Immunoglobulin G-mediated food intolerance and metabolic syndrome influence the occurrence of reflux esophagitis in Helicobacter pylori-infected patients.

BACKGROUND: Reflux esophagitis has an increasing prevalence and complex and diverse symptoms. Identifying its risk factors is crucial to understanding the etiology, prevention, and management of the disease. The occurrence of reflux esophagitis may be associated with food reactions, Helicobacter pylori (H. pylori) infection, and metabolic syndromes. AIM: To investigate the risk factors for reflux esophagitis and analyze the effects of immunoglobulin (Ig) G-mediated food intolerance, H. pylori infection, and metabolic syndrome on reflux esophagitis. METHODS: Outpatients attending the Second Medical Center of the PLA General Hospital between 2017 and 2021 were retrospectively enrolled. The patients' basic information, test results, gastroscopy results, H. pylori test results, and IgG-mediated food intolerance results were collected. Multivariate logistic regression analysis was used to analyze risk factors for reflux esophagitis. Statistical mediation analysis was used to evaluate the effects of IgG-mediated food intolerance and metabolic syndrome on H. pylori infection affecting reflux esophagitis. RESULTS: A total of 7954 outpatients were included; the prevalence of reflux esophagitis, IgG-mediated food intolerance, H. pylori infection, and metabolic syndrome were 20.84%, 61.77%, 35.91%, and 60.15%, respectively. Multivariate analysis showed that the independent risk factors for reflux esophagitis included IgG-mediated food intolerance (OR = 1.688, 95%CI: 1.497-1.903, P < 0.00001) and metabolic syndrome (OR = 1.165, 95%CI: 1.030-1.317, P = 0.01484), and the independent protective factor for reflux esophagitis was H. pylori infection (OR = 0.400, 95%CI: 0.351-0.456, P < 0.00001). IgG-mediated food intolerance had a partially positive mediating effect on H. pylori infection as it was associated with reduced occurrence of reflux esophagitis (P = 0.0200). Metabolic syndrome had a partially negative mediating effect on H. pylori infection and reduced the occurrence of reflux esophagitis (P = 0.0220). CONCLUSION: Patients with IgG-mediated food intolerance and metabolic syndrome were at higher risk of developing reflux esophagitis, while patients with H. pylori infection were at lower risk. IgG-mediated food intolerance reduced the risk of reflux esophagitis pathogenesis in patients with H. pylori infection; however, metabolic syndrome increased the risk of patients with H. pylori infection developing reflux esophagitis.

Helicobacter pylori infection and small intestinal bacterial overgrowth: a systematic review and meta-analysis.

BACKGROUND: There is a link between Helicobacter pylori (HP) infection and small intestinal bacterial overgrowth (SIBO) with nonspecific digestive symptoms. Nonetheless, whether HP infection is associated with SIBO in adults remains unclear. Based on a meta-analysis, we evaluated this relationship. RESULTS: Observational studies relevant to our research were identified by searching PubMed, Embase, the Cochrane Library, and the Web of Science. We evaluated between-study heterogeneity using the Cochrane Q test and estimated the I2 statistic. Random-effects models were used when significant heterogeneity was observed; otherwise, fixed-effects models were used. Ten datasets from eight studies, including 874 patients, were involved in the meta-analysis. It was shown that HP infection was related to a higher odds of SIBO (odds ratio [OR]: 1.82, 95% confidence interval: 1.29 to 2.58, p < 0.001) with mild heterogeneity (p for Cochrane Q test = 0.11, I2 = 7%). Subgroup analyses showed that HP infection was related to SIBO in young patients (mean age < 48 years, OR: 2.68, 95% CI: 1.67 to 4.28, p < 0.001; I2 = 15%) but not in older patients (mean age ≥ 48 years, OR: 1.15, 95% CI: 0.69 to 1.92, p < 0.60; I2 = 1%; p for subgroup difference = 0.02). Subgroup analyses further indicated that the association was not significantly affected by the country of study, comorbidities, exposure to proton pump inhibitors, or methods of evaluating HP infection and SIBO. CONCLUSIONS: HP infection may be related to SIBO in adults, which supports the detection of SIBO in patients with digestive symptoms and HP infection.

Temperature variability and common diseases of the elderly in China: a national cross-sectional study.

BACKGROUND: In the context of climate change, it has been well observed that short-term temperature variability (TV) could increase the overall and cause-specific mortality and morbidity. However, the association between long-term TV and a broader spectrum of diseases is not yet well understood, especially in the elderly. METHODS: Our study used data from the fourth Urban and Rural Elderly Population (UREP) study. Long-term TV was calculated from the standard deviation (SD) of daily minimum and maximum temperatures within the study periods (2010-2014, 2011-2014, 2012-2014, 2013-2014, and 2014). Ten self-reported diseases and conditions were collected by questionnaire, including cataract, hypertension, diabetes, cardio-cerebrovascular diseases, stomach diseases, arthritis, chronic lung disease, asthma, cancer, and reproductive diseases. The province-stratified logistic regression model was used to quantify the association between long-term TV and the prevalence of each disease. RESULTS: A total of 184,047 participants were included in our study. In general, there were significant associations between TV and the prevalence of most diseases at the national level. Cardio-cerebrovascular disease (OR: 1.16, 95% CI: 1.13, 1.20) generated the highest estimates, followed by stomach diseases (OR: 1.15, 95% CI: 1.10, 1.19), asthma (OR: 1.14, 95% CI: 1.06, 1.22), chronic lung diseases (OR: 1.08, 95% CI: 1.03, 1.13), arthritis (OR: 1.08, 95% CI: 1.05, 1.11), and cataract (OR: 1.06, 95% CI: 1.02, 1.10). Moreover, the associations varied by geographical regions and across subgroups stratified by sex, household income, physical activity, and education. CONCLUSIONS: Our study showed that long-term exposure to TV was associated with the prevalence of main diseases in the elderly. More attention should be paid to the elderly and targeted strategies should be implemented, such as an early warning system.

Preliminary study on visual recognition under low visibility conditions caused by artificial dynamic smog.

AIM: To quantitatively evaluate the effect of a simulated smog environment on human visual function by psychophysical methods. METHODS: The smog environment was simulated in a 40×40×60 cm3 glass chamber filled with a PM2.5 aerosol, and 14 subjects with normal visual function were examined by psychophysical methods with the foggy smog box placed in front of their eyes. The transmission of light through the smog box, an indication of the percentage concentration of smog, was determined with a luminance meter. Visual function under different smog concentrations was evaluated by the E-visual acuity, crowded E-visual acuity and contrast sensitivity. RESULTS: E-visual acuity, crowded E-visual acuity and contrast sensitivity were all impaired with a decrease in the transmission rate (TR) according to power functions, with invariable exponents of -1.41, -1.62 and -0.7, respectively, and R2 values of 0.99 for E and crowded E-visual acuity, 0.96 for contrast sensitivity. Crowded E-visual acuity decreased faster than E-visual acuity. There was a good correlation between the TR, extinction coefficient and visibility under heavy-smog conditions. CONCLUSION: Increases in smog concentration have a strong effect on visual function.

[Characteristics of Water-soluble Inorganic Ions in PM2.5 and PM2.5-10 in Mountain Background Region of East China in Spring].

PM2.5 and PM2.5-10 samples were collected during March to May of 2014 at the National atmospheric background monitoring station (Wuyishan station) in Fujian Province. Water-soluble inorganic ions in PM2.5 and PM2.5-10 were determined. Meteorological parameters and air pollutants including SO2, NO2, O3, PM10 and PM2.5 were also recorded. The results showed the total water-soluble inorganic ions concentrations were (8.3 ± 2.8 ) µg x m(-3) and (1.3 ± 0.9) µg x m(-3), which accounted for (43.7 ± 7.5) % and (24.4 ± 6.4) % of the PM2.5 and PM2.5-10 mass, respectively. Sulfate and nitrate were the dominant ions in PM2.5 and PM2.5-10, respectively, which accounted for (32.4 ± 6.3) % and (8.9 ± 3.7) % of them, respectively. Sulfate mainly existed in fine particle in the forms of (NH4)2SO4 and K2SO4, while nitrate mainly existed in coarse particle in the form of Mg(NO3)2. The water-soluble inorganic ions at the Wuyishan background monitoring station in spring mainly came from long-distance transportation of dust , sea salt and pollutant of heavy polluted regions.

[Influence of atmospheric transport on air pollutant levels at a mountain background site of East China].

Transport characteristics of air pollutants transported to the background atmosphere of East China were investigated using HYSPLIT (Hybrid Single Particle Lagrangian Integrated Trajectory) 4.8 model driven by NCEP reanalysis data during June 2011 to May 2012. Based on the air pollutants monitoring data collected at the National atmospheric background monitoring station (Wuyishan station) in Fujian Province, characteristics of different clustered air masses as well as the origins of highly polluted air masses were further examined. The results showed that 65% of all the trajectories, in which air masses mainly passed over highly polluted area of East China, Jiangxi province and upper air in desert areas of Northwest China, carried polluted air to the station, while the rest of trajectories (35%) with air masses originated from ocean could effectively remove air pollutants at the Wuyishan station. However, the impact on the air pollutants for each air mass group varied with seasons. Elevated SO2 concentrations observed at the background station were mainly influenced by coal burning activities in Northern China during heating season. The high CO concentrations were likely associated with the pollutants emission in the process of coal production and consumption in Anhui province. The elevated NO(x), O3, PM10 and PM2.5 concentrations were mostly impacted by East China with high levels of air pollutants.

[Characteristics and impact factors of O3 concentrations in mountain background region of East China].

The O3 concentrations were measured online from March 2011 to February 2012 at the national atmospheric background monitoring station in Wuyishan of Fujian Province to discuss the characteristic of O3 concentrations and the impact factors in forest and mountain background region of East China. HYSPLIT (Hybrid Single Particle Lagrangian Integrated Trajectory) Model was used to investigate the potential sources of particulates during the pollution episodes. The results showed that the background concentration of O3 was (87.9 +/- 34.1) microg x m(-3). Seasonal variations of O3 loadings were observed, and the loadings decreased in the order spring > autumn > summer > winter. Analysis of correlation between O3 and other gas pollutants suggested regional transportation, stratospheric injection and photochemical production were the major sources of O3 in Wuyishan background station. The episodes were related with transportations of air parcel from Yangtze River Delta region, Pearl River Delta region and the high altitudes.

Mesenchymal stem cells alleviate TNBS-induced colitis by modulating inflammatory and autoimmune responses.

AIM: To investigate the potential therapeutic effects of mesenchymal stem cells (MSCs) in inflammatory bowel disease (IBD), we transplanted MSCs into an experimental model of IBD. METHODS: A rectal enema of trinitrobenzene sulfonic acid (TNBS) (100 mg/kg body weight) was administered to female BALB/c mice. Bone marrow mesenchymal stem cells (BMSCs) were derived from male green fluorescent protein (GFP) transgenic mice and were transplanted intravenously into the experimental animals after disease onset. Clinical activity scores and histological changes were evaluated. GFP and Sex determining region Y gene (SRY) expression were used for cell tracking. Ki67 positive cells and Lgr5-expressing cells were determined to measure proliferative activity. Inflammatory response was determined by measuring the levels of different inflammatory mediators in the colon and serum. The inflammatory cytokines included tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), interleukin-2 (IL-2), IL-6, IL-17, IL-4, IL-10, and transforming growth factor (TGF-ß). Master regulators of Th1 cells (T-box expressed in T cells, T-bet), Th17 cells (retinoid related orphan receptor gamma(t), RORγt), Th2 cells (GATA family of transcription factors 3, GATA3) and regulatory T cells (forkhead box P3, Foxp3) were also determined. RESULTS: Systemic infusion of GFP-BMSCs ameliorated the clinical and histopathologic severity of colitis, including body weight loss, diarrhea and inflammation, and increased survival (P < 0.05). The cell tracking study showed that MSCs homed to the injured colon. MSCs promoted proliferation of intestinal epithelial cells and differentiation of intestinal stem cells (P < 0.01). This therapeutic effect was mainly mediated by down-regulation of both Th1-Th17-driven autoimmune and inflammatory responses (IL-2, TNF-α, IFN-γ, T-bet; IL-6, IL-17, RORγt), and by up-regulation of Th2 activities (IL-4, IL-10, GATA-3) (P < 0.05). MSCs also induced activated CD4(+)CD25(+)Foxp3(+) regulatory T cells (TGF-ß, IL-10, Foxp3) with a suppressive capacity on Th1-Th17 effecter responses and promoted Th2 differentiation in vivo (P < 0.05). CONCLUSION: MSCs are key regulators of immune and inflammatory responses and may be an attractive candidate for cell-based therapy of IBD.

[A retrospective study of 22 years endoscopic follow-up in elderly patients with gastrointestinal submucosal tumors].

OBJECTIVE: To observe the occurrence characteristics, dynamic variations and potential risks of smaller gastrointestinal submucosal tumor (SMT) in elderly patients. METHODS: A total of 54 SMT patients were retrospectively recruited from January 1981 to September 2010. There were 51 males (94.4%) and 3 females (5.6%) with an average age of (74 ± 1) years. During each visit, all the relevant data were collected, including symptoms, number of lesion, lesion location, shape, size (maximum transverse diameter under endoscope or endoscopic ultrasonography (EUS), morphology of mucosa, frequency and duration of follow-ups, treatment and pathological results. And the data were analyzed to examine the characteristics of SMT in elderly patients and their dynamic variations. Further more, according to lesion diameter, they were divided into two groups: a diameter ≤ 1 cm (n = 36) and a diameter > 1 cm and ≤ 3 cm (n = 16). Then the change of two groups were observed and compared during the follow-ups. RESULTS: Two cases were not under surveillance after direct surgical resection. The other 52 patients received a follow-up of 22 years. Among them, 5 patients underwent surgical resection for fast-growing tumor and mucosal ulcer. And all their pathologic diagnoses were malignant. Only 1 patient (2.8%) in the diameter ≤ 1 cm group and 4 in the diameter > 1 cm and ≤ 3 cm group turned malignant at 6 years. But, among 4 patients, the shortest interval was merely 14 months. Therefore, compared with the diameter > 1 cm group, the diameter ≤ 1 cm group had a lower rate of malignancy (P < 0.05). CONCLUSIONS: The incidence of smaller SMT (especially diameter ≤ 1 cm) is high in elderly patients, but the malignant potential remains low. Therefore, for elderly patients whose diameters of SMT are no bigger than 3 cm and without obvious malignancy under endoscope or EUS, we may plan an appropriate surveillance interval based on the size of tumor during a long follow-up period.

[Characteristics of PM10 and PM2.5 concentrations in mountain background region of East China].

The online PM10 and PM2.5 concentrations were measured from March 2011 'to February 2012 at the national atmospheric background monitoring station in Wuyishan of Fujian Province to discuss the characteristic of PM10 and PM2.5 concentrations and the impact factors in forest and mountain background region of East China. HYSPLIT (Hybrid Single Particle Lagrangian Integrated Trajectory) Model was used to investigate the potential sources of particulates during the pollution episodes. The results showed that the background concentrations of PM10 and PM2.5 were (23 +/- 16) microg.m-3 and (18 +/- 12) microg.m-3, respectively. Seasonal variations of PMl0 and PM2.5 loadings were observed, and loadings decreased in the same order: spring > autumn > winter > summer. PM10 and PM2.5 concentrations were obviously higher in spring than in other seasons because of the transportation of dust storm. The fine particles were the dominant pollutant which accounted for 76% of PM10. The good correlation between PM10/PM2.5 and gas pollutants suggested that regional transportation and secondary aerosol were the major sources in the background station. One episode occurring in April 2011 was related with the transportation of dust storm. However, another episode occurring in September 2011 had close relationship with the transportation of higher pollutant loadings in East China.

[The value of serum intestinal fatty acid binding protein measurement in discriminating intestinal ischemia in patients with acute abdomen].

OBJECTIVE: To assess the differential diagnostic value of serum intestinal fatty acid binding protein (I-FABP) in distinguishing intestinal ischemia patients from acute abdomen patients. METHODS: A total of 151 patients with acute abdomen and 17 healthy controls from the PLA General Hospital were enrolled from November, 2009 to August, 2011. Serum I-FABP levels were measured by ELISA. According to the ROC curve, the cut-off value, sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS: Of the 151 acute abdomen patients, there were 24 intestinal ischemia patients and 127 without intestinal ischemia. Serum I-FABP level in intestinal ischemia group [(109.67 ± 48.82) µg/L] was significantly higher than those in patients without intestinal ischemia [(36.78 ± 11.25) µg/L] and healthy controls[(8.33 ± 6.25) µg/L](all P values < 0.01). The serum I-FABP cut-off value for the diagnosis of intestinal ischemia was 87.52 µg/L. Serum I-FABP was efficient in terms of sensitivity (0.762), NPV(0.963), PLR(3.05) and NLR (0.24) in the diagnosis of intestinal ischemia. CONCLUSION: I-FABP is potentially useful for discriminating intestinal ischemia from acute abdomen.

Role of serum carcinoembryonic antigen in the detection of colorectal cancer before and after surgical resection.

AIM: To determine whether serum levels of carcinoembryonic antigen (CEA) correlate with the presence of primary colorectal cancer (CRC), and/or recurrent CRC following radical resection. METHODS: A total of 413 patients with CRC underwent radical surgery between January 1998 and December 2002 in our department and were enrolled in this study. The median follow-up period was 69 mo (range, 3-118 mo), and CRC recurrence was experienced by 90/413 (21.8%) patients. Serum levels of CEA were assayed preoperatively, and using a cutoff value of 5 ng/mL, patients were divided into two groups, those with normal serum CEA levels (e.g., ≤ 5 ng/mL) and those with elevated CEA levels (> 5 ng/mL). RESULTS: The overall sensitivity of CEA for the detection of primary CRC was 37.0%. The sensitivity of CEA according to stage, was 21.4%, 38.9%, and 41.7% for stages I-III, respectively. Moreover, for stage II and stage III cases, the 5-year disease-free survival rates were reduced for patients with elevated preoperative serum CEA levels (P < 0.05). The overall sensitivity of CEA for detecting recurrent CRC was 54.4%, and sensitivity rates of 36.6%, 66.7%, and 75.0% were associated with cases of local recurrence, single metastasis, and multiple metastases, respectively. In patients with normal serum levels of CEA preoperatively, the sensitivity of CEA for detecting recurrence was reduced compared with patients having a history of elevated CEA prior to radical resection (32.6% vs 77.3%, respectively, P < 0.05). CONCLUSION: CRC patients with normal serum CEA levels prior to resection maintained these levels during CRC recurrence, especially in cases of local recurrence vs cases of metastasis.

[Results of a 5-year population-based followed-up for 367 ulcerative colitis patients].

OBJECTIVE: To investigate the prognostic and relapsing factors of ulcerative colitis by a 5-year population-based follow-up. METHODS: A total of 525 patients diagnosed with ulcerative colitis during the period from 1994 to 2005 at our hospital were recruited and followed prospectively for 5 years or until a relapse. The evaluation at 5 years included interview, clinical examination, laboratory tests and colonoscopy. RESULTS: Among these patients, 367 patients suffered from a relapse of ulcerative colitis with a median age of 42 years old. And 263 (50.1%) patients took part in the follow-up study. The median duration of maintenance treatment was (16.3±3.9) months. The proportion of relapse was significant greater in females (P<0.05) and in patients over 60 years old versus those under 60 (P<0.05). The value of CRP was unrelated with the relapsing rate (P>0.05). During the follow-up, 36.5% of the patients relapsed within 12 months, 75.3% within 2 years and 87.8% within 5 years. And 61.5% of the patients relapsed after drug withdrawal, 11.3% in maintenance treatment and 27.2% with no treatment. Severity, extent of disease and duration of maintenance treatment showed significant differences between the relapsing group and relapsing-free groups (P<0.05). CONCLUSION: The relapsing factors of ulcerative colitis are gender, age, severity, extent of disease and duration of maintenance treatment.