Evaluation of urea breath test as a diagnostic tool for Helicobacter pylori infection in adult dyspeptic patients

In this editorial,we discuss the article in the World Journal of Gastroenterology.The article conducts a meta-analysis of the diagnostic accuracy of the urea breath test(UBT),a non-invasive method for detecting Helicobacter pylori(H.pylori)infection in humans.It is based on radionuclide-labeled urea.Various methods,both invasive and non-invasive,are available for diagnosing H.pylori infection,inclu-ding endoscopy with biopsy,serology for immunoglobulin titers,stool antigen analysis,and UBT.Several guidelines recommend UBTs as the primary choice for diagnosing H.pylori infection and for reexamining after eradication therapy.It is used to be the first choice non-invasive test due to their high accuracy,specificity,rapid results,and simplicity.Moreover,its performance remains unaffected by the distribution of H.pylori in the stomach,allowing a high flow of patients to be tested.Despite its widespread use,the performance characteristics of UBT have been inconsistently described and remain incompletely defined.There are two UBTs available with Food and Drug Administration approval:The 13C and 14C tests.Both tests are affordable and can provide real-time results.Physicians may prefer the 13C test because it is non-radioactive,compared to 14C which uses a radioactive isotope,especially in young children and pregnant women.Although there was heterogeneity among the studies regarding the diagnostic accuracy of both UBTs,13C-UBT consistently outperforms the 14C-UBT.This makes the 13C-UBT the preferred diagnostic approach.Furthermore,the provided findings of the meta-analysis emphasize the significance of precise considerations when choosing urea dosage,assessment timing,and measurement techniques for both the 13C-UBT and 14C-UBT,to enhance diagnostic precision.

Urea breath test for Helicobacter pylori infection in adult dyspeptic patients: A meta-analysis of diagnostic test accuracy

BACKGROUND Helicobacter pylori(H.pylori)infection has been well-established as a significant risk factor for several gastrointestinal disorders.The urea breath test(UBT)has emerged as a leading non-invasive method for detecting H.pylori.Despite numerous studies confirming its substantial accuracy,the reliability of UBT results is often compromised by inherent limitations.These findings underscore the need for a rigorous statistical synthesis to clarify and reconcile the diagnostic accuracy of the UBT for the diagnosis of H.pylori infection.AIM To determine and compare the diagnostic accuracy of 13C-UBT and 14C-UBT for H.pylori infection in adult patients with dyspepsia.METHODS We conducted an independent search of the PubMed/MEDLINE,EMBASE,and Cochrane Central databases until April 2022.Our search included diagnostic accuracy studies that evaluated at least one of the index tests(^(13)C-UBT or ^(14)C-UBT)against a reference standard.We used the QUADAS-2 tool to assess the methodo-logical quality of the studies.We utilized the bivariate random-effects model to calculate sensitivity,specificity,positive and negative test likelihood ratios(LR+and LR-),as well as the diagnostic odds ratio(DOR),and their 95%confidence intervals.We conducted subgroup analyses based on urea dosing,time after urea administration,and assessment technique.To investigate a possible threshold effect,we conducted Spearman correlation analysis,and we generated summary receiver operating characteristic(SROC)curves to assess heterogeneity.Finally,we visually inspected a funnel plot and used Egger’s test to evaluate publication bias.endorsing both as reliable diagnostic tools in clinical practice.CONCLUSION In summary,our study has demonstrated that ^(13)C-UBT has been found to outperform the ^(14)C-UBT,making it the preferred diagnostic approach.Additionally,our results emphasize the significance of carefully considering urea dosage,assessment timing,and measurement techniques for both tests to enhance diagnostic precision.Nevertheless,it is crucial for researchers and clinicians to evaluate the strengths and limitations of our findings before implementing them in practice.

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.

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.

Exhaled Breath Vapor of Humans Reflects the Changes in Deuterium Concentration in the Body Water

The concentration of the heavy isotope of hydrogen, deuterium (D), is not routinely measured in (human) medical laboratory tests, even though an increasing number of papers prove the pivotal role of D in tumor growth, cell cycle regulation, cell metabolism, and aging. Data from a prospective phase 2 clinical study and numerous retrospective clinical studies proved the anticancer effect of deuterium depletion achieved by replacing the regular water intake with deuterium-depleted water (DDW). In previous studies, the changes in serum D concentration of DDW-consuming patients were followed using blood samples and mass spectrometry, which was invasive, costly, and time-consuming. As future clinical trials will also require a follow-up of internal D level and the patient’s compliance, a new sampling device and procedure was developed based on condensing the exhaled breath water vapor and measuring its D content using a liquid water isotope laser analyzer. Test results showed that the device provided accurate, reliable, and reproducible data. According to the data, the internal D level in a person consuming normal water was stable. In contrast, exclusive consumption of DDW for several days resulted in a gradual decrease of D concentration in exhaled breath condensate (EBC), which was proportional to the D concentration of DDW. These data confirm that orally applied DDW equilibrates with the person’s water pool quickly, leading to a reduced internal D level reflected in the D content of EBC.

Inter-Fraction Analysis of One Week Hypo-Fractionation of Deep Inspiration Breath Hold (DIBH) Technique for Left Sided Breast Cancer Radiation Treatment

The aim of this study was to investigate the inter-fraction variations, patient comfort and knowledge at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). The differences in set-up that occurred between treatment sessions for the left sided breast patients were observed and recorded. Measurements of routine set-up variation for 24 patients were performed by matching the cone beam computed tomography (CBCT) and the planning computed tomography (CT). Scans of all five fractions per patient were used to quantify the setup variations with standard deviation (SD) in all the three directions (anterior posterior, left right, and superior inferior). The patients DIBH comfort and knowledge was also evaluated. The average translational errors for the anterior posterior (AP, z), left-right (LR, x), and Superior-inferior (SI, y) directions were 0.40 cm, 0.40 cm, and 0.40 cm, respectively. The translation variation of the three directions showed statistical significance (P < 0.05). On comfort and knowledge investigation, among all participants, 80% moderately agreed that the therapist’s instructions for operating the deep inspiration breath hold (DIBH) technique were easy to understand, and 63.33% indicated that their comfort with the DIBH technique was neutral or average. The inter-fraction variations in patients with left-sided breast cancer were qualitatively analyzed. Significant shifts between CBCT and planning CT images were observed. The daily treatment verification could assist accurate dose delivery.

Analysis of the Effect of Psychological Nursing Combined with Breathing Exercises in Improving Lung Function in Patients with Pneumoconiosis

Objective: To analyze the effect of psychological nursing combined with breathing exercises on lung function of patients with pneumoconiosis, and to analyze the methods. A total of 64 cases of pneumoconiosis admitted from January 2020 to December 2022 were divided into the reference group and the experimental group by random numerical table. On the basis of symptomatic treatment, the control group was combined with conventional nursing measures and breathing exercises, while the experimental group was treated with psychological nursing on the basis of the control group, and the pulmonary function indexes and adverse mood of the two groups before and after nursing were compared. Results: There was no difference in SAS score, SDS score and pulmonary function indexes between the two groups before intervention (P > 0.05), and the SAS score in the experimental group was the SDS score was lower than that of the control group, and FEV1, FEV1% and FEV1/FVC were higher than those of the control group, and the P < 0.05 was lower.

Infant’s Sigh Breathing Matters—The Role of the Hering-Breuer Deflation Reflex in Bronchial Decongestion

Background: The prolonged slow expiratory (PSE) technique can induce sigh breaths related to the Hering-Breuer reflex in children.PSE is a specific chest physiotherapy technique often used in children to help with the clearance of secretions, reduce pulmonary obstruction and decrease ventilatory effort. Purpose: The main objective of this review was to synthesize and clarify the existing knowledge of the physiological mechanism behind the Hering-Breuer reflex and its utility in the PSE technique. The secondary objective was to provide an overview of PSE which is probably the main mechanical feature for mucus clearance in infants and to identify gaps and any further research required. Method: A comprehensive literature search was performed using PubMed/MEDLINE and Ovid EMBASE, from 1968 to January 2024, using search terms relating to “Interaction of Hering-Breuer reflex and chest physiotherapy therapy, sigh breath in infants and prolonged slow expiration technique” to create an overview of the advances and gaps in current knowledge of PSE. Result: The data obtained following treatment with PSE maneuvers in infants with histories of recurrent wheezing shows that the presence of sighs could be the main active principle of treatment. Conclusion: Changes in volume induced by PSE technique and, effects from crying may stimulate the Hering-Breuer deflation reflex and sighs in turn improving alveolar ventilation as well as lung volume in infants.

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.

The Importance of Breathing Training in Folk Dance Teaching

The importance of breathing training in dance teaching is reflected in the two aspects of enhancing the quality of dance movements and sublimating the connotation of dance movements.For example,high-quality breathing can help performers complete the dance movements and improve the coordination of the movements;at the same time,the unique body rhythm formed by breathing can strengthen the visual effect of the performance and convey its spirit and soul to the audience.This requires folk dance teachers to carry out relevant training and teaching activities based on the categories and skills of dance breathing,such as changing students’ideological cognition,developing periodic breathing training courses,providing personalized guidance to students,and allowing students to adjust their learning and practice methods in the evaluation.

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.

利用Breath Figure法制备具有Honeycomb结构的有机/无机复合膜

以聚苯乙烯和正硅酸乙酯的有机溶液为铸膜溶液,利用Breath Figure法制备了PS/SiO2 Honeycomb结构复合膜.采用SEM对复合膜进行了形貌分析,探讨了聚合物浓度、PS/TEOS配比、聚合物的结构、溶剂等对膜Honeycomb结构的影响.研究结果表明,聚合物浓度在20～50mg/mL,PS/TEOS质量比大于2∶1的条件下可以制备结构完整的多孔膜,且制备的Honeycomb结构在0.8cm2内无缺陷;采用双羧基封端的聚苯乙烯成膜效果好于单羧基封端的成膜效果;以氯仿和苯作为溶剂均可以制备完全Honeycomb结构的复合膜,但以苯为溶剂制备的多孔膜孔径较大.成膜中TEOS水解不完全,复合膜中混杂着未完全水解的TEOS以及SiO2.EDS面扫描分析表明,Si和O均匀地分散在复合膜中.

Breath Figure法制备聚碳酸酯(PC)蜂窝状多孔膜

以单组分聚碳酸酯(PC)为膜材质,在一定的湿度环境下,利用Breath Figure法在玻璃基板上成功制备了蜂窝状孔结构的聚碳酸酯多孔膜。研究了溶剂、溶液浓度和湿度对所成多孔膜结构和形貌的影响。实验结果表明,采用二氯甲烷为溶剂所制得的孔结构规整,排列均匀紧密,孔径大小为(3.30±0.19)μm,而以三氯甲烷为溶剂只能得到孔径大小不均且无紧密排列的孔。环境湿度从43%增加到91%,孔径大小由(2.28±0.63)μm增加到(9.07±1.42)μm,且湿度与孔大小基本上呈现一阶线性关系,通过理论推导得出直线斜率为0.15μm/%,即在此体系中湿度每增加1%,所形成的孔大小增加0.15μm。

Breathing Television:A Breathing Controlled Multimedia Player for Reducing Breathing Rate

We have designed a breathing paced television;a television that plays content in sync with users’ activity of exhaling through pursed lips, to achieve better motivation and compliance of such exercises. Described system has been tested with control group who have watched the same video. Breathing rate reduction was significantly higher in active group (54.48% ± 8.34%) than in control group (6.84% ± 17.21%), however, the proposed method of watching television is obviously not as trivial as watching television per se.

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.

An Air-Breathing Micro Direct Methanol Fuel Cell with 3D KOH-Etched Cathode Structure

A micro direct methanol fuel cell （μDMFC） using MEMS technology is reported. The prototype features a unique 3D air-breathing cathode structure fabricated using KOH etching and double-side lithography. The optimization of the MEMS fabrication process is analyzed. The experimental results show the prototype generates a maximum power density of 2.52mW/cm^2 at room temperature. This performance is better than the published resuits of other silicon-based passive μDMFCs. Moreover,it is comparable with that of our previous active μDMFCs which require an external pump, certificating the feasibility of this new configuration.

Comparisons of Image Quality and ADCs in Breath-Hold, Respiratory-Triggered and Free-Breathing DWI of Pancreas at 3-T

Objective: To compare image quality and apparent diffusion coefficients (ADC) of the normal pancreas parenchymas in breath-hold, respiratory-triggered and free-breathing diffusion weighted imaging (DWI) at 3.0-Tesla. Methods: DWI of the pancreas was performed at 3.0-Tesla in 21 healthy volunteers with breath-hold, respiratory-triggered and free-breathing using b-values of 0 and 500 s/mm2. For all three sequences, two readers assigned an image quality score to images at b0 and b500, and two independent readers measured ADCs for the head, body and tail of pancreas. Image quality scores and ADCs of pancreas in the three DWIs were compared. Results: For b0, image quality scores was not significantly different among the three sequences (p = 0.103). For b500, image quality score was significantly lower in free-breathing DWI than breath-hold or respiratory-triggered DWI (p = 0.000), and not significantly different between breath-hold and respiratory-triggered DWI (p = 0.212). Mean ADCs differed significantly among the anatomical regions with the lowest values measured in the pancreatic tail both at breath-hold and respiratory-triggered DWIs whereas no significant difference was found at free-breathing DWI. Conclusion: Breath-hold or respiratory-triggered technique provided DW images of pancreas with acceptable quality at 3.0-Tesla. Breath-hold is the preferred DWI technique for ADC measurements of pancreas.

Effect of sumatriptan on gastric emptying:A crossover study using the BreathID system

AIM:To determine the effect of oral sumatriptan on gastric emptying using a continuous 13 C breath test(BreathID system).METHODS:Ten healthy male volunteers participated in this randomized,2-way crossover study.The subjects fasted overnight and were randomly assigned to receive a test meal(200 kcal/200 mL) 30 min after pre-medication with sumatriptan 50 mg(sumatriptan condition),or the test meal alone(control condition).Gastric emptying was monitored for 4 h after administration of the test meal by the 13 C-acetic acid breath test performed continually using the BreathID system.Then,using Oridion Research Software(β version),the time taken for emptying of 50% of the labeled meal(T 1/2) similar to the scintigraphy lag time for 10% emptying of the labeled meal(T lag),the gastric emptying coefficient(GEC),and the regression-estimated constants(β and κ) were calculated.The statistical significance of any differences in the parameters were analyzed using Wilcoxon's signed-rank test.RESULTS:In the sumatriptan condition,significant differences compared with the control condition were found in T 1/2 [median 131.84 min(range,103.13-168.70) vs 120.27 min(89.61-138.25);P = 0.0016],T lag [median 80.085 min(59.23-125.89) vs 61.11 min(39.86-87.05);P = 0.0125],and β [median 2.3374(1.6407-3.8209) vs 2.0847(1.4755-2.9269);P = 0.0284].There were no significant differences in the GEC or κ between the 2 conditions.CONCLUSION:This study showed that oral sumatriptan significantly delayed gastric emptying of a liquid meal.

非语言声音在多模态隐喻构建中的机制分析——以Greenpeace公益广告Breathe为例

以Greenpeace的环保公益广告Breathe为语料,探讨非语言声音如何通过转喻激活始源域,冲破语言和文字的阻碍,与由影像转喻激活的目标域通过隐喻映射相互作用,整合概念,构建以转喻为基础的多模态隐喻语篇,有效传递广告信息。