Proton Pump Inhibitor-unresponsive Laryngeal Symptoms Are Associated With Psychological Comorbidities and Sleep Disturbance: A Manometry and Impedance-pH Monitoring Study

Background/Aims@#Laryngeal symptoms are largely treated with empiric proton pump inhibitor (PPI) therapy if no apparent pathology shown on ear, nose, and throat evaluation and reflux-related etiologies are suspected. However, treatment response remains unsatisfactory. This study aimed to investigate the clinical and physiological characteristics of patients with PPI-refractory laryngeal symptoms. @*Methods@#Patients with persistent laryngeal symptoms despite PPI treatment for ≥ 8 weeks were recruited. A multidisciplinary evaluationcomprising validated questionnaires for laryngeal symptoms (reflux symptom index [RSI]), gastroesophageal reflux disease symptoms, psychological comorbidity (5-item brief symptom rating scale [BSRS-5]) and sleep disturbance (Pittsburgh sleep quality index [PSQI]), esophagogastroduodenoscopy, ambulatory impedance-pH monitoring, and high-resolution impedance manometry were performed.Healthy asymptomatic individuals were also recruited for comparison of psychological morbidity and sleep disturbances. @*Results@#Ninety-seven adult patients and 48 healthy volunteers were analyzed. The patients had markedly higher prevalence of psychological distress (52.6% vs 2.1%, P < 0.001) and sleep disturbance (82.5% vs 37.5%, P < 0.001) than the healthy volunteers. There were significant correlations between RSI and BSRS-5 scores, and between RSI and PSQI scores (r = 0.26, P = 0.010, and r = 0.29, P = 0.004, respectively). Fifty-eight patients had concurrent gastroesophageal reflux disease symptoms. They had more prominent sleep disturbances (89.7% vs 71.8%, P < 0.001) than those with laryngeal symptoms alone but similar reflux profiles and esophageal motility. @*Conclusions@#PPI-refractory laryngeal symptoms are mostly associated with psychological comorbidities and sleep disturbances. Recognition of these psychosocial comorbidities may help optimize management in these patients.

Inflammatory Bowel Disease and Neurodegenerative Diseases

A growing body of evidence has demonstrated an intricate association between inflammatory bowel disease (IBD) and neurodegenerative conditions, expanding beyond previous foci of comorbidities between IBD and mood disorders. These new discoveries stem from an improved understanding of the gut-microbiome-brain axis: specifically, the ability of the intestinal microbiota to modulate inflammation and regulate neuromodulatory compounds. Clinical retrospective studies incorporating large sample sizes and population-based cohorts have demonstrated and confirmed the relevance of IBD and chronic neurodegeneration in clinical medicine. In this review, we expound upon the current knowledge on the gut-microbiome-brain axis, highlighting several plausible mechanisms linking IBD with neurodegeneration. We also summarize the known associations between IBD with Parkinson disease, Alzheimer disease, vascular dementia and ischemic stroke, and multiple sclerosis in a clinical context. Finally, we discuss the implications of an improved understanding of the gut-microbiome-brain axis in preventing, diagnosing, and managing neurodegeneration among IBD and non-IBD patients.

The efficacies of sequential versus simple anastomosis of saphenous vein in off-pump coronary artery bypass grafting: A propensity score matching study / 中国胸心血管外科临床杂志

@#Objective    To evaluate the short- and mid-term outcomes of sequential anastomosis and simple anastomosis of saphenous vein in off-pump coronary artery bypass grafting. Methods    The clinical data of 438 patients who underwent sequential anastomosis of saphenous vein and 165 patients who underwent simple anastomosis of saphenous vein from 2015 to 2018 in Daxing Teaching Hospital were retrospectively analyzed. After propensity score matching, 130 pairs of patients were included in the sequential anastomosis group [78 males and 52 females, aged 60 (52, 68) years] and simple anastomosis group [80 males and 50 females, aged 61 (52, 70) years]. The short- and mid-term clinical outcomes were compared. Results    The two propensity score-matched groups had similar baseline clinical data. No significant difference was found between sequential anastomosis and simple anastomosis groups in the in-hospital outcomes, including in-hospital death (1.5% vs. 1.5%, P=1.000), the incidence of complications (4.6% vs. 6.2%, P>0.05), and the mean flow of grafts (30.0±11.8 mL/min vs. 28.0±9.5 mL/min, P=0.597). The operation time of the sequential anastomosis group was shorter than that of the simple anastomosis group (142.5±21.2 min vs. 186.3±27.6 min, P<0.001). The drainage of the sequential anastomosis group was less than that of the simple anastomosis group (204.7±39.6 mL vs. 271.3±48.3 mL, P<0.001). The follow-up time was 12-60 (28.3±8.9) months, during which the mortality of the two groups was not statistically different (3.2% vs. 4.0%, P=0.796). Conclusion    The saphenous vein sequential anastomosis of saphenous vein is superior to the simple anastomosis. Sequential anastomosis technique can reduce aortic anastomosis,  shorten operation time, and reduce bleeding drainage during off-pump coronary artery bypass grafting. The short- and mid- term clinical effects are satisfactory.

Effect of preoperative intra-aortic balloon pump insertion in patients undergoing off-pump coronary artery bypass grafting: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To evaluate the clinical efficacy of preoperative intra-aortic balloon pump (IABP) insertion in patients with off-pump coronary artery bypass grafting (OPCABG) surgery. Methods    The clinical data of 130 patients who underwent OPCABG with IABP from 2015 to 2019 in our hospital were retrospectively analyzed. The patients were divided into two groups, including a group A (preoperative IABP insertion, n=72) and a group B (emergent IABP insertion, n=58). There were 42 males and 30 females in the group A with an average age of 60-72 (65.0±5.2) years. There were 32 males and 26 females in the group B with an average age of 56-73 (62.3±7.6) years. The in-hospital mortality rate and prognosis were compared between the two groups. Results    The in-hospital mortality rate in the group A (4.2%) was significantly lower than that in the group B (12.1%, P=0.002). The IABP time (40.8±10.3 min vs. 65.3±15.6 min), mechanical ventilation time (18.7±6.1 min vs. 48.7±10.5 min) and ICU stay time (48.1±7.8 min vs. 90.2±21.3 min) of the group A were shorter than those of the group B (P<0.05). The number of bypass grafts was not significantly different between the two groups (3.6±1.2 vs. 3.8±1.0, P=0.387). Multivariable logistic regression analysis indicated that independent risk factors for in-hospital mortality included age [OR=1.04, 95%CI (1.01, 1.10), P=0.030], female [OR=2.56, 95%CI (1.53, 6.12), P=0.000] and left ventricular end-diastolic diameter [OR=1.05, 95%CI (1.01, 1.13), P=0.030]. Preoperative IABP support was the protective factor [OR=0.17, 95%CI (0.01, 0.78), P=0.005]. Conclusion    Patients undergoing OPCABG with preoperative IABP insertion may reduce in-hospital mortality rate and improve outcomes.

The Practice of Gastrointestinal Motility Laboratory During COVID-19 Pandemic: Position Statements of the Asian Neurogastroenterology and Motility Association (ANMA-GML-COVID-19 Position Statements)

During the Coronavirus Disease 2019 (COVID-19) pandemic, practices of gastrointestinal procedures within the digestive tract require special precautions due to the risk of contraction of severe acute respiratoy syndrome coronavirus-2 (SARS-CoV-2) infection. Many procedures in the gastrointestinal motility laboratory may be considered moderate to high-risk for viral transmission. Healthcare staff working in gastrointestinal motility laboratories are frequently exposed to splashes, air droplets, mucus, or saliva during the procedures. Moreover, some are aerosol-generating and thus have a high risk of viral transmission. There are multiple guidelines on the practices of gastrointestinal endoscopy during this pandemic. However, such guidelines are still lacking and urgently needed for the practice of gastrointestinal motility laboratories. Hence, the Asian Neurogastroenterology and Motility Association had organized a group of gastrointestinal motility experts and infectious disease specialists to produce a position statement paper based-on current available evidence and consensus opinion with aims to provide a clear guidance on the practices of gastrointestinal motility laboratories during the COVID-19 pandemic. This guideline covers a wide range of topics on gastrointestinal motility activities from scheduling a motility test, the precautions at different steps of the procedure to disinfection for the safety and well-being of the patients and the healthcare workers. These practices may vary in different countries depending on the stages of the pandemic, local or institutional policy, and the availability of healthcare resources. This guideline is useful when the transmission rate of SARS-CoV-2 is high. It may change rapidly depending on the situation of the epidemic and when new evidence becomes available.

Non-pharmacological Approach in the Management of Functional Dyspepsia

Functional dyspepsia (FD) is a common functional gastrointestinal disease which bears a significant burden on society and individuals. Despite the high prevalence of FD, its pathophysiology remains poorly understood and the treatment options are limited and unsatisfactory. In the absence of effective pharmacological treatments for FD, non-pharmacological approaches, including: reassurance, lifestyle modification, psychotherapy, dietary interventions, medical food, acupuncture, and electrical stimulation and modulation are sought after by many physicians and FD patients. In this article, we review clinical studies which investigate nonpharmacological therapies for FD. We will also discuss potential mechanisms involved in the therapeutic effects of these nonpharmacological approaches. Though the evidences to support the routine use of the non-pharmacological management is still lacking, the non-invasive nature and potentially minimal side-effects of these therapies may be attractive in the FD management. In order to confirm the clinical effectiveness of these non-pharmacological approaches, more well-conducted, methodologically rigorous, and large-scaled clinical trials are required.

Sexual Abuse Is Associated With an Abnormal Psychological Profile and Sleep Difficulty in Patients With Irritable Bowel Syndrome in Taiwan

BACKGROUND/AIMS: Both sexual and physical abuse history have been reported to be associated with irritable bowel syndrome (IBS) in Western countries. The impact of abuse history in IBS patients in Asia remains unclear. We aim to determine the prevalence of abuse history, its associated psychological profiles, and sleep problems among IBS patients in Taiwan. METHODS: In total, 194 Rome III-defined IBS patients were invited to participate. Age- and sex-matched healthy carriers of chronic hepatitis B or hepatitis C without chronic abdominal symptoms were identified as disease-controls. We administered a validated questionnaire to evaluate bowel symptoms, physical/sexual abuse history, anxiety/depression (Hospital Anxiety and Depression Scale [HADS]), and sleep quality. RESULTS: IBS patients had a significantly higher prevalence of sexual abuse history than the disease-control group both before (16.5% vs 6.7%, P < 0.05) and after (16.0% vs 6.6%, P < 0.05) adolescence. These significant differences were mainly observed in women (13.4% vs 3.4%, P < 0.05). No difference was noted in history of physical abuse between the 2 groups. IBS patients with a history of sexual abuse had significantly higher HADS scores and higher frequencies of sleep difficulty than those without. CONCLUSIONS: In Taiwan, sexual abuse history was more prevalent in female IBS patients than controls. Sexual abuse history may contribute to higher anxiety/depression levels and sleep difficulties, which are commonly experienced in IBS patients. In Asia, abuse history should be obtained when approaching IBS patients to facilitate better management.

Association between Free Triiodothyronine Levels and Peripheral Arterial Disease in Euthyroid Participants / 生物医学与环境科学（英文）

This current cross-sectional study investigates the relationship between thyroid hormones and peripheral artery disease (PAD) among euthyroid Chinese population aged 40 years and above. Serum free triiodothyronine (FT3), free thyroxin (FT4), thyroid-stimulating hormone (TSH), and thyroid antibodies were measured. PAD was defined as ankle-brachial index (ABI) < 0.9. There were 91 (2.9%) PAD cases among the 3,148 euthyroid study participants. Participants in the highest quartile of FT3 and free-triiodothyronine-to-free-thyroxin (FT3/FT4 ratio) had a decreased risk of prevalent PAD (multivariate-adjusted odds ratio, 95% confidence interval: 0.32, 0.15-0.62, P for trend = 0.01 and 0.31, 0.13-0.66, P for trend = 0.004, respectively) compared to those in the lowest quartile. To conclude, FT3 levels and the FT3/FT4 ratio was inversely associated with prevalent PAD in euthyroid Chinese population aged 40 years and above.

Associations between adipose tissue distribution and macro-vascular complications:A cross-sectional study in type 2 diabetic patients / 中华内分泌代谢杂志

Objective This study aimed to investigate the associations between adipose tissue distribution and risks of macro-vascular complications in type 2 diabetic patients. Methods The study included T2DM patients either previously diagnosed by questionnaire or newly diagnosed with fasting plasma glucose(FPG)≥7. 0 mmol/L and/or 2 hour postprandial glucose ( 2h PG )≥11. 1 mmol/L from residents older than 40 years from Jiading Community, Shanghai, China(n=10 375). Each participant had gone through anthropometric measurements, blood tests, vascular function tests including carotid intima-media thickness ( CIMT ) , ankle-brachial index ( ABI ) , branchial-ankle pulse wave velocity( baPWV) as well as carotid plaques. Results WHR quartiles was significantly associated with high risks for ten-year cardiovascular disease risks [ ASCVD high risk: OR:1. 17 ( 1. 05-1. 31 );Framingham high risk:1. 13(1. 00-1. 29)]. However, WHR has no significant relations with risks of increased carotid intima-media thickness( CIMT) , abnormal ankle-brachial index( ABI) , increased brachial ankle pulse wave velocity( baPWV) or carotid plaques. Conclusions In type 2 diabetic patients, abdominal adipose tissue has an independent role in high risk for ten-year cardiovascular diseases. However it has no relations with other vascular functions including increased CIMT, abnormal ABI, increased baPWV, or carotid plaque.

Dynamic studies on photosynthetic and growth characteristics of Angecila dahurcia / 中国中药杂志

Photosynthetic and growth characteristics of Angelica dahurica were studied in order to clarity the relations of photosynthesis, growth and root dry weight, and provide a theoretical basis for its cultivation. Photosynthesis and growth indexes were meas- ured every 25 days. The contents of chlorophyll a, b, a + b, soluble protein and the activities of Hill reaction, Ca(2+)-ATPase, Mg(2+)-ATPase had an increasing trend; They had the highest value in leaf high-speed growth period. Then, they were decreased in root high- speed growth period. The root dry weight showed negative corelation with photosynthetic characteristics indexes except stomatal con- ductance, however, the negative corelation only from net photosynthetic rate and Ca(2+)-ATPase were significant. The vegetative growth period of spring sowing A. dahuricia was divided into three phases: seedling period, leaf high-speed growth period and root high-speed growth period. The root dry weight showed a significantly positive corelation with the root diameter, leaf dry weight, shoot dry weight, aboveground dry weight. There was the competitive relation between aboveground and underground, so underground growth could be es- timated from leaf area and shoot dimeter.

Chicory extract's influence on gut bacteria of abdominal obesity rat / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the efficacy mechanisme of chicory extract interventing abdominal obesity rat from the aspect of gut bacteria.</p><p><b>METHOD</b>Male SD rats were randomly divided into five groups, namely the normal group, model group, large and small dose group of chicory and the fenofibrate group. Normal group was given deionized water, the other group was given fructose water and give the medical treatment of chicory and fenofibrate. Assay triglycerides, total cholesterol, LDL and HDL by biochemical methods and measure body weight and abdominal circumference and microscopicly observe the count changes of gut bacteria through real-time PCR method.</p><p><b>RESULT</b>Compared with normal group, the triglyceride level and abdominal circumference were significantly higher (P < 0.05), weight and high-density lipoprotein increased but no significant changes and E. coli, lactobacillus increased significantly. Compared with model group, chicory extract large and small dose group and the fenofibrate group can significantly reduce triglyceride levels (P < 0.05), reduce the number of E. coli and Lactobacillus and increase the number of bifidobacteria. The fenofibrate group can significantly reduce total cholesterol and high-density lipoprotein levels.</p><p><b>CONCLUSION</b>The chicory's treatment effect on abdominal obesity is significant. The efficacy mechanisme intervention abdominal obesity may be related to the reduction of the number of lactic acid bacteria and E. coli and the increase of bifidobacteria.</p>

An Investigation and Analysis on Satisfaction of Pediatric Services in Guangdong Province / 中华医院管理杂志

Object Through performing the service satisfaction survey,to learn their interest claim and discover the service defects ,so as to provide advice and countermeasures.Method Using field survey methods and statistics analysis to study.Result The satisfaction of relatives of pediatric patients at the level of "relatively good" and "good" is about 60% both in medical treatment environment and equipment ,over 70% in medical treatment effect,doctor capacity,nursing capacity and overall assessment,but only 5.1% in medical expenses.Conclusion Relatives of pediatric patients have high satisfaction in treatment capability of medical staff,medical treatment effect as well as overall assessment ,normal satisfaction in medical environment and equipment,but lowest satisfaction in medical expenses,and the satisfaction in tertiary hospital is not high.Relatives in some districts demand much in some aspects,such as improving hospital environment,attaching importance to ward hygiene ,improving service attitude,and providing single ward ect.

Quantitative determination of podophyllotoxin in dermal and blood microdialysis samples of rats by liquid chromatography-tandem mass spectrometry / 南方医科大学学报

<p><b>OBJECTIVE</b>To develop and validate a sensitive method for quantitative analysis of podophyllotoxin in blood and dermal microdialysis samples of rats based on liquid chromatography-tandem mass spectrometry (UFLC-MS-MS).</p><p><b>METHODS</b>The microdialysis samples were prepared by liquid-liquid extraction using ethyl acetate with etoposide as the internal standard (IS). Podophyllotoxin was separated with an Agilent ZORBAX XDB-C18 column (2.1 mmx50 mm, 3.5 microm). The mobile phase consisted of acetonitrile: 10 mmol/L ammonium acetate (40:60, V/V) at a flow rate of 0.3 ml/min and the analysis was performed at the ambient temperature. The UFLC-MS/MS system was operated in the mode of multiple reaction monitoring using the electrospray ionization technique in positive mode.</p><p><b>RESULTS</b>Podophyllotoxin and etoposide responses were optimized at the transitions m/z 432.7-->397.3 and 589.5-->229.5, respectively. Calibration curves were linear over the range 2.0-1000 ng/ml. The lowest limits of quantification and detection values were 2.0 ng/ml and 0.7 ng/ml, respectively. The inter- and intra-day precision and accuracy were both less than 15%.</p><p><b>CONCLUSION</b>This selective and sensitive method can be used to quantity podophyllotoxin in the blood and dermal microdialysates of rats.</p>

Study on the dynamic growth rhythm of Achyranthes bidentata under different densities / 中国中药杂志

<p><b>OBJECTIVE</b>The experiment was conducted to study the dynamic growth rhythm of Achyranthes bidentata under different densities.</p><p><b>METHOD</b>The plant samples were collected to measure the growth rate of each organ.</p><p><b>RESULT</b>Under different densities, the growing dynamic rhythm of A. bidentata were similar. The growth of main root exhibited a trend of "slow-fast-slow" by stages. The increase of dry root weight was fastest during the period of 30-40 days before harvest. The dry-matter increasing rate of whole plant was fastest in the later period of branching stage. The differences of root yields among the plants growing under different densities were significant.</p><p><b>CONCLUSION</b>For high yield and good quality, the density of planting of A. bidentata should be considered.</p>

Primary study on developmental speciality and cultural practices of Amphicarpaea edgeworthii / 中国中药杂志

<p><b>OBJECTIVE</b>The experiments were conducted to study specialty of seed germinating, plant growing and developing and cultural practices of A. edgeworthii.</p><p><b>METHOD</b>The germinating and sowing test, growth habitants, photosensitive reaction of seedling from subterraneous seeds and above ground seeds on A. edgeworthii were studied in this experiment.</p><p><b>RESULT AND CONCLUSION</b>The results indicated that (1) The water could not be absorbed by seed from plant above ground; (2) The underground and above ground seeds could normally germinate, grow, blossom and bear fruits, A. edgeworthii sowed in early May, blossomed in early September and matured in the last ten days of October; (3) The seed leaf of seedling grew underground; (4) The underground seed was produced from subterraneous branch stem which developed from node of seed leaf; (5) A. edgeworthii was shade demanding, high-temperature sensible short-day light plant. The flowering could be greatly advantaged by short-day light treatment (12, 10, 8, 6 h). Cultural practices were studied also in this experiment.</p>