Helicobacter pylori infection in clinical practice: probiotics and a combination of probiotics + lactoferrin improve compliance, but not eradication, in sequential therapy

Background: Sequential therapy (ST) seems to offer higher success rates than triple therapy (TT) in the eradication of Helicobacter pylori (H. pylori) infection. However, from the standpoint of therapeutic compliance, there is no difference between the two treatments. Adjuvant treatment (especially with probiotics (PB) and lactoferrin (LF)) has often improved compliance and eradication rates in patients subjected to TT, while ST had never been used in association with adjuvants. Methods: Over a period of 2 years, we randomized and divided 227 consecutive adult patients with H. pylori infection into three groups. The patients were given ST with the addition of adjuvants, as follows: group A (ST + placebo), group B (ST + LF + PB), and group C (ST + PB). Our goal was to assess therapeutic compliance, so we prepared a questionnaire to help determine the severity of the side effects. We also determined the eradication rates for the groups. Results: Patients with ST + placebo had the worst compliance as compared with the other two groups in terms of the absence of symptoms (p < .001 between B and A; p = .001 between C and A) and the presence of intolerable symptoms (p = .016 between B and A; p = .046 between C and A). The differences between the values for the treated groups and those for the placebo group were statistically significant. On the other hand, there was no statistically significant difference in compliance between groups B and C. The eradication rate was similar for the three groups. Conclusions: Probiotics associated with ST provide optimum therapeutic compliance compared with the placebo and, despite the need to take a larger number of tablets, they should be taken into consideration as an adjuvant to therapy for H. pylori infection. The addition of LF to the PB did not bring about any further improvements in compliance. As compared with the placebo, the eradication rate of ST did not improve by adding LF + PB or by using PB alone.     

Dynamic of use of chemotherapeutic preparations: quantity, nomenclature, main trends and the problems in medical practice

Data on the amounts, nomenclature and trends in the dynamics of the use of chemotherapeutic drugs in medicine and agriculture in the RSFSR in 1971-1983 were examined. It was shown that the amounts of their use for these purposes permanently increased. The levels of the use of antibacterial drugs in agriculture markedly exceeded (1.5 to 9 times in different years) those in medicine. On the whole tetracyclines, penicillins and nitrofurans were the drugs most widely used in both medicine and agriculture. The proportions of their use amounted to 39.7-61.2, 9.8-28.1 and 8.3-17.9 per cent, respectively. The use of chloramphenicol and aminoglycosides was somewhat lower, i.e. 10.6-15.8 and 6.5-9.2 per cent, respectively. The proportion of the use of the drugs of other groups did not exceed 2.1 per cent. It was stated that the chemotherapeutic drugs used in medicine for treatment of patients were widely used for nonmedical purposes. Among them are tetracyclines, chloramphenicol, aminoglycosides and lately nitrofurans. The levels of the use of some chemotherapeutic drugs and variability in their MICs for the Shigella populations tested were compared. It was concluded that the level of the drug use was not the only factor influencing development of the resistance in Shigella spp.     

Haplotypes inside the beta-globin gene: use as new biomarkers for beta-thalassemia prenatal diagnosis in north of Iran

Background

Beta-thalassemia is common in the Mediterranean area as well as the Middle East and India. Official report in Iran revealed the average prevalence rate of carriers about 4%. More than 20 restriction fragment length polymorphisms (RFLPs) are known in the beta-globin gene cluster and used in the prenatal diagnosis (PND) services. Some of these locations may have low allele frequency and are not informative in the prenatal diagnosis. The current study aims to find new haplotypes and polymorphisms with high allele frequency in the local population.

Methods

Two thousand three hundred fifty samples (1,321 male and 1,029 female) from the northern Iran, whom suspected to be the carriers either for alpha or beta thalassemia and referred to the local diagnostic laboratory as a routine services were investigated during five years, (2010–2015). The beta-globin gene was sequenced for all samples.

Results

Heterozygosity for five SNPs in the beta-globin gene was calculated separately. 383 individuals (16.29%) showed no sign of nucleotide change in the beta-globin gene sequence. In total, codon2 (C/T) 31.72%, IVSII-16 (C/G) 31.72%, IVSII-74 (G/T) 54.71%, IVSII-81 (C/T) 19.47%, and IVSII-666 (T/C) 31.72% were seen respectively. Although all five polymorphisms showed reasonably high heterozygosity, IVSII-74 (G/T) [GG wild type (36.5%), G/T (54.71%) and TT (8.8%)] revealed the highest heterozygosity rate. Four combinations of these five SNPs were defined as new haplotypes named M1 to M4. ARMS-PCR also were designed and applied to detect IVSII-74 (G/T) nucleotide position.

Conclusions

This study represents an intragenic polymorphism, IVSII-74, a reliable position with high heterozygosity rates in Iranian population for PND analysis.

Trial registration

Retrospectively registered.

     

Endpoints,patient selection,and biomarkers in the design of clinical trials for cancer vaccines

Therapeutic cancer vaccines are an emerging and potentially effective treatment modality. Cancer vaccines are usually very well tolerated, with minimal toxicity compared with chemotherapy. Unlike conventional cytotoxic therapies, immunotherapy does not result in immediate tumor shrinkage but may alter growth rate and thus prolong survival. Multiple randomized controlled trials of various immunotherapeutic agents have shown a delayed separation in Kaplan–Meier survival curves, with no evidence of clinical benefit within the first 6–12 months of vaccine treatment. Overall survival benefit is seen in patients with lower disease burden who are not expected to die within those initial 6–12 months. The concept of improved overall survival without marked initial tumor reduction represents a significant shift from the current paradigms established by standard cytotoxic therapies. Future clinical studies of therapeutic vaccines should enroll patients with either lower tumor burden, more indolent disease or both, and must seek to identify early markers of clinical benefit that may correlate with survival. Until then, improved overall survival is the only clear, discriminatory endpoint for therapeutic vaccines as monotherapies.     

Application of biomarkers in the clinical development of new drugs for chondroprotection in destructive joint diseases: a review

Emerging evidence supports the concept that biochemical markers are clinically useful non-invasive diagnostic tools for the monitoring of changes in cartilage turnover in patients with destructive joint diseases such as osteoarthritis (OA) and rheumatoid arthritis (RA). Epidemiological studies demonstrated that measurements of different degradation products of proteins in the extracellular matrix of hyaline cartilage in urine or serum samples are (1) increased in OA or RA patients compared with healthy individuals, (2) correlate with disease activity, and (3) are predictive for the rate of changes in radiographic measures of cartilage loss. The present review provides an updated list of available biomarkers and summarize the research data arguing for their clinical utility. In addition, it addresses the question whether or not the monitoring of biomarkers during different treatment modalities could be a useful approach to characterize the chondro-protective effects of approved and candidate drugs. Finally, it briefly reviews the in vitro/ex vivo experimental settings — isolated chondrocyte cultures and articular cartilage explants — that can assist in the verification of novel markers, but also studies assessing direct effects of drug candidates on chondrocytes. Collectively, biomarkers may acquire a function as established efficacy parameters in the clinical development of novel chondro-protective agents.     

The effectiveness of two smoking cessation programmes for use in general practice: a randomised clinical trial.

OBJECTIVE--To evaluate a structured, behavioural change, smoking cessation intervention designed for use within general practice. DESIGN--Randomised controlled clinical trial. SETTING--General practices in Newcastle, Australia. PATIENTS--311 Patients identified as smokers by a screening question were enrolled in the study. Of these, 101 were assigned to a structured behavioural change programme, 104 to a simple advice programme adapted from previous research, and 106 to a control group. No significant differences were found between groups for demographic and smoking related variables before the study. INTERVENTIONS--Patients in the simple advice group received a brief statement of advice from the general practitioner as well as three pamphlets; those in the structured intervention group were given strategies which included attitude and behavioural change programmes as well as techniques to aid compliance. The amount of smoking in all groups was assessed by self reports with validation by measurement of salivary cotinine concentrations. MAIN OUTCOME MEASURE--Significant increase in cessation rates. CONCLUSIONS--Significant differences between controls and the structured behavioural change group were found at the one month follow up, but only for self reported abstinence. The simple advice programme did not produce any significant differences over the control group. General practitioner evaluation of the structured programme highlighted difficulties in relation to the duration of the intervention. Overall the structured programme in its present form did not appear to be an effective programme for use within general practice.     

The discovery of how gender influences age immunological mechanisms in health and disease,and the identification of ageing gender-specific biomarkers,could lead to specifically tailored treatment and ultimately improve therapeutic success rates

The control of human health and diseases in the elderly population is becoming a challenge, since mean age and life expectation are progressively increasing as well as chronic degenerative diseases. These disorders are of complex diagnosis and they are difficult to be treated, but it is hoped that the predictive medicine will lead to more specific and effective treatment by using specific markers to identify persons with high risk of developing disease, before the clinical manifestation. Peripheral blood targets and biomarkers are currently the most practical, non-invasive means of disease diagnosing, predicting prognosis and therapeutic response. Human longevity is directly correlated with the optimal functioning of the immune system. Recent findings indicate that the sexual dimorphism of T helper (Th) cytokine pathways and the regulation of Th cell network homeostasis are normally present in the immune response and undergoes to adverse changes with ageing. Furthermore, immune senescence affects both men and women, but it does not affect them equally. Therefore, we hypothesize that the comprehension of the interferences between these gender specific pathways, the ageing immunological mechanism in pathological or healthy state and the current therapies, could lead to specifically tailored treatment and eventually improve the therapeutic success rates. Reaching this aim requires the identification of ageing gender-specific biomarkers that could easily reveal the above mentioned correlations.     

Protected areas in the future: the implications of change,and the need for new policies

Papers

Protected areas in the future: the implications of change, and the need for new policies     

Hypotheses, rationale, design, and methods for prognostic evaluation of cardiac biomarker elevation after percutaneous and surgical revascularization in the absence of manifest myocardial infarction. A comparative analysis of biomarkers and cardiac magnetic resonance. The MASS-V Trial

ABSTRACT: BACKGROUND: Although the release of cardiac biomarkers after percutaneous (PCI) or surgical revascularization (CABG) is common, its prognostic significance is not known. Questions remain about the mechanisms and degree of correlation between the release, the volume of myocardial tissue loss, and the long-term significance. Delayed-enhancement of cardiac magnetic resonance (CMR) consistently quantifies areas of irreversible myocardial injury. To investigate the quantitative relationship between irreversible injury and cardiac biomarkers, we will evaluate the extent of irreversible injury in patients undergoing PCI and CABG and relate it to postprocedural modifications in cardiac biomarkers and long-term prognosis. METHODS: The study will include 150 patients with multivessel coronary artery disease (CAD) with left ventricle ejection fraction (LVEF) and a formal indication for CABG; 50 patients will undergo CABG with cardiopulmonary bypass (CPB); 50 patients with the same arterial and ventricular condition indicated for myocardial revascularization will undergo CABG without CPB; and another 50 patients with CAD and preserved ventricular function will undergo PCI using stents. All patients will undergo CMR before and after surgery or PCI. We will also evaluate the release of cardiac markers of necrosis immediately before and after each procedure. Primary outcome considered is overall death in a 5-year follow-up. Secondary outcomes are levels of CK-MB isoenzyme and I-Troponin in association with presence of myocardial fibrosis and systolic left ventricle dysfunction assessed by CMR. DISCUSSION: The MASS-V Trial aims to establish reliable values for parameters of enzyme markers of myocardial necrosis in the absence of manifest myocardial infarction after mechanical interventions. The establishments of these indices have diagnostic value and clinical prognosis and therefore require relevant and different therapeutic measures. In daily practice, the inappropriate use of these necrosis markers has led to misdiagnosis and therefore wrong treatment. The appearance of a more sensitive tool such as CMR provides an unprecedented diagnostic accuracy of myocardial damage when correlated with necrosis enzyme markers. We aim to correlate laboratory data with imaging, thereby establishing more refined data on the presence or absence of irreversible myocardial injury after the procedure, either percutaneous or surgical, and this, with or without the use of cardiopulmonary bypass.     

The use of biomarkers in Daphnia magna toxicity testing. IV. Cellular Energy Allocation: a new methodology to assess the energy budget of toxicant-stressed Daphnia populations

The Cellular Energy Allocation (CEA) methodology wasdeveloped as biomarker technique to assess the effectof toxic stress on the energy budget of testorganisms. This short-term assay is based on thebiochemical assessment of changes in the energyreserves (total carbohydrate, protein and lipidcontent) and the energy consumption (electrontransport activity). The CEA methodology was evaluatedusing Daphnia magna juveniles exposed for 96hto sublethal lindane and mercury chlorideconcentrations. The ecological relevance of the CEAassay was assessed by comparing the sub-organismalresponse with population level parameters (obtainedfrom 21 day life table experiments) such as theintrinsic rate of natural increase (r_m) and themean total offspring per female. Two differentmethodologies were used to assess the effect levels:the no (lowest) observed effect level (NOAECs-LOAECs)approach and the regression-based approach. Bothtoxicants caused a significant decrease in the netenergy budget of D. magna, with a LowestObserved (Adverse) Effect Concentration (LOAEC) of0.18 mg/l and 5.6 µg/l for lindane andHgCl₂,respectively. Changes in the lipid content of theorganisms were detected at toxicant concentrationslower than those affecting the total carbohydrate andprotein content. Toxicant specific effects wereobserved on the electron transport activity.Comparison of the CEA results with those of thepopulation level tests revealed that for mercury theCEA based LOAEC was a three times lower than thatbased on r_m and the total brood size(18 µg/l). For lindane the CEA based LOAEC was twotimes lower than the LOAEC based on r_m(0.32 mg/l) but was higher than that based on thetotal number of offspring produced (0.1 mg/l).Using the regression-based approach, EC₁₀ valueswere calculated using three parameter sigmoid orlogistic models. Comparison between the CEA andr_m based EC₁₀ values demonstrates that forboth chemicals similar effect concentrations areobtained: the CEA-based EC₁₀ (0.20 mg/l) forlindane is 1.5 times higher than the r_m-basedEC₁₀ threshold (0.13 mg/l), while for mercury thebiomarker-based EC₁₀ value (9 µg/l) was 1.4times lower than the population-based EC₁₀ value(12.5 µg/l).From these results, we suggest that the short-term CEAassay may be useful for predicting long-term effectsat the population level. The consequences of theobserved effects on the energy budget of the testorganism are discussed in the context of the effectsemerging at the population and community level.     

Temporal and vertical variations of lipid biomarkers during a bottom ice diatom bloom in the Canadian Beaufort Sea: further evidence for the use of the IP25 biomarker as a proxy for spring Arctic sea ice

Variations in the concentrations of the sea ice diatom biomarker, IP₂₅ (Ice Proxy with 25 carbon atoms), were measured in the bottom 10 cm of sea ice collected from the eastern Beaufort Sea and Amundsen Gulf from January to June 2008, as part of the International Polar Year–Circumpolar Flaw Lead system study. Temporal and vertical changes in IP₂₅ concentrations were compared against other biomarkers and indicators of ice algal production. IP₂₅ was not detected in sea ice samples collected from mid-winter to early spring, likely as a result of light-limiting conditions for algal growth and accumulation. From early March to mid-June, IP₂₅ concentrations correlated well with those of fatty acids (r = 0.79; P < 0.001), less so with total sterols (r = 0.63; P < 0.001) and qualitatively with chlorophyll a concentrations and diatom cell abundances from adjacent sea ice cores. Approximately 90% of the total sea ice IP₂₅ accumulation occurred from mid-March to late-May, coincident with the ice algal bloom period. The majority (ca. 87–93%) of IP₂₅ was biosynthesised within the lower 5 cm of the sea ice where brine volume fractions were >5% which is consistent with the hypothesis that brine channel connectivity limits the internal colonisation of sea ice by diatoms. Maximum IP₂₅ concentrations occurred at 1–3 cm from the ice–water interface providing further evidence for a selective sea ice diatom origin for this biomarker. In contrast, vertical concentration profiles for fatty acids and sterols indicated mixed sources for these biomarkers.