Eradication therapy for peptic ulcer disease in Helicobacter pylori-positive people

BACKGROUND: Peptic ulcer disease is the cause of dyspepsia in about 10% of people. Ninety-five percent of duodenal and 70% of gastric ulcers are associated with Helicobacter pylori. Eradication of H. pylori reduces the relapse rate of ulcers but the magnitude of this effect is uncertain. This is an update of Ford AC, Delaney B, Forman D, Moayyedi P. Eradication therapy for peptic ulcer disease in Helicobacter pylori-positive patients. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD003840. DOI: 10.1002/14651858.CD003840.pub4. OBJECTIVES: To assess the proportion of peptic ulcers healed and the proportion of participants who remained free from relapse with eradication therapy against placebo or other pharmacological therapies in H. pylori-positive people.To assess the proportion of participants that achieved complete relief of symptoms and improvement in quality of life scores.To compare the incidence of adverse effects/drop-outs (total number for each drug) associated with the different treatments.To assess the proportion of participants in whom successful eradication was achieved. SEARCH METHODS: In this update, we identified trials by searching the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (1950 to March 2016) and Ovid EMBASE (1980 to March 2016). To identify further relevant trials, we handsearched reference lists from trials selected by electronic searching, and published abstracts from conference proceedings from the United European Gastroenterology Week (published in Gut) and Digestive Disease Week (published in Gastroenterology). The search was last updated in March 2016. We contacted members of Cochrane Upper GI and Pancreatic Diseases, and experts in the field and asked them to provide details of outstanding clinical trials and any relevant unpublished materials. SELECTION CRITERIA: We analysed randomised controlled trials of short- and long-term treatment of peptic ulcer disease in H. pylori-positive adults. Participants received at least one week of H. pylori eradication compared with ulcer healing drug, placebo or no treatment. Trials were included if they reported assessment from two weeks onwards. DATA COLLECTION AND ANALYSIS: We collected data on ulcer healing, recurrence, relief of symptoms and adverse effects. We calculated the risk ratio (RR) with 95% confidence intervals (CI) using both fixed-effect and random-effects models with Review Manager software (RevMan 5.3) based on intention-to-treat analysis as far as possible. MAIN RESULTS: A total of 55 trials were included for one or more outcomes for this review.In duodenal ulcer healing, eradication therapy was superior to ulcer healing drug (UHD) (34 trials, 3910 participants, RR of ulcer persisting = 0.66, 95% confidence interval (CI) 0.58 to 0.76; 381/2286 (adjusted proportion: 12.4%) in eradication therapy plus UHD versus 304/1624 (18.7%) in UHD; low quality evidence) and no treatment (two trials, 207 participants, RR 0.37, 95% CI 0.26 to 0.53; 30/125 (adjusted proportion: 21.7%) in eradication therapy versus 48/82 (58.5%) in no treatment; low quality evidence).In gastric ulcer healing, the differences were imprecise between eradication therapy and UHD (15 trials, 1974 participants, RR 1.23, 95% CI 0.90 to 1.68; 220/1192 (adjusted proportion: 16.0%) in eradication therapy plus UHD versus 102/782 (13.0%) in UHD; very low quality evidence). In preventing duodenal ulcer recurrence the differences were imprecise between maintenance therapy with H.pylori eradication therapy and maintenance therapy with UHD (four trials, 319 participants, RR of ulcer recurring 0.73; 95% CI 0.42 to 1.25; 19/159 (adjusted proportion: 11.9%) in eradication therapy versus 26/160 (16.3%) in UHD; very low quality evidence), but eradication therapy was superior to no treatment (27 trials 2509 participants, RR 0.20, 95% CI 0.15 to 0.26; 215/1501 (adjusted proportion: 12.9%) in eradication therapy versus 649/1008 (64.4%) in no treatment; very low quality evidence).In preventing gastric ulcer recurrence, eradication therapy was superior to no treatment (12 trials, 1476 participants, RR 0.31, 95% CI 0.22 to 0.45; 116/697 (adjusted proportion: 16.3%) in eradication therapy versus 356/679 (52.4%) in no treatment; very low quality evidence). None of the trials reported proportion of people with gastric ulcer not healed after initial therapy between H.pylori eradication therapy and no active treatment or the proportion of people with recurrent gastric ulcer or peptic ulcers during maintenance therapy between H.pylori eradication therapy and ulcer healing drug therapy. AUTHORS' CONCLUSIONS: Adding a one to two-week course of H. pylori eradication therapy is an effective treatment for people with H. pylori-positive duodenal ulcer when compared to ulcer healing drugs alone and no treatment. H. pylori eradication therapy is also effective in preventing recurrence of duodenal and gastric ulcer compared to no treatment. There is currently no evidence that H. pylori eradication therapy is an effective treatment in people with gastric ulcer or that it is effective in preventing recurrence of duodenal ulcer compared to ulcer healing drug. However, confidence intervals were wide and significant benefits or harms of H. pylori eradication therapy in acute ulcer healing of gastric ulcers compared to no treatment, and in preventing recurrence of duodenal ulcers compared to ulcer healing drugs cannot be ruled out

Do strange stars exist in the Universe?

Definitely, an affirmative answer to this question would have implications of fundamental importance for astrophysics (a new class of compact stars), and for the physics of strong interactions (deconfined phase of quark matter, and strange matter hypothesis). In the present work, we use observational data for the newly discovered millisecond X-ray pulsar SAX J1808.4-3658 and for the atoll source 4U 1728-34 to constrain the radius of the underlying compact stars. Comparing the mass-radius relation of these two compact stars with theoretical models for both neutron stars and strange stars, we argue that a strange star model is more consistent with SAX J1808.4-3658 and 4U 1728-34, and suggest that they are likely strange star candidates.Comment: In memory of Bhaskar Datta. -- Invited talk at the Pacific Rim Conference on Stellar Astrophysics (Hong Kong, aug. 1999

Effects of a piezoelectric substrate on phonon-drag thermopower in monolayer graphene

The phonon-drag thermopower is studied in a monolayer graphene on a piezoelectric substrate. The phonon-drag contribution [Formula: see text] from the extrinsic potential of piezoelectric surface acoustic (PA) phonons of a piezoelectric substrate (GaAs) is calculated as a function of temperature T and electron concentration n s. At a very low temperature, [Formula: see text] is found to be much greater than [Formula: see text] of the intrinsic deformation potential of acoustic (DA) phonons of the graphene. There is a crossover of [Formula: see text] and [Formula: see text] at around ~5 K. In graphene samples of about  >10 µm size, we predict S (g) ~ 20 µV at 10 K, which is much greater than the diffusion component of the thermopower and can be experimentally observed. In the Bloch-Gruneisen (BG) regime T and n s dependence are, respectively, given by the power laws [Formula: see text] ([Formula: see text]) ~ T (2)(T (3)) and [Formula: see text], [Formula: see text] ~ [Formula: see text]. The T(n s) dependence is the manifestation of the 2D phonons (Dirac phase of the electrons). The effect of the screening is discussed. Analogous to Herring's law (S (g) μ p ~ T (-1)), we predict a new relation S (g) μ p ~ [Formula: see text], where μ p is the phonon-limited mobility. We suggest that the n s dependent measurements will play a more significant role in identifying the Dirac phase and the effect of screening.Private Fellowship

Effects of a piezoelectric substrate on phonon-drag thermopower in monolayer graphene

The phonon-drag thermopower is studied in a monolayer graphene on a piezoelectric substrate. The phonon-drag contribution [Formula: see text] from the extrinsic potential of piezoelectric surface acoustic (PA) phonons of a piezoelectric substrate (GaAs) is calculated as a function of temperature T and electron concentration n s. At a very low temperature, [Formula: see text] is found to be much greater than [Formula: see text] of the intrinsic deformation potential of acoustic (DA) phonons of the graphene. There is a crossover of [Formula: see text] and [Formula: see text] at around ~5 K. In graphene samples of about  >10 µm size, we predict S (g) ~ 20 µV at 10 K, which is much greater than the diffusion component of the thermopower and can be experimentally observed. In the Bloch-Gruneisen (BG) regime T and n s dependence are, respectively, given by the power laws [Formula: see text] ([Formula: see text]) ~ T (2)(T (3)) and [Formula: see text], [Formula: see text] ~ [Formula: see text]. The T(n s) dependence is the manifestation of the 2D phonons (Dirac phase of the electrons). The effect of the screening is discussed. Analogous to Herring's law (S (g) μ p ~ T (-1)), we predict a new relation S (g) μ p ~ [Formula: see text], where μ p is the phonon-limited mobility. We suggest that the n s dependent measurements will play a more significant role in identifying the Dirac phase and the effect of screening.Private Fellowship

Ethnicity, popular democratic movements and labour in Malaysia

This article uses framing theory to examine how activists and trade unions have framed labour’s political agenda in Malaysia. A polity grounded in ethnicity continues to hinder the formation of cross-ethnic collective worker identities and labour politics. However, inclusive popular democratising movements have strengthened in recent years, providing a favourable context for greater emphasis on non-ethnic political action by trade unions. The latter have shifted in this direction, adopting elements of the popular movement’s ‘human rights’ internationalism. Thus, the democratic movement’s frame has influenced that of the trade unions, with implications for framing theory

Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group

<p>Abstract</p> <p>Background</p> <p>Postpartum hemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. Several recent publications have noted an increasing trend in incidence over time. The international PPH collaboration was convened to explore the observed trends and to set out actions to address the factors identified.</p> <p>Methods</p> <p>We reviewed available data sources on the incidence of PPH over time in Australia, Belgium, Canada, France, the United Kingdom and the USA. Where information was available, the incidence of PPH was stratified by cause.</p> <p>Results</p> <p>We observed an increasing trend in PPH, using heterogeneous definitions, in Australia, Canada, the UK and the USA. The observed increase in PPH in Australia, Canada and the USA was limited solely to immediate/atonic PPH. We noted increasing rates of severe adverse outcomes due to hemorrhage in Australia, Canada, the UK and the USA.</p> <p>Conclusion</p> <p><it>Key Recommendations</it></p> <p indent="1">1. Future revisions of the International Classification of Diseases should include separate codes for atonic PPH and PPH immediately following childbirth that is due to other causes. Also, additional codes are required for placenta accreta/percreta/increta.</p> <p indent="1">2. Definitions of PPH should be unified; further research is required to investigate how definitions are applied in practice to the coding of data.</p> <p indent="1">3. Additional improvement in the collection of data concerning PPH is required, specifically including a measure of severity.</p> <p indent="1">4. Further research is required to determine whether an increased rate of reported PPH is also observed in other countries, and to further investigate potential risk factors including increased duration of labor, obesity and changes in second and third stage management practice.</p> <p indent="1">5. Training should be provided to all staff involved in maternity care concerning assessment of blood loss and the monitoring of women after childbirth. This is key to reducing the severity of PPH and preventing any adverse outcomes.</p> <p indent="1">6. Clinicians should be more vigilant given the possibility that the frequency and severity of PPH has in fact increased. This applies particularly to small hospitals with relatively few deliveries where management protocols may not be defined adequately and drugs or equipment may not be on hand to deal with unexpected severe PPH.</p

Voids

This article describes underground open spaces or cavities that may be of natural or man-made origin. Natural structures include caves, dissolution and collapse cavities in soluble rocks, cambering fissures (or gulls), open fault cavities, and lava tubes. Man-made voids include all the different types of mines, habitation, religious and storage spaces, military excavations, tunnels, and shafts

Stable Genetic Influence on Anxiety-Related Behaviours Across Middle Childhood

We examined the aetiology of anxiety symptoms in an unselected population at ages 7 and 9, a period during which anxiety disorders first begin to develop (mean age at onset is 11 years). Specifically, the aim of the study was to investigate genetic and environmental continuity and change in components of anxiety in middle childhood. Parents of over 3,500 twin pairs completed the Anxiety-Related Behaviours Questionnaire (ARBQ) when twins were 7 and 9 years old. Multivariate-longitudinal analyses were conducted to examine genetic and environmental influences on stability and change in four anxiety scales: Negative Cognition, Negative Affect, Fear and Social Anxiety. We found moderate temporal stability in all four scales from 7 to 9 years (correlations ranging from 0.45 to 0.54) and moderate heritability (average 54%). Both shared and non-shared environmental influences were modest (average 18%–28% respectively). Genetic factors (68%) explained most of the homotypic continuity in anxiety. We show that homotypic continuity of Anxiety-Related Behaviours (i.e. the continuation of one specific type of anxiety over time) was largely driven by genetic factors. In contrast, though more varied, heterotypic continuity between some traits (i.e. the change from one type of anxiety-related behaviour into another over time) was mainly due to shared-environmental factors

Scaling Relations and Overabundance of Massive Clusters at Z ≳ 1 from Weak-Lensing Studies with the Hubble Space Telescope

We present weak gravitational lensing analysis of 22 high-redshift (z 1) clusters based on Hubble Space Telescope images. Most clusters in our sample provide significant lensing signals and are well detected in their reconstructed two-dimensional mass maps. Combining the current results and our previous weak-lensing studies of five other high-z clusters, we compare gravitational lensing masses of these clusters with other observables. We revisit the question whether the presence of the most massive clusters in our sample is in tension with the current ΛCDM structure formation paradigm. We find that the lensing masses are tightly correlated with the gas temperatures and establish, for the first time, the lensing mass-temperature relation at z 1. For the power-law slope of the M-TX relation (MT α), we obtain α = 1.54 ± 0.23. This is consistent with the theoretical self-similar prediction α = 3/2 and with the results previously reported in the literature for much lower redshift samples. However, our normalization is lower than the previous results by 20%-30%, indicating that the normalization in the M-TX relation might evolve. After correcting for Eddington bias and updating the discovery area with a more conservative choice, we find that the existence of the most massive clusters in our sample still provides a tension with the current ΛCDM model. The combined probability of finding the four most massive clusters in this sample after the marginalization over cosmological parameters is less than 1%