Pathogenesis of Helicobacter Pylori Infection: Colonization, Virulence Factors of the Bacterium and Immune and Non-immune Host Response

Helicobacter pylori (Hp), a gram-negative, spiral-shaped bacterium is one of the most widely spread pathogens in humans, as it concerns half of the world population. Mechanisms that allow Hp to cause a life-long infection involve modulation of the immune response and host cellular processes which include activation of the innate immune response, resistance to phagocytosis, modulation of dendritic cell activity and regulatory T cells, and production of proinflammatory cytokines. This is accomplished via virulence factors such as colonization factors (a variety of adhesins), factors that allow it to evade host defence (flagella and motility, urease system, induction of hypochlorhydria) and factors that are responsible for tissue injury (heat shock proteins A and B, vacuolating cytotoxin A, neutrophil activating protein of Hp, and cytotoxin-associated gene A). The interaction between bacterial effectors, environmental factors (genetic susceptibility to infection) and factors that modulate the host's response, such as polymorphisms in genes encoding cytokines or cytokine receptors, have been shown to influence the clinical outcome of Hp infection either towards peptic ulcer and/or cancer. Future studies, directed toward understanding interactions between Hp and immune cells in vivo, may lead to the development of novel therapeutic approaches for eradication of Hp

Building Simulation 7h International Building Performance Simulation Association Conference in Rio de Janeiro, Brazil

Abstract Energy savings from the use of daylighting in commercial buildings are realized through implementation of photoelectric lighting controls that dim electric lights when sufficient daylight is available to provide adequate workplane illumination. The dimming level of electric lighting is based on the signal of a photosensor. Current simulation approaches for such systems are based on the questionable assumption that the signal of the photosensor is proportional to the task illuminance. This paper presents a method that simulates the performance of photosensor controls considering the acceptance angle, angular sensitivity, placement of the photosensor within a space, and color correction filter. The method is based on the multiplication of two fisheye images: one generated from the angular sensitivity of the photosensor and the other from a 180-or 360-degree fisheye image of the space as "seen" by the photosensor. The paper includes a detailed description of the method and its implementation, example applications, and validation results based on comparison with measurements in an actual office space. Introduction Controlling the output of electric lights using photosensor-based control technology can maximize energy savings resulting from daylighting while preserving occupant comfort and productivit

The design and evaluation of three advanced daylighting systems: Light shelves, light pipes and skylights

We present results from the design and evaluation of three advanced daylighting systems: a light shelf, a light pipe, and a skylight. These systems use optical films and an optimized geometry to passively intercept and redirect sunlight further into the building. The objectives of these designs are to increase daylighting illuminance levels at distances of 4.6-9.l m (15-30 ft) from the window, and to improve the uniformity of the daylight distribution and the luminance gradient across the room under variable sun and sky conditions throughout the year. The designs were developed through a series of computer-assisted ray-tracing studies, photometric measurements, and observations using physical scale models. Comprehensive sets of laboratory measurements in combination with analytical routines were then used to simulate daylight performance for any solar position. Results show increased daylight levels and an improved luminance gradient throughout the year-indicating that lighting energy consumption and cooling energy due to lighting can be substantially reduced with improvements to visual comfort. Future development of the designs may further improve the daylighting performance of these systems.This research was funded by the California Institute for Energy Efficiency (CIEE), a research unit of the University of California. CIEE is a consortium of the CPUC, the CEC, and California utilities including LADWP, SCE, SCG, SMUD, and PG&E. Publication of research results does not imply CIEE endorsement of or agreement with these findings, nor that of any CIEE sponsor. Additional related support was provided by the Assistant Secretary for Energy Efficiency and Renewable Energy, Office of Building Technologies, Building Systems and Materials Division of the U.S. Department of Energy under Contract No. DEAC03-76SF00098

Lack of effects of pioglitazone on cardiac function in patients with type 2 diabetes and evidence of left ventricular diastolic dysfunction: a tissue doppler imaging study

<p>Abstract</p> <p>Background</p> <p>Thiazolidinediones, used for the treatment of patients with type 2 diabetes mellitus (DM2), are associated with an increased incidence of heart failure. We sought to investigate the effects of pioglitazone on novel echocardiographic indices of left ventricular (LV) diastolic function in DM2 patients with LV diastolic dysfunction (LVDD).</p> <p>Methods</p> <p>Eighty-eight asymptomatic DM2 patients on metformin and/or sulfonylureas, aged 64.5 ± 7.7 years, without known cardiovascular disease, with normal LV systolic function and evidence of LVDD were randomly assigned to pioglitazone 30 mg/day (n = 42) or an increase in dose of other oral agents (n = 39) for 6 months. All patients underwent transthoracic conventional and Tissue Doppler Imaging echocardiography at baseline and follow-up. The primary end-point was change in early diastolic velocity of the mitral annulus (E').</p> <p>Results</p> <p>Improvement of glycaemic control was similar in the 2 groups. A significant difference (p < 0.05) between the 2 groups was found in the treatment-induced changes in fasting insulin, the insulin resistance index HOMA, HDL cholesterol, triglycerides, diastolic blood pressure (all in favor of pioglitazone) and in body weight (increase with pioglitazone). No significant changes were observed in any echocardiographic parameter in either group and did not differ between groups (p = NS for all). E' increased non-significantly and to a similar extent in both groups (p = NS).</p> <p>Conclusions</p> <p>In asymptomatic DM2 patients with LVDD, the addition of pioglitazone to oral conventional treatment for 6 months does not induce any adverse or favorable changes in LV diastolic or systolic function despite improvements in glycaemic control, insulin sensitivity, lipid profile, and blood pressure.</p

A Lyophilized Form of Saccharomyces Boulardii Enhances the Helicobacter pylori Eradication Rates of Omeprazole-Triple Therapy in Patients With Peptic Ulcer Disease or Functional Dyspepsia

Background: Saccharomyces boulardii prevents antibiotic-induced diarrhea and exerts anti-H.pylori effects in vitro and in vivo. Aim: To assess whether S. boulardii enhances the efficacy of classic triple therapy in eradicating H. pylori. Methods: Seventy patients with peptic ulcer or functional dyspepsia according to Rome III criteria and H. pylori infection were treated with omeprazole 20 mg bid, clarithromycin 500 mg bid and amoxicillin 1 g bid for 14 days. A total of 36 out of 70 (51%) patients were randomized to S. boulardii [Ultralevure®, two capsules tid for 14 days (group A) and 34 (49%) on no intervention (group B). H. pylori eradication was assessed by a 13C-Urea Breath Test. Results: At baseline there were no significant differences between the two groups in any patient or disease characteristics. H. pylori was eradicated in 30/36 (83.4%) patients in group A vs 20/34 (58.8%) in group B (P=0.034, 95% CI 4.4% to 43.6%). Seven patients in group B (20.6%) and 1 patient in group A stopped treatment because of diarrhea (95% CI 3.3% to 32.7%, P=0.026). Multi-factorial analysis did not reveal any patient or disease related parameter linked to treatment outcome except for the use of the probiotic. Conclusion: S. boulardii enhanced the effect of classic triple therapy mainly by preventing antibiotic- and/or proton pump inhibitor-induced diarrhea

Contribution of home availability, parental child-feeding practices and health beliefs on children’s sweets and salty snacks consumption in Europe: Feel4Diabetes-Study

The Feel4Diabetes-Study has received funding from the European Union's Horizon 2020 research and innovation program (Grant Agreement: n degrees 643708). The content of this article reflects only the authors' views, and the European Community is not liable for any use that may be made of the information contained therein. The funding body had no role in the design of this study and collection, analysis and interpretation of the data and inwriting this manuscript.Adoption of healthy dietary and snacking habits could support optimum physical and mental development in children as they define health in adulthood. This study assessed parameters associated with children’s snacking such as food home availability, parenting practices, and parents’ health beliefs. In this cross-sectional study 12, 039 children, 49.4% boys 5-12 years old, participating in the European Feel4Diabetes-Study were included. Children’s weekly consumption of sweets and salty snacks, home availability of snacks, food parenting practices, and health beliefs were assessed via questionnaires. Logistic regression was applied to explore associations of a) home availability of snacks, b) food parenting practices (permissiveness and rewarding with snacks) and c) parent’s opinions on deterministic health beliefs with children’s consumption of sweets and salty snacks. Results showed that home availability (sweets: ORadj 4.76, 95%CI: 4.32, 5.23; salty snacks: ORadj: 6.56, 95%CI: 5.64, 7.61), allowing to consume (sweets: ORadj: 3.29, 95%CI: 2.95, 3.67; salty snacks: ORadj: 3.41, 95%CI: 2.98, 3.90) and rewarding with sweets/salty snacks (sweets: ORadj: 2.69, 95%CI: 2.23, 3.24; salty snacks: ORadj: 4.34, 95%CI: 3.57, 5.28) ‘sometimes/or less frequently’ compared to ‘always/or often’ were associated with lower weekly consumption of sweets and snacks. Parents’ disagreement compared to agreement with deterministic health beliefs and inattentive eating were associated with lower consumption of salty snacks and sweets in children. Overall, the findings of this study indicate that attempts to promote healthy snacking habits in children should aim to improve parental dietary habits, food parenting practices, health beliefs, and reducing home availability of unhealthy foods and snacks.European Union's Horizon 2020 research and innovation program 64370

ECCO Topical Review on Biological Treatment Cycles in Crohn’s Disease

There are now a growing number of licensed biological therapies for patients with Crohn’s disease. However, there can be significant costs associated with long-term maintenance treatment, as well as some concerns about potential side-effects. As a result, there has been increasing interest in elective biological treatment discontinuation in selected patients, after a sustained period of remission. Following discontinuation, in cases of relapse, evidence to date has suggested that remission may often be regained by re-treatment with the same biological agent. Therefore, a concept has emerged in which cycles of biological therapy might be used. If this treatment strategy were to be applied in a subgroup of patients at low risk of relapse, cycling might allow a substantial number of patients to have a lower, overall therapeutic burden—ensuring decreased exposure to biological therapy but still enabling appropriate disease control.Currently, there remains uncertainty about the benefit–risk balance for using cycles of biological treatment for patients with Crohn’s disease. Accordingly, an expert panel was convened by the European Crohn’s and Colitis Organisation [ECCO] to review the published literature and agree a series of consensus practice points. The panel aimed to provide evidence-based guidance on multiple aspects of biological treatment discontinuation and cycling, including the risk of relapse after elective treatment discontinuation, predictors of probable relapse or remission, safety, patient preferences, and pharmacoeconomic aspects. Crucially, discussions about biological treatment discontinuation and cycling should be individualized, to enable shared decision-making by patients with their clinicians

Appropriate Therapeutic Drug Monitoring of Biologic Agents for Patients With Inflammatory Bowel Diseases.

BACKGROUND & AIMS: Therapeutic drug monitoring (TDM) is widely available for biologic therapies in patients with inflammatory bowel disease (IBD). We reviewed current data and provided expert opinion regarding the clinical utility of TDM for biologic therapies in IBD. METHODS: We used a modified Delphi method to establish consensus. A comprehensive literature review was performed regarding the use of TDM of biologic therapy in IBD and presented to international IBD specialists. Subsequently, 28 statements on the application of TDM in clinical practice were rated on a scale of 1 to 10 (1 = strongly disagree and 10 = strongly agree) by each of the panellists. Statements were accepted if 80% or more of the participants agreed with a score ≥7. The remaining statements were discussed and revised based on the available evidence followed by a second round of voting. RESULTS: The panel agreed on 24 (86%) statements. For anti-tumor necrosis factor (anti-TNF) therapies, proactive TDM was found to be appropriate after induction and at least once during maintenance therapy, but this was not the case for the other biologics. Reactive TDM was appropriate for all agents both for primary non-response and secondary loss of response. The panellists also agreed on several statements regarding TDM and appropriate drug and anti-drug antibody (ADA) concentration thresholds for biologics in specific clinical scenarios. CONCLUSION: Consensus was achieved towards the utility of TDM of biologics in IBD, particularly anti-TNF therapies. More data are needed especially on non-anti-TNF biologics to further define optimal drug concentration and ADA thresholds as these can vary depending on the therapeutic outcomes assessed