men, patients under 55 years, and patients diagnosed by UBT had a higher risk of not undergoing a confirmatory test. Conclusions: Investigation of H. pylori infection by gastroenterologists is rare in absence of a formal indication; however, endoscopy is commonly used for dyspeptic patients <55 years without red flags and non‐invasive tests are still used for dyspeptic patients ≥55 years or presenting alarm signs. Men, patients under 55 years, and patients diagnosed by UBT have an increased risk of being lost to follow‐up after eradication treatment. [ABSTRACT FROM AUTHOR]

This paper aims to provide an overview of the contemporary quantitative methods to assess alcohol consumption. We identified and rated six data collection methods according to four typical aims (i.e. to assess: per capita consumption, drinking patterns, event-specific consumption, and consumption over time) and five desirable features (low cognitive bias, contextual information, low participant and researcher burden, low costs). The results are presented in an overview table, which reveals that questionnaire-based methods are easy and cost-efficient but often distorted by cognitive biases. These biases can be avoided by analyzing sales/production statistics and wastewater samples, but these methods are unable to provide information on individual drinking patterns. Breathalyzers or transdermal monitors enable relatively precise measurement of individual consumption without any cognitive bias. However, the required devices are expensive and difficult to apply correctly, which makes data collection time, labor, and cost-intensive, particularly as sample sizes increase. Ecological momentary assessment (e.g. series of questionnaires within short timeframes completed in the participants' natural environments) reduces, but does not eliminate, cognitive biases and maximizes ecological validity. Unfortunately, this method also increases the response burden, potentially resulting in assessment reactivity and drop-out. Highlighting the combination of strengths and weaknesses of each method, this overview may serve as useful guidance for study planning and implementation. [ABSTRACT FROM AUTHOR]

In summary, surgery for acute diverticulitis typically results in colorectal anastomosis; resection of the small bowel as documented in the discussed patient is not common, but may have been necessary due to intraoperative complications. Keywords: Enterocolonic fistula; Colon diverticulitis; Fistulectomy; Anastomotic leak; Breath tests EN Enterocolonic fistula Colon diverticulitis Fistulectomy Anastomotic leak Breath tests 429 435 7 08/24/23 20230801 NES 230801 Presentation of case I Dr. T. Roskaric i : Six years prior to admission, the patient underwent surgery for an inflammatory conglomerate tumor due to complicated sigmoid diverticulitis; 28 cm of the colon and 18 cm of the small bowel were resected. Given the patient's advanced age and history of coronary heart disease and anemia, one may think of ischemic colitis in this patient; however, this diagnosis can also be ruled out because the patient denied abdominal pain. Another potential risk factor associated with recurrence of diverticulitis is an involved colon length greater than 5 cm and the presence of a retroperitoneal abscess [[23]] (in our patient, the initially affected colon segment was 28 cm in length). [Extracted from the article]

Although exhaled aerosols and their patterns may seem chaotic in appearance, they inherently contain information related to the underlying respiratory physiology and anatomy. This study presented a multi-level database of simulated exhaled aerosol images from both normal and diseased lungs. An anatomically accurate mouth-lung geometry extending to G9 was modified to model two stages of obstructions in small airways and physiology-based simulations were utilized to capture the fluid-particle dynamics and exhaled aerosol images from varying breath tests. The dataset was designed to test two performance metrics of convolutional neural network (CNN) models when used for transfer learning: interpolation and extrapolation. To this aim, three testing datasets with decreasing image similarities were developed (i.e., level 1, inbox, and outbox). Four network models (AlexNet, ResNet-50, MobileNet, and EfficientNet) were tested and the performances of all models decreased for the outbox test images, which were outside the design space. The effect of continuous learning was also assessed for each model by adding new images into the training dataset and the newly trained network was tested at multiple levels. Among the four network models, ResNet-50 excelled in performance in both multi-level testing and continuous learning, the latter of which enhanced the accuracy of the most challenging classification task (i.e., 3-class with outbox test images) from 60.65% to 98.92%. The datasets can serve as a benchmark training/testing database for validating existent CNN models or quantifying the performance metrics of new CNN models. Dataset: The dataset is submitted and will be published as a supplement to this paper in the journal Data, this field will be filled by the editors of the journal. CFD Lung Diagnosis|Kaggle.Dataset License: license under (CC0, CC-BY, CC-BY-SA, CC-BYaeor-NC, etc.) [ABSTRACT FROM AUTHOR]

Background: The day-to-day (DTD) management model encourages patients to actively participate in their healthcare by setting goals. We determined the effectiveness of the DTD model in the treatment of Helicobacter pylori (H. pylori) infection, as compared with conventional outpatient education (OE). Methods: We randomized 254 H. pylori-positive patients into a DTD group (127 patients) and an OE group (127 patients) prior to primary treatment with 14-day bismuth-containing quadruple therapy, including esomeprazole, amoxicillin, and clarithromycin. Both groups received consistent medication instructions. Patients in the DTD group recorded daily attendance after completing their daily medication plan from day 1 to day 14. The medication compliance, follow-up compliance, H. pylori eradication rates, and adverse events (AEs) were evaluated. Results: In the modified intention-to-treat (MITT) and per-protocol (PP) analyses, the DTD group showed significantly higher medication compliance than the OE group (P = 0.001 and P = 0.031, respectively). Both the MITT and PP analyses showed significant differences in follow-up compliance (P < 0.001 and P = 0.003, respectively) and timing of the review urea breath test (P < 0.001 and P = 0.001, respectively) between the two groups. However, no significant differences were observed in the H. pylori eradication rates (95.8% vs. 93.8%, P = 0.529) in the PP analysis, or AEs incidence (25.4% vs. 28.3%, P = 0.603) between the two groups. Conclusion: This study demonstrated the novel application of the DTD model in the treatment of H. pylori infection, which enabled patients to develop habitual medication-taking behaviors without physician intervention. [ABSTRACT FROM AUTHOR]

Background: Lactose intolerance is defined as the presence of gastrointestinal symptoms, such as bloating, abdominal pain or diarrhoea, after consumption of lactose in individuals with lactose malabsorption. Most cases involve primary lactose intolerance, caused by a loss of activity of the enzyme lactase, needed for digestion of lactose. A traditional method of establishing lactose intolerance is the hydrogen breath test (HBT), accompanied by a questionnaire to document complaints experienced by the patient during the test. Due to knowledge on lactase-persistent alleles, DNA genotyping has become available for the diagnostic work-up for lactose intolerance. Both methods are currently in use. The aim of this study is to provide a definite diagnostic approach for patients suspected of lactose intolerance in a Dutch population. Methods: In this retrospective, observational study, patients aged 15 years or older were included after presenting to their treating physician with symptoms suggestive of lactose intolerance. HBT, including a questionnaire to document complaints and DNA genotyping of LCT-13,910 C/T was performed for each patient as part of a routine diagnostic work-up. Results: 1101 patients were included (29% men). Positive and negative predictive value, sensitivity and specificity of HBT versus DNA genotyping were 80% (CI 75–84), 97% (CI 96–98), 89% (CI 84–92) and 94% (92–96) respectively. The use of the questionnaire added little diagnostic value. Conclusions: In a population with a high prevalence of lactase-persistent alleles, we advise to exclude HBT from the diagnostic route for suspected lactose intolerance, and replace it with genotyping of lactase-persistent alleles. [ABSTRACT FROM AUTHOR]

Introduction: Socioeconomically deprived populations are at greater risk for smoking‐induced diseases and death, such as cancers, and cardiovascular and respiratory illnesses. The initiation of a nurse‐led smoking cessation program in clinical practice is an effective method to enhance smoking cessation among cardiovascular and respiratory patients in Pakistan. This study aimed to evaluate the effectiveness of nurse‐led smoking reduction intervention performed at out‐patient clinics in Karachi, Pakistan. Methods: A single group pre‐and post‐test study was conducted on eligible patients (n = 83) with a typical profile of cardiovascular and respiratory diseases in a tertiary care hospital from December 2020 to July 2021. Intervention: The multi‐modal nurse‐led intervention consisted of two face‐to‐face motivational counseling (30‐min) and free nicotine replacement therapy with telephonic counseling and follow‐ups offered to all eligible patients for 2 months. Results: The nurse‐led intervention resulted in a significant decrease in daily cigarette consumption in most of the patients (75.9%) by 50% and 16.9% of the patients reported smoking abstinence (quitter) at 1‐week follow‐up (p <.001), verified by a CO breath test. Conclusion: A nurse‐managed smoking reduction intervention for even a short duration (2 months) in clinics is an effective approach in enhancing smoking abstinence and reduction among cardiovascular and respiratory patients. [ABSTRACT FROM AUTHOR]

INTRODUCTION Few studies have examined the effect of feedback based on oral-malodor measurements on the motivation to quit smoking. Therefore, this study examined whether oral-malodor measurements were associated with the intention to quit smoking. METHODS This retrospective, uncontrolled before-after study invited smokers to a workplace health event in 2019 and 2020 to motivate them to quit smoking. They attended seminars on oral health and smoking cessation aids, and then underwent respiratory function and oral-malodor measurements using exhaled and oral cavity air, respectively. Intention to quit smoking was evaluated by answers to questions regarding the intention to quit in the next 1 or 6 months in questionnaires collected before and after the event. This study analyzed 241 men aged 20-54 years (mean: 33.2 ± 10.5) to examine factors associated with the intention to quit in multivariable logistic regression analyses for age, tobacco type (cigarettes and heated-tobacco products), and category of tobacco consumption. RESULTS Before the event, 8.7%, 17.0%, and 74.3% of smokers had intended to quit in the next month, the next six months, or had no intention to quit, respectively. After the event, the respective percentages were 17.8%, 26.6%, and 55.6%. A higher methyl mercaptan concentration, a volatile sulfide component of oral malodor, was significantly associated with the intention to quit in the next month (adjusted odds ratio, AOR=4.24; 95% CI: 1.52-11.8, p=0.006). The participants with higher daily tobacco consumption were less likely to acquire the intention to quit in the next six months (A0R=0.37; 95% CI: 0.15-0.92, p=0.032). Other variables, such as lung age deficit, exhaled CO concentration, and hydrogen sulfide concentration (another component of oral malodor), were not significantly associated. CONCLUSIONS Oral-malodor measurement feedback may help motivate men to quit smoking in the next 1 month rather than in the next six months. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The study aimed to compare the efficacies and safety of 14-day hybrid therapy, 14-day high-dose dual therapy, and10-day bismuth quadruple therapy in the first-line treatment ofHelicobacterpylori infections. METHODS: In this multicenter, open-label, randomized trial, we recruited adult H. pylori-infected patients from 9 centers in Taiwan. Subjects were randomly assigned (1:1:1) to 14-day hybrid therapy, 14-day high-dose dual therapy, or 10-day bismuth quadruple therapy. Eradication status was determined by the 13C-urea breath test. The primary outcome was the eradication rate of H. pylori assessed in the intention-to-treat population. RESULTS: Between August 1, 2018, and December 2021, 918 patients were randomly assigned in this study. The intention-to-treat eradication rates were 91.5% (280/306; 95% confidence interval [CI] 88.4%-94.6%) for 14-day hybrid therapy, 83.3% (255/306; 95% CI 87.8%-95.0%) for 14-day high-dose dual therapy, and 90.2% (276/306; 95% CI 87.8%-95.0%) for 10-day bismuth quadruple therapy. Both hybrid therapy (difference 8.2%; 95% CI 4.5%-11.9%; P = 0.002) and bismuth quadruple therapy (difference 6.9%; 95% CI 1.6%-12.2%; P = 0.012) were superior to high-dose dual therapy and were similar to one another. The frequency of adverse events was 27% (81/303) with 14-day hybrid therapy, 13% (40/305) with 14-day high-dose dual therapy, and 32% (96/303) with 10-day bismuth quadruple therapy. Patients receiving high-dose dual therapy had the fewest adverse events (both P < 0.001). INTRODUCTION: The study aimed to compare the efficacies and safety of 14-day hybrid therapy, 14-day high-dose dual therapy, and10-day bismuth quadruple therapy in the first-line treatment ofHelicobacterpylori infections. METHODS: In this multicenter, open-label, randomized trial, we recruited adult H. pylori-infected patients from 9 centers in Taiwan. Subjects were randomly assigned (1:1:1) to 14-day hybrid therapy, 14-day high-dose dual therapy, or 10-day bismuth quadruple therapy. Eradication status was determined by the 13C-urea breath test. The primary outcome was the eradication rate of H. pylori assessed in the intention-to-treat population. RESULTS: Between August 1, 2018, and December 2021, 918 patients were randomly assigned in this study. The intention-to-treat eradication rates were 91.5% (280/306; 95% confidence interval [CI] 88.4%-94.6%) for 14-day hybrid therapy, 83.3% (255/306; 95% CI 87.8%-95.0%) for 14-day high-dose dual therapy, and 90.2% (276/306; 95% CI 87.8%-95.0%) for 10-day bismuth quadruple therapy. Both hybrid therapy (difference 8.2%; 95% CI 4.5%-11.9%; P = 0.002) and bismuth quadruple therapy (difference 6.9%; 95% CI 1.6%-12.2%; P = 0.012) were superior to high-dose dual therapy and were similar to one another. The frequency of adverse events was 27% (81/303) with 14-day hybrid therapy, 13% (40/305) with 14-day high-dose dual therapy, and 32% (96/303) with 10-day bismuth quadruple therapy. Patients receiving high-dose dual therapy had the fewest adverse events (both P < 0.001). [ABSTRACT FROM AUTHOR]

Background and aims: Several methods are available to diagnose Helicobacter pylori infection. Our objective was to evaluate the tests used for both the initial diagnosis and the confirmation of eradication after treatment in Europe. Methods: The European Registry on the management of Helicobacter pylori infection is an international, multicentre, prospective, non-interventional registry aiming to evaluate the management of Helicobacter pylori-infected patients in Europe. Countries with at least 100 cases registered from June 2013 to April 2021, and with a validated diagnostic method were analysed. Data were quality reviewed. Results: A total of 34,920 adult patients from 20 countries were included (mean age 51 years; 61% women). To establish the initial diagnosis, invasive tests were performed in 19,801 (71%) patients, non-invasive in 11,369 (41%), and both in 3437 (12%). The most frequent were histology (n = 11,885; 43%), a rapid urease test (n = 10,636; 38%) and an urea breath test (n = 7577; 27%). According to the age, invasive tests were indicated in 11,179 (77%) ≥50 years, and in 8603 (65%) <50 years. Depending on the country, the use of invasive tests ranged from 29–99% in <50 years to 60–99% in ≥50. Most of the tests used to confirm eradication were non-invasive (n = 32,540; 93%), with the urea breath test being the most frequent (n = 32,540; 78%). In 2983 (9%) post-treatment tests, histology (n = 1887; 5%) or a rapid urease test (n = 1223; 4%) were performed. Conclusion: A great heterogeneity was observed for the initial diagnosis and confirmation of the eradication. The reasons for the apparent lack of adherence to the clinical guidelines should be further explored. [ABSTRACT FROM AUTHOR]

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes an acute respiratory illness. A substantial proportion of adults experience persistent symptoms. There is a paucity of data on respiratory sequelae in children. Exhaled breath condensate (EBC) is a non-invasive tool used to assess airway inflammation. Objectives: This study aimed to evaluate EBC parameters, respiratory, mental and physical ability among children post COVID-19 infection. Methods: Observational study of confirmed SARS-CoV-2 infection cases among children, aged 5–18 years, evaluated once, 1–6 months post positive SARS-CoV-2 PCR testing. All subjects performed spirometry, 6-min walk test (6MWT), EBC (pH, interleukin-6), and completed medical history questionnaires, Depression, Anxiety, and Stress Scale (DASS-21), and physical activity scores. Severity of COVID-19 disease was classified according to WHO criteria. Results: Fifty-eight children were included and classified asymptomatic (n = 14), mild (n = 37), and moderate (n = 7) disease. The asymptomatic group included younger patients compared to the mild and moderate groups (8.9 ± 2.5y vs. 12.3 ± 3.6y and 14.6 ± 2.5y, respectively, p = 0.001), as well as lower DASS-21 total scores (3.4 ± 4 vs. 8.7 ± 9.4 and 8.7 ± 0.6 respectively, p = 0.056), with higher scores in proximity to positive PCR (p = 0.011). No differences were found between the 3 groups regarding EBC, 6MWT, spirometry, body mass index percentile, and activity scores. Conclusions: COVID-19 is an asymptomatic-mild disease in most young healthy children, with gradually diminishing emotional symptoms. Children without prolonged respiratory symptoms revealed no significant pulmonary sequelae as evaluated by EBC markers, spirometry, 6MWT, and activity scores. Larger studies are required to assess long-term pediatric consequences of post SARS‐CoV‐2 infection, to assess the need for pulmonology surveillance. [ABSTRACT FROM AUTHOR]

Electronic cigarette use is highest among adults of child-bearing age. Many parents that use electronic cigarettes believe that secondhand exposure of electronic cigarette vapors for their children is not dangerous and is less harmful than secondhand exposure to traditional cigarette smoke. These beliefs may prompt excessive secondhand exposure to electronic cigarette vapors for their children. Little research has been done to document exposure in children. The traditional biological method of exposure detection is through a blood draw, which is difficult and undesirable in children. The purpose of this study was to assess the feasibility of using saliva and exhaled breath condensate as non-invasive biomatrices for detecting secondhand electronic cigarette vapor exposure in children. In this cross-sectionally designed study, we recruited 22 children exposed to electronic cigarette vapors and 26 non-exposed between the ages of 4–12 years. We compared metabolic features across three biomatrices, blood, saliva, and exhaled breath condensate. We noted moderate to strong pairwise, sample-specific, and feature-specific adjusted correlations. Annotated features associated with direct and secondhand electronic cigarette exposure were noted. These results demonstrate that less invasive biomatrices may be used to detect features associated with secondhand electronic cigarette vapor exposure in children. [ABSTRACT FROM AUTHOR]

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Introduction: Pulmonary function tests such as spirometer and peak expiratory flow rate are the standard measures to test lung volumes and capacities; but generally there is a lack of such equipment in emergency departments. Hence there is a need for an easier, quicker and convenient outcome measure in such set-ups. Single breath count (SBC) can be a simple assessment method in such clinical settings. However no studies for normal values of SBC in young Healthy adults were found during the search for literature. Objective: The objective of this study was to estimate normal value of SBC in Healthy young adult population. Results: 100 participants were enrolled from 18-24 years of age in the study. The mean SBC was 39(±7) and 41(±9) in females and males respectively. The SBC had a significant positive correlation with age at r=0.3, p value 0.0051 and height at r=0.28, p value 0.0038. The SBC had a non-significant negative correlation with BMI and weight. Discussion: The results show that SBC was influenced significantly by gender (males>females), age and height of the individuals. However BMI and weight did not seem to influence the SBC. Conclusion: SBC is a test which is easy to perform and appears to correlate well with standard measures of pulmonary functions. We estimated the normal values of SBC in young healthy adults which can be used in the clinical set up. [ABSTRACT FROM AUTHOR]

Continuous monitoring for immunosuppressive status, infection and complications are a must for kidney transplantation (KTx) recipients. Traditional monitoring including blood sampling and kidney biopsy, which caused tremendous medical cost and trauma. Therefore, a cheaper and less invasive approach was urgently needed. We thought that a breath test has the potential to become a feasible tool for KTx monitoring. A prospective-specimen collection, retrospective-blinded assessment strategy was used in this study. Exhaled breath samples from 175 KTx recipients were collected in West China Hospital and tested by online ultraviolet photoionization time-of-flight mass spectrometry (UVP-TOF–MS). The classification models based on breath test performed well in classifying normal and abnormal values of creatinine, estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN) and tacrolimus, with AUC values of 0.889, 0.850, 0.849 and 0.889, respectively. Regression analysis also demonstrated the predictive ability of breath test for clinical creatinine, eGFR, BUN, tacrolimus level, as the predicted values obtained from the regression model correlated well with the clinical true values (p < 0.05). The findings of this investigation implied that a breath test by using UVP-TOF–MS for KTx recipient monitoring is possible and accurate, which might be useful for future clinical screenings. [ABSTRACT FROM AUTHOR]

Background: Helicobacter pylori (H. pylori) has increasingly been shown to be related to extragastric diseases. Glycated hemoglobin A1c (HbA1c), an indicator of glycemic control, is closely linked to the event of diabetes. The purpose of this research was to analyze the association between H. pylori and HbA1c through a cohort study. Methods: The population who underwent multiple physical checkups in the physical examination center of Taizhou Hospital was included. All of them underwent urea breath test, serological examination and physical parameter measurement. Multiple regression was used for analyzing the influencing factors of HbA1c. In addition, the result of HbA1c on H. pylori infection was studied by restricted cubic spline (RCS) analysis. The triglyceride glucose (TyG) index represents the level of insulin resistance (IR) in the population. The population was classified on the basis of primary and last H. pylori infection, therefore, the variations of HbA1c and TyG index among totally different teams were investigated. Results: Multiple regression demonstrated that H. pylori was an influential factor in HbA1c. RCS analysis showed a nonlinear relationship between HbA1c and H. pylori infection. When HbA1c>5.7%, the chance of H. pylori infection was considerably enlarged. Additionally, long-term H. pylori infection increased HbA1c levels, while HbA1c levels decreased after H. pylori eradication. Similarly, long-term H. pylori infection also increased the TyG index. Conclusion: Prediabetes increases the danger of H. pylori infection, long-term H. pylori infection increases HbA1c and IR levels, and wipeout of H. pylori could have a positive impact for glycemic control in the population. [ABSTRACT FROM AUTHOR]

Introduction: Nicotine dependence is known to be a chronic remitting and relapsing addictive disorder. Among cancer patients who smoke, nicotine addiction has been found to be more when compared with smoking healthy individuals. Smokerlyzer machine can be used to test smoking substance use and de-addiction services can be provided at Preventive Oncology units. The objectives of the study include: (i) To assess eCO using a Smokerlyzer hand-held machine and correlate it with the smoking status, (ii) To assess the cut-off value for smoking use, and discusses the benefits of this method. Methods: In this cross-sectional study, healthy individuals at the workplace were tested for exhaled CO (eCO), which is used as a biological marker for monitoring the tobacco smoking. We discuss the feasibility of testing and its implications for cancer patients. The Bedfont EC50 Smokerlyzer machine was used to measure the concentration of CO in the end-tidal expired air. Results: Among 643 study subjects, we found a statistically significant difference (P <.001) of median (IQR) eCO (measured in ppm) among smokers and non-smokers 2(1,5) vs 1(1,2). A significant and moderate positive correlation (Spearman rank correlation coefficient:.463) was observed between eCO and subjects who used cigarettes (measured in pack years). The ROC curve shows a cut off value for eCO as 2.5 with sensitivity 43.6% and 1 – specificity 2.76% (Specificity: 97.24%), which was rounded to 3. The area under the curve is 74.9%, which indicates a moderate discrimination performance of the test. The diagnostic accuracy of the test is 82.89%, which shows the proportion of correct test results. Conclusion: Estimating eCO in health care settings will enable monitoring the smoking substance use which has important impact on clinical outcomes. In cancer hospitals, when the goal is complete abstinence a stringent CO cutoff in the range of 3-4 ppm should be used. [ABSTRACT FROM AUTHOR]

Background: Early detection is critical for improving the survival of breast cancer (BC) patients. Exhaled breath testing as a non-invasive technique might help to improve BC detection. However, the breath test accuracy for BC diagnosis is unclear. Methods: This multi-center cohort study consecutively recruited 5047 women from four areas of China who underwent BC screening. Breath samples were collected through standardized breath collection procedures. Volatile organic compound (VOC) markers were identified from a high-throughput breathomics analysis by the high-pressure photon ionization–time-of-flight mass spectrometry (HPPI-TOFMS). Diagnostic models were constructed using the random forest algorithm in the discovery cohort and tested in three external validation cohorts. Results: A total of 465 (9.21%) participants were identified with BC. Ten optimal VOC markers were identified to distinguish the breath samples of BC patients from those of non-cancer women. A diagnostic model (BreathBC) consisting of 10 optimal VOC markers showed an area under the curve (AUC) of 0.87 in external validation cohorts. BreathBC-Plus, which combined 10 VOC markers with risk factors, achieved better performance (AUC = 0.94 in the external validation cohorts), superior to that of mammography and ultrasound. Overall, the BreathBC-Plus detection rates were 96.97% for ductal carcinoma in situ, 85.06%, 90.00%, 88.24%, and 100% for stages I, II, III, and IV BC, respectively, with a specificity of 87.70% in the external validation cohorts. Conclusions: This is the largest study on breath tests to date. Considering the easy-to-perform procedure and high accuracy, these findings exemplify the potential applicability of breath tests in BC screening. [ABSTRACT FROM AUTHOR]

With the application of low-dose computed tomography in lung cancer screening, pulmonary nodules have become increasingly detected. Accurate discrimination between primary lung cancer and benign nodules poses a significant clinical challenge. This study aimed to investigate the viability of exhaled breath as a diagnostic tool for pulmonary nodules and compare the breath test with 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)-computed tomography (CT). Exhaled breath was collected by Tedlar bags and analyzed by high-pressure photon ionization time-of-flight mass spectrometry (HPPI-TOFMS). A retrospective cohort (n = 100) and a prospective cohort (n = 63) of patients with pulmonary nodules were established. In the validation cohort, the breath test achieved an area under the receiver operating characteristic curve (AUC) of 0.872 (95% CI 0.760-0.983) and a combination of 16 volatile organic compounds achieved an AUC of 0.744 (95% CI 0.7586-0.901). For PET-CT, the SUVmax alone had an AUC of 0.608 (95% CI 0.433-0.784) while after combining with CT image features, 18F-FDG PET-CT had an AUC of 0.821 (95% CI 0.662-0.979). Overall, the study demonstrated the efficacy of a breath test utilizing HPPI-TOFMS for discriminating lung cancer from benign pulmonary nodules. Furthermore, the accuracy achieved by the exhaled breath test was comparable with 18F-FDG PET-CT. [ABSTRACT FROM AUTHOR]

The phenomenon of youth preloading with alcohol is related to increased rates of assault, injury and arrest. We have no empirical, field-based, research on the impact of preloading and alcohol use at a large-scale public event. Random samples of patrons were breathalysed (BrAC) on entry and exit of a horse racing/music event (n = 286), and questioned regarding their preloading, spending, and group characteristics. 79% of participants sampled at entry and 85% at exit reported preloading prior to the event. Of those who preloaded, 87% were observed to have BrAC readings over zero (with a mean BrAC of.071 at a median time of day of 12.29 pm). No differences were found between genders on preloading or BrAC at entry. Group size was found to explain 9% of the unique variance in entry BrAC. Those patrons who preloaded had significantly higher BrAC at exit, with preloading accounting for almost identical variance to the number of reported drinks consumed within the venue. Preloading at large-scale public events is highly endorsed by both male and female youth and is associated with a pattern of continued drinking throughout the course of the event. Interventions to manage risk are suggested. [ABSTRACT FROM AUTHOR]

Inhaler misuse is common among patients with chronic obstructive pulmonary disease and associated with poor disease control. Many patient characteristics are reported to impact inhaler use, but there are no studies in the literature on the best way to evaluate them. This narrative review aims to identify patient characteristics that influence the correct use of an inhaler and describe the tools available for their assessment. First, we searched four different databases to identify reviews describing patient characteristics reported to impact inhaler use. In a second step, ways to characterize these aspects were searched using the same databases. Fifteen patient characteristics impacting on the use of inhalers were identified. Peak inspiratory flow, dexterity, and cognitive impairment were the most studied characteristics and appeared to have the highest impact on the correct use of inhalers. Notably, peak inspiratory flow can be reliably assessed in clinical practice using the In-Check Dial®. Triggering coordination, breath retention, collaboration/consciousness, and muscle strength in the fingers were important characteristics, but insufficient data exist to recommend the use of a specific tool for their assessment in daily practice. Other identified characteristics have a more uncertain impact. A demonstration of inhalation technique by the patient, combined with the measurement of peak inspiratory flow using the In-Check Dial®, appears to be an effective strategy to assess the characteristics with the highest impact on the correct use of an inhaler. In the future, "smart" inhalers could also play a decisive role in this area. [ABSTRACT FROM AUTHOR]

Background: Bismuth‐containing quadruple therapy is an effective regimen for Helicobacter pylori (H. pylori) treatment. No head‐to‐head comparison trials have been conducted to evaluate the efficacy of colloidal bismuth pectin (CBP) in quadruple therapy for eradicating H. pylori. We aimed to compare the efficacy and safety of CBP quadruple therapy and bismuth potassium citrate (BPC) quadruple therapy for 14 days in the first‐line treatment of H. pylori. Methods: In this multicenter, randomized, double‐blind, non‐inferiority clinical trial, H. pylori‐infected subjects without eradication history were randomized to receive amoxicillin 1 g twice daily, tetracycline 500 mg three time daily, esomeprazole 20 mg twice daily in combination with CBP 200 mg three time daily or BPC 240 mg twice daily for 14 days. 13C‐urea breath tests were used to access the eradication rate at least 4 weeks after treatment. Results: Between April 2021 and July 2022, 406 patients were assessed for eligibility and 339 subjects were randomized. The cure rates (primary outcome) of CBP and BPC quadruple therapy were 90.5% and 92.3% (p = 0.56) by intention‐to‐treat analysis, respectively, and 96.1% and 96.2% (p = 1.00) by per‐protocol analysis, respectively. CBP quadruple therapy was non‐inferior to BPC quadruple therapy in the intention‐to‐treat and per‐protocol analysis (p < 0.025). The frequency of adverse events and compliance were not different among the two groups (p > 0.05). Conclusions: Both CBP and BPC quadruple therapy for 14 days provide high efficacy, good compliance, and safety in the first‐line treatment of H. pylori in China. [ABSTRACT FROM AUTHOR]

Background and Aim: Helicobacter pylori (HP) infection remains a significant global public health problem. This study aimed to study the prevalence of HP infection and treatment outcomes in Thailand. Methods: We retrospectively reviewed the results of the urea breath test (UBT) performed at the King Chulalongkorn Memorial Hospital between 2018 and 2021. The prevalence of HP infection was evaluated in dyspeptic patients undergoing UBT screening. In patients with known HP infection, the treatment regimen and the success rate in each patient were recorded. Results: One‐thousand nine‐hundred and two patients were included in this study. The prevalence of HP infection in dyspeptic patients was 20.77% (UBT was positive in 65 out of 313 patients). Of the 1589 patients who received the first treatment regimen, 1352 (85.08%) had a negative UBT result. Patients who failed in each treatment regimen were treated with subsequent regimens. The overall success rates for the second, third, and fourth regimens were 69.87% (109 of 156 patients), 53.85% (14 of 26 patients), and 50% (3 of 6 patients), respectively. Univariate logistic regression analysis found that using lansoprazole was associated with failure of treatment with OR = 2.11 (95% CI: 1.14–3.92, P = 0.018). Conclusion: Current primary HP treatment regimens have an eradication rate of >80%. Even though the previous regimens failed, without available antibiotic sensitivity results, the subsequent regimens were successful by at least 50%. In cases of multiple‐treatment failure and where antibiotic sensitivity tests were unavailable, continuing to change regimens could provide satisfactory results. [ABSTRACT FROM AUTHOR]

The urea breath test is a non-invasive diagnostic method for Helicobacter pylori infections, which relies on the change in the proportion of 13CO2 in exhaled air. Nondispersive infrared sensors are commonly used for the urea breath test in laboratory equipment, but Raman spectroscopy demonstrated potential for more accurate measurements. The accuracy of the Helicobacter pylori detection via the urea breath test using 13CO2 as a biomarker is affected by measurement errors, including equipment error and δ13C measurement uncertainty. We present a Raman scattering-based gas analyzer capable of δ13C measurements in exhaled air. The technical details of the various measurement conditions have been discussed. Standard gas samples were measured. 12CO2 and 13CO2 calibration coefficients were determined. The Raman spectrum of the exhaled air was measured and the δ13C change (in the process of the urea breath test) was calculated. The total error measured was 6% and does not exceed the limit of 10% that was analytically calculated. [ABSTRACT FROM AUTHOR]

ImportanceFourth-generation nicotine salt pod system (NSPS) electronic cigarettes (e-cigarettes) are the leading class of e-cigarettes. They contain high nicotine concentrations, which may facilitate switching among smokers, but could also lead to increased exposure to nicotine and biomarkers of potential harm. African American and Latinx smokers experience significant tobacco-related health disparities. The potential of NSPS e-cigarettes to reduce smoking-related harm among these groups is unknown.ObjectiveTo compare the harm reduction potential of NSPS e-cigarette vs combustible cigarettes.Design, setting, and participantsThis unblinded randomized clinical trial compared 6 weeks of e-cigarette use vs cigarettes as usual from to 2018 to 2019 among smokers in the San Diego, California, and Kansas City, Missouri, areas. Participants included African American and Latinx adult combustible cigarette smokers who smoked at least 5 cigarettes/d on at least 25 of the past 30 days for at least 6 months and were interested in switching to e-cigarettes. Data were analyzed from September 18, 2019, to September 4, 2020.Interventions6 weeks of e-cigarette use in a choice of pod flavors (5% nicotine) along with brief education, training, and action planning to completely switch to e-cigarettes from combustible cigarettes. The control group smoked combustible cigarettes as usual.Main outcomes and measuresThe primary outcome was reduction in urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) concentration at week 6. Secondary outcomes were change in urinary cotinine, expired carbon monoxide (CO), respiratory symptoms, lung function, blood pressure, past 7-day consumption of combustible cigarettes, and switching rates (e-cigarette group only) at weeks 2 and 6.ResultsThis study included 186 participants, including 92 African American participants and 94 Latinx participants. The mean (SD) age was 43.3 (12.5) years, and 75 (40.3%) were women. Participants smoked a mean (SD) of 12.1 (7.2) cigarettes/d on 6.8 (0.6) d/wk at baseline. A total of 125 participants were randomized to the e-cigarette group and 61 were randomized to the control group. At baseline, median (interquartile range) NNAL was 124 (45-197) pg/mL in the e-cigarette group and 88 (58-197) pg/mL in the control group. At week 6, the e-cigarette group had significantly greater reductions in NNAL (relative risk [RR], 0.36 [95% CI, 0.23-0.54]; P

Oxidative stress is associated with numerous health conditions and disorders, and aldehydes are known biomarkers of oxidative stress that can be non-invasively measured in exhaled human breath. Few studies report breath aldehyde levels in human populations, and none claim participant numbers in the hundreds or more. Further, the breath community must first define the existing aldehyde concentration variance in a normal population to understand when these levels are significantly perturbed by exogenous stressors or health conditions. In this study, we collected breath samples from 692 participants and quantified C4-C10 straight chain aldehyde levels. C9 aldehyde was the most abundant in breath, followed by C6. C4 and C5 appear to have bimodal distributions. Post hoc, we mined our dataset for other breath carbonyls captured by our assay, which involves elution of breath samples onto a solid phase extraction cartridge, derivatization and liquid chromatography-quadrupole time of flight mass spectrometry (LC-qTOF). We found a total of 21 additional derivatized compounds. Using self-reported demographic factors from our participants, we found no correlation between these breath carbonyls and age, gender, body mass index (BMI), ethnicity or smoking habit (tobacco and marijuana). This work was preceded by a small confounders study, which was intended to refine our breath collection procedure. We found that breath aldehyde levels can be affected by participants' using scented hygiene products such as lotions and mouthwashes, while collecting consecutive breath samples, rinsing the mouth with water, and filtering inspired air did not have an effect. Using these parameters to guide our sampling, subjects were instructed to avoid the prior conditions to provide a breath sample for our study.

Exhaled breath aerosols contain valuable metabolomic content due to gas exchange with blood at the alveolar capillary interface in the lung. Passive and selective filtering of these aerosols and droplets may reduce the amount of saliva contaminants and serve as an aid to enhance targeted metabolomic content when sampled in exhaled breath condensate (EBC). It is currently unknown if breath aerosol size distribution affects the types or abundances of metabolites sampled through EBC. This pilot study uses a previously described hand-held human breath sampler device with varying notch filter geometries to redirect the trajectory of breath aerosols based on size. Ten notch filter lengths were simulated with the device to calculate the effect of filter length on the breath aerosol size distribution and the proportion of aerosols which make their way through to an EBC collection tube. From three notch filter lengths, we investigate metabolite content of various aerosol fractions. We analyzed the non-volatile fraction of breath condensate with high performance liquid chromatography-mass spectrometry for broad metabolite coverage. We hypothesize that: (1) increasing the length of the notch filter in this device will prevent larger aerosols from reaching the collection tube thus altering the breath aerosol size distribution sampled in EBC; and (2) there is not a systematic large-scale difference in EBC metabolomic content that correlates with breath aerosol size. From simulation results, particles typically larger than 10 µm were filtered out. This indicates that a longer notch filter in this device prevents larger particles from reaching the collection tube thus altering the aerosol particle size distribution. Most compounds were commonly present in all three filter lengths tested, and we did not see strong statistical evidence of systematic metabolite differences between breath aerosol size distributions.

Background The widespread availability of cannabis raises concerns regarding its effect on driving performance and operation of complex equipment. Currently, there are no established safe driving limits regarding ∆9-tetrahydrocannabinol (THC) concentrations in blood or breath. Daily cannabis users build up a large body burden of THC with residual excretion for days or weeks after the start of abstinence. Therefore, it is critical to have a sensitive and specific analytical assay that quantifies THC, the main psychoactive component of cannabis, and multiple metabolites to improve interpretation of cannabinoids in blood; some analytes may indicate recent use. Methods A liquid chromatography tandem mass spectrometry (LC-MS/MS) method was developed to quantify THC, cannabinol (CBN), cannabidiol (CBD), 11-hydroxy-THC (11-OH-THC), (±)-11-nor-9-carboxy-Δ9-THC (THCCOOH), (+)-11-nor-Δ9-THC-9-carboxylic acid glucuronide (THCCOOH-gluc), cannabigerol (CBG), and tetrahydrocannabivarin (THCV) in whole blood (WB). WB samples were prepared by solid-phase extraction (SPE) and quantified by LC-MS/MS. A rapid and simple method involving methanol elution of THC in breath collected in SensAbues® devices was optimized. Results Lower limits of quantification ranged from 0.5 to 2 μg/L in WB. An LLOQ of 80 pg/pad was achieved for THC concentrations in breath. Calibration curves were linear (R2>0.995) with calibrator concentrations within ±15% of their target and quality control (QC) bias and imprecision ≤15%. No major matrix effects or drug interferences were observed. Conclusions The methods were robust and adequately quantified cannabinoids in biological blood and breath samples. These methods will be used to identify cannabinoid concentrations in an upcoming study of the effects of cannabis on driving.

Resumen: Introducción: El metano (CH4) es un gas inerte producido por anaerobios colónicos y se ha asociado a diferentes patologías intestinales, incluyendo el síndrome de intestino irritable (SII). De acuerdo con la región geográfica la prevalencia de metanógenos es variable, siendo mayor en África (80%) y menor en Estados Unidos (35-40%). En México se desconoce cuál es la prevalencia de metanógenos. Objetivo: Evaluar la prevalencia de productores de CH4 y los factores asociados en un grupo de pacientes con SII y controles en población mexicana. Material y métodos: Se realizó de forma basal la medición en ayuno de gas alveolar de H2 y CH4 a través de cromatografía de gases estacionaria a pacientes consecutivos con diagnóstico de SII y un grupo control. Se clasificaron como metanógenos los sujetos con niveles basales de H2 de 0 ppm y CH4 ≥ 5 ppm. Resultados: Se incluyeron 132 controles (53.8% mujeres) y 67 pacientes con SII (76% mujeres). De forma global (n = 199), la prevalencia de metanógenos fue del 38% (n = 76) (IC 95%: 0.31-0.45). Los sujetos metanógenos tuvieron mayor prevalencia de sobrepeso/obesidad (56.5 vs 39.8%, p = 0.028). La prevalencia de metanógenos en controles sanos fue del 41.6% (IC 95%: 0.33-0.49), mientras que en los pacientes con SII fue del 31.4% (n = 21, 71% SII-E y 29% SII-M). Conclusiones: La prevalencia de metanógenos en México es comparable con lo reportado en otras poblaciones y se asoció con sobrepeso/obesidad. Una tercera parte de los pacientes con SII son metanógenos, y esto se asoció en especial con el subtipo estreñimiento. Abstract: Introduction: Methane (CH4) is an inert gas produced by colonic anaerobes and has been associated with different intestinal diseases, including irritable bowel syndrome (IBS). According to geographic region, the prevalence of methanogens varies, being higher in Africa (80%) and lower in the United States (35-40%). In Mexico, the prevalence of methanogens is unknown. Aim: To evaluate the prevalence of CH4 producers and associated factors in a group of patients with IBS and controls in a Mexican population. Materials and methods: A baseline fasting measurement of alveolar H2 and CH4 gas was carried out, by gas chromatography (stationary phase), in consecutive patients diagnosed with IBS and a control group. Subjects with baseline levels of H2 of 0 ppm and CH4 ≥ 5 ppm were classified as methanogenic. Results: A total of 132 controls (53.8% women) and 67 patients with IBS (76% women) were included. The overall prevalence (n = 199) of methanogenic subjects was 38% (n = 76) (95% CI: 0.31-0.45) and they had a greater prevalence of overweight/obesity (56.5 vs 39.8%, P = .028). The prevalence of methanogens in the healthy controls was 41.6% (95% CI: 0.33-0.49), whereas, in the patients with IBS, it was 31.4% (n = 21, 71% IBS-C and 29% IBS-M). Conclusions: The prevalence of methanogens in our study on a Mexican population was comparable to that reported in other populations and was associated with overweight/obesity. One-third of the patients with IBS presented with methanogens. Said microorganisms were particularly associated with the constipation-predominant IBS subtype.

In vivo methods to estimate human liver mitochondrial activity are lacking and this project’s goal was to use a non-invasive breath test to quantify complete mitochondrial fat oxidation and determine how test results changed when liver disease state was altered over time. Patients with suspected non-alcoholic fatty liver disease (NAFLD; 9 men, 16 women, 47 ± 10 years, 113 ± 23 kg) underwent a diagnostic liver biopsy and liver tissue was histologically scored by a pathologist using the NAFLD activity score (0–8). To assess liver oxidation activity, a labeled medium chain fatty acid was consumed orally (23.4 mg 13C4-octanoate) and breath samples collected over 135 min. Total CO2 production rates were measured using breath 13CO2 analysis by isotope ratio mass spectrometry. Fasting endogenous glucose production (EGP) was measured using an IV infusion of 13C6-glucose. At baseline, subjects oxidized 23.4 ± 3.9% (14.9%– 31.5%) of the octanoate dose and octanoate oxidation (OctOx) was negatively correlated with fasting plasma glucose (r = −0.474, p = 0.017) and EGP (r = −0.441, p = 0.028). Twenty-two subjects returned for repeat tests 10.2 ± 1.0 months later, following lifestyle treatment or standardized care. OctOx (% dose/kg) was significantly greater across all subjects (p = 0.044), negatively related to reductions in EGP (r = −0.401, p = 0.064), and tended to correlate with reduced fasting glucose (r = −0.371, p = 0.090). Subjects exhibited reductions in steatosis (p = 0.007) which tended to correlate with increased OctOx (% of dose/kg, r = −0.411, p = 0.058). Based on our findings, the use of an 13C-octanoate breath test may be an indicator of hepatic steatosis and glucose metabolism, but these relationships require verification through larger studies in NAFLD populations. [ABSTRACT FROM AUTHOR]

Background: The increasing antibiotic resistance is the main issue causing Helicobacter pylori (H. pylori) eradication failure. As a nutritional supplement, Egg Yolk Antibody (Ig Y) provides a new approach for H. pylori infection rescue therapy. Methods: In this randomized, controlled study, 100 H. pylori-positive patients with previous H. pylori eradication treatment were included. All individuals received standard bismuth-containing quadruple therapy twice daily (5 mg ilaprazole, 100 mg doxycycline, 500 mg clarithromycin or 1 g amoxicillin or 100 mg furazolidone, and 220 mg colloidal bismuth tartrate) for 14 days and were randomized to receive either twice daily 7 g Ig Y-H. pylori treatment (study group) or not (control group). 4 weeks after the end of treatment, urea breath tests were used to assess the H. pylori eradication rate. All participants scored by the Global Overall Symptom scale (GOS) and recorded adverse events during the trial. Results: The H. pylori eradication rates were 84.0% (95% CI 73.5-94.5%) vs. 80.0% (95% CI 68.5-91.5%) in the study and control groups at intention-to-treat (ITT) analysis and 85.7% (95% CI 75.6-95.9%) vs. 80.0% (95% CI 68.5-91.5%) at perprotocol (PP) analysis, respectively. The number of over 80% symptom relief after treatment in the two groups was 27 (60%) and 12 (29.2%) (p < 0.05), and the incidences of adverse events were 4 (8%) and 6 (12%), respectively. Conclusion: Both groups achieved satisfactory eradication efficiency in H. pylori rescue therapy and Ig Y-H. pylori effectively alleviates the symptoms with good compliance and fewer adverse effects. [ABSTRACT FROM AUTHOR]

As of today, there is a lack of a perfect non-invasive test for the surveillance of patients for potential relapse following curative treatment. Breath volatile organic compounds (VOCs) have been demonstrated to be an accurate diagnostic tool for gastric cancer (GC) detection; here, we aimed to prove the yield of the markers in surveillance, i.e., following curative surgical management. Patients were sampled in regular intervals before and within 3 years following curative surgery for GC; gas chromatography-mass spectrometry (GC-MS) and nanosensor technologies were used for the VOC assessment. GC-MS measurements revealed a single VOC (14b-Pregnane) that significantly decreased at 12 months, and three VOCs (Isochiapin B, Dotriacontane, Threitol, 2-O-octyl-) that decreased at 18 months following surgery. The nanomaterial-based sensors S9 and S14 revealed changes in the breath VOC content 9 months after surgery. Our study results confirm the cancer origin of the particular VOCs, as well as suggest the value of breath VOC testing for cancer patient surveillance, either during the treatment phase or thereafter, for potential relapse. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the release of volatile compounds in mutton shashliks (named as FxLy, x-fat cubes: 0-4; y-lean cubes: 4-0) with different fat–lean ratios before and during consumption, respectively. In total, 67 volatile compounds were identified in shashliks using gas chromatography/mass spectrometry. Aldehyde, alcohol, and ketone were the major volatile substances, accounting for more than 75% of the total volatile compounds. There were significant differences in the volatile compounds of mutton shashliks with different fat–lean ratios. With the increase of the fat content, the types and content of volatile substances released also increase. However, when the percentage of fat exceeded 50%, the number of furans and pyrazine, which were characteristic of the volatile compounds of roasted meat, was decreased. The release of volatiles during the consumption of mutton shashliks was measured using the exhaled breath test and the results showed that adding an appropriate amount of fat (<50%) helps to enrich the volatile compound components in the mouth. However, shashliks with higher fat–lean ratios (>2:2) shorten the mastication duration and weaken the breakdown of bolus particles in the consumption process, which is not conducive to the release potential of volatile substances. Therefore, setting the fat to lean ratio to 2:2 is the best choice for making mutton shashliks, as it (F2L2) can provide rich flavor substances for mutton shashliks before and during consumption. [ABSTRACT FROM AUTHOR]

The relief from clinical symptoms of Helicobacter pylori infection caused by Lactobacillus acidophilus treatment was analyzed by a 13C-urea breath test. To this end, 200 patients diagnosed with Helicobacter pylori infection were divided into two equal groups of 100 patients, designated as the control and study groups, respectively. The control group received conventional quadruple therapy that included enteric-coated esomeprazole magnesium tablets, amoxicillin, clarithromycin, and colloidal pectin bismuth for 2 weeks. The study group, in addition to the conventional quadruple therapy, received Lactobacillus acidophilus tablets orally for 2 weeks. The Helicobacter pylori eradication rate (P < 0.05) and total effective rate (P < 0.05) of the study group were higher than the control group. The incidence of adverse reactions including acid reflux, upper abdominal pain, abdominal fullness, and vomiting in the study group was lower (P < 0.05) than the control group. There was no statistically significant difference (P > 0.05) in the levels of tumor nuclear factor-a, high sensitivity C-reaction protein, and interlukin-6 between two groups before treatment. However, the level of these indicators in the study group after treatment was lower than that in the control group. Similarly, there was no statistically significant difference in CD3+, CD4+, CD8+, or CD4+/CD8+ between the two groups before treatment. However, the level of CD3+, CD4+, and CD4+/CD8+ after treatment was significantly higher, while CD8+ was significantly lower in the study group. In conclusion, Lactobacillus acidophilus treatment exhibits a high eradication rate of Helicobacter pylori with good safety and relief from Helicobacter pylori-associated clinical symptoms. [ABSTRACT FROM AUTHOR]

Background & Objective: Chronic inflammation, dyspnea and activity limitation are common phenomena in patients with chronic obstructive lung disease. Clinical studies suggest that Ubiquinone has anti-inflammatory and energetic properties. Here the beneficial effect of CoQ10 in patients with COPD will be studied. Materials & Methods: Baesd on the census method, 90 patients with moderate to severe COPD were divided into two identical placebo and CoQ10 groups. High sensitive-C-reactive protein (hs-CRP), Forced Expiratory Volume in 1 second, numerical rating breathlessness scale and "the time to get exhausted" were evaluated and recorded at baseline and the end of the study. The CoQ10 group received 120 mg of CoQ10 supplement per day versus the placebo group who also received a placebo (identical in look, size and taste to pharmaceutical sample) and were followed for 6 weeks. Data were analyzed using t-test, and nonparametric statistical tests. Qualitative variables were assessed by chi-square or Fisher exact tests. Results: The study included 49(53.6%) women and 41(46.4%) men, collectively 90 patients with moderate to severe COPD. The mean age was 66.97±12.59 years in the placebo and 64.21±11.78 years in the CoQ10 group (p=0.30). Breathlessness scale was improved in CoQ10 group (p<0.001). hs-CRP significantly declined after intervention in the CoQ10 compared to the placebo group (p<0.001).No serious side effects were observed as a result of CoQ10 consumption. Conclusion: Daily administration of CoQ10 in COPD patients increases hs-CRP and improves dyspnea and "the time to get exhausted” without side effect. [ABSTRACT FROM AUTHOR]

Introduction: One of the problems caused by COVID-19 is decreased lung function and muscle weakness. Excessive increase in the curvature of the thoracic spine is known as a kyphosis deformity. The purpose of this study was to compare the quality of breathing in COVID-19 patients with that of individuals with and without kyphosis. Material & Methods: This study was a causal-comparative study. The statistical population of this study consisted of individuals aged 18 to 30 years old from the city of Urmia in 2021. Of this population, 30 individuals were selected as a group with kyphosis and 30 individuals without kyphosis according to the inclusion criteria. The respiratory quality of the two groups was measured with the St. George’s Respiratory Questionnaire, and the circumference of the thoracic arch was determined with a flexible ruler. Data analysis was performed with SPSS version 25 using the independent t-test. Findings: The mean scores of individual data, including age, height, and weight, were obtained at 24.50±3.64 years, 164.07±4.87 cm, and 66.07±9.54 kg in the group with kyphosis and 23.57±3.91 years, 163.20±4.77 cm, and 64.37±10.96 kg in the group without kyphosis, respectively. There was no significant difference between the two groups when comparing scores for pulmonary symptoms (P=0.83), activity (P=0.69), social and psychological impact (P=0.71), and total questionnaire score (P=0.65). Discussion & Conclusion: Respiratory physical, psychological, and social complications occurred in both groups with and without kyphosis. Although the complications were more severe in individuals with kyphosis, they were not significantly different from those in the group without kyphosis. It is possible that conducting similar studies examining the lung volumes of people with different degrees of kyphosis abnormalities would yield different results. [ABSTRACT FROM AUTHOR]

There has been phenomenal interest concerning gut microbiota dysbiosis including small intestinal bacterial overgrowth (SIBO). However, the diagnostic methods for SIBO are still unsatisfactory. The current review covers the different invasive and noninvasive tests to diagnose SIBO, their methodology, interpretation, sensitivity, specificity, and limitations based on the selected articles from literature search using searchterms 'small intestinal bacterial overgrowth' AND 'digestive diseases' OR'diagnosis' OR 'hydrogen breath test' in PubMed in December 2022. The current review will cover some potential methods for diagnosis of SIBO that may be of clinical utility in the future. SIBO was conventionally defined as a total bacterial count >105 colony forming units (CFU) per mL on quantitative culture of upper gut aspirate. The threshold for the diagnosis of SIBO has been reduced to >103CFU per mL of aspirate recently. Considering the invasiveness of collecting upper gut aspirate, need for laboratory infrastructure and manpower to culture it, noninvasive hydrogen breath tests (HBT) became popular. However, due to the poor sensitivity and specificity of HBT to diagnose SIBO, their utility is being challenged. A new technology of measuring intra-luminal hydrogen gas has a potential to bring a paradigm shift in the diagnostic tests for SIBO. [ABSTRACT FROM AUTHOR]

For detecting field carcinogenesis non-invasively, early technical development and case–control testing of exhaled breath condensate microRNAs was performed. In design, human lung tissue microRNA-seq discovery was reconciled with TCGA and published tumor-discriminant microRNAs, yielding a panel of 24 upregulated microRNAs. The airway origin of exhaled microRNAs was topographically "fingerprinted", using paired EBC, upper and lower airway donor sample sets. A clinic-based case–control study (166 NSCLC cases, 185 controls) was interrogated with the microRNA panel by qualitative RT-PCR. Data were analyzed by logistic regression (LR), and by random-forest (RF) models. Feasibility testing of exhaled microRNA detection, including optimized whole EBC extraction, and RT and qualitative PCR method evaluation, was performed. For sensitivity in this low template setting, intercalating dye-based URT-PCR was superior to fluorescent probe-based PCR (TaqMan). In application, adjusted logistic regression models identified exhaled miR-21, 33b, 212 as overall case–control discriminant. RF analysis of combined clinical + microRNA models showed modest added discrimination capacity (1.1–2.5%) beyond clinical models alone: all subjects 1.1% (p = 8.7e−04)); former smokers 2.5% (p = 3.6e−05); early stage 1.2% (p = 9.0e−03), yielding combined ROC AUC ranging from 0.74 to 0.83. We conclude that exhaled microRNAs are qualitatively measureable, reflect in part lower airway signatures; and when further refined/quantitated, can potentially help to improve lung cancer risk assessment. [ABSTRACT FROM AUTHOR]

Background: The prevalence of asthma-like symptoms in preschool children is high. Despite numerous efforts, there still is no clinically available diagnostic tool to discriminate asthmatic children from children with transient wheeze at preschool age. This leads to potential overtreatment of children outgrowing their symptoms, and to potential undertreatment of children who turn out to have asthma. Our research group developed a breath test (using GC-tof–MS for VOC-analysis in exhaled breath) that is able to predict a diagnosis of asthma at preschool age. The ADEM2 study assesses the improvement in health gain and costs of care with the application of this breath test in wheezing preschool children. Methods: This study is a combination of a multi-centre, parallel group, two arm, randomised controlled trial and a multi-centre longitudinal observational cohort study. The preschool children randomised into the treatment arm of the RCT receive a probability diagnosis (and corresponding treatment recommendations) of either asthma or transient wheeze based on the exhaled breath test. Children in the usual care arm do not receive a probability diagnosis. Participants are longitudinally followed up until the age of 6 years. The primary outcome is disease control after 1 and 2 years of follow-up. Participants of the RCT, together with a group of healthy preschool children, also contribute to the parallel observational cohort study developed to assess the validity of alternative VOC-sensing techniques and to explore numerous other potential discriminating biological parameters (such as allergic sensitisation, immunological markers, epigenetics, transcriptomics, microbiomics) and the subsequent identification of underlying disease pathways and relation to the discriminative VOCs in exhaled breath. Discussion: The potential societal and clinical impact of the diagnostic tool for wheezing preschool children is substantial. By means of the breath test, it will become possible to deliver customized and high qualitative care to the large group of vulnerable preschool children with asthma-like symptoms. By applying a multi-omics approach to an extensive set of biological parameters we aim to explore (new) pathogenic mechanisms in the early development of asthma, creating potentially interesting targets for the development of new therapies. Trial registration: Netherlands Trial Register, NL7336, Date registered 11–10-2018. [ABSTRACT FROM AUTHOR]