A case report on irritable bowel syndrome treated with low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet / 中华临床营养杂志

Irritable bowel syndrome (IBS) is characterized by abdominal pain associated with changes in defecation frequency and blood folate level. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. High-FODMAP diet could elicit or exacerbate IBS-associated bowel symptoms, which is inadequately recognized among gastroenterologists in China. Here we report an IBS case, focusing on the association between high-FODMAP diet and bowel symptoms and the intervention of low-FODMAP diet.

Prevalence rate and influencing factors of restless leg syndrome in maintenance hemodialysis patients in Anhui province / 中华肾脏病杂志

Objective:To explore the prevalence rate of restless leg syndrome (RLS) and its related influencing factors in patients with maintenance hemodialysis (MHD) in Anhui province.Methods:It was a cross-sectional study, including regular MHD patients in blood purification centers of 27 hospitals in southern, central and northern Anhui province from January to March 2020. The investigation included general demographic characteristics, primary diseases, complications, dialysis-related conditions and drug use. According to the presence or absence of RLS, the patients were divided into RLS group and non-RLS group, and the differences of clinical data between the two groups were compared. Logistic regression analysis method was used to analyze the influencing factors of RLS.Results:The study included 3 025 MHD patients, aged (54.8±12.8) years old, with 1 819 males (60.1%) and 1 206 females (39.9%). The dialysis age was (5.5±3.8) years. The prevalence rates of RLS in MHD patients were 8.8% (265/3 025), of which 13.7% (77/561), 7.7% (88/1 145) and 7.6% (100/1 319) in southern, central and northern Anhui province, respectively. The prevalence rates of RLS in MHD patients in secondary and tertiary hospitals were 9.5% (55/577) and 8.6% (210/2 448), respectively. Proportion of hypertension, dialysis age, intact parathyroid hormone, alkaline phosphatase, 25(OH)D3, and proportions of secondary hyperparathyroidism, erythropoietin use, iron supplements, active vitamin D use, calcimimetic use, dialysis blood flow <250 ml/min and low-flux dialyzers in RLS group were higher than those in non-RLS group, while hemoglobin level and proportions of non-calcium-phosphorus binders and high-flux dialyzers were lower than those in non-RLS group (all P<0.05). Multivariate logistic regression analysis results showed that long dialysis age ( OR=1.188, 95% CI 1.031-1.369, P=0.017) and high alkaline phosphatase ( OR=1.007, 95% CI 1.001-1.013, P=0.047) were correlated with a higher risk of RLS in MHD patients. Conclusions:The prevalence rate of RLS in MHD patients in Anhui province is 8.8%. The prevalence rates of RLS in MHD patients in southern, central and northern Anhui province are 13.7%, 7.7% and 7.6%, respectively. The prevalence rate of RLS in secondary and tertiary hospitals are 9.5% and 8.6%, respectively. Long dialysis age and high alkaline phosphatase are associated with a high risk of RLS in MHD patients.

Effects of andrographolide on angiogenesis in diabetic foot rats and its mechanism / 中国药房

OBJECTIVE To investigate the effects of andrographolide （Andro） on angiogenesis in rats with diabetic foot and to explore its mechanism of action based on the Hippo-Yes-associated protein （YAP） signaling pathway. METHODS The rat model of type 2 diabetes was established by using low-dose streptozotocin combined with high-fat and high-glucose diet. On the basis of successful modeling， the rat model of diabetes foot was established by scalding. Model rats were randomly divided into 5 groups with 12 rats in each group： model group， Andro low-dose， medium-dose， and high-dose groups （1， 10， and 20 mg/kg）， as well as inhibitor group （20 mg/kg Andro+100 mg/kg of verteporfin， an specific inhibitor of Hippo-YAP signaling pathway）； other 12 healthy rats were included in the Control group. Rats in each group were intragastrically and intraperitoneally injected with solvents or corresponding drugs， once a day， for 2 consecutive weeks. The wound healing， fasting blood glucose （FBG） and fasting insulin （FINS） were detected in rats after medication. HE staining was performed to observe the tissue damage and capillary number of rat trauma； the number of endothelial progenitor cells （EPCs） in peripheral blood of rats was counted by using flow cytometry； the contents of serum total cholesterol （TC）， triglyceride （TG）， high-density lipoprotein cholesterol （HDL-C） and low-density lipoprotein cholesterol （LDL-C） in rats were determined by fully automatic biochemical analyzer； the expressions of hypoxia- inducible factor 1α （HIF-1α）， vascular endothelial growth factor （VEGF） and Hippo-YAP signaling pathway-related proteins in the traumatic tissues of rats in each group were detected by Western blot. RESULTS Compared with Control group， the wound healing rate， capillary number， the proportion of EPCs， HDL-C content， as well as the protein expression levels of HIF-1α and VEGF and the phosphorylation levels of mammalian Ste20-like kinase 1， large tumor suppressor gene 1 and YAP proteins were significantly reduced in the model group， while the FBG， FINS levels and TC， TG and LDL-C contents were significantly increased （P＜0.05）. Compared with model group， the above indexes were significantly reversed in Andro low-dose， medium-dose and high-dose group， in a dose-dependent manner （P＜ 0.05）； verteporfin attenuated the above reversal effect of Andro （P＜0.05）. CONCLUSIONS Andro has the effects of lowering blood glucose and blood lipids， promoting blood vessel formation and wound healing in rats with diabetic foot， and its mechanism of action may be related to the activation of Hippo-YAP signaling pathway.

Influence of the intake of different oils on non-alcoholic fatty liver disease / 临床肝胆病杂志

At present, there are no universally accepted hepatoprotective drugs that are recommended for the conventional treatment of nonalcoholic fatty liver disease (NAFLD), and the main prevention and treatment methods for NAFLD include diet control, exercise, and weight-loss surgery. Diet control is the most basic intervention method, and scientific and reasonable dietary guidance is of particular importance. This article briefly summarizes the influence of several kinds of oils commonly contained in diet on hepatic steatosis, inflammation, and oxidative stress of NAFLD, and it is pointed out that fish oil, olive oil, virgin coconut oil, and pine nut oil are beneficial to NAFLD, while excessive intake of lard and palm oil will aggravate NAFLD.

Influence of the intake of different oils on non-alcoholic fatty liver disease / 临床肝胆病杂志

At present, there are no universally accepted hepatoprotective drugs that are recommended for the conventional treatment of nonalcoholic fatty liver disease (NAFLD), and the main prevention and treatment methods for NAFLD include diet control, exercise, and weight-loss surgery. Diet control is the most basic intervention method, and scientific and reasonable dietary guidance is of particular importance. This article briefly summarizes the influence of several kinds of oils commonly contained in diet on hepatic steatosis, inflammation, and oxidative stress of NAFLD, and it is pointed out that fish oil, olive oil, virgin coconut oil, and pine nut oil are beneficial to NAFLD, while excessive intake of lard and palm oil will aggravate NAFLD.

Clinical features and genetic analysis of a child with late-onset immune dysregulation, polyendocrinopathy, enteropathy, X-Linked syndrome / 中华医学遗传学杂志

OBJECTIVE@#To report on the clinical features and result of genetic testing for a child featuring immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome.@*METHODS@#Clinical records, genetic testing, laboratory investigation and treatment of the child were summarized in addition with a comprehensive review of the literature.@*RESULTS@#The 3-year-old boy was administered due to intractable diarrhea, recurrent infections, liver dysfunction and failure to thrive, though no diabetes or skin disorder was observed. Laboratory testing showed elevated liver enzymes and total IgE, decreased albumin and electrolyte imbalance. Gastrointestinal endoscopy revealed erosion and granules in the duodenum, and edema in the terminal ileum and colon. Biopsies showed villous atrophy in the duodenum and terminal ileum. Genetic testing revealed that the patient has carried a missense c.1087A>G (p.I363V) variant in the exon 10 of the FOXP3 gene. He was treated with enteral and parenteral nutrition, anti infection and Sirolimus, and was waiting for hemopoietic stem cell transplantation.@*CONCLUSION@#Although IPEX syndrome usually occur during infancy, it should not be ruled out solely based on the age, and its presentation can be variable. For male children with refractory diarrhea, autoimmune disorder and growth retardation, the diagnosis should be suspected and confirmed by genetic testing.

Clinical analysis of 32 children with perforation caused by foreign body in upper gastrointestinal tract / 中华实用儿科临床杂志

Objective:To explore the clinical characteristics and treatment strategies of upper gastrointestinal perforation caused by ingested foreign bodies in children.Methods:A retrospective analysis of 32 patients with upper gastrointestinal perforation secondary to foreign bodies in Henan Children′s Hospital from January 2011 to February 2019 was performed.Some basic information was collected, including age, gender, type of foreign bodies, location of perforation, time of swallowing, clinical symptoms, treatment methods and outcomes.Results:Among the 32 children, there were 20 cases (62.5%) were male and 12 cases (37.5%) were female.The predilection age was 0 to <3 years old [21 cases (65.6%)]. The most common type of upper gastrointestinal foreign bodies was jujube pits [13 cases (40.6%)], followed by button batteries [10 cases (31.2%)], magnets [3 cases (9.4%)], fish bones [2 cases (6.3%)], lollipop stick [2 cases (6.3%)], button battery combined with magnet [1 case (3.1%)] and metal pin [1 case (3.1%)]. Majority of perforation was located in the esophagus [25 cases (78.2%)], especially in the upper esophagus [15/25 cases, (60.0%)]. The common symptoms of upper gastrointestinal perforation include fever [22 cases (68.8%)], dysphagia and/or salivation [21 cases (65.6%)], vomiting [24 cases (75%)], abdominal pain [5 cases (15.6%)] and expiratory dyspnea [1 case (3.1%)]. All the foreign bodies were successfully extracted by endoscopy [28 cases (87.5%)] and surgery [4 cases (12.5%)]. Moreover, all the patients recovered with both treatments of indwelling gastrointestinal decompression tube and enteral nutrition, including nasojejunal tube [24 cases (75.0%)], endoscopic hemoclip and nasojejunal nutrition [2 cases (6.3%)], and surgical operation [6 cases (18.7%)].Conclusions:The upper gastrointestinal foreign body is a common emergency in children, and might cause perforation, especially jujube pits, button batteries and magnets.The endoscopic procedure is safe and effective for the removal of foreign bodies.However, the surgical intervention is required as soon as possible due to the failure of endoscopic treatment.

Discovery of a series of dimethoxybenzene FGFR inhibitors with 5pyrrolo2,3-pyrazine scaffold: structure-activity relationship, crystal structural characterization and study

Genomic alterations are commonly found in the signaling pathways of fibroblast growth factor receptors (FGFRs). Although there is no selective FGFR inhibitors in market, several promising inhibitors have been investigated in clinical trials, and showed encouraging efficacies in patients. By designing a hybrid between the FGFR-selectivity-enhancing motif dimethoxybenzene group and our previously identified novel scaffold, we discovered a new series of potent FGFR inhibitors, with the best one showing sub-nanomolar enzymatic activity. After several round of optimization and with the solved crystal structure, detailed structure-activity relationship was elaborated. Together with metabolic stability tests and pharmacokinetic profiling, a representative compound () was selected and tested in xenograft mouse model, and the result demonstrated that inhibitor was effective against tumors with FGFR genetic alterations, exhibiting potential for further development.

Efficacy of inverso isomer of CendR peptide on tumor tissue penetration

The dense extracellular matrix and high interstitial fluid pressure of tumor tissues prevent the ability of anti-tumor agents to penetrate deep into the tumor parenchyma for treatment effects. C-end rule (CendR) peptides can enhance the permeability of tumor blood vessels and tumor tissues binding to neuropilin-1 (NRP-1), thus aiding in drug delivery. In this study, we selected one of the CendR peptides (sequence RGERPPR) as the parent l-peptide and substituted d-amino acids for the l-amino acids to synthesize its inverso peptide (RGERPPR). We investigated the NRP-1 binding activity and tumor-penetrating ability of (RGERPPR). We found that the binding affinity of (RGERPPR) with NRP-1 and the cellular uptake was significantly higher than that of RGERPPR. Evans Blue tests revealed that (RGERPPR) exhibited improved tumor-penetrating ability in C6, U87 and A549 tumor-bearing nude mice. Using nude mice bearing A549 xenograft tumors as a model, we found that the rate of tumor growth in the group co-administered with (RGERPPR) and gemcitabine (Gem) was significantly lower than the gemcitabine-treated group with a tumor suppression rate (TSR%) of 55.4%. Together, our results demonstrate that (RGERPPR) is a potential tumor-penetrating peptide.

Regional Brain Activity During Rest and Gastric Water Load in Subtypes of Functional Dyspepsia: A Preliminary Brain Functional Magnetic Resonance Imaging Study

BACKGROUND/AIMS: Functional dyspepsia (FD) remains a great clinical challenge since the FD subtypes, defined by Rome III classification, still have heterogeneous pathogenesis. Previous studies have shown notable differences in visceral sensation processing in the CNS in FD compared to healthy subjects (HS). However, the role of CNS in the pathogenesis of each FD subtype has not been recognized. METHODS: Twenty-eight FD patients, including 10 epigastric pain syndrome (EPS), 9 postprandial distress syndrome (PDS), and 9 mixed-type, and 10 HS, were enrolled. All subjects underwent a proximal gastric perfusion water load test and the regional brain activities during resting state and water load test were investigated by functional magnetic resonance imaging. RESULTS: For regional brain activities during the resting state and water load test, each FD subtype was significantly different from HS (P < 0.05). Focusing on EPS and PDS, the regional brain activities of EPS were stronger than PDS in the left paracentral lobule, right inferior frontal gyrus pars opercularis, postcentral gyrus, precuneus, insula, parahippocampal gyrus, caudate nucleus, and bilateral cingulate cortices at the resting state (P < 0.05), and stronger than PDS in the left inferior temporal and fusiform gyri during the water load test (P < 0.05). CONCLUSIONS: Compared to HS, FD subtypes had different regional brain activities at rest and during water load test, whereby the differences displayed distinct manifestations for each subtype. Compared to PDS, EPS presented more significant differences from HS at rest, suggesting that the abnormality of central visceral pain processing could be one of the main pathogenesis mechanisms for EPS.

Analysis of risk factors for acute kidney injury following hepatic arterial chemoembolization inpatientswithhepatocellularcarcinomaofChildclassA / 中华放射学杂志

Objective To explore the incidence and risk factors of acute kidney injury (AKI) following hepatic arterial chemoembolization inpatients with hepatocellular carcinoma(HCC),Child class A. Methods Retrospective analysis was performed on patients with HCC,Child Class A who were admitted from January 2008 to October 2016.The inclusion criteria:(1) patients were diagnosed with pathologically confirmed hepatocellular carcinoma based on the standards of primary liver cancer diagnosis and treatment (2011 edition);(2) patients have complete laboratory parameters and imaging data within the 7 days before the TACE treatment;(3) the Child-pugh score was 5 to 6;(4) patients have no acute or chronic renalfailure before the treatment of TACE.The morbidity of AKI after TACE was investigated.Twenty-six factors such as age,sexy,contrast dose,hemoglobin were included as independent variable, so as to investigate the risk factors for postoperative AKI. Results A total of 818 patients were included in the study, including 38 experiencing postoperative AKI(4.64%).Multivariate logistic regression analysis identified elevated preoperative uric acid as the independent risk factor for postoperative AKI(OR=1.005,95% CI 1.000 to 1.009,P=0.037), and elevated preoperative hemoglobin as the protective factor for postoperative AKI(OR=0.974,95% CI 0.952 to 0.997,P=0.028).Conclusions AKI is not uncommon following hepatic arterial chemoembolization inpatients with HCC,Child Class A,and is correlated with elevated uric acid and anemia.Preoperative risk assessment and anemia correction might be effective for reducing the incidence of AKI following hepatic arterial chemoembolization.

The application and research diversified teaching methods in the teaching of diagnostics and clinical probation / 中华医学教育探索杂志

Objective To probe into the effect of diversified teaching methods in the teaching of di-agnostics and clinical probation.Methods One hundred clinical undergraduates were randomly divided in-to experimental class (fifty students) and traditional class (fifty students). The experimental class was based on the textbook of diagnostics.It used PBL to share teaching resources with teachers and students,and used electronic simulation and standardized patients to carry out clinical probation in combination with clinical practice. Through the objective structured clinical examination and questionnaire survey, students' learning situation of two classes was analyzed. R 3.3.3 was used to perform t test or χ2test for the data of two classes. Result The evaluation results show that the average scores of the students in the experimental class OSCE are excellent, and the average scores of the tests are higher than those of the traditional class, and the difference is statistically significant (P<0.05). The result of questionnaire showed that the students of experimental class were more satisfied than the traditional class students (P<0.05) in all aspects. Conclusions Diversified teaching methods are beneficial to cultivating students' theoretical practice trans-formation ability,clinical thinking ability and independent problem solving ability.

Evaluation of hypoxic pulmonary vascular remodeling based on fractal theory / 实用放射学杂志

Objective To evaluate the relationship between the spatial structure of pulmonary vascular tree and oxygen partial pressure in patients with chronic obstructive pulmonary disease(COPD) by the fractal dimension method.Methods 106 patients with COPD and 100 healthy people without COPD as controls were included in this study.All of the patients underwent multidetector CT scan and blood gas analysis.The pulmonary vascular trees were generated using post-processing software,and the FD of the pulmonary vascular trees were determined with ImageJ software in a personal computer.The fractal dimension were evaluated in the two groups.The relationship between FD and oxygen partial pressure in patients with COPD was analyzed.Results The FD value of the patients with COPD was lower than that of the patients without COPD (t =5.21,P＜ 0.01).There was a significant correlation between FD and the PaO2 in patients with COPD (r=0.692,P＜ 0.01).Conclusion FD analysis can effectively evaluate the process of pulmonary vascular remodeling induced by hypoxia in patients with COPD,which may be used as an important index for quantitative evaluation of pulmonary vascular remodeling in the course of COPD.

Correlations of serum lipoprotein (a) with ischemic stroke and its etiological subtypes / 国际脑血管病杂志

Objective To investigate the correlation between serum lipoprotein (a) (Lp(a)) level andischemic stroke and its etiological subtypes. Methods The consecutive inpatients with acute ischemic stroke (case group) and age-and sex-matched healthy subjects (control group) over the same period were enrolled retrospectively. The demographic and baseline clinical data, as well as fasting blood glucose, fibrinogen,homocysteine, total cholesterol, triacylglycerol, high-densitylipoprotein cholesterol, low -density lipoprotein cholesterol, and Lp(a) concentration of the case group and the control group were collected. According to TOAST classification criteria, the patients in the case group were divided into large artery atherosclerosis (LAA), small artery occlusion (SAO) and cardioembolism (CE), and the patients with other determined etiology and undetermined etiology were excluded. Multivariate logistic regression analysis was used to make clear the correlation between serum Lp(a) and acute ischemic stroke and its etiological subtypes. Results A total of 214 patients with ischemic stroke were enrolled. Ninety-seven had LAA (45.33%), 64 (29.91%) had SAO, and 53 (24.77%) had CE. There were 118 subjects in the control group. There were significant differences in the proportions of hypertension, diabetes, hyperlipidemia, atrial fibrillation and alcohol consumption, as well as systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol, low -density lipoprotein cholesterol, Lp(a), fibrinogen, and homocysteine between the case group and the control group (all P <0.001). Multivariate logistic regression analysis showed that after adjustment for age and sex, Lp(a) is an independent risk factor for ischemic stroke (odds ratio [OR] 2.014, 95% confidence interval [CI ] 1.273-3.092, P = 0.036). The independent risk factors for LAA included hypertension (OR 3.353, 95% CI 1.714-6.558, P = 0.001), systolic blood pressure ( OR 2.786, 95% CI 1.136-5.538, P =0.016), homocysteine ( OR 1.108, 95% CI 1.031-2.191, P = 0.005), total cholesterol (OR 2.169, 95% CI 1.599-4.943, P = 0.001), low -density lipoprotein cholesterol ( OR2.782, 95% CI 1.093-5.238, P =0.024), and Lp(a) (OR 3.072, 95% CI 1.907-8.064, P =0.001). Theindependent risk factors for SAO included hypertension ( OR 7.042, 95% CI 3.189-25.55, P =0.001), diabetes mellitus (OR 5.162, 95% CI 2.372-11.23, P =0.001), fibrinogen (OR 1.667, 95% CI 1.434-2.025, P = 0.045), and homocysteine (OR 1.967, 95% CI 1.859-1.995, P =0.036). The independent risk factors for CE included atrial fibrillation (OR 13.340, 95% CI 4.637-39.20, P = 0.001), fibrinogen (OR 2.365, 95% CI 1.147- 4.904, P =0.029), and Lp(a) (OR 1.656, 95% CI 1.996-3.001, P = 0.035). Conclusions Lp(a) is an independent risk factor for ischemic stroke, and can be used as a serum biomarker for predicting the risk of the onset of ischemic stroke. There are differences in independent risk factors between the different stroke etiological subtypes. Lp(a) is independently associated with LAA and CE; however, it has no independent correlation with SAO.

Preparation of MRI molecular probe targeting human epidermal growth factor receptor 2 and the ;preliminary study of breast cancer cell in vitro / 中华放射学杂志

Objective To develop a superparamagnetic iron oxide nanoparticles ( SPIO ) based on MRI probe specifically targeting human epidermal growth factor receptor 2 (HER2) and explore its value as MRI positive contrast agents in vitro.Methods (1) The superparamagnetic iron oxide ( PS) was obtained by means of classical coprecipitation in polylactic acid solution , then coupled with fluorescein isothiocyanate (FITC) labeled LTVSPYW to develop the targeted probe ( FITC-LTVSPWY-PS).The particle size was measured under transmission electron microscope.Relaxation rate was detected by 3.0 T MR scanner.(2) Climbing films of human breast cancer cell MCF-7 were prepared and incubated with FITC-LTVSPWY-SPIO, then fluorescence distribution was observed under inverted microscope.And distribution of iron particles was confirmed by prussian blue staining.(3) MCF-7 and MDA-MB-231 cells were incubated with FITC-LTVSPWY-SPIO and PS, respectively.MCF-7 incubated with FITC-LTVSPWY-PS were used as experimental group, MCF-7 treated with PS as control group , and cells added with nothing as blank group.There were 3 samples in each group.The MR imaging was performed only once and T 2 WI signal intensity of cells was recorded.The comparison of T 2 signal intensity among groups was conducted by using one-way ANOVA.Results The core and surface size of nanoparticles were (13.9 ±1.6) nm and (122.0 ±5.5) nm respectively.Zeta potential and relaxation rate of the FITC-LTVSPWY-PS were ( -30.7 ±2.2 ) mV and 70.7 m· M-1 · s-1 respectively, and the PS were (28.1 ±2.8) mV and 72.1 m· M-1 · s-1 respectively.The fluorescence could be seen on the surface of MCF-7 cells, and the prussian blue staining showed that FITC-LTVSPWY-PS could specifically target HER 2-positive cells.The low signal on T 2 WI was observed in MCF-7 cells incubated with FITC-LTVSPWY-PS, whereas cells treated with PS and blank group showed equal signals , the T2 values were ( 61.8 ±5.7 ) , ( 101.6 ±2.5 ) and ( 103.5 ±1.9 ) ms respectively.Significant difference existed among these groups ( F =355.698, P <0.05 ).Conclusions The MR targeting probe FITC-LTVSPWY-PS was prepared successfully , its physical characterization and magnetic properties could target the HER 2 highly expressing on the surface of breast cancer cells and meet the need of targeted imaging.It provides an important tool for MR molecular imaging.

A case of fasciolasis hepatic in Zunyi City,Guizhou Province / 中国血吸虫病防治杂志

Four adults of Fasciola hepatica were found from the bile ducts of a patient diagnosed as biliary calculi during a surgi-cal operation. We investigated retrospectively the infection source and concluded that the patient may be infected by eating raw or half-cooked Zizania latifolia,an aquatic plant,which was contaminated with metacercariae of F. hepatica.

Response of Esophagus to High and Low Temperatures in Patients With Achalasia

BACKGROUND/AIMS: Achalasia patients would feel exacerbated dysphagia, chest pain and regurgitation when they drink cold beverages or eat cold food. But these symptoms would relieve when they drink hot water. Reasons are unknown. METHODS: Twelve achalasia patients (mean age, 34 +/- 10 years; F:M, 3:9) who never had any invasive therapies were chosen from Peking Union Medical College Hospital. They were asked to fill in the questionnaire on eating habits including food temperature and related symptoms and to receive high-resolution manometry examination. The exam was done in 2 separated days, at swallowing room temperature (25degrees C) then hot (50degrees C) water, and at room temperature (25degrees C) then cold (2degrees C) water, respectively. Parameters associated with esophageal motility were analyzed. RESULTS: Most patients (9/12) reported discomfort when they ate cold food. All patients reported no additional discomfort when they ate hot food. Drinking hot water was effective in 5/8 patients who ever tried to relieve chest pain attacks. On manometry, cold water increased lower esophageal sphincter (LES) resting pressure (P = 0.003), and prolonged the duration of esophageal body contraction (P = 0.002). Hot water decreased LES resting pressure and residue pressure during swallow (P = 0.008 and P = 0.002), increased LES relaxation rate (P = 0.029) and shortened the duration of esophageal body contraction (P = 0.003). CONCLUSIONS: Cold water could increase LES resting pressure, prolong the contraction duration of esophageal body, and exacerbate achalasia symptoms. Hot water could reduce LES resting pressure, assist LES relaxation, shorten the contraction duration of esophageal body and relieve symptoms. Thus achalasia patients are recommended to eat hot and warm food and avoid cold food.

The study on the function of gastrointestinal autonomic nerve in reflux esophagitis patients / 中华消化杂志

Objective To explore the features of autonomic nerve function in reflux esophagitis (RE) patients, and the role of abnormal function in the pathogenesis of RE. Methods Twenty RE patients (RE group) and 18 healthy controls (HS group) all underwent heart rate variability (HRV) with meal stimulation to test the function of autonomic nerve. At same time, the endoscopic Los Angeles (LA) Classification, RE symptom score, Gastroesophageal reflux disease-health related quality of life (GERD-HRQL), Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were evaluated in the RE patients. Of those, 12 RE patients were re-examined the function of autonomic never after 2 to 4 months [mean (3.7±0.8) months] of proton pump inhibitors (PPI) treatment. Results In fasting state, the sympathetic activity was higher in RE group than in HS group, while the parasympathetic activity was lower in HS group (P=0.022 and 0.034). Postprandial, the trend of autonomic functional change was the same in RE group and HS group. Postprandial, the sympathetic activity was negatively correlated with symptom score in RE patients; however, the parasympathetic activity was positively correlated with RE symptom score. The influence of meal on the balance of sympathetic and parasympathetic was negatively correlated with RE symptom score (r=-0.48, P=0.022). The influence of meal on the parasympathetic nerve was positively correlated with RE symptom score and GERD-HRQL score. After PPI treatments, RE symptom score, GERD-HRQL score, SAS score and SDS score were all significantly decreased in RE patients. There was no significant difference in autonomic nerve function before and after PPI treatment. Conclusions There is abnormal autonomic nerve function in RE patients, characterized by higher sympathetic activity and lower parasympathetic activity in fasting state. The autonomic nerve function is correlated with RE symptom score. The abnormal autonomic nerve function may be one of the causes of RE.