1A) Given his abdominal

discomfort and an abnormal hepat

1A). Given his abdominal

discomfort and an abnormal hepatic Doppler study, he proceeded to an abdominal angiogram, which revealed a severe stenosis between the donor and recipient cava with minimal hepatic venous (HV) outflow (Fig. 2). The intercaval anastomosis was crossed with a guide wire and a balloon dilatation to 8 mm was performed resulting in markedly improved hepatic venous outflow (Fig. 3). Two months later the patient’s dyspnea had completely resolved and PaO2 on room air had risen to 89 mmHg (Fig. 4). A repeat 99mTcMAA lung perfusion scan (Fig. 1B) revealed no significant brain uptake and thus confirmed resolution of HPS. To our knowledge, the recurrence of HPS in an adult NCPH patient post-OLT has not been reported. HPS has been reported to recur posttransplantation in the context of serious graft disease or cirrhosis.[2] In our case it redeveloped in the absence of any evidence www.selleckchem.com/products/Bortezomib.html of graft

damage, suggesting that the hemodynamic alterations associated with impairment RG7204 cost of hepatic outflow were solely responsible. While HV outlet obstruction is an unusual cause of HPS, the syndrome has been described in individuals with IVC obstruction with amelioration of hypoxia on restoration of flow.[3] Why the disease occurs in only a minority of cirrhosis patients and only occasionally in patients with NCPH is uncertain. However, this presumably reflects an underlying “susceptibility” in those who develop the syndrome which is absent in most patients. What factors govern this susceptibility is as yet unknown. The redevelopment of clinically significant

HPS in our patient many years posttransplant after apparent complete resolution of the syndrome shows that this susceptibility 上海皓元 persists for life and that it cannot be related to liver disease per se or some host susceptibility factor within the liver. “
“A 62-year-old male was referred to our department after a segmental resection of the small bowel due to a spontaneous perforation 3 months earlier. He complained of anorexia, fever and abdominal pain. The patient had lost 10 kg of body mass within the last 3 months. He had no history of celiac disease or chronic diarrhea. On admission, the patient was in poor general condition with severe cachexia. The abdomen was distended and a large firm mass was palpable in the left midabdomen. The peripheral lymph nodes were not enlarged. Laboratory tests revealed pancytopenia and hypoalbuminemia. Liver function tests, serum lactate dehydrogenase and β2-microglobulin were mildly elevated. Computed tomography (CT) scan of the abdomen showed multiple cystic lesions with fat-fluid levels within the mesentery (arrows) and a hypotrophic spleen (Figure 1A). Magnetic resonance imaging (MRI) demonstrated several intra-abdominal cysts (arrows) along the mesentery (Figure 1B) and multiple bone lesions suggesting metastases. On surgical exploration, the mesenteric lymph nodes were cystic and 1–10 cm in size (Figure 2).

Tranexamic acid may be given alone or together with standard dose

Tranexamic acid may be given alone or together with standard doses of coagulation factor concentrates. (Level 4) [ [45] ] Tranexamic acid should not be given to patients with FIX deficiency receiving prothrombin complex Adriamycin concentrates,

as this will exacerbate the risk of thromboembolism. (Level 5) [ [46] ] If treatment with both agents is deemed necessary, it is recommended that at least 12 h elapse between the last dose of APCC and the administration of tranexamic acid. (Level 5) [ [46] ] In contrast, thromboembolism is less likely when tranexamic acid is used in combination with rFVIIa to enhance hemostasis. (Level 4) [ [47] ] Epsilon aminocaproic acid (EACA) is similar to tranexamic acid, but is less widely used as it has a shorter plasma half-life, is less potent, and is more toxic [40]. EACA is typically administered to adults orally or intravenously every 4–6 h up to a maximum of 24 g day−1 in an adult. A 250 mg mL−1 syrup formulation is also available. Gastrointestinal upset is a common complication; reducing

the dose often helps. Myopathy is a rare adverse reaction specifically reported in association with aminocaproic acid therapy (but not tranexamic acid), typically occurring after administration of high doses for several weeks. The myopathy is often painful BGJ398 mw and associated with elevated levels of creatine kinase and even myoglobinuria. Full resolution may be expected once drug treatment is stopped. Bleeding in patients with hemophilia MCE公司 can occur at different sites (Tables 1–1 and 1–1), each of which requires specific management. As a general principle in case of large internal hemorrhage, hemoglobin should be checked and corrected while other measures are being planned. Measures of hemodynamic stability, such as pulse and blood pressure, should be monitored as indicated. A joint bleed is defined as an episode characterized by rapid loss of range of motion as

compared with baseline that is associated with any combination of the following: pain or an unusual sensation in the joint, palpable swelling and warmth of the skin over the joint [1]. The onset of bleeding in joints is frequently described by patients as a tingling sensation and tightness within the joint. This “aura” precedes the appearance of clinical signs. The earliest clinical signs of a joint bleed are increased warmth over the area and discomfort with movement, particularly at the ends of range. Later symptoms and signs include pain at rest, swelling, tenderness, and extreme loss of motion. A re-bleed is defined as worsening of the condition either on treatment or within 72 h after stopping treatment [1]. A target joint is a joint in which 3 or more spontaneous bleeds have occurred within a consecutive 6-month period. Following a joint bleed, flexion is usually the most comfortable position, and any attempt to change this position causes more pain.

Vitamin D homeostasis is maintained by the synthetic activity of

Vitamin D homeostasis is maintained by the synthetic activity of 1a-hydroxylase and catabolic activity of 24-hydroxylase (CYP24A1). 1,25(OH)2D3 regulates 1a-hydroxylase activity both directly through negative feedback but also by way of inhibition of parathyroid hormone (PTH) activity. Conversely, in response to hypocalcemia, PTH increases 1a-hydroxylase transcription and, therefore, 1,25(OH)2D3 synthesis through a cyclic adenosine monophosphate (cAMP)-dependent pathway. Another mediator of vitamin D homeostasis is fibroblast growth factor 23 (FGF23) which is produced primarily by osteoblasts and

osteocytes and influences vitamin D metabolism through down-regulation of 1a-hydroxylase activity and promotion of 24-hydroxylase activity.[3] Sex hormones, calcitonin, and prolactin

can also affect vitamin D homeostasis, though 1a-hydroxylase activity remains this website the primary factor find more in vitamin D homeostasis.[4] In addition to sun exposure and diet, vitamin D levels may also be affected by genetic factors and high heritability of VDD has been shown in several epidemiologic studies.[5, 6] The exact genes involved have only recently been investigated, with the most substantial study to date showing single nucleotide polymorphisms (SNPs) in the genes encoding CYPR21 and DBP were associated with vitamin D status in an initial cohort of 156 unrelated healthy Caucasians and a similar replication cohort of 340 patients.[7] Given the essential role of CYPR21 and DBP in vitamin D homeostasis, these findings are not surprising and have been replicated in other studies.[8] Interestingly, the study by Ramos-Lopez et al.[8] associated the CYP2R1 gene with both vitamin D levels and type 1 diabetes, although no data exist evaluating the SNPs associated with vitamin D levels in NAFLD patients. Conversely, the genes associated with a high incidence of NAFLD have not been evaluated 上海皓元医药股份有限公司 for a putative role in vitamin D metabolism. The primary mediator of vitamin D is the vitamin D nuclear

receptor (VDR), which is a member of the superfamily of nuclear hormone receptors. VDR has four major domains that interact to confer ligand-activated transcription factor activity: a ligand-binding domain, a retinoid X receptor (RXR) heterodimerization domain, a DNA binding domain to vitamin D response elements, and a recruitment domain of VDR coregulators.[9] VDR bound to RXR forms a heterodimer that interacts with vitamin D response elements (VDRE) located within promoter regions of target genes and leads to activation or repression of transcription.[10] Target genes of the VDR are broad and include functions of hormone secretion, immune regulation, cellular proliferation, and differentiation. The nonclassic actions of vitamin D can be grouped into three primary categories to include modulation of immunologic function, hormone secretion, and cellular proliferation and differentiation (Fig. 1).

Wilson disease gene product (ATP7B) functions in copper incorpora

Wilson disease gene product (ATP7B) functions in copper incorporation to ceruloplasmin (Cp) and biliary copper excretion. Our previous study showed the late endosome localization of ATP7B and described the copper transport pathway from the

late endosome to trans-Golgi network (TGN). However, the cellular localization of ATP7B and copper metabolism in hepatocytes remains controversial. The present study was performed to evaluate the role of Niemann–Pick type C (NPC) gene product NPC1 on intracellular copper transport in hepatocytes. Methods:  We induced the NPC phenotype using U18666A to modulate the vesicle traffic from the late endosome to TGN. Then, Alisertib we examined the effect of NPC1 overexpression on the localization of ATP7B and secretion of holo-Cp, a copper-binding mature form of Cp. Results:  Overexpression of NPC1 increased holo-Cp secretion to culture medium of U18666A-treated cells, but did not affect the secretion of albumin. Manipulation of NPC1

function affected the localization of ATP7B and late endosome markers, but did not change the localization of a TGN marker. ATP7B co-localized with the late endosome markers, but not with the TGN marker. Conclusion:  These findings suggest that ATP7B localizes CHIR 99021 in the late endosomes and that copper in the late endosomes is transported to the secretory compartment via an NPC1-dependent pathway and incorporated into Cp. “
“Background and Aim:  Small-for-size grafts are prone to mechanical injury and a series of chemical injuries that are related to hemodynamic force. Hepatic stellate cells activate and trans-differentiate into contractile myofibroblast-like cells during liver injury. However, the role of hepatic

stellate cells on sinusoidal microcirculation is unknown with small-for-size grafts. Methods:  Thirty-five percent of small-for-size liver transplantation was performed with rats as donors and recipients. Endothelin-1 levels as well as hepatic stellate cells activation-related protein expression, endothelin-1 receptors, 上海皓元医药股份有限公司 and ultrastructural changes were examined. The cellular localizations of two types of endothelin-1 receptors were detected. Furthermore, liver function and sinusoidal microcirculation were analyzed using two different selective antagonists of endothelin-1 receptor. Results:  Intragraft expression of hepatic stellate cells activation-related protein such as desmin, crystallin-B and smooth muscle α-actin was upregulated as well as serum endothelin-1 levels and intragraft expression of the two endothelin receptors. The antagonist to endothelin-1 A receptor not to the endothelin-1 B receptor could attenuate microcirculatory disturbance and improve liver function.

[55, 56] There is no effective disease-specific treatment for CAD

[55, 56] There is no effective disease-specific treatment for CADASIL and current therapy addresses symptoms. For migraine with aura, conventional prophylactic medications are recommended if attack frequency warrants treatment. Acetazolamide has been anecdotally reported to be effective in the prophylaxis of migraine in CADASIL, but randomized, controlled trials are lacking.57-59 Acetazolamide has

also been suggested to improve overall cerebral hemodynamics buy Staurosporine in CADASIL, perhaps suggesting a protective effect, but this has also not been proven in controlled trials.[60, 61] For acute treatment of migraine attacks, triptans and ergot derivatives should generally be avoided due to the high risk of stroke in these patients, and simple analgesics and non-steroidal anti-inflammatory drugs are preferred.[22] For secondary stroke prevention, antiplatelet agents should be used over anticoagulants due to high

prevalence of cerebral microbleeds, which may suggest an increased risk of symptomatic intracerebral hemorrhage.[43, 62] Cerebrovascular risk factors should be tightly controlled, including appropriate use of antihypertensive agents and statins.[22] The efficacy of donepezil in the treatment of cognitive impairment in CADASIL patients was studied in a randomized, controlled trial of 168 patients. There was no significant difference between donepezil and placebo in the primary end-point, which was defined as a change from baseline in the score buy ABT-199 on the vascular Alzheimer’s disease assessment scale cognitive subscale at 18 weeks. Improvement was noted, however, on several secondary end-points that were measures of executive function,

but its clinical significance remains unclear.[63] An important aspect of care in CADASIL patients is supportive and involves rehabilitation, physiotherapy, psychiatric and psychological support, and nursing care. Genetic counseling is also important for these patients and for their at risk asymptomatic family members.[22] Acute head pain in the postpartum period should raise concern, especially if “red flags” are MCE公司 present, as Dr. Robbins points out. The differential diagnosis of sudden severe headache is long, and even when diagnostic testing is negative, a high suspicion level should persist before diagnosing sudden acute (“crash”) migraine or benign thunderclap headache. In this case, initial work-up might have yielded the diagnosis of CADASIL, but the patient was lost to follow-up and further evaluation was halted. It is peculiar that this genetic disease produces in most patients characteristic migraine auras and headaches.

We hypothesized that CD40L may play a key role in the pathogenesi

We hypothesized that CD40L may play a key role in the pathogenesis of the elevated serum IgM and analyzed genetic

and epigenetic modifications Fer-1 cost of the gene coding for CD40L in CD4+ and CD8+ T cells isolated from circulating mononuclear cells from PBC patients and healthy controls. We herein demonstrate significantly lower levels of DNA methylation of the CD40L promoter in CD4+ T cells from PBC patients, as compared with controls, and this decreased methylation was inversely correlated with levels of serum IgM in PBC patients.Conclusion: The findings of an absence of genetic modifications of the CD40L gene, in concert with decreased DNA methylation of the CD40L promoter in PBC patients, suggests that environmental factors, rather than genetics, must play a major role in the pathogenesis of elevated serum IgM MK-2206 in vitro in PBC. (HEPATOLOGY 2012) Although mechanisms underlying the loss of self-tolerance in autoimmunity

remain largely unknown, recent data have shown that the cluster of differentiation 40 ligand (CD40L) plays an important role in the pathogenesis of a number of autoimmune diseases.1, 2 Naïve T cells require contact with appropriately activated antigen-presenting cells (APCs) to be primed, and the CD40-CD40L system constitutes one of the fundamental accessory systems in T-cell priming.3 CD40 is expressed on all APCs and is up-regulated upon cell activation secondary to infection or inflammation.4 CD40 binds to its natural ligand CD40L, which is expressed primarily on activated CD4+ T cells. MCE Moreover, CD40 is constitutively expressed by B cells and its interaction with CD40L is critical for immunoglobulin (Ig) class-switch recombination5; mutations of the X-linked CD40L gene lead to a disorder characterized by elevated levels of IgM in the blood, immunodeficiency, and a high incidence of opportunistic infections.6 Finally, CD40-CD40L interactions have also been shown

to be essential for peripheral B-cell tolerance.7 Primary biliary cirrhosis (PBC) is an autoimmune disease of the liver, characterized by the presence of high titers of circulating antimitochondrial antibodies (AMAs) and liver-infiltrating autoreactive T lymphocytes, leading to the progressive destruction of small intrahepatic bile ducts.8 Other characteristics of PBC include high levels of serum IgM and a strong gender bias, with a female:male ratio of 9:1.8 Similarly to most autoimmune diseases, PBC is reasoned to result from the combined effects of genetics and the environment.9, 10 Epigenetic modifications, particularly DNA methylation, are known regulatory mechanism of gene expression and appear as ideal candidates to explain the environmental influence on individual susceptibility to complex diseases, such as PBC.11 However, although abnormal DNA demethylation has been shown in CD4+ T cells in women with lupus,12 the actual involvement of epigenetic mechanisms exemplified by abnormal DNA methylation in PBC has not been studied.

Results: Patients who attended the IBD clinic were at different s

Results: Patients who attended the IBD clinic were at different stages of the disease activity and many were recent inpatients. The dietitian assessed 26 patients for which majority had Crohn’s disease (20/26), with male dominance (14/26) and a median age of 35 years (range 16–71 years). 50% of patients were malnourished using the SGA (Table 1), and

21 (81%) had lost weight prior to clinic review (Table 2) with an average weight loss of Obeticholic Acid clinical trial 10% usual body weight. Table 1 SNAQ screening tool and SGA assessment tool results Table 2 Weight loss in patients Conclusion: Malnutrition and weight loss frequently occurs in patients at all stages of IBD suggesting a role for dietary advice in outpatient clinics. Screening tools such as SNAQ may identify patients at risk of malnutrition, which can be determined through multifaceted assessments, to allow provision of specific advice. 1. Neelemaat F, Kruizenga HM, de Vet HCW, Seidell JC, Butterman M, van Bokhost-de van der Schueren MAE 2008 Screening malnutrition Small molecule library ic50 in hospital outpatients. Can the SNAQ malnutrition screening tool also be applied to this population? Clinical Nutrition 27, 439e446 2. Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, Jeejeebhoy KN What is subjective global assessment of nutritional status? Journal of Parenteral

and Enteral Nutrition 11:1:8–13 E STREBE,1 M DEETLEFS,2 G WITTE,1 H VAN WESTEROP,3 J KERSTEN,3 S HOUGEE1 1Nutricia Advanced Medical Nutrition, The Netherlands, 2Nutricia Advanced Medical Nutrition, Australia & New Zealand, 3TNO Triskelion BV, Zeist, Netherlands Introduction: According to some studies, enteral

nutrition (EN) seems to contain high fructan levels 1. This present study aims to demonstrate that the method used for analyses in these studies overestimates the fructan levels in EN. Methods: Nutrison 1.0, Nutrison 1.0 Multifibre (MF) and maltodextrin (MD, the main carbohydrate in EN not containing fructans) were analysed for fructan content. A similar enzymatic treatment was followed by (1) spectrophotometric analyses of glucose + fructose according to a commercially available FRUC-HK kit as previously used1 or (2) fructose analyses by High Performance Anion Exchange Chromatography with Pulsed Amperometric Detection (HPAEC-PAD)2. medchemexpress Measurements were conducted by Danone Research and were verified by TNO Triskelion, an independent contract research organization for food analysis. Results: Fructan content measurements (g/100 g)   Danone Research TNO Triskelion Nutrison 1.0 Nutrison MF 1.0 MD Nutrison 1.0 Nutrison MF 1.0 MD FRUC-HK kit 1.6 2.1 >5 1.4 2.1 4.9 HPAEC-PAD (nd = not detected) <0.1 (nd) 0.59 <0.1 (nd) <0.1 (nd) 0.6 <0.1 (nd) FRUC-HK detected fructans with both Nutrison samples and MD. HPAEC-PAD confirms that Nutrison 1.0 and MD do not contain fructans and Nutrison MF contains fructans but at lower levels than indicated by FRUC-HK.

The current analysis compares prescribed and patient/caregiver-re

The current analysis compares prescribed and patient/caregiver-reported rFVIIa administration in paediatric and adult CHwI patients in this study. Patients with ≥4 bleeding episodes within a 3-month period prescribed rFVIIa as first-line therapy for bleeding check details episodes were eligible. Patients/caregivers completed a diary for ≥90 days or until the patient experienced four bleeds. Initial, total and mean rFVIIa doses reported for each bleeding episode were calculated and compared with the physician-prescribed doses. Of 52 enrolled patients (25 children; 27 adults),

39 (75%) completed the study. Children and adults had similar mean durations of bleeding episodes. Both patient groups were administered higher initial rFVIIa doses for joint bleeds than prescribed: median (range) 215.2 (74.1–400.0) mcg kg−1 vs. 200.0 (61.0–270.0) mcg kg−1 for children, and 231.3 (59.3–379.7) mcg kg−1 vs. 123.0 (81.0–289.0) mcg kg−1 for adults. The median infused dose for joint bleeds was higher in adults than children (175.2 vs. 148.0 mcg kg−1), but children received significantly more doses per joint bleed than adults (median 6.5 vs. 3.0). The

Caspase inhibitor review median total dose per joint bleed was higher in children than adults (1248.7 vs. 441.6). For children and adults, both initial and additional doses administered for bleeds were higher than prescribed. Children received higher total doses per bleed due to an increased number of infusions per bleed. “
“The phenotypic variability in haemophilia is well documented; however, the biological basis beyond factor VIII and IX activities to explain the differing clinical pictures of the disease remains unclear. It has therefore been of interest to explore other modulators of the disease’s variability. Furthermore, a scoring system that reflects the multiple facets of haemophilia symptoms would be useful to compare patients via a comprehensive assessment tool. To this end, Schulman et al., created a measure known as the Haemophilia Severity Score (HSS) as one way to compare phenotypic

severity. The aim of this study was to document the differing symptomatology medchemexpress of haemophilia patients using the HSS. Clinical data for 178 haemophilia patients without inhibitors were reviewed and annual incidence of haemarthrosis, orthopaedic joint scores and annual factor usage calculated. Each parameter was then entered into the formula to create the HSS for haemophilia A and B patients with mild, moderate and severe factor deficiencies. Variability in the HSS for patients with the same baseline level of factor was observed for all three deficiency levels and both haemophilia types. In addition, we found that moderate and severe haemophilic B patients tended to have more morbidity based on the above calculations than the haemophilic A counterparts.

7 In the group of patients treated with dose-adjusted sorafenib f

7 In the group of patients treated with dose-adjusted sorafenib for ≥70% of the Estrogen antagonist treatment period the average received dose was 474 mg daily (469 mg daily for BCLC B and 476 mg daily for BCLC C patients). Instead, in the group of patients who maintained full dose of sorafenib for the entire treatment period or received a dose-adjusted for <70% of the whole treatment period the mean received dose was 748 mg daily (723 mg daily for BCLC B and

754 mg daily for BCLC C patients). In the SOFIA study the average actual received doses of sorafenib were 474 mg daily in the dose-adjusted group and 748 mg daily in the full-dose group. These average doses were strictly similar to the theoretical doses of 400 mg and 800 mg daily. Therefore,

we also performed analyses according to these theoretical doses. Sorafenib-based treatment strategies were evaluated according to BCLC (B or C) stage and sorafenib dose (full dose: 800 mg daily; dose-adjusted: 400 mg daily). The strategies analyzed were: (1) full or dose-adjusted sorafenib for BCLC B and C patients together (Fig. 1A); (2) full or dose-adjusted sorafenib for BCLC B patients (Fig. 1B); (3) full or dose-adjusted sorafenib for BCLC C patients (Fig. 1C). Given that there are no other agents besides sorafenib that have demonstrated significant survival benefit or have been approved for this patient population by the Food and Drug Administration (FDA), all sorafenib strategies were compared to best supportive care (BSC). BSC incorporated medical staff visits, hospitalizations, and laboratory MI-503 molecular weight and radiology tests. Survival of patients who underwent BSC was modeled by application of risk ratios from a recent meta-analysis of 30 randomized controlled trials (RCTs) of untreated HCC patients enrolled in trials of palliative treatments. 3, 4 Treatment effectiveness was modeled by application of Kaplan-Meier survival curves from the recent field practice prospective SOFIA study (6). We used a Markov model to simulate the costs and effects

associated with sorafenib treatment 上海皓元医药股份有限公司 and BSC over a 5-year time horizon. The model was designed to simulate cohorts of Caucasian male patients, 67 years old, with BCLC C HCC (75%), or BCLC B HCC who failed locoregional therapies (25%), well-compensated cirrhosis, and with performance status of 0-1, as included in the SOFIA study. The model comprised three health states: BCLC B HCC, BCLC C HC,C and death (Fig. 2). In such a model patients suffering an acute event could die during that month or survive (at least for that month). The health states were mutually exclusive, i.e., a patient could experience a single health state at any given time. For each transition, we obtained the time-dependent transition rates by assuming a Weibull distribution, parameters of which were estimated using available data (6).

Sequential therapy also cured significantly more patients harbori

Sequential therapy also cured significantly more patients harboring strains resistant only to clarithromycin than triple therapy (p = .0216). Five randomized trials took place comparing sequential therapy to standard therapy across three countries. Although sequential therapy is thought to be especially useful in overcoming this website clarithromycin resistance, a study from China showed that this may be negated when dual clarithromycin and metronidazole resistance is present [19]. In this study, there was no significant difference between the eradication rates achieved with standard triple therapy (66.4%)

and sequential (72.1%) in either the ITT or the PP analysis. Sequential therapy achieved significantly higher eradication rates (88.8%; 95% CI: 51.7–88.7) than triple therapy (43.7%; 95% CI: 19.7–70) in patients harboring strains resistant only to clarithromycin. However, in patients harboring strains resistant

to clarithromycin and metronidazole, neither treatment was able to reach an eradication rate >55%. In Morocco, two randomized studies were performed comparing sequential to standard therapy. In both, sequential therapy performed impressively against standard triple, with ITT eradication rates of 65.9% in the standard triple therapy group and 82.8 in the sequential therapy group in one, and 94.2% for sequential and 70% for metronidazole-based triple therapy and 78% for clarithromycin-based

triple in the other [20, 21]. Another two randomized, DNA Damage inhibitor prospective studies carried out in India also showed significantly better eradication rates for sequential therapy [22, 23]. One study on patients with all causes of dyspepsia showed an advantage for sequential MCE公司 therapy with an ITT eradication rate of 88.2 vs 79.1% for triple [22]. A second study looking at patients with documented peptic ulcer disease also found sequential therapy superior although the raw ITT eradication rates were less impressive (76.0 vs 61.9%) [23]. Three meta-analyses examining the efficacy of sequential versus standard triple therapy in Asia were also published this year, all of which favored sequential therapy. One included all studies with Asian adults and reported a pooled RR of 1.1 for eradication with sequential therapy over standard triple with an NNT of 14 [24]. In a second meta-analysis limited to nine studies conducted in Asia, the odds ratio (OR) for eradication of H. pylori with sequential therapy over standard triple was 1.8 [25]. A further meta-analysis of Korean studies only also favored of sequential therapy with an OR of 1.8 [26]. Concomitant therapy was evaluated in one article published this year from an area of high antibiotic resistance and found to have an ITT eradication rate in first-line therapy of 91.5 and 60.6% as second therapy [27].