Summary
Background
The long‐term effects of H. pylori eradication in preventing upper GI bleeding (UGIB) remains unknown.
Aim
To determine the long‐term risks of UGIB after H. pylori eradication
...Methods
We included all patients who had received clarithromycin‐containing triple therapy for the treatment of H. pyliori infection between 2003 and 2012, without subsequent need for re‐treatment. We included a propensity score (PS)‐matched endoscopy cohort of H. pylori‐negative patients as controls. The primary endpoint was the risk of subsequent UGIB. A multivariable Cox model was used to compute the hazard ratio (HR) of UGIB.
Results
We included 62 738 H. pylori‐eradicated and 62 738 PS‐matched H. pylori‐negative patients, with a median follow‐up of 8.1 years (IQR 5.5‐10.6). The incidence of UGIB was 20.8 (95% CI 19.5‐22.1) and 13.6 (95% CI 12.7‐14.7) per 10 000 person‐years in H. pylori‐eradicated and H. pylori‐negative patients, respectively. Compared to controls, H. pylori‐eradicated patients had a significantly higher risk of UGIB (HR: 1.65, 95% CI 1.49‐1.83). The risk of UGIB in H. pylori‐eradicated patients increased after the first 2 years of follow up (HR: 2.18, 95% CI 1.91‐2.49). Age‐stratified analysis showed that patients >45 years had higher UGIB risk, even after eradication.
Conclusions
Despite H. pylori eradication, the long‐term risk of UGIB was still higher than in H. pylori‐negative control subjects. The protective effects of eradication therapy in preventing UGIB appeared to be limited to younger patients, and to within the first 2 years after eradication.
Despite H. pylori eradication, the long‐term risk of UGIB was still higher than H. pylori‐negative subjects. The protective effects of H. pylori eradication in preventing UGIB appeared to belimited to within the first 2 years after eradication.
LINKED CONTENT
This article is linked to Jiang et al papers. To view these articles, visit https://doi.org/10.1111/apt.16604 and https://doi.org/10.1111/apt.16736
LINKED CONTENT
This article is linked to Jiang et al and Sugano & Howden papers. To view these articles, visit https://doi.org/10.1111/apt.16604 and https://doi.org/10.1111/apt.16617
Given the continued burden of COVID-19 worldwide, there is a high unmet need for data on the effect of social distancing and face mask use to mitigate the risk of COVID-19. We examined the ...association of community-level social distancing measures and individual face mask use with risk of predicted COVID-19 in a large prospective U.S. cohort study of 198,077 participants. Individuals living in communities with the greatest social distancing had a 31% lower risk of predicted COVID-19 compared with those living in communities with poor social distancing. Self-reported 'always' use of face mask was associated with a 62% reduced risk of predicted COVID-19 even among individuals living in a community with poor social distancing. These findings provide support for the efficacy of mask-wearing even in settings of poor social distancing in reducing COVID-19 transmission. Despite mass vaccination campaigns in many parts of the world, continued efforts at social distancing and face mask use remain critically important in reducing the spread of COVID-19.
Background
Previous studies have demonstrated the seasonal variations of non‐variceal upper gastrointestinal bleeding (UGIB), but there is scanty data on lower gastrointestinal bleeding (LGIB) and ...the association with other meteorological parameters.
Methods
We included all patients hospitalized for UGIB and LGIB between 2009 and 2018 in Hong Kong. The monthly age‐standardized and sex‐standardized GIB incidences were fitted to meteorological data including average temperature (AT), maximum temperature (MaxT), minimum temperature (MinT), temperature range (TR), average precipitation, average atmospheric pressure (AtomP), and average relative humidity after adjusting for prescriptions of aspirin, proton pump inhibitors, and Helicobacter pylori eradication therapy using the autoregressive integrated moving average model.
Results
Despite a gradual decline in UGIB incidences, the incidences of UGIB were still higher in winter months. The incidence and fluctuation of both UGIB and LGIB were higher in the older age groups, especially those ≥80 years. The seasonality was only identified in those ≥60 years for UGIB, and only in those ≥80 years for LGIB. UGIB incidence was inversely associated with AT, MaxT, and MinT, but positively associated with TR and AtomP. LGIB was also significantly associated with AT, MaxT, MinT, and AtomP.
Conclusion
Despite the changes in GIB incidences, the seasonal patterns of GIB were still marked in the elderly. With the aging population, the impacts of seasonal variations on GIB incidences could be considerable.
Individuals with cancer may be at high risk for coronavirus disease 2019 (COVID‐19) and adverse outcomes. However, evidence from large population‐based studies examining whether cancer and ...cancer‐related therapy exacerbates the risk of COVID‐19 infection is still limited. Data were collected from the COVID Symptom Study smartphone application since March 29 through May 8, 2020. Among 23,266 participants with cancer and 1,784,293 without cancer, we documented 10,404 reports of a positive COVID‐19 test. Compared with participants without cancer, those living with cancer had a 60% increased risk of a positive COVID‐19 test. Among patients with cancer, current treatment with chemotherapy or immunotherapy was associated with a 2.2‐fold increased risk of a positive test. The association between cancer and COVID‐19 infection was stronger among participants >65 years and males. Future studies are needed to identify subgroups by tumor types and treatment regimens who are particularly at risk for COVID‐19 infection and adverse outcomes.
Patients with cancer may be at a higher risk for COVID‐19; however, supporting evidence from large population‐based studies is still limited. This study examined whether incidence of infection is higher in individuals with cancer.
We performed a meta-analysis of all published studies to determine the diagnostic accuracy of artificial intelligence (AI) on histology prediction and detection of colorectal polyps.
We searched ...Embase, PubMed, Medline, Web of Science, and Cochrane library databases to identify studies using AI for colorectal polyp histology prediction and detection. The quality of included studies was measured by the Quality Assessment of Diagnostic Accuracy Studies tool. We used a bivariate meta-analysis following a random-effects model to summarize the data and plotted hierarchical summary receiver operating characteristic curves. The area under the hierarchical summary receiver operating characteristic curve (AUC) served as an indicator of the diagnostic accuracy and during head-to-head comparisons.
A total of 7680 images of colorectal polyps from 18 studies were included in the analysis of histology prediction. The accuracy of the AI (AUC) was .96 (95% confidence interval CI, .95-.98), with a corresponding pooled sensitivity of 92.3% (95% CI, 88.8%-94.9%) and specificity of 89.8% (95% CI, 85.3%-93.0%). The AUC of AI using narrow-band imaging (NBI) was significantly higher than the AUC using non-NBI (.98 vs .84, P < .01). The performance of AI was superior to nonexpert endoscopists (.97 vs .90, P < .01). For characterization of diminutive polyps using a deep learning model with nonmagnifying NBI, the pooled negative predictive value was 95.1% (95% CI, 87.7%-98.1%). For polyp detection, the pooled AUC was .90 (95% CI, .67-1.00) with a sensitivity of 95.0% (95% CI, 91.0%-97.0%) and a specificity of 88.0% (95% CI, 58.0%-99.0%).
AI was accurate in histology prediction and detection of colorectal polyps, including diminutive polyps. The performance of AI was better under NBI and was superior to nonexpert endoscopists. Despite the difference in AI models and study designs, AI performances are rather consistent, which could serve as a reference for future AI studies.
Background
Failure rates of clarithromycin‐containing triple therapy for H. pylori are rising. To determine the trend of failure rates of clarithromycin‐containing triple therapy in different age ...groups in Hong Kong over the past 15 years.
Materials and Methods
This is a population‐based retrospective age‐period‐cohort study involving all adult H. pylori‐infected patients who had received the first course of clarithromycin‐containing triple therapy in 2003–2017. Failed eradication was identified by the need of retreatment within 2 years of eradication. Logistic regression model was used to characterize the risk of retreatment.
Results
113,526 H. pylori‐infected patients were included. The overall failure rate increased from 4.83% in 2003 to 10.2% in 2016 (p for linear trend <0.001). When stratified by age of eradication, patients 75 years or above had the lowest retreatment rate of 5.11%, which progressively increased in younger patients (60–74 years: OR 1.26, 95% CI 1.15–1.38; 45–59 years: OR 1.36, 95% CI 1.24–1.48; 18–44 years: OR 1.55, 95% CI 1.41–1.69). The results remained consistent when stratified by year of birth, and period of eradication. Other risk factors for retreatment included female (OR 1.24, 95% CI 1.18–1.30), triple therapy containing metronidazole (OR 2.30, 95% CI 2.12–2.50), and shorter duration of therapy (10 days: OR 0.88, 95% CI 0.79–0.97; 14 days: OR 0.67, 95% CI 0.58–0.77 vs 7 days).
Conclusions
While failure rates of clarithromycin‐containing triple therapy progressively increased over the past 15 years, the failure rate was particularly high among younger patients, which could undermine the potential benefits of early H. pylori eradication.
Flexible electronics, as an emerging and exciting research field, have brought great interest to the issue of how to make flexible electronic materials that offer both durability and high performance ...at strained states. With the advent of on‐body wearable and implantable electronics, as well as increasing demands for human‐friendly intelligent soft robots, enormous effort is being expended on highly flexible functional materials, especially stretchable electrodes, by both the academic and industrial communities. Among different deformation modes, stretchability is the most demanding and challenging. This review focuses on the latest advances in stretchable transparent electrodes based on a new design strategy known as kirigami (the art of paper cutting) and investigates the recent progress on novel applications, including skin‐like electronics, implantable biodegradable devices, and bioinspired soft robotics. By comparing the optoelectrical and mechanical properties of different electrode materials, some of the most important outcomes with comments on their merits and demerits are raised. Key design considerations in terms of geometries, substrates, and adhesion are also discussed, offering insights into the universal strategies for engineering stretchable electrodes regardless of the material. It is suggested that highly stretchable and biocompatible electrodes will greatly boost the development of next‐generation intelligent life‐like electronics.
Latest advances in stretchable transparent electrodes based on a new design strategy known as kirigami (the art of paper cutting) and their novel applications in skin‐like electronics, implantable biodegradable devices, and bioinspired soft robotics are comprehensively reviewed. Key design considerations in terms of geometries, substrates, and adhesion are discussed, offering insights into the universal strategies for engineering stretchable electrodes.
PDF
