ObjectiveTo date, no randomised trials have compared the efficacy of vonoprazan and amoxicillin dual therapy with other standard regimens for Helicobacter pylori treatment. This study aimed to investigate the efficacy of the 7-day vonoprazan and low-dose amoxicillin dual therapy as a first-line H. pylori treatment, and compared this with vonoprazan-based triple therapy.DesignThis prospective, randomised clinical trial was performed at seven Japanese institutions. Patients with H. pylori–positive culture test and naive to treatment were randomly assigned in a 1:1 ratio to either VA-dual therapy (vonoprazan 20 mg+amoxicillin 750 mg twice/day) or VAC-triple therapy (vonoprazan 20 mg+amoxicillin 750 mg+clarithromycin 200 mg twice/day) for 7 days, with stratification by age, sex, H. pylori antimicrobial resistance and institution. Eradication success was evaluated by 13C-urea breath test at least 4 weeks after treatment.ResultsBetween October 2018 and June 2019, 629 subjects were screened and 335 were randomised. The eradication rates of VA-dual and VAC-triple therapies were 84.5% and 89.2% (p=0.203) by intention-to-treat analysis, respectively, and 87.1% and 90.2% (p=0.372) by per-protocol analysis, respectively. VA-dual was non-inferior to VAC-triple in the per-protocol analysis. The eradication rates in strains resistant to clarithromycin for VA-dual were significantly higher than those for VAC-triple (92.3% vs 76.2%; p=0.048). The incidence of adverse events was equal between groups.ConclusionThe 7-day vonoprazan and low-dose amoxicillin dual therapy provided acceptable H. pylori eradication rates and a similar effect to vonoprazan-based triple therapy in regions with high clarithromycin resistance.Trial registration numberUMIN000034140.
The surface tension of molten tin has been determined by the sessile drop method at temperatures ranging from 523 to 1033 K and in the oxygen partial pressure (P(O(2))) range from 2.85 x 10(-19) to 8.56 x 10(-6) MPa, and its dependence on temperature and oxygen partial pressure has been analyzed. At P(O(2))=2.85 x 10(-19) and 1.06 x 10(-15) MPa, the surface tension decreases linearly with the increase of temperature and its temperature coefficients are -0.151 and -0.094 mN m(-1) K(-1), respectively. However, at high P(O(2)) (3.17 x 10(-10), 8.56 x 10(-6) MPa), the surface tension increases with the temperature near the melting point (505 K) and decreases above 723 K. The surface tension decrease with increasing P(O(2)) is much larger near the melting point than at temperatures above 823 K. The contact angle between the molten tin and the alumina substrate is 158-173 degrees, and the wettability is poor.
Patients with hypovascular hypointense liver nodules are at a higher risk for HCC development at any sites of the liver than those without such nodules.
To turn the advantage of energy measurement in x-ray transmission diagnosis into practice, we propose a novel detector for the estimation of x-ray energy distribution. This detector consists of several segment detectors arrayed in the direction of x-ray incidence. Each segment detector measures x-rays as current. With unfolding measured currents, the x-ray energy distribution is obtained. The practical application of this detector was verified by estimating the iodine thickness in an acryl phantom.
For ion beam radiation therapy, the measurement of effective atomic numbers is necessary to know the material distribution in a human body: the range of ion beams entering the human body is influenced by the material distribution along their paths. Effective atomic numbers, however, cannot be measured at hospitals because monochromatic X-rays with different energies are necessary and are used only at synchrotron facilities. To make the effective atomic number measurements at hand, we propose energy-resolved computed tomography (CT) using a "transXend detector". By assigning two narrow energy ranges in the unfolding process of the data obtained by the transXend detector, the effective atomic numbers for acrylic and aluminum can be estimated by energy-resolved CT. The estimated effective atomic numbers are compared with those obtained by dual-energy and monochromatic X-ray CT.
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