perioperative period is needed; however, conventional liver Objective. To determine its predictive capability on function tests have limited reliability 3,4 and the results of graft quality and resultant clinical outcome, the indocyvarious quantitative liver function tests have been conflictanine green (ICG) elimination test was performed by a ing. 5-10spectrophotometric method and a noninvasive fingerRecently, the indocyanine green (ICG) elimination test has piece method with 50 orthotopic liver transplantations.been suggested as a predictor of graft viability and outcome, Background. Early detection of poor-functioning hebut its significance has not been fully clarified. [5][6][7]11,12 The patic grafts is one of the most important issues in liver primary goal of this study was to determine whether the ICG transplantation, but no reliable methods exist. Methods.elimination test can predict graft viability and outcome in The ICG test was performed after 50 orthotopic liver the early postoperative period. The secondary goal of this transplantations on postoperative days 1, 3, and 7. Indostudy was to evaluate the applicability of a new noninvasive cyanine green elimination constants (K ICG ) were meaoptical finger-piece method 13 against the conventional specsured by both a standard spectrophotometric analysis trophotometric method for ICG determination. 14 Median cold ischemia elimination test, conducted spectrophotometrically or time of the liver was 12.1 hours, ranging from 7.6 to 25.0 hours. optically on the day after liver transplantation, is a reli-Recipient hepatectomy and liver replacement were performed by the able indicator of graft quality and subsequent graft out-standard technique in 30 cases and by the piggyback method in 20 come early after liver transplantation. (HEPATOLOGY cases. 15 Median warm ischemia time of the graft was 50 minutes, ranging from 28 to 68 minutes. 1996;24:1165-1171.) Postoperative ManagementDespite significant improvements in patient outcome after Postoperative immunosuppression was with tacrolimus and steorthotopic liver transplantation, primary nonfunctioning roids. The rationale for dose adjustment of these agents and suppleand/or poor functioning grafts in the immediate postoperative mentary administration of steroids, azathioprine, or OKT3 have been period remain an important problem.1,2 A reliable method to described elsewhere.

| INTRODUC TI ONHelicobacter pylori infection of the gastric epithelial mucosa affects approximately 50% of the population worldwide. In developing countries, H pylori infection has been observed in more than 90% of the population because this infection remains asymptomatic in early childhood, resulting in an enormous economic burden on healthcare resources. 1,2 Standard triple antibiotic therapy (proton-pump inhibitor (PPI) in combination with two of the following: amoxicillin, clarithromycin, or metronidazole) has been the preferred initial approach for H pylori eradication. 3 However, due to increased resistance of H pylori to clarithromycin and/or metronidazole, the eradication rate with triple therapy has reduced to <70% presently, down from >90% observed in the 1990s. 4 In Japan, decreased eradication of H pylori with the Abstract Background: Probiotics are beneficial to patients with Helicobacter pylori infections by modulating the gut microbiota. Biofermin-R (BFR) is a multiple antibiotic-resistant lactic acid bacteria preparation of Enterococcus faecium 129 BIO 3B-R and is effective in normalizing the gut microbiota when used in combination with antibiotics. This study aimed to determine the effect of BFR in combination with vonoprazan (VPZ)based therapy on gut microbiota. Methods: Patients with positive urinary anti-H pylori antibody test (primary test) and fecal H pylori antigen test (secondary test) were examined. Patients in group 1 (BFR − )received VPZ (20 mg twice daily), amoxicillin (750 mg twice daily), and clarithromycin (400 mg twice daily) for 7 days. Patients in group 2 (BFR + ) received BFR (3 tablets/ day) for 7 days, in addition to the aforementioned treatments. Following treatment, the relative abundance, α-diversity, and β-diversity of gut microbiota were assessed.Results: Supplementation with BFR prevented the decrease in α-diversity after eradication therapy (Day 7). β-diversity was similar between groups. The incidence rate of diarrhea was non-significantly higher in the BFR − than in the BFR + group (73.1% vs 56.5%; P = .361). Stool consistency was comparable in the BFR + group on Days 7 and 1 (3.86 ± 0.95 vs 3.86 ± 1.46; P = .415). Conclusion:Biofermin-R combined with VPZ-based therapy resulted in higher microbial α-strain diversity and suppressed stool softening during H pylori eradication therapy. K E Y W O R D S Biofermin-R, gut microbiota, Helicobacter pylori, vonoprazan S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Kakiuchi T, Mizoe A, Yamamoto K, et al. Effect of probiotics during vonoprazan-containing triple therapy on gut microbiota in Helicobacter pylori infection: A randomized controlled trial. Helicobacter. 2020;25:e12690.

Technetium-99m-diethylenetriaminepentaacetic acid-galactosyl-human serum albumin (Tc-GSA) is a receptor binding agent, specific for asialoglycoprotein receptor, that resides exclusively on the plasma membrane of mammalian hepatocytes. The usefulness of Tc-GSA for estimating the hepatic functional reserve was retrospectively evaluated in patients undergoing a hepatic resection. Tc-GSA scintigraphy was performed in 35 patients before hepatectomy, and the hepatic uptake ratio (LHL15) was calculated. The LHL15 was then compared with the findings of conventional liver function tests, the indocyanine green retention rate in 15 minutes (ICG R15), and histologic activity index (HAI) score. Significant correlations were observed between the LHL15 and values of ICG R15, prothrombin time activity, serum levels of total bilirubin, hyaluronic acid, and values of HAI score. Ratios of LHL15 to preoperative liver volume (LHL-V) correlated well with the regenerative rates of the residual liver after major hepatectomy. In addition, patients with more than 0.76 of LHL-V value had no complications in postoperative course, whereas those with less than 0.73 had several complications due to hepatic dysfunction. Tc-GSA scintigraphy thus appears to be a useful diagnostic tool for evaluating functioning mass of the liver and the values of LHL-V seems to be able to demonstrate regenerative activity in the residual liver after hepatectomy.

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This case report concerns a 62-year-old female who was known to have cirrhosis. An endoscopic examination showed no evidence of haemorrhaging due to either oesophageal or gastric varices. Angiographic studies demonstrated extravasation from the ileal varices. There was a prominent arterio-portal shunt in the liver, and the shunt was considered to be a contributing factor to induce portal hypertension and variceal bleeding in the ileum. Therefore, transcatheter arterial embolization was performed, but was unsuccessful. As a result, the patient underwent a laparotomy, and a dilatating ileocaecal vein and a communicating ovarian vein were selectively ligated. Following the procedure, the haemorrhaging stopped and she then recovered. The patient is doing well 21 months after surgery at the time of writing.