Efficacy and safety of endoscopic submucosal dissection for early gastric cancer and precancerous lesions in elderly patients.

BACKGROUND: With advancements in the development of endoscopic technologies, the endoscopic submucosal dissection (ESD) has been one of the gold-standard therapies for early gastric cancer. AIM: To investigate the efficacy and safety ESD in the treatment of early gastric cancer and precancerous lesions in the elderly patients. METHODS: Seventy-eight elderly patients with early gastric cancer and precancerous lesions admitted to the Third Affiliated Hospital of Qiqihar Medical University were selected and classified into two groups according to the different surgical therapies they received between January 2021 and June 2022. Among them, 39 patients treated with ESD were included in an experimental group, and 39 patients treated with endoscopic mucosal resection (EMR) were included in a control group. We compared the basic intraoperative conditions, postoperative short-term recovery, long-term recovery effects and functional status of gastric mucosa between the two groups; the basic intraoperative conditions included lesion resection, intraoperative bleeding and operation time; the postoperative short-term recovery assessment indexes were length of hospital stay and incidence of surgical complications; and the long-term recovery assessment indexes were the recurrence rate at 1 year postoperatively and the survival situation at 1 year and 3 years postoperatively; and we compared the preoperative and predischarge serum pepsinogen I (PG I) and PG II levels and PG I/PG II ratio in the two groups before surgery and discharge. RESULTS: The curative resection rate and the rate of en bloc resection were higher in the experimental group than in the control group. The intraoperative bleeding volume was higher in the experimental group than in the control group. The operation time was longer in the experimental group than that in the control group, and the rate for base residual focus was lower in the experimental group than that of the control group, and the differences were all statistically significant (all P < 0.05). The length of hospital stay was longer in the experimental group than in the control group, and the incidence of surgical complications, 1-year postoperative recurrence rate and 3-year postoperative survival rate were lower in the experimental group than in the control group, and the differences were statistically significant (all P < 0.05). However, the difference in the 1-year postoperative survival rate was not statistically significant between the two groups (P > 0.05). Before discharge, PG I and PG I/PG II ratio were elevated in both groups compared with the preoperative period, and the above indexes were higher in the experimental group than those in the control group, and the differences were statistically significant (both P < 0.05). Moreover, before discharge, PG II level was lower in both groups compared with the preoperative period, and the level was lower in the experimental group than in the control group, and the differences were all statistically significant (all P < 0.05). CONCLUSION: Compared with EMR, ESD surgery is more thorough. It reduces the rate of base residual focus, recurrence rate, surgical complications, and promotes the recovery of gastric cells and glandular function. It is safe and suitable for clinical application.

Pepsin concentration in oral lavage fluid of rabbit reflux model constructed by dilating the lower esophageal sphincter.

The aim of this study was to explore the changes in pH and pepsin concentrations in oral lavage fluid of rabbit reflux model. A total of 18 New Zealand rabbits were randomly divided into two groups. The lower esophageal sphincters (LESs) of the rabbits in the experimental group (EG) were dilated by balloon after the LESs were localized by manometry. The pH levels of the throat and the lower esophagus were monitored 1 week before and 2 weeks after inflation. Oral lavage fluid was collected 1 week before, and 2 and 8 weeks after inflation. The pH monitoring showed that the percentage of reflux time, the number of reflux events, and the longest time of reflux after the dilation (AE) in the EG were significantly higher than before the dilation (P < 0.01). The pepsin concentrations at 2 and 8 weeks AE in the EG were significantly higher than that before and that in the control group (P < 0.05). Based on receiver operating characteristic curve analysis, the best diagnostic threshold value was 30.3 ng/ml. The reflux model constructed by balloon inflation of the LES in rabbits is characterized by a decrease in throat pH and an increase in salivary pepsin concentration.

A Comparison Between W Score and RYAN Score in Diagnosing Laryngopharyngeal Reflux Disease.

OBJECTIVE: To assess the diagnostic value of the W score in differentiating laryngopharyngeal reflux disease (LPRD) patients from the normal population by pharyngeal pH (Dx-pH) monitoring, compared with the RYAN score. METHODS: One hundred and eight patients with suspected LPRD and complete follow-up results after more than 8 weeks of anti-reflux therapy were enrolled from the Department of Otolaryngology-Head and Neck Surgery, Gastroenterology and Respiratory Medicine of seven hospitals. Their Dx-pH monitoring data before treatment were reanalyzed to obtain the W score in addition to the RYAN score and then the diagnostic sensitivity and specificity were compared and evaluated with reference to the result of anti-reflux therapy. RESULTS: In eighty-seven (80.6%) cases, anti-reflux therapy was effective, and in 21 patients (19.4%), therapy was ineffective. Twenty-seven patients (25.0%) had a positive RYAN score. The W score was positive in 79 (73.1%) patients. There were 52 patients who had a negative RYAN score, but a positive W score. The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of the RYAN score were 28.7%, 90.5%, 92.6%, and 23.5%, respectively (kappa = 0.092, P = 0.068), whereas those of the W score for LPRD was 83.9%, 71.4%, 92.4%, and 51.7%, respectively (kappa = 0.484, P < 0.001). CONCLUSIONS: W score is much more sensitive for the diagnosis of LPRD. Prospective studies with larger patient populations are necessary to validate and improve diagnostic efficacy. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR1800014931.

A Novel Strategy for the Treatment of Allergic Rhinitis: Regulating Treg/Th17 and Th1/Th2 Balance In Vivo by Vitamin D.

Objective: This prospective study is aimed at observing the number of nasal itching and sneezing in rats from the macroscopic level and examine the pathological changes of nasal mucosa, Th1 and Th2-related cytokines, and Treg/Th17 by vitamin D3 administration from the microscopic level, in order to explore the role of vitamin D in allergic rhinitis and to provide theoretical guidance for prevention and treatment. Results: There were significant differences in nasal itching and sneezing between the administration groups and the positive groups. Meanwhile, the level of Th1 and Treg in the administration groups increased, while the level of Th2 and Th17 decreased, indicating that the balance of Th1/Th2 was corrected. Our study revealed that vitamin D3 has preventive and therapeutic effects on allergic rhinitis, which provides theoretical guidance for practical application.

[Analysis of the effect of noninvasive positive-pressure ventilation with simultaneous detection of Dx-pH monitoring in oropharynx and esophagus for 48 hours in patients with moderate and severe OSA].

Objective:To investigate the effect of noninvasive positive-pressure ventilation（NPPV） on the related indexes of gastroesophageal reflux（GER） and laryngopharyngeal reflux（LPR） in patients with moderate and severe obstructive sleep apnea（OSA）. Method:This was a retrospective study of 23 cases with moderate or severe OSA and suspected laryngopharyngeal reflux disease （LPRD）. The results of 48h-pH monitoring of oropharynx and esophagus, polysomnography（PSG） and NPPV were analyzed to explore the relationship between reflux related parameters and sleep disordered respiratory. To analyze the impact of NPPV on reflux, the data related to nocturnal reflux with or without NPPV treatment was compared. Result:On the first day of Dx-pH, 5 cases of LPRD were diagnosed with a positive Ryan score rate of 21.7%. There were 19 cases（82.6%） with more than one nocturnal reflux event with pH6.0 as the threshold. Ten cases of GERD were diagnosed with a positive DeMeester score rate of 43.5%. The lowest pH value of oropharynx and esophagus was negatively correlated with the obstructive apnea index（OAI）. The total number of reflux episodes falling below pH thresholds of 6.0 and the duration of the longest episode of gastroesophageal reflux were positively correlated with AHI and OAI（P<0.05）. On the night of NPPV treatment, the lowest pH value in the oropharynx increased, while the total number of reflux episodes below pH6.0 and the percentage time below pH5.0 decreased（P<0.05）. Similar significant difference was found in the GER parameters（P<0.05）. Conclusion:OSA patients were associated with a higher incidence of GER at night and a certain degree of LPR. NPPV treatment can not only effectively improve GER, but also reduce LPR to a certain extent.

Relationship between reflux diseases and obstructive sleep apnea together with continuous positive airway pressure treatment efficiency analysis.

BACKGROUND: Obstructive sleep apnea (OSA) is known to be highly associated with reflux diseases. There is evidence that continuous positive airway pressure (CPAP) can decrease the clinical symptoms of gastroesophageal reflux (GER) in OSA patients, but whether CPAP can decrease nocturnal laryngopharyngeal reflux (LPR) episodes is still lack of strong evidence. OBJECTIVE: To investigate the efficiency of CPAP on LPR and the relationship between LPR, GER and OSA. STUDY DESIGN: retrospective study. METHODS: Forty adult patients who had confirmed OSA by polysomnography and suspected LPR were enrolled. Their results of synchronous polysomnography and 24 h esophageal and oropharyngeal Dx-pH monitoring were analyzed. Twenty-seven OSA patients were treated with CPAP on the second night. The nocturnal reflux parameters with and without CPAP treatment were compared. RESULTS: 15.0% and 42.5% of OSA patients were associated with LPR and GER through Dx-pH monitoring respectively. Nevertheless, more than one reflux attack falling below pH6.0 of oropharynx during sleep time was detected in 80.0% patients. There was a significant inverse correlation between the lowest/mean pH values of oropharynx and obstructive apnea index (OAI), so was the lowest pH values of esophagus. Significant positive correlation was calculated between the total number of reflux episodes below pH6.0 of oropharynx and apnea-hypopnea index (AHI)/OAI/hypopnea index (HI). A similar positive correlation was also significant between AHI/OAI and GER parameters. The assessment of the efficacy of CPAP treatment showed significant difference both in GER and LPR related parameter. CONCLUSIONS: OSA patients have a higher incidence of nocturnal LPR and GER. CPAP treatment can effectively reduce both GER and LPR attacks while disordered sleep events reduced in OSA patients.

Relationship between laryngopharyngeal reflux disease and gastroesophageal reflux disease based on synchronous esophageal and oropharyngeal Dx-pH monitoring.

PURPOSE: To use the synchronous esophageal and oropharyngeal Dx-pH monitoring analysis to investigate the relationship between LPRD and GERD. MATERIALS AND METHODS: Synchronous esophageal and oropharyngeal Dx-pH monitoring, electronic gastroscopy, reflux symptom index (RSI) and gastroesophageal reflux questionnaire (Gerd-Q) were collected from 514 consecutive patients and comparative analysis was done. RESULTS: A total of 85 patients had positive Ryan score and 251 cases had positive DeMeester or acid exposure time percent (AET) ≥4.2%. Moreover, 61.2% (52/85) of all LPRD cases were pure LPRD without GERD. There was no statistical difference in the acid exposure to oropharynx between pure LPRD group and LPRD+GERD group (U test, P > 0.05). Furthermore, there were no statistical differences in the other esophageal reflux data between pure GERD without LPRD group and LPRD+GERD group (U test, P > 0.05) apart from the number of episodes, which was higher in the pure GERD group than in LPRD+GERD group (U test, P = 0.027). Additionally, 149 patients were diagnosed with reflux esophagitis by electronic gastroscopy. No significant difference in the acid exposure to oropharynx was seen between different grades of reflux esophagitis (U test, P > 0.05). Among the LPRD patients, 32 cases (37.6%) were negative for Gerd-Q, Dx-pH esophageal probe and gastroscopy. CONCLUSION: The results of synchronous esophageal and oropharyngeal Dx-pH monitoring demonstrated that LPRD and GERD could co-exist as separate medical conditions. Our data suggest that some LPRD are not accompanied by GERD, and that LPRD is not secondary to severe GERD.

Reflux finding score is associated with gastroesophageal flap valve status in patients with laryngopharyngeal reflux disease: a retrospective study.

Endoscopic grading of gastroesophageal flap valve (GEFV) is simple and reproducible and offers useful information for reflux activity. To investigate the potential correlation between GEFV grading and reflux finding score (RFS) in patients with laryngopharyngeal reflux disease (LPRD), 225 consecutive Patients with suspected LPRD who underwent both routine upper gastrointestinal endoscopy and laryngoscope were enrolled in our study. Patients with a RFS of more than 7 were diagnosed with LPRD. The GEFV was graded as I through IV according to Hill's classification and was classified into two groups: normal GEFV group (grades I and II) and the abnormal GEFV group (grades III and IV). The percent of GEFV grades I to IV was 39.1%, 39.1%, 12.4%, and 9.3%, respectively. Age was significantly related to an abnormal GEFV (p = 0.002). Gender, BMI, smoke and alcohol were not related to GEFV grade. Fifty-one patients (22.67%) had positive RFS. Reflux finding scores were higher in GEFV grades III and IV than I and II (p < 0.05). Endoscopic grading of GEFV is well correlated with reflux finding score in patients with LPRD. This is a simple and useful technique that provides valuable diagnostic information of LPRD.

Utility of 24-hour pharyngeal pH monitoring and clinical feature in laryngopharyngeal reflux disease.

BACKGROUND: pH monitoring can reflect the changes in H+ in the airway. OBJECTIVES: To explore the utility of pharyngeal pH monitoring in the diagnosis of laryngopharyngeal reflux disease (LPRD). MATERIAL AND METHODS: Clinical data from 956 suspected LPRD patients from February 2016 to March 2018 were analyzed retrospectively. RESULTS: One hundred forty-one patients had positive Ryan score. The positive rates of reflux symptom index (RSI), reflux finding score (RFS), RSI and RFS and RSI or RFS were 14.7%, 32.5%, 21.9%, 7.8% and 46.5%, respectively. The RFS in the positive Ryan score group was higher than that in the negative Ryan score group [(6 ± 3.5) vs. (4.8 ± 2.9)], while the RSI was not significantly different from that in the negative Ryan score group [(10.9 ± 8) vs. (11.3 ± 7.1)]. Regarding Ryan score as the gold standard in the diagnosis of LPRD, the sensitivity, specificity, positive and negative predictive value of identifying LPRD by RSI/RFS were 15.9%, 86.3%, 50.4% and 54%, respectively. CONCLUSIONS: Ryan score, RSI and RFS have poor correlation in detecting LPRD. Some patients may be missed with the Ryan score as a diagnostic criterion. SIGNIFICANCE: Pharyngeal pH monitoring is useful and more appropriate index is expected.

Application of acclimated sewage sludge as a bio-augmentation/bio-stimulation strategy for remediating chlorpyrifos contamination in soil with/without cadmium.

This experiment was performed to investigate the effects of acclimated sewage sludge (ASS) and sterilized ASS on the fates of chlorpyrifos (CP) in soil with or without cadmium (Cd), as well as the improvement of soil biochemical properties. Results showed that both ASS and sterilized ASS could significantly promote CP dissipation, and the groups with ASS had the highest efficiency on CP removal, whose degradation rates reached 71.3%-85.9% at the 30th day (40.4%-50.2% higher than non-sludge groups). Besides, the degradation rate of CP was not severely influenced by the existence of Cd, and the population of soil microorganism dramatically increased after adding sludge. The soil enzyme activities (dehydrogenase, acid phosphatase and FDA hydrolase activities) ranked from high to low were as follows: groups with sterilized ASS>groups with ASS>groups without sludge. Simultaneously, 16S rRNA gene sequencing revealed that ASS changed bacterial community structure and diversity in soil. In addition, alkali-hydrolyzable nitrogen and Olsen- phosphorus increased after application of sludge, indicating that the addition of ASS (or sterilized ASS) could effectively improve soil fertility.

A combinatory use of adenoviruses expressing melanoma differentiation-associated gene-7 and replication-competent adenoviruses produces synergistic effects on pancreatic carcinoma cells.

Type 5 adenoviruses expressing mda-7 gene (Ad-mda-7) induced cell death in various kinds of human tumors, but pancreatic carcinoma cells were relatively resistant to Ad-mda-7-mediated cytotoxicity. We then examined whether infection of Ad-mda-7 together with replication-competent Ad produced combinatory cytotoxic effects. We prepared replication-competent Ad, defective of the E1B55kDa gene or activated by a transcriptional regulatory region of the midkine or the survivin gene of which the expression was up-regulated in human tumors. Type 5 Ad bearing the exogenous regulatory region were further modified by replacing the fiber-knob region with that of type 35 Ad. Pancreatic carcinoma cells were infected with replication-incompetent Ad-mda-7 and the replication-competent Ad. Combinatory effects were examined with the CalcuSyn software and cell cycle analyses. Ad-mda-7 and the replication-competent Ad achieved cytotoxicity to pancreatic carcinoma. A combinatory use of Ad-mda-7 and either Ad defective of the E1B55kDa gene or Ad activated by the regulatory region produced synergistic cytotoxic effects. Cell cycle analyses demonstrated that the combination increased sub-G1 populations. These data collectively suggest that expression of MDA-7 augments cytotoxicity of replication-competent Ad and achieves adjuvant effects on Ad-mediated cell death.

Fas ligand DNA enhances a vaccination effect by coadministered DNA encoding a tumor antigen through augmenting production of antibody against the tumor antigen.

Interaction of Fas and Fas ligand (FasL) plays an important role in the regulation of immune responses by inducing apoptosis of activated cells; however, a possible role of FasL in DNA vaccination has not been well understood. We examined whether administration of DNA encoding FasL gene enhanced antitumor effects in mice that were vaccinated with DNA expressing a putative tumor antigen gene, ß-galactosidase (ß-gal). Growth of ß-gal-positive Colon 26 tumors was retarded in the syngeneic mice immunized with ß-gal and FasL DNA compared with those vaccinated with ß-gal or FasL DNA. We did not detect increased numbers of ß-gal-specific CD8(+) T cells in lymph node of mice that received combination of ß-gal and FasL DNA, but amounts of anti-ß-gal antibody increased with the combination but not with ß-gal or FasL DNA injection alone. Subtype analysis of anti-ß-gal antibody produced by the combination of ß-gal and FasL DNA or ß-gal DNA injection showed that IgG2a amounts were greater in mice injected with both DNA than those with ß-gal DNA alone, but IgG2b amounts were lower in both DNA-injected than ß-gal DNA-injected mice. These data suggest that FasL is involved in boosting humoral immunity against a gene product encoded by coinjected DNA and enhances the vaccination effects.

Correction of rolling wheel images captured by a linear array camera.

As a critical part of the train, wheels affect railway transport security to a large extent. This paper introduces an online method to detect the wheel tread of a train. The wheel tread images are collected by industrial linear array charge coupled device (CCD) cameras when the train is moving at a low velocity. This study defines the positioning of the cameras and determines how to select other parameters such as the horizontal angle and the scanning range. The deformation of the wheel tread image can be calculated based on these parameters and corrected by gray interpolation.

Association between the C.1161G>A and C.1779C>G genetic variants of XRCC1 gene and hepatocellular carcinoma risk in Chinese population.

The human X-ray repair complementing group 1 gene (XRCC1) is an important candidate gene influencing hepatocellular carcinoma (HCC) susceptibility. The objective of this study was to detect the association between c.1161G>A and c.1779C>G variants of XRCC1 gene and HCC risk. This study was conducted in Chinese population consisting of 623 HCC cases and 639 controls. These two genetic variants could be genotyped by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The association of XRCC1 gene variants with the risk of HCC was investigated under different genetic models. Our findings suggested that the genotypes/alleles from c.1161G>A and c.1779C>G genetic variants were statistically associated with HCC risk. As for the c.1161G>A, the AA genotype was statistically associated with the increased risk of HCC compared to GG wild genotype (OR = 2.36, 95% CI 1.63-3.40, P < 0.001). As for the c.1779C>G, the risk of HCC was significantly higher for GG genotype compared to CC wild genotype (OR = 2.17, 95% CI 1.51-3.12, P < 0.001). Furthermore, significant differences in the risk of HCC were also detected in other genetic models for these two variants. The allele-A of c.1161G>A and allele-G of c.1779C>G variants may contribute to the susceptibility of HCC (A versus G: OR = 1.48, 95% CI 1.26-1.75, P < 0.001 and G versus C: OR = 1.51, 95% CI 1.28-1.78, P < 0.001). Our data indicated that these two variants of XRCC1 gene were statistically associated with HCC risk in Chinese population.

[Secondary productivity of macrobenthos in rocky intertidal zone of Yushan Islands, Zhejiang Province].

In order to understand the current status of macrobenthos in intertidal zone of Yushan Islands, macrobenthos samples were collected from 5 sections in the intertidal zone in four seasons from March 2009 to January 2010, with the density, biomass, secondary productivity, and P/B value of the macrobenthos investigated by using Brey's empirical formula. The mean density of the marobenthos was 1419.5 ind x m(-2), mean biomass in ash free dry mass (AFDM) was 565.53 g x m(-2), mean annual secondary productivity was 285.58 g x m(-2) x a(-1) (AFDM), and mean annual P/B value was 0.51. The secondary productivity was mainly affected by mollusca and gastropda, with five critical species Septifer virgatus, Modiolus modiolus, Serpulorbis imbricata, Tetraclita japonica, and T. squamosa contributed 84.0% of the total. The P/B value in the study area was lower than that in other sea areas, showing that the generation turnover rate of the macrobenthos in the intertidal zone of Yushan Islands was slower, and the community structure was more stable.

[An association study of abdominal obesity and polymorphisms of UCP2 and SREBP1c genes].

OBJECTIVE: To investigate the association of -866A/G polymorphism of uncoupling protein 2 (UCP2) gene, and 54G/C polymorphism of sterol regulatory element binding protein 1c (SREBP1c) gene with abdominal obesity in the population of type 2 diabetes mellitus families. METHODS: Eligible type 2 diabetes mellitus cases from newly diagnosed and previous hospitalized patients were choson, then their family members (siblings and parents) tracked. A set of questionnaires was administered to obtain information on demographic characteristics. Physical measurements were recorded. DNA was extracted from blood samples and genotyped using polymerase chain reaction with restriction fragment length polymorphism (PCR-RFLP). Generalized estimating equation (GEE) was used to adjust for within-family correlation in analysis of relationships of factors. RESULTS: In the study population, the frequency of A allele of UCP2-866A/G polymorphism was 0.459, and of G allele 0.541; the frequency of G allele of SREBP1c 54G/C polymorphism was 0.822, and of C allele 0.178. Totally 762 participants were analyzed using GEE regression. It was shown that the odds ratio (OR) of the population with only 54G/C polymorphism of SREBP1c gene being the mutant type (GC/CC) was statistically significant while -866A/G polymorphism of UCP2 gene not being the mutant type (AG/GG) was not. The OR of the population with the opposite genotype status was 1.8 (P=0.042), and that with mutant types of both polymorphisms 3.2(P=0.001). CONCLUSION: In the population of type 2 diabetes mellitus families, only 54G/C polymorphism of SREBP1c gene being the mutant type (GC/CC) might be a moderate risk factor of abdominal obesity. When both the two polymorphisms studied are the mutant type, the risk of abdominal obesity may increase significantly.