This document outlines the objectives, strategy guidelines, and the approach for the harmonisation of European space technology activities, in line with and in support of the resolution “Shaping of the Future of Europe in Space”, adopted at the ESA Ministerial Council in May 1999.

Background.Although combinations of antibiotics and antisecretory drugs are useful for treatment ofHelicobacter pyloriinfection, treatment failure is common. The aim of this study was to evaluate the relation between pretreatment antibiotic resistance and outcome by using six different treatment regimens forH. pyloriinfection.Patients and Methods.Three hundred sixty‐nine consecutiveH. pylori–infected patients with dyspeptic symptoms were enrolled in three consecutive randomized, controlled, single‐center clinical trials: trial A, 128 patients; trial B, 125 patients; trial C, 116 patients. Treatments consisted of (A) a 15‐day course of dual therapy (omeprazole, 20 mg bid, and amoxicillin, 1 gm bid, or clarithromycin, 500 mg tid) (OA vs OC); (B) a 7‐day triple therapy of omeprazole, 20 mg bid, plus metronidazole, 500 mg bid, and amoxicillin, 1,000 mg bid, or clarithromycin, 500 mg tid (OMA vs OMC); or (C) omeprazole, 20 mg bid, plus metronidazole, 500 mg bid, plus tetracycline, 500 mg qid, or doxycycline, 100 mg tid (OMT vs OMD). Diagnostic endoscopy was made in all patients before and 5 to 6 weeks after therapy. Six biopsies were taken from each patient for histology, rapid urease test, andH. pyloriculture; antibiotic susceptibility testing was performed using the E‐test method.Results.Overall cure rates were poor for both dual therapies OA and OC (38% and 37%, respectively) and for triple therapies OMA, OMC, and OMD (57%, 55%, and 58%, respectively). The OMT combination was successful in 91% (95% confidence interval [CI], 80.4%–97%). Metronidazole resistance was present in 29.7% (95% CI, 24%–35%), amoxicillin resistance was present in 26% (95% CI, 21%–32%), clarithromycin resistance was present in 23.1% (95% CI, 18%–29%), tetracycline resistance was present in 14% (95% CI, 10%–20%), and doxycycline resistance was present in 33.3% (95% CI, 21%–47%). Antibiotic resistance markedly reduced the cure rates and accounted for most of the poor results with the triple therapies: 89% versus 23%; 77% versus 26%; 100% versus 60%; and 67% versus 23% for OMC, OMA, OMT, and OMD, respectively. OMT appeared to be the best because of the high success rate with metronidazole‐resistantH. pylori(71%) and in low‐level tetracycline resistance.Conclusions.Pretreatment antibiotic‐resistantH. pylorican, in part, explain the low cure rate of the infection and the variability in outcome in reported trials.

H. pylori (Hp) strains which possess the cytotoxin associated gene product (Cag A) elicit more gastric inflammation than Cag A neg. strains.PURPOSE: To correlate the presence of serum antibodies to Cag A with the histologic severity of fundic gastritis, basal (BAn) and peak (PAn) acid output, and fasting serum gastrin.METHODS: 81 healthy volunteers underwent serum collection and nasogastric (NG) intubation.BAn and PAn (pentagastrin 6ug/kg) were determined, following which fundic mucosa was biopsied under fluoroscopic guidance via forceps placed through the NG tube.Biopsies were classified for severity of gastritis and presence of Hp by a blinded pathologist.Serum IgG to Hp and Cag A antibodies were determined blindly from coded specimens by ELISA.RESULTS:

Aims of the study: To evaluate Helicobacter Pylori significance in the development of intestinal metaplasia (IM) in gastric mucosa and to establish how the bacterial eradication modifies its further evolution.Subjects and methods: Ninety-nine consecutive patients affected from inflammatory and/ or ulcerative diseases of the stomach and/or of the duodenum showing IM in histologic specimen collected during upper endoscopy were studied for a two years period after first diagnosis.Every patient allowed to the study was endoscopically reinvestigated every year and underwent to six biopsies each time, three from angular and three from body mucosa of the stomach in order to evaluate IM and HP presence.The HP positive patients affected from IM underwent eradication by triple therapy with omeprazole 40 mg once daily for 4 weeks, amoxycillin 1 g twice daily for one week and clarithrom~cin 500 mg twice daily for one week.Statistical analysis was performed by % method.Results: Eighty-two (82,8%) out of 99 IM positive patients resulted also lip positive and seventeen (17,2%) HP negative at histology.All 82 IM and HP positive patients underwent eradication therapy and 69 (84,1%) of them resulted eradicated two months after the end of treatment by urea-breath test.Twelve and twenty-four months later 98 patients out of 99 underwent endoscopic control; one IM positive HP negative patient dropped out.In control group (16 IM positive HP negative) 14 patients (87,5%) at first year and 15 patients (93,7%) at second year control showed again IM.All of them resulted HP negative at histology in both occasions.In the treated patients group (82 IM positive-HP positive) only 53 (64,5%) at first year control and 49 (59,7%) at second year control were found positive for IM at histology.In both cases 40 patients, out of 53 at first year control and out of 49 at second year control, were histologically negative for HP detection.29 (35,5%) initially IM positive patients resulted negative after one year and 33 (40,2%) after two years.Moreover 27(93,1%) out of 29 IM negative patients at first year and 31 (93.9%)out of 33 IM negative patients at second year resulted Helicobacter Pylori negative at histology.Statistical analysis by Z z method between IM positive-HP negative patients and IM positive-HP positive one and two years after eradication showed P < 0.001.Conclusions: Helicobacter Pylori eradication allows regression of histological intestinal metaplasia in the stomach in more than 30% cases after two years from eradication.According to Correa's gastric carcinogenesis model, Helicobacter Pylori positive patients with proven intestinal metaplasia have to be eradicated.

Aims of the study: To evaluate Helicobacter Pylori significance in the development of intestinal metaplasia (IM) in gastric mucosa and to establish how the bacterial eradication modifies its further evolution.Subjects and methods: Ninety-nine consecutive patients affected from inflammatory and/ or ulcerative diseases of the stomach and/or of the duodenum showing IM in histologic specimen collected during upper endoscopy were studied for a two years period after first diagnosis.Every patient allowed to the study was endoscopically reinvestigated every year and underwent to six biopsies each time, three from angular and three from body mucosa of the stomach in order to evaluate IM and HP presence.The HP positive patients affected from IM underwent eradication by triple therapy with omeprazole 40 mg once daily for 4 weeks, amoxycillin 1 g twice daily for one week and clarithrom~cin 500 mg twice daily for one week.Statistical analysis was performed by % method.Results: Eighty-two (82,8%) out of 99 IM positive patients resulted also lip positive and seventeen (17,2%) HP negative at histology.All 82 IM and HP positive patients underwent eradication therapy and 69 (84,1%) of them resulted eradicated two months after the end of treatment by urea-breath test.Twelve and twenty-four months later 98 patients out of 99 underwent endoscopic control; one IM positive HP negative patient dropped out.In control group (16 IM positive HP negative) 14 patients (87,5%) at first year and 15 patients (93,7%) at second year control showed again IM.All of them resulted HP negative at histology in both occasions.In the treated patients group (82 IM positive-HP positive) only 53 (64,5%) at first year control and 49 (59,7%) at second year control were found positive for IM at histology.In both cases 40 patients, out of 53 at first year control and out of 49 at second year control, were histologically negative for HP detection.29 (35,5%) initially IM positive patients resulted negative after one year and 33 (40,2%) after two years.Moreover 27(93,1%) out of 29 IM negative patients at first year and 31 (93.9%)out of 33 IM negative patients at second year resulted Helicobacter Pylori negative at histology.Statistical analysis by Z z method between IM positive-HP negative patients and IM positive-HP positive one and two years after eradication showed P < 0.001.Conclusions: Helicobacter Pylori eradication allows regression of histological intestinal metaplasia in the stomach in more than 30% cases after two years from eradication.According to Correa's gastric carcinogenesis model, Helicobacter Pylori positive patients with proven intestinal metaplasia have to be eradicated.

Background:The efficacy of omeprazole and amoxycillin dual therapy to treat Helicobacter pylori infection has been inconsistent, suggesting the presence of host or bacterial factors influencing treatment success. The aim of this study was to assess the role of pre‐treatment amoxycillin resistance in the efficacy of omeprazole and amoxycillin dual therapy.Methods:We studied 43 consecutive dyspeptic patients with H. pylori infection. Pre‐treatment H. pylori infection was established by the combination of positive rapid urease test, culture and histology. Amoxycillin susceptibility testing was performed by an Epsilometer test (E‐test) method and amoxycillin resistance was defined as minimum inhibitory concentration greater than 8 μg/mL. Patients received 20 mg omeprazole twice daily for 28 days and amoxycillin 1000 mg twice daily for 2 weeks. Adverse effects were documented using a questionnaire. H. pylori status was reassessed 6–8 weeks after the end of treatment by rapid urease testing and histological examination of gastric biopsies.Results:Forty‐two dyspeptic patients completed the study, and one patient dropped out. H. pylori infection was cured in 23 of 42 patients (55%). The cure rate was higher in patients harbouring amoxycillin‐sensitive organisms than in those with resistant strains: 66% (19/29) vs. 31% (4/13), respectively (P = 0.049). No significant differences in cure rates were evident in relation to age, sex, smoking habits or compliance.Conclusions:The effectiveness of amoxycillin–omeprazole dual therapy was greatly reduced in the presence of pre‐treatment amoxycillin‐resistant H. pylori. The success rate in patients with amoxycillin‐sensitive H. pylori was only 66%, suggesting the presence of additional factors affecting the efficacy of this therapy.

Rosetta is a correrstone mission of the science programme of the European Space Agency (ESA) and it has been studied as a collaborative project with NASA. The major scientific objectives of Rosetta is to return cometary samples to Earth. About 20 kg of cometary material from up to 3m below the surface would be made available to the scientific community for analysis. Since relatively little is known a priory about the environment to be expected, the mission design must be based on a limited body of knowledge and rely on autonomy. The paper outlines the main mission characteristics and the experimental approach to demonstrate the mission feasibility.