Search

This study aimed to investigate whether perceived stress mediated the relationship between hope and anxiety/depression symptoms among patients with COVID-19 during the epidemic. In addition, the potential moderating effect of coping styles was examined.From February 26 to March 10, 2020, patients with COVID-19 were asked to complete a questionnaire online, which included demographic characteristics, as well as the SCL-90-Anxiety, SCL-90-Depression, Chinese Perceived Stress Scale (CPSS), Herth Hope Index (HHI), and Trait Coping Style Questionnaire (TCSQ). Hierarchical linear regression was performed to explore independent factors of anxiety/depression. A multi-group structural equation modeling with the collected data from patients in the Negative Coping style (NC) group and Positive Coping style (PC) group was used to test the hypothesized mechanism.In total, 382 valid questionnaires of patients were obtained, including 96 from NC patients and 286 from PC patients. In the hierarchical linear regression, hope and perceived stress were independent risk factors for both anxiety and depression in the total sample and PC group. However, hope was not independently related to anxiety/depression in the NC group. As hypothesized, the hope of patients had significant and negative indirect effects on both anxiety and depression that were mediated by perceived stress, However, the direct effect from stress on anxiety and depression was stronger for NC patients than for PC patients. Besides, hope had significant direct effects on anxiety/depression in PC patients, but not in NC patients.During the COVID-19 epidemic, perceived stress could mediate the relationship between hope and anxiety/depression symptoms among COVID-19 patients, with coping style moderating this cultivation process.

In China, four symptoms of functional gastrointestinal disorders, postprandial fullness, early satiety, bloating, and abdominal distension are commonly and interchangeably expressed as a single chief complaint, "Zhang". In this study we aimed to explore the most efficient method of determining the characteristics of symptoms in such patients.Consecutive patients with the chief complaint of abdominal "Zhang" from December 2017 to June 2018 were included. Their symptom patterns were determined by face-to-face interviews. Patients with a single symptom (postprandial fullness, early satiety, bloating, or abdominal distension) completed the questionnaire assessing their understanding of the symptoms using three methods including concept terms, pictograms, and verbal descriptions.A total of 230 patients (121 men, 109 women; mean age 43.7 ± 12.6 y) were included. Verbal descriptions were most applicable to identify patients' symptom patterns, followed by concept terms and pictograms. Early satiety was the most difficult to identify (20.9% agreement between patient's understanding and doctor's diagnosis by using concept term), whereas fullness and bloating had apparently higher recognition (70.7% and 72.1% by concept terms). Elder patients (60 y) and those with more frequent symptom attacks (≥once daily) showed relatively poorer understanding of the symptoms.Early satiety is poorly identified by patients. Existing pictograms fail to show comprehension-improving features in a Chinese cultural setting. Verbal descriptions may be the best option for diagnosing abdominal "Zhang". More caution is required during the inquiry of medical history from elder patients with frequent symptom attacks.

Enteric glial cells (EGCs) are involved in intestinal inflammation. In this study, we will investigate how Bifidobacterium bifidum (B.b.) and Bacteroides fragilis (B.f.) influence EGC regulation. After pretreatment with lipopolysaccharide (LPS) and interferon-γ (IFN-γ), the expressions of major histocompatibility complex class II (MHC-II), CD80, CD86, glial cell line-derived neurotrophic factor (GDNF), toll-like receptor 2 (TLR-2), and tumor necrosis factor-α (TNF-α) in EGCs were detected using polymerase chain reaction and western blot after co-culture with the supernatants of B.b. or B.f. (multiplicity of infection, 40:1 or 80:1). Finally, EGCs were co-cultured with naive CD

Helical polymers present some interesting and distinctive properties, and one of the most distinguished applications of them is the chiral recognition and resolution of enantiomers. In this work, star-shaped hybrid helical poly (phenyl isocyanide) (PPI) with polyhedral oligomeric silsesquioxanes (POSS) as the core was designed and synthesized by "grafting to" strategy. The homoarm star-shaped hybrid POSS-(PPI)8 was first obtained by the click reaction between azide-modified POSS (POSS-(N3 )8 ) and alkynyl-modified PPI (PPI-Alkynyl). The hybrid POSS-(PPI)8 was with predominated left-handed helical conformation and exhibited excellent ability in the enantioselective crystallization of racemic compounds. In the meantime, heteroarm star-shaped hybrid (PEG)4 -POSS-(PPI)4 was prepared by the click reaction of POSS-(N3 )8 with PPI-Alkynyl and alkynyl-modified poly (ethylene glycol) (PEG-Alkynyl). The hybrid (PEG)4 -POSS-(PPI)4 was amphiphilic, and it could self-assemble to form spherical micelles in aqueous solutions.

Objective. To analyze the EEG features of four subacute sclerosing panencephalitis cases in North China. Methods. We retrospectively analyzed the EEG features in four patients with subacute sclerosing panencephalitis and 12 patients in control group from North China. Results. The periodic long-interval diffuse discharges were found in all of the four cases with subacute sclerosing panencephalitis. The morphology and component of periodic complexes were varied in different patients and different wakefulness states. Some EEG parameter settings help to identify periodic long-interval diffuse discharges including the slowed sweep speed, decreased sensitivity and reduced number of montages. In each patient with subacute sclerosing panencephalitis, the periodic long-interval diffuse discharges associated with two types of brief episodes (1:1) during awake period were found and none of the patients in the control group had this EEG pattern. The score system based on the periodic discharges and brief episodes also shows that all the patients with SSPE reached score 5 while none of the patients in the control group has a score greater than 3, which suggests that this EEG pattern may have diagnostic value. Conclusions. In subacute sclerosing panencephalitis, the morphology and component of periodic long-interval diffuse discharges were varied in different patients and different wakefulness states. Specific EEG parameter settings help to identify periodic long-interval diffuse discharges. Periodic long-interval diffuse discharges associated with two types of brief episodes (1:1) during awake period may strongly suggest the diagnosis of subacute sclerosing panencephalitis.

Helical polymers have attracted a great deal of attention and been extensively investigated due to their various applications. One of the most important applications of helical polymers is chiral recognition and resolution of enantiomers for the reason that a pair of enantiomers is commonly with different physiological and toxicological behaviors in biological systems. Helical polymers usually present unexpected high chiral recognition ability to a variety of racemic compounds. What’s more, the chiral recognition and resolution abilities of the system are dependent on the highly ordered helical structures of the helical polymers. This mini review mainly focuses on the recent progress in chiral recognition and resolution based on helical polymers. The synthetic methodology for helical polymers is firstly discussed briefly. Then recent advances of chiral recognition and resolution systems based on helical polymers, especially polyacetylenes and polyisocyanides, are described. We hope this mini review will inspire more interest in developing helical polymers and encourage further advances in chiral-related disciplines.

Polyhedral oligomeric silsesquioxane (POSS) based starlike hybrid helical poly(phenyl isocyanide)s (PPIs) with well-defined structures were designed and prepared in this contribution. The POSS modified with Pd(II) complexes (POSS-Pd(II)) was firstly obtained. Then well-defined starlike hybrid helical PPIs with POSS cores were synthesized through the polymerization of phenyl isocyanide monomers using POSS-Pd(II) as the initiator. The polymerization proceeded in a living and controlled manner. Meanwhile, polymerization of chiral phenyl isocyanides with decyl chain modified pendant L- or D-alanine afforded optically active hybrid starlike helical PPIs with preferred handedness. What's more, amphiphilic starlike hybrid helical PPI block copolymers showing thermoresponses were easily obtained, and their self-assembly and thermo-responsive behaviours were studied. In addition, cross-linked hybrid helical PPIs were obtained via the transesterification reaction between pentafluorophenyl ester and cystamine. Benefitting from the essential chirality of the handed helical PPIs, the cross-linked hybrid PPIs showed excellent ability in the enantioselective crystallization of racemic compounds. The enantiomeric excess (ee) of the induced crystal of threonine could be up to 95%.

Vanadium complexes containing bulky ligands were investigated for allene polymerization. Such complexes exhibit distinguished 2,3-selectivity (>99%) for phenylallene (PA) polymerization, which was proved from the corresponding nuclear magnetic resonance spectra. In particular, the catalysts with different structures show extremely high 2,3-selectivity. High molecular weight polymers (up to 740 kDa) were obtained in the presence of AliBu3 as a co-catalyst. Also, the polymerization of monomer containing a methoxy or bromine group smoothly proceeded using the vanadium complexes.

OBJECTIVE: Abnormal liver function is a common form of extra-pulmonary organ damage in patients with coronavirus disease 2019 (COVID-19). Patients with severe COVID-19 have a higher probability and progression of liver injury than those without severe disease. We aimed to evaluate the prognosis of liver injury in patients with COVID-19. METHODS: We retrospectively included 502 patients with laboratory-confirmed SARS-CoV-2 infection. Clinical features and survival of patients with and without liver injury were compared. Cox proportional hazards models were used to determine the variables that might have an effect on survival. RESULTS: Among the 502 patients enrolled, 301 patients had abnormal liver function with increased neutrophil count, C-reactive protein, creatinine, troponin I (TnI), D-dimer, lactose dehydrogenase and creatine kinase. Patients with abnormal liver functions had a higher mortality rate (28.9% vs 9.0%, P < 0.001), a higher ratio of male sex (65.1% vs 40.8%, P < 0.001) and a higher chance of developing systemic inflammatory response syndrome (53.5% vs 41.3%, P = 0.007). Among patients with abnormal liver functions, patients with grade 2 liver damage (with both abnormal alanine aminotransferase or aspartate aminotransferase levels and abnormal alkaline phosphatase or gamma-glutamyl transpeptidase levels) had a higher ratio of male patients, elevated neutrophil count, procalcitonin, D-dimer levels and mortality rate. Multivariate Cox regression analyses suggested that the grade of liver damage (hazard ratio: 1.377, 95% confidence interval: 1.000-1.896, P = 0.049) was an independent predictor of death. CONCLUSIONS: Patients with COVID-19 and abnormal liver functions have a higher mortality than those with normal liver functions. Liver damage is an independent prognostic factor of COVID-19.

Objective To compare the performance of gastroenterologists major in western medicine in diagnosing traditional Chinese medicine (TCM) syndrome types of functional dyspepsia (FD), postprandial distress (PDS) and epigastric pain syndromes (EPS) based on the main symptoms, with that of traditional TCM practitioners in outpatient services. Methods Patients with PDS or EPS were enrolled in the study from six tertiary referral centers between January 2016 and December 2017. Their symptoms were first diagnosed by medical doctors, and then by the TCM practitioners. The diagnostic agreement between the gastroenterologists and the TCM practitioners was calculated. The patients' data and their types of FD syndrome were collected and analyzed. Results In total 160 patients, including 81 with PDS and 79 with EPS were enrolled. The total diagnostic consistency rate between the gastroenterologists and TCM practitioners was 86.3%, while that of PDS and EPS was 85.2% and 87.3%, respectively. The most common type of PDS diagnosed by TCM practitioners was liver-stomach disharmony syndrome (33.3%), spleen deficiency and qi-stagnation syndrome (33.3%), while that for EPS was liver-stomach disharmony syndrome (36.7%). Conclusions Gastroenterologists had a high diagnostic agreement about the types of FD syndromes based on differential diagnosis of the main symptoms, compared with TCM practitioners. This may aid gastroenterologists in selecting Chinese medicine for FD-based on syndrome differentiation.

The precise synthesis of a new series of densely grafted bottlebrushes that bear helical polyisocyanide side chains on polyisocyanide backbones is described. New C1 polymers, polyisocyanides that b...

Azobenzene (Azo)-containing phenyl isocyanide (AzoPI, monomer 1) was synthesized via the combination of Williamson etherification and a transesterification reaction, and it could be polymerized to afford poly-1n with the phenyl alkyne–Pd(II) complex as the initiator in a living/controlled manner. Since the obtained poly-1n was living, helical copolymers were obtained through the polymerization of oligo polyethylene glycol group-functionalized phenyl isocyanide (monomer 2) using poly-140 as the macroinitiator. The obtained copolymers were optically active and exhibited light-responsive properties. The poly(140-b-2m) copolymers were amphiphilic and could self-assemble into supramolecular aggregates in aqueous solutions. The TEM results showed that poly(140-b-220) self-assembled to form hollow spindly aggregates with an average length of ∼430 nm and an average diameter of ∼160 nm, while poly(140-b-240) self-assembled into wormlike micelles with an average length of ∼280 nm and an average width of ∼48 nm, and poly(140-b-280) self-assembled into spherical micelles with an average diameter of ∼82 nm. Meanwhile, when α-cyclodextrin (α-CD) was added into the aqueous solution of poly(140-b-240), the wormlike micelles of poly(140-b-240) changed into spherical micelles of the poly(140-b-240)/α-CD complex with an average diameter of ∼104 nm. What's more, due to the UV-response of Azo groups, irregular aggregates of poly(140-b-240) and poly(140-b-240)/α-CD were observed upon UV irradiation. In the meantime, the fluorescence emission of Azo groups was unexpectedly observed in THF solution. When water was added into the THF solution, the intensity of the fluorescence emission became higher. Moreover, the fluorescence intensity increased with the increase in the ratio of water to THF.

A dumbbell-shaped copolymer (PDMAEMA)4-PCL-SS-PCL-(PDMAEMA)4 with a lower critical solution temperature (LCST) and redox responses was first synthesized by the combination of ring opening polymerization (ROP), click chemistry and atom transfer radical polymerization (ATRP). Then a dumbbell-shaped copolymer (PDMAPS)4-PCL-SS-PCL-(PDMAPS)4 with an upper critical solution temperature (UCST) and redox responses was obtained through the quaternization reaction between DMAEMA and excess 1,3-propane sultone. Both (PDMAEMA)4-PCL-SS-PCL-(PDMAEMA)4 and (PDMAPS)4-PCL-SS-PCL-(PDMAPS)4 were amphiphilic, and they could self-assemble into spherical micelles under certain conditions. Benefitting from the LCST-type thermoresponse of PDMAEMA and UCST-type thermoresponse of PDMAPS, both dumbbell-shaped copolymers (PDMAEMA)4-PCL-SS-PCL-(PDMAEMA)4 and (PDMAPS)4-PCL-SS-PCL-(PDMAPS)4 presented temperature-responsive properties. The morphology and size of their assemblies would be changed when the temperature is altered. Meanwhile, due to the redox-response of disulfide bonds, both (PDMAEMA)4-PCL-SS-PCL-(PDMAEMA)4 and (PDMAPS)4-PCL-SS-PCL-(PDMAPS)4 showed redox-responsive properties. When DL-dithiothreitol (DTT) was added into the systems, disulfide bonds were broken, causing the change of (PDMAEMA)4-PCL-SS-PCL-(PDMAEMA)4 to PCL-(PDMAEMA)4, while (PDMAPS)4-PCL-SS-PCL-(PDMAPS)4 changed into PCL-(PDMAPS)4. The distributions of Rh for both (PDMAEMA)4-PCL-SS-PCL-(PDMAEMA)4 and (PDMAPS)4-PCL-SS-PCL-(PDMAPS)4 assemblies broadened with asymmetric peaks, giving rise to curves with double peaks. After 24 h, DLS curves became symmetric with a single peak, and the Rh was about half that of the original assemblies. In the meantime, dispersed spherical micelles could be observed by TEM.

Objective In this study we aimed to assess the prevalence of functional bowel disorders (FBD) in a group of Chinese first-year undergraduates and the association between common beverage intake and FBD. Methods A cross-sectional survey was conducted among first-year undergraduates in Huazhong University of Science and Technology (Wuhan, Hubei Province, China). In total, 3102 questionnaires on their lifestyle, dietary habits and gastrointestinal symptoms were collected and analyzed. FBD was diagnosed based on the Rome IV criteria. A logistic regression analysis was performed to compare the differences in beverage intake in participants with and without FBD in order to identify possible risk factors for FBD. Results The overall prevalence of FBD was 7.64%. The logistic regression analysis showed that those who drank coffee at a frequency of once a month to thrice a week had a higher prevalence of FBD than those who drank it less than once a month (odds ratio 1.405 [95% confidence interval 1.013-1.949]) after adjusted for age, sex, sleep quality, exercise, stress and other dietary habits. However, a further increase in coffee consumption did not lead to an elevated prevalence of FBD. Conclusions Among the first-year undergraduates, FBD affected 7.64% of them. Coffee consumption might be related to an increased prevalence of FBD.

OBJECTIVES Functional constipation is a gastrointestinal disorder prevalent around the world. Lubiprostone is the first locally acting type-2 chloride channel activator to be used for treating constipation. This study aimed to evaluate the efficacy and safety of lubiprostone in Chinese adults with functional constipation. METHODS This was a multicenter, randomized, double-blind, placebo-controlled study. Patients with functional constipation were randomized to receive either lubiprostone (24 mcg twice daily) or placebo for 4 weeks. The primary end-point was the frequency of spontaneous bowel movements (SBMs) during the first week of treatment. The secondary end-points included the median time of the first SBM, SBM frequency at weeks 2, 3 and 4, weekly response rate of SBMs, the stool consistency score and average number of complete spontaneous bowel movements (CSBMs) per week. RESULTS In total, 259 patients were randomized, with 130 in the lubiprostone group and 129 in the placebo group. SBM frequency was higher in the lubiprostone group (4.88 ± 4.09/wk) than that in the placebo group (3.22 ± 2.01/wk) at week 1 (P

Objective Few studies have systematically assessed symptom-based diagnoses of functional gastrointestinal disorders (FGID) in China. This study aimed to evaluate the positive endoscopic and ultrasonographic findings in patients with symptom-based FGID. Methods Adult patients with gastrointestinal symptoms but not red flag symptoms who were empirically diagnosed with FGID underwent an upper or lower gastrointestinal endoscopy. An abdominal ultrasonography was also performed to screen for potential organic diseases. Patients' data were collected and the Rome III questionnaire was used for symptom-based assessment. Results Positive endoscopic and ultrasonographic findings were detected in 31.8%, 26.2% and 9.9% of patients with esophageal, gastroduodenal and intestinal disorders, respectively. Among patients diagnosed with FGID using the questionnaire, the rates of positive endoscopic and ultrasonographic findings were higher in patients with upper gastrointestinal symptoms than in those with lower gastrointestinal symptoms. Moreover, patients elder than 34.5 years with upper gastrointestinal symptoms and those elder than 47.5 years with lower gastrointestinal symptoms were more likely to have positive endoscopic and ultrasonographic findings. Conclusions The Rome III questionnaire is a valuable diagnostic tool for screening FGID in China. However, the rates of positive endoscopic and ultrasonographic findings vary depending on the location of symptoms. Endoscopy and ultrasonography have irreplaceable value, especially for investigating upper gastrointestinal symptoms.

A novel enantiopure phenyl isocyanide (1) carrying tert-butyloxycarboryl (Boc) protected l-prolinol ester was designed and synthesized. Living polymerization of 1 using a alkyne–Pd(II) catalyst afforded helical poly-1ms in high yields with controlled molecular weights (Mns) and narrow molecular weight distributions (Mw/Mns). Removing the protecting Boc groups on the l-prolinol ester pendants lead to the formation of helical poly-2m, which showed high optical activity owing to the preferred left-handed helix of polyisocyanide main chain. The poly-2ms showed excellent catalytic ability on asymmetric Michael addition reaction. Both the enantiomeric excess (ee) and diastereomeric ratio (dr) values of the product were linearly correlated to the Mn and optical activity of poly-2m. Increasing the Mn of poly-2ms will amplify the stereoselectivity of the asymmetric Michael addition reaction until the Mn reached to 44.9 kDa, revealing the polymerization amplified stereoselectivity (PASS) behavior of the asymmetric ...

OBJECTIVE Acute gastric or intestinal spasm-like pain is common in clinical setting. Hyoscine butylbromide (HBB), an anti-cholinergic agent, relieves pain in stomach and bowel cramps by inhibiting smooth muscle contractility. In this study, we aimed to compare the efficacy and safety of parenteral HBB and anisodamine for treating acute gastric or intestinal pain. METHODS In this randomized, controlled, double-blind, parallel-group, multicenter non-inferiority trial, 299 Chinese patients were randomly assigned to HBB or anisodamine in a ratio of 1:1. They were administrated a single dose of either HBB 20 mg or anisodamine 10 mg, and a second dose was given when needed. The primary end-point was the difference in pain intensity (PID) from the pre-dose baseline at 20 min after the first injection. RESULTS Altogether 295 patients completed the protocol (153 in the HBB and 142 in the anisodamine group). For the primary end-point, the PID was -4.09 (95% confidence interval [CI]: -4.41, -3.76) for the HBB group and -3.66 (95% CI: -4.02, -3.31) for the anisodamine group (P < 0.0001 for non-inferiority). The percentage of patients with at least one adverse event was lower in the HBB group than in the anisodamine group (13.1% vs 17.6%), but there was no statistical significance (P = 0.279). The most frequent adverse events were thirst (7.8%) and dry mouth (2.6%) in the HBB group, and thirst (7.0%), dry mouth (3.5%) and nodal arrhythmia (2.1%) in the anisodamine group. CONCLUSIONS HBB 20 mg was not inferior to anisodamine 10 mg in pain relief of patients with acute gastric or intestinal spasm-like pain. Both drugs were safe and well tolerated.

OBJECTIVE To systematically evaluate the diagnostic efficacy of confocal laser endomicroscopy (CLE) for gastric atrophy (GA) and gastric intestinal metaplasia (GIM). METHODS Literature search was performed in PubMed and the Cochrane Library for CLE, GA and GIM. The sensitivity, specificity and diagnostic odds ratio (DOR) in diagnosing GA and GIM were pooled for analysis. A summary receiver operating curve (SROC) was documented and the area under the curve was calculated. RESULTS Of the 10 studies included in this current analysis, the pooled sensitivity, specificity and DOR of CLE to diagnose GA and GIM were found to be 88%, 98% and 330.85, and 93%, 98% and 439.97, respectively. The area under the SROC were 0.9491 and 0.9812 for the diagnosis of GA and GIM, respectively. Higher sensitivity and specificity of this technique in diagnosing GA and GIM were found in patients without representative disease spectrum and those received pCLE by subgroup analysis. CONCLUSION CLE is of great value and may be considered an alternative modality for the early diagnosis of GA and GIM.

To evaluate current diagnosis and treatment of patients with nocturnal gastroesophageal reflux (nGER). METHODS This multicenter observational study was conducted in 44 hospitals in China from May 2017 to February 2018. Outpatients with nGER were recruited and their relevant data were collected using a questionnaire, including age, gender, body mass index, history of smoking and alcohol consumption, comorbid diseases, lifestyle, self-reported health status, medical history, nGER symptoms and severity, Hospital Anxiety Depression Scale, Pittsburgh Sleep Quality Index, diagnosis and treatment choices. The study was registered on the Chinese Clinical Trial Registry (no. ChiCTR1800017525). RESULTS The study included 4978 individuals, with valid questionnaires collected from 4448 patients (89.4%). The symptoms of heartburn and regurgitation were more severe at night than during the day (P

OBJECTIVE Confocal laser endomicroscopy (CLE) is a recently developed technique used to diagnose gastrointestinal diseases. The current meta-analysis aimed to systematically assess the ability of CLE to diagnose neoplasia and gastric adenocarcinoma. METHODS A comprehensive literature search was performed using PubMed, Embase and the Cochrane Library for endomicroscopy, gastric neoplasia and gastric adenocarcinoma. Sensitivity and specificity data on the diagnosis of neoplasia and gastric adenocarcinoma were pooled. A summary receiver operating characteristic (sROC) curve was performed and the area under the curve was calculated. RESULTS In all, 13 studies were included in the current study. The pooled sensitivity and specificity assessing CLE as a method to diagnose gastric neoplasia were 0.81 and 0.98, respectively. For the diagnosis of gastric adenocarcinoma, the pooled sensitivity and specificity were 0.89 and 0.99, respectively. The pooled sensitivity and specificity were 0.82 and 0.95 when differentiating high-grade intraepithelial neoplasia from low-grade intraepithelial neoplasia. Additionally, the pooled sensitivity and specificity were 0.87 and 0.96, respectively, when distinguishing undifferentiated gastric adenocarcinoma from differentiated gastric adenocarcinoma. CONCLUSION CLE has a high sensitivity and specificity for diagnosing gastric intraepithelial neoplasia and gastric adenocarcinoma; therefore, it could be considered an alternative to the endoscopic method used to diagnose gastric intraepithelial neoplasia and gastric adenocarcinoma.

Objective We aimed to investigate the clinical features, precipitating factors, bowel habits, bothersome symptoms and treatment strategies of individuals in China with self-reported constipation. Methods An internet-based survey was conducted in China. The participants had self-reported chronic constipation (≥1 symptoms including straining, hard stools, time-consuming defecation, sensations of incomplete evacuation and anorectal blockage, using manual assistance, and fewer than three defecations per week, for over 6 months). Data on their sex, age and occupation, precipitating factors, bowel habit, main symptoms and treatment options were collected. Results Overall, 6318 participants fulfilled the inclusion criteria for chronic constipation. More women (54.6%, n = 3450) than men reported constipation. The most common age group for constipation was 31 to 40 years (40.0%, n = 2520) and the most common occupation was office workers (43.6%, n = 2754). Disordered eating routines, consuming spicy food, and failure to defecate in time were the most common factors associated with constipation. Overall, 76.0% (n = 4804) participants did not defecate in the morning; 56.2% (n = 3548) spent 6 to 15 minutes in defecating. The most prevalent symptom was straining (39.4%, n = 2489). For preferred treatment options, 81.7% (n = 5160) selected changes in their lifestyle and diet, 51.1% (n = 3229) selected using traditional Chinese medicine, and 25.2% (n = 1590) selected using laxatives. Conclusions Constipation rates were higher in women, people aged 31 to 40 years old, and those working in offices. Having eating disorders, eating spicy food and withholding stools were the most common precipitating factors. Straining was the most prevalent symptom. Lifestyle changes were the most common action taken for managing constipation.

Objective To investigate the influence of posture on the anatomy and function of esophageal sphincters using solid-state high-resolution manometry. Methods Fifty individuals underwent esophageal manometry with a 36-channel solid-state catheter in the supine and upright positions. The length and pressure of the esophageal sphincters, as well as the esophageal and intra-abdominal lengths of lower esophageal sphincter (LES), were recorded. The residual pressure of the upper esophageal sphincter (UES) and the 4-s integrated relaxation pressure were also measured when the participants swallowed 10 consecutive servings of water (5 mL each). The Bland–Altman plot was used to assess agreement between these parameters in the supine and upright positions. Results The LES resting pressure was significantly decreased in the upright position compared with the supine position (13.85 ± 5.90 mmHg vs 18.09 ± 7.80 mmHg, P = 0.000). Weaker integrated relaxation pressures were observed when the participants were in the upright position (5.66 ± 3.33 mmHg vs 7.80 ± 3.25 mmHg, P = 0.000). Compared with the supine position, the upright esophageal length was longer (P = 0.004) and the upper border of the LES was lower (P = 0.050) when the individuals were in the upright position. The agreement between the two positions was acceptable for the esophageal length, LES upper border location and LES pressure measurements. Conclusions Body position exerts a greater influence on the LES than on the UES. Thus, it is necessary to establish normal values for the LES basal pressure and residual pressure in different positions.

We developed a novel magnetic-controlled capsule endoscopy (MCE) system for use in the human stomach. The aim of the current study was to compare the diagnostic accuracy of MCE with that of standard gastroscopy for gastric diseases.A total of 68 patients were enrolled in this self-controlled trial. Patients were evaluated by both MCE and gastroscopy. Gastroscopy was performed 4 – 24 hours after completion of the MCE examination.The positive percent agreement between MCE and gastroscopy was 96.0 %, and the negative percent agreement was 77.8 %. The overall agreement was 91.2 % with a kappa value of 0.765 (P 0.001). A total of 68 pathological findings were detected, of which 53 were identified by both methods. The MCE and standard gastroscopy missed seven and eight findings, respectively.MCE showed a diagnostic accuracy similar to that of standard gastroscopy. These results suggest that MCE is a promising alternative to gastroscopy for noninvasive screening of gastric diseases.Clinical trial registration number: NCT01903629.

Acute gastric or intestinal spasm-like pain is common in clinical setting. Hyoscine butylbromide (HBB), an anti-cholinergic agent, relieves pain in stomach and bowel cramps by inhibiting smooth muscle contractility. In this study, we aimed to compare the efficacy and safety of parenteral HBB and anisodamine for treating acute gastric or intestinal pain.In this randomized, controlled, double-blind, parallel-group, multicenter non-inferiority trial, 299 Chinese patients were randomly assigned to HBB or anisodamine in a ratio of 1:1. They were administrated a single dose of either HBB 20 mg or anisodamine 10 mg, and a second dose was given when needed. The primary end-point was the difference in pain intensity (PID) from the pre-dose baseline at 20 min after the first injection.Altogether 295 patients completed the protocol (153 in the HBB and 142 in the anisodamine group). For the primary end-point, the PID was -4.09 (95% confidence interval [CI]: -4.41, -3.76) for the HBB group and -3.66 (95% CI: -4.02, -3.31) for the anisodamine group (P0.0001 for non-inferiority). The percentage of patients with at least one adverse event was lower in the HBB group than in the anisodamine group (13.1% vs 17.6%), but there was no statistical significance (P = 0.279). The most frequent adverse events were thirst (7.8%) and dry mouth (2.6%) in the HBB group, and thirst (7.0%), dry mouth (3.5%) and nodal arrhythmia (2.1%) in the anisodamine group.HBB 20 mg was not inferior to anisodamine 10 mg in pain relief of patients with acute gastric or intestinal spasm-like pain. Both drugs were safe and well tolerated.

To systematically evaluate the diagnostic efficacy of confocal laser endomicroscopy (CLE) for gastric atrophy (GA) and gastric intestinal metaplasia (GIM).Literature search was performed in PubMed and the Cochrane Library for CLE, GA and GIM. The sensitivity, specificity and diagnostic odds ratio (DOR) in diagnosing GA and GIM were pooled for analysis. A summary receiver operating curve (SROC) was documented and the area under the curve was calculated.Of the 10 studies included in this current analysis, the pooled sensitivity, specificity and DOR of CLE to diagnose GA and GIM were found to be 88%, 98% and 330.85, and 93%, 98% and 439.97, respectively. The area under the SROC were 0.9491 and 0.9812 for the diagnosis of GA and GIM, respectively. Higher sensitivity and specificity of this technique in diagnosing GA and GIM were found in patients without representative disease spectrum and those received pCLE by subgroup analysis.CLE is of great value and may be considered an alternative modality for the early diagnosis of GA and GIM.

Objective To evaluate the Paris criteria, the revised diagnostic criteria and the simplified diagnostic scoring system in the diagnosis of primary biliary cirrhosis (PBC)–autoimmune hepatitis (AIH) overlap syndrome in Chinese patients. Methods Medical records of the patients who were diagnosed with PBC at the Union Hospital and Tongji Hospital, Tongji Medical University, Huazhong University of Science and Technology (Wuhan, Hubei Province, China) from 2003 to 2012 were retrospectively reviewed. The overlap syndrome was diagnosed based on the Paris criteria, the revised criteria and the simplified criteria, respectively. Patients' clinical characteristics, laboratory examination results and histological findings were collected. The sensitivity and specificity of the three criteria for diagnosing PBC–AIH overlap syndrome were calculated. Results PBC–AIH overlap syndrome was diagnosed in 2, 13 and 10 patients with PBC based on the Paris, the revised and the simplified criteria, respectively. The sensitivity and specificity of the simplified criteria in diagnosing the overlap syndrome was 90.0% and 98.2%, which were the highest among the three criteria, followed by the revised criteria. The Paris criteria showed a high specificity (100%) but a relatively low sensitivity (20.0%). In addition, some patients who did not fulfil the Paris criteria still benefited from the immunosuppressive agents. Conclusions For Chinese patients with the PBC–AIH overlap syndrome, the simplified criteria appear to be the most efficacious compared with the Paris criteria and the revised criteria. Further studies should be performed to confirm these observations with respect to long-term outcomes and therapeutic implications.

ObjectiveWe aimed to describe the clinical picture, management and outcomes of Chinese patients with peptic ulcer bleeding (PUB), especially in those with high risks. MethodsA multicenter endoscopic survey was conducted. All consecutive patients with endoscopy confirmed PUB from October 2010 to June 2011 were enrolled. Data including patients' gender, age, symptoms and endoscopic findings, Forrest classification, and endoscopic and medical treatment were documented. High-risk ulcer was defined as Forrest grades Ia to IIb upon endoscopy. Rates of rebleeding, surgery and mortality were recorded. ResultsIn all, 1006 patients were included. Of these 437 (43.4%) were categorized with high-risk PUB, among whom 110 (25.2%) received endoscopic treatment, and the success rate was 99.1%. Rebleeding rates 1-3 days, 4-5 days and 6-30 days after treatment in high-risk patients who did and did not receive endoscopic treatment were 10.9% versus 10.4%, 3.6% versus 3.7% and 0.9% versus 1.5%, respectively. The surgery rates of high-risk patients with or without endoscopic treatment were 1.8% (2/110) versus 1.8% (6/327). During the 9-month study period, two patients with high-risk PUB died, therefore, the overall mortality rate of high-risk PUB was 0.5% (2/437). ConclusionThe study suggests that the proportions of high-risk PUB in China is 43.4%, while rebleeding and surgery rate after endoscopic treatment as well as the mortality rate of high-risk PUB in China are 15.6%, 1.8% and 0.5%, respectively.

Off-axis optical system has a wide application in space optics and remote detective area. The high surface shape accuracy can be ensured with the development of advanced manufacture technique. So the only condition which limits the wide application of off-axis optical system is how to realize the precise alignment of it. Based on a RC reflective optical system whose diameter is 400mm, the alignment method which combines the high resolution initial placement and computer-aided alignment is introduced. By designing a system which can measure the off-axis fabrication and off-axis angle precisely, the high resolution initial placement of off-axis mirror can be ensured with a measurement accuracy of ±0.05mm and ±10”. The good initial placement can give a good initial state, so the computer-aided model can be converged well. The experiment shows that a system which has a good initial placement could have a good wave aberration of 0.04λ after three times iteration adjustment.

With the development of space and aviation industry, the optical systems with high resolution and better imaging quality are required. According to the alignment technical process, the factors of every step which have big influence to the imaging quality are analyzed. It is detected that the micro-stress assembly of the optical unit and the high co-axial precision of the entire optical system are the two important factors which are supposed to determine how well the imaging quality of the optical system is; also the technical methods are discussed to ensure these two factors from the engineering view. The reflective interference testing method to measure the surface figure and the transitive interference testing method to measure the wave aberration of the optical unit are combined to ensure the micro-stress assembly of the optical unit, so it will not bring astigmatism to the whole system imaging quality. Optical alignment machining and precision alignment are combined to ensure the high co-axial precision of the optical system. An optical lens of high accuracy is assembled by using these methods; the final wave aberration of optical lens is 0.022λ.

The role of low-grade inflammation in the development of post‑infectious irritable bowel syndrome (PI‑IBS) has attracted increasing attention. Abnormal CD11c+ mononuclear phagocytes, such as dendritic cells (DCs), macrophages, and monocytes, are involved in the disruption of immune tolerance in organisms, which can lead to the development of chronic inflammatory diseases. The present study tested the hypothesis that CD11c+ lamina propria mononuclear phagocytes (CD11c+ LPMPs) contribute to increased mucosal permeability and visceral hypersensitivity in a PI‑IBS mouse model. CD11c+ LPMPs were isolated and purified via the digestion of intestinal tissues and magnetic‑activated cell sorting. We detected increased mucosal permeability, visceral hypersensitivity and intestinal inflammation during both the acute and chronic stages of Trichinella infection. Following the transfer of CD11c+ LPMPs from PI‑IBS mice into normal mice, low‑grade inflammation was detected, as demonstrated by increased IL‑4 expression in the ileum, as well as enhanced mucosal permeability, as indicated by decreased transepithelial electrical resistance and the pre-sence of ultrastructural alterations. More importantly, the mice that underwent adoptive transfer of CD11c+ LPMPs from the PI‑IBS mice also exhibited increased abdominal withdrawal reflex scores and a decreased threshold. Our data demonstrated that the CD11c+ LPMPs from this PI‑IBS mouse model were not only able to transfer enteric inflammation to the normal mice but also caused abnormal intestinal function, characterized by epithelial barrier disruption and visceral hyperalgesia.

To evaluate gut microbial dysbiosis in two visceral hypersensitive models in comparison with irritable bowel syndrome (IBS) patients and to explore the extent to which these models capture the dysbiosis of IBS patients.Visceral hypersensitivity was developed using the maternal separation (MS) rat model and post-inflammatory rat model. The visceral sensitivity of the model groups and control group was evaluated using the abdominal withdraw reflex score and electromyography in response to graded colorectal distention. The 16S ribosomal RNA gene from fecal samples was pyrosequenced and analyzed. The correlation between dysbiosis in the microbiota and visceral hypersensitivity was calculated. Positive findings were compared to sequencing data from a published human IBS cohort.Dysbiosis triggered by neonatal maternal separation was lasting but not static. Both MS and post-inflammatory rat fecal microbiota deviated from that of the control rats to an extent that was larger than the co-housing effect. Two short chain fatty acid producing genera, Fusobacterium and Clostridium XI, were shared by the human IBS cohort and by the maternal separation rats and post-inflammatory rats, respectively, to different extents. Fusobacterium was significantly increased in the MS group, and its abundance positively correlated with the degree of visceral hypersensitivity. Porphyromonadaceae was a protective biomarker for both the rat control group and healthy human controls.The dysbiosis MS rat model and the post-inflammatory rat model captured some of the dysbiosis features of IBS patients. Fusobacterium, Clostridium XI and Porphyromonadaceae were identified as targets for future mechanistic research.

Objective To evaluate and compare the clinical characteristics, manometric results and treatment outcomes of different subtypes of achalasia in untreated Chinese patients using high-resolution esophageal manometry. Methods A total of 75 achalasia patients and 34 healthy controls were enrolled in the study, and three achalasia subtypes were determined based on the Chicago classification. Clinical characteristics, manometric and treatment outcomes were compared. Results In all, 25 patients were classified as type I, 46 as type II and 4 as type III. The mean overall length of lower esophageal sphincter (LES) in type III was significantly longer than those in the controls and type I patients (P

SUMMARY Our objective was to investigate the endoscopic and clinico-pathological characteristics in patients with Barrett's esophagus (BE) in China. Using the terms ‘Barrett's esophagus’ and ‘Barrett's esophagus, China’ as key words, literatures published in Chinese and English journals were searched in Chinese data banks, as well as PubMed and ISI Web of Science from 1989 to 2007. An analysis was carried out with the standard inclusion and exclusion criteria. A total of 4120 cases were included in this study. BE was found in 2.44% of patients undergoing endoscopy for various symptoms of upper gastrointestinal tract diseases; the male : female ratio was 2.09 : 1, the average age of detection of BE was 53.15 years old, and 51% of patients with BE had typical symptoms for gastroesophageal reflux disease (GERD). The island-type BE was predominant (56.80%), and the occurrence of BE with special intestinal metaplasia (SIM) was 36.58%, but SIM was more common in tongue-type BE than island-type and circumferential-type BE (both P < 0. 001), as well as in long segment BE (LSBE) than in short segment BE (SSBE) (P < 0. 001). A total of 46.39% of patients had Helicobacter pylori infection. The mean length of follow up was 2 years in 492 patiens. The incidence of adenocarcinoma was 0.61% patient-years of total follow up. In China, the endoscopic prevalence of BE is lower, but the average age of diagnosis is younger; a high proportion of H. pylori infection is found in patients with BE, and about half of the patients have no typical symptoms of GERD; the tongue-type BE and the LSBE are apt to SIM.

Background We analysed and compared the aquaporin 8(AQP8)expression in ascending and descending colon mucosa between patients with diarrhoea-predominant irritable bowel syndrome(D-IBS)and healthy volunteers,in order to study the relationship between the clinical feature of IBS,the expression of AQP8 and the pathological mechanism of D- IBS. Methods Specimens were taken from the proximal ascending colon or distal descending colon of D-IBS patients(n=26) and healthy volunteers(n=30),and AQP8 mRNA expression of each specimen was determined by fluorescent quantitative reverse transcription polymerase chain reaction(FQ-RT-PCR).In patients with D-IBS,the relationship was analysed between AQP8 expression in both ascending and descending colons and clinical features including gender, age of onset,duration of illness,frequency of defecation,and stool characteristics. Results Although AQP8 was present in the epithelium of the ascending and descending colons in healthy persons and D-IBS patients,the AQP8 level of the D-IBS patients was significantly lower than that of the healthy persons(P0.01 in the ascending colon,P0.05 in the descending colon).AQP8 expression was not correlated with the age of patients with D-IBS(P0.05 both in the ascending and descending colons)or the age at the onset(P0.05 both in the ascending and descending colons),but closely with the duration of illness(P0.05 in the ascending colon,P0.01 in the descending colon),frequency of defecation(P0.01 in the ascending colon,P0.05 in the descending colon)and stool characteristics (P0.01 in the ascending colon,P0.05 in the descending colon). Conclusions The decreased AQP8 expression in D-IBS patients indicates that dysfunction of colonic absorption may cause reduced water absorption,loose stool and diarrhoea.The expression of AQP8 may be related to D-IBS. Chin Med J 2007;120(4):313-316

Confocal laser endomicroscopy (CLE) is a recently developed technique used to diagnose gastrointestinal diseases. The current meta-analysis aimed to systematically assess the ability of CLE to diagnose neoplasia and gastric adenocarcinoma.A comprehensive literature search was performed using PubMed, Embase and the Cochrane Library for endomicroscopy, gastric neoplasia and gastric adenocarcinoma. Sensitivity and specificity data on the diagnosis of neoplasia and gastric adenocarcinoma were pooled. A summary receiver operating characteristic (sROC) curve was performed and the area under the curve was calculated.In all, 13 studies were included in the current study. The pooled sensitivity and specificity assessing CLE as a method to diagnose gastric neoplasia were 0.81 and 0.98, respectively. For the diagnosis of gastric adenocarcinoma, the pooled sensitivity and specificity were 0.89 and 0.99, respectively. The pooled sensitivity and specificity were 0.82 and 0.95 when differentiating high-grade intraepithelial neoplasia from low-grade intraepithelial neoplasia. Additionally, the pooled sensitivity and specificity were 0.87 and 0.96, respectively, when distinguishing undifferentiated gastric adenocarcinoma from differentiated gastric adenocarcinoma.CLE has a high sensitivity and specificity for diagnosing gastric intraepithelial neoplasia and gastric adenocarcinoma; therefore, it could be considered an alternative to the endoscopic method used to diagnose gastric intraepithelial neoplasia and gastric adenocarcinoma.

AIM: To compare symptom control with esomeprazole regimens for non-erosive reflux disease and chronic gastritis in patients with a negative endoscopy. METHODS: This randomized, open-label study was designed in line with clinical practice in China. Patients with typical reflux symptoms for ≥ 3 mo and a negative endoscopy who had a Gastroesophageal Reflux Disease Questionnaire score ≥ 8 were randomized to initial treatment with esomeprazole 20 mg once daily either for 8 wk or for 2 wk. Patients with symptom relief could enter another 24 wk of maintenance/on-demand treatment, where further courses of esomeprazole 20 mg once daily were given if symptoms recurred. The primary endpoint was the symptom control rate at week 24 of the maintenance/on-demand treatment period. Secondary endpoints were symptom relief rate, success rate (defined as patients who had symptom relief after initial treatment and after 24 wk of maintenance treatment), time-to-first-relapse and satisfaction rate. RESULTS: Based on the data collected in the modified intention-to-treat population (MITT; patients in the ITT population with symptom relief after initial esomeprazole treatment, n = 262), the symptom control rate showed a small but statistically significant difference in favor of the 8-wk regimen (94.9% vs 87.3%, P = 0.0473). Among the secondary endpoints, based on the data collected in the ITT population (n = 305), the 8-wk group presented marginally better results in symptom relief after initial esomeprazole treatment (88.3% vs 83.4%, P = 0.2513) and success rate over the whole study (83.8% vs 72.8%, P = 0.0258). The 8-wk regimen was found to provide a 46% reduction in risk of relapse vs the 2-wk regimen (HR = 0.543; 95%CI: 0.388-0.761). In addition, fewer unscheduled visits and higher patient satisfaction supported the therapeutic benefits of the 8-wk regimen over the 2-wk regimen. Safety was comparable between the two groups, with both regimens being well tolerated. CONCLUSION: Chinese patients diagnosed with chronic gastritis achieved marginally better control of reflux symptoms with an 8-wk vs a 2-wk esomeprazole regimen, with a similar safety profile.