Bismuth triple therapy was the first truly effective Helicobacter pylori eradication therapy. The addition of a proton pump inhibitor largely overcame the problem of metronidazole resistance. Resistance to its being the primary first line therapy have centered on convenience (the large number of tablets required) and side effects causing difficulties with patient adherence. Understanding why the regimen is less successful in some regions remains unexplained in part because of the lack of studies including susceptibility testing. A number of modifications have been proposed such as twice-a-day therapy which addresses both major criticism but the studies with susceptibility testing required to prove its effectiveness in high metronidazole resistance areas are lacking. Most publications lack the data required to understand why they were successful or failed (e.g., detailed resistance and adherence data) and are therefore of little value. We discuss and provide recommendations regarding variations including substitution of doxycycline, amoxicillin, and twice a day therapy. We describe what is known and unknown and provide suggestions regarding what is needed to rationally and effectively use bismuth quadruple therapy. Its primary use is when penicillin cannot be used or when clarithromycin and metronidazole resistance is common. Durations of therapy less than 14 days are not recommended.

Background & Aims-Elevated microsatellite alterations at selected tetranucleotide repeats (EMAST) occurs during microsatellite instability (MSI) that is not associated with major defects in DNA mismatch repair (MMR) but rather the reduced (heterogenous) expression of the MMR protein hMSH3; it occurs in sporadic colorectal tumors. We examined the timing of development of EMAST during progression of colorectal neoplasias and looked for correlations between EMAST and clinical and pathology features of tumors.

) of long-range (=300 miles) electric vehicle batteries. In addition, the heteronet-enabled mechanical compliance of CM electrodes, in combination with readily deformable CNF separators, allows the fabrication of paper crane batteries via origami folding technique.