Effect of Crown Ether Additives on the Enhanced Performance of Metallic Bipolar Plates for Proton Exchange Membrane Fuel Cells.

One of the key components of the fuel cell stack is a metallic bipolar plate (MBP) that plays multiple roles, such as current collector, fuel and oxidant distributor, and mechanical support. However, corrosion and consequent metal elution are major drawbacks of the MBP because they diminish the efficiency and power performance of membrane-electrode assemblies (MEAs). Herein, we show that the crown ether (CE) additive can simultaneously inhibit surface corrosion of the MBP and act as a scavenger for eluted metal ions to alleviate contamination of other components. From the electrochemical measurement, high-resolution imaging, and elemental analysis, we have found that the CE undergoes electrolytic decomposition and makes an efficient protective layer in an in situ manner. This layer prevents direct contact between the MBP and electrolyte as well as the dissolution of metal ions into the electrolyte. In addition, we demonstrate that the CE can improve the recovery protocol of the MEA owing to the formation of host-guest complexes between the CE and metal cations. These results provide key insights into the design of high-performance MBPs for proton-exchange membrane fuel cells.

Advances in Polymer Binder Materials for Lithium-Ion Battery Electrodes and Separators.

Lithium-ion batteries (LIBs) have become indispensable energy-storage devices for various applications, ranging from portable electronics to electric vehicles and renewable energy systems. The performance and reliability of LIBs depend on several key components, including the electrodes, separators, and electrolytes. Among these, the choice of binder materials for the electrodes plays a critical role in determining the overall performance and durability of LIBs. This review introduces polymer binders that have been traditionally used in the cathode, anode, and separator materials of LIBs. Furthermore, it explores the problems identified in traditional polymer binders and examines the research trends in next-generation polymer binder materials for lithium-ion batteries as alternatives. To date, the widespread use of N-methyl-2-pyrrolidone (NMP) as a solvent in lithium battery electrode production has been a standard practice. However, recent concerns regarding its high toxicity have prompted increased environmental scrutiny and the imposition of strict chemical regulations. As a result, there is a growing urgency to explore alternatives that are both environmentally benign and safer for use in battery manufacturing. This pressing need is further underscored by the rising demand for diverse binder research within the lithium battery industry. In light of the current emphasis on sustainability and environmental responsibility, it is imperative to investigate a range of binder options that can align with the evolving landscape of green and eco-conscious battery production. In this review paper, we introduce various binder options that can align with the evolving landscape of environmentally friendly and sustainable battery production, considering the current emphasis on battery performance enhancement and environmental responsibility.

Mechanochemical Enhancement of the Structural Stability of Pseudorotaxane Intermediates in the Synthesis of Rotaxanes.

Mechanochemical syntheses of rotaxanes have attracted considerable attention of late because of the superior reaction rates and higher yields associated with their production compared with analogous reactions carried out in solution. Previous investigators, however, have focused on the demonstration of the mechanochemical syntheses of rotaxanes per se, rather than on studying the solid-phase host-guest molecular interplay related to their rapid formation and high yields. In this investigation, we attribute the lower yields of rotaxanes prepared in solution to the limited concentration and a desolvation energy penalty that must be compensated for by host-guest interactions during complexation that precedes the templation leading to rotaxane formation. It follows that, if the desolvation energy can be removed and higher concentrations can be attained, even weak host-guest interactions can drive the complexation of host and guest molecules efficiently. In order to test this hypothesis, we chose two host-guest pairs of permethylated pillar[5]arene/1,6-diaminohexane and permethylated pillar[5]arene/2,2'-(ethylenedioxy)bis(ethylamine) for the simple reason that they exhibit extremely low binding constants (2.7 ± 0.4 M-1 when 1,6-diaminohexane is the guest and <0.1 M-1 when 2,2'-(ethylenedioxy)bis(ethylamine) is the guest in CDCl3; i.e., ostensibly no pseudorotaxane formation is observed). We argue that the amount of pseudorotaxanes formed in the solid state is responsive to mechanical treatments or otherwise and changes in temperature during stoppering reactions. Compared to the amount of pseudorotaxanes that can be obtained in solution, large quantities of pseudorotaxanes are formed in the solid state because of concentration and desolvation effects. This mechanochemical enhancement of pseudorotaxane formation is referred to as a self-correction in the current investigation. Rotaxanes based on permethylated pillar[5]arene/1,6-diaminohexane and permethylated pillar[5]arene/2,2'-(ethylenedioxy)bis(ethylamine) have been synthesized in much higher yields compared to those obtained in solution, aided and abetted by self-correction effects during mechanical treatments and heating at a mild temperature of 50 °C.

Redox-Active Phenanthrenequinone Triangles in Aqueous Rechargeable Zinc Batteries.

Aqueous rechargeable zinc batteries (ZBs) have received considerable attention recently for large-scale energy storage systems in terms of rate performance, cost, and safety. Nevertheless, these ZBs still remain a subject for investigation, as researchers search for cathode materials enabling high performance. Among the various candidate cathode materials for ZBs, quinone compounds stand out as candidates because of their high specific capacity, sustainability, and low cost. Quinone-based cathodes, however, suffer from the critical limitation of undergoing dissolution during battery cycling, leading to a deterioration in battery life. To address this problem, we have introduced a redox-active triangular phenanthrenequinone-based macrocycle (PQ-Δ) with a rigid geometry and layered superstructure. Notably, we have confirmed that Zn2+ ions, together with H2O molecules, can be inserted into the PQ-Δ organic cathode, and, as a consequence, the interfacial resistance between the cathode and electrolytes is decreased effectively. Density functional theory calculations have revealed that the low interfacial resistance can be attributed mainly to decreasing the desolvation energy penalty as a result of the insertion of hydrated Zn2+ ions in the PQ-Δ cathode. The combined effects of the insertion of hydrated Zn2+ ions and the robust triangular structure of PQ-Δ serve to achieve a large reversible capacity of 210 mAh g-1 at a high current density of 150 mA g-1, along with an excellent cycle-life, that is, 99.9% retention after 500 cycles. These findings suggest that the utilization of electron-active organic macrocycles, combined with the low interfacial resistance associated with the solvation of divalent carrier ions, is essential for the overall performance of divalent battery systems.

Conductive 2D metal-organic framework for high-performance cathodes in aqueous rechargeable zinc batteries.

Currently, there is considerable interest in developing advanced rechargeable batteries that boast efficient distribution of electricity and economic feasibility for use in large-scale energy storage systems. Rechargeable aqueous zinc batteries are promising alternatives to lithium-ion batteries in terms of rate performance, cost, and safety. In this investigation, we employ Cu3(HHTP)2, a two-dimensional (2D) conductive metal-organic framework (MOF) with large one-dimensional channels, as a zinc battery cathode. Owing to its unique structure, hydrated Zn2+ ions which are inserted directly into the host structure, Cu3(HHTP)2, allow high diffusion rate and low interfacial resistance which enable the Cu3(HHTP)2 cathode to follow the intercalation pseudocapacitance mechanism. Cu3(HHTP)2 exhibits a high reversible capacity of 228 mAh g-1 at 50 mA g-1. At a high current density of 4000 mA g-1 (~18 C), 75.0% of the initial capacity is maintained after 500 cycles. These results provide key insights into high-performance, 2D conductive MOF designs for battery electrodes.

Direct Observation of an Anomalous Spinel-to-Layered Phase Transition Mediated by Crystal Water Intercalation.

The phase transition of layered manganese oxides to spinel phases is a well-known phenomenon in rechargeable batteries and is the main origin of the capacity fading in these materials. This spontaneous phase transition is associated with the intrinsic properties of manganese, such as its size, preferred crystal positions, and reaction characteristics, and it is therefore very difficult to avoid. The introduction of crystal water by an electrochemical process enables the inverse phase transition from spinel to a layered Birnessite structure. Scanning transmission electron microscopy can be used to directly visualize the rearrangement of lattice atoms, the simultaneous insertion of crystal water, the formation of a transient structure at the phase boundary, and layer-by-layer progression of the phase transition from the edge. This research indicates that crystal water intercalation can reverse phase transformation with thermodynamically favored directionality.

The High Performance of Crystal Water Containing Manganese Birnessite Cathodes for Magnesium Batteries.

Rechargeable magnesium batteries have lately received great attention for large-scale energy storage systems due to their high volumetric capacities, low materials cost, and safe characteristic. However, the bivalency of Mg(2+) ions has made it challenging to find cathode materials operating at high voltages with decent (de)intercalation kinetics. In an effort to overcome this challenge, we adopt an unconventional approach of engaging crystal water in the layered structure of Birnessite MnO2 because the crystal water can effectively screen electrostatic interactions between Mg(2+) ions and the host anions. The crucial role of the crystal water was revealed by directly visualizing its presence and dynamic rearrangement using scanning transmission electron microscopy (STEM). Moreover, the importance of lowering desolvation energy penalty at the cathode-electrolyte interface was elucidated by working with water containing nonaqueous electrolytes. In aqueous electrolytes, the decreased interfacial energy penalty by hydration of Mg(2+) allows Birnessite MnO2 to achieve a large reversible capacity (231.1 mAh g(-1)) at high operating voltage (2.8 V vs Mg/Mg(2+)) with excellent cycle life (62.5% retention after 10000 cycles), unveiling the importance of effective charge shielding in the host and facile Mg(2+) ions transfer through the cathode's interface.

Acute toxic hepatitis caused by an aloe vera preparation in a young patient: a case report with a literature review.

Aloe is one of the leading products used in phytomedicine. Several cases of aloe-induced toxic hepatitis have been reported in recent years. However, its toxicology has not yet been systematically described in the literature. A 21-year-old female patient was admitted to our hospital with acute hepatitis after taking an aloe vera preparation for four weeks. Her history, clinical manifestation, laboratory findings, and histological findings all led to the diagnosis of aloe vera-induced toxic hepatitis. We report herein on a case of acute toxic hepatitis induced by aloe vera.

Effective liquid-phase exfoliation and sodium ion battery application of MoS2 nanosheets.

Two-dimensional (2D) molybdenum disulfide (MoS2) has been taken much attention for various applications, such as catalyst, energy storage, and electronics. However, the lack of effective exfoliation methods for obtaining 2D materials in a large quantity has been one of the technical barriers for the real applications. We report a facile liquid-phase exfoliation method to improve the exfoliation efficiency for single-layer MoS2 sheets in 1-methyl-2-pyrrolidinone (NMP) with a sodium hydroxide (NaOH) assistant. The concentration of the exfoliated MoS2 nanosheets was greatly improved compared to that achieved with conventional liquid-phase exfoliation methods using NMP solvent. We demonstrate stable operation of sodium-ion battery by using the exfoliated MoS2 and MoS2-rGO composite as anode materials.

Improved reversibility in lithium-oxygen battery: understanding elementary reactions and surface charge engineering of metal alloy catalyst.

Most Li-O2 batteries suffer from sluggish kinetics during oxygen evolution reactions (OERs). To overcome this drawback, we take the lesson from other catalysis researches that showed improved catalytic activities by employing metal alloy catalysts. Such research effort has led us to find Pt3Co nanoparticles as an effective OER catalyst in Li-O2 batteries. The superior catalytic activity was reflected in the substantially decreased overpotentials and improved cycling/rate performance compared to those of other catalysts. Density functional theory calculations suggested that the low OER overpotentials are associated with the reduced adsorption strength of LiO2 on the outermost Pt catalytic sites. Also, the alloy catalyst generates amorphous Li2O2 conformally coated around the catalyst and thus facilitates easier decomposition and higher reversibility. This investigation conveys an important message that understanding elementary reactions and surface charge engineering of air-catalysts are one of the most effective approaches in resolving the chronic sluggish charging kinetics in Li-O2 batteries.

A case of anisakiasis invading the stomach and the colon at the same time after eating anchovies.

Anisakiasis of the gastrointestinal tract is caused by the ingestion of raw fish or uncooked food infested with Anisakis larvae. A large number of cases of gastric anisakiasis have been reported in countries where the eating of raw fish is customary. However, there have been few reports of anisakiasis of the colon confirmed by colonoscopy and also very few reports of endoscopic ultrasonographic findings of anisakiasis. A 47-year-old man had epigastric pain with nausea after eating raw anchovies. Endoscopy found a living tubular structure penetrating into the lesser curvature of the stomach and the midtranseverse colon area. It was withdrawn with biopsy forceps. We report a case of anisakiasis simultaneously invading the stomach and the colon confirmed by endosopic utrasonographic findings and biopsy findings.

Helicobacter pylori seropositivity is positively associated with colorectal neoplasms.

BACKGROUND/AIMS: Helicobacter pylori is a well known precursor to gastric cancer and gastric mucosa-associated lymphoid tissue lymphoma. This study was to determine whether H. pylori was associated with colorectal neoplasms in Korean subjects undergoing routine checkup. METHODS: A total of 10,082 subjects underwent routine checkups from January 2004 to April 2005. A H. pylori IgG test and stool occult blood test were included in the routine checkup program. Colonoscopy was performed if the stool occult blood test was positive or under subject request. Patients who underwent colonoscopy and had histologically confirmed cases of colorectal neoplasms were designanted as the subject group and those without as the control group. RESULTS: Of the 10,082 subjects, 597 had full colonoscopy. The results identified 9 colorectal carcinomas and 118 adenomas. H. pylori seropositivity was identified in 6 (66%) subjects with colorectal carcinoma, 81 (68.6%) with colorectal adenoma and 248 (52.8%) controls. Subjects having colorectal neoplasms had a significantly higher H. pylori seropositivity rate compared with the controls (OR 1.94, 95% CI 1.28-2.95). This remained significant after adjusting for age, sex, body mass index, HbA1c and total cholesterol (OR 1.90, 95% CI 1.23-2.93). Patients with distal neoplasms also had a significantly higher H. pylori seroposivity rate (OR 1.88, 95% CI 1.17-3.01) which persisted after multivariate adjustment (OR 1.79, 95% CI 1.10-2.94). CONCLUSIONS: Subjects with colorectal neoplasms present an increased H. pylori seroprevalence compared with controls.

Spectrum of final pathological diagnosis of gastric adenoma after endoscopic resection.

AIM: To investigate how many discrepancies occur in patients before and after endoscopic treatment of referred adenoma and the reason for these results. METHODS: We retrospectively reviewed data from 554 cases of 534 patients who were referred from primary care centres for adenoma treatment and treated for endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) at Chungnam National University Hospital, from July 2006 to June 2009. Re-endoscopy was examined in 142 cases and biopsy was performed in 108 cases prior to treatment. Three endoscopists (1, 2 and 3) performed all EMRs or ESDs and three pathologists (1, 2 and 3) diagnosed most of the cases. Transfer notes, medical records and endoscopic pictures of these cases were retrospectively reviewed and analyzed. RESULTS: Adenocarcinoma was 72 (13.0%) cases in total 554 cases after endoscopic treatment of referred adenoma. When the grade of dysplasia was high (55.0%), biopsy number was more than three (22.7%), size was no smaller than 2.0 cm (23.2%), morphologic type was depressed (35.8%) or yamada type IV (100%), and color was red (30.9%) or mixed-or-undetermined (25.0%), it had much more malignancy rate than the others (P < 0.05). All 18 cases diagnosed as adenocarcinoma in the re-endoscopic forceps biopsy were performed by endoscopist 1. There were different malignancy rates according to the pathologist (P = 0.027). CONCLUSION: High grade dysplasia is the most important factor for predicting malignancy as a final pathologic diagnosis before treating the referred gastric adenoma. This discrepancy can occur mainly through inappropriately selecting a biopsy site where cancer cells do not exist, but it also depends on the pathologist to some extent.

Efficacy of initial treatment with clevudine in naive patients with chronic hepatitis B.

BACKGROUND/AIMS: Clevudine, a pyrimidine nucleoside analogue, has potent antiviral effects in patients with chronic viral hepatitis B (CHB). We report the efficacy of initial treatment with clevudine in naïve patients with CHB living in Daejeon and Chungcheong Province, South Korea. METHODS: One hundred five adults with CHB were administered 30 mg of clevudine per day for an average of 51 weeks. We evaluated viral markers and liver biochemistry retrospectively every 3 months. RESULTS: Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and hepatitis B virus (HBV) DNA before the treatment were 184 ± 188 IU/L, 150 ± 138 IU/L, and 7.1 ± 1.2 log copies/mL, respectively. Undetectable rates (< 60 IU/mL) of DNA were 36.2%, 68.9%, 83.6%, 76.2%, and 75.8% at 12, 24, 36, 48, and 60 weeks, respectively. Seroconversion rates were 9.1%, 13.6%, 24.6%, 26.5%, and 26.1% and ALT normalization rates were 64.5%, 78.1%, 87.9%, 90.0% at 12, 24, 36, and 48 weeks, respectively. Six patients (5.7%) had a viral breakthrough. CONCLUSIONS: Clevudine is a useful drug in the initial treatment of patients with CHB, with a potent antiviral effect and low incidence of viral breakthrough.

[Change of Clostridium difficile colitis during recent 10 years in Korea].

BACKGROUND/AIMS: Our clinical experience and recent published literatures suggest that Clostridium difficile colitis (CDC) has become more common and potentially more pathogenic in recent years. The aim of study was to evaluate changes in the epidemiological features of CDC in hospitalized patients in Korea. METHODS: We retrospectively reviewed all patients of CDC diagnosed at Kangnam St. Mary Hospital from 1998 to 2007. CDC was defined as having a positive C. difficile cytotoxicity assay, or endoscopic or pathologic evidence of CDC. RESULTS: A total of 189 cases (male 73, female 116, mean age 63.3 years) of CDC were diagnosed during the study period. The prevalence of CDC increased from 1.9/10,000 patient admissions in 1998-1999 to 8.82/10,000 patient admissions in 2006-2007. One hundred sixty three indication for cases (86.2%) of patients identified a prior use of antibiotics in the 2 months preceding diagnosis. The most common antibiotic use was prophylactic use during perioperational period (33.3%) followed by pneumonia (23.3%). The overall response rate to initial antibiotics was 82.7%. One hundred seventy two (91%) patients were initially treated with metronidazole. The response rate was 84.3%. All patients with initial failure to metronidazole were successfully treated by vancomycin. The response rate of vancomycin as first treatment was 80%. Three deaths were associated with CDC despite the use of combination of metronidazole and vancomycin. CONCLUSIONS: The prevalence of CDC in hospitalized patients in Korea significantly increased from 1998 to 2007.

Diagnostic value of the PPI test for detection of GERD in Korean patients and factors associated with PPI responsiveness.

OBJECTIVES: Data supporting the use of the proton pump inhibitor (PPI) test as a diagnostic test of gastroesophageal reflux disease (GERD) in Asia are lacking. The aims of this study were to evaluate the diagnostic characteristics of the PPI test and factors associated with responsiveness to PPIs. METHODS: The PPI test was evaluated using lansoprazole (30 mg bid) for two weeks. All patients underwent endoscopy after symptom assessment. Patients without erosive esophagitis (ERD) underwent 48 h esophageal Bravo pH monitoring. Subjects were considered to be responsive to PPIs if they reported a > 50% reduction in reflux symptom score. RESULTS: Seventy-three patients (M:F = 40:37, 47 +/- 13 years) were enrolled. We identified 46 patients with ERD, 18 patients with nonerosive reflux disease (NERD) and 9 patients without GERD. The PPI response rate was higher in patients with GERD than in patients without GERD (49/64, 77% vs. 4/9, 44%; p < 0.05). The sensitivity, specificity, and positive and negative predictive values were 77%, 56%, 92% and 25%, respectively. The PPI responsiveness was 80% (37/46) in the ERD group and 67% (12/18) in the NERD group. PPI response was not affected by age, sex, Helicobacter pylori, the psychological characteristics or cytochrome P2C genotypes. ERD and symptom-reflux association were the factors affecting PPI responsiveness. CONCLUSIONS: The PPI test was modestly sensitive and specific for diagnosing GERD. However, it would be useful for discriminating patients with ERD. In the NERD group, patients with positive symptom-reflux association would be most benefit from PPI treatment.

Clinical outcomes of self-expandable metal stent and prognostic factors for stent patency in gastric outlet obstruction caused by gastric cancer.

The aim of this study was to assess clinical outcomes of endoscopic stenting for a gastric outlet obstruction caused by gastric cancer and the prognostic factors for stent patency by reviewing medical records. Eighty-one stents were inserted into 75 patients (48 men, average age 66 years). The technical and clinical success rates were 98 and 87%, respectively. The median stent patency was 55 days (95% CI 40-70 days). The median survival was 79 days (95% CI 58-123 days). Stent reobstruction caused by tumor ingrowth or overgrowth occurred in 25 cases (31%). Cox multivariate regression analysis showed that covered stents (odds ratio 0.29, 95% CI 0.11-0.76; P = 0.01) and chemotherapy after stent placement (odds ratio 0.34, 95% CI 0.13-0.91; P = 0.03) were significant prognostic factors for stent patency. This study found that endoscopic stenting is a safe and effective palliation treatment for malignant gastric outlet obstruction and a covered stent and chemotherapy are significant prognostic factors for stent patency.

Clinical outcomes of self-expandable metal stents in palliation of malignant anastomotic strictures caused by recurrent gastric cancer.

AIM: To examine the technical feasibility and clinical outcomes of the endoscopic insertion of a self-expandable metal stent (SEMS) for the palliation of a malignant anastomotic stricture caused by recurrent gastric cancer. METHODS: The medical records of patients, who had obstructive symptoms caused by a malignant anastomotic stricture after gastric surgery and underwent endoscopic insertion of a SEMS from January 2001 to December 2007 at Kangnam St Mary's Hospital, were reviewed retrospectively. RESULTS: Twenty patients (15 male, mean age 63 years) were included. The operations were a total gastrectomy with esophagojejunostomy (n = 12), subtotal gastrectomy with Billroth-I reconstruction (n = 2) and subtotal gastrectomy with Billroth-II reconstruction (n = 8). The technical and clinical success rates were 100% and 70%, respectively. A small bowel or colon stricture was the reason for a lack of improvement in symptoms in 4 patients. Two of these patients showed improvement in symptoms after another stent was placed. Stent reobstruction caused by tumor ingrowth or overgrowth occurred in 3 patients (15%) within 1 mo after stenting. Stent migration occurred with a covered stent in 3 patients who underwent a subtotal gastrectomy with Billroth-II reconstruction. Two cases of partial stent migration were easily treated with a second stent or stent repositioning. The median stent patency was 56 d (range, 5-439 d). The median survival was 83 d (range, 12-439 d). CONCLUSION: Endoscopic insertion of a SEMS provides safe and effective palliation of a recurrent anastomotic stricture caused by gastric cancer. A meticulous evaluation of the presence of other strictures before inserting the stent is essential for symptom improvement.

Is it reasonable to treat early gastric cancer with signet ring cell histology by endoscopic resection? Analysis of factors related to lymph-node metastasis.

BACKGROUND/AIM: Early gastric cancer (EGC) with signet ring cell histology has a more favorable prognosis than other undifferentiated gastric adenocarcinomas. The presence of lymph-node metastasis is the most important factor in treating EGC by endoscopic resection. The aim of this study was to identify the factors predicting successful endoscopic treatment of EGC with signet ring cell histology. METHODS: Data from 215 patients who had undergone gastrectomy with D2 lymph-node dissection for EGC with signet ring cell histology between January 1999 and December 2007 were retrospectively reviewed. Associations between various clinicopathological factors and the presence of lymph-node metastasis were analyzed to identify factors predictive of lymph-node metastasis. RESULTS: The overall incidence of lymph-node metastasis was 7.9%: 1.9% with intramucosal cancer and 6% with submucosal cancer. Univariate analysis identified the depth of tumor invasion to the submucosa and positive lymphatic-vascular involvement as associated with lymph-node metastasis (both P<0.01). On multivariate analysis, positive lymphatic-vascular involvement was the most significant factor related to lymph-node metastasis (odds ratio: 43.7; 95% confidence interval: 8.7-220.9), followed by the depth of invasion (odds ratio: 4.87; 95% confidence interval: 1.02-23.21). Patients with EGC with signet ring cell histology and a diameter of less than 25 mm, invasion within the sm2 layer, and no lymphatic-vascular involvement had no lymph-node metastasis. CONCLUSION: EGC with signet ring cell histology can be treated by endoscopic mucosal resection, if it is smaller than 25 mm, limited within the sm2 layer, and does not involve the lymphatic-vascular structure. More extensive prospective data are required to confirm definitive guidelines for the endoscopic treatment of patients with EGC with signet ring cell histology.

[Relationship between pepsinogen I/II ratio and age or upper gastrointestinal diseases in Helicobacter pylori-positive and -negative subjects].

BACKGROUND/AIMS: Although previous reports suggested that pepsinogen (PG) I/II ratio was the index of gastric atrophy, PG I/II ratio was also related to other factors such as Helicobacter pylori (H. pylori) infection, various gastrointestinal diseases, and aging. The aim of this study was to evaluate the relationship between serum PG I/II ratio and age or upper gastro-intestinal diseases according to H. pylori infection status. METHODS: A total of 529 individuals (307 male; mean age, 57.2 years) were divided into 4 groups (94 gastric ulcers, 35 duodenal ulcers, 105 reflux esophagitis, and 295 atrophic gastritis) according to endoscopic diagnosis. H. pylori infection was determined by H. pylori IgG antibody (ELISA) and PG was measured by latex immunoassay. RESULTS: H. pylori infected patients showed markedly increased serum PG II levels (24.0+/-14.7 ng/mL vs. 13.8+/-16.6 ng/mL, p0.001) and low PG I/II ratio (3.9+/-2.0 vs. 6.0+/-2.5, p0.001) than non-infected subjects. In H. pylori infected patients, mean PG I/II ratios in the gastric ulcer and atrophic gastritis group were significantly lower than those of the duodenal ulcer and reflux esophagitis group (p0.001, ANOVA, Turkey's multiples comparison test). The mean ratio of open type atrophic gastritis was lower than that of close type atrophic gastritis (3.0+/-1.4 vs. 3.8+/-1.7, p0.005). PG I/II ratio gradually decreased with age in H. pylori-infected patients with atrophic gastritis (R(2)=0.9, p=0.005, linear regression analysis). CONCLUSION: Serum PG I/II ratio reflects H. pylori infection and gastric atrophy. In the presence of H. pylori infection, gastric atrophy progresses with age.