老年睡眠障碍患者胃管反流病、功能性肠病及功能性消化不良患病的现况调查分析

目的:调查老年睡眠障碍患者胃管反流病(GERD)、功能性肠病(FBD)及功能性消化不良(FD)的患病现况。方法:选择参加我院2012年春季体检人员中有睡眠障碍的患者为调查对象,进行"消化道症状问卷"调查,并按年龄分层进行比较。结果:共入选377例睡眠障碍患者,老年组确诊为GERD、FBD及FD患者129例(53.53%),发生率明显高于成年患者(45例,33.06%)(P0.01)。老年睡眠障碍患者中GERD和功能性便秘的发生率明显高于成年组,而FD及肠易激综合征患病的发生率均明显低于后者(P均0.01~0.05);老年睡眠障碍患者重叠型及GERD+FBD各亚型重叠发生率明显高于成年组,而单一型发生率明显低于后者(P均0.01~0.05)。结论:老年睡眠障碍患者GERD、FBD及FD的发生率均较成年人高,且以GERD及功能性便秘为主。     

Helicobacter pylori and Non-malignant Diseases

It is well known that Helicobacter pylori infection is associated with many nonmalignant disorders such as gastritis, peptic ulcer, gastroesophageal reflux disease (GERD), gastric polyp, nonsteroidal anti-inflammatory drug (NSAID)/aspirin-induced gastric injury, and functional dyspepsia. In 2008, interesting articles on the association of H. pylori infection with these disorders were presented, some of which intended to reveal the mechanisms of inter-individual differences in response to H. pylori infection, and have demonstrated that genetic differences in host and bacterial factors as well as environmental factors account for these differences. A decline in the occurrence of peptic ulcer related to H. pylori was confirmed. An inverse relationship between H. pylori infection and GERD was also confirmed but the impact of gastric atrophy on the prevention of GERD remained debatable. For NSAID-induced gastric injury, eradication of H. pylori infection has been recommended. During this year, eradication of H. pylori infection was recommended for patients treated with antiplatelet therapy as well as aspirin and NSAID. It was also reported that for patients with functional dyspepsia, eradication of H. pylori offers a modest but significant benefit.     

CCN1 is critical for acid-induced esophageal epithelial cell transformation

CCN1 is a matricellular protein involved in both wound healing and cancer cell invasion. Increased CCN1 expression has been associated with the development of Barrett’s esophagus and the increased risk of progression to esophageal adenocarcinoma. In both cases, acid reflux is a major contributor. Low pH has been shown to induce CCN1 gene expression in esophageal epithelial cells. Here we demonstrated that both CCN1 and low pH could cause esophageal epithelial cell transformation, including loss of E-cadherin, disruption of cell-cell junctions, and expression of mesenchymal markers. Furthermore, knockdown of CCN1 through RNA interference sufficiently attenuated acid-driven cell phenotypic changes, while over-expression of CCN1 exacerbated these effects, indicating a critical role of CCN1 in acid-induced esophageal epithelial cell transformation. Given the pivotal role of low pH in gastro-esophageal reflux disease and its progression towards esophageal adenocarcinoma, our study identified CCN1 as a key molecule mediating this process.     

Helicobacter pylori and Non-malignant Diseases

In 2007 Helicobacter pylori research continued to deal with some controversies raised in the last decade. The main problems remain unsolved: peptic ulcer disease negative for H. pylori , synergism of H. pylori infection and aspirin and other nonsteroidal anti-inflammatory drugs or cyclooxygenase 2 specific inhibitors, the role of H. pylori eradication in uninvestigated and nonulcer dyspepsia, and the possible protective effect of H. pylori infection against gastroesophageal reflux disease and its complications such as Barrett's esophagus and adenocarcinoma. The incidence and prevalence of peptic ulcer disease as well as ulcer-related mortality are continuing to decline all over the world. The increasing consumption of anti-inflammatory and antisecretory drugs was not found to change the trend over the last period and therefore H. pylori was considered the key factor in causing ulcer-related mortality. Some progress has been achieved in understanding H. pylori -induced immunological processes, and attack mechanisms, as well as specific pathogenesis in uremic and cirrhotic patients. There is still a lot to learn about the bacterium and host factors related to H. pylori infection and its complications.     

酸吸入致大鼠肺纤维化初步探索

目的研究实验性酸吸入与大鼠肺间质纤维化的相关性及其可能的作用机制,并与传统的博来霉素致纤维化作一比较。方法健康雄性SD大鼠120只,随机分为正常对照组、博来霉素组、高浓度盐酸组、中浓度盐酸组和低浓度盐酸组,每组24只。博来霉素组气管内一次性注入博来霉素诱导纤维化,盐酸组每周气管内滴注不同浓度盐酸1次,正常对照组每周气管内滴注生理盐水1次。各组分别于造模后第7、14、28及42天随机处死6只,取肺组织行HE、Masson染色评价肺组织病理变化,用RT-PCR方法测定肺组织转化生长因子β1(TGF-β1)的mRNA表达,用免疫组化的方法半定量测定I型胶原蛋白、结缔组织生长因子(CTGF)的表达。结果盐酸组肺泡炎程度始终显著高于对照组,在开始2周内达到一个高峰,随后仍旧维持一个相对较高状态,28d达到或者超过博来霉素组水平。盐酸组纤维化程度随时间逐渐增强,显著高于对照组,但始终未超过博来霉素组。盐酸组肺组织TGF-β1mRNA在28d时达到博来霉素组水平,至42d时全面超过博来霉素组水平。博来霉素组大鼠各时间点肺组织I型胶原表达均显著高于正常阴性对照组及3个盐酸组。高、中浓度盐酸组CTGF表达从14d起高于正常阴性对照组,且随滴注次数及时间增加而增强。结论本实验从一个角度反映了经常性胃食管酸反流引起的酸吸入与肺纤维化的相关性,为揭示胃食管反流病(GERD)与特发性肺纤维化(IPF)的关系提供了初步的实验室证据。     

Helicobacter pylori and Gastroesophageal Reflux Disease: A Case–Control Study

Background:  Gastric colonization with Helicobacter pylori is a proposed protective factor against gastroesophageal reflux disease (GERD), but little population-based data exist and other data conflict.
Methods:  We conducted a case–control study within the membership of a large integrated health-care system that compared GERD-free subjects with two groups: subjects with a physician-assigned GERD diagnosis and randomly selected members with self-described weekly GERD symptoms. Subjects completed interviews, GERD questionnaires, and antibody testing for H. pylori and its cagA protein.
Results:  Serologic data were available for 301 physician-assigned GERD patients, 81 general membership subjects with GERD symptoms, and 175 general membership subjects without GERD symptoms. Physician-assigned GERD patients were less likely to have H. pylori antibodies than GERD-free member controls (odds ratio (OR) = 0.27, 95% confidence interval (CI) 0.15–0.47); there was also an inverse association between H. pylori and GERD symptom severity (OR = 0.18, 95% CI 0.08–0.41; severe or very severe symptoms) and GERD frequency (OR = 0.18, 95% CI 0.09–0.38; for symptoms at least weekly). The association was stronger among persons with erosive GERD and was similar between H. pylori -positive subjects with and without cagA. There was no association among persons who were cagA positive, but H. pylori negative. Similar findings were found in analyses of the general membership with self-described GERD symptoms.
Conclusions:  H. pylori antibody status was inversely associated with a GERD diagnosis and GERD symptoms compared with a general membership population.     

Potential chemical transformation of phosphinic acid derivatives and their applications in the synthesis of drugs

The chemical transformation of phosphinic acid is a well-considered mature area of research on account of the historical significant reactions such as Kabachnik–Fields, Mannich, Arbuzov, Michaelis–Becker, etc. Considerable advances have been made over last years especially in metal-catalyzed, free-radical processes and asymmetric synthesis using catalytic enantioselective. As a result, the aim of this synopsis is to make the reader familiar with advances in the approaches of phosphinic acids toward the synthesis of highly functionalized and valuable buildings blocks. Another purpose of this survey is to provide the current status of the applications of phosphinic acids in the synthesis of drugs.     

终末期肾病患者合并胃食管反流病的临床研究进展

胃食管反流病(GERD)是最常见的食管疾病之一。多项研究表明,终末期肾病(ERSD)患者GERD的患病率高于普通人群。目前对于ERSD患者特别是血液透析患者GERD的症状特点及严重程度的研究较少。ESRD患者常并发或伴发糖尿病、高血压等,而糖尿病神经病变可影响胃排空功能,钙拮抗剂和硝酸酯类药物可影响LES舒张功能。透析相关淀粉样变通过影响食管蠕动、食管下段括约肌张力和胃排空影响GERD的发生。ERSD患者中,相当比例的患者全身状况不佳,行胃镜风险较高,常常应用标准化量表或质子泵抑制剂诊断试验评估患者症状性GERD患病情况。ESRD及透析患者GERD的知晓率仍较低,部分患者自行服用碳酸氢钠等非一线药物控制症状。理论上对于ESRD及透析患者伴随的GERD进行早期诊断和治疗可能提高患者生活质量,并减少水钠摄入,改善血压及透析间期体重增加,降低心血管事件风险,具体的临床获益仍有待进一步研究证实。