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Helicobacter pylori (H. pylori) infection is widespread all over the world. The greatest number of infected people are in developing countries, whereas in developed countries the rate of infection is the smallest. Among risk factors of infection, the socioeconomic environment is regarded as one of the most important. In developed countries, the incidence of H. pylori infection in children is smaller than 12% and shows a tendency to decrease, while in developing countries it may exceed 40% (1). Multicenter studies conducted in Poland in the years [2002][2003] have demonstrated a high rate of H. pylori seroprevalence in both children and adults. In children aged 6 month to 18 years H. pylori seroprevalence rate was 32% and in adults aged 19 to 89 years 84% and varied depending on the region of the country (2). An influence of poor sanitary and hygiene conditions, economical status and parents education on the infection rate was demonstrated. In the last years a tendency to the decrease of infection rate has been shown, which could be linked to the improvement of social condition (3). H. pylori infection is a principal cause of chronic gastritis and peptic ulcer disease in children. In adulthood it leads to many diseases of the gastrointestinal tract including in particular JOURNAL OF PHYSIOLOGY AND PHARMACOLOGY 2014, 65, 6, 801-807 www. Helicobacter pylori (H. pylori) plays an important role in the pathogenesis of the upper gastrointestinal tract diseases in both children and adults. The aim of this paper was to assess the differences between the clinical course of the disease in children and adults. This paper also presents an analysis of clinical symptoms, endoscopic and histopathological findings, H. pylori cagA and vacA genotypes rates and analysis of the sensitivity of these strains to antibiotics in the Polish population, with possible practical and therapeutic implications. The multicenter study on the frequency of H. pylori infections assessed by the presence of antibodies in IgG class against H. pylori in serum was conducted in the years 2002 and 2003. The study group included 6565 children and adults, in 3827 of whom antibodies levels were above 24 U/mL. The authors analyzed clinical and endoscopic symptoms and in some patients with H. pylori seropositivity also histopathological changes, and cagA and vacA genes. Sensitivity of H. pylori strains to antibiotics were also analyzed. Differences between the frequency of infection between children and adults were determined. Endoscopic examination in adults revealed more frequent cases of gastropathy (P=0.003) and erosive gastritis (P=0.001), and in children-thick mucosal folds (P<0.0001). Histopathological examinations carried out in adults have revealed atrophic gastritis and intestinal metaplasia. In children, cagA(+)s1m1 was observed more frequently than in adults (34.0% versus 23.1%; P=0.02) contrary to cagA(-)s2m2 which occurred more frequently in adults (27.1% versus 14.0%; P=0.003). No effect of the infection on nausea, regurgitation, vomiting, heartburn, and abdominal pain in children was detected. However, adults infected with H. pylori suffered from more frequent episodes of heartburn and abdominal pain. The H. pylori strain exhibited a high resistance to metronidazole (higher in adults: 41.7% versus 27.4%; P=0.002), and to clarithromycin (higher in children: 20.2% versus 15.4%; P>0.05), and dual resistance to metronidazole and clarithromycin (higher in children: 9.9% versus 8.4%; P>0.05). Resistance of the H. pylori to amoxicillin and tetracycline was not detected. The conducted study indicated clinical differences in the H. pylori infection in children and adults. Among the differences in children, especially the more frequent infections by the cagA(+)s1m1/m2 strain could have an influence on further consequences of the infection. The obtained results could be useful in therapeutic decisions

Non-invasive diagnostic tests for Helicobacter pylori infection

BACKGROUND: Helicobacter pylori (H pylori) infection has been implicated in a number of malignancies and non-malignant conditions including peptic ulcers, non-ulcer dyspepsia, recurrent peptic ulcer bleeding, unexplained iron deficiency anaemia, idiopathic thrombocytopaenia purpura, and colorectal adenomas. The confirmatory diagnosis of H pylori is by endoscopic biopsy, followed by histopathological examination using haemotoxylin and eosin (H & E) stain or special stains such as Giemsa stain and Warthin-Starry stain. Special stains are more accurate than H & E stain. There is significant uncertainty about the diagnostic accuracy of non-invasive tests for diagnosis of H pylori. OBJECTIVES: To compare the diagnostic accuracy of urea breath test, serology, and stool antigen test, used alone or in combination, for diagnosis of H pylori infection in symptomatic and asymptomatic people, so that eradication therapy for H pylori can be started. SEARCH METHODS: We searched MEDLINE, Embase, the Science Citation Index and the National Institute for Health Research Health Technology Assessment Database on 4 March 2016. We screened references in the included studies to identify additional studies. We also conducted citation searches of relevant studies, most recently on 4 December 2016. We did not restrict studies by language or publication status, or whether data were collected prospectively or retrospectively. SELECTION CRITERIA: We included diagnostic accuracy studies that evaluated at least one of the index tests (urea breath test using isotopes such as13C or14C, serology and stool antigen test) against the reference standard (histopathological examination using H & E stain, special stains or immunohistochemical stain) in people suspected of having H pylori infection. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the references to identify relevant studies and independently extracted data. We assessed the methodological quality of studies using the QUADAS-2 tool. We performed meta-analysis by using the hierarchical summary receiver operating characteristic (HSROC) model to estimate and compare SROC curves. Where appropriate, we used bivariate or univariate logistic regression models to estimate summary sensitivities and specificities. MAIN RESULTS: We included 101 studies involving 11,003 participants, of which 5839 participants (53.1%) had H pylori infection. The prevalence of H pylori infection in the studies ranged from 15.2% to 94.7%, with a median prevalence of 53.7% (interquartile range 42.0% to 66.5%). Most of the studies (57%) included participants with dyspepsia and 53 studies excluded participants who recently had proton pump inhibitors or antibiotics.There was at least an unclear risk of bias or unclear applicability concern for each study.Of the 101 studies, 15 compared the accuracy of two index tests and two studies compared the accuracy of three index tests. Thirty-four studies (4242 participants) evaluated serology; 29 studies (2988 participants) evaluated stool antigen test; 34 studies (3139 participants) evaluated urea breath test-13C; 21 studies (1810 participants) evaluated urea breath test-14C; and two studies (127 participants) evaluated urea breath test but did not report the isotope used. The thresholds used to define test positivity and the staining techniques used for histopathological examination (reference standard) varied between studies. Due to sparse data for each threshold reported, it was not possible to identify the best threshold for each test.Using data from 99 studies in an indirect test comparison, there was statistical evidence of a difference in diagnostic accuracy between urea breath test-13C, urea breath test-14C, serology and stool antigen test (P = 0.024). The diagnostic odds ratios for urea breath test-13C, urea breath test-14C, serology, and stool antigen test were 153 (95% confidence interval (CI) 73.7 to 316), 105 (95% CI 74.0 to 150), 47.4 (95% CI 25.5 to 88.1) and 45.1 (95% CI 24.2 to 84.1). The sensitivity (95% CI) estimated at a fixed specificity of 0.90 (median from studies across the four tests), was 0.94 (95% CI 0.89 to 0.97) for urea breath test-13C, 0.92 (95% CI 0.89 to 0.94) for urea breath test-14C, 0.84 (95% CI 0.74 to 0.91) for serology, and 0.83 (95% CI 0.73 to 0.90) for stool antigen test. This implies that on average, given a specificity of 0.90 and prevalence of 53.7% (median specificity and prevalence in the studies), out of 1000 people tested for H pylori infection, there will be 46 false positives (people without H pylori infection who will be diagnosed as having H pylori infection). In this hypothetical cohort, urea breath test-13C, urea breath test-14C, serology, and stool antigen test will give 30 (95% CI 15 to 58), 42 (95% CI 30 to 58), 86 (95% CI 50 to 140), and 89 (95% CI 52 to 146) false negatives respectively (people with H pylori infection for whom the diagnosis of H pylori will be missed).Direct comparisons were based on few head-to-head studies. The ratios of diagnostic odds ratios (DORs) were 0.68 (95% CI 0.12 to 3.70; P = 0.56) for urea breath test-13C versus serology (seven studies), and 0.88 (95% CI 0.14 to 5.56; P = 0.84) for urea breath test-13C versus stool antigen test (seven studies). The 95% CIs of these estimates overlap with those of the ratios of DORs from the indirect comparison. Data were limited or unavailable for meta-analysis of other direct comparisons. AUTHORS' CONCLUSIONS: In people without a history of gastrectomy and those who have not recently had antibiotics or proton ,pump inhibitors, urea breath tests had high diagnostic accuracy while serology and stool antigen tests were less accurate for diagnosis of Helicobacter pylori infection.This is based on an indirect test comparison (with potential for bias due to confounding), as evidence from direct comparisons was limited or unavailable. The thresholds used for these tests were highly variable and we were unable to identify specific thresholds that might be useful in clinical practice.We need further comparative studies of high methodological quality to obtain more reliable evidence of relative accuracy between the tests. Such studies should be conducted prospectively in a representative spectrum of participants and clearly reported to ensure low risk of bias. Most importantly, studies should prespecify and clearly report thresholds used, and should avoid inappropriate exclusions

Denticles. A literature review

Denticles are pulp degenerations in the form of calcified deposits of mineral salts, usually found in molars and lower incisors, as well as in impacted teeth and deciduous molars. Denticles may come in various sizes, from microscopic particles to larger mass that almost obliterate the pulp chamber and are visible only on X-ray images. Denticles form as a result of chronic inflammatory lesions, but may also be caused by injuries and conservative treatment. They are most frequently found in necrotic foci. Denticles may cause problems for root canal treatment, as their presence might make it difficult to obtain proper access to the pulp chamber bottom and the canal orifices. There is also the increased risk of bending or breaking the endodontic instruments. Sometimes, denticles fill the entire space of the tooth chamber and pushing the pulp to the edges of the chamber. Denticles can cause pain due to the pressure on the nerves and blood vessels supplying the internal tissue of the tooth. The presence of large denticles might eventually lead to necrosis of the pulp. Denticles accompany certain diseases, such as dentin dysplasia, odontodysplasia or Albright hereditary dystrophy

Effects of inhibitor of Src kinases, SU6656, on differentiation of megakaryocytic progenitors and activity of α1,6-fucosyltransferase

α1,6-fucosyltransferase (FUT8) attaches fucose residues via an α1,6 linkage to the innermost N-acetylglucosamine residue of N-linked glycans. Glycans with this type of structure are present in GpIIb/GpIIIa complex (CD41a) which is present on megakaryocytes (Mks) and platelets. CD41a is the earliest marker of megakaryocytopoiesis. The aim of this study was to analyse the morphology, phenotype, ploidy level and activity of FUT8 during induced differentiation/maturation of Mk progenitor cells in ex vivo culture. We used SU6656, a selective inhibitor of Src tyrosine kinases, as differentiation-inducing agent for Mks. The addition of SU6656 to the culture system of megakaryocytic progenitors from cord blood CD34+ cells and Meg-01 cell line induced their maturation towards later stages of Mk differentiation with increased activity of FUT8. We suggest FUT8 as a candidate for an early marker of differentiation and possibly of the ploidy level of Mks. We confirm a special status of FUT8 in megakaryocytopoiesis

XEN Glaucoma Implant for the Management of Glaucoma in Naïve Patients versus Patients with Previous Glaucoma Surgery

This retrospective study analyzed the surgical and refractive outcomes of a XEN Gel Implant (Allergan, Abbvie Company, Irvine, CA, USA) in naïve patients versus those with previous glaucoma surgery. We evaluated the efficacy of XEN implantation in 86 glaucoma patients during a long-term follow-up period. Patients were divided into two groups: naïve patients (Group 1) and patients with previous glaucoma surgery (Group 2). Eyes that received a XEN Gel Stent placement from December 2014 to October 2019 were included. Intraocular pressure (IOP) change, corrected distance visual acuity (CDVA), change in glaucoma medications, frequency of slit lamp revision procedures, and frequency of secondary glaucoma surgeries were the primary outcomes. In Group 1, the mean IOP before surgery was decreased significantly from 25.00 ± 7.52 mmHg to 16.83 ± 5.12 mmHg by the end of the study. In Group 2, the mean IOP decreased significantly from 25.35 ± 7.81 mmHg to 17.54 ± 5.34 mmHg. The mean IOP decrease from baseline was 29% in Group 1 and 27% in Group 2 (p = 0.567). There were no significant differences between the groups in the IOP baseline level, the final level, or the change between preoperative and final levels. The qualified success rate for Group 2 was 68.7% versus 76.5% for Group 1 for the initial procedure and 15.4% vs. 20.2%, respectively, for complete success rate (p > 0.05). However, at the end of the follow-up, more patients achieved an IOP < 18 mmHg in Group 1 than in Group 2. Despite the need for more anti-glaucoma medications, repeat XEN Gel implantation appears to show promising results in patients with previously failed anti-glaucoma procedures, owing to its minimal invasiveness