Helicobacter

With the rising prevalence of antimicrobial resistance, the eradication rates of Helicobacter pylori (H. pylori) with standard treatments are decreasing to unacceptable levels (i.e., ≤80%) in most countries. After these disappointing results, several authorities have proposed that infection with H. pylori should be approached and treated as any other bacterial infectious disease. This implicates that clinicians should prescribe empirical treatments yielding a per protocol eradication of at least 90%. In recent years several treatments producing ≥90% cure rates have been proposed including sequential therapy, concomitant quadruple therapy, hybrid (dual-concomitant) therapy, and bismuth-containing quadruple therapy. These treatments are likely to represent the recommended first-line treatments in the near future. In the present paper, we are considering a series of critical issues regarding currently available means and approaches for the management of H. pylori infection. Clinical needs and realistic endpoints are taken into account. Furthermore, emerging strategies for the eradication of H. pylori and the existing evidence of their clinical validation and widespread applicability are discussed

Coexistence of gastrointestinal stromal tumor (GIST) and colorectal adenocarcinoma: A case report

<p>Abstract</p> <p>Background</p> <p>Gastrointestinal stromal tumors (GIST) represent the most common mesenchymal tumors of the digestive tract. Over the last ten years the management of GISTs has dramatically altered but their coexistence with other gasrointesinal tumors of different histogenesis presents a special interest. The coexistence of GISTs with other primaries is usually discovered incidentally during GI surgery for carcinomas.</p> <p>Case presentation</p> <p>We present here, a case of a 66-year-old patient with intestinal GIST and a synchronous colorectal adenocarcinoma discovered incidentally during surgical treatment of the recurrent GIST. Immunohistochemical examination revealed the concurrence of histologically proved GIST (strongly positive staining for c-kit, vimentin, SMA, and focal positive in S-100, while CD-34 was negative) and Dukes Stage C, (T3, N3, M0 according the TNM staging classification of colorectal cancer).</p> <p>Conclusion</p> <p>The coexistence of GIST with either synchronous or metachronous colorectal cancer represents a phenomenon with increasing number of relative reports in the literature the last 5 years. In any case of GIST the surgeon should be alert to recognize a possible coexistent tumor with different histological origin and to perform a thorough preoperative and intraoperative control. The correct diagnosis before and at the time of the surgical procedure is the cornerstone that secures the patients' best prognosis.</p

The role of carotid plaque echogenicity in baroreflex sensitivity

ObjectiveThe baroreflex sensitivity is impaired in patients with carotid atherosclerosis. The purpose of our study was to assess the impact of carotid plaque echogenicity on the baroreflex function in patients with significant carotid atherosclerosis, who have not undergone carotid surgery.MethodSpontaneous baroreflex sensitivity (sBRS) was estimated in 45 patients with at least a severe carotid stenosis (70%-99%). sBRS calculation was performed noninvasively, with the spontaneous sequence method, based on indirectly estimated central blood pressures from radial recordings. This method failed in three patients due to poor-quality recordings, and eventually 42 patients were evaluated. After carotid duplex examination, carotid plaque echogenicity was graded from 1 to 4 according to Gray-Weale classification and the patients were divided into two groups: the echolucent group (grades 1 and 2) and the echogenic group (grades 3 and 4).ResultsSixteen patients (38%) and 26 patients (62%) were included in the echolucent and echogenic group, respectively. Diabetes mellitus was observed more frequently among echolucent plaques (χ2 = 8.0; P < .004), while those plaques were also more commonly symptomatic compared with echogenic atheromas (χ2 = 8.5; P < .003). Systolic arterial pressure, diastolic arterial pressure, and heart rate were similar in the two groups. Nevertheless, the mean value of baroreflex sensitivity was found to be significantly lower in the echogenic group (2.96 ms/mm Hg) compared with the echolucent one (5.0 ms/mm Hg), (F [1, 42] = 10.1; P < .003).ConclusionsThese findings suggest that echogenic plaques are associated with reduced baroreflex function compared with echolucent ones. Further investigation is warranted to define whether such an sBRS impairment could be responsible for cardiovascular morbidity associated with echogenic plaques

The Helicobacter pylori Genome Project : insights into H. pylori population structure from analysis of a worldwide collection of complete genomes

Helicobacter pylori, a dominant member of the gastric microbiota, shares co-evolutionary history with humans. This has led to the development of genetically distinct H. pylori subpopulations associated with the geographic origin of the host and with differential gastric disease risk. Here, we provide insights into H. pylori population structure as a part of the Helicobacter pylori Genome Project (HpGP), a multi-disciplinary initiative aimed at elucidating H. pylori pathogenesis and identifying new therapeutic targets. We collected 1011 well-characterized clinical strains from 50 countries and generated high-quality genome sequences. We analysed core genome diversity and population structure of the HpGP dataset and 255 worldwide reference genomes to outline the ancestral contribution to Eurasian, African, and American populations. We found evidence of substantial contribution of population hpNorthAsia and subpopulation hspUral in Northern European H. pylori. The genomes of H. pylori isolated from northern and southern Indigenous Americans differed in that bacteria isolated in northern Indigenous communities were more similar to North Asian H. pylori while the southern had higher relatedness to hpEastAsia. Notably, we also found a highly clonal yet geographically dispersed North American subpopulation, which is negative for the cag pathogenicity island, and present in 7% of sequenced US genomes. We expect the HpGP dataset and the corresponding strains to become a major asset for H. pylori genomics

Strategiczna baza danych społeczno-ekonomicznych i środowiskowych w turystyce – rola analizy zbiorów typu Big Data

This research studies the application of modern practices and technologies for the collection of a large volume and variety of data, in order to develop a research knowledge base for data mining and analysis in the tourism sector and especially on Cruise and Ship Lines Passengers. Emphasis was given to the application of appropriate methods of data analysis and processing, to produce tangible results for the benefit of sustainable tourism development. Current research focuses on structuring a data warehouse for the collected information in order to apply online analytical processing techniques on the stored data, as well as data mining and data visualization. A holistic approach is proposed, along with a new model for analyzing the impact of tourism activity in general—and cruises in particular—on local society. The results will be utilized as a strategic tool for decision-making by those involved in the tourism sector of cruise areas, with ways to maximize the benefits of tourism, such as increasing overnight stays and, more broadly, passenger consumption, and ways to reduce the environmental impact of visitors and passengers in the ecosystem of cruise areas.W artykule przedstawiono zastosowanie nowoczesnych narzędzi i technologii umożliwiających gromadzenie dużej ilości różnorodnych danych w celu tworzenia ich zbiorów, pozwalających na eksplorację i analizę naukową danych dotyczących sektora usług turystycznych, a zwłaszcza problemów linii i statków wycieczkowych oraz ich pasażerów. Szczególny nacisk położono na zastosowanie odpowiednich metod analizy i przetwarzania danych do uzyskiwania konkretnych wyników, które będą wspierać zrównoważony rozwój turystyki. Przeprowadzone badania koncentrują się na architekturze hurtowni danych, w których gromadzone są pozyskane informacje, umożliwiającej analityczne przetwarzanie zgromadzonych danych (OLAP), a także analizę zestawów danych (data mining) i ich wizualizację. Wyniki badań zostaną wykorzystane jako strategiczne narzędzie podejmowania decyzji w sektorze usług turystycznych, w szczególności w obszarze dotyczącym rejsów wycieczkowych, oraz maksymalizacji korzyści, takich jak zwiększenie liczby noclegów i szerzej – konsumpcji pasażerów, umożliwią także zmniejszenie wpływu odwiedzających i pasażerów statków wycieczkowych na ekosystemy odwiedzanych obszarów

Unilateral Iliac Artery Stenting Improves Perfusion and Symptoms in Both Limbs in Patients With Bilateral Iliac Lesions

Purpose: To test the hypothesis that unilateral dilation of a common (CIA) or internal iliac artery (IIA) stenosis in selected patients with contralateral chronic iliac artery occlusion is adequate to offer clinical benefit to the untreated chronically occluded limb. Methods: Sixteen patients (11 men; mean age 66.7 +/- 4.9 years) with chronic occlusion of one CIA [with or without extension to the external iliac artery (EA)] and CIA stenosis (n=11), IIA stenosis (n=3), CIA and IIA stenoses (n=1), or IIA and EIA stenoses (n=1) on the contralateral side were treated with unilateral angioplasty/stenting of the iliac artery stenosis as sole treatment for both limbs. Clinical and hemodynamic success of this approach was assessed for both limbs. Results: Eleven patients were treated with stenting of the stenosed CIA, 2 with IIA dilation, one with IIA stenting, one with stenting of both the CIA and IIA, and the last with IIA and EIA stenting. Technical success was obtained in all. Immediate hemodynamic success was also 100% for both limbs: the mean resting ankle-brachial index increased from 0.67 +/- 0.06 to 0.88 +/- 0.04 on the stenosis side and from to 0.53 +/- 0.06 to 0.69 +/- 0.07 in the contralateral occluded limb (p&lt;0.001). Clinical success was 100% for the treated limb immediately after the procedure and 93.8% for the contralateral limb. One patient with ischemic rest pain in the occluded limb continued to experience severe symptoms after contralateral CIA stenting despite hemodynamic improvement; he had a femorofemoral graft implanted 2 months after the initial intervention and was considered the only clinical failure. During a mean 24-month follow-up (range 12-54), all stented arteries remained patent. Conclusion: In selected patients with CIA or IIA stenosis and long chronic occlusion of the contralateral iliac axis, unilateral dilation/stenting of the stenosis alone increases blood flow and improves clinical symptoms to both limbs. J Endovasc Ther. 2013;20:106-11