14C-urea breath test in the detection of Helicobacter pylori infection

Helicobacter pylori infection is supposed to be one of the major causes of digestive and other diseases. Among a lot of invasive and non-invasive methods for its detection, none is ideal. The aim is an assessment of the Helicobacter pylori infection in the stomach using breath test and comparison to other diagnostic methods, as well as following up the effects of therapy. In 17 patients with digestive discomfort, breath test, rapid urease test and histology were performed, while in 47 patients with proven HP infection the effect of therapy was followed up using breath test and clinical findings. Breath test was performed after per oral administration of the capsule of (14)C urea (37 kBq). Findings of the breath and urease tests were in accordance in 14/17 patients (83%) while breath test and histology in 16/17 patients (94%). During follow-up of the therapeutic effects, breath test and clinical findings were in accordance in 43/47 patients (98%). Breath test can be useful in diagnosis but is a method of choice in following up the patients after therapy for H. pylori infection, because it is non-invasive, fast and precise.     

GM、G试验及真菌培养鉴定对肺部侵袭性真菌感染的诊断价值

目的：检测疑诊为肺部侵袭性真菌感染（IFI）患者的支气管肺泡灌洗液（BALF）和血清半乳甘露聚糖（galacto-mannan,GM）、血清（1,3）-β-D葡聚糖[（1,3）-beta-D-glucan,G test]并对BALF进行真菌培养鉴定,评估上述实验诊断方法对临床深部真菌感染的诊断效率。方法回顾性分析148例IFI疑诊患者,总结血清／BALF GM、血清G试验和真菌培养结果,分别评估其敏感性、特异性、阳性预测值、阴性预测值和联合检测对IFI的诊断价值。结果148例病例中临床诊断为IFI有48例,临床排除100例,在48例IFI患者中,血清GM阳性3例,BALF GM阳性25例,G试验阳性31例,真菌培养阳性30例。联合检测敏感性91．6％、特异性70．0％、阳性预测值59．5％、阴性预测值94．6％,联合检测大幅度提高了其诊断敏感性。结论联合检测GM、G试验和真菌培养鉴定能提高IFI诊断敏感性,对肺部IFI具有较好的诊断价值。     

^14C—尿素呼气试验对胃幽门螺杆菌感染的诊断价值

目的建立１４Ｃ尿素呼气试验，评价其临床应用价值。方法胃镜下取胃窦粘膜作细胞培养及病理切片，染色阳性为幽门螺杆菌（Ｈｐ）感染的对比指标。对１３８４例临床怀疑为胃及十二指肠疾病的患者进行呼气试验，其中４４例行多时相动态呼气试验，以确定最佳集气时间。结果动态检测示３０分钟为１４Ｃ呼气量峰值，如将Ｈｐ阳性阈值定于呼气比值大于３５，则１４Ｃ呼气试验对Ｈｐ感染检出的灵敏度为９６７％，特异性为９６５％。１４Ｃ呼气试验在成人人群中的阳性率为５０４％，在儿童中为８１２％。结论１４Ｃ呼气试验在胃肠道Ｈｐ感染检测中具有良好的灵敏度及特异性，方法简便可靠，易于临床推广     

Time-optimized carbon-14 breath test for Helicobacter pylori contamination of the stomach.

PURPOSE: Evidence that Helicobacter pylori plays an important role in peptic ulcer disease has generated intense interest in the development of various screening strategies. H. pylori can be detected high sensitivity and specificity by the noninvasive carbon-14 (C-14) breath test. METHODS: The authors assessed the cost-effectiveness of screening patients with dyspepsia before endoscopy. Thirty-four patients with dyspepsia were evaluated by the C-14 breath test, and then the authors reevaluated the criteria for the diagnosis of H. pylori. The discrimination obtained by using values of cumulative radioactivity or specific activity of breath samples collected between 10 and 60 minutes were studied. RESULTS: The main feature of H. pylori colonization in the stomach was a rapid increase of carbon dioxide in expired breath within 10 minutes after oral administration of C-14. Performance of the test was equally excellent for 10-minute values and 60-minute cumulative excretion. CONCLUSION: The C-14 breath test is a reliable method for diagnosing H. pylori colonization in the stomach, and the accuracy is not compromised by reducing the sample time to maintain better cost-effectiveness and patient acceptance.     

Validation of a simplified carbon-14-urea breath test for routine use for detecting Helicobacter [correction of Heliobacter] pylori noninvasively

A carbon-14 (14C) urea breath test for detecting Helicobacter pylori with multiple breath sampling was developed. Carbon-14-urea (110 kBq) administered orally to 18 normal subjects and to 82 patients with Helicobacter infection. The exhaled 14C-labeled CO2 was trapped at 10-min intervals for 90 min. The total 14C activity exhaled over 90 min was integrated and expressed in %activity of the total dose given. In normals, a mean of 0.59% +/- 0.24% was measured, resulting in an upper limit of normal of 1.07%. In 82 patients, a sensitivity of 90.2%, a specificity of 83.8%, and a positive predictive value of 90.2% was found. The single probes at intervals of 40-60 min correlated best with the integrated result, with r ranging from 0.986 to 0.990. The test's diagnostic accuracy did not change at all when reevaluated with the 40-, 50-, or 60-min sample data alone. Thus, the 14C-urea breath test can be applied routinely as a noninvasive, low-cost and one-sample test with high diagnostic accuracy in detecting Helicobacter pylori colonization.     

Could the simplified <Superscript>14</Superscript>C urea breath test be a new standard in noninvasive diagnosis of <Emphasis Type="Italic">Helicobacter pylori</Emphasis> infection?

OBJECTIVE: The carbon-14 ((14)C) urea breath test (UBT) is a reliable and noninvasive technique for the diagnosis of Helicobacter pylori (HP) infection. The diagnostic performance of a new practical and low dose (14)C UBT system (Heliprobe, Stockholm, Sweden) was compared with those of other diagnostic tests, namely, rapid urease test (RUT), histopathology, and DNA detection using polymerase chain reaction (PCR). METHODS: Eighty-nine patients (mean age = 45 +/- 13, 30 men) with dyspeptic complaints who underwent an endoscopic procedure were studied. Biopsy specimens acquired during the procedure were subjected to RUT, histopathological examination using hematoxylin and eosin (HP-HE) and PCR. All patients underwent UBT using the Heliprobe system on a different day. The gold standard for HP positivity was defined as any two of the three tests being positive, excluding UBT, and the sensitivity and specificity of any single test alone were determined using this gold standard. Whenever only one test was positive, it was considered to be a false-positive one. RESULTS: With the gold standard used in this study, 59 (66%) patients were diagnosed HP positive. The Heliprobe method detected HP infection with 96.6% sensitivity and 100% specificity and had the best diagnostic performance when compared with all the other methods. The sensitivity and specificity of the other methods for the detection of HP positivity were 89.8% and 100% for RUT, 93.2% and 63.3% for PCR, and 93.2% and 76.6% for HP-HE, respectively. Areas under the receiver-operating characteristic were 0.977 for UBT, 0.947 for RUT, 0.84 for HP-HE, and 0.775 for PCR. CONCLUSIONS: Using a combination of invasive diagnostic tests as the gold standard, Heliprobe UBT was found to be highly sensitive and specific for the diagnosis of HP infection in patients with dyspeptic complaints.     

15 N-尿素发射光谱分析法检测幽门螺杆菌感染

目的：建立检测幽门螺杆菌感染的无损伤、无放射性方法－－^15N-尿素发射光谱分析法。方法：对26例受检者^15N-尿素发射光谱分析法检测其幽门螺杆菌感染。结果：诊断特异性为81％，灵敏度为89％，阳性预测值为84％。结论：该方法具有一定的实用意义。     

Quantification of Helicobacter pylori infection in gastritis and ulcer disease using a simple and rapid carbon-14-urea breath test

Gastric urease was studied isotopically in 230 patients with biopsy-proven normal mucosa or chronic gastritis, including 59 patients with ulcer disease. Carbon-14-urea was given in 25 ml of water without substrate carrier or nutrient-dense meal, and breath samples were collected over a 60-min period. The amount of 14CO2 excreted at 10 min was independent of the rate of gastric emptying and was not quantitatively influenced by the buccal urease activity. The 10-min 14CO2 values discriminated well between Helicobacter pylori positive and negative patients (94% sensitivity, 89% specificity) and correlated with the number of organisms assessed by histology. The test was a good predictor of chronic gastritis (95% sensitivity and 96% specificity), and a quantitative relationship was observed between 14CO2 values and the severity and activity of the gastritis. In H. pylori positive patients, breath 14CO2 was found to be similar in patients with and without ulcer disease, suggesting that the number of bacteria is not a determining factor for the onset of ulceration.     

Accuracy of a rapid 10-minute carbon-14 urea breath test for the diagnosis of Helicobacter pylori-associated peptic ulcer disease

Urease in the human gastric mucosa is a marker for infection with Helicobacter pylori (HP), an organism which is associated with peptic ulcer disease. To detect gastric urease, we examined 184 patients (144 males, 40 females; mean age: 49.8±15.6 years) with suspected peptic ulcer disease. Fasting patients were given orally 5 Ci of carbon-14 labelled urea. From each patient only one breath sample was collected in hyamine at 10 min. The amount of ¹⁴C collected at 10 min was expressed as follows: [(DPM/mmol CO₂ collected)/(DPM administered)] × 100 × body weight (kg). The presence of HP colonization was determined by examination of multiple endoscopic prepyloric antral biopsy specimens subjected to culture or a rapid urease test. For the purpose of this study, HP-positive patients were defined as those with characteristic bacteria as indicated by a positive result of either the culture or the rapid urease test; HP-negative patients were defined as those with negative findings on both the culture and the rapid urease test. Of the 184 cases, 99 (53.8%) were positive for HP infection, and 85 (46.2%), negative. The sensitivity and specificity of the rapid 10 min ¹⁴C-urea breath test for the diagnosis of HP-associated peptic ulcer disease were evaluated by a receiver operating characteristic (ROC) curve with a variable cut-off value from 1.5 to 4.5. When a cut-off value of 1.5 was selected, the sensitivity was 100% and the specificity, 83.5%; when a cut-off value of 4.5 was selected, the sensitivity was 54.5% and the specificity, 97.6%. Correspondence to: Chia-Hung Kao     

Relationship between Helicobacter pylori infection estimated by 14C-urea breath test and gender, blood groups and Rhesus factor

The aim of this study was the detection of helicobacter pylori (HP) infection and estimation of this infection relationship with age, gender, blood groups and Rhesus factor, as well as the assessment of the accuracy of the method. A total of 227 patients with gastritis were examined. Blood ABO groups and Rh positivity were determined using standard tests. Infection by HP was proved by (14)C-urea breath test and gastric biopsy. Patients were aged 20-81 years (X=51.7 years) and the presence of HP was not related to the age (P>0.05). From the total number of patients, 25/69 males and 68/158 females were HP positive. There was no significant difference between genders and HP infection (P>0.05). From the 227 investigated patients, 69 (30%) belonged to blood group O, 96 (42%) to A, 40 (18%) to B and 22 (10%) to AB. HP was detected in 27/69 patients with blood group O, 45/96 patients with blood group A, 16/40 patients with blood group B and 5/22 patients with blood group AB. There was no statistically significant difference (P>0.05) in the incidence of HP infection between these groups (proving that HP infection did not depend upon the blood groups). Also, there was no significant correlation between the presence of particular blood group in HP+ patients related to the reported frequency of the blood groups in Serbian population (0--38%, A--42%, B--15%, AB--5%). HP was found in 16/36 Rh- and in 77/191 Rh+ patients without statistical difference (P>0.05). Also, there was no significant correlation of the presence of the Rh factor in the HP positive patients to the frequency of the Rh factor in the Serbian population (84% Rh+ and 16% Rh-). The basic value of the HP+ test was slightly, but not significantly lower in comparison to the HP- patients (P>0.05). On the contrary, test values showed a highly significant difference (P<0.01) in HP+ and HP- patients. In conclusion, in adults HP infection does not depend upon the patient's age, gender, blood group type or Rh factor. In clinical terms, there were 93 true positive (TP), 129 true negative (TN), 5 false negative (FN) and 0 false positive (FP) patients. Sensitivity of the method was 94.9%, specificity 100%, positive predictive value 100%, negative predictive value 96.3% and accuracy 97.8%.     

幽门螺杆菌感染与胃息肉关系探讨

目的 探讨不同类型胃息肉与幽门螺杆菌感染的关系。方法 经胃镜活检及病理诊断胃息肉106例,内镜下摘除的胃息肉作HE染色,判定胃息肉组织学类型及炎症反应程度。同时在胃窦部取材2～3块,分别作快速尿毒酶试验及美蓝染色,以检测Hp感染率,两者均阳性判为Hp感染。结果 106例胃息肉Hp总检出率为65.1％。胃息肉以增生息肉多见,共76例,占71.7％,腺癌性息肉30例,占28.3％。Hp感染率在增生性息肉中为73.7％(56/76),显著高于腺癌性息肉43.1％(13/30)(P<0.01)。活动性炎症在增生性息肉中为55.3％(42/76),显著高于腺瘤性息肉 0％(9/30)(P>0.05)。结论 增生性息肉的发生可能与Hp感染有关,这可能与Hp引起胃粘膜活动性炎症反应有关。     

Carbon-14 urea breath test for the diagnosis of Campylobacter pylori associated gastritis

Urease in the human gastric mucosa is a marker for infection with Campylobacter pylori (CP), an organism suspected of causing chronic gastritis and peptic ulceration. To detect gastric urease, we examined 32 patients who were being evaluated for possible peptic ulcer disease. Fasting patients were given 10 microCi (370 kBq) of 14C-labeled urea. Breath samples were collected in hyamine at intervals between 1 and 30 min. The amount of 14C collected at these times was expressed as: body weight X (% of administered dose of 14C in sample)/(mmol of CO2 collected). The presence of C. pylori colonization was also determined by examination of multiple endoscopic gastric biopsy specimens. On average, patients who were proven to have C. pylori infection exhaled 20 times more labeled CO2 than patients who were not infected. The difference between infected patients and C. pylori negative "control" patients was highly significant at all time points between 2 and 30 min after ingestion of the radionuclide (p less than 0.0001). The noninvasive urea breath is less expensive than endoscopic biopsy of the stomach and more accurate than serology as a means of detecting Campylobacter pylori infection. Because the test detects actual viable CP organisms, it can be used to confirm eradication of the bacterium after antibacterial therapy.     

G试验联合尿真菌培养对泌尿系侵袭性真菌感染诊断效能的影响

 目的 探讨血清(1,3)-β-D葡聚糖检测(G试验)联合尿真菌培养对泌尿系侵袭性真菌感染(invasive fungal infection,IFI)诊断效能的影响。方法 选取2019-05至2020-10武警特色医学中心收治的疑似泌尿系IFI患者135例为研究对象,采集所有患者血清及清洁中段尿标本。采用MB-80微生物快速动态检测系统进行血清G试验,并进行尿真菌培养,以患者临床症状、影像学诊断、抗菌药物使用情况及相应症状转归情况作为诊断IFI的诊断标准,统计G试验、尿真菌培养检测结果,分析二者单独或联合诊断的灵敏度、特异度、准确度。结果 本组共135例疑似泌尿系IFI患者,经临床综合诊断确诊为泌尿系IFI患者52例;尿真菌培养检出泌尿系IFI阳性63例;G试验检出泌尿系IFI阳性64例;G试验联合尿真菌培养检出泌尿系IFI阳性43例。尿真菌培养共检出真菌63株,假丝酵母菌属61例,其中白假丝酵母菌最多,共45例(71.43%);2例为曲霉菌属。G试验联合尿真菌培养诊断泌尿系IFI的灵敏度[80.77%(42/52)]、阴性预测值(negative predictive value,NPV)[89.13%(82/92)]与二者单独诊断对比差异无统计学意义;G试验联合尿真菌培养诊断泌尿系IFI的特异度[98.80%(82/83)]、准确度[91.85%(124/135)]、阳性预测值(positive predictive value,PPV)[97.67%(42/43)]、约登(Youden)指数(0.796)均高于二者单独诊断,差异有统计学意义(P＜0.05)。结论 临床诊断泌尿系IFI时采用G试验联合尿真菌培养,能提高诊断特异度、准确度及阳性预测值。     

幽门螺杆菌与胸痛关系探讨

目的 探讨幽门螺杆菌(H．pylori)感染时胸痛的发生与功能性消化不良(FD)、冠心病(CHD)的关系。方法 采用胃镜检查530例患者，钳取胃粘膜组织，用Giemsa染色及PCR基因扩增法检涵H.pylori，按H．pylori阳性与否比较胸痛发生率，分析FD、CHD与H．pylori之间的关系。结果 H．pylori阴性中胸痛发生率为13．0％(39／300)；H．pylori阳性中胸痛发生率为19．6％(45／230)，两组比较差异有显著性(P＜0．05)；胸痛者84人中，45例H．pylori阳性中单FD发生率11．1％(5／45)，单CHD发生率33．3％(15／45)，两者比较差异有显著性(P＜0．05)。在胸痛者H．pylori阳性中FD和CHD均有的发生率为31．1％(14／45)，与H．pylori阴性中FD和CHD均有的5．1％(2／39)相比差异有显著性(P＜0．05)。结论 H．pylori感染时，胸痛的发生可能与FD和CHD发病有关，而且二者还可能发生部分重叠。H．pylori阳性患者出现胸痛时，一定要警惕CHD可能；在治疗H．pylori阳性FD时，不能忽视CHD的治疗。     

Role of 99mTc Sulesomab in the diagnosis of prosthetic joint infections

BACKGROUND: Investigation of suspected infection in prosthetic joint replacements is a difficult orthopaedic problem with important therapeutic implications. METHODS: We retrospectively analysed the results of 38 patients referred with a clinical suspicion of bone or joint infections. Referrals were made for suspected infection of prosthetic hip joints (17), total knee replacements (13), total elbow replacements (4) and total shoulder replacements (4). Sulesomab imaging was done with 650 MBq of 99mTc Sulesomab. The scintigraphic diagnosis was compared with the final clinical diagnosis and information collected from routine blood tests (erythrocyte sedimentation rate, C-reactive protein and full blood count), plain radiographs, appropriate microbiology, culture and/or histology where available. The final diagnosis was determined by conclusive microbiology, culture and/or histology, intra-operative findings, aspiration, complementary investigations like computed tomography/magnetic resonance imaging and long-term clinical follow-up. RESULTS: The overall sensitivity was 90.90% and specificity 81.48%. The individual sensitivity and specificity of each category were compared. Knee prostheses showed better sensitivity and specificity compared to that for hip prostheses. CONCLUSIONS: 99mTc Sulesomab seems to be useful in excluding infection rather than confirming it, with a high negative predictive value (95.65%).     

Detection of Helicobacter pylori in gastric biopsy and resection specimens

AIM: To compare the sensitivity of detecting H. pylori in gastric biopsy and resection specimens using modified Giemsa stain and immunohistochemistry, using a commercially available anti-H. pylori antibody (Dako, Denmark). METHODS: Gastric antral biopsy specimens showing chronic gastritis (28 cases) together with tissue blocks from gastrectomy specimens for duodenal ulcer (2 cases) were stained with modified Giemsa and immunoenzymatic alkaline phosphatase - anti-alkaline phosphatase (APAAP) method, and were carefully examined for the presence of H. pylori. RESULTS: Using a modified Giemsa stain, the spiral shaped bacteria of H. pylori stained blue, were attached to the brush border of the gastric foveolar epithelial cells. However, the specificity of modified Giemsa stain depended on the morphological appearance of H. pylori. The specificity of immunostaining permitted detection of low numbers or even single organisms. In all cases bacteria were more prominent and easier to detect in immunostained preparations. H. pylori was identified in 22 (73.3%) of 30 sections stained with modified Giemsa stain, but it could be identified with greater frequency in sections stained with APAAP, in 27 (90%) of 30 sections. CONCLUSION: Immunohistochemical identification of H. pylori was better than Giemsa stain for detecting that organism.     

A new self-diagnostic test for biceps femoris muscle strains.

OBJECTIVE: We compared a self-performed diagnostic test that we have been using since 1987, with other commonly used clinical tests for biceps femoris muscle-strain injuries. SETTING: Private practice focusing on sports injuries. PATIENTS: One-hundred forty professional male soccer players (ages 17 to 33 years) with a history and clinical findings of a pulled hamstring muscle (patients with direct trauma were excluded) had an ultrasound-proven grade I or II biceps femoris muscle injury. INTERVENTIONS: In these ultrasound-positive patients, the "taking off the shoe" test (TOST) was performed by the patient himself on both the affected and unaffected legs; and the physician then performed the resisted range of motion, passive range of motion, and active range of motion tests. RESULTS: The TOST had a sensitivity and specificity of 100%, and a positive predictive value and an negative predictive value of 100% for biceps femoris injury as found on ultrasound. The other muscle tests had an average sensitivity of 57%, specificity of 100%, accuracy of 79%, and negative predictive value of 70%. CONCLUSION: This preliminary, nonblinded observational study of the TOST found it to be more reliable than other commonly used clinical tests for hamstring tears. The clinical value of this easy-to-perform test should be evaluated in a prospective fashion.     

Helicobacter pylori infection and seasickness susceptibility among naval sailors: is there any association?

BACKGROUND: Vomiting is a very common and bothersome expression of seasickness. Previous works have shown that Helicobacter pylori infection may be related to vomiting resulting from nongastrointestinal causes, and physiological research has revealed that H. pylori may alter gastric motility. These findings, along with anecdotal case histories, led us to suspect that H. pylori infection may be related to the vomiting of seasickness. The objective of this study was to evaluate the association between H. pylori infection and seasickness susceptibility. METHODS: Participants were 90 healthy, male, naval crew members 19.5 to 25 years of age. Forty-five were susceptible to seasickness, and 45 were nonsusceptible control subjects. Quantitative analysis of IgG levels for H. pylori was performed with an enzyme-linked immunosorbent assay. RESULTS: The rate of H. pylori infection was 38% in the susceptible group, compared with 31% in the nonsusceptible group (p = 0.5). The titer of antibodies to H. pylori among case subjects was 81.2 U/mL (95% confidence interval, 11.5-151.1 U/mL), compared with 31.1 U/mL (95% confidence interval, 0.1-65.1 U/mL) for control subjects (p = 0.2). CONCLUSION: The current study does not support an association between H. pylori infection and seasickness susceptibility among sailors.     

幽门螺杆菌粪便抗原检测对诊断儿童幽门螺杆菌感染的价值

目的评价酶联免疫法检测幽门螺杆菌粪便抗原(HpAg)在诊断儿童幽门螺杆菌(Hp)感染及治疗后复查的价值。方法采用快速尿素酶试验,组织切片染色法,酶联免疫分析法,细菌分离培养Hp。结果ELISA检测粪便HpAg阳性率(85.2%)与其他3种方法差异无显著性(P>0.05)。HpAg的敏感度为98.1%,特异性为84.2%,阳性预测值为97.1%,阴性预测值为88.9%,总有效率为95.1%。结论HpAg具有简便、经济、无创伤性等特点,可用于儿童Hp感染的诊断和观察治疗后Hp的转阴情况。     

14C-尿素呼气试验诊断幽门螺杆菌感染的价值

 目的 探讨正常人群和慢性胃炎及消化性溃疡患者幽门螺杆菌(Hp)感染情况.方法 3 497例健康体检者和638例慢性胃炎和消化性溃疡患者行14C-尿素呼气试验(14C -Urea breath test,14C-UBT)Hp检测.计算机自动得出数据,2 min计数(dpm)＜100 dpm 为正常,即Hp阴性;＞101 dpm为异常,即Hp阳性.结果 健康体检3 497例,Hp阳性1 748例,阳性率50 %,发现胃癌1例(14C-UBT 1 200 dpm);慢性胃炎及消化性溃疡组638例,Hp阳性339例,阳性率53%.两组相比差异无统计学意义(P＞0.05).但是,健康体检组阳性者中＞601 dpm占41.2%(720/1748);慢性胃炎和消化性溃疡组阳性者中＞601dpm占38.3%(131/339).两组相比差异有统计学意义(P＜0.05).结论 在健康人群中存在有较高比例的Hp感染趋向,14C-UBT检测Hp的优点是简便、准确、安全、无创、经济、重复性好.