Fourteen-day vonoprazan-based bismuth quadruple therapy for H. pylori eradication in an area with high clarithromycin and levofloxacin resistance: a prospective randomized study (VQ-HP trial).

Potassium-competitive acid blockers (P-CABs) provide potent acid inhibition, yet studies on P-CAB-based quadruple therapy for H. pylori eradication are limited. We theorized that integrating bismuth subsalicylate into a quadruple therapy regimen could enhance eradication rates. However, data on the efficacy of vonoprazan bismuth quadruple therapy are notably scarce. Therefore, the aim of this study was to evaluate the efficacy of vonoprazan-based bismuth quadruple therapy in areas with high clarithromycin and levofloxacin resistance. This was a prospective, single-center, randomized trial conducted to compare the efficacy of 7-day and 14-day vonoprazan-based bismuth quadruple therapy for H. pylori eradication between June 1, 2021, and March 31, 2022. Qualified patients were randomly assigned to the 7-day or 14-day regimen (1:1 ratio by computer-generated randomized list as follows: 51 patients for the 7-day regimen and 50 patients for the 14-day regimen). The regimens consisted of vonoprazan (20 mg) twice daily, bismuth subsalicylate (1024 mg) twice daily, metronidazole (400 mg) three times daily, and tetracycline (500 mg) four times daily. CYP3A4/5 genotyping and antibiotic susceptibility tests were also performed. Successful eradication was defined as 13negative C-UBTs 4 weeks after treatment. The primary endpoint was to compare the efficacy of 7-day and 14-day regimens as first-line treatments, which were assessed by intention-to-treat (ITT) and per-protocol (PP) analyses. The secondary endpoints included adverse effects. A total of 337 dyspeptic patients who underwent gastroscopy were included; 105 patients (31.1%) were diagnosed with H. pylori infection, and 101 patients were randomly assigned to each regimen. No dropouts were detected. The antibiotic resistance rate was 33.3% for clarithromycin, 29.4% for metronidazole, and 27.7% for levofloxacin. The CYP3A4 genotype was associated with 100% rapid metabolism. The H. pylori eradication rates for the 7-day and 14-day regimens were 84.4%, 95% CI 74.3-94.2 and 94%, 95% CI 87.4-100, respectively (RR difference 0.25, 95% CI 0.03-0.53, p value = 0.11). Interestingly, the 14-day regimen led to 100% eradication in the clarithromycin-resistant group. Among the patients in the 7-day regimen group, only two exhibited resistance to clarithromycin; unfortunately, neither of them achieved a cure from H. pylori infection. The incidence of adverse events was similar in both treatment groups, occurring in 29.4% (15/51) and 28% (14/50) of patients in the 7-day and 14-day regimens, respectively. No serious adverse reactions were reported. In conclusion, 14 days of vonoprazan-based bismuth quadruple therapy is highly effective for H. pylori eradication in areas with high levels of dual clarithromycin and levofloxacin resistance.

Predictive Factors Associated with Survival in Female Gastric Cancer Patients in Southeast Asia.

Introduction: Association of Southeast Asian Nations (ASEAN) countries have high Helicobacter pylori infections, and gastric cancer (GC) is a leading fatal cancer in this region, especially in female patients. This study aimed to compare clinical manifestations, histopathological subtypes, and prognostic factors associated with the overall survival rate of female GC patients in this important region. Methods: This retrospective cohort study was conducted between 2007 and 2022 at a tertiary care center in Thailand. All clinical information, endoscopic findings, and histological types were extensively reviewed. Furthermore, all qualified studies in ASEAN published in PubMed and Scopus between 2000 and 2022 were extracted and thoroughly analyzed. Young female GC patients are defined as those ≤50 years of age. Results: A total of 98 Thai female GC patients were included, with a mean age of 58.99 ± 14 years; 70.4% were elderly women. The common presenting symptoms were weight loss (69.4%) and dyspepsia (68.4%). Younger female GC patients had significantly more common diffuse-type GC than elderly female GC patients (82.8% vs. 53.6%, p-value = 0.007). Moreover, elderly female GC patients demonstrated significantly better survival than younger female GC patients (44.8% vs. 20.7%, odds ratio = 3.49; 95% confidence interval: 1.20-10.14, p-value = 0.022). Furthermore, a total of 1,491 female GC patients from ASEAN were reviewed and included in this study, aged 15 to 93 years. The top three countries with the highest proportion of female GC from ASEAN were Indonesia (66.7%), Thailand (44.9%), and Singapore (38.4%). Conclusion: GC in women is not uncommon in ASEAN and presents at an advanced stage with a grave prognosis. This study showed that ASEAN countries with the highest disease burden were Indonesia, Thailand, and Singapore. Overall, survival rates for female GC patients in ASEAN countries were relatively low, highlighting the need for proactive measures such as intensive H. pylori eradication and the development of early detection methods for GC.

The Effects of 12-Week Traditional Thai Exercise (Ruesi Dadton) on Glycemic Control and Inflammatory Markers in Prediabetes: A Randomized Controlled Trial.

Hyperglycemia and inflammation are hallmarks of the prediabetes stage, which has the potential to develop into diabetes mellitus. In this stage, lifestyle changes and exercise are recommended and have been shown to be effective. However, there has been insufficient study investigating the impact of Ruesi Dadton (RD) exercise on prediabetes. Therefore, this study aimed to investigate the effect of RD exercise on biomarkers of glycemic level including fasting plasma glucose (FPG), the 2 h oral glucose tolerance test (OGTT), hemoglobin A1C (HbA1C), the biomarkers of inflammation C-reactive protein (CRP) and interleukin 6 (IL-6), and body mass index (BMI) on prediabetes during 12-week RD exercise. A total of 64 participants were randomly assigned into two groups, RD and control (CON), and were tested by measuring their glycemic levels to screen for prediabetes. The RD group was instructed to perform 10 postures of RD exercise in 60 min, three times a week. The CON group received standard lifestyle recommendations that were not pharmacologically managed. The results reveal that the RD group experienced a significant decrease in FPG, OGTT, HbA1C, and IL-6 (p < 0.01), and BMI and CRP (p < 0.05) compared to the CON group. In addition, the CON group had considerably higher glycemic levels, BMI and IL-6 levels (p < 0.01). Our study demonstrates that RD could decrease the biomarkers of glycemic level and inflammation during 12 weeks of RD exercise in prediabetes. These findings suggest that RD exercise is an effective approach for reducing systemic inflammation and controlling glycemic levels in prediabetic patients.

Effects of Omega-3-Rich Pork Lard on Serum Lipid Profile and Gut Microbiome in C57BL/6NJ Mice.

Background and Aims: Hyperlipidemia is a risk factor for cardiovascular diseases. This study is aimed at investigating the effects of consuming omega-3-rich pork lard on the serum lipid profile and gut microbiome of the mice model. Methods and Results: We divided 23 C57BL/6NJ males (16-week-old) into 3 groups, and each group received either a control diet, a high-fat diet of coconut oil (coconut oil), or a high-fat diet of omega-3-rich pork lard (omega lard) for 28 days. Thereafter, fasting serum lipids and fecal microbiomes were analyzed. The serum cholesterol, triglyceride, and LDL levels of the omega lard-treated group were significantly reduced compared to the coconut oil-treated group (P < 0.05). However, the microbiome analysis revealed a significant increase in the abundance of Lachnospiraceae in the omega lard-treated group compared to the coconut oil-treated group (P < 0.05). Furthermore, Spearman's correlation analysis revealed that the increased serum lipid content was positively correlated with the abundance of Bacteroidaceae (P < 0.05) and negatively correlated with the abundance of Lachnospiraceae (P < 0.05). Conclusions: These findings suggested that omega-3-rich pork lard altered the serum lipid profile and gut microbiome in the mice model. Practical Application. The excellent protection offered by omega-3-rich pork lard against hyperlipidemia indicated that pork lard could be used as alternative cooking oil for health-conscious individuals. It could also be introduced as a functional ingredient for patients with hyperlipidemia.

The Effects of Increasing Dietary Fat on Serum Lipid Profile and Modification of Gut Microbiome in C57BL/6N Mice.

Hyperlipidemia is a condition where the blood shows an elevated level of lipid, such as cholesterol and triglyceride. It is considered a risk factor for all coronary artery death globally. Association of microbiome with non-communicable diseases (NCDs) including hyperlipidemia has been reportedly associated. In this study, we hypothesize that the change in microbiome is correlated to the change in serum lipid level, which resulted by increasing dietary fat consumption. The 32 male, 14-week-old, C57BL/6N were divided into 4 groups, each group received control diet, 10%, 20%, and 40% kcal fat diet prepared from purified pork lard, respectively for 28 days. Fasting serum lipids and fecal microbiome were then analyzed. The group of animals assigned to 40% kcal fat showed significantly increased serum cholesterol, LDL, and HDL (p < 0.05). Microbiome analysis revealed the abundance of Muribaculaceae and Saccharimonadaceae were significantly decreased (p < 0.05). On the contrary, the abundance of Clostridia_UCG014, Akkermansiaceae, Bacteroidaceae, Oscillospiraceae, and Erysipelotrichaceae were significantly increased (p < 0.05). Spearman correlation indicated that the abundance of Akkermansiaceae and Bacteroidaceae were positively associated with the increased of serum cholesterol and LDL (p < 0.05), while the abundance of Muribaculaceae, Clostridia_UCG-014, and Saccharimonadaceae were negatively associated (p < 0.05). These results suggest that dietary fat have ability to manipulated microbiome with relative to elevation of serum lipid profile.

Glucose-Lowering Efficacy of Water Extract of Malvastrum coromandelianum in Type 2 Diabetes Subjects: A Double Blind, Randomized Controlled Trial.

BACKGROUND: Water extract from Malvastrum coromandelianum (Linn.) Garcke (MC) has been shown to have glucose lowering effect, short- and long-term safety in animal studies. A preliminary study in human reveals safety and its potential use as an adjunctive treatment to antihyperglycemic medications. OBJECTIVE: To investigate the glycemic-lowering efficacy ofMC in type 2 diabetes subjects. MATERIAL AND METHOD: A multicenter randomized, double-blind, placebo-controlled trial was conducted. Seventy-one diabetes subjects, who were treated with either diet control or single oral anti-diabetic drug (sulphonylurea or biguanide) with HbA1C between 6.5-9%, were recruited. Subjects were randomized to take MC tablets in a total dose of 1,200 mg/day or placebo for 12 weeks. Clinical parameters, glycemic control, HOMA-IR and HOMA-ß were assessed. RESULTS: Both MC (n = 34) and placebo (n = 37) groups had comparable baseline characteristics with a mean baseline HbA1C of 7.6 ± 0.82 vs. 7.5 ± 0.8%, respectively. During the study, HbA1C did not differ statistically after 4, 8 and 12 weeks of treatment (7.7 ± 0.97 vs. 7.6 ± 1.0, 7.9 ± 1.09 vs. 7.8 ± 1.03 and 7.8 ± 1.1 vs. 7.6 ± 1.1%, respectively). The body weight, insulin resistance and insulin secretion were also similar between groups (p > 0.05). No episode of hypoglycemia was reported. CONCLUSION: MC in a dosage of 1,200 mg/day does not have glucose lowering efficacy in type 2 diabetes.

The efficacy of powdered ginger in osteoarthritis of the knee.

Ginger is an effective treatment against nausea and vomiting but there are only a few clinical studies of the effect as an anti-inflammatory or analgesic agent. A double-blind randomized controlled trial of one gram of powdered ginger per day in a capsule compared with a placebo in patients with osteoarthritic knees was carried out. The number of participants in each group was thirty. The length of treatment was eight weeks. The efficacy of the drug was monitored by using the Knee Injury and Osteoarthritis Outcome Score (KOOS). The authors used repeated ANOVA to compare scores between each group. One gram ofpowdered ginger per day did not improve kneejoint pain, symptoms, daily activities, sports activities and quality of life compared with a placebo. Prominent side effects did not occur The systolic and diastolic blood pressure, body mass index and blood chemistry were not changed after receiving treatment. The present study showed that one gram per day of powdered ginger could not relieve joint pain and improve symptoms and the quality of life during eight weeks of-treatment of osteoarthritis of the knee compared with the placebo.