18 F-FAPI for Imaging Metastatic Perivascular Epithelioid Cell Neoplasm

ABSTRACT

We compared 18 F-FAPI and 18 F-FDG PET/CT findings of metastatic perivacular epitheliod cell tumor in a 23-year-old woman. Apart from showing strong uptake of a left upper lung mass that showed moderate uptake on 18 F-FDG, 18 F-FAPI PET/CT additionally presented hypermetabolism in diffuse multifocal lesion throughout the body. This case suggests that 18 F-FAPI PET/CT might play a more beneficial role than 18 F-FDG PET/CT in identifying and assessing the extent of perivascular epithelioid cell tumors.

First-in-human study of PSMA-targeting agent, [18F]AlF-P16-093: dosimetry and initial evaluation in prostate cancer patients

PURPOSE

This is a first-in-human study to evaluate the radiation dosimetry of a new prostate-specific membrane antigen (PSMA)-targeted radiopharmaceutical, [18F]AlF-P16-093, and also initial investigation of its ability to detect PSMA-positive tumors using PET scans in a cohort of prostate cancer (PCa) patients.

METHODS

The [18F]AlF-P16-093 was automatically synthesized with a GE TRACERlab. A total of 23 patients with histopathologically proven PCa were prospectively enrolled. Dosimetry and biodistribution study investigations were carried out on a subset of six (6) PCa patients, involving multiple time-point scanning. The mean absorbed doses were estimated with PMOD and OLINDA software.

RESULTS

[18F]AlF-P16-093 was successfully synthesized, and radiochemical purity was > 95%, and average labeling yield was 36.5 ± 8.3% (decay correction, n = 12). The highest tracer uptake was observed in the kidneys, spleen, and liver, contributing to an effective dose of 16.8 ± 1.3 μSv/MBq, which was ~ 30% lower than that of [68Ga]Ga-P16-093. All subjects tolerated the PET examination well, and no reportable side-effects were observed. The PSMA-positive tumors displayed rapid uptake, and they were all detectable within 10 min, and no additional lesions were observed in the following multi-time points scanning. Each patient had at least one detectable tumor lesion, and a total of 356 tumor lesions were observed, including intraprostatic, lymph node metastases, bone metastases, and other soft tissue metastases.

CONCLUSIONS

We report herein a streamlined method for high yield synthesis of [18F]AlF-P16-093. Preliminary study in PCa patients has demonstrated its safety and acceptable radiation dosimetry. The initial diagnostic study indicated that [18F]AlF-P16-093 PET/CT is efficacious and potentially useful for a widespread application in the diagnosis of PCa patients.

Descriptive study of COVID-19 vaccinations and infections within an NHS workforce

BACKGROUND

Healthcare workers were a priority group for coronavirus disease 2019 (COVID-19) vaccination during the pandemic. Occupational exposure may account for some of the increased risk faced.

AIMS

Describe COVID-19 vaccine uptake and infection rates in staff across a large NHS board in Scotland to better understand occupational risk during the pandemic.

METHODS

Descriptive cross-sectional study. Demographic data were extracted on 5 August 2021 from 26 058 members of staff. COVID-19 vaccination status and positive polymerase chain reaction (PCR) results were extracted on two separate dates to describe the timeline of staff infections between March 2020 and January 2022.

RESULTS

There was high uptake of all three vaccine doses across all demographic groups in hospital staff. PCR positivity decreased with increasing age and Scottish Index of Multiple Deprivation score. Staff and nosocomial COVID-19 infections followed peaks in community infection rates.

CONCLUSIONS

NHS Lothian is a typical NHS workforce with good vaccine uptake. Beyond very early cases, there seems to be minimal evidence of occupational acquisition of COVID-19. The large number of nosocomial infections at the start of the pandemic may, in fact, reflect lack of community testing at this time. Despite protection from high vaccine coverage, job type and good Infection Prevention and Control practices, it seems that staff remain at high risk of catching the highly transmissible omicron variant from the community rather than work.

Determining the optimal pharmacokinetic modelling and simplified quantification method of [18F]AlF-P16-093 for patients with primary prostate cancer (PPCa)

PURPOSE

This paper discusses the optimization of pharmacokinetic modelling and alternate simplified quantification method for [18F]AlF-P16-093, a novel tracer for in vivo imaging of prostate cancer.

METHODS

Dynamic PET/CT scans were conducted on eight primary prostate cancer patients, followed by a whole-body scan at 60 min post-injection. Time-activity curves (TACs) were obtained by drawing volumes of interest for primary prostatic and metastatic lesions. Optimal kinetic modelling involved evaluating three compartmental models (1T2K, 2T3K, and 2T4K) accounting for fractional blood volume (Vb). The simplified quantification method was then determined based on the correlation between the static uptake measure and total distribution volume (Vt) obtained from the optimal pharmacokinetic analysis.

RESULTS

In total, 17 intraprostatic lesions, 10 lymph nodes, and 36 osseous metastases were evaluated. Visually, the contrast of the tumor increased and showed the steepest incline within the first few minutes, whereas background activity decreased over time. Full pharmacokinetic analysis revealed that a reversible two-compartmental (2T4K) model is the preferred kinetic model for the given tracer. The kinetic parameters K1, k3, Vb, and Vt were all significantly higher in lesions when compared with normal tissue (P < 0.01). Several simplified protocols were tested for approximating comprehensive dynamic quantification in tumors, with image-based SURmean (the ratio of tumor SUVmean to blood SUVmean) within the 28-34 min window found to be sufficient for approximating the total distribution Vt values (R2 = 0.949, P < 0.01). Both Vt and SURmean correlated significantly with the total serum prostate-specific antigen (tPSA) levels (P < 0.01).

CONCLUSIONS

This study introduced an optimized pharmacokinetic modelling approach and a simplified acquisition method for [18F]AlF-P16-093, a novel PSMA-targeted radioligand, highlighting the feasibility of utilizing one static PET imaging (between 30 and 60 min) for the diagnosis of prostate cancer. Note that the image-derived input function in this study may not reflect the true corrected plasma input function, therefore the interpretation of the associated kinetic parameter estimates should be done with caution.

Multimodal imaging diagnosis for bone fibrous dysplasia malignant transformation: A case report

Fibrous dysplasia of bone (FDB) is a rare benign condition in which fibrous tissue replaces normal bone architecture. FDB rarely undergoes malignant transformation, but there are reports of locally aggressive fibrous dysplasia with cortical destruction and soft tissue extension. Diagnosis of FDB malignant transformation is not easy, especially in monostotic form, because of the overlap in imaging features of locally aggressive fibrous dysplasia and fibrous dysplasia with malignant transformation. The present case study reports a rare case of FDB in a 23-year-old man with polyostotic fibrous dysplasia arising in the left side of the pelvis and lower limb bones with partial transformation to fibrosarcoma. This study explored the multimodal imaging features of FDB malignant transformation, to achieve early detection and improve diagnostic accuracy of local FDB aggressiveness and its malignant transformation.

Dietary Total Antioxidant Capacity and Cognitive Function in Older Adults in the United States: The NHANES 2011-2014

OBJECTIVES

Oxidative stress level takes part in the development of cognitive decline. However, the association between total antioxidant capacity (TAC) from diet and cognitive function is controversial. The aim of this study was to investigate the relationship between TAC and the cognitive function of older adults in the U.S.

DESIGN

A cross-sectional study.

SETTING

National Health and Nutrition Examination Surveys database.

PARTICIPANTS

2712 older adults aged over 60 years.

MEASUREMENTS

TAC was calculated from 8 antioxidative vitamins based on the reference values for vitamin C equivalent antioxidant capacity obtained from individuals' 24 h dietary recall. Four memory-related assessments were employed [Immediate Recall test (IRT), Delayed Recall test (DRT), Animal Fluency test (AFT), and Digit Symbol Substitution test (DSST)].

RESULTS

Among the 2712 participants, the median age was 68 years, and 50.4% were women. Participants in the group with higher TAC levels had relatively higher IRT, AFT and DSST scores (P=0.025, P=0.008, P<0.001, respectively). In adjusted weighted linear regression, log-transformed TAC was positively associated with AFT (β=1.10, 95%CI: 0.51, 1.70) and DSST (β=2.81, 95%CI: 1.16, 4.45). Compared with the first quartile, the participants in the second (Q2 vs. Q1, OR=0.66, 95%CI: 0.43,1.02) and fourth quartile (Q4 vs. Q1, OR=0.47, 95%CI:0.28, 0.78) of log-transformed TAC showed a decreased risk of impaired cognitive function (ICF) after adjusting for confounders. The dose-response analysis indicated a gradual descent in the risk of ICF as TAC increases. Diabetes mellitus (DM) mediated part of the effect of TAC on ICF. The relationship between TAC and ICF was more pronounced in subjects with DM (Q4 vs Q1, OR=0.36, 95%CI:0.17, 0.74).

CONCLUSION

Our findings support that higher dietary antioxidant potential was related to a decreased risk of cognitive dysfunction, particularly in the subjects with DM who may have oxidative injury. DM was one of the factors mediating the effect of TAC on ICF.

Chinese Version of the Baylor Profound Mental Status Examination: A Brief Staging Measure for Patients with Severe Alzheimer's Disease

BACKGROUND

A specialized instrument for assessing the cognition of patients with severe Alzheimer's disease (AD) is needed in China.

OBJECTIVES

To validate the Chinese version of the Baylor Profound Mental Status Examination (BPMSE-Ch).

DESIGN

The BPMSE is a simplified scale which has proved to be a reliable and valid tool for evaluating patients with moderate to severe AD, it is worthwhile to extend the use of it to Chinese patients with AD.

SETTING

Patients were assessed from the Memory Clinic Outpatient.

PARTICIPANTS

All participants were diagnosed as having probable AD by assessment.

MEASUREMENTS

The BPMSE was translated into Chinese and back translated. The BPMSE-Ch was administered to 102 AD patients with a Mini-Mental State Examination (MMSE) score below 17. We assessed the internal consistency, reliability, and construct validity between the BPMSE-Ch and MMSE, Severe Impairment Battery (SIB), Global Deterioration Scale (GDS-1), Geriatric Depression Scale(GDS-2), Instrumental Activities of Daily Living (IADL), Physical Self-Maintenance Scale (PSMS), Neuropsychiatric Inventory (NPI) and Clinical Dementia Rating (CDR).

RESULTS

The BPMSE-Ch showed good internal consistency (α = 0.87); inter-rater and test-retest reliability were both excellent, ranging from 0.91 to 0.99. The construct validity of the measure was also supported by significant correlations with MMSE, SIB. Moreover, as expected, the BMPSE-Ch had a lower floor effect than the MMSE, but a ceiling effect existed for patients with MMSE scores above 11.

CONCLUSIONS

The BPMSE-Ch is a reliable and valid tool for evaluating cognitive function in Chinese patients with severe AD.

[Chorionic villus cell culture and karyotype analysis in 1 983 cases of spontaneous miscarriage]

Objective: To investigate the relationship between spontaneous miscarriage and embryonic chromosome abnormalities, and to evaluate the clinical application of karyotype analysis by chorionic villus cell culture. Methods: The chorionic villus karyotype of 1 983 cases of miscarriage from January 2010 to July 2016 in Guangzhou Women and Children's Mecical Center were analyzed retrospectively. The miscarried chorionic villi were obtained by curettage under sterilized condition. The chromosome specimens were prepared after chorionic villus cell culture. Karyotype analysis was performed by G-banding technique. Results: In the 1 983 samples, successful karyotype analysis was performed in 1 770 cases, with the successful rate of 89.98%. Chromosomal abnormalities were found in 1 038 cases (58.64%, 1 038/1 770). Chromosomal structural abnormalities were found in 37 cases. The numeral abnormalities were more common than structural abnormalities, and most of the numeral abnormalities were aneupoidies. In turn, they were trisomy 16, 45,X, trisomy 22, trisomy 2, trisomy 21, trisomy 15. The most common structural abnormality was balanced translocation, including Robersonian translocation. Female embryoes accounted for 61.02% (1 080/1 770) miscarriages and for 57.4%(596/1 770) of chromosomal abnormalities, while male embroyes acoounted for 61.02% (1 080/1 770) , 57.4% (596/1 770) respectively. The proportion of female embryoes was higher than male embryoes. The median age of the patients was 30 years old (16-46 years old) . As the maternal age increased, the proportion chromosomal abnormalities increased. The incidence of chromosomal abnormalities in the advanced age group (≥35 years) was 68.38% (240/351) , which was significantly higher than that in the younger group (56.24%, 798/1 419; χ(2)=17.10, P<0.01). Conclusions: Embryonic chromosomal abnormalities are the most common cause of early spontaneous miscarriage. The abnormalities centralize in some karyotypes. There is certain relationship between maternal age and the incidence of miscarriage, as well as the embryonic gender. Chorionic villus cell culture and karyotype analysis are helpful in finding the cause of miscarriage and counsel the patients.

[Corneal astigmatism among 2 085 age-related cataract patients before surgery]

Objective: To investigate the characteristics and distribution of corneal astigmatism before surgery among age-related cataract patients in the Hubei area. Methods: Retrospective study. From January 1, 2012 to July 31, 2016, IOL Master measurements of all qualified cataract surgery candidates were retrospectively collected. Descriptive statistical analysis was used to assess the degree, distribution and type of corneal astigmatism. Kolmogorov-Smirnov (K-S) test was used to evaluate the normal distribution of variables. One-way analysis of variance and Kruskal-Wallis test were applied for the comparison of variance for normally and non-normally distributed quantitative data among different age groups. Spearman's rank test was used to assess the relationship between age and corneal astigmatism. Results: The mean age of the 2 085 patients (3 586 eyes) involved was (73.1±9.43) years old, with more women (58.3%) than men. The mean value of corneal curvature was 44.33 D (95%CI: 44.28-44.39), and the mean corneal astigmatism was 1.06 D (range, 0.05 D to 6.74 D). K-S test indicated the distribution of corneal curvature was normal (P=0.18), while corneal astigmatism did not obey the normal distribution (P<0.01). Corneal astigmatism was between 0.25 D and 1.25 D in 67.7% of the eyes, >1.25 D in 29.7%, and<0.25 D in 4.2%. Corneal astigmatism degree increased with the age increase (P<0.01). There was no statistical difference in corneal astigmatism between women and men (P=0.075). However, women had steeper corneal curvatures than men with statistical difference (P<0.01). Corneal astigmatism with the rule was observed in 29.0% of the eyes, while astigmatism against the rule was found in 53.0%. And astigmatism against the rule increased with age. Conclusion: Corneal astigmatism mostly distributes between 0.25 D and 1.25 D in age-related cataract patients who lived in Hubei. Corneal astigmatism degree increased with age, and the dominant type was astigmatism against the rule. There was no difference in astigmatism between men and women patients aged 50 years and above, but in 70- to 79-year-old patients, women had a higher astigmatism degree than men. The corneal curvature of women was steeper than men in general and in each age group. (Chin J Ophthalmol, 2017, 53: 522-527).

Short-term and long-term effect of diaphragm biofeedback training in gastroesophageal reflux disease: an open-label, pilot, randomized trial

This study investigated the effectiveness of diaphragm biofeedback training (DBT) for patients with gastroesophageal reflux disease (GERD). A total of 40 patients with GERD treated at the Peking Union Medical College Hospital between September 2004 and July 2006 were randomized to receive DBT and rabeprazole proton pump inhibitor (PPI) or rabeprazole alone. The DBT + rabeprazole group received DBT during the 8-week initial treatment; the rabeprazole group did not. During the 6-month follow up, all patients took acid suppression according to their reflux symptoms, and the patients in the DBT + rabeprazole group were required to continue DBT. The primary outcome (used for power analysis) was the amount of acid suppression used at 6 months. Secondary outcomes were reflux symptoms, health-related quality of life (HRQL), and esophageal motility differences after the 8-week treatment compared with baseline. Acid suppression usage significantly decreased in the DBT + rabeprazole group compared with the rabeprazole group at 6 months (P < 0.05). At 8 weeks, reflux symptoms and GERD-HRQL were significantly improved in both groups (P < 0.05), without difference between them. Crural diaphragm tension (CDT) and gastroesophageal junction pressure (GEJP) significantly increased in the DBT + rabeprazole group (P < 0.05), but without change in lower esophageal sphincter (LES) pressure. There was no significant change in CDT, GEJP, and LES pressure compared with baseline in the rabeprazole group. In conclusion, long-term DBT could reduce acid suppression usage by enhancing the anti-reflux barrier, providing a non-pharmacological maintenance therapy and reducing medical costs for patients with GERD.

Mesenchymal stromal cells infusions improve refractory chronic graft versus host disease through an increase of CD5+ regulatory B cells producing interleukin 10

Refractory chronic graft-versus-host disease (cGVHD) is a significant complication resulting from allogeneic hematopoietic stem cell transplantation (HSCT). Mesenchymal stromal cells (MSCs) have shown promise for treating refractory cGVHD, but the favorable effects of MSCs therapy in cGVHD are complex and not fully understood. In this prospective clinical study, 20 of 23 cGVHD patients had a complete response or partial response in a 12-month follow-up study. The most marked improvements in cGVHD symptoms were observed in the skin, oral mucosa and liver. Clinical improvement was accompanied by a significantly increased number of interleukin (IL)-10-producing CD5+ B cells. Importantly, CD5+ B cells from cGVHD patients showed increased IL-10 expression after MSCs treatment, which was associated with reduced inflammatory cytokine production by T cells. Mechanistically, MSCs could promote the survival and proliferation of CD5+ regulatory B cells (Bregs), and indoleamine 2, 3-dioxygenase partially participates in the MSC-mediated effects on Breg cells. Thus, CD5+ Breg cells may have an important role in the process of MSC-induced amelioration of refractory cGVHD and may provide new clues to reveal novel mechanisms of action for MSCs.

Prucalopride in the treatment of chronic constipation in patients from the Asia-Pacific region: a randomized, double-blind, placebo-controlled study

BACKGROUND

The study evaluated efficacy and safety of the 2 mg dose of prucalopride compared to placebo in patients with chronic constipation (CC) from the Asia-Pacific region.

METHODS

Randomized, placebo-controlled, parallel-group, phase III study with 2-week run-in, 12-week treatment phase, and 1-week follow-up. Adult patients with CC (≤2 spontaneous bowel movements per week) received 2 mg prucalopride or placebo, once-daily, for 12 weeks. Primary efficacy measure was percentage of patients with average of ≥3 spontaneous complete bowel movements (SCBMs) per week (Responders) during the 12-week treatment. A key secondary endpoint was Responders during first 4 weeks of treatment. Other efficacy assessments were based on patient diaries, their assessments of symptoms and quality of life, and investigator's assessment on efficacy of treatment. Safety assessments included adverse events, laboratory values, and cardiovascular events.

KEY RESULTS

Efficacy and safety were evaluated for 501 patients who received study drug. On the primary endpoint, prucalopride was significantly more effective than placebo with 83 (33.3%) vs 26 (10.3%) patients having a weekly average of ≥3 SCBMs during the 12-week treatment (P < 0.001). Respective percentages were 34.5%vs 11.1% over first 4 weeks (P < 0.001). On other secondary endpoints, clinical improvement was generally larger and statistically superior (P < 0.001) in the prucalopride group. Most frequently reported adverse events were diarrhea, nausea, abdominal pain, and headache.

CONCLUSION & INFERENCES

Prucalopride 2 mg given once-daily significantly improved bowel function, associated symptoms, and satisfaction in CC over a 12-week treatment period, and was safe and well tolerated by patients in the Asia-Pacific region.

Genetic polymorphism of catechol O-methyltransferase and pharmacokinetics of levodopa in healthy Chinese subjects

We studied the distribution of catechol O-methyltransferase (COMT) genotypes in the Chinese Fujian Han population and explored the potential effect of COMT genetic polymorphism on the pharmacokinetics of levodopa. Polymerase chain reaction (PCR) was employed in the COMT genotype analysis of 166 volunteers. After a single oral dose of levodopa/benserazide, the plasma concentration of levodopa was determined by high-performance liquid chromatography (HPLC) with electrochemical detection (ECD). In the 166 subjects, the frequencies of G/G, G/A and A/A COMT genotypes were 58.4%, 36.7% and 4.9%, respectively. The frequency of the homozygous A/A genotype was much lower than in caucasians and Southwest Asians. COMT activity of erythrocytes in the G/A genotype group was significantly lower than in the G/G genotype group but significantly higher than in the A/A genotype group. There was no significant difference in pharmacokinetic parameters, including t(1/2alpha), t(1/2beta), AUC(0-infinity), CL/F, C(max), t(max) and V/F. The frequency of COMT genotypes in the Chinese Fujian Han population, which is related to COMT enzyme activity, is significantly different from that in caucasians and Southwest Asians. The pharmacokinetic characteristics of levodopa in healthy Chinese subjects may not be dependent on their COMT genotype status. From the 166 volunteers, 5 G/G, 5 G/A and 4 A/A genotype male subjects were recruited for the study of levodopa pharmacokinetics.

Transcutaneous electroacupuncture improves dyspeptic symptoms and increases high frequency heart rate variability in patients with functional dyspepsia

The aim of the study was to evaluate the therapeutic value and possible mechanisms of transcutaneous electroacupuncture (TEA) in a double-blind and cross-over study in patients with functional dyspepsia (FD). Twenty-seven patients with FD were enrolled and the study consisted of two parts: (i) acute effects of TEA at PC6 and ST36 on gastric slow waves and heart rate variability and (ii) chronic (2 weeks) effects of TEA at PC6 and ST36 on dyspepsia symptoms, gastric slow waves, heart rate variability and neuropeptide Y (NPY) and motilin. The results of this study are: (i) The dyspepsia symptom score was decreased by 55% at the end of chronic TEA and the improvement was significant (P < 0.01); (ii) the high frequency (HF) assessed from the spectral analysis of heart rate variability was markedly increased with both acute TEA (76% increase, P = 0.01) and chronic TEA (75% increase, P = 0.025); (iii) gastric slow waves were not altered by either acute or chronic TEA; and (iv) the plasma level of NPY but not motilin was increased after chronic TEA. Non-invasive and needleless transcutaenous electroacupuncture at ST36 and PC6 markedly improves dyspepsia symptoms and the improvement may be associated with the increase in HF heart rate variability and the modulation of NPY.

[Clinical characteristics and diagnosis of chronic intestinal pseudo-obstruction]

OBJECTIVE

To analyze and determine the clinical characteristics and diagnostic methods of chronic intestinal pseudo-obstruction(CIP).

METHODS

We reviewed the medical records of all 23 patients who diagnosed with CIP in Peking Union Medical College Hospital from 1978 to 2000.

RESULTS

Twenty three patients fulfilled the diagnostic criteria (9 male, 14 female, median age 50 years, range 4-75 years). The main symptoms at the presentation were abdominal distension(87%), pain(57%), diarrhea(65%), constipation(48%), vomiting(39%) and weight loss(83%). In this group of CIP patients, the abdominal distension was more common and serious than pain, presenting with diarrhea, weight loss and dismotility in esophagus and stomach. Bowel loops and visible peristaltic waves were seldom observed in the CIP patients. The plain film showed the multiple air-fluid levels (17/20, 85%) and generalized intestinal distention and air in colon. The abnormal findings on the barium contrast examination included intestinal dilation (19/23, 83%), weaken peristalses or/and prolongation of transit time (74%) without mechanical lesions. The pseudo-obstruction involved the small intestine (83%) and colon (39%) that determined according to the radiographic features, abnormal gastrointestinal motor functions, findings of endoscopic examination and laparotomy. Eighteen cases were chronic idiopathic intestinal pseudo-obstruction (1 familial myopathy), 5 were secondary to CTD.

CONCLUSIONS

Comparison with the typical mechanical obstruction, the presentations of CIP have some relatively characteristics. The clinical diagnosis of CIP can be confirmed on the basis of typical clinical symptoms and radiographic features, abnormal gastrointestinal motility.

[Gastric solid emptying in diabetic rats and its respond to Chinese traditional medicine]

OBJECTIVE

To investigate the change of gastric solid emptying at different stages in diabetic rats, and the effect of Chinese traditional medicine(CTM) on gastric emptying.

METHODS

40 Wistar rats were randomly divided into three groups: CTM treated diabetic(15 rats), untreated diabetic(15 rats) and control(10 rats). Diabetes was induced by i.p. of streptozotocin(STZ), 65 mg/kg. CTM, 3.75 g/kg daily (consisting of Dan shen, Fu Ling mainly which functioned as Huo xue hua yu and Bu shen) was administrated in treated diabetic rats. Blood glucose and body weights were measured weekly. 12 and 24 weeks after induction of diabetes, gastric emptying was examined with scintigraphy for 240 min (30 min interval). A test meal (42 kJ) labeled with 99mTc-SC(2.96 x 10(5) Bq) was provided.

RESULTS

(1) There were no significant differences in total gastric retention rate and T 1/2 among three groups at 12 weeks. (2) The lag phase of total stomach in DM-B was (41.56 +/- 8.39) min, shorter than in control's (67.50 +/- 9.09) min, (P < 0.05). (3) The proximal gastric retention rate of 12-week diabetes at 90 min were (38.2 +/- 6.2)% (vs control, P < 0.01), (16.0 +/- 7.9)% (vs control, P < 0.01), and (61.9 +/- 3.5)%; and of 24-week at 120 min were (21.3 +/- 6.8)% (vs control, NS), (48.5 +/- 8.2)% (vs control, P < 0.05, vs treated diabetes, P < 0.01), (28.3 +/- 6.4)% in treated, untreated and control group respectively. (4) There was negative correlation between blood glucose and gastric retention rate (r = -0.62, P < 0.05).

CONCLUSION

(1) The proximal gastric solid emptying was impaired in diabetic rats, there was significantly accelerated in 12-week and slowed down in 24-week compared with control. (2) CTM could modify these impairment. (3) Hyperglycemia had positive correlation to gastric emptying in animal model, which might explain the clinic presentations of patients with diabetes in early stage.

[Primary approach on midgastric-transverse band modifying the distribution of food between proximal and distal stomach]

OBJECTIVE

To explore the physiological function of the midgastric-transverse band (MTB) in the modification of intragastric food distribution in digestive period.

METHODS

18 healthy subjects(HS) and 18 patients with functional dyspepsia(FD) participated in this study. After fasting over 8 hours all subjects took 150 ml of milk (777 J) mixed with 150 g Magnesium Sulfate, and laid supinely on 30 degrees angle with horizontal line, X-ray films were taken at 0, 30, 60, and 90 minutes after the meal, respectively. Analyzed parameters included the width of MTB, the total, proximal and distal gastric area (TGA, PGA and DGA), the ratio of proximal and distal stomach during every 30 minutes period, the correlation between MTB and PGA, MTB and DGA.

RESULTS

(1) There was significant difference of MTB and DGA in every period postprandially (P < 0.05 or 0.01), by contrast, there were no significant differences of TGA or PGA between HS and FD except at TGA 90 min (P < 0.05). (2) There were close correlation between MTB and PGA at 0 (P < 0.01), 30 (P < 0.01), 60 min (P < 0.01) after the meal in HS, but only at 0 min (P < 0.01) in FD. Also close correlations between MTB and DGA at 60 (P < 0.01) and 90 min (P < 0.01) in HS, but in FD. (3) the ratios of PGA from 0-30 min and 60-90 min in FD significantly decreased respectively, however the other ratios were shown no significant difference between HS and FD during each period. (4) there were close correlations between PGA and MTB at 0, 30, 60 min after the meal in HS, however except 0 min there were no correlations in FD. By contrast, between DGA and MTB there were close correlations at 60, or 90 min in HS, no correlation in FD at any time point.

CONCLUSIONS

MTB may play an important role in modifying intragastric food distribution in HS, while the dysfunction of MTB may result in the distal gastric overloading in FD, the mechanism of MTB needs further studies.

[Correlation of Helicobacter pylori infection with symptoms and gastric electrical activity in functional dyspepsia]

OBJECTIVE

To investigate correlation of Helicobacter pylori (Hp) infection with symptoms and gastric electrical activity in patients with functional dyspepsia (FD).

METHODS

Sixty patients with FD confirmed by gastroscopy and pathology were enrolled in this study. Of them, 30 Hp positive (Hp+) and 30 Hp negative (Hp-). Ten dyspeptic symptoms were scored according to severity (0-3) and frequency (0-3), including abdominal bloating, abdominal pain, nausea, vomiting, early satiety, heartburn, and so on. Digitrapper EGG was used for recording 30 min during fasting and 60 min after a test meal (1890 kJ, C:F:P = 3.9:3.4:1).

RESULTS

(1) The total symptom score (TSS) was 26.57 +/- 9.16 and 24.37 +/- 6.86 in Hp+ and Hp- groups respectively (NS). There was no significance of each symptom score between both groups, except the score of heartburn in Hp+ were higher than in Hp- group (2.30 +/- 2.04 vs 1.13 +/- 1.78, P < 0.05). (2) The percentage of normal EGG rhythm (2.4-3.7 cpm) was (64.80 +/- 4.74)% in fasting and (55.84 +/- 4.71)% in postprandial stage in Hp+ group and (64.89 +/- 5.04)%, (62.72 +/- 4.57)% in Hp- group. There was no significance of the percentage of normal EGG rhythm, power ratio(PR), and dominant frequency(DF) between HP+ and HP- groups. (3) However, there was close negative correlation of TSS with normal rhythm in postprandial stage in Hp+ group (r = 0.41, P < 0.05).

CONCLUSION

There may be different pathophysiologic basis in FD with or without Hp infection. Hp infection may influence postprandial gastric electrical activity. Further study needs to be investigated.

[Gastro-pyloro-duodenal motor cooperation in patients with dyspepsia]

OBJECTIVE

To investigate the role of the midgastric transverse band(MTB) and gastro-pyloro-duodenal motility in functional dyspepsia (FD) and diabetic dyspepsia (DD).

METHODS

Healthy subjects, patients with FD and DD participated in the study. Of them, 65 subjects received radionuclide gastric emptying, 48 complex ultrasonograph, and 35 gastro-pyloro-duodenal manometry.

RESULTS

(1) MTB was (7.01 +/- 1.31), (3.39 +/- 0.21) cm in FD and DD, which was significantly wider than that in HS group [(2.42 +/- 0.16) cm, P < 0.01, P < 0.001]. (2) The half gastric emptying time (t 1/2) in FD and DD were prolonged, gastric remained rate at 120 min increased, the gastric emptying velocity reduced when compared with HS. (3) The gastric occlusive and non-occlusive peristaltic contractions could be clearly shown under ultrasonograph. The percentage of emptying circle > 10 seconds was reduced in FD and DD. (4) There was decreased number of migrating motor complex phase III in FD and DD, when compared with HS.

CONCLUSIONS

MTB is an area with physiological function, which affects intra-gastric food distribution. Patients with FD and DD showed delayed gastric emptying associated with decreased gastric motor activity and antro-pyloro-duodenal in-cooperative function. There may be different pathogenesis in FD and DD. Further study needs to be performed.

[Electrogastograph during interdigestive and digestive stages in patients with functional dyspepsia]

OBJECTIVE

To investigate the relationship between dynamic change of electrogastrogram (EGG) with motility index of antrum during migrating motor complex (MMC) cycle in healthy subjects and functional dyspepsia, and to verify whether a 100% coupling of electrical and mechanical events existed after meal.

METHODS

Eleven healthy subjects (HS) and 14 patients with functional dyspepsia (FD) were studied. An 8-channel Dent-sleeve catheter was positioned under fluoroscopic guidance across antropyloroduodenal region and bipolar electrodes were attached to the skin corresponding to the location of antrum. Antropyloroduodenal pressure waves and electrical signals were transferred simultaneously to PC Polygraph (CTD) and recorded for 3 hours preprandially and 2 hours after ingestion of 40 g solid meal (336 kJ). The power of EGG and motility index (MI) of antral contractions were calculated as the area under curve (AUC) by a build-in computer program.

RESULTS

The power increases of EGG increased significantly in phase II (P < 0.01), phase III (P < 0.01) and after meal (P < 0.01) compared with phase I in HS, however, this dynamic increase was not found in FD. The power of EGG was positively correlated with the motility index of antrum both in HS (r = 0.87, P < 0.01) and in FD (r = 0.79, P < 0.01) during the interdigestive period. A significant increase of EGG power after meal was found in HS, which corresponded to the degree of phase III and kept stable for the whole postprandial period. In contrast, power increase was not found in FD except during 30 min after test meal.

CONCLUSIONS

Prolonged cutaneous EGG recording can reflect the periodic variation of MMC cycle. EGG response in HS but not in FD after meal is characterized as persistent increase which is corresponded to phase III.

The cortical vibrissae representation is normal in transgenic mice lacking the 5-HT(1B) receptor

Recent studies have suggested that 5-HT may modulate thalamocortical development in somatosensory cortex (S-I) of rats and mice, and that the 5-HT(1B) receptor may play a critical role in this process. Analysis of CO-stained sections through lamina IV of S-I in perinatal and adult 5-HT(1B) knockout mice revealed a normal vibrissae-related pattern, indicating that activation of the 5-HT(1B) receptor is not necessary for the normal development of the vibrissae representation in S-I.

Morphometric evaluation of the human cervical motoneurons

Morphometric analysis of the human cervical large motoneurons in the anterior horn was performed in 7 male cadavers with the help of an image-analyzer and the use of a new tissue preparation method which minimizes shrinkage. This method makes it possible to precisely evaluate the size of cervical motoneurons at each level. Our study revealed a difference in number, average area and total area of the motoneurons between C1-C3 and C4-C7 levels. This results can be of importance in setting standard values for the understanding of morphological and functional correlations.

Gastro-oesophageal reflux disease in Asia

Gastro-oesophageal reflux disease (GORD) occurs more frequently in Europe and North America than in Asia but its prevalence is now increasing in many Asian countries. Many reasons have been given for the lower prevalence of GORD in Asia. Low dietary fat and genetically determined factors, such as body mass index and maximal acid output, may be important. Other dietary factors appear to be less relevant. Increased intake of carbonated drinks or aggravating medicines may influence the increasing rates of GORD in some Asian countries but no strong evidence links other factors, such as the age of the population, smoking or alcohol consumption, to GORD. The management of GORD in Asia is similar to that in Europe and North America but the lower incidence of severe oesophagitis in Asia may alter the approach slightly. Also, because Asians tend to develop stomach cancer at an earlier age, endoscopy is used routinely at an earlier stage of investigation. Gastro-oesophageal reflux disease is essentially a motility disorder, so short-term management of the disease can usually be achieved using prokinetic agents (or histamine (H2)-receptor antagonists). More severe and recurrent GORD may require proton pump inhibitors (PPI) or a combination of prokinetic agents and PPI. The choice of long-term treatment may be influenced by the relative costs of prokinetic agents and PPI.

[An epidemiologic study of irritable bowel syndrome in Beijing - a stratified randomized study by clustering sampling]

OBJECTIVE

To explore the prevalence of irritable bowel syndrome (IBS) and its risk factors in Beijing.

METHODS

Phase I: a screening program for IBS was carried out in Beijing area according to symptoms using both Manning (modified including constipation) and Rome criteria. Random clustered sampling involving 2 486 subjects of the inhabitants was carried out under stratification of city, suburban and rural areas. Sample size of each studied area was in proportion to the population of the area. The range of age was 18 - 70. All subjects studied were requested to fill in a questionnaire assisted by trained doctors or medical students during the visit to their families. Phase II: a small number of patients who fulfilled the Manning criteria were further selected to undergo detail clinical examination in the hospital including laboratory examination, abdominal ultrasonography, colonoscopy or/and barium enema to exclude organic disease of the colon. Prevalence of IBS of the population was then adjusted by the rate of correct diagnosis during phase II study. Minnesota Multi - Personality Indices was used in some cases. Potential risk factors were explored by comparing frequencies among IBS group and non - IBS group using chi(2) and logistic analysis of multifactors.

RESULTS

The adjusted point prevalence of IBS in Beijing according to Manning criteria was 7.26%, in contrast to Rome criteria - 0.82%. Higher prevalence rate of IBS in the city (10.50%) than in rural areas (6.14%) (P < 0.001) was noticed. Male to female ratio was 1:1.15 with majority of IBS fell in age 18 - 40 (51.6%), and among intellectuals. Our study indicated that history of dysentery (OR = 3.00), exposure to coldness (OR = 1.55), ingestion of cold food and raw materials (OR = 1.24) might serve as the most important risk factors (P < 0.001). Patients with IBS seemed to have a higher tendency of abnormal personalities.

CONCLUSION

IBS is a common disorder in Beijing which deserves greater care.

Epidemiologic study of the irritable bowel syndrome in Beijing: stratified randomized study by cluster sampling

OBJECTIVE

To explore the prevalence of irritable bowel syndrome (IBS) in Beijing and its risk factors.

METHODS

Phase I: a screening for IBS in Beijing area according to symptoms using both Manning (modified including constipation) and Rome criteria. 2486 subjects were studied by cluster sampling of the inhabitant groups according to a stratified design of urban, suburban and rural areas, and sample size of each area studied was in proportion to the population of the area. Selection of the inhabitant groups was made by simple random sampling. Age of subjects enrolled in the study was 18-70 years. All subjects fulfilling the selection criteria were requested to fill in a questionnaire assisted by trained doctors or medical students during the visit to their families. Phase II: an aliquot of patients who fulfilled at least the Manning criteria were further selected according to their scoring series to undergo detail clinical examination in the hospital including laboratory examination, abdominal ultrasonography, colonoscopy or/and barium enema to exclude organic disease of the colon. Prevalence of IBS of the population was then adjusted by the rate of correct diagnosis during Phase II study. Study using Minnesota Multi-Personality Indices (MMPI) was done in some cases. Probable risk factors were explored by comparing their frequencies among IBS group and non-IBS group using chi 2 and logistic analysis of multifactors.

RESULTS

The adjusted point prevalence of IBS in Beijing is 7.26% according to Manning criteria, and is 0.82% according to Rome criteria. There is a higher prevalence rate in city (10.50%) than in rural areas (6.14%) by stratified analysis (P < 0.001). Male to female ratio is 1:1.15. And IBS is more common in people aged between 18-40 years (51.6%), and among the intellectuals. Our study indicated that history of dysentery (OR 3.00), exposure to cool (OR 1.55) and ingestion of cold food and raw materials (OR 1.24) may be the most important risk factors (P < 0.001), and IBS patients may have a higher tendency of psychological abnormalities.

CONCLUSION

IBS is a common disorder in Beijing and should be taken into consideration in the human welfare strategy.

Increased serotonin in the developing superior colliculus affects receptive-field size of retinotectal afferents but not that of postsynaptic neurons

Administration of a single subcutaneous dose of 5,7-dihydroxytryptamine (5,7-DHT) to newborn hamsters results in a significant increase in the density of serotoninergic (5-HT) fibers in the superficial layers of the superior colliculus (SC) and marked abnormalities in the uncrossed retinotectal projection when these animals reach adulthood (Rhoades et al., 1993). The present study was undertaken to determine whether elevation of 5-HT in the developing SC altered the visual representation in SC. Multi-unit recordings from SC cells demonstrated that the overall organization of the visual map in the superficial SC laminae was normal and that the receptive-field sizes for unit clusters were unchanged in the 5,7-DHT-treated animals. However, when a combination of CNQX and MK-801 was directly applied to the SC to block postsynaptic activity, the receptive fields of unit clusters (presumably retinotectal axon terminals) in the 5,7-DHT treated animals were significantly larger than those in the normally reared hamsters. These results are consistent with the conclusions that elevation of 5-HT levels in the developing SC reduces the postnatal refinement of the crossed retinotectal axons, and that mechanisms operating within the SC may act to maintain normal sizes for the receptive fields of its constituent neurons.

[The relationship between obstructive sleep apnea and gastroesophageal reflux and the effect of antireflux therapy]

OBJECTIVE

To evaluate the relationship between gastroesophageal reflux (GER) and obstructive sleep apnea (OSA) and the effect of combined therapy with cisapride and omeprazole.

METHODS

24-hour esophageal pH and manometric monitoring and polysomnography (PSG) were performed in 18 patients with snoring, daytime sleepiness and acid reflux, heartburn and regurgitation. Cisapride 10 mg qid and omeprazole 20 mg q12h were given to patients with GER and OSA. these tests were repeated on the 7th day.

RESULTS

7 of the 18 patients with OSA had severe GER. All except one had daytime GER as well as nocturnal GER. Nocturnal recordings were analyzed and it was found that esophageal pH below 4.0 was frequently followed by swallow action (58.6%, control = 20.6%, P < 0.05), gross body movement (18.6%, control = 4.8%, P < 0.05) and arousal (26.8%, control = 16.8%, P < 0.05). The mean lowest esophageal pressure [(-15.2 +/- 9.6) mmHg] before and [(-18.6 +/- 10.1) mmHg] after the drops of pH were significantly lower than that during control periods [(-10.6 +/- 8.1) mmHg, P < 0.005]. After antireflux therapy, there was dramatically improvement in total apnea time [from (52.7 +/- 27.1) to (21.6 +/- 21.2) minutes, P < 0.002)] and apnea hypopnea index (AHI) [from (38.9 +/- 17.6) to (15.2 +/- 12.3) No./h, P < 0.002].

CONCLUSION

GER is a predisposing factor for OSA, they may coexist and aggravate each other. Combined therapy with cisapride and omeprazole is a new, simple and effective method for GER with OSA.

Temporal and spatial relationship of pylorus to antroduodenal motility in functional dyspepsia

OBJECTIVE

To investigate the temporal and spatial relationship of pylorus to antroduodenal motility in functional dyspepsia (FD).

METHODS

Eleven healthy subjects (HS) and 14 patients with FD were studied. Antral-pyloro-duodenal manometry was performed for 3 hours fasting and 2 hours after 80 Kcal of solid test meal.

RESULTS

(1) The incidence of phase III was 7/11 in HS and 3/14 in FD in antrum (P < 0.05), 8/11 and 4/14 in pylorus (P < 0.05), 10/11 and 6/14 in duodenum (P < 0.05), respectively. (2) The percentage of antropyloroduodenal coordinations during phase II of MMC was 58.5% in HS and 18.5% in FD (P < 0.001). (3) The pyloroduodenal coordination was 78.2% and 38.9% (P < 0.01) at 60 minutes after meal and 77.1% and 54.0% (P < 0.01) at 120 minutes postprandially in HS and in FD. (4) The percentage of isolated pyloric pressure waves (IPPWs) was 4.8%, 29.7% (P < 0.001) at 60 minutes, and 9.3%, 25.1% (P < 0.01) at 120 minutes in HS and FD.

CONCLUSIONS

There were abnormalities of gastro-pyloro-duodenal motility in both interdigestive and digestive stages; the higher incidence of IPPWs and disordered temporal and spatial relationship of pylorus to antroduodenal motility may result in a delayed gastric emptying in FD. The possible mechanism may be involved in abnormal neural control.

Augmentation of serotonin in the developing superior colliculus alters the normal development of the uncrossed retinotectal projection

A previous study from this laboratory showed that sprouting of serotoninergic axons in the hamster's superior colliculus (SC) induced by a single subcutaneous injection of 5,7-dihydroxytryptamine (5,7-DHT) at birth (postnatal day 0; P-0) resulted in an abnormal terminal distribution of the uncrossed retinotectal projection. The present study provided further evidence to support the role of increased 5-HT levels within the SC in this phenomenon. Slow-release polymer (ELVAX) chips impregnated with serotonin (5-HT) were placed over the SC on either P-1 or P-3, and retinotectal projections were assessed via anterograde transport of horseradish peroxidase when animals reached P > 18. Analysis of ELVAX chips indicated that they released 5-HT in amounts of > or = 1 pmole/hour for at least 12 days. Assessment of the SC of treated hamsters indicated significantly elevated 5-HT concentrations as late as P-12, but not on P-16. Implantation of 5-HT chips, but not control chips, resulted in abnormalities in the uncrossed retinotectal projection similar to those observed in the 5,7-DHT-treated animals. The patches that normally develop in the rostral part of the stratum opticum were not present, and uncrossed axons were distributed densely in this layer and in the lower portion of the stratum griseum superficiale throughout the rostrocaudal and mediolateral extents of the SC. Quantitative analysis of these changes indicated significant differences between the organization of the uncrossed retinotectal projections of 5-HT-treated animals vs. either blank-implant treated or completely untreated animals but not between 5-HT-treated hamsters and animals that received neonatal 5,7-DHT injections. All of these results support the conclusion that increased SC concentrations of 5-HT altered retinotectal development.

[Potential role of gut peptides in stress-induced colonic motor disorder]

OBJECTIVE

To explore the potential role of gut peptide in stress-induced colonic motor disorder.

METHODS

In 9 conscious Wistar rats pre-equipped with strain-gauge transducers on ascending and descending colon, colonic motility was recorded before, during and after stress. And colonic transit was evaluated by instilling Cr into the cecum through chronically implanted cannula in each group of 16 rats with or without stress, and then calculating the geometric center (GC) of radioactivity. The contents of VIP, SP, NT, SST, MOT and Leu-ENK in plasma, colonic mucosa and muscle layer were assessed in 16 stressed and 16 control rats. Exogenous peptides (VIP, SP, SST, NT) were intravenously administered in 9 rats to determine the colonic motor response. Also, the effects of peptides on colonic circular muscle strips were investigated.

RESULTS

Motor activity was increased after stress, whereas colonic transit was delayed. In the stressed rats, plasma levels of VIP and Leu-ENK were higher than those in controls. The content of Leu-ENK in muscle tissue decreased. Both in vivo and in vitro studies showed that SP and NT excited, whereas VIP and SST inhibited colonic motor activity.

CONCLUSION

Release of certain peptides is altered by stress. Increased release of ENK and VIP may be involved in stress-induced colonic motor disorder and in the regulation of "stress hormone" release.

Age-related reductions in number and size of anterior horn cells at C6 level of the human spinal cord

We examined numbers and sizes of anterior horn cells (AHCs) of the human spinal cord at C6 level with aging process. Spinal cords were obtained from twenty-four male cadavers, age ranged from 41 to 97 years without any accompanying pathological changes of the spinal cord. For quantitative investigation of the AHCs, spinal cord segments were embedded in celloidin after secondary fixation and dehydration; sections (20 microns thick) were stained with luxol fast blue-periodic acid-Schiff-hematoxylin and Klüver-Barrera methods; the neuronal number, the cell body area and the perimeter of AHCs in the gray matter (equivalent to the Rexed's lamina IX) were counted and measured using a combination of a microscope with a drawing tube, a digitizer and a computer at 400 times magnification. A marked reduction in number of AHCs was found in the aged subjects. Similarly, there were significantly age-related decreases in the cross-sectional area and perimeter of AHCs at C6 segment of the spinal cord. These findings indicate that the reduction in number and size of AHCs in the human spinal cord is associated with degenerative neuronal changes and loss of motoneurons during aging process.

Two auxin-responsive domains interact positively to induce expression of the early indoleacetic acid-inducible gene PS-IAA4/5

The plant growth hormone indole-3-acetic acid (IAA) transcriptionally activates expression of several genes in plants. We have previously identified a 164-bp promoter region (-318 to -154) in the PS-IAA4/5 gene that confers IAA inducibility. Linker-scanning mutagenesis across the region has identified two positive domains: domain A (48 bp; -203 to -156) and domain B (44 bp; -299 to -256), responsible for transcriptional activation of PS-IAA4/5 by IAA. Domain A contains the highly conserved sequence 5'-TGTCCCAT-3' found among various IAA-inducible genes and behaves as the major auxin-responsive element. Domain B functions as an enhancer element which may also contain a less efficient auxin-responsive element. The two domains act cooperatively to stimulate transcription; however, tetramerization of domain A or B compensates for the loss of A or B function. The two domains can also mediate IAA-induced transcription from the heterologous cauliflower mosaic virus 35S promoter (-73 to +1). In vivo competition experiments with icosamers of domain A or B show that the domains interact specifically and with different affinities to low abundance, positive transcription factor(s). A model for transcriptional activation of PS-IAA4/5 by IAA is discussed.

Abnormal cardiovascular reflexes in patients with achalasia

Using 3 non-invasive tests, abnormalities of cardiovascular reflex function were found in 7 of 15 patients with achalasia. Abnormalities of heart rate responses to the Valsalva maneuver, deep breathing, and standing were noted in patients with autonomic neuropathy defect. The findings are consistent with the hypothesis that an abnormality of vagal function may contribute to the pathogenesis of achalasia.

Impaired esophageal emptying in reflux disease

OBJECTIVES

The symptoms and mucosal damage that occur in gastroesophageal reflux disease (GERD) may be a consequence of either an increased frequency of reflux events or of a prolonged process of esophageal acid clearance. Acid clearance is dependent both upon effective esophageal emptying of luminal fluid and on normal salivary function to titrate residual acid to neutrality. This investigation examined the efficacy of esophageal emptying in a large group of GERD patients.

METHODS

Barium swallow examinations were done to categorize and quantify esophageal emptying dysfunction in 67 consecutive patients with reflux disease, compared with 85 patient asymptomatic controls. Quantitative fluoroscopic estimates of esophageal residua were compared with scintigraphic quantification in 14 controls and 20 GERD patients.

RESULTS

There was progressive impairment of esophageal emptying in the reflux patients without esophagitis compared with the controls, and it was even greater in patients with endoscopically evident esophagitis compared with reflux patients without esophagitis. Good correlation existed between the fluoroscopic and scintigraphic assessment of esophageal emptying.

CONCLUSIONS

These findings support the hypothesis that impaired esophageal emptying is an important determinant in the development of esophagitis among reflux patients. The dominant site of impaired emptying in the reflux patients was the phrenic ampulla as opposed to the tubular esophagus, suggesting a pathophysiological contribution of hiatus hernia.