Background/Aims: There is less acid burden in Chinese gastroesophageal reflux disease (GERD) patients. However, the Lyon consensus proposed a higher threshold of acid exposure time (AET > 6%) for GERD. The aims are to apply the updated criteria in Chinese GERD patients and clarify its influence on clinical outcome. Methods: Patients who were referred for both esophageal high-resolution manometry and 24-hour esophageal pH monitoring due to reflux symptoms were retrospectively screened. Those patients with AET > 4% was included and grouped into either AET 4-6% or AET > 6%. Their manometric profile, reflux profile, and response to proton pump inhibitors (PPIs) were evaluated. Adjunctive evidence proposed in the Lyon consensus was added in patients with AET 4-6% for therapeutic gain. Another group of patients (n = 144) with AET < 4% were included as non-GERD patients. Results: In total, 151 patients (102 males) were included with 113 patients AET > 6% (74.9%). GERD patients with AET > 4% were with more male, older patients, and higher body mass index compared with non-GERD patients. Meanwhile, GERD patients were less competent in esophagogastric junction pressure. However, the manometric and reflux profile were similar between patients with AET > 6% and 4-6%. The response rate of PPI therapy was 64.6% and 63.2%, respectively, in groups of AET > 6% and 4-6% (P > 0.05). When adjunctive evidence was added in patients with AET 4-6%, no therapeutic gain was obtained. Conclusions The efficacy of PPI therapy was similar in patients with AET > 6% and 4-6%. The increase of the AET threshold did not influence the clinical outcome of Chinese GERD patients.

Objective To investigate the level of serum lipoprotein-associated phospholipase A2(Lp-PLA2) activity in healthy adults of Changsha area and establish the reference interval of serum Lp-PLA2activity. Methods A total of 424 healthy adults (175 males and 249 females) were classified into five groups by different age, including 20 to 29, 30 to 39, 40 to 49, 50 to 59 and over 60 years old group. Serum Lp-PLA2activity was measured by continuous-monitoring assay. According to the requirements of Clinical and Laboratory Standards Institute (CLSI) C28-A3, the reference interval of Lp-PLA2activity was established by nonparametric method.Results The levels of serum Lp-PLA2activities in both males and females showed normal distribution. The average of Lp-PLA2activity was (478± 135)U/L in 175 males and (402±116)U/L in 249 females with statistically significant difference (t＝6.184, P＜0.01). Z test result showed Z＞Z?, so the reference intervals of males and females were established respectively. There was no statistical difference of Lp-PLA2activities among the varied groups of males (F＝1.259, P＝0.288), but there were statistical differences among the varied groups of females (F＝9.341, P＜0.01). The females of the age over 40 years old showed higher activities than those of age under 40 years old (t＝5.732,P＜0.01). However, there was no statistical significance of serum Lp-PLA2activities in the females between the two groups of the age under 40 and the three groups of age over 40. Therefore, the reference intervals of serum Lp-PLA2activities in healthy adults were established as followed: 217-761 U/L for males, 168-566 U/L for the females of 20 to 39 years old and 203-702 U/L for the fe-males of 40 to 86 years old. Conclusion The reference interval of serum Lp-PLA2activity in physical examination of healthy adults in Changsha area was established.

ObjectiveTo investigate the expression of the neutral cholesterol ester hydrolase 1 (NCEH1) gene in liver cancer tissue and human hepatoma cell lines and the effect of NCEH1 gene knockdown on the proliferation, apoptosis, invasion, and metastasis abilities of human hepatoma SMMC-7721 cells. MethodsLiver cancer tissue samples and adjacent tissue samples were collected from 32 patients with liver cancer who underwent surgical treatment in Guangzhou Red Cross Hospital Affiliated to Jinan University from January 2013 to June 2019, and quantitative real-time PCR was used to measure the relative expression level of the NCEH1 gene. Gene expression data of liver cancer samples up to September 2020 were downloaded from the ICGC database, and R software was used to analyze the data and obtain the expression level of the NCEH1 gene in each sample. The paired Wilcoxon signed-rank test and the Wilcoxon rank-sum test were used to investigate the differences between liver cancer tissue and adjacent tissue. Quantitative real-time PCR was used to measure the expression level of the NCEH1 gene in human hepatoma SMMC-7721, Bel-7402, HepG2, and Hep3B cells and normal human HL7702 liver cells. The lentivirus-mediated small interfering RNA (siRNA) technique was used to establish a human hepatoma SMMC-7721 cell line with NCEH1 gene knockdown, and the cells were divided into NCEH1 knockdown group (KD group) and negative control group (NC group); quantitative real-time PCR was used to measure the knockdown efficiency of the NCEH1 gene, and then MTT assay, flow cytometry with Annexin V-APC single staining, wound healing assay, Transwell assay, and Transwell chamber invasion assay were used to measure the proliferation, apoptosis, metastasis, and invasion abilities of SMMC-7721 cells in both groups. The t-test was used for statistical analysis of data between the two groups. ResultsThe mean expression level of the NCEH1 gene in liver cancer tissue was significantly higher than that in adjacent tissue (specimens from our hospital: Z=2.263, P=0.024; ICGC database: U=18 768, P＜0.001). SMMC-7721 cell line with moderate potential of invasion and metastasis had the highest expression level of the NCEH1 gene, followed by BEL-7402 and HepG2 cell lines with low potential of invasion and metastasis, and Hep3B cell line without the potential of invasion and metastasis had the lowest expression level. The KD group had a significantly lower expression level of the NCEH1 gene than the NC group (t=11.578, P=0000 3), and the knockdown efficiency of the NCEH1 gene was as high as 74.0%. Compared with the NC group, the KD group had a significant reduction in cell growth rate, a significant increase in apoptosis rate, and significant reductions in migration rate and the number of metastatic and invasive cells (t=32.100, 27.303, 9.51, 38.123, and 22.331, all P＜0.001). Conclusion There is a significant increase in the expression of the NCEH1 gene in liver cancer tissue and cell lines, and the NCEH1 gene can promote the growth, proliferation, invasion, and metastasis of hepatoma cells and inhibit their apoptosis, suggesting that it may be a potential therapeutic target for liver cancer.

Introduces the regulatory requirements of the Natural and Over-the-Counter Health Products Administration on the quality of natural health products, and adopts the literature research method to translate and interpret Health Canada's "Guidelines for the Quality of Natural Health Products" on the quality management and quality control of natural health products. Policy documents, from the perspective of stakeholders, provide requirements for the detection methods and standards of natural health products, such as characterization, identification experiments, component content, pollutants and impurity content detection, etc. To achieve natural health Quality management and quality control in the whole process of product production. Familiar with and understand the requirements for the quality management of natural health products in Canada will help to promote the legal and compliant management of product quality in the production process of Traditional Chinese Medicine (TCM) products after registration in Canada, and promote the production and sustainable development of TCM products. At the same time, it provides a reference for further improving my country's drug quality management system normative system documents, and assists the effective connection between the registration-related standards of Chinese patent medicines and international standards.

BACKGROUND/AIMS: Anti-reflux barrier dysfunction is one of the primary mechanisms in gastroesophageal reflux disease (GERD) pathogenesis. The esophagogastric junction contractile integral (EGJ-CI) is a new metric adopted to evaluate the EGJ contractility, which implies the anti-reflux barrier function. The aim of the current study was to validate this new metric in patients with GERD and its correlation with the esophageal acid exposure, as well as the efficacy of proton pump inhibitor treatment. METHODS: Ninety-eight patients with GERD and 21 healthy controls were included in the study. Upper endoscopy, high-resolution manometry (HRM) and 24-hour multichannel intraluminal impedance-pH monitoring were performed in all patients. Three respiration cycles were chosen at the initial HRM resting frame and the value computed with distal contractile integral tool was then divided by the duration of the cycles to yield EGJ-CI. All the patients were treated with esomeprazole 20 mg twice-daily for 8 weeks. RESULTS: EGJ-CI was lower in the patients with GERD than that of the controls (P < 0.05). For patients with GERD, EGJ-CI was lower in those with hiatal hernia (P < 0.05). The new metric correlated with esophageal acid exposure in the supine position (P < 0.05), and it also negatively correlated to the total reflux episodes (P < 0.05). There was no significant difference on EGJ-CI between patients with and without response to the esomeprazole treatment (P = 0.627). CONCLUSIONS: EGJ-CI reflected the dysfunction of the anti-reflux barrier in patients with GERD, but it had little impact on the esomeprazole response.
Endoscopy ; Esomeprazole ; Esophagogastric Junction* ; Gastroesophageal Reflux* ; Hernia ; Hernia, Hiatal ; Humans ; Manometry ; Proton Pump Inhibitors ; Proton Pumps ; Respiration ; Supine Position

International registration of herbal drugs is a necessary prerequisite for the internationalization of Chinese materia medica. North America and European Union occupy an important position in the world herbal drugs market, and their drug administration and quality supervision requirements are relatively complete and progressiveness. By summarizing the definition of herbal drugs in North America and European Union, combing and interpreting the relevant laws, regulations and policy documents, this article constructed the registration path of herbal drugs, and discussed the current status of market registration of herbal drugs in North America and European Union based on the examples of successful marketing of herbal drugs under current application and approval in overseas markets. This article believed that in the future, an internationally matched TCM quality standard evidence system should be built, clinical trials of TCM products in line with international standards should be carried out, standards that are the same or higher than international mainstream GMP should be developed, the registration path of TCM compounds should be explored, and professionals to establish an international registration application team should be recruited to provide theoretical and practical support for China's overseas registration of Chinese TCM products, promote TCM products to enter the world mainstream market, and achieve high-quality development of TCM internationalization.

Objective To explore the role and efficacy of VEGF and HGF gene adenovirus vector in promoting angiogenesis in ischemic tissue.Methods 84 Kunming mice were randomly divided into sham group,control group,VEGF group,HGF group and VEGF+HGF group,and the left lower limb ischemia model was established.The blood supply of ischemic tissue was observed by rheometer,and the expression levels of VEGF and HGF in each group were detected by Western Blot and ELISA.Immunohistochemical staining was used to detect angiogenesis(CD31,SMA)in ischemic tissues.Safety was assessed by side effects during treatment in mice.Results After the successful modeling,the blood flow velocity of the left lower limb in each group decreased significantly.On the 7th day after operation,the blood flow of the left lower limb in each group was significantly better than that on the 0th day after operation(P<0.05),and the blood flow of the left lower limb in Ad-VEGF-HGF group was significantly better than that in other groups(P<0.05).On the 28th day after operation,the blood flow of the left lower limb in Ad-VEGF-HGF group gradually stabilized,the blood flow in Ad-VEGF-HGF group was significantly better than that in other groups,and both VEGF group and HGF group were significantly better than the control group(P<0.05).On the 7th,14th,and 28th days following surgery,HGF and VEGF protein levels in the Ad-HGF,Ad-VEGF,and Ad-VEGF-HGF groups were substantially greater than those in the control group(P<0.05).The expression level in the Ad-VEGF-HGF group peaked on the 14th day(all P<0.001)and subsequently declined to preoperative levels on the 28th day after operation.Conclusion Ad-VEGF-HGF gene injection can effectively boost VEGF and HGF protein expression and rapidly reach the relative peak level,encour-aging angiogenesis after lower limb ischemia,increasing blood flow,and improving lower limb circulation.

Objective:To investigate the value of rate-pressure product (RPP) in predicating the prognosis of postural tachycardia syndrome (POTS) in children.Methods:Fifty-three children (26 males and 27 females) aged 5 to 15 who had syncope of unknown reasons or presyncope and were diagnosed with POTS by head-up tilt test (HUTT) at the Children′s Syncope Specialist Clinic, the Second Xiangya Hospital, Central South University from April 2012 to May 2019 were selected as the POTS group.Thirty-eight children aged 5 to 16 (19 males and 19 females) who underwent medical examinations at the Children′s Health Specialist Clinic of the Second Xiangya Hospital, Central South University over the same period were enrolled as controls (control group). POTS children were followed up after intervention and they were divided into the response group ( n=40) and the non-response group ( n=13) according to the follow-up results.The products (RPP0, RPP5, RPP10) of the heart rate (HR0, HR5, HR10) and systolic blood pressure (SBP0, SBP5, SBP10) at baseline (HUTT 0 min), HUTT 5 min and HUTT 10 min were calculated.Statistical analysis was performed using SPSS 22.0 software and EmpowerStats software. Results:(1) There was no statistical difference in age and gender between the POTS group and the control group (all P> 0.05). (2) HR5 [(115.45±14.50) times/min vs.(95.79±13.89) times/min], HR10 [(120.57±16.13) times/min vs.(96.05±12.43) times/min], RPP5 (12 814.55±2 304.56 vs.10 371.42±1 910.20), and RPP10 (13 449.17±2 360.40 vs.10 523.18±1 771.48) in the POTS group were significantly higher than those in the control group( t=0.799, 7.842, 5.747, 6.446, all P<0.01). No statistical difference of HR0 and RPP0 was observed between the 2 groups (all P>0.05). (3) In the POTS group: HR5 [(98.73±12.43) times/min vs.(113.77±17.65) times/min], HR10 [(96.90±13.96) times/min vs.(119.08±13.52) times/min], RPP5 (11 125.45±1 952.35 vs.12 914.69±3 192.12) and RPP10 (10 819.58± 2 144.26 vs.13 375.46±2 807.01) in the response group were significantly lower than those in the non-response group( t=3.406, 5.012, 2.432, 3.455, all P<0.01). HR0 and RPP0 were no significantly different between the 2 groups(all P>0.05). (4) When SBP10<114 mmHg(1 mmHg= 0.133 kPa), the probability of response after POTS intervention increased by 10% with every 1 mmHg increase in SBP10, and there was a non-linear relationship between the 2 group ( P<0.05). (5) The receiver operating characteristic curve suggested that when RPP5 was 11 548.50, the sensitivity and specificity to predict the response after POTS intervention were 81.82% and 61.70%, respectively.When RPP10 was 10 988.00, the sensitivity and specificity were 77.78% and 86.21%, respectively. Conclusions:RPP is closely related to the intervention effect of POTS in children.RPP5 and RPP10 can predict the prognosis of POTS in children.There is a non-linear relationship between SBP10 and the intervention effect of POTS in children.

Objective:To summarize clinical characteristics of and treatment experience with patients with critical illnesses in a dermatological ward.Methods:All patients with serious or life-threatening conditions, who were hospitalized at the dermatological ward of the Second Xiangya Hospital of Central South University from July 9, 2011 to December 31, 2020, were collected, and their clinical data were retrospectively analyzed. Demographic characteristics, disease types and proportions, main complications, causes of serious or life-threatening conditions, important treatment measures and outcomes were summarized, and causes of death were also analyzed and discussed.Results:A total of 1 057 patients with critical illnesses were collected, with a male-to-female ratio of 1∶1.11, and 64.81% of them aged 18 to 65 years. The types of diseases mainly included drug eruptions (332 cases) , connective tissue diseases (226 cases) , bullous skin diseases (104 cases) , psoriasis (57 cases) , erythroderma (45 cases) , infectious skin diseases (67 cases) , etc. Among them, psoriasis (39 cases) and erythroderma (32 cases) mostly occurred in males, and connective tissue diseases (168 cases) mostly occurred in females. Common complications mainly involved infections, important organ damage or dysfunction, hypoalbuminemia, and fluid, electrolyte and acid-base imbalances. A total of 94 patients were diagnosed with life-threatening conditions, which were found to be mainly caused by primary skin diseases, hematologic abnormalities, respiratory failure, nervous system abnormalities, renal failure, sepsis, fluid, electrolyte and acid-base imbalances, etc. During the management of critical illnesses, 43 patients were treated with high-dose glucocorticoid pulse therapy, 264 were treated with gamma-globulin pulse therapy, 355 were transfused with other blood products, and 34 received special therapies such as hemoperfusion/immunoadsorption therapy, plasma exchange, dialysis, artificial liver support therapy; 42 patients were transferred to the intensive care unit (ICU) , 12 were transferred to the department of surgery for operations, and 12 were transferred to the department of obstetrics and gynecology for delivery or induction of labor. After treatment, 989 patients (93.57%) achieved improvement and were discharged. A total of 14 patients (1.32%) died, of whom 7 died of secondary sepsis, 2 died of severe pulmonary infections, 2 died of asphyxia caused by respiratory mucosa shedding-induced airway obstruction, the other 3 died of gastrointestinal hemorrhage, cerebral hemorrhage and neuropsychiatric systemic lupus erythematosus, respectively.Conclusions:Critical cases in the dermatological ward mainly suffered from serious skin diseases such as severe drug eruptions, connective tissue diseases and bullous skin diseases, as well as complications such as severe underlying diseases, severe organ dysfunction, sepsis or severe fluid, electrolyte and acid-base imbalances. In terms of treatment, it is of critical significance to make a clear diagnosis and assess the severity of disease as early as possible, monitor and prevent possible complications, and to consult with specialists in relevant disciplines in time.

Three-dimensional tooth segmentation is the segmentation of single-tooth models from a digital dental model. It is an important foundation for diagnosis, planning, treatment and customized appliance manufacturing in digital orthodontics. With the deep integration of artificial intelligence technology and big data from stomatology, the use of deep learning algorithms to assist 3D tooth segmentation has gradually become mainstream. This review summarizes the current situation of deep learning algorithms that assist 3D tooth segmentation from the aspects of dataset establishment, algorithm architecture, algorithm performance, innovation and advantages, deficiencies of current research and prospects. The results of the literature review showed that deep learning tooth segmentation methods could obtain an accuracy of more than 95% and had good robustness. However, the segmentation of complex dental models, operation time and richness of the training database still need to be improved. Research and development of the "consumption reduction and strong core" algorithm, establishment of an authoritative data sample base with multiple centers, and expansion of data application depth and breadth will lead to further development in this field.