Background/Aims: Reflux symptoms frequently present in patients diagnosed with functional dyspepsia (FD). This investigation sought to elucidate the contribution of gastroesophageal reflux in the overlap relationship. Methods: Consecutive patients presenting with reflux symptoms and/or FD symptoms were prospectively included. Comprehensive assessments, including symptoms evaluation, endoscopy, esophageal functional examinations (high-resolution manometry and reflux monitoring), and proton pump inhibitor (PPI) treatment efficacy evaluation, were conducted in these patients. Results: The study enrolled 315 patients, 43.2% of which had concurrent FD symptoms and overlapping reflux symptoms. Notably, a mere 28.7% of patients in the overlap symptoms group had objective gastroesophageal reflux disease evidences (the grade of esophagitis≥ B or the acid exposure time ≥ 4.2%). Functional heartburn was demonstrated to be the main cause of overlapping reflux symptoms(55.1%). Reflux parameters analysis revealed that the reflux burden in the overlap symptoms group paralleled that of the FD symptoms group, with both registering lower levels than the reflux symptoms group (P < 0.05). Furthermore, PPI response rates were notably diminished in the overlap symptoms group (P < 0.001), even for those with objective gastroesophageal reflux disease evidences. Conclusions The study illuminated that overlapping reflux symptoms in FD was common. Strikingly, these symptoms primarily diverged from reflux etiology and exhibited suboptimal responses to PPI intervention. These findings challenge prevailing paradigms and accentuate the imperative for nuanced therapeutic approaches tailored to the distinctive characteristics of overlapping reflux symptoms in the context of FD.

Background/Aims: Reflux symptoms frequently present in patients diagnosed with functional dyspepsia (FD). This investigation sought to elucidate the contribution of gastroesophageal reflux in the overlap relationship. Methods: Consecutive patients presenting with reflux symptoms and/or FD symptoms were prospectively included. Comprehensive assessments, including symptoms evaluation, endoscopy, esophageal functional examinations (high-resolution manometry and reflux monitoring), and proton pump inhibitor (PPI) treatment efficacy evaluation, were conducted in these patients. Results: The study enrolled 315 patients, 43.2% of which had concurrent FD symptoms and overlapping reflux symptoms. Notably, a mere 28.7% of patients in the overlap symptoms group had objective gastroesophageal reflux disease evidences (the grade of esophagitis≥ B or the acid exposure time ≥ 4.2%). Functional heartburn was demonstrated to be the main cause of overlapping reflux symptoms(55.1%). Reflux parameters analysis revealed that the reflux burden in the overlap symptoms group paralleled that of the FD symptoms group, with both registering lower levels than the reflux symptoms group (P < 0.05). Furthermore, PPI response rates were notably diminished in the overlap symptoms group (P < 0.001), even for those with objective gastroesophageal reflux disease evidences. Conclusions The study illuminated that overlapping reflux symptoms in FD was common. Strikingly, these symptoms primarily diverged from reflux etiology and exhibited suboptimal responses to PPI intervention. These findings challenge prevailing paradigms and accentuate the imperative for nuanced therapeutic approaches tailored to the distinctive characteristics of overlapping reflux symptoms in the context of FD.

Background/Aims: Reflux symptoms frequently present in patients diagnosed with functional dyspepsia (FD). This investigation sought to elucidate the contribution of gastroesophageal reflux in the overlap relationship. Methods: Consecutive patients presenting with reflux symptoms and/or FD symptoms were prospectively included. Comprehensive assessments, including symptoms evaluation, endoscopy, esophageal functional examinations (high-resolution manometry and reflux monitoring), and proton pump inhibitor (PPI) treatment efficacy evaluation, were conducted in these patients. Results: The study enrolled 315 patients, 43.2% of which had concurrent FD symptoms and overlapping reflux symptoms. Notably, a mere 28.7% of patients in the overlap symptoms group had objective gastroesophageal reflux disease evidences (the grade of esophagitis≥ B or the acid exposure time ≥ 4.2%). Functional heartburn was demonstrated to be the main cause of overlapping reflux symptoms(55.1%). Reflux parameters analysis revealed that the reflux burden in the overlap symptoms group paralleled that of the FD symptoms group, with both registering lower levels than the reflux symptoms group (P < 0.05). Furthermore, PPI response rates were notably diminished in the overlap symptoms group (P < 0.001), even for those with objective gastroesophageal reflux disease evidences. Conclusions The study illuminated that overlapping reflux symptoms in FD was common. Strikingly, these symptoms primarily diverged from reflux etiology and exhibited suboptimal responses to PPI intervention. These findings challenge prevailing paradigms and accentuate the imperative for nuanced therapeutic approaches tailored to the distinctive characteristics of overlapping reflux symptoms in the context of FD.

Objective To establish a preliminary evaluation system for gastrointestinal qi stagnation syndrome.Methods On the basis of the systematic evaluation of medical literature in the early stage of the research group,24 high-frequency items were subjected to Delphi method,the item indexes were determined through three rounds of expert consultation,and the proportion value of the indexes was determined by AHP,and the evaluation system of gastrointestinal qi stagnation syndrome was initially constructed.Results A total of 84 valid questionnaires were collected by three rounds of Delphi method,including 15 in the first round,32 in the second round and 37 in the third round.According to the statistics,16 items including distention(stuffy)or distending pain or moving pain(epigastric,abdominal,etc.),belching,borborygmus,flatus,etc.were selected.The order of the proportion of the first level indexes obtained by the analytic hierarchy process from high to low is:clinical symptoms,pulse,tongue;The proportion of secondary indicators from high to low is as follows:distention(stuffy)or distending pain or moving pain(epigastric,abdominal,etc.),pulse string,greasy fur,thin white fur,slippery pulse string,pulse sinking string,light red tongue,flatus,borborygmus,belching,induced or aggravated in case of emotional distress,hiccup,abdominal mass,anorexia,vomiting,belching and swallowing acid.Conclusion Delphi method and analytic hierarchy process have been used to study gastrointestinal qi stagnation syndrome,and an evaluation system has been preliminarily formed.The index structure is reasonable,targeted and has strong clinical practicability.

Achalasia is a primary esophageal motility disorder manifested by dysphagia and chest pain that impair patients’ quality of life, and it also leads to chronic esophageal inflammation by food retention and increases the risk of esophageal cancer. Although achalasia has long been reported, the epidemiology, diagnosis and treatment of achalasia are not fully understood. The current clinical dilemma of achalasia is mainly due to its unclear pathogenesis. In this paper, epidemiology, diagnosis treatment, as well as possible pathogenesis of achalasia will be reviewed and summarized. The proposed hypothesis on the pathogenesis of achalasia is that genetically susceptible populations potentially have a higher risk of infection with viruses, triggering autoimmune and inflammation responses to inhibitory neurons in lower esophageal sphincter.

Background Exposure to air pollutants O₃ and PM_2.5 is closely related to population mortality. Most of the domestic research findings are for residents in coastal areas, and less for those in the central and western regions. Objective To investigate the acute effects of O₃ and PM_2.5 on the mortality of residents in a city of central China. Methods Data were collected on atmospheric pollutants, meteorological data, and population mortality in a city of central China from January 1, 2015 to June 30, 2021. Meteorological data included daily average temperature, air pressure, and relative humidity. Atmospheric pollution data included daily mean concentrations of PM_2.5, PM₁₀, SO₂, NO₂, and CO and maximum 8 h O₃. Generalized additive model with Poisson distribution was used for estimating the relationships between air pollutants (O₃ and PM_2.5) and population mortality, and further stratified by age, gender, and education. Results The daily maximum 8 h average concentration of O₃ in the city during the study period was 94.38 μɡ·m⁻³ and the daily average concentration of PM_2.5 was 55.56 μɡ·m⁻³. In the single-pollutant model, the correlations between O₃ concentration and total deaths as well as deaths due to respiratory, circulatory, hypertension, coronary heart disease, and stroke were strongest at lag02, lag2, lag02, lag0, lag02, and lag0, and for every 10 μɡ·m⁻³ increase in concentration of O₃, the associated ER (95%CI) values of daily mortality were increased by 0.09% (−0.08%–0.25%), 0.35% (0–0.71%), 0.43% (0.18%–0.68%), 0.45% (0.02%–0.91%), 0.59% (0.16%–1.02%), and 0.33% (0.01%–0.65%), respectively. The effect of O₃ on total mortality was not statistically significant (P>0.05). The correlations between PM_2.5 concentration and total deaths, as well as deaths due to respiratory, circulatory, hypertension, coronary heart disease, and stroke were strongest at lag1, lag5, lag01, lag05, lag04, and lag01, and for every 10 μɡ·m⁻³ increase in concentration of PM_2.5, the associated ER (95%CI) values of daily mortality increased by 0.02% (−0.09–0.13%), 0.25% (0.01%–0.50%), 0.35% (0.16%–0.54%), 1.18% (0.59%–1.77%), 0.17% (−0.13%–0.40%), and 0.65% (0.38%–0.92%), respectively, with no statistically significant effects of PM_2.5 on total mortality and mortality due to coronary heart disease (P>0.05). During warm season (from May to October), the ER (95%CI) values of total deaths per 10 μɡ·m⁻³ increase in O₃ in male, people aged 6~65 years, people aged >65 years, and people below high school education were 0.46% (0.16%–0.75%), 0.38% (0.08%–0.68%), 0.41% (0.14%–0.66%), and 0.38% (0.14%–0.61%), respectively, while the O₃ effect was not statistically significant (P>0.05) during cool season (from November to April). Conclusions Atmospheric pollutants (O₃ and PM_2.5) have acute effects on mortality in the city, with the elderly, people with less than a high school education, and those with circulatory disease being more sensitive to O₃ and PM_2.5 exposures.

Background In recent years, our country's atmospheric particulate matter pollution has improved significantly, while ozone (O₃) pollution has become increasingly serious. As a secondary pollutant, O₃ is closely related to human health. Objective To study the effect of short-term exposure to ozone in ambient air on population mortality in China. Methods A computer search with key words of "ozone or O₃", "death", and "time series" in Chinese or "ozone", "mortality", and "China" in English was performed in Web of Science, PubMed, China National Knowledge Infrastructure, Wanfang, and VIP databases to find literature on effects of short-term ozone exposure on population mortality covering a time period from January 1, 1990 to December 31, 2021. According to a set of inclusion and exclusion criteria developed for this study, literaturescreening, quality evaluation, andrelevant data extraction were carried out. Finally, R 4.1.2 software was used to perform meta-analysis to estimate target effect sizes. Results A total of 978 articles were retrieved. According to the inclusion and exclusion criteria, 18 articles were finally included, including 39 effect size estimates. The results showed that every 10 μɡ·m⁻³ increase in ambient ozone concentration was associated with an increase of 0.45% (95%CI: 0.39%-0.51%), 0.50% (95%CI: 0.33%-0.68%), and 0.60% (95%CI: 0.48%-0.72%) in total, respiratory, and cardiovascular disease mortalities , respectively. The results of subgroup analysis by age, sex, and season showed that when ozone concentration increased 10 μɡ·m⁻³, an increase of 0.34% (95%CI: 0.17%-0.51%) in mortality was observed in the ≥ 65-year-old population, higher than 0.09% (95%CI: −0.21%-0.39%) increase in the <65-year-old population; the mortality increase in females [0.44% (95%CI: 0.30%-0.58%)] was greater than that in males [0.35% (95%CI: 0.22%-0.48%)]; compared with the warm season [0.29% (95%CI: 0.16%-0.42%)], mortality increase was higher in the cold season [1.03% (95%CI: 0.71%-1.35%)]. Conclusion Ambient ozone is an important factor affecting population mortality. The elderly and women ≥ 65 years old in China are more sensitive to ozone, and the impact of ozone exposure on population mortality is greater in cold season.

Objective:To observe and analyze the changes of macular retinal thickness and related factors in children with occult myopia.Methods:A prospective longitudinal control study. From February 2021 to February 2022, 120 eyes of 60 children who first visited Department of Ophthalmology of The Affiliated Hospital of Chengde Medical College without any corresponding myopia correction treatment were included in the study. There were 32 males (64 eyes) and 28 females (56 eyes), with the age of 4-6 years. Visual acuity, medical optometry, corneal topography, spectral-domain optical coherence tomography (OCT) and axial length (AL) were measured at the first visit and 3, 6, 9 and 12 months. The children were divided into occult myopia group with 60 eyes of 30 cases and control group with 60 eyes of 30 cases according to visual acuity, equivalent spherical refraction (SE), AL and corneal curvature (CC). The macular fovea retinal thickness was measured by spectral-domain OCT enhanced deep imaging technique. According to the treatment and study of diabetic retinopathy, the retina within the 6 mm of the macular center was divided into three concentric circles with the macular fovea as the center, the central fovea of 1 mm, the inner ring of 1-3 mm and the outer ring of 3-6 mm. In the inner ring and outer ring, the retina was divided into 4 areas, upper and lower, left and right, with a total of 9 regions. The four regions of the inner ring and the outer ring were superior, inferior, nasal and temporal, respectively. The differences of AL, CC, SE, macular retinal thickness and the changes of related factors with time were compared between the occult myopia group and the control group. SE, AL, CC and retinal thickness in different macular regions of the two groups were compared by repeated measurement analysis of variance. In pairwise comparison, the minimum significant difference t test was used in different measurement time points, and the independent sample t test was used between groups at the same measurement time points. Results:At first diagnosis and after diagnosis, there were significant differences in SE ( F=783.710), AL ( F=742.192), macular fovea ( F=330.292), inferior and temporal ( F=158.250, 108.292) side of the outer ring retinal thickness in occult myopia group ( P <0.01). In the control group, there were significant differences in the retinal thickness of SE ( F=1 793.976), AL ( F=457.362), macular fovea ( F=31.029), inferior and temporal ( F=7.405, 77.245) side of the outer ring retinal thickness ( P<0.01). In both groups, with the prolongation of the time after the first diagnosis, the SE gradually increased, the AL gradually lengthened, and the thickness of the macular fovea, inferior and temporal side of the outer ring retinal thickness gradually thinned. Independent sample t test was performed on the data with differences between groups at the same time, and the results showed that at 3, 6, 9 and 12 months after first diagnosis, there were significant differences in SE, AL and CC between the occult myopia group and the control group ( t=-4.801,-11.532, 16.276, -17.145), AL ( t=24.203, 26.353, 27.057, 25.552); CC ( t=-23.362, -25.382, -25.890, -24.350; P<0.01). There were significant differences in macular fovea, inferior and temporal side of the outer ring retinal thickness at 6, 9 and 12 months, macular fovea ( t=-2.596, -2.542, -2.941; P<0.05), outer ring temporal ( t =-2.285, -2.610, -2.506; P<0.05). Conclusion:The SE and AL of the occult myopia group and the control group increase with time, and the former increase more rapidly than the latter; the macular fovea, inferior and temporal side of the outer ring retinal become thinner, and the former become thinner than the latter.

BACKGROUNDThe global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease (COPD) guidelines classify patients into four groups according to the number of symptoms and the level of future risk of acute exacerbation COPD (AECOPD). This study aimed to compare the results of different methods used in diagnosis of COPD and evaluate the accuracy of the assessment methods in guiding clinical practice.

METHODSA survey was conducted of 194 COPD outpatients between March and September 2012. Demographic characteristics, the number of exacerbations the patient has had within the previous 12 months, COPD assessment test (CAT), Modified British Medical Research Council (mMRC) scale, and results of the lung function tests were recorded.

RESULTSOf the 194 patients assessed, 21 had a CAT score ≥10 and an mMRC grade ≤1, 13 had a CAT score <10 and an mMRC grade ≥2. A predicted forced expiratory volume in one second (FEV1%) of <50% with less than two acute exacerbations was observed in 39 patients, while a predicted FEV1% of ≥50% was noted in 20 patients with two or more acute exacerbations. The sensitivity of a predicted FEV1% <50% in predicting the risk of AECOPD in the future was 80.9%, while that in the real number of AECOPD events recorded was 62.8%, the difference being statistically significant (P = 0.004). The sensitivity of CAT in predicting the severity of symptoms was 90%, while that of mMRC was 83.8%, and the difference was not statistically significant.

CONCLUSIONSThe COPD assessment method recommended by the global initiative for chronic obstructive pulmonary disease (GOLD) 2011 is complicated and should be simplified. CAT is more comprehensive and accurate than mMRC. The lung function classification is a better tool for predicting the risk of AECOPD in the future, and the number of AECOPD can be referred to when required.

Objective To establish an analytical method of chromatographic fingerprint of cortex moutan in Dianjiang County through HPLC;To provide reference for the quality control and general evaluation. Methods HPLC with Shim-pack VP-ODS C18 column (4.6 mm×250 mm, 5μm) was used;paeonol was taken as standard;the mobile phase was MeOH-H2O with liner gradient eluation;the delection mavelength was at 274 nm for paeonol and 230 nm for paeoniflorin;the flow rate was 1.0 mL/min. Fourteen batches of samples were analyzed to establish the fingerprint with paeonol and paeoniflorin as reference. Results The results of the 14 batches of samples and similarity evaluation showed that the similar degrees to the 10 batches among the 14 samples were between 0.968-0.998, which illustrated the good similar degrees among samples. Conclusion The established fingerprint with characteristics of stability, good reproducibility and simplicity, can be used for the quality evaluation and control of cortex moutan.