Static Stretching Combined with Conscious Slower Breathing May Increase Parasympathetic Activity and Reduce Stress in Adult Women

Background: Women are thought to be more susceptible to stress than men in a stressful society, and reducing stress is crucial for women to maintain their health. Static stretching (SST) is applied in various fields to not only increase muscle flexibility but also reduce stress. Additionally, conscious slower breathing (CSB) predominates parasympathetic activity, causing a relaxing effect. These results indicate that combining SST and CSB may be more useful in reducing stress. However, to the best of our knowledge, the effect of this combination remains unclear. Objective: This study aimed to elucidate the effects of the combination of SST and CSB on autonomic activity and stress in adult women. Methods: Eleven healthy Japanese adult female participants performed SST with nonconscious natural breathing for 20 min. The same participants performed SST in combination with CSB (2 s inspiratory and 4 s expiratory) for 20 min on another day. Salivary cortisol and chromogranin A levels were measured before and after stretching as stress markers of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system. The coefficient of variation of the R-R interval (CVR-R) and high-frequency component (HF), which reflect parasympathetic nerve activity, and heart rate and low-frequency component (LF)/HF ratio, which reflect sympathetic nerve activity, were measured before, during, and after stretching. Results: SST decreased cortisol levels but with no significant changes in chromogranin A, heart rate, CVR-R, HF, or LF/HF ratio. The combination of SST and CSB increased CVR-R and HF levels in addition to decreasing cortisol levels but with no significant changes in chromogranin A, heart rate, or LF/HF levels. Conclusion: These results indicate that the combination of SST and CSB may increase parasympathetic activity and reduce stress. However, future randomized controlled trials with larger sample sizes should support this conclusion.

Study on the influence of side-blown airflow velocities on plasma and combustion wave generated from fused silica induced by combined pulse laser

This study examines the impact of variations in side-blowing airflow velocity on plasma generation,combustion wave propagation mechanisms,and surface damage in fused silica induced by a combined millisecond-nanosecond pulsed laser.The airflow rate and pulse delay are the main experimental variables.The evolution of plasma motion was recorded using ultrafast time-resolved optical shadowing.The experimental results demonstrate that the expansion velocities of the plasma and combustion wave are influenced differently by the sideblowing airflow at different airflow rates(0.2 Ma,0.4 Ma,and 0.6 Ma).As the flow rate of the sideblow air stream increases,the initial expansion velocities of the plasma and combustion wave gradually decrease,and the side-blow air stream increasingly suppresses the plasma.It is important to note that the target vapor is always formed and ionized into plasma during the combined pulse laser action.Therefore,the side-blown airflow alone cannot completely clear the plasma.Depending on the delay conditions,the pressure of the side-blowing airflow,the influence of inverse Bremsstrahlung radiation absorption and target surface absorption mechanisms can lead to a phenomenon known as the double combustion waves when using a nanosecond pulse laser.Both simulation and experimental results are consistent,indicating the potential for further exploration of fused silica targets in the laser field.

Advancements in breath-based diagnostics for pancreatic cancer:Current insights and future perspectives

Recent decades have seen a concerning surge in carcinogenic diseases,with cancer cases and deaths on the rise globally.Conventional diagnostic methods are often invasive and time-consuming,highlighting the need for fast,accurate,and painless alternatives.Non-invasive exhaled breath analysis emerges as a promising solution,with over 200 volatile organic compounds(VOCs)detected in exhaled air,showing potential as biomarkers for various diseases,including cancer.Despite the lack of standardized methodologies,advancements in analytical instruments have expanded detection capabilities,reaching 3500 VOCs.Studies have identified specific VOC patterns associated with different cancers,offering hope for non-invasive diagnosis.Techniques such as gas chromatography-mass spectrometry and electronic noses show promise in distinguishing between healthy individuals and cancer patients.However,further research and standardization are needed to realize the full clinical potential of breath-based diagnostics,particularly in the early detection of challenging cancers like pancreatic cancer.

Identification of breath volatile organic compounds to distinguish pancreatic adenocarcinoma,pancreatic cystic neoplasm,and patients without pancreatic lesions

BACKGROUND Volatile organic compounds(VOCs)are a promising potential biomarker that may be able to identify the presence of cancers.AIM To identify exhaled breath VOCs that distinguish pancreatic ductal adenocar-cinoma(PDAC)from intraductal papillary mucinous neoplasm(IPMN)and healthy volunteers.METHODS We collected exhaled breath from histologically proven PDAC patients,radiological diagnosis IPMN,and healthy volunteers using the ReCIVA®device between 10/2021-11/2022.VOCs were identified by thermal desorption-gas chromatography/field-asymmetric ion mobility spectrometry and compared between groups.RESULTS A total of 156 participants(44%male,mean age 62.6±10.6)were enrolled(54 PDAC,42 IPMN,and 60 controls).Among the nine VOCs identified,two VOCs that showed differences between groups were dimethyl sulfide[0.73 vs 0.74 vs 0.94 arbitrary units(AU),respectively;P=0.008]and acetone dimers(3.95 vs 4.49 vs 5.19 AU,respectively;P<0.001).After adjusting for the imbalance parameters,PDAC showed higher dimethyl sulfide levels than the control and IPMN groups,with adjusted odds ratio(aOR)of 6.98(95%CI:1.15-42.17)and 4.56(1.03-20.20),respectively(P<0.05 both).Acetone dimer levels were also higher in PDAC compared to controls and IPMN(aOR:5.12(1.80-14.57)and aOR:3.35(1.47-7.63),respectively(P<0.05 both).Acetone dimer,but not dimethyl sulfide,performed better than CA19-9 in PDAC diagnosis(AUROC 0.910 vs 0.796).The AUROC of acetone dimer increased to 0.936 when combined with CA19-9,which was better than CA19-9 alone(P<0.05).CONCLUSION Dimethyl sulfide and acetone dimer are VOCs that potentially distinguish PDAC from IPMN and healthy participants.Additional prospective studies are required to validate these findings.

Effects of relaxation breathing exercise on fatigue and cortisol level among Indonesian gynecological cancer patients undergoing chemotherapy:a pilot study

Objective:This study aimed to determine the effect of the relaxation breathing exercise(RBE)on fatigue and cortisol levels among Indonesian women with gynecological cancer undergoing chemotherapy.Methods:This pilot study consecutively recruited 44 gynecological cancer patients to receive RBE(22)or usual care(22).Cortisol level was measured before and after completion of the intervention(day 8).Fatigue was measured using the Piper Fatigue Scale(PFS).Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale(HADS)at the baseline days of the study for days 1,4,and 8.The obtained data were analyzed using Fisher’s exact test,the independent t-test,and the Mann-Whitney U test.Results:There were significant increases in cortisol levels within the groups,either the intervention or control groups,respectively(P-value=0.0003 and 0.001).Despite there being no statistical significance between the intervention and control groups,there were noticeable differences in the cortisol levels,indicating the extreme increase in cortisol levels in the control group(Median[IQR1-IQR3]:2.30[0.99-9.09];Min-Max:0.43-23.38)compared with the intervention group(Median[IQR1-IQR3]=2.97[1.26-5.18];Min-Max=0.39-6.91).Conclusions:RBE helps prevent a significant increase in cortisol levels that can alleviate fatigue for women with gynecological cancer.Further research was recommended to compare several intervention modalities for fatigue and cancer-related symptom management based on cortisol level changes.

Breath tests and irritable bowel syndrome

Breath tests are non-invasive tests and can detect H2 and CH4 gases which are produced by bacterial fermentation of unabsorbed intestinal carbohydrate and are excreted in the breath. These tests are used in the diagnosis of carbohydrate malabsorption, small intestinal bacterial overgrowth, and for measuring the orocecal transit time. Malabsorption of carbohydrates is a key trigger of irritable bowel syndrome (IBS)-type symptoms such as diarrhea and/or constipation, bloating, excess flatulence, headaches and lack of energy. Abdominal bloating is a common nonspecific symptom which can negatively impact quality of life. It may reflect dietary imbalance, such as excess fiber intake, or may be a manifestation of IBS. However, bloating may also represent small intestinal bacterial overgrowth. Patients with persistent symptoms of abdominal bloating and distension despite dietary interventions should be referred for H2 breath testing to determine the presence or absence of bacterial overgrowth. If bacterial overgrowth is identified, patients are typically treated with antibiotics. Evaluation of IBS generally includes testing of other disorders that cause similar symptoms. Carbohydrate malabsorption (lactose, fructose, sorbitol) can cause abdominal fullness, bloating, nausea, abdominal pain, flatulence, and diarrhea, which are similar to the symptoms of IBS. However, it is unclear if these digestive disorders contribute to or cause the symptoms of IBS. Research studies show that a proper diagnosis and effective dietary intervention significantly reduces the severity and frequency of gastrointestinal symptoms in IBS. Thus, diagnosis of malabsorption of these carbohydrates in IBS using a breath test is very important to guide the clinician in the proper treatment of IBS patients.

Association between acute pancreatitis and small intestinal bacterial overgrowth assessed by hydrogen breath test

AIM To elucidate the effects of small intestinal bacterial overgrowth(SIBO) on the severity and complications of acute pancreatitis(AP).METHODS In total,208 patients with AP as defined by the revised Atlanta classification were admitted to Xuanwu Hospital of capital Medical University from 2013 to 2016. All patients were admitted within 72 h of AP onset. The hydrogen breath test was performed 7 d after AP onset to detect hydrogen production and evaluate the development of SIBO. The incidence of SIBO was analyzed in patients with AP of three different severity grades. The association between SIBO and complications of AP was also assessed.RESULTS Of the 27 patients with severe AP(SAP),seven(25.92%) developed SIBO. Of the 86 patients with moderately severe AP(MSAP),22(25.58%) developed SIBO. Of the 95 patients with mild AP(MAP),eight(8.42%) developed SIBO. There were significant differences in the rates of SIBO among patients with AP of different severities. Additionally,more severe APwas associated with higher rates of SIBO positivity(P < 0.05). SIBO in patients with AP mainly occurred within 72 h of the onset of AP. The incidence of organ failure was significantly higher in patients with SIBO than in those without(P < 0.05).CONCLUSION SIBO occurs more frequently in patients with MSAP or SAP than in those with MAP,usually ≤ 72 h after AP onset. Additionally,SIBO is associated with organ failure.

Exhaled breath analysis in hepatology: State-of-the-art and perspectives

Liver disease is characterized by breath exhalation of peculiar volatile organic compounds(VOCs).Thanks to the availability of sensitive technologies for breath analysis,this empiric approach has recently gained increasing attention in the context of hepatology,following the good results obtained in other fields of medicine.After the first studies that led to the identification of selected VOCs for pathophysiological purposes,subsequent research has progressively turned towards the comprehensive assessment of exhaled breath for potential clinical application.Specific VOC patterns were found to discriminate subjects with liver cirrhosis,to rate disease severity,and,eventually,to forecast adverse clinical outcomes even beyond existing scores.Preliminary results suggest that breath analysis could be useful also for detecting and staging hepatic encephalopathy and for predicting steatohepatitis in patients with nonalcoholic fatty liver disease.However,clinical translation is still hampered by a number of methodological limitations,including the lack of standardization and the consequent poor comparability between studies and the absence of external validation of obtained results.Given the low-cost and easy execution at bedside of the new technologies(e-nose),larger and well-structured studies are expected in order to provide the adequate level of evidence to support VOC analysis in clinical practice.

Breath volatile organic compounds for the gut-fatty liver axis: promise, peril, and path forward

The worldwide interest in the gut microbiome and its impact on the upstream liver highlight a critical upside to breath research: it can uniquely measure otherwise unmeasurable biology. Bacteria make gases [volatile organic compounds(VOCs)] that are directly relevant to pathophysiology of the fatty liver and associated conditions, including obesity. Measurement of these VOCs and their metabolites in the exhaled breath, therefore, present an opportunity to safely and easily evaluate, on both a personal and a population level, some of our most pressing public health threats. This is an opportunity that must be pursued. To date, however, breath analysis remains a slowly evolving field which only occasionally impacts clinical research or patient care. One major obstacle to progress is that breath analysis is inherently and emphatically mutli-disciplinary: it connects engineering, chemistry, breath mechanics, biology and medicine. Unbalanced or incomplete teams may produce inconsistent and often unsatisfactory results. A second impediment is the lack of a well-known stepwise structure for the development of non-invasive diagnostics. As a result, the breath research landscape is replete with orphaned single-center pilot studies. Often, important hypotheses and key observations have not been pursued to maturation. This paper reviews the rationale and requirements for breath VOC research applied to the gut-fatty liver axis and offers some suggestions for future development.

Breath-based meditation: A mechanism to restore the physiological and cognitive reserves for optimal human performance

Stress can be associated with many physiologicalchanges resulting in significant decrements in human performance.Due to growing interests in alternative and complementary medicine by Westerners,many of the traditions and holistic yogic breathing practices today are being utilized as a measure for healthier lifestyles.These state-of-the-art practices can have a significant impact on common mental health conditions such as depression and generalized anxiety disorder.However,the potential of yogic breathing on optimizing human performance and overall well-being is not well known.Breathing techniques such as alternate nostril,Sudarshan Kriya and bhastrika utilizes rhythmic breathing to guide practitioners into a deep meditative state of relaxation and promote self-awareness.Furthermore,yogic breathing is physiologically stimulating and can be described as a natural"technological"solution to optimize human performance which can be categorized into:(1)cognitive function(i.e.,mind,vigilance);and(2)physical performance(i.e.,cardiorespiratory,metabolism,exercise,whole body).Based on previous studies,we postulate that daily practice of breathing meditation techniques play a significant role in preserving the compensatory mechanisms available to sustain physiological function.This preservation of physiological function may help to offset the time associated with reaching a threshold for clinical expression of chronic state(i.e.,hypertension,depression,dementia)or acute state(i.e.,massive hemorrhage,panic attic)of medical conditions.However,additional rigorous biomedical research is needed to evaluate the physiological mechanisms of various forms of meditation(i.e.,breath-based,mantra,mindfulness)on human performance.These efforts will help to define how compensatory reserve mechanisms of cardiovascular and immune systems are modulated by breath-based meditation.While it has been suggested that breath-based meditation is easier for beginning practitioners when compared to other forms of meditation more research is needed to elucidate these observations.A breath-based meditation sequence suchas Sudarshan Kriya has the potential to help develop an individual’s self-awareness and support better integration of the brain(i.e.,mind)with other organ systems(i.e.,body)for enhanced human performance.

Gender-associated differences in urea breath test for Helicobacter pylori infection referrals and results among dyspeptic patients

AIM: To verify whether there is a gender difference in the 13C-urea breath test results in a large cohort. METHODS: The test results of dyspeptic patients referred for 13C-urea breath testing between January and December, 2007 were evaluated. Testing was carried out at the health insurance organization branches and evaluated at a central laboratory in Israel. RESULTS: Of a total of 28 746 test results, 18 122 (63.04%) were from females and 10 624 (36.95%) from males. Overall, 10 188 (35.4%) results [expressed as delta over baseline (DOB)] were positive (DOB 13C > 5), 18,326 (63.7%) were negative (DOB 13C < 3.5) and 232 (0.8%) were borderline (DOB 13C 3.5-5). There was a significant difference between the total positive rate among females and males (34.8% vs 37.2%, respectively, P = 0.0003). The mean test value was increased by approximately 10 units for females compared to males (P < 0.01) and this difference was consistent for all age groups (i.e., between 10-80 years of age, P < 0.01). CONCLUSION: More females were referred to 13C-urea breath testing. More males had positive results. The mean test values were significantly higher among females of all age groups, possibly representing an increased bacterial load among females and suggesting gender-associated differences in Helicobacter pylori host interactions.

Generation of breathing solitons in the propagation and interactions of Airy–Gaussian beams in a cubic–quintic nonlinear medium

Using the split-step Fourier transform method, we numerically investigate the generation of breathing solitons in the propagation and interactions of Airy–Gaussian（AiG） beams in a cubic–quintic nonlinear medium in one transverse dimension. We show that the propagation of single AiG beams can generate stable breathing solitons that do not accelerate within a certain initial power range. The propagation direction of these breathing solitons can be controlled by introducing a launch angle to the incident AiG beams. When two AiG beams accelerated in opposite directions interact with each other,different breathing solitons and soliton pairs are observed by adjusting the phase shift, the beam interval, the amplitudes,and the light field distribution of the initial AiG beams.

Measurement of hepatic functional mass by means of ^(13)C-methacetin and ^(13)C-phenylalanine breath tests in chronic liver disease: Comparison with Child-Pugh score and serum bile acid levels

AIM: To evaluate and compare the clinical usefulness of 13C-phenylalanine and 13C-methacetin breath tests in quantitating functional hepatic mass in patients with chronic liver disease and to further compare these results with those of conventional tests, Child-Pugh score and serum bile acid levels.METHODS: One hundred and forty patients (50 HCV-related chronic hepatitis, 90 liver cirrhosis patients) and 40 matched healthy controls were studied. Both breath test and routine liver test, serum levels of cholic and chenodeoxycholic acid conjugates were evaluated.RESULTS: Methacetin breath test, expressed as 60 min cumulative percent of oxidation, discriminated the hepatic functional capacity not only between controls and liver disease patients, but also between different categories of chronic liver disease patients. Methacetin breath test was correlated with liver function tests and serum bile acids.Furthermore, methacetin breath test, as well as serum bile acids, were highly predictive of Child-Pugh scores. The diagnostic power of phenylalanine breath test was always less than that of methacetin breath test.CONCLUSION: Methacetin breath test represents a safe and accurate diagnostic tool in the evaluation of hepatic functional mass in chronic liver disease patients.

Modified Helicobacter test using a new test meal and a 13C-urea breath test in Helicobacter pylori positive and negative dyspepsia patients on proton pump inhibitors

AIM To determine the sensitivity and specificity of the ^(13)C-urea breath test(UBT) in patients taking proton pump inhibitors(PPIs), using a new test meal Refex. METHODS One hundred and fourteen consecutive patients with dyspepsia, 53 Helicobacter pylori(H. pylori) positive, 49 H. pylori negative, were included in the study. The patients were then given esomeprazole 40 mg for 29 consecutive days, and the ^(13)C-UBT with the new test meal was performed the next morning. RESULTS The sensitivity of the ^(13)C-UBT with a cut off 2.5‰ was92.45%(95%CI: 81.79%-97.91%) by per-protocol(PP) analysis and 78.13 %(95%CI: 66.03%-87.49%) by intention-to-treat(ITT) analysis. The specificity of the ^(13)C-UBT test was 96.00 % in the ITT population(95%CI: 86.29%-99.51%) and 97.96% in the PP population(95%CI: 89.15%-99.95%).CONCLUSION The new test meal based ^(13)C-UBT is highly accurate in patients on PPIs and can be used in those unable to stop their PPI treatment.

The spring Yellow Sea fog：synoptic and air–sea characteristics associated with different airflow paths

The fog occurs frequently over the Yellow Sea in spring（April–May）, a climatical period of Asian monsoon transition. A comprehensive survey of the characteristic weather pattern and the air-sea condition is provided associated with the fog for the period of 1960–2006. The sea fog is categorized by airflow pathways of backward trajectory cluster analysis with the surface observations derived from international comprehensive oceanatmosphere dataset（I_COADS） I_COADS datasets and contemporaneous wind fields from the National Centers for Environmental Prediction（NCEP）/National Center for Atmospheric Research（NCAR） reanalysis. On the basis of the airflow paths, the large-scale lower-tropospheric circulation patterns and the associated surface divergence,the distribution of a vertical humidity, the horizontal water vapor transportation and the air-sea temperature difference are investigated and the major findings are summarized as follows.（1） Four primary clusters of the airflow paths that lead to spring sea fog formation are identified. They are originated from the northwest, east,southeast and southwest of the Yellow Sea, respectively.（2） Springtime Yellow Sea fog occurs under two typical weather patterns： the Yellow Sea high（YSH） and cyclone and anticyclone couplet（CAC）. Each pattern appears by about equal chance in April but the YSH occurrence drops to around one third and the CAC rises to around two third of chance in May.（3） The common feature in the two types of synoptic conditions is that surface divergence center is located over the Yellow Sea.（4） For the YSH type of fog, water vapor comes mainly from local evaporation with a well-defined dry layer present in the lower atmosphere; for the CAC type of fog, however, water vapor comes mainly from areas outside the Yellow Sea with a thick surface layer of high humidity.（5） With the differences in weather patterns and its associated vertical distribution of the humidity and the transportation of water vapor, there are two types of sea fogs. Most fogs of the CAC types are ＂warm＂ fog, while fogs of YSH type have nearly equal chance to be ＂warm＂ and ＂cold＂ fog.

Airflow adjustment and minimization of the air power of ventilation network

It is often required to know which roadway （adjustment roadway） resistances and how much values of the resis- tances should be changed to make the airflow rates in roadways （target roadways） to certain required values in the practice of mine ventilation. In this case, the airflow rates of the target roadways and the resistances of the roadways other than the ad- justment roadways are the given conditions and the resistances of the adjustment roadways are the solutions to be found. No straightforward method to solve the problem has been found up to now. Therefore, trial and error method using the ventilation network analysis program is utilized to solve the problem so far. The method takes long calculation time and the best answer is not necessarily obtained. The authors newly defined ＂airflow element＂ as an element of the ventilation network analysis. The resistances that satisfy the airflow requirements can be calculated straight forwardly by putting the function of the airflow element into the ventilation network analysis. The air power required for the ventilation can be minimized while meeting the airflow requirements by the advanced application of the method. The authors made the computer program fulfill the method. The program was applied to actual ventilation network and it was found that the method is very practical and the time required for the analysis is short.

Update on diagnostic value of breath test in gastrointestinal and liver diseases

In the field of gastroenterology,breath tests(BTs) are used intermittently as diagnostic tools that allow indirect,non-invasive and relatively less cumbersome evaluation of several disorders by simply quantifying the appearance in exhaled breath of a metabolite of a specific substrate administered.The aim of this review is to have an insight into the principles,methods of analysis and performance parameters of various hydrogen,methane and carbon BTs which are available for diagnosing gastrointestinal disorders such as Helicobacter pylori infection,small intestinal bacterial overgrowth,and carbohydrate malabsorption.Evaluation of gastric emptying is routinely performed by scintigraphy which is however,difficult to perform and not suitable for children and pregnant women,this review has abridged the 13C-octanoic acid test in comparison to scintigraphy and has emphasized on its working protocol and challenges.A new development such as electronic nose test is also highlighted.Moreover we have also explored the limitations and constraints restraining the wide use of these BT.We conclude that breath testing has an enormous potential to be used as a diagnostic modality.In addition it offers distinct advantages over the traditional invasive methods commonly employed.

Shortness of breath in clinical practice: A case for left atrial function and exercise stress testing for a comprehensive diastolic heart failure workup

The symptom cluster of shortness of breath(SOB) contributes significantly to the outpatient workload of cardiology services. The workup of these patients includes blood chemistry and biomarkers, imaging and functional testing of the heart and lungs. A diagnosis of diastolic heart failure is inferred through the exclusion of systolic abnormalities, a normal pulmonary function test and normal hemoglobin, coupled with diastolic abnormalities on echocardiography. Differentiating confounders such as obesity or deconditioning in a patient with diastolic abnormalities is difficult. While the most recent guidelines provide more avenues for diagnosis, such as incorporating the left atrial size, little emphasis is given to understanding left atrial function, which contributes to at least 25% of diastolic left ventricular filling; additionally, exercise stress testing to elicit symptoms and test the dynamics of diastolic parameters, especially when access to the "gold standard" invasive tests is lacking, presents clinical translational gaps. It is thus important in diastolic heart failure work up to understand left atrial mechanics and the role of exercise testing to build a comprehensive argument for the diagnosis of diastolic heart failure in a patient presenting with SOB.

Breath test for differential diagnosis between small intestinal bacterial overgrowth and irritable bowel disease:An observation on non-absorbable antibiotics

AIM： To estimate the prevalence of small intestine bacterial overgrowth （SIBO） among patients with an earlier diagnosis of irritable bowel disease （IBS） in our geographical area, and to collect information on the use of locally acting non-absorbable antibiotics in the management of SIBO. METHODS： A non-interventional study was conducted in 73 consecutive patients with a symptom-based diagnosis.. RESULTS： When the patients underwent a ＂breath test＂, 33 （45.2%） showed the presence of a SIBO. Arcer treatment with rifaximin 1200 mg/d for seven days in 32 patients, 19 （59.4%） showed a negative ＂breath test＂ one week later as well as a significant reduction of symptoms, thus confirming the relationship between SIBO and many of the symptoms claimed by patients. In the other 13 patients, ＂breath test＂ remained positive, and a further cycle of treatment with ciprofloxacin 500 mg/d was given for 7 additional days, resulting in a negative ＂breath test＂ in one patient only. CONCLUSION： （1） about half of the patients with a symptomatic diagnosis of IBS have actually SIBO, which is responsible for most of the symptoms attributed to IBS; （2） only a ＂breath test＂ with lactulose （or with glucose in subjects with an intolerance to lactose） can provide a differential diagnosis between IBS and SIBO, with almost identical symptoms; and （3） the use of non-absorbable antibiotics may be useful to reduce the degree of SIBO and related symptoms; it must be accompanied, however, by the correction of the wrong alimentary habits underlying SIBO.

Breath and string test: A diagnostic package for the identification of treatment failure and antibiotic resistance of Helicobacter pylori without the necessity of upper gastrointestinal endoscopy

AIM: Helicobacter pylori (H pylori) resistance after failed eradication has a major impact on the outcome of a further treatment regimen. The aim of this study was to assess the validity of a non-invasive strategy using the 13C-urea breath test (UBT) and the gastric string test in identifying post-treatment resistance of H pylori. METHODS: The UBT was routinely performed 4 to 6 wk after H pylori eradication therapy. Forty-two patients (24 females, 18 males, mean age 48 years) with a positive UBT were included in the study. A gastric string test using a capsule containing a 90 cm-long nylon fiber was performed. Before the capsule was swallowed, the free end of the string was taped to the cheek. After one hour in the stomach, the string was withdrawn. The distal 20 cm of the string was inoculated onto an agar plate and processed under micro-aerophilic conditions. Following the string test, upper gastrointestinal endoscopy was performed to obtain gastric biopsies for conventional culture. RESULTS: H pylori was successfully cultured from the gastric string in 34 patients (81%), but not in 5 patients due to contamination with oropharyngeal flora. H py/oriwas cultured from the gastric biopsies obtained at endoscopy in 39 patients (93%). CONCLUSION: The UBT followed by the gastric string test in the case of treatment failure is a valid diagnostic strategy with the aim of determining the post-therapeutic antibiotic resistance of H pylori with little inconvenience to the patient. Upper Gl-endoscopy can be avoided in several cases by applying consequently this diagnostic package.