This article summarized the overview of voice training, common training forms, and the application effect of voice training in the treatment of speech disorders in Parkinson′s disease patients, analyzed the shortcomings of its application and put forward prospects for future research, aiming to provide valuable references for both patients and healthcare workers.

Gastroesophageal reflux disease (GERD) is characterized by significant clinical heterogeneity. Conventional diagnostic approaches, including symptom-based questionnaires, empirical acid suppression trials, and single-modality objective tests, demonstrate limited sensitivity and specificity, often resulting in diagnostic inaccuracies and inefficient resource utilization. To overcome these diagnostic challenges, this article provides a systematic review of recent advancements and ongoing debates in GERD diagnostics, with a focus on the diagnostic value of multimodal parameters as outlined in the Lyon Consensus 2.0. It also explores the clinical relevance of emerging auxiliary diagnostic metrics. We emphasize that integrating clinical symptomatology, endoscopic findings, esophageal physiological measurements, and psychosocial factors (augmented by composite scoring systems and artificial intelligence), offers a promising strategy for accurate diagnosis and personalized treatment of GERD.

This article summarized the overview of voice training, common training forms, and the application effect of voice training in the treatment of speech disorders in Parkinson′s disease patients, analyzed the shortcomings of its application and put forward prospects for future research, aiming to provide valuable references for both patients and healthcare workers.

Gastroesophageal reflux disease (GERD) is characterized by significant clinical heterogeneity. Conventional diagnostic approaches, including symptom-based questionnaires, empirical acid suppression trials, and single-modality objective tests, demonstrate limited sensitivity and specificity, often resulting in diagnostic inaccuracies and inefficient resource utilization. To overcome these diagnostic challenges, this article provides a systematic review of recent advancements and ongoing debates in GERD diagnostics, with a focus on the diagnostic value of multimodal parameters as outlined in the Lyon Consensus 2.0. It also explores the clinical relevance of emerging auxiliary diagnostic metrics. We emphasize that integrating clinical symptomatology, endoscopic findings, esophageal physiological measurements, and psychosocial factors (augmented by composite scoring systems and artificial intelligence), offers a promising strategy for accurate diagnosis and personalized treatment of GERD.

Background::Erosive esophagitis (EE) is a gastroesophageal reflux disease characterized by mucosal breaks in the esophagus. Proton pump inhibitors are widely used as maintenance therapy for EE, but many patients still relapse. In this trial, we evaluated the noninferiority of vonoprazan vs. lansoprazole as maintenance therapy in patients with healed EE. Methods::We performed a double-blind, double-dummy, multicenter, phase 3 clinical trial among non-Japanese Asian adults with endoscopically confirmed healed EE from April 2015 to February 2019. Patients from China, South Korea, and Malaysia were randomized to vonoprazan 10 mg or 20 mg once daily or lansoprazole 15 mg once daily for 24 weeks. The primary endpoint was endoscopically confirmed EE recurrence rate over 24 weeks with a noninferiority margin of 10% using a two-sided 95% confidence interval (CI). Treatment-emergent adverse events (TEAEs) were recorded.Results::Among 703 patients, EE recurrence was observed in 24/181 (13.3%) and 21/171 (12.3%) patients receiving vonoprazan 10 mg or 20 mg, respectively, and 47/184 (25.5%) patients receiving lansoprazole (differences: -12.3% [95% CI, -20.3% to-4.3%] and -13.3% [95% CI, -21.3% to -5.3%], respectively), meeting the primary endpoint of noninferiority to lansoprazole in preventing EE recurrence at 24 weeks. Evidence of superiority (upper bound of 95% CI <0%) was also observed. At 12 weeks, endoscopically confirmed EE recurrence was observed in 5/18, 2/20, and 7/20 of patients receiving vonoprazan 10 mg, vonoprazan 20 mg, and lansoprazole, respectively. TEAEs were experienced by 66.8% (157/235), 69.0% (156/226), and 65.3% (158/242) of patients receiving vonoprazan 10 mg, vonoprazan 20 mg, and lansoprazole, respectively. The most common TEAE was upper respiratory tract infection in 12.8% (30/235) and 12.8% (29/226) patients in vonoprazan 10 mg and 20 mg groups, respectively and 8.7% (21/242) patients in lansoprazole group.Conclusion::Vonoprazan maintenance therapy was well-tolerated and noninferior to lansoprazole for preventing EE recurrence in Asian patients with healed EE.Trial Registration::https://clinicaltrials.gov; NCT02388737.

Objective:To establish the normal values of water-perfused high resolution esophageal manometry (HREM)(GAP-36A) at resting period, water swallowing, semisolid swallowing and solid swallowing in Chinese population.Methods:From September 1, 2019 to June 30, 2020, 91 healthy volunteers receiving water-perfused HREM (GAP-36A) at resting period, water swallowing, semisolid swallowing and solid swallowing were selected from 9 hospitals (Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; the First Affiliated Hospital of Dalian Medical University; the Second Hospital of Hebei Medical University; the Second Affiliated Hospital, Naval Medical University; the First Affiliated Hospital, Sun Yat-sen University; the First Affiliated Hospital, University of Science and Technology of China; Aviation General Hospital of China Medical University; the Affiliated Hospital of Medical School of Nanjing University and the First People′s Hospital of Yichang). Parameters included the position of the upper and lower edges of the upper esophageal sphincter (UES) and lower esophageal sphincter (LES), the length of the LES and UES, the position of the pressure inversion point (PIP), the resting pressure of UES and LES and swallow-related parameters such as the distal contraction integral (DCI), 4 s integrated relaxation pressure (IRP), distal latency (DL) and UES residual pressure. One-way analysis of variance, post-hoc test and sum rank test were used for statistical analysis.Results:A total of 87 healthy volunteers were enrolled, including 40 males and 47 females, aged (38.5±14.2) years old (ranged from 19 to 65 years old). The position of the upper and lower edges of the LES was (42.7±2.8) and (45.6±2.8) cm, respectively, the length of the LES was (2.9±0.4) cm, and the position of PIP was (43.3±2.8) cm. The position of the upper and lower edges of the UES was (18.1±3.0) and (22.6±2.0) cm, respectively, and the length of the UES was (4.8±1.0) cm. The resting pressure of LES and UES was (17.4±10.7) and (84.1±61.1) mmHg (1 mmHg=0.133 kPa), respectively. The DCI value at solid swallowing was higher than those at water swallowing and semisolid swallowing ((2 512.4±1 448.0) mmHg·s·cm vs. (2 183.2±1 441.2) and (2 150.8±1 244.8) mmHg·s·cm), and the differences were statistically significant ( t=-4.30 and -3.74, both P<0.001). The values of 4 s IRP at semisolid swallowing and solid swallowing were lower than that at water swallowing ((4.6±4.1) and (4.9±3.9) mmHg vs. (5.4±3.9) mmHg), and the differences were statistically significant ( t=3.38 and 2.09, P=0.001 and 0.037). The DL at water swallowing was shorter than those at semisolid swallowing and solid swallowing ((8.5±1.8) s vs. (9.8±2.2) and (10.6±2.8) s), and the DL at semisolid swallowing was shorter than that at solid swallowing, and the differences were statistically significant ( t=-10.21, -13.91 and -4.68, all P<0.001). The UES residual pressure at water swallowing was higher than those at semisolid swallowing and solid swallowing (9.5 mmHg, 6.5 to 12.3 mmHg vs. 8.0 mmHg, 4.5 to 11.7 mmHg and 5.5 mmHg, 2.0 to 9.3 mmHg), and the UES residual pressure at semisolid swallowing was higher than that at solid swallowing, and the differences were statistically significant ( t=3.48, 10.30 and 6.35, all P<0.001). Conclusions:The normal values of water-perfused HREM (GAP-36A) in Chinese population at resting period, water swallowing, semisolid swallowing and solid swallowing can provide a reference basis for clinical diagnosis and treatment for patients receiving water-perfused HREM examination.

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 explore the effects of group intervention model based on self-disclosure theory on burden of main caregivers among stroke patients. Methods? From January 2015 to January 2016, we selected 60 main caregivers of stroke inpatients from Department of Neurology and Neurological Rehabilitation in Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine as subjects by convenience sampling. All of the patients were divided into observation group and control group according to the admission time, 30 cases in each group. Observation group received group intervention model based on self-disclosure theory. Control group carried out routine nursing instruction. Burden and life quality were evaluated with the Zarit Caregiver Burden Interview (ZBI) and World Health Organzation Quality of Life Assessment Instrument Brief Version (WHOQOL-BREF) before and five weeks after intervention. Results? There were statistical differences in the total score of ZBI and the scores of two dimensions (personal burden and responsibility burden) of main caregivers of stroke patients in observation group before and after intervention (P＜0.05). There was no statistical difference in the total score of ZBI and the scores of two dimensions (personal burden and responsibility burden) of main caregivers of stroke patients in control group before and after intervention (P＞0.05). The differences in the total score of ZBI and the scores of two dimensions of main caregivers of stroke patients were statistical between two groups after intervention (P＜0.05). There were statistical differences in the total score of WHOQOL-BREF and the scores of two dimensions (psychology and social relations) in observation group before and after intervention (P＜0.05). There were statistical differences in the total score of WHOQOL-BREF and the scores of social relations in control group before and after intervention (P＜ 0.05). There were statistical differences in the total score and scores of physiology, psychology and social relations between two groups before and after intervention (P＜ 0.05). Conclusions? The application of group intervention model based on self-disclosure theory in main caregivers of stroke patients can effectively reduce caregivers burden and improve their quality of life.

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

OBJECTIVE:To observe the efficacy and safety of levofloxacin and capreomycin combined with chemotherapy regi-men in the treatment of multi-drug resistant tuberculosis(MDR-TB). METHODS:84 MDR-TB patients were randomly divided in-to observation group (42 cases) and control group (42 cases). Observation group received 0.75 g Capreomycin sulfate for injec-tion,addint into 100 ml 0.9% Sodium chloride injection,intravenous infusion,once a day+0.4 g Levofloxacin hydrochloride tab-let,orally,once a day+0.2 g Protionamide tablet,orally,3 times a day+0.3 g Pasiniazid tablet,orally,3 times a day+0.5 g Pyra-zinamide tablet,orally,4 times a day. Control group received 0.4 g Amikacin sulfate injection,adding into 100 ml 0.9% Sodium chloride injection,once a day,intravenous infusion+0.3 g Ofloxacin tablet,orally,twice a day+Protionamide tablet (the same dose with observation group)+Pasiniazid tablet (the same dose with observation group)+Pyrazinamide tablet (the same dose with observation group). All patient were given 0.1 g Glucuronolactone tablet,orally,3 times a day. The treatment course for both group was 12 months. Sputum negative conversion rate,negative conversion time,symptom improvement time,lesion absorption and lung cavity closing,and cell immune indexes (CD4+CD25+/CD4+,CD4+CD25+CD127low/CD4+),IL-17 level before and after treatment,and the incidence of adverse reactions in 2 groups were observed. RESULTS:The sputum negative conversion rate,ab-sorption rate,lung cavity closing and narrowing cases in research group after 3,6,9,12,18 months treatment were significantly higher than control group,sputum negative conversion time,symptom improvement time in observation group were significantly lower than control group,the differences were statistically significant(P<0.05). Before treatment,there were no significant differ-ences in CD4+CD25+/CD4+,CD4+CD25+CD127low/CD4+,IL-17 level in 2 groups(P>0.05). After treatment,CD4+CD25+/CD4+,CD4+CD25+CD127low/CD4+ in 2 groups were significantly lower than before,and observation group was lower than control group,IL-17 level was significantly higher than before,and observation group was higher than control group,the differences were statistically significant (P<0.05). And there was no significant difference in the incidence of adverse reactions in 2 groups (P>0.05). CON-CLUSIONS:Levofloxacin and capreomycin combined with chemotherapy in the treatment of MDR-TB,it can reduce T regulatory cells,increase IL-17 level,do not increase the incidence of adverse reactions.