Visceral hypersensitivity is the core pathogenesis process of functional gastrointestinal disorders( FGIDs). Numerous studies showed that psychological stress plays a key role in the development of visceral hypersensitivity. Brain center is the key part involved in psychological stress-induced visceral hypersensitivity, especially senior central sensitization. However,the specific pathophysiological mechanism remains unclear. This article reviewed studies on central role mechanism of psychological stress-induced visceral hypersensitivity.

Objective To explore the relationship between nonalcoholic fatty liver (NFALD)and apolipoprotein E (ApoE)gene polymorphism in Shanghai undergraduate students. Methods A cross-sectional survey was performed in 4 148 students from Shanghai Tongji University. Quesgionary, physical measurement, ultrasonography and biochemical parameters were used to diagnose NFALD. In patients with NAFLD and 200 healthy subjects (served as control), ApoE genotypes were determined by PCR-RFLP. Results (1)Totally 398 subjects were diagnosed as NAFLD (prevalence 9.6%). Body mass index, waist-to-hip ratio, triglycerides, total cholesterol, alanine transaminase, aspartate aminotransferase and γ-glutamyltransferase in NAFLD group were higher than those in control, which were related to the degree of NAFLD (P＜0.01). (2)ApoE genotypes distributions were significantly different between two groups (χ2=10.52, P＜0.01). In NAFLD,E4/4 genotype frequency (5.5%)increased, and E3/3 (61.8%)decreased . (3)Unconditional logistic regression showed that E4/4 were closely associated with lipid profiles. Conclusion ApoE point mutations 112 and 158 may cause different dyslipidosis. E4/4 genotype seems to be one of the genetic predisposition factors of NAFLD.

Objective To assess whether a follow-up endoscopy after endoscopic submucosal dissec-tion(ESD)for gastric lesions is effective for prevention of delayed bleeding. Methods Papers published in Medline,Embase,Cochrane library,Elsevier,Wanfang,VIP and CNKI were searched for the studies eval-uating the efficacy of follow-up endoscopy for reducing delayed postoperative bleeding after ESD for gastric le-sions. Statistic analyses were performed using RevMan 5. 1 software. Results A total of 10 studies including 4 randomized control trials and 6 cohort studies were enrolled. Analysis of these studies showed that the inci-dence of delayed bleeding was not significantly different between the patients receiving a follow-up endoscopy and those not(OR= 1. 38,95% CI:0. 89-2. 13,P= 0. 15). Also,there was no difference in the incidence of delayed bleeding between the prophylactic hemostasis and nonprophylactic hemostasis groups( OR = 1. 45, 95% CI:0. 65-3. 22,P= 0. 36). Conclusion A follow-up endoscopy after gastric ESD may contribute little to the prevention of delayed bleeding,but may be useful for the high-risk patients,which can control the bleeding rate at a low level.

Objective To investigate the influential factors for the colonoscopic polyp detection rate (PDR) and adenomade detection rate(ADR) in high-risk population in community colorectal cancer screening.Methods Data of patients who were determined as high-risk population in community colorectal cancer screening tests and received colonoscopy in the Digestive Endoscopic Center of Tongji Hospital from May 2014 to November 2014 were collected.PDR and ADR were calculated by different genders, ages, history of abdominal operation, anesthesia assistance, quality of bowel preparation and experience of operators.Thex2 test and logistic regression analysis were used to compare the PDR and ADR between different groups.Results A total of 417 patients received complete colonoscopies.The total PDR was 35.25％.Univariate analysis revealed that gender (OR =2.298,95％ CI: 1.525-3.463), history of abdominal operation (OR =0.596,95％CI:0.390-0.910), anesthesia assistance (OR =1.864,95％ CI: 1.086-3.200) and quality of bowel preparation were significantly associated with PDR while multivariate analysis revealed that only gender, history of abdominal operation and quality of bowel preparation were independent influential factors for PDR.The total ADR was 30.22％.Like PDR, univariate analysis revealed that gender(OR =2.113,95％CI: 1.382-3.229), history of abdominal operation(OR =0.604,95％ CI:0.387-0.941), anesthesia assistance(OR =2.344,95％ CI: 1.283-4.281) and quality of bowel preparation were significantly associated with ADR.However, multivariate analysis revealed that only gender, history of abdominal operation and quality of bowel preparation were independent influential factors for ADR.Conclusion For patients who were highrisk in community colorectal cancer screening, men have greater risk to develop polyps and adenomas than women.Colonoscopy should be more careful in patients with history of abdominal operation, for quality of bowel preparation is directly related to PDR and ADR.

Objective To evaluate the diagnostic value and limitation of multichannel intraluminal esophageal impedance and pH (MII-pH) monitoring on the diagnosis of gastroesophageal reflux-related chronic cough (GERC).Methods The patients with suspicious GERC consecutively referred to our respiratory clinic between May 2010 and July 2011 underwent a MII-pH monitoring,and received anti-reflux drug therapy,irrespective of the laboratory findings.Chronic cough due to gastroesophageal reflux was determined when there was a favorable response to anti-reflux therapy.Then,the sensitivity,specificity,false positive and negative rate,total consistence,positively and negatively predictive value,the area under the curve of ROC and the Kappa value of the laboratory investigation were calculated for the diagnosis of GERC.Results During the research period,56 patients completed MII-pH monitoring.Among them,the abnormal reflux was found in 35 patients,and GERC was finally confirmed in 30 patients (85.7％) including 25 patients (83.3％) due to acid reflux and 5 patients (16.7％) due to non-acid reflux.In the remaining 21 patients with normal reflux episodes,6 patients (28.6％) could be explained by non-acid reflux for their cough because of a relatively predominant weakly acid reflux and favorable response to empirical anti-reflux therapy.For the diagnosis of GERC,MII-pH monitoring had the sensitivity of 83.3％,the specificity of 75.0％,false positive rate of 25.0％,false negative rate of 16.7％,total consistence of 80.4％,positive predictive value of 85.7％,negative predictive value of 71.4％,the area under the curve of ROC of 0.792 and Kappa value of 0.577 respectively.Conclusion MII-pH is a sensitive and reliable tool for the diagnosis of GERC due to its ability to detect both acid and non-acid reflux.

Objective: To investigate the pH value of towels in public places in Hangzhou City, so as to provide the evidence for improving health supervision of towels in public places. Methods: One three- and higher-star hotel, one less than three-star hotel, one express hotel, one barber shop and one beauty shop were selected from 13 counties (districts) of Hangzhou City in 2021, and 3% to 5% of all cleaned and disinfected towels that planned to be used were randomly sampled. The type of public places and towels cleaning and disinfection were collected using the basic investigation form provided in the Public Place Health Risk Factors Surveillance Program (2021 version), and the pH value of towels was measured according to the national criteria Textiles-determination of pH of aqueous extract (GB/T 7573-2009). According to the national criteria of Hygienic indicators and limits for public places (GB 37488-2019), a pH value of 6.5 to 8.5 was defined qualified, and the rates of qualified pH values was estimated for towels sampled from different places and with different cleaning and disinfection types. Results: Totally 64 public places were investigated, and 807 towels were measured for pH values, with a median pH value of 7.3 (interquartile range, 0.7). A total of 655 towels had qualified pH values (81.16%). The rates of qualified pH values were 84.95%, 75.56%, 73.21%, 85.61% and 88.81% for towels sampled from the three- and higher-star hotel, less than three-star hotel, express hotel, barber shop and beauty shop, respectively (χ2=19.307, P=0.001). The rate of qualified pH values for self-cleaned and -disinfected towels was significantly higher than for towels with outsourcing cleaning and disinfection services (88.28% vs. 77.18%; χ2=14.973, P<0.001). The rate of qualified pH values was 83.82% for towels with outsourcing cleaning and disinfection services sampled from the three- and higher-star hotel, and was both 100.00% for self-cleaned and -disinfected towels sampled from the less than three-star hotel and beauty shop. Conclusion The cleaning quality of towels remains to be improved in public places in Hangzhou City, and health supervisions on towels are recommended to be improved in public places.

Objective To observe the protective effects of nuclear factor (NF) κB inhibitor pyrrolidine dithiocarbamate (PDTC) on chronic mixed reflux esophagitis in rats and its influence on NF-κB/interleukin (IL)-6 signaling pathway.Method A total of 40 healthy male Sprague-Dawley (SD) rats were divided into healthy control group,sham operation group,model control group,omeprazole group and PDTC group with eight rats in each group.Except rats in healthy control group and sham operation group,mixed reflux esophagitis model were established in all the other groups.The rats of healthy control group,sham operation group and model control group were all intraperitoneally injected with 2 mL 0.9％ NaCl,rats of omeprazole group were intraperitoneally injected with omeprazole 20 mg/kg,and rats of PDTC group were intraperitoneally injected with PDTC 100 mg/kg every day.After six weeks,the rats were sacrificed,the morphological changes of esophageal tissues were observed and scored by visual inspection and under light microscope.The serum levels of NF-κB p65 and IL-6 in rats of each group were assessed by enzyme linked immunoassay (ELISA).t test was performed for mean comparison among groups.Results The scores of esophageal mucosa judged by visual inspection of healthy control group,sham operation group,model control group,omeprazole group and PDTC group were 0.000 20.000,0.000±0.000,2.250± 0.707,1.125 ± 0.835 and 1.429± 0.535,respectively.The pathological scores were 0.00020.000,0.000±0.000,2.625±0.518,1.500±0.535,1.429±0.535,respectively.Compared with those of model control group,the scores judged by visual inspection and the pathological scores of healthy control group,sham operation group,omeprazole group and PDTC group were lower,and the differences were statistically significant (t=7.603,7.603,2.909,2.506; t=9.674,9.674,4.277,4.399,all P＜0.05).The serum levels of NF-κB p65 protein of healthy control group,sham operation group,omeprazole group and PDTC group were (68.618±18.450) pg/mL,(77.824±22.228) pg/mL,(106.693±45.312) pg/mL and (103.781± 42.502)pg/mL,respectively; compared with that of model group ((184.882±49.165) pg/mL),which were significantly lower and the differences were statistically significant (t=6.262,5.612,3.308 and 3.427,all P＜0.05).The serum levels of IL-6 protein were (24.826±4.008) pg/mL,(23.599±4.351) pg/mL,(32.370± 11.657) pg/mL and (33.694±10.394) pg/mL,respectively,which significantly decreased when compared with that of model group ((51.378±9.697) pg/mL,t=7.157,7.393,3.546 and 3.392,all P＜0.05).There was no significant difference between PDTC group and omeprazole group in the score judged by visual inspection,pathological scores,the serum levels of NF-κB p65 and IL-6 protein (all P＞0.05).Conclusion NF-κB inhibitor PDTC could reduce the injury severity of esophageal mucosal in reflux esophagitis rat,which mechanism might be related with the down-regulation of NF-κB/1L-6 signaling pathway.

Objective To observe the protective effects of quercetin on esophageal mucosa in chronic mixed reflux esophagitis (RE) rats and the effect of quercetin on nuclear factor (NF)-κB/interleukin (IL)-6 signaling pathway.Methods Mixed RE model was successfully induced by cardia ligation and esophagoduodenostomy.48 healthy male Sprague-Dawley rats were equally divided into the following 6 groups using random number table method:normal control group,sham-operation group,model control group,omeprazole group,low-dose quercetin group,and high-dose quercetin group.The 6 groups were treated with peritoneal injection of 2 ml normal saline (normal control,sham-operation,model control groups),20 mg/kg omeprazole,100 mg/kg quercetin (low-dose) and 200 mg/kg quercetin (high-dose) once daily,respectively.The rats were sacrificed after 6 weeks of intervention.The microscopic pathological changes of esophageal mucosa were scored.NF-κB p65 and IL-6 protein levels in esophageal mucosa and serum were assessed using immunohistochemistry and enzyme-linked immunosorbent assay,respectively.Results In normal control group,shamoperation group,model control group,omeprazole group,low-dose quercetin group and high-dose quercetin group,the pathological scores of esophageal mucosa were 0.250 ± 0.463,0.250 ± 0.463,2.625 ± 0.518,1.500 ±0.535,1.250 ±0.463,and 1.375 ±0.518; the NF-κB p65 protein scores in esophageal mucosa were 0.500±0.535,0.625 ±0.518,3.500 ±0.535,1.875 ±0.649,1.750 ±0.707,and 2.000 ±0.535; the IL-6 protein scores in esophageal mucosa were 1.125 ± 0.641,1.125 ± 0.835,5.375 ± 0.518,2.375 ± 0.518,2.000 ±0.535,and 2.250 ±0.463; the serum NF-κB p65 protein levels were (68.618 ± 18.500),(77.824 ± 22.228),(184.882 ± 49.165),(106.693 ± 45.312),(76.215 ± 16.588),and (108.207 ± 42.107) pg/ml; the serum IL-6 protein levels were (24.826 ±4.008),(23.599 ±4.351),(51.378 ± 9.697),(32.370 ± 11.657),(23.085 ± 4.660),and (26.243 ± 4.955) pg/ml.In terms of the 5 indicators,there were no statistically significant differences between the normal control group and the sham-operation group (P =1.000,P =0.642,P =1.000,P =0.518,P =0.673) ; the results in the normal control,shamoperation,omeprazole,low-dose quercetin,and high-dose quercetin groups were significantly different from those in the model control group (P < 0.001,P < 0.001,P < 0.001,P =0.002,P =0.001 ; P < 0.001,P < 0.001,P<0.001,P=0.004,P=0.002; P=0.001,P<0.001,P<0.001,P=0.025,P=0.023; all P <0.001 ; P <0.001,P <0.001,P <0.001,P =0.023,P <0.001) ; there were no statistically significant differences between low-dose quercetin group and omeprazole group,nor between high-dose quercetin group and omeprazole group (P=0.334,P=0.717,P=0.176,P=0.121,P =0.074; P =0.642,P=0.678,P=0.619,P =0.949,P =0.225); there were no statistically significant differences between low-dose quercetin group and high-dose quercetin group (P =0.619,P =0.438,P =0.334,P =0.086,P =0.243).The microscopic pathological score of esophageal mucosa was positively correlated with NF-κB p65 and IL-6 protein scores in esophageal mucosa (r =0.803,P < 0.001 ; r =0.758,P < 0.001),also positively correlated with serum NF-κB p65 and IL-6 protein levels (r=0.486,P=0.004; r=0.544,P=0.001).Conclusions The expression levels of NF-κB p65 and IL-6 protein in esophageal mucosa and serum increase with the severity of esophageal mucosal injury.Quercetin can reduce the severity of esophageal mucosal injury in RE,possibly through down-regulating NF-κB and IL-6 expression and mitigatng esophageal inflammatory status.

Objective To elucidate cerebral cortical response to esophageal acid exposure in normal individuals by functional magnetic resonance imaging (fMRI) and the characteristics of activity. Methods Fifteen volunteers were received intraesophageal perfusion with either 0.9% of sodium chloride or acid (0.1 mmol/L HC1) solutions. The modified block-design model of fMRI scanning was performed simultaneously. All of 32 minutes were needed for resting (A, 8 minutes), 0.9% of sodium chloride perfusion (B,8 minutes), acid perfusion (C,8 minutes) and 0.9% of sodium chloride perfusion again (D,8 minutes). Each chunk was consisted of 160 scans and every scan contained 3 seconds. Six hundred and forty scans were collected in all. The clinical response to esophageal acid exposure was observed and the changes in the cerebral regions was statistically analyzed. Results After perfusion of 0.9% of sodium chloride or acid, 10 out of 15 volunteers had chemosensitive complaints, such as pain in pars laryngen pharyngis, heartburn and chest complaint. The initial active domains involved deutocerebrum, anterior part of callosal gyrus, left side of insula, two sides of amygdale and subiculum hippocampi, two outers of forehead cortex. The provoked regions of acid perfusion (C-A) and 0.9% of sodium chloride perfusion again (D-A) were as same as that of the activated domains by initial perfusion of 0.9% sodium chloride (B-A). The intensity and amplitude of most provoked regions increased gradually(D-A> B-A, P< 0.01). Conclusions The two different stimulations of saline and acid provoke similar cerebral regions that may act in the regulation of esophageal sensitivity. There are the evidences of the central mechanism of esophageal visceral hypersensitivity by acid perfusion.

Objective To evaluate the expression of substance P (SP) and caltenin gene related peptide (CGRP) in esophagueal mucosa from patients with non-erosive gnstroesophageal reflux disease (NERD) and reflux esophagitis (RE) and to explore their role in the development of NERD. Methods Fif-ty-one patients with typical symptoms of gnstroesophageal reflux disease (GERD) were evaluated with reflux disease questionnaire (RDQ), PPI test, endoscopy and 24hr esophageal pH monitoring. The patients were then divided into RE group (n = 21), NERD group with acid refluux (NERD+, n = 12) and NERD group without acid reflux (NERD-, n = 18) according to the evaluation results. The expression of SP and CGRP in esophagus mucosa from these patients and 10 healthy control subjects were assayed by immunohistochemis-try, and the stain positive index (PI) was calculated by Color patho-image analysis software and compared. Results The PIs of SP and CGRP in NERD- group were 96.77±31.74 and 24.76±29.15, respectively, which were significantly higher than those of NERD+ group (73.64±31.38, 9.78±10.30, respectively, P < 0.05), RE group (67.56±34.62, 9.61±6.20, respectively, P < 0.05) and control group (59.82± 46.15, 8.64±12.12, respectively, P < 0.05). Conclusion Expressions of SP and CGRP in esophagus mucosa from NERD patients without detectable acid reflux are significantly increased, they may play an im-portant role in esophageal visceral sensitivity.