Radiomic features on multiparametric MRI for differentiating pseudoprogression from recurrence in high-grade gliomas.

BACKGROUND: Distinguishing between tumor recurrence and pseudoprogression (PsP) in high-grade glioma postoperatively is challenging. This study aims to enhance this differentiation using a combination of intratumoral and peritumoral radiomics. PURPOSE: To assess the effectiveness of intratumoral and peritumoral radiomics in improving the differentiation between high-grade glioma recurrence and pseudoprogression after surgery. MATERIAL AND METHODS: A total of 109 cases were randomly divided into training and validation sets, with 1316 features extracted from intratumoral and peritumoral volumes of interest (VOIs) on conventional magnetic resonance imaging (MRI) and apparent diffusion coefficient (ADC) maps. Feature selection was performed using the mRMR algorithm, resulting in intratumoral (100 features), peritumoral (100 features), and combined (200 features) subsets. Optimal features were then selected using PCC and RFE algorithms and modeled using LR, SVM, and LDA classifiers. Diagnostic performance was compared using area under the receiver operating characteristic curve (AUC), evaluated in the validation set. A nomogram was established using radscores from intratumoral, peritumoral, and combined models. RESULTS: The combined model, utilizing 14 optimal features (8 peritumoral, 6 intratumoral) and LR as the best classifier, outperformed the single intratumoral and peritumoral models. In the training set, the AUC values for the combined model, intratumoral model, and peritumoral model were 0.938, 0.921, and 0.847, respectively; in the validation set, the AUC values were 0.841, 0.755, and 0.705. The nomogram model demonstrated AUCs of 0.960 (training set) and 0.850 (validation set). CONCLUSION: The combination of intratumoral and peritumoral radiomics is effective in distinguishing high-grade glioma recurrence from pseudoprogression after surgery.

A TGF-ß signaling-related lncRNA signature for prediction of glioma prognosis, immune microenvironment, and immunotherapy response.

AIMS: The dysregulation of TGF-ß signaling is a crucial pathophysiological process in tumorigenesis and progression. LncRNAs have diverse biological functions and are significant participants in the regulation of tumor signaling pathways. However, the clinical value of lncRNAs related to TGF-ß signaling in glioma is currently unclear. METHODS: Data on glioma's RNA-seq transcriptome, somatic mutation, DNA methylation data, and clinicopathological information were derived from the CGGA and TCGA databases. A prognostic lncRNA signature was constructed by Cox and LASSO regression analyses. TIMER2.0 database was utilized to deduce immune infiltration characteristics. "ELMER v.2" was used to reconstruct TF-methylation-gene regulatory network. Immunotherapy and chemotherapy response predictions were implemented by the TIDE algorithm and GDSC database, respectively. In vitro and in vivo experiments were conducted to verify the results and clarify the regulatory mechanism of lncRNA. RESULTS: In glioma, a TGF-ß signaling-related 15-lncRNA signature was constructed, including AC010173.1, HOXA-AS2, AC074286.1, AL592424.1, DRAIC, HOXC13-AS, AC007938.1, AC010729.1, AC013472.3, AC093895.1, AC131097.4, AL606970.4, HOXC-AS1, AGAP2-AS1, and AC002456.1. This signature proved to be a reliable prognostic tool, with high risk indicating an unfavorable prognosis and being linked to malignant clinicopathological and genomic mutation traits. Risk levels were associated with different immune infiltration landscapes, where high risk was indicative of high levels of macrophage infiltration. In addition, high risk also suggested better immunotherapy and chemotherapy response. cg05987823 was an important methylation site in glioma progression, and AP-1 transcription factor family participated in the regulation of signature lncRNA expression. AGAP2-AS1 knockdown in in vitro and in vivo experiments inhibited the proliferation, migration, and invasion of glioma cells, as well as the growth of glioma, by downregulating the expression levels of NF-κB and ERK 1/2 in the TGF-ß signaling pathway. CONCLUSIONS: A prognostic lncRNA signature of TGF-ß signaling was established in glioma, which can be used for prognostic judgment, immune infiltration status inference, and immunotherapy response prediction. AGAP2-AS1 plays an important role in glioma progression.

Identified lung adenocarcinoma metabolic phenotypes and their association with tumor immune microenvironment.

BACKGROUND: Lung adenocarcinoma (LUAD), a subtype of non-small cell lung cancer (NSCLC), causes high mortality around the world. Previous studies have suggested that the metabolic pattern of tumor is associated with tumor response to immunotherapy and patient's survival outcome. Yet, this relationship in LUAD is still unknown. METHODS: Therefore, in this study, we identified the immune landscape in different tumor subtypes classified by metabolism-related genes expression with a large-scale dataset (tumor samples, n = 2181; normal samples, n = 419). We comprehensively correlated metabolism-related phenotypes with diverse clinicopathologic characteristics, genomic features, and immunotherapeutic efficacy in LUAD patients. RESULTS: And we confirmed tumors with activated lipid metabolism tend to have higher immunocytes infiltration and better response to checkpoint immunotherapy. This work highlights the connection between the metabolic pattern of tumor and tumor immune infiltration in LUAD. A scoring system based on metabolism-related gene expression is not only able to predict prognosis of patient with LUAD but also applied to pan-cancer. LUAD response to checkpoint immunotherapy can also be predicted by this scoring system. CONCLUSIONS: This work revealed the significant connection between metabolic pattern of tumor and tumor immune infiltration, regulating LUAD patients' response to immunotherapy.

Genetic Profiles Playing Opposite Roles of Pathogenesis in Schizophrenia and Glioma.

BACKGROUND: Patients diagnosed with schizophrenia were found having lower risks to develop cancers, including glioma. Based on this epidemiology, we hypothesized that there were gene profiles playing opposite roles in pathogenesis of schizophrenia and glioma. METHODS: Based on GEO datasets and TCGA, key genes of schizophrenia genes on the opposite development of glioma were screened by different expressed genes (DEGs) screening, weighted gene coexpression network analysis (WGCNA), disease-specific survival (DSS), and glioma grading and verified by gene set enrichment analysis (GSEA). RESULTS: First, 612 DEGs were screened from schizophrenia and control brain samples. Second, 134 key genes more specific to schizophrenia were left by WGCNA, with 93 key genes having annotations in TCGA. Third, DSS of glioma helped to find 42 key gene expressions of schizophrenia oppositely associated with survival of glioma. Finally, 24 key genes showed opposite expression trends in schizophrenia and different glioma grading, i.e., the upregulated key genes in schizophrenia expressed increasingly in higher grade glioma, and vice versa. CAMK2D and MPC2 were taken as the examples and evaluated by GSEA, which indeed showed opposite trends in the same pathways of schizophrenia and glioma. CONCLUSION: This workflow of selecting novel targeted genes which may have opposite roles in pathogenesis of two diseases was firstly and innovatively generated by our team. Some filtered key genes were indeed found by their potential effects in several mechanism studies, indicating our process could be effective to generate novel targeted genes. These 24 key genes may provide potential directions for future biochemical and pharmacotherapeutic research studies.

Clinical characteristics and disease-specific prognostic nomogram for primary gliosarcoma: a SEER population-based analysis.

Because the study population with gliosarcoma (GSM) is limited, the understanding of this disease is insufficient. In this study, the authors aimed to determine the clinical characteristics and independent prognostic factors influencing the prognosis of GSM patients and to develop a nomogram to predict the prognosis of GSM patients after craniotomy. A total of 498 patients diagnosed with primary GSM between 2004 and 2015 were extracted from the 18 Registries Research Data of the Surveillance, Epidemiology, and End Results (SEER) database. The median disease-specific survival (DSS) was 12.0 months, and the postoperative 0.5-, 1-, and 3-year DSS rates were 71.4%, 46.4% and 9.8%, respectively. We applied both the Cox proportional hazards model and the decision tree model to determine the prognostic factors of primary GSM. The Cox proportional hazards model demonstrated that age at presentation, tumour size, metastasis state and adjuvant chemotherapy (CT) were independent prognostic factors for DSS. The decision tree model suggested that age <71 years and adjuvant CT were associated with a better prognosis for GSM patients. The nomogram generated via the Cox proportional hazards model was developed by applying the rms package in R version 3.5.0. The C-index of internal validation for DSS prediction was 0.67 (95% confidence interval (CI), 0.63 to 0.70). The calibration curve at one year suggested that there was good consistency between the predicted DSS and the actual DSS probability. This study was the first to develop a disease-specific nomogram for predicting the prognosis of primary GSM patients after craniotomy, which can help clinicians immediately and accurately predict patient prognosis and conduct further treatment.

Coiling Is Not Superior to Clipping in Patients with High-Grade Aneurysmal Subarachnoid Hemorrhage: Systematic Review and Meta-Analysis.

BACKGROUND: Outcomes of coiling embolization versus clipping for patients with high-grade aneurysmal subarachnoid hemorrhage (aSAH) have not been previously compared. We reviewed current evidence regarding the safety and efficacy of clipping versus coiling for high-grade aSAH. METHODS: We conducted a meta-analysis of studies that compared clipping with coiling in patients with high-grade aSAH published from January 1999 to February 2016 in Medline, Embase, and Cochrane databases based on PRISMA inclusion and exclusion criteria. Binary outcome comparisons between clipping and coiling were described using odds ratios (ORs). RESULTS: Three randomized controlled trials (RCTs) and 16 observational studies were included. There was no statistical difference in good outcome rates between the clipping and coiling groups (OR, 1.44; 95% confidence interval [CI], 0.97-2.13). Subgroup analysis showed no significant difference between the 2 treatments in non-RCTs (OR, 1.49; 95% CI, 0.95-2.36) and RCTs (OR, 1.15; 95% CI, 0.59-2.25). Coiling was associated with higher mortality (OR, 0.55; 95% CI, 0.41-0.75). Lower mortality was associated with clipping in non-RCTs (OR, 0.54; 95% CI, 0.40-0.74), but there was no difference in the RCTs (OR, 0.79; 95% CI, 0.19-3.39). Coiling was not associated with lower rates of complications including rebleeding (OR, 0.62; 95% CI, 0.30-1.29), ischemic infarct (OR, 0.89; 95% CI, 0.53-1.49), symptomatic vasospasm (OR, 0.76; 95% CI, 0.45-1.29), or shunt-dependent hydrocephalus (OR, 1.33; 95% CI, 0.52-3.40). CONCLUSION: The outcome with coiling is not superior to clipping in patients with high-grade aSAH; moreover, coiling has a greater risk of mortality.

[The characteristics of anorectal manometry in Parkinson's disease with constipation and functional constipation].

OBJECTIVE: To investigate the discrepancy of anorectal function in patients of Parkinson's disease (PD) with constipation and functional constipation (FC). METHODS: Fifteen consecutive male PD patients with constipation and 45 male FC patients were recruited for the study. All subjects underwent colonoscopy or barium enema in order to exclude organic colon diseases. Every patient underwent anorectal manometry and was categorized into subgroups of either dyssynergia defecation (F3a) or inadequate defecatory propulsion (F3b). RESULTS: The ages of PD with constipation and FC patients were (70 ± 11) and (68 ± 11) years old respectively. The rectal resting pressure in PD with constipation was higher than that in FC group without statistical significance [9.0(4.0, 15.0) mm Hg vs 6.0(3.0, 9.5) mm Hg, P = 0.082, 1 mm Hg = 0.133 kPa]. The anal resting pressure in PD group was not different from FC group [(51.2 ± 17.2) mm Hg vs (59.7 ± 20.4) mm Hg, P = 0.152]. During anal squeezing, the maximal contraction pressure and area under the squeeze curve in PD with constipation group were both significantly lower than FC patients [maximal contraction pressure: (136.9 ± 43.8) mm Hg vs (183.0 ± 62.1) mm Hg, P = 0.010; area under the squeeze curve: (823.5 ± 635.7) mm Hg·s vs (1392.4 ± 939.9) mm Hg·s, P = 0.033]. During forced defecation, both of the defecation rectal pressure and defecation anal pressure in PD with constipation group were significantly lower than that of FC patients [22.0(15.0, 30.0) vs 42.0(31.0, 55.0) mm Hg, P = 0.000; and (46.3 ± 23.3) vs (77.9 ± 35.1) mm Hg, P = 0.002]. The proportions of F3a subtype were 10/15 and 46.7% (21/45) in PD with constipation and FC patients respectively. There was no significant difference in the constituent ratio (P = 0.120). Initial rectal sensory volumes were (91.3 ± 56.9) ml and (67.2 ± 38.9) ml in PD with constipation and FC patients respectively. Even both volumes were higher than the normal controls, there was no significant difference between the two groups (P = 0.074). CONCLUSIONS: Both PD with constipation and FC patients have abnormal anorectal motility and sensation comparing to the FC group, the parameters of anal contraction and defecation are significantly lower, F3b is dominant, and rectal sensory threshold is higher in PD with constipation patients. These parameters could possibly characterize the anorectal manometry for PD with constipation patients, which is helpful to understand the pathogenesis of PD and differentiate from other diseases.

Changing pattern of adenocarcinoma of the esophagogastric junction in recent 10 years: experience at a large tertiary medical center in China.

AIMS AND BACKGROUND: To investigate the changing pattern of adenocarcinoma of the esophagogastric junction subtypes and its time trend relationship with that of reflux esophagitis over 10 years at a tertiary medical center in China. METHODS AND STUDY DESIGN: . The medical records of all patients who underwent gastroscopy from 2000 to 2009 were reviewed. Subtypes of adenocarcinoma of the esophagogastric junction according to Siewert's classification, gastric non-cardiac adenocarcinoma, esophageal squamous cell carcinoma, reflux esophagitis and Helicobacter pylori infection were diagnosed according to the results of gastroscopy and mucosal histopathology. All the patients were divided into three cohorts (cohort A [2000-2003], cohort B [2004-2006]), cohort C [2007-2009]), and the proportion of adenocarcinoma of the esophagogastric junction and its subtypes in all upper gastrointestinal tumors (adenocarcinoma of the esophagogastric junction, gastric non-cardiac adenocarcinoma and esophageal squamous cell carcinoma) in each cohort were compared. The annual percentages of adenocarcinoma of the esophagogastric junction, reflux esophagitis and H pylori in all patients were also compared. RESULTS: 70,073 patients (cohort A, n = 20298, cohort B, n = 20443, cohort C, n = 29332) who underwent gastroscopy were reviewed. Totally there were 279 patients with adenocarcinoma of the esophagogastric junction (0.398%, M:F = 5.6:1), 794 gastric non-cardiac adenocarcinoma patients (1.133%, M:F = 2:1), 366 esophageal squamous cell carcinoma patients (0.522%, M:F = 3.4:1) and 4681 reflux esophagitis patients. Among the three subtypes of adenocarcinoma of the esophagogastric junction, only type I adenocarcinoma of the esophagogastric junction in upper GI tumors exhibited increasing trend over time (1.86%, 3.39% and 4.94% for cohort A, B and C, respectively, P = 0.009). According to the WHO classification of histological types, the tubular types of adenocarcinoma of the esophagogastric junction have decreased (P = 0.008), whereas papillary type (P = 0.001) increased. The annual detection rate of type I adenocarcinoma of the esophagogastric junction appeared to be positively correlated with reflux esophagitis (r = 0.846, P = 0.002) and negatively with H pylori infection (r = -0.785, P = 0.007) in time trend. CONCLUSIONS: Over a recent 10-year period, the three subtypes of adenocarcinoma of the esophagogastric junction showed different changing trends, suggesting heterogeneous characteristics of the three Siewert types of adenocarcinoma of the esophagogastric junction.

Target recognition of ladar range images using even-order Zernike moments.

Ladar range images have attracted considerable attention in automatic target recognition fields. In this paper, Zernike moments (ZMs) are applied to classify the target of the range image from an arbitrary azimuth angle. However, ZMs suffer from high computational costs. To improve the performance of target recognition based on small samples, even-order ZMs with serial-parallel backpropagation neural networks (BPNNs) are applied to recognize the target of the range image. It is found that the rotation invariance and classified performance of the even-order ZMs are both better than for odd-order moments and for moments compressed by principal component analysis. The experimental results demonstrate that combining the even-order ZMs with serial-parallel BPNNs can significantly improve the recognition rate for small samples.

A comparative study of 22-channel water-perfusion system and solid-state system with 36-sensors in esophageal manometery.

BACKGROUND: To compare the characteristics between 22-channel water-perfusion manometry (WPM) and solid-state manometry (SSM) with 36 sensors of the pressure measurements, as well as patients' discomfort indices in nose and pharynx, the preparation and operation time of the manometry. METHODS: 12 volunteers were included in the study. Each of the volunteers underwent esophageal manometry by both 22-channel water-perfusion catheter (WPC) and solid-state catheter (SSC) with 36 sensors in random order, and separated by 30 min. The subjects gave a VAS score soon after each test. Non-parametric tests were used to analyze the differences and Bland-Altman plots were used to assess the consistency of the two systems. RESULTS: During the wet swallows, there were significant differences between the two systems in three measurements of location of lower esophageal sphincter (LES) upper margin (Z = -2.11, P = 0.035), LES relax ratio (Z = -2.20, P = 0.028) and IRP4s (Z = -2.05, P = 0.041). During the jelly pocket swallows, LES relax ratio measurements of the two systems showed significant differences (Z = -2.805, P = 0.005). Further Bland-Altman plots analysis presented good agreement between the two systems measurements of location of LES upper margin, LES relax ratio and IRP4s. The discomfort indices of subjects' nasal sensation were higher when inserting the solid-state catheter [5(3.75-5)] than water-perfusion one (2.5(2-4)) (Z = -2.471, P = 0.013), as well as the discomfort indices of pharyngeal sensation (7.5(4.75-9) vs. 4.5(3.75-6.5)), (Z = -2.354, P = 0.019). The preparation time for WPC was 40(39-41) minutes, which was much longer than that for SSC 32.5(31.75-33) minutes, (Z = -3.087, P = 0.002). And the nurses reported it's much easier to insert WPC (Z = -3.126, P = 0.002). CONCLUSIONS: In conclusion, most pressure measurements were consistent between WPM and SSM. Patients tolerated better with WPC, while for operators, the SSC presented more convenient.

[Diagnostic values of GerdQ, 24-h ambulatory oesophageal pH and impedance-pH monitoring in Barrett's esophagus, reflux esophagitis and non-erosive reflux disease].

OBJECTIVE: To compare the diagnostic values of GerdQ questionnaire, 24-h pH monitoring and 24-h impedance-pH monitoring for gastroesophageal reflux disease (GERD) and to analyze the reflux patterns of Barrett's esophagus (BE), reflux esophagitis (RE) and non-erosive disease (NERD). METHODS: From June 1, 2009 to September 30, 2010, 205 GERD patients were included according to the Montreal consensus. All were surveyed by a GerdQ questionnaire and underwent 24-h impedance-pH monitoring. The diagnostic sensitivities of GerdQ, 24-h pH-DeM and 24-h IMP-pH were compared and the reflux pattern of BE, RE and NERD analyzed. RESULTS: A total of 205 GERD patients including 10 BE, 28 RE and 167 NERD were recruited. (1) The diagnostic rate of 24-h IMP-pH was 74.1%. It was significantly higher than that of GerdQ (51.7%) and 24-h pH-DeM (29.2%). (2) The diagnostic sensitivities of GerdQ and 24-h pH-DeM for BE and RE were higher than that for NERD. But there were no significant differences of 24-h IMP-pH for three types of GERD (70.0%, 82.1% and 73.1%). (3) There were positive correlations among the scores of GerdQ, pH-DeM scores and acid scores in IMP-pH (r = 0.242, P = 0.000; r = 0.182, P = 0.009 and r = 0.632, P = 0.000). (4) Added diagnostic values of IMP-pH were 58.5% and 74.5% respectively in patients who would have been missed by GerdQ and pH-DeM. (5) The detection rate and score of acid reflux in RE patients were higher than that of NERD [53.6% vs 23.4%, P < 0.05; 45.6 (35.0 - 67.5) vs 23.1 (9.3 - 35.0), P < 0.05]. But gas score and separate acid reflux were lower than that in NERD [17 (0 - 194) vs 30 (0 - 500), P < 0.05; 57.4% vs 28.6%, P < 0.05]. CONCLUSIONS: Acid reflux plays an important role in RE. The value of GerdQ and 24-h pH-DeM and 24-h IMP-pH monitoring were similar for the diagnosis of RE. Weak acid may be more important for BE and NERD patients than separate acid reflux. And 24-h IMP-pH monitoring has a distinct advantage in diagnosing these two types.

[A survey of nonsteroidal anti-inflammatory drugs and aspirin associated peptic ulcer bleeding in hospitals].

OBJECTIVE: To investigate the clinical characteristic and prognosis of nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin associated peptic ulcer bleeding. METHOD: All patients with peptic ulcer bleeding were studied by the same researcher after admission and discharge. RESULTS: Fifty-one cases with NSAIDs and aspirin medication of the total peptic ulcer bleeding patients (147 cases) were included (34.7%). Compared with patients not associated with NSAIDs and aspirin medication, they are older [(41.2 ± 1.9) years vs (59.4 ± 2.2) years, P < 0.001], more commonly associated with hypertension (10.4% vs 39.2%, P < 0.001), coronary heart disease (10.4% vs 17.6%, P < 0.001), diabetes (4.2% vs 19.6%, P = 0.005); and had more severe anemia (7.3% vs 23.5%, P = 0.008). Fewer patients in NSAIDs group had epigastric pain (61.5% vs 27.5%, P < 0.001), while there was more re-bleeding (9.4% vs 15.7%, P = 0.034). In all bleeding patients, factors associated with re-bleeding, surgical intervention and death included NSAIDs and aspirin medication, and low platelet count. In patients with NSAIDs and aspirin medication, re-bleeding was associated with previous ulcer history (P < 0.05). CONCLUSION: Peptic ulcer bleeding patients with NSAIDs and aspirin medication were more severe ill, and less likely to present with epigastric pain.

[The roles of Helicobacter pylori and pattern of gastritis in the pathogenesis of reflux esophagitis].

OBJECTIVE: Comparing the infection rates and density of Helicobacter pylori (H. pylori) and the patterns of gastritis in reflux esophagitis (RE) and non-erosive reflux disease (NERD) patients to investigate the role of H. pylori in the pathogenesis of RE. METHODS: Two hundred and twenty-three out-patients with typical gastroesophageal reflux symptoms who consecutively visited the hospital underwent ambulatory 24-hour pH monitoring and gastroscopy, and biopsy of the gastric mucosa. RE and NERD were diagnosed based on the presentation of endoscopy. Gastritis was divided into four different patterns: chronic non-atrophic antritis (CNAA); chronic non-atrophic pan-gastritis (CNAG); chronic atrophic antritis (CAA); and chronic atrophic pan-gastritis (CAG). H. pylori infection was evaluated by Warthin-Starry staining. DeMeester score > or = 15 was considered as pathological acid reflux. RESULTS: Sixty-two patients (27.8%) were found to have RE, 161 (72.2%) were found to have NERD. Totally, 67 patients had H. pylori infection (30.0%). There was no significant difference in H. pylori infection rate between the RE and NERD groups (25.8% vs. 31.5%, P > 0.05). 45 of the 223 patients were diagnosed as with CNAA (20.2%), 88 (39.5%) with CNAG, 65 (29.2%) with CAA, and 25 (11.2%) with CAG. The CAG rates in the RE and NERD groups were 6.5% and 13.0% respectively (P > 0.05). There were no differences in abnormal pH monitoring rate and DeMeester score among the different patterns of gastritis. In the sixty-seven H. pylori-positive GERD patients, the 24 h pH monitoring positive rate of the moderate-severe H. pylori colonization density group was 46.4%, significantly higher than that of the mild H. pylori colonization density group (73.5%, P < 0.05); and the mean intra-gastric pH value during 24 hours of the moderate-severe H. pylori colonization density group was 2.3 +/- 0.8, significantly higher than that of the mild H. pylori colonization density group (2.0 +/- 1.1, P < 0.05). CONCLUSION: H. pylori infection is associated with the pattern of gastritis, but shows no relationship to the incidence of RE. High density of H. pylori colonization in gastric corpus may reduce the esophageal acid exposure. Diffuse atrophic gastritis may protect the patients from RE.

[Comparison of esophageal acid exposure characteristics between reflux oesophagitis and non-erosive reflux diseases].

OBJECTIVES: Comparing the esophageal acid exposure characteristics between reflux oesophagitis (RE) and non-erosive reflux disease (NERD) patients to identify the NERD subgroups. METHODS: One hundred and twenty-eight patients with heartburn and acid regurgitation were evaluated. Esophageal mucosa injury was assessed by gastroscopy. The extent of esophageal acid exposure was determined by ambulatory 24 h esophageal pH monitoring. DeMeester point >/= 15 was taken as positive. RESULTS: Thirty-seven patients were found to have RE (28.9%), 91 were diagnosed as NERD. There was no difference at DeMeester point between RE and NERD (P > 0.05). Patients with RE have more long reflux episodes than NERD patients (8.16 +/- 10.27 vs 3.96 +/- 6.87; P = 0.004). Among NERD patients, 46 (50.5%) had an abnormal pH monitoring (NERD+); another 45 were normal (NERD-). Patients with NERD+ were more likely to demonstrate at positive symptom index (SI > 50%) than those with NERD- (43.5% vs 15.6%; P < 0.001). In NERD- group, patients with a positive SI (NERD-SI+) have more reflux episodes than those with a negative SI (NERD-SI-) (55.29 +/- 24.68 vs 34.87 +/- 24.06; P < 0.05), as well as the fraction time of 24 h that pH < 4 in upright (4.16 +/- 2.98 vs 1.88 +/- 1.60; P < 0.05). Twenty-five RE patients have an abnormal pH monitoring (RE+, 67.6%), another 12 were normal (RE-). RE- patients have a higher median of intra-esophageal and gastric pH than RE+ patients respectively (6.75 +/- 0.42 vs 5.18 +/- 1.32; 2.69 +/- 2.59 vs 1.49 +/- 0.66; P < 0.05). CONCLUSIONS: RE patients have longer reflux episodes than NERD. The symptoms of most gastroesophageal reflux disease patients associate with acid reflux. Acid reflux characteristics and symptom patterns suggest subgroups of NERD patients. The bile or mixed reflux may be involved in the pathogenesis of RE- group.

[Anxiety and depression related to the symptoms of gastroesophageal reflux disease].

OBJECTIVE: To compare the differences in the psychological scale scoring among different subgroups reflux esophagitis (RE) and non-erosive reflux disease (NERD) and to explore the influence of mental factors on the pathogenesis of RE and NERD. METHODS: Two hundred and six patients with typical heartburn and acid regurgitation underwent endoscopy and esophageal pH monitoring and then were divided into 4 groups: RE+ group (n = 35, 24.3%) with RE and positive pH monitoring results, RH- group (n = 15, 30.0%) with RE and negative pH monitoring results, NERD+ group (n = 77, 40%), with NERD and positive pH monitoring results, and NERD- group (n = 79, 50.6%) with NERD and negative pH monitoring results that was re-divided into 2 subgroups according to the symptom index (SI): NERD-SI+ group (n = 18, 22.8%) with positive symptom index and NERD-SI- group (n = 61, 77.2%) with negative SI. The demographic data and body mass index (BMI) were investigated. The psychological questionnaires: Symptom Checklist 90 (SCL-90), and Hospital Anxiety and Depression Scale (HAD) were used. RESULTS: (1) Male patients were dominant in the RE group and RE+ subgroup, while female patients were dominant in the NERD group and NERD+ subgroup. The values of BMI of the RE group and RE+ subgroup were significantly higher than those of the NERD group and NERD+ subgroup. (2) The abnormal pH monitoring rate of the RE group was 70.0%, significantly higher than that of the NERD group (49.4%). The average DeMeester's score of the RE group was 39.3 (96.5), significantly higher than that of the NERD group 13.8 (33.6). The average DeMeester's score of the RE+ group was 68.1 (95.2), significantly higher than that of the NERD+ group 40.1 (64.4). (3) 44.6% (29/65) of the patients presented depression and 36.9% (24/65) had anxiety, most of them were in mild or moderate degree. The scores of most items of each mental scale were significantly higher in the NERD- patients than in the NERD+ patients, especially in the NERD-SI- subgroup. CONCLUSION: The symptoms of RE+ and NERD+ patients are associated with esophageal acid exposure and the acid reflux in the RE patients is much severer than that in the NERD patients. Anxiety and depression are related to the symptoms of patients without objective evidence of esophageal mucosal injury and acid reflux (NERD-), especially in the symptom index negative subgroup. Visceral hypersensitivity and stress play an important role in the pathogenesis of gastroesophageal reflux.

[Changes of gastric mucosa histopathology after Helicobacter pylori eradication].

OBJECTIVE: To investigate the relationship between Helicobacter pylori (Hp) infection and gastric cancer through the changes of gastric mucosa histopathology within 5 years after Hp eradication in Hp-positive subjects in the high incidence region of gastric cancer. METHODS: One thousand and six adults were selected from general population in Yantai, Shandong Province, the high incidence region of gastric cancer. Gastroscopy and CLO test were performed in all subjects. Biopsy samples from the gastric antrum and body were obtained for histology and assessment of Hp infection. All the Hp-positive subjects were then randomly divided into two groups: treatment group receiving OAC triple therapy and placebo as controls. These subjects were endoscopically followed up in the second and fifth year. In this article, we compared the endoscopic appearance and histology of the biopsy specimens from the same site obtained at the first and final visit. Statistical analysis was done by chi(2) test. RESULTS: All the 552 Hp-positive subjects were randomly divided into treatment group or control group, 276 in each. During the five-year follow-up, the number of patients who continued to be negative or positive for Hp was 161 and 198, respectively. Statistical analysis revealed that: (1) At the initial visit, there were no significant differences in the severity and activity of inflammation between the biopsy specimens from the antrum (P = 0.105) and body (P = 0.084) in both groups. But the proportion of atrophy and intestinal metaplasia in the antrum was much higher than that in the body (P = 0.000). (2) The severity and activity of inflammation in both the antrum and body were markedly reduced after Hp eradication (P = 0.000). (3) Within the five years after Hp eradication, intestinal metaplasia in the antrum regressed or had no progression, while the proportion of intestinal metaplasia in the Hp-positive group increased significantly (P = 0.032). (4) After Hp eradication, the atrophy in both the antrum and body had no significant regression. P value was 0.223 and 0.402, respectively. CONCLUSIONS: Hp eradication results in remarkable reduction in the severity and activity of chronic gastritis, marked resolution of intestinal metaplasia in the antrum. On the other hand, continued Hp infection leads to progressive aggrevation of atrophy and intestinal metaplasia.