Objective To investigate the relationship of body mass index with hiatal hernia (HH) and reflux esophagitis (RE).Methods Two hundreds and twenty seven gastroesophageal reflux disease (GERD) patients with typical acid regurgitation and heartburn were enrolled and categorized into three groups according to body mass index (BMI, kg/m2) as normal weight (18.5≤BMI ＜24), overweight (24≤BMI＜28), and obesity (BMI≥28).RE, non-erosive reflux disease (NERD) and HH were diagnosed by gastroscopy.All the patients underwent ambulatory 24-hour pH monitoring and the pathological acid reflux was considered when the DeMeester score≥15.Effects of BMI on RE and HH were estimated by using logistic regression analysis.Results The percentages of RE and HH were 30.0%(68/227) and 5.7%(13/227), respectively.76.9% (10/13) HH patients had RE. Proportions of RE and HH increased significantly with increasing BMI (P＜0.05), so was that of RE above grade B in three groups (6.4%, 16.9% and 31.6%,P=0.003).DeMeester scores of the three groups were 15.9, 19.8 and 36.9, respectively (P＜0.05).The average 24-hour intra-esophagus pH value of overweight group, was significantly lower than that of normal weight patients in the afternoon and midnight (P＜0.01).Multivariate analysis showed obesity was a risk factor for HH with OR 7.058 (95% CI: 1.294～38.488, P=0.024), male (OR: 2.537, 95% CI: 1.350～4.766, P=0.004), overweight (OR: 1.921, 95% CI: 1.005～3.670, P=0.048), obesity (OR: 3.305, 95% CI: 1.123～9.724, P=0.030) and HH (OR: 6.879, 95% CI: 1.695～27.913, P=0.007) were risk factors for RE.Conclusion BMI has a significant association with HH and RE, obesity is a common risk factor for both HH and RE, HH may induce the development of RE.

Bone Neoplasms ; Cartilage Diseases ; Humans ; Osteochondroma ; Soft Tissue Neoplasms

Objective To study the role of esophagogastric junction contractile index (EGJ-CI) in evaluating the function of anti-reflux barrier,and in differentiating patients with gastroesophageal reflux disease (GERD) from those with functional heartburn (FH).Methods A total of 115 patients presenting heartburn were enrolled in the study from January 2012 to June 2015.All subjects had completed Gerd-Q questionnaire and undergone gastroscopy,24-hour pH-impedance monitoring and esophageal high-resolution manometry.GERD patients were divided into as reflux esophagitis,acid-nonerosive reflux disease (NERD) and weakly acid-NERD groups.Patients with normal esophageal mucosa,normal acid exposure and negative proton pump inhibitor test were enrolled in FH group.EGJ-CI (mmHg · cm) as well as EGJ rest pressure and 4s integrated relaxation pressure (IRP 4s) were measured.Results Among the 115 patients,18 were reflux esophagitis [(49.0 ± 18.9) years,M ∶ F =10 ∶ 8],25 were acid-NERD [(48.7 ± 14.4) years,M∶F=13∶ 12],37 were weakly acid-NERD [(52.0 ±14.8) years,M∶F=15∶22] and 35 were FH [(53.6 ± 14.8),M∶ F =8∶27].No differences of Gerd-Q scores were noticed between the four groups.(1) Negative correlations were demonstrated between EGJ-CI and esophageal acid exposure time (r =-0.283,P =0.002),EGJ-CI and acid reflux events (r =-0.233,P =0.012),EGJ-CI and weakly acid reflux events (r =-0.213,P =0.022),EGJ-CI and non-acid reflux events (r =-0.200,P =0.032).(2)The value of EGJ-CI was significantly higher in FH patients than in the three subgroups of GERD(all P ＜ 0.01).EGJ rest pressure of FH group was higher than that of acid-NERD (P ＜ 0.01).IRP 4s in acid-NERD group was lower than that of FH and weakly acid-NERD (P ＜ 0.05).(3) The area under curve (AUC) of EGJ-CI was higher than that of EGJ-CIT,EGJ rest pressure or IRP 4s (0.686 vs 0.678,0.641 and 0.578).The cut-off value of EGJ-CI to differentiate GERD from FH was 9.74 mmHg · cm with sensitivity 82.86％ and specificity 51.52％.Conclusions The EGJ-CI values are negatively correlated with esophageal acid exposure time,weakly acid reflux events and non-acid reflux events.Thus it might be used as a metric to reflect the anti-reflux function of EGJ.According to the cut-off value of EGJ-CI 9.74 mmHg · cm,patients with GERD can be sensitively differentiated from patients with FH.

Objective To evaluate the value of the Heidelberg retina tomograph - Ⅱ in detection of primary chronic angle-closure glaucoma(CACG) in a Chinese population, and to investigate the difference of parameters detected by HRT-Ⅱ between normal subjects and CACG patients. To evaluate the sensitivity and specificity of optic disk detection using Moorfields regression analysis (MRA) and linear discriminant function(LDF) of the HRT-Ⅱ in differentiating normal from CACG eyes. Design Prospective, comparative case series. Participants 64 eyes of 32 normal subjects and 77 eyes of 51 patients with CACG were studied. The normal subjects were ageand refraction-matched with the glaucoma patients. Methods The interventions consisted of optic disk imaged by means of HRT-Ⅱ and visual field (VF) detected with Oculus Twinfield perimetry. The CACG patients then were divided into two groups according to the VF discriminant standard and mean defect (MD) of Oculus Twinfield perimetry, the group with the glaucomatous VF defect and the group without VF defect. The optic disk was described with 14 optic disk parameters. The optic disc parameters between the normal and the patients were compared. The optic disks were also classified as "normal/borderline/outside normal limits" on the basis of MRA. The results from MRA and from LDF provided in the HRT-Ⅱ were compared. Main Outcome Measures Optic disk parameters, MD of the VF, the VF discriminant standard, the sensitivity and specificity of HRT-Ⅱ examination. Results Between the normal and CACG patients, differences of the most of optic disk parameters were significant statistically (P

Objective To evaluate the clinical significance of intercellular space diameters (ISD)of squamous epithelium by light microscopy (LM) in lower esophagus of erosive reflux esophagitis (ERD),non-erosive reflux disease ( NERD), Barrett esophagus (BE) and healthy controls. Methods A total of 21 ERD and 21 NERD patients with reflux symptoms and confirmed with 24-hour esophageal pH monitoring, 13 BE patients diagnosed by gastroscopy and biopsy, and 20 other healthy controls were enrolled in the study.Samples of ERD, NERD and control group were collected at 2 cm above dentate line, and made HE slides in the conventional way. Images for measurement of ICS were acquired with oil lens ( × 1000). ICS of squamous epithelium was quantitatively measured by computer-assisted morphometry. Ten cells were taken for each sample, 10 consecutive ISD for each cell, i.e. 100 ISD for each subject. Mean ISD was calculated.Results Mean ISDs by LM in control, BE, ERD, and NERD groups were 0. 59, 0. 99, 1.29 and 1.06 μm, respectively. The mean ISDs in BE, ERD, and NERD group were much greater than that in control (P＜0. 05). The mean, maximal and minimal ISDs of group ERD were greater than those of NERD and BE (P = 0. 000). However, the ISDs of NERD and BE are of no significant difference ( P ＞ 0. 05 ). The cut-off value of mean ISD for diagnosis of gastro-esophageal reflux disease (GERD) was 0. 85 μm. Diagnostic sensitivity and specificity for ERD, NERD and BE were 89. 1% and 100. 0%, with reference to clinical symptoms, endoscopy and ISDs above the cut-off value. Conclusion Larger ISDs in lower esophagus by using LM will be found in all subgroups of GERD, including ERD, NERD and BE. Increased ISDs may be one of the markers for diagnosis of ERD, NERD and BE.

Objective To study the differences of esophageal manometry (M),pH set-up method (P) and X-ray (X) on positioning of the 24-hour esophageal pH catheter and relative factors. Methods Fifty subjects underwent M, then pH catheter was located by P and X. The difference between methods and the relative factors such as body height,lower esophageal sphincter (LES) length etc were analyzed. The difference of less than 2 cm between two methods was accepted. Results The length between the location determined by M,Pand X and nose were (37.9 ±2.9),(40.8 ±4.4) and (40.7 ±5.3) cm, respectively.There was significant difference between P and M as well as between X and M (P＜ 0.01 ). The coincidence rate was 62.0%(31/50) between P and M;84.0%(42/50) between P and X;and 58.0%(29/50) between X and M. Compared with P,M was (2.9 ±3.9) cm nearer to the stomach. Age, body height and LES length were main factors which affect the difference between P and M (P＜ 0.01 or ＜ 0.05),body height and LES length were main factors which affect the difference between X and M (P＜0.05 or ＜0.01). Conclusions Compared with M, the location determined by P is nearer to stomach. The location of X is varied. Body height and LES length are main relative factors.

Objective To investigate the cytotoxicity of silica nanoparticles on vascular endothelial cells, and to clarify its action mechanism.Methods The 60 nm silica nanoparticle was selected and the invitro cultured human umbilical vein endothelial cells (HUVECs)were used as cell model.The HUVECs were divided into control and silica nanoparticle exposure groups with concentrations of 12.5,25.0,and 100.00 mg·L-1 .MTT assay was used for the determination of cell viability,lactate dehydrogenase (LDH)release assay for membrane integrity,flow cytometry (FCM)for intracellular reactive oxygen species (ROS)content,and real-time PCR assay for intracellular NF-E2-related factor 2 (Nrf2 ), heme oxygenase-1 (HO-1 ), superoxide dismutase 2 (SOD2 ) and glutamate-cysteine ligase catalytic subunit (GCLC)mRNA levels.Results The MTT results showed that the cell viabilities in each silica nnaoparticle exposure group were decreased compared with control group in a dose-dependent manner. Upon the silica nanoparticle exposure for 12 h,the cell viability was declined significantly only in 100 mg·L-1 exposure group compared with control group (P<0.05).When exposured for 24 h,the cell viabilities in 25.0, 50.0,and 100.0 mg·L-1 exposure groups were declined significantly compared with control group (P<0.05). Under the exposure to silica nanoparticle with the same dose, the cell viabilities were decreased along with the elongation of exposure time.LDH assay and FCM showed that except for that in 12.5 mg·L-1 exposure group, both the LDH activities in media and intracellular ROS levels in other exposure groups were increased compared with control group (P<0.05 ). The results of real-time fluorescence PCR showed that the mRNA levels of Nrf2, HO-1,SOD2 and GCLC in 100 mg·L-1 silica nanoparticle exposure group were increased significantly compared with control group (P<0.05).Conclusion Silica nanoparticles have toxicity to vascular endothelial cells,which includes reducing cell viability,membrane integrity destruction,induction of ROS generation,and tranSCriptional regulation of redox-related factors. Oxidative damage is one of the mechanisms of vascular endothelial toxicity mediated by silica nanoparticles.

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 dyssynergic 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) vs42.0(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.

Objective:To compare the leaf open time (LOT) parameters and γ passing rates between the 4.0.4 and 4.2.3 helix Tomotherapy planning systems and evaluate the improvement.Methods:Retrospective comparison of the treatment plans of 345 cases selected by 4.0.4 and 4.2.3 versions was performed. The Machine Specific Sinogram of each plan was extracted from the archived plan file to calculate the LOT. The evaluated LOT parameters included the projection time, the maximum LOT, the mean non-zeros time, the time difference between the projection time and the maximum LOT, the relative count of leaves with LOT greater than maximum LOT minus 5 ms, the relative count of leaves with LOT lower than 100 ms and the beam on time. The γ passing rate (criteria: 3 mm/3%, 10% threshold and global error) and the LOT parameters between two version systems were evaluated with the independent t-test. The relationship between the LOT parameters and γ passing rate was analyzed by the multiple linear regression method. Results:The γ passing rate of the Ver 4.0.4 system was 97.86%, significantly lower than 98.6% of the Ver 4.2.3 system ( P<0.001). The time gap between the projection time and the maximum LOT of the Ver 4.2.3 system was significantly less than that of the Ver 4.0.4 system (1 ms vs. 11 ms, P<0.001). For the Ver 4.0.4 system, the multiple linear regression method showed that the maximum LOT ratio and the beam on time were negatively correlated with the γ passing rate (both P<0.001). However, for the Ver 4.2.3 system, only the beam on time showed a negative correlation with the γ passing rate ( P<0.001). Conclusion:The γ passing rate of the Ver 4.2.3 system is significantly higher than that of the Ver 4.0.4 system. The decrease of γ passing rate caused by the leaves near the maximum LOT is properly resolved in the new version system.

Objective:To evaluate the sensitivity of the ArcCheck dosimetry system in detecting the leaf open time errors during the center and off-center helical tomotheray delivery quality assurance (DQA).Methods:Nine nasopharyngeal carcinoma (NPC) patients were selected in this study. Two DQA plans were created for each patient: the" center" plan was created by moving the image of the ArcCheck phantom to place the high dose region on the phantom center and the " off-center" plan was created by offsetting the phantom and putting several diodes through a higher does region. Leaf open time errors of 2, 4, 6, 8 and 10 ms were introduced to the Sinogram which was modified using Matlab. Each intentional error plan and original (no error) plan for each patient were measured using both " center" and " off-center" DQA methods, the γ analysis was performed to evaluate the DQA results. The different dose and distance error criteria of 3%/3 mm, 3%/2 mm and 2%/2 mm were selected, and different thresholds of 5%, 10% and 15% were selected for γ analysis. The gradient and the minimum detectable error approach were taken to quantitatively analyze the sensitivity. The correlation between different dose distance error criteria and different thresholds was also evaluated by Pearson correlation analysis. Results:The absolute value of γ gradient of the " center" DQA plans were larger than those of the " off-center" plans in all different γ criteria (all P<0.05). The stricter the γ criteria were adopted, the more sensitive DQA results of leaf open time error were obtained. The minimum detectable error was 2 ms in all different γ criteria for the " center" DQA plan. The minimum error detectability of the " off-center" DQA plan was weaker than that of the " center" DQA plan. The γ passing rates of three different dose distance error criteria were significantly strongly correlated for the " center" DQA plan ( R2>0.9). For the " off-center " DQA plan, only the 3%/3 mm and 3%/2 mm criteria were significantly strongly correlated ( R2>0.9). Significant strong correlation was observed in the γ passing rate at different thresholds between the " off-center" and " center" DQA plans. Conclusions:The " center" DQA plan method is more sensitive than the " off-center" DQA plan method in all γ criteria, and the γ passing rates in different γ criteria are strongly correlated for the " center" DQA plan. The " center" DQA plan method is recommended.