Continuous-wave upconversion lasing with a sub-10 W cm-2 threshold enabled by atomic disorder in the host matrix

Microscale lasers efficiently deliver coherent photons into small volumes for intracellular biosensors and all-photonic microprocessors. Such technologies have given rise to a compelling pursuit of ever-smaller and ever-more-efficient microlasers. Upconversion microlasers have great potential owing to their large anti-Stokes shifts but have lagged behind other microlasers due to their high pump power requirement for population inversion of multiphoton-excited states. Here, we demonstrate continuous-wave upconversion lasing at an ultralow lasing threshold (4.7 W cm⁻²) by adopting monolithic whispering-gallery-mode microspheres synthesized by laser-induced liquefaction of upconversion nanoparticles and subsequent rapid quenching (“liquid-quenching”). Liquid-quenching completely integrates upconversion nanoparticles to provide high pump-to-gain interaction with low intracavity losses for efficient lasing. Atomic-scale disorder in the liquid-quenched host matrix suppresses phonon-assisted energy back transfer to achieve efficient population inversion. Narrow laser lines were spectrally tuned by up to 3.56 nm by injection pump power and operation temperature adjustments. Our low-threshold, wavelength-tunable, and continuous-wave upconversion microlaser with a narrow linewidth represents the anti-Stokes-shift microlaser that is competitive against state-of-the-art Stokes-shift microlasers, which paves the way for high-resolution atomic spectroscopy, biomedical quantitative phase imaging, and high-speed optical communication via wavelength-division-multiplexing.

Upconversion microlasers present a lot of advantages but also require high pumping powers. Here the authors present a high-performing microlaser based on anti-Stokes-shift in upconversion nanoparticles synthesized using a technique of liquid quenching.

A colorimetric alkaline phosphatase biosensor based on p-aminophenol-mediated growth of silver nanoparticles

Alkaline phosphatase (ALP) is an enzyme that catalyzes the dephosphorylation of proteins, nucleic acids, and biomolecules. It is a potential biomarker for diverse diseases such as breast cancer, osteopenia, and hepatobiliary. Herein, we developed a colorimetric sensor for the ALP assay based on its enzymatic activity to dephosphorylate the p-aminophenol phosphate (pAPP) into pAP. In a solution containing silver nanoparticles (AgNPs) and Ag⁺ ions prepared using a low concentration of NaBH₄, pAP mediates the growth of AgNPs by reducing the concentration of Ag⁺ ions to enhance the intensity of localized surface plasmon resonance as the pAPP cannot induce a reduction of the remaining Ag⁺ due to the masking of the hydroxyl with phosphate. The quantitative assay of the ALP was demonstrated via the colorimetric detection of the pAP-mediated growth of AgNPs in the presence of an ALP. The highly sensitive enzymatic growth of AgNPs provided a wider dynamic linear range of 0.5-225 U/L with a lower limit of detection of 0.24 U/L than that previously reported. The use of pAP resulted in excellent selectivity of the sensor for the ALP assay in human serum, yielding a high recovery rate and a high precision of 99.2 ± 1.5 % for the standard addition method.

Solid-state colorimetric polydiacetylene liposome biosensor sensitized by gold nanoparticles

Polydiacetylene (PDA), a conjugated polymer, has attracted attention for realization of a label-free real-time colorimetric biosensor because it exhibits large and rapid colorimetric responses upon the binding of biomolecules. This is due to the conformational distortion of its conjugated backbone. However, solid-state PDA biosensors for point-of-care diagnosis remain unexplored. We describe a highly sensitive solid-state biosensor based on PDA liposomes. We employed gold nanoparticles (AuNPs) on PDA liposomes as the molecular-binding-signal sensitizer, which provides additional conformational distortion in the backbone structure of PDA by exerting steric repulsion to the attached biomolecules. To prove the concept, AuNPs and a thrombin-binding-aptamer were individually functionalized on PDA liposomes, which were attached to a substrate for the detection of thrombin. We found that the sensitivity was enhanced 2.5 times in the presence of AuNPs compared with the case without AuNPs. Because the steric repulsion of the AuNPs is target-independent, we believe that our solid-state biosensor provides a path toward advanced solid-state biosensors.

Ultrafast Single-Band Upconversion Luminescence in a Liquid-Quenched Amorphous Matrix

Achieving single-band upconversion is a challenging but rewarding approach to attain optimal performance in diverse applications, such as multiplexed molecular imaging, security coding, and nonlinear photonic devices. Here, highly efficient single-band upconversion luminescence in the green spectral regime (16.4 times increase in emission at 525 nm) accomplished by realizing minimal energy loss from two-photon upconversion in a newly synthesized liquid-quenched amorphous matrix is reported. In contrast to previously reported single-band upconversion, this phenomenon originates from the elevated transition probability of the host sensitive transition via changes in the host matrix's microstructure. The elevated transition probability facilitates ultrafast decay of upconversion luminescence with decay times as short as 0.2 µs, the fastest decay ever reported. The material in this study therefore has strong potential for use in photonic devices demanding high upconversion efficiency with a fast response time, which to date has been inaccessible using upconversion materials.

Spectral and spatial characterization of upconversion luminescent nanocrystals as nanowaveguides

Lanthanide upconversion (UC) luminescent nanocrystals exhibit a uniquely sharp multiband emission over a broad spectral bandwidth covering the ultraviolet region to the near-infrared (NIR) region when subjected to NIR excitation, which is vital for multichannel optical communication using wavelength-division multiplexing to achieve high transmission rates. In this study, we experimentally and theoretically investigated the spectral and spatial characterization of a single NaYF₄:Yb³⁺,Tm³⁺(Yb³⁺,Er³⁺) UC nanocrystal as a nanowaveguide. We suggest that a UC nanocrystal can be used as a nanowaveguide because it produces a range of output colors simultaneously and provides unaltered emission bands during propagation. Via the observation of single NaYF₄:Yb³⁺,Tm³⁺(Yb³⁺,Er³⁺) UC nanocrystals, we found, for the first time, that a single UC nanocrystal exhibited wavelength- and position-dependent UC emissions. In addition, by adding Ag coating to the UC nanocrystal to act as a plasmonic waveguide and introducing a photonic crystal, the scattering loss of the UC emissions was significantly suppressed in the middle of the NaYF₄ nanocrystal, indicating efficient light guiding through the UC nanocrystal. Our discovery provides a basic understanding of the use of UC nanocrystals as nanowaveguides at the single-nanoparticle level, expanding our knowledge of the performance optimization of UC nanomaterials.

Enhancement of osseointegration by direct coating of rhBMP-2 on target-ion induced plasma sputtering treated SLA surface for dental application

Owing to the excellent bioactive properties of recombinant human bone morphogenetic proteins (rhBMPs), dentistry considers them as a fascinating adjuvant alternative for enhancing bone regeneration and bone-to-implant junction in the early implantation stages. However, stable loading and delivery efficiency of rhBMPs on the implant surfaces involve major concerns because of the harsh wearing condition under load during implantation. In this study, to achieve successful rhBMP-2 delivery, a nanoporous surface structure is introduced on the sandblasting with large grit and acid-etching (SLA)-treated titanium (Ti) surface via the tantalum (Ta) target-ion induced plasma sputtering (TIPS) technique. Unlike oxidation-induced surface nanoporous fabrications on a Ti surface, TIPS-treated surfaces provide excellent structural unity of the nanoporous structure with the substrate due to their etching-based fabrication mechanism. SLA/TIPS-treated Ti exhibits distinct nanoporous structures on the microscale surface geometry and better hydrophilicity compared with SLA-treated Ti. A sufficiently empty nanoporous surface structure combined with the hydrophilic property of SLA/TIPS-treated Ti facilitates the formation of a thick and uniform coating layer of rhBMP-2 on the surface without any macro- and microcoagulation. Compared with the SLA-treated Ti surface, the amount of coated rhBMP-2 increases up to 63% on the SLA/TIPS-treated Ti surface. As a result, the in vitro pre-osteoblast cell response of the SLA/TIPS-treated Ti surface, especially cell adhesion and differentiation behaviors, improves remarkably. A bone-regenerating direct comparison between the rhBMP-2-coated SLA-treated and SLA/TIPS-treated Ti is conducted on a defective dog mandible model. After 8 weeks of implantation surgery, SLA/TIPS-treated Ti with rhBMP-2 exhibits a better degree of contact area for the implanted bone, which mineralizes new bones around the implant. Quantitative results of bone-in-contact ratio and new bone volume also show significantly higher values for the SLA/TIPS-treated Ti with the rhBMP-2 specimen. These results confirm that an SLA/TIPS-treated surface is a suitable rhBMP-2 carrier for a dental implant to achieve early and strong osseointegration of Ti dental implants.

Anti-obesity effects of gochujang products prepared using rice koji and soybean meju in rats

The Korean traditional hot sauce gochujang has been reported to have biological activities. Different kinds of gochujang products were prepared based on combinations of a fungal rice koji with two kinds of bacterial soybean mejus. Diets that included gochujang products were fed to rats and anti-obesity effects were investigated. Gochujang products reduced body weight gains, epididymal fat weights, and triglyceride levels in the serum and the liver. Effects were exerted by the diet that included the non-fermented gochujang mixture, increased using a fungal rice koji, and further enhanced using a bacterial soybean meju. Dietary effects were apparently induced via inhibition of the lipogenic enzymes fatty acid synthase, malic enzyme, and lipoprotein lipase by gochujang products in epididymal adipose tissues, and inhibition of glucose-6-phosphate dehydrogenase in the liver. High levels of capsaicin and genistein in gochujang products are considered to contribute to anti-obesity effects.

In Vivo Tissue Pharmacokinetics of Carbon-11-Labeled Clozapine in Healthy Volunteers: A Positron Emission Tomography Study

We investigated clozapine (CLZ) tissue pharmacokinetics in vivo by using carbon-11-labeled CLZ (¹¹C-CLZ) and positron emission tomography (PET). Eight healthy volunteers underwent ¹¹C-CLZ studies wherein computed tomography image acquisition was followed by PET scans (whole-body, four; brain, four). After bolus intravenous ¹¹C-CLZ injection, PET images were acquired at various timepoints for 2–3 hours. Tissue ¹¹C-CLZ signals were plotted over time, and pharmacokinetic parameters were determined. High ¹¹C-CLZ radioactivity was detected in the liver and brain, implying CLZ hepatic metabolism and efficient blood–brain barrier penetration. The urinary and hepatobiliary tracts were involved in ¹¹C-CLZ excretion. Moderate to high radioactivity was observed in the dopaminergic and serotonergic receptor-rich brain regions, indicating CLZ binding to multiple receptor types. To our knowledge, this is the first study to report the determination of ¹¹C-CLZ tissue pharmacokinetics in humans. PET using radiolabeled drugs can provide valuable information that could complement plasma pharmacokinetic data.

High prevalence of significant histology in asymptomatic chronic hepatitis B patients with genotype C and high serum HBV DNA levels

Current treatment guidelines suggest that antiviral therapy be considered for chronic hepatitis B (CHB) patients with high viral load if a biopsy shows significant liver disease despite alanine aminotransferase (ALT) levels two times or less than the upper limit of normal (ULN). We evaluated the histological findings in CHB patients with high viral load and persistently normal or slightly elevated serum ALT levels. Between January 2003 and June 2006, 105 consecutive treatment-naive patients with CHB who underwent ultrasonography-guided percutaneous liver biopsy, had detectable serum HBV DNA (>10(5) copies/mL) in a direct hybridization assay and normal or slightly elevated serum ALT levels (≤2 × ULN) for at least 12 months were included in a prospective study. Histological assessment was based on the METAVIR scoring system. Significant histology was defined as fibrosis stage ≥F2 or necroinflammation grade ≥A2. Among the 105 CHB patients with high viral load and persistently normal or slightly elevated serum ALT levels for at least 12 months, significant fibrosis (F2-F4 fibrosis) was observed in 63 patients (60.0%) and the actual significant histology was found in 65 patients (61.9%). On multivariate analysis, serum ALT levels and age at which they entered the study were independent factors associated with significant histology. Odds ratios for significant histology increased progressively according to serum ALT levels and age. In conclusion, a large proportion of CHB patients with genotype C, high viral load and ALT ≤2 × ULN had significant liver disease on liver biopsy and should be considered for antiviral therapy.

Semi-automated disk-type solid-phase extraction method for polychlorinated dibenzo-p-dioxins and dibenzofurans in aqueous samples and its application to natural water

A disk-type solid-phase extraction (SPE) method was used for the extraction of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) in natural water and tap water. Since this SPE system comprised airtight glass covers with a decompression pump, it enabled continuous extraction with semi-automation. The disk-type SPE method was validated by comparing its recovery rates of spiked internal standards with those of the liquid-liquid extraction (LLE). The recovery ranges of both methods were similar in terms of (13)C-labeled internal standards: 64.3-99.2% for the LLE and 52.4-93.6% for the SPE. For the native spike of 1,3,6,8-tetrachlorinated dibenzo-p-dioxin (TCDD) and octachlorinated dibenzo-p-dioxin (OCDD), the recoveries in the SPE were in the normal range of 77.9-101.1%. However, in the LLE, the recoveries of 1,3,6,8-TCDD decreased significantly. One of the reasons for the low recovery is that the solubility of this congener is high. The semi-automated SPE method was applied to the analysis of different types of water: river water, snow, sea water, raw water for drinking purposes, and tap water. PCDD/F congeners were found in some sea water and snow samples, while their concentrations in the other samples were below the limits of detection (LODs). This SPE system is appropriate for the routine analysis of water samples below 50L.

The water extract of Samultang protects the lipopolysaccharide (LPS)/phorbol 12-myristate 13-acetate (PMA)-induced damage and nitric oxide production of C6 glial cells via down-regulation of NF-kappaB

Samultang has been traditionally used for treatment of ischemic heart and brain diseases in oriental medicine. However, little is known about the mechanism by which Samultang rescues the myocardial and neuronal cells from ischemic damage. This study was designed to evaluate whether the water extract of Samultang may modulate the production of nitric oxide (NO) in LPS and PMA treated-C6 glial cells to protect the cells from NO-induced cytotoxicity. C6 glial cells treated with both LPS and PMA significantly produced a large amount of NO compared to untreated, PMA, or LPS-treated cells. In parallel with NO production, cotreatment of LPS and PMA induced the severe apoptotic death of C6 glial cells. However, Samultang significantly reduced both cell death and NO production by LPS/PMA in a dose-dependent manner. In addition, the modulatory effects of Samultang on LPS/PMA-induced cytotoxicity and NO production could be mimicked by exogenous treatments of N(G)MMA, a nitric oxide synthase (NOS) inhibitor, and pyrrolidine dithiocarbamate (PDTC), a strong NF-kappaB inhibitor. Treatment of C6-glial cells with LPS/PMA induced the transcriptional activation of NF-kappaB, which was markedly inhibited by Samultang. Taken together, we suggest that the protective effects of Samultang against LPS/PMA-induced cytotoxicity may be mediated by the suppression of NO synthesis via down-regulation of NF-kappaB activation.

Protective effects of Debo on zinc-induced apoptosis of C6 glial cells via modulation of intracellular antioxidant, reduced glutathione

In the present study, the mechanical basis of a traditional herbal prescription, Debo. on cytotoxic damage of the brain cells including C6 glial and PC12 cells has been studied. Traditionally, Debo has been employed for the purpose of preventing responses to trauma, ischemia, and other diseases in the nervous system. C6 glial cells were exposed to oxidative stress through the imployment of ZnCl2, and generates H2O2 and hydroxyl radicals by fenton reaction. ZnCl2-induced death of C6 glial cells, which was revealed as apoptosis by chromatin condensation as well as DNA fragmentation. Pretreatment of Debo significantly prevented apoptotic death of C6 glial cells via inhibition of H2O, generation as well as the recovering of an antioxidant, reduced glutathione (GSH). Also, deprivation of serum and glucose, found in ischemia, deceased the viability of PC12 cells up to 60% via generation of H2O2. However, Debo significantly protected cells from ischemic damage through decrease in H2O, generation. Furthermore, Debo markedly inhibited the transcriptional activation of NF-kappaB by ZnCI, in C6 glial cells. These results suggest that Debo may function as an antioxidant system against free radicals and be applicable to protect brain cells against oxidative or ischemic stresses.

Danchunhwan water extract prevents apoptotic death by peroxynitrite and nitric oxide in human dopaminergic neuroblastoma SH-SY5Y cells

In the present study, the protective effects of Danchunhwan on the cytotoxicity by peroxynitrite and nitric oxide (NO) were investigated in human dopaminergic neuroblastoma SH-SYSY cells. Danchunhwan has been used to treat infarction and cerebrovascular diseases in Oriental medicine for centuries. Cells were pretreated with Danchunhwan and exposed to sodium nitroprusside (SNP), an NO donor, and 3-morpholinosydnonimine (SIN-1) which simultaneously generates NO and superoxide, thus possibly forming peroxynitrite. Exposure of cells to SIN-1 for 24 hr induced 75% of apoptotic cell death, as evaluated by ladder-pattern fragmentation of genomic DNA and characteristic of apoptosis using 4', 6-diamidino-2-phenylinol (DAPI). However, pretreatment of SH-SY5Y cells with Danchunhwan inhibited the apoptotic cell death in a dose-dependent manner. Even though Danchunhwan was washed out after preincubation for 12 hr, cells were still remained to be resistant against cytotoxicity of SIN-1. It also inhibited SIN-1-induced activation of caspase 3-like protease in a dose-dependent fashion. Furthermore, Danchunhwan recovered the levels of intracellular antioxidant system, reduced glutathione (GSH) (83%), which was decreased by the addition of SIN-1 (63%). Taken together, we suggest that Danchunhwan protects human neuroblastoma SH-SY5Y cells from apoptotic death by free radicals including peroxynitrite and NO via generation of antioxidant, GSH.

Serum 8-hydroxy-guanine levels are increased in diabetic patients

OBJECTIVE

The production of reactive oxygen species is increased in diabetic patients, especially in those will poor glycemic control. We have investigated oxidative damage in type 2 diabetic patients using serum 8-hydroxyguanine (8-OHG) as a biomarker.

RESEARCH DESIGN AND METHODS

We studied 41 type 2 diabetic patients and compared them with 3 nondiabetic control subjects. Serum 8-OHG concentration was assayed using high-pressure liquid chromatography.

RESULTS

The type 2 diabetic patients had significantly higher concentrations of 8-OHG in their serum than the control subjects (5.03 +/- 0.69 vs. 0.96 +/- 0.15 pmol/ml P < 0.01). There was no association between the levels of 8-OHG and HbA1c. We also could not and any correlation between serum 8-OHG levels and age, duration of diabetes, serum lipids, or creatinine or albumin exeretion rate. Creatinine clearance showed marginal correlation with serum 8-OHG levels (P = 0.06). Among the diabetic patients, those with proliferative retinopathy had significantly higher 8-OHG levels than those with nonproliferative retinopathy or without retinopathy. Likewise, the serum 8-OHG levels in patients who had advanced nephropathy (azotemia) were higher than in patients with normoalbuminuria, microalbuminuria, or overt proteinuria.

CONCLUSIONS

Our findings show that measuring serum 8-OHG is a novel convenient method for evaluating oxidative DNA damage. Diabetic patients, especially those with advanced microvascular complications, had significantly higher serum 8-OHG levels; this suggests that such changes may contribute to the development of microvascular complications of diabetes.

An ischemic skin lesion after chemoembolization of the right internal mammary artery in a patient with hepatocellular carcinoma

A huge nodular hepatocellular carcinoma located at the anterior superior portion of the left lobe in a patient with hepatocellular carcinoma was treated with transcatheter arterial chemoembolization through the left hepatic artery. Three months later, however, there was a re-elevation of the serum alpha-fetoprotein level and evidence of a marginal recurrence at the left side of the previously embolized tumor was noted on the postembolization computed tomographic scan. Although the hepatic artery was intact in the second hepatic arteriography, we found that the right internal mammary artery was feeding the recurred hepatocellular carcinoma. This internal mammary artery was successfully treated with Lipiodol-transcatheter arterial chemoembolization. However, an ischemic lesion occurred in the skin of the anterior chest and abdominal wall several days after internal mammary artery embolization. We report here a very rare case of ischemic skin lesion on the anterior chest and abdominal wall following transcatheter arterial chemoembolization of the right internal mammary artery. This internal mammary artery was embolized because it had developed a collateral tumor feeding vessel following the initial chemoembolization of a hepatocellular carcinoma.

Reduced IL-2 but elevated IL-4, IL-6, and IgE serum levels in patients with cerebral infarction during the acute stage

Cytokines in the central nervous system (CNS) may play an important role in functioning as intercellular signals that orchestrate the response to injury. Whether this is a cause or result of the brain disease process is uncertain. We investigated IFN-gamma, IL-2, IL-4, IL-6, and IgE in the sera of 38 patients with cerebral infarction during the acute stage and 10 normal controls using an originally devised sensitive sandwich enzyme-linked immunosorbent assay (ELISA). We found that serum levels of IL-2 derived from T helper 1 (Th1) cells were slightly reduced in patients with cerebral infarction, whereas serum levels of IL-4 and IL-6 derived from Th2 cells were elevated significantly. IL-4 induces synthesis of IgE in human B cells. Endogenous IL-6 plays an obligatory role in IL-4-dependent human IgE synthesis. We observed that serum IgE levels were elevated significantly in patients with cerebral infarction. However, serum IFN-gamma levels were not elevated significantly in cerebral infarction patients. These findings suggest that elevated IL-4, IL-6, and IgE levels in the human serum may be an important factor in cerebral infarction during the acute stage. Decrease of IL-2 levels in the serum of patients with cerebral infarction may be a regulatory mechanism.

The water extract of Jagamchotang protects the ischemia/reperfusion-induced cytotoxicity of rat neonatal myocardial cells via generation of nitric oxide

Jagamchotang has been used for treatment of ischemic myocardial diseases in Chinese traditional medicine. However, little is known about the mechanism by which Jagamchotang rescues myocardial cells from ischemic damages. To elucidate the protective mechanisms, the effects of Jagamchotang on ischemia/reperfusion-induced cytotoxicity and generation of nitric oxide (NO) are investigated in primary neonatal myocardial cells. Ischemia/reperfusion itself induces severe myocardial cell death in vitro. However, treatment of the cells with Jagamchotang significantly reduces both ischemia/reperfusion-induced myocardial cell death and LDH release. In addition, pretreatment of Jagamchotang before reperfusion recovers the lose of beating rates after ischemia/reperfusion. For a while, the water extract of Jagamchotang stimulates myocardial cells in ischemic condition to produce nitric oxide (NO) in a dose dependent manner and it protects the damage of myocardial cells. Furthermore, the protective effects of the water extract of Jagamchotang is mimicked by treatment of sodium nitroprusside, an exogenous NO donor. NG-monomethyi-L-argine (NGMMA), a specific inhibitor of nitric oxide synthase (NOS), significantly blocks the protective effects of Jagamchotang on the cells after ischemia/reperfusion. Taken together, we suggest that the protective effects of Jagamchotang against ischemia/reperfusion-induced myocardial damages may be mediated by NO production during ischemic condition.

Hwansodan protects PC12 cells against serum-deprivation-induced apoptosis via a mechanism involving Ras and mitogen-activated protein (MAP) kinase pathway

Hwansodan has been used as a prescription for senile and vascular dementia in Oriental medicine. We investigated the neuroprotective effects of Hwansodan water extract on the apoptotic death of PC12 cells by serum deprivation. Hwansodan significantly rescued PC12 cells from apoptotic death by serum deprivation in a dose-dependent manner. The nuclear staining of PC12 cells clearly showed that Hwansodan attenuated nuclear condensation and fragmentation, which represents typical neuronal apoptotic characteristics. Hwansodan also prevents DNA fragmentation and caspase-3-like protease activation in serum-deprived PC12 cells and induces the tyrosine phosphorylation of proteins around 44 kDa, which was identified as ERK1 with electrophoretic gel mobility shift by Western blot. In addition, MEK inhibitor PD98059 and Ras inactivator, alpha-hydroxyfarnesylphosphonic acid and mevastatin, attenuated the neuroprotective effects of Hwansodan in serum-deprived PC12 cells. These results indicate that Ras/MEK/ERK signaling pathway plays a role in neuroprotective effects of Hwansodan in serum-deprived PC12 cells.

Upper extremity and rib stress fractures in a child

Stress fractures in children are rare compared with the incidence in adults. This report describes an 11-year-old girl with stress fractures of the acromion, clavicle, and first rib on the left and contralateral fractures of the first and second ribs. It was eventually discovered that these fractures were caused by a nervous tic consisting of repetitive, vigorous shrugging and translation of the shoulders.

The functional relationships between hiatal hernia and reflux esophagitis

The purpose of this research was to investigate functional studies by which the hiatal hernia (HH) may be relevant to a reflux esophagitis (RE). Group I consisted of healthy controls who were endoscopically normal (n = 21). Group II consisted of patients with hiatal hernia but no reflux esophagitis (n = 8). Group III had patients with hiatal hernia with reflux esophagitis (n = 9). Group IV had patients with reflux esophagitis but no hiatal hernia (n = 16). Esophageal manometry, ambulatory 24 hour intraesophageal pH monitoring, acid clearance test, and gastric emptying scan were performed in each of the patients. The contraction amplitude at 3 cm above the lower esophageal sphincter did not differ significantly among the four groups, but the mean lower esophageal sphincter pressure was significantly decreased in group II. The DeMeester score in ambulatory 24 hour intraesophageal pH monitoring was significantly higher in group III compared with the controls. No significant difference among the groups was found with respect to acid clearance. Total and proximal gastric emptying times (T1/2) were significantly delayed in group III. We found that hiatal hernia combined with delayed gastric emptying may bear a relationship to the multifactorial origins of reflux esophagitis, and we suggest a rationale for using prokinetic agents as the therapeutic regimen in patients with HH complicated by RE.