Esophageal manometry and 24-hour pH monitoring in esophagus surgery:28-year Chinese experience in a single center

Objective To retrospectively review the experience of esophageal manometry and 24-hour pH monitoring in e-sophagus surgery. Methods From 1982 to 2010,patients with unspecific chest pain and undergone esophageal surgery were received esophageal manometry and 24-hour pH monitoring. Results Among the patients with

Diagnosis of gastroesophageal reflux disease in elderly subjects using 24-houres ophageal pH monitoring

Objective To evaluate the relationship between the parameters of 24 hour esophageal pH monitoring and gastroesophageal reflux disease (GERD) among elderly subjects. Methods Twenty four hour esophageal pH monitoring was carried out in 20 elderly subjects without apparent GERD symptoms (controls) and 69 suspected GERD subjects.Results Normal values of the parameters from 20 elderly controls were obtained. Percent of total time, percent of supine time and percent of upright time in which the pH was <4 (indicating reflux) were less than 3.3%, 1.4%, 5.5%, respectively. The number of reflux episodes and episodes lasting longer than 5 minutes were less than 65 and 2 times respectively. The values obtained in 66 GERD suspected subjects were significantly different from those in norrmal controls. The differences of reflux parameters between the esophagitis group and non esophagitis group, such as percent of total time with pH<4, percent of supine time with pH<4 and number of reflux lasting longer than 5 minutes were also significant. Conclusions About 51.6% patients (34/66) with reflux symptoms but without endoscopic evidence of esophagitis were definitely diagnosed as GERD by esophageal pH monitoring. Duration of esophageal acid exposure correlated with the severity of GERD.

Pre-Lung transplant reflux testing demonstrates high prevalence of gastroesophageal reflux in cystic fibrosis and reduces chronic rejection risk

BACKGROUND Gastroesophageal reflux(GER)has been associated with poor outcomes after lung transplantation for chronic lung disease,including increased risk of chronic rejection.GER is common in cystic fibrosis(CF),but factors influencing the likelihood of pre-transplant pH testing,and the impact of testing on clinical management and transplant outcomes in patients with CF are unknown.AIM To evaluate the role of pre-transplant reflux testing in the evaluation of lung transplant candidates with CF.METHODS This was a retrospective study from 2007-2019 at a tertiary medical center that included all patients with CF undergoing lung transplant.Patients with pretransplant anti-reflux surgery were excluded.Baseline characteristics(age at transplantation,gender,race,body mass index),self-reported GER symptoms prior to transplantation,and pre-transplant cardiopulmonary testing results,were recorded.Reflux testing consisted of either 24-h pH-or combined multichannel intraluminal impedance and pH monitoring.Post-transplant care included a standard immunosuppressive regimen,and regular surveillance bronchoscopy and pulmonary spirometry in accordance with institutional practice as well as in symptomatic patients.The primary outcome of chronic lung allograft dysfunction(CLAD)was defined clinically and histologically per International Society of Heart and Lung Transplantation criteria.Statistical analysis was performed with Fisher’s exact test to assess differences between cohorts,and time-to-event Cox proportional hazards modeling.RESULTS After applying inclusion and exclusion criteria,a total of 60 patients were included in the study.Among all CF patients,41(68.3%)completed reflux monitoring as part of pre-lung transplant evaluation.Objective evidence of pathologic reflux,defined as acid exposure time>4%,was found in 24 subjects,representing 58%of the tested group.CF patients with pre-transplant reflux testing were older(35.8 vs 30.1 years,P=0.01)and more commonly reported typical esophageal reflux symptoms(53.7%vs 26.3%,P=0.06)compared to those without reflux testing.Other patient demographics and baseline cardiopulmonary function did not significantly differ between CF subjects with and without pre-transplant reflux testing.Patients with CF were less likely to undergo pre-transplant reflux testing compared to other pulmonary diagnoses(68%vs 85%,P=0.003).There was a decreased risk of CLAD in patients with CF who underwent reflux testing compared to those who did not,after controlling for confounders(Cox Hazard Ratio 0.26;95%CI:0.08-0.92).CONCLUSION Pre-transplant reflux testing revealed high prevalence of pathologic reflux in CF patients and was associated with decreased risk of CLAD.Systematic reflux testing may enhance outcomes in this patient population.

Monitoring of Sweat pH and Dual-Mode Anti-Counterfeiting from Metal-Organic Framework-Based Multifunctional Gel

Monitoring of sweat pH plays important roles in physiological health,nutritional balance,psychological stress,and sports performance.However,the combination of functional MOFs with phosphorescent material to acquire the real-time physiological information,as well as the application of dual mode anti-counterfeiting,has seldom been reported.Herein,we developed multifunctional gel films based on MOFs and phosphorescent dyes which responded to H+ions and the related mechanism was studied in detail.Upon exposure to H+,the composite gel film exhibited decreased fluorescent signal but enhanced room temperature phosphorescence(RTP),which could be utilized for sweat pH sensing through a dual-mode.Moreover,multifunctional gel films exhibited a potential application in information encryption and anti-counterfeiting by designing of stimulus responsive multiple patterns.This research provided a new avenue for portable and non-invasive sweat pH monitoring methods while also offering insights into stimulus-responsive multifunctional materials.

A 640×640 ISFET array for detecting cell metabolism

Ion sensitive field effect transistor(ISFET)devices are highly accurate,convenient,fast and low-cost in the detection of ions and biological macromolecules,such as DNA molecules,antibodies,enzymatic substrates and cellular metabolites.For high-throughput cell metabolism detection,we successfully designed a very large-scale biomedical sensing application specific integrated circuit(ASIC)with a 640×640 ISFET array.The circuit design is highly integrated by compressing the size of a pixel to 7.4×7.4μm^(2)and arranging the layout of even and odd columns in an interdigital pattern to maximize the utilization of space.The chip can operate at a speed of 2.083M pixels/s and the dynamic process of the fluid flow on the surface of the array was monitored through ion imaging.The pH sensitivity is 33±4 mV/pH and the drift rate is 0.06 mV/min after 5 h,indicating the stability and robustness of the chip.Moreover,the chip was applied to monitor pH changes in CaSki cells metabolism,with pH shifting from 8.04 to 7.40 on average.This platform has the potential for continuous and parallel monitoring of cell metabolism in single-cell culture arrays.

Does (supra)gastric belching trigger recurrent hiccups?

Twenty-four hours multichannel intraesophageal impedance and pH monitoring in a patient who suffered from recurrent hiccups for more than a year revealed frequent supragastric belching and pathological oesophageal acid exposure. Furthermore, a temporal relationship between the start of a hiccup episode and gastric belching was observed. The data support the hypothesis that there is an association between supragastric belching, persistent recurrent hiccups and gastro-oesophageal reflux disease, and that gastric belching may evoke hiccup attacks.

THE RELATIONSHIP BETWEEN THE SPONTANEOUS NOCTURNALEPISODES OF ALKALINIZATION AND AUTONOMIC NERVOUS FUNCTION ON FD PATIENTS

Objective To study the relationshlp between the spontaneous nocturnal eplsodes of alkaiinization and the autonomic nerve system function and vagal function-Methods 24-hour intragastric pH was measured and autonomic and vagal function was measured with the time domain analyses of heart rate variability in 2o patients with functional dyspepsia but without diseases of the cardiovascular system- Results 13 of 2o had the nocturnal episodes of alkalinization. The to tal 24-hour SDNN and MSSD were normal in 2o subjects with FD. There was no signiflcant difference (P>O. O5) in the comparison of the total SDNN and rMSSD of the 2 groups with alkalinization and without alkalinization. The 2 groups both had higher PNN5os in the nocturnal time, and there was no significant difference (P>O. O5). Conclusion The results suggest that the total autonpmlc nerve function and vagal function of patients with FD are normal vagal activities of the 2 groups are both increased in the nocturnal period. The reason for tbe nocturnal episodes of alkalinization is not a decrease of vagal activity with a subsequent decrease of

Refractory gastroesophageal reflux disease

Gastroesophageal reflux disease(GERD)is a condition that develops when the reflux of stomach contents into the esophagus causes troublesome symptoms,esophageal injury,and/or complications.Use of proton pump inhibitors(PPI)remains the standard therapy for GERD and is effective in most patients.Those whose symptoms are refractory to PPIs should be evaluated further and other treatment options should be considered,according to individual patient characteristics.Response to PPIs could be total(no symptoms),partial(residual breakthrough symptoms),or absent(no change in symptoms).Patients experiencing complete response do not usually need further management.Patients with partial response can be treated surgically or by using emerging endoscopic therapies.Patients who exhibit no response to PPI need further evaluation to rule out other causes.

Esophageal motility in patients with sliding hiatal hernia with reflux esophagitis

Background Patients with sliding hiatus hernia （HH） and reflux esophagitis （RE） usually suffer from esophageal dysmotility. The aim of the present study was to investigate the role of acid reflux and duodenal gastroesophageal reflux （DGER）, esophageal manometry, and esophageal dysmotility by applying the barium meal examination. Methods RE with HH was initially diagnosed using the reflux disease questionnaire, and was further confirmed by a barium meal examination and an endoscopy. The radiographic technique was used to test for spasms, strictures, and the coarseness of the mucosa, also was to study the types of reflux and clearance. Then, the esophageal manometry, the esophageal 24-hour pH, and the bilirubin monitoring were observed. Results Fifty-five patients were diagnosed as HH combined with RE and divided into two groups according to the severity of their esophagitis： group HH1 （grades A and B） and group HH2 （grades C and D）. The barium meal examination revealed that the mucosa was either granular or nodular in all cases. The dump reflux and delayed clearance were more significant in patients in the HH2 group than those in the HH1 group （P 〈0.05）. The percentages of total, supine, and upright acid exposure time were greater in patients with HH than those in the control group （P 〈0.01）, but the differences between the HH1 and the HH2 groups were not significant. Lower esophageal sphictor pressure （LESP） was lower in the HH group than in the control group （P 〈0.05）. Three DGER parameters： the percentage of time with absorbance greater than 0.14, the number of bile reflux episodes, the number of bile refluxes lasting longer than 5 minutes were （28.43±23.34）, （40.57±31.30）, and （15.15±8.72）, respectively in the HH2 group; these statistics were significantly higher than those for the HH1 （P 〈0.05）. The frequency and amplitude of peristalsis were all lower in HH patients than in the control （P 〈0.05）. Of all the patients, 54.3% （30 of 55） with acid reflux and DGER simultaneously in the HH group exhibited refluxes of barium from the stomach to the esophagus in the recumbent position, and 29.4% （5 in 17） with delayed clearance in the HH group were correlated with esophageal body peristalses. The result was that the frequency and amplitude of peristalsis were less and the duration of esophageal peristalsis was longer than those of control group. Conclusions Esophageal dysmotility may play an important role in the severity of RE combined with HH. Esophageal motility results on a barium examination may coincide with esophageal manometry, 24-hour pH, and bilirubin monitoring in the RE and HH, but the radiologic method was the simplest to apply.