Oropharyngeal pH Monitoring for the Detection of Liquid and Aerosolized Supraesophageal Gastric Reflux

The association between gastroesophageal reflux disease (GERD) and extraesophageal symptoms is poorly understood and difficult to document. pH monitoring in this group of patients has resulted in conflicting data due to lack of diagnostic sensitivity. Recently, a new sensitive pH device for detection of liquid and aerosolized droplets in the oropharynx (The Dx–pH Measurement System [Dx–pH]) has become available. Our hypothesis is that we will be able to improve our ability to identify and understand this group of patients with this device. The aim of this preliminary observation study was to compare the results of this new device to the standard esophageal and pharyngeal pH probes in a small group of patients with extraesophageal symptoms. Patients with suspected extraesophageal GER symptoms underwent traditional 24-hour esophago-pharyngeal pH monitoring (24pH) simultaneous with Dx–pH monitoring in the oropharynx. Tracings were reviewed for comparison and correlation between the two probes, with an event in the Dx–pH Probe being defined as a rapid drop >3 standard deviation from baseline. Fifteen patients (10 females, 5 males) with mean age of 57.5 years (range, 25–75) were studied. The predominant chief complaint included 12/15 chronic cough, 2/15 asthma; and 1/15 throat clearing. All Dx–pH events were preceded and associated with distal esophageal pH drops in a progressive ante grade manner. Ten patients had 1–13 abnormal oropharyngeal pH events as measured by Dx–pH monitoring with a total of 48 events. The median pH of reflux events had a statistically significant increase from 3.1 at the distal esophageal probe to 5.2 at the pharynx and 5.6 at the oropharynx, the latter being 80% higher than the distal esophageal probe (P < 0.001). The percentage of acid events decreased in a cephalad manner from 66.7% at distal esophagus to 25% at the pharynx and only 6.25% at the oropharyngeal Dx–pH Probe, with the remaining events being weakly acidic. Dx–pH Probe is a new sensitive oropharyngeal pH device whose values correlate well with the gold-standard 24-hour pH device, and appears to accurately detect pH events that begin at the distal esophagus and travel upward to the oropharynx. This device suggests that supraesophageal events manifest themselves as rapid pH drops (>10%), which are likely not to be identified using the standard criteria of pH <4 due to the gradient of increasing pH from the lower esophagus to the oropharynx.     

Subjective, laryngoscopic, and acoustic measurements of laryngeal reflux before and after treatment with omeprazole

Laryngeal manifestation of gastroesophageal reflux is felt to be prevalent in our society. In general, diagnosis has been based primarily on symptoms. Historically, additional testing included laryngoscopy, barium swallow, manometry, and more recently, single- and double-probe pH monitoring. We evaluated 68 patients who were symptomatically suggestive of having reflux laryngitis. We administered surveys grading their symptoms. All patients underwent standardized videolaryngostroboscopic evaluation and computerized acoustic analysis. Patients then underwent a uniform therapy of dietary restrictions and omeprazole, a hydrogen ion inhibitor, for 12 weeks. Patients were then retested. This regimen demonstrated an 85% success of relieving symptoms. Utilizing the new laryngoscopic grading system, improvement was found to be statistically significant in improvement of all findings except granulomas. In patients with the pretherapy complaint of hoarseness, acoustic measures of jitter, shimmer, habitual frequency, and frequency range all showed significant improvement. The authors conclude that in patients with symptomatic reflux laryngitis, standardized videolaryngoscopy and, if hoarse, acoustic analysis are useful exam techniques to aide diagnosis and monitor therapy. Anti-reflux therapy with omeprazole is effective and improvement can be objectively demonstrated with the techniques described.     

The Prevalence of Hypopharynx Findings Associated with Gastroesophageal Reflux in Normal Volunteers

Routine laryngeal examination of patients with otolaryngologic complaints often reveals findings thought to result from gastroesophageal reflux. The direct association between these mucosal findings and uncontrolled reflux is not well established. To begin exploring the specificity of tissue signs, 105 normal, healthy, adult volunteers were examined by routine video fiber-optic endoscopy for the presence of findings attributed to reflux disease. Medical conditions, lifestyle factors, and ENT complaints were surveyed to reveal potential airway irritants, while the study design attempted to eliminate silent reflux. The majority of subjects (86%) had findings associated with reflux and certain signs reached a prevalence of 70%. Prevalence was not affected by ENT complaint, smoking, alcohol, or asthma. Intraexaminer and interexaminer agreement information is provided. The traditional attribution of hypopharynx irritation signs to reflux is challenged; the need for improved diagnostic specificity is highlighted.     

Chronic dysphonia secondary to gastroesophageal reflux disease (GERD): Diagnosis using simultaneous dual-probe prolonged pH monitoring

The association of chronic dysphonia with gastroesophageal reflux has been reported in the otalaryngologic literature; unfortunately, these reports are primarily anecdotal. Because of the difficulty in documenting reflux, patients are often left without a definitive diagnosis or therapy. The purpose of this paper is to report on an objective method of documenting gastroesophageal reflux disease by using ambulatory esophageal and hypopharyngeal pH monitoring. 70% of the subjects who underwent simultaneous dual-probe pH monitoring evidenced reflux in the hypopharynx in both an upright and supine position. All of the subjects had erythema of the arytenoid cartilages on indirect examination; so this appears to be of clinical diagnostic significance.     

Candida laryngitis appearing asleukoplakia and gerd

The symptoms and physical findings of reflux laryngopharyngitisare characteristic, but the mucosal alterations evident in the larynx are not exclusive to reflux. When conventional reflux management produces an equivocal response, other etiologic factors such as mycotic laryngitis, need consideration. The differential diagnosis of dysphonia in an immunocompromised patient always includes mycotic infections, but mycotic laryngitis can also occur in the immunocompetent host. Laryngeal candidiasis can produce physical findings, such as erythema and leukoplakia, that are similar to reflux laryngopharyngitis. Predisposing factors include previous radiation therapy, antibiotic therapy, corticosteroids, and any alteration in the mucosal barrier. Diagnosis is established by mucosal biopsy with special staining of the tissue to identify the characteristic hyphae. Treatment of mycoses can be difficult and long-term therapy is often required.     

Gastroesophageal reflux laryngitis resistant to omeprazole therapy

Gastroesophageal reflux disease (GERD) is known to cause a variety of symptoms that lead a patient to seek otolaryngologic care. New advances in the treatment of GERD have enabled otolaryngologists to eliminate most of the signs and symptoms caused by acid reflux. Omeprazole, the most recent pharmacologic advancement, has been reported to be universally successful in controlling acid release from the stomach of patients with GERD. This report describes a series of patients with GERD for whom high-dose omeprazole therapy was not successful in completely reducing gastric acid levels of GERD symptomatology.     

Short-Term Therapeutic Trial of Proton Pump Inhibitors in Suspected Extraesophageal Reflux

Pharyngoesophageal gastric acid reflux is thought to initiate chronic posterior laryngitis. The gold standard for measuring gastric reflux is dual-channel 24-hour pH monitoring. This is a time-consuming, inconvenient, expensive method that is not available in all areas. New therapeutic regimes that make use of proton pump inhibitors (PPIs) have proven to be therapeutically efficient for control of acid reflux. Twenty-four consecutive patients with chronic voice disorders and signs of posterior laryngitis were selected for therapy. Twenty-four hour pH monitoring was performed independently before the therapy. The trial therapy consisted of all patients receiving pantoprazole, 40 mg once daily for 6 weeks. Immediately following the therapy a statistically significant (p < 0.05) improvement was observed in all patients. This improvement was analyzed retrospectively by comparison with the results of 24-hour pH monitoring. In 71% of the patients the 24-hour pH-monitoring gave a positive result showing a high number of patients with extraesophageal reflux in our study group. Patients with positive results of pH-monitoring responded in a statistically significant manner (p < 0.05) to the pantoprazole therapy, whereas those patients without detected reflux did not. A 3-month follow-up of the patients with a positive result of the pH-monitoring confirmed the improvement. No patients reported adverse effects. A 6-week treatment with pantoprazole can be clinically justified. It helps to save time and reduce costs, allows for selection of reflux-negative patients for alternative therapy, and may prevent inadequate treatment of patients with false-negative pH monitoring. Twenty-four hour pH monitoring is still recommended for patients unresponsive to this trial therapy.     

地源热泵的应用对环境的影响分析

地源热泵被认为是一种高效、节能、环保、有利于可持续发展的技术,它被认为是21世纪最有效的空调技术。然而地源热泵的大量使用也带来了一系列的环境问题。分别针对地表水源热泵、地下水源热泵以及土壤源热泵的使用对环境的影响进行了深入分析,并对可能的解决方案进行了讨论。     

Quantitative color analysis of laryngeal erythemain chronic posterior laryngitis

The purpose of this study was to quantitatively analyze the degree of erythema visible in the larynges of normal subjects and of patients with symptoms of chronic posterior laryngitis. Video-documented examinations of laryngoscopy were digitized and then analyzed using computer image analysis software that allowed quantification of average color values, hue, saturation, and brightness from digitized color images. Documented laryngoscopic images from 7 normal subjects and 64 patients complaining of chronic laryngitis symptoms were examined, and additional patient examinations which were obtained and documented during treatment for reflux laryngitis were analyzed. Analysis was made of five different areas of each laryngeal image: the right and left vocal folds, the right and left vocal processes, and the posterior arytenoid mucosa. Data analysis showed that average color value ratings of redness for the patients with chronic laryngitis were significantly (p <0 .0561) greater than the average values for normal subjects for the vocal folds. Color values for redness of the posterior laryngeal structures and vocal folds in the patients who were treated for reflux laryngitis were significantly (p < 0.05) reduced over time and correlated with the clinical response to treatment. The data suggest that computer color analysis of documented video-laryngoscopy examinations can provide quantitative data on degree of erythema and may be useful as a quantitative means of diagnosis and documentation of treatment outcome for reflux laryngitis.     

Effect of zinc substitution on magnetic and electrical properties of nanocrystalline nickel ferrite synthesized by refluxing method

Nanocrystalline Nickel ferrite (NiFe₂O₄) and Zn substituted nickel ferrite (NiZnFe₂O₄) have been synthesized by the refluxing method. These ferrites were characterized by XRD, TEM, Mossbauer spectroscopy and VSM in order to study the effect of zinc substitution in nickel ferrite. XRD diffraction results confirm the spinel structure for the prepared nanocrystalline ferrites with an average crystallite size of 14-16 nm. Lattice parameter was found to increase with the substitution of Zn²⁺ ions from 8.40 Å to 8.42 Å. TEM images confirmed average particle size of about 20 nm and indicates nanocrystalline nature of the compounds. A shift in isomeric deviation with the doublet was observed due to the influence of Zn substitution in the nickel ferrite. The Zn content has a significant influence on the magnetic behavior and electrical conductivity of NiFe₂O₄. Saturation magnetization drastically increased whereas room temperature electrical conductivity decreased due to the addition of Zn content in NiFe₂O₄, indicating super magnetic material with lesser coercivity.     

"自动回流消化仪"消化-AFS法测定油中的砷

本文报道了“自动回流消化仪”消化，原子荧光光度法测定的油中的砷。“自动回流消化仪”消化油既防止了砷元素的损失，又能使油容易消化，同时在试剂用量、劳动强度、消化速度等方面都有较好的效果。原子荧光光度法，采用新的仪器和原理，提出了方法的灵敏度。该法回收率为91.8％－104.7%,相对标准偏差0.51%，与传统湿法消化法比较无显著性差异（t0.05）。     

小流量旋涡泵的理论设计与试验研究

建立了以效率和工作范围为主线的小流量旋涡泵的理论设计方法，并对ＸＷＢ－３／１３０和ＸＷＢ－１／１１０两台旋涡泵进行了试验研究．理论分析和试验结果表明：较大的流道面积Ｆ可以拓宽泵的工作范围，较大的径向间隙△ｐ和轴向单边间隙δα会降低泵的扬程和效率。     

泵站水泵进水池内防涡装置有效性的数值验证

本文提出了一种消除泵站水泵吸水管内旋涡和流动分离的圆锥形防涡装置。为了验证该装置的有效性,建立了泵站水泵进水池和吸水管内三维湍流流场的数学模型,用分区网格构造了泵站水泵进水池和吸水管的贴体计算网格,采用有限体积方法,计算了无圆锥形防涡装置和有圆锥形防涡装置时,水泵进水池和吸水管内三维湍流流场,结果证明该圆锥形防涡装置能有效消除水泵吸水管内旋涡和流动分离。     

308nmXeCl准分子激光双侧面对称泵浦之形腔染料激光器研究

描述了用３０８ｎｍＸｅＣｌ准分子激光双侧面对称泵浦之形腔染料激光器，重点探讨了这种激光器的输出光束质量改善问题，实验发现这种双侧面对称泵浦较传统的横向泵浦，光束质量有较好的改善，对于２×１０－３ｍｏｌ／ｌ浓度的ｃｏｕｍａｒｉｎ４６０染料甲醇溶液，在波长４６０ｎｍ处，实验得到１１．７％的能量转换效率     

Cell-based screening strategy in the search for bioactive microbial secondary metabolites Utilization of microbial and animal cells with special functions

Here we present results obtained in our group from cell-based screenings of microbial secondary metabolites using intact microbial and mammalian cells having specific functions. We present summaries of the following five categories of compounds and the strategies that were used to identify them. (1) Antibacterial agents targeting cell wall peptidoglycan synthesis as well as active agents against organisms other than bacteria were identified by a combination of Bacillus subtilis and Mycoplasma as test organisms. (2) Antimetabolites, such as herbicidal agents targeting glutamine synthase, were identified using B. subtilis grown on minimal medium with or without the addition of glutamine and folate inhibitors by combination of B. subtilis and Enterococcus faecium, which have distinct folate metabolic pathways. (3) Among inhibitors of lipid metabolism, acyl-CoA synthetase inhibitors were identified using two mutants of C. lipolytica with different deletion sites in the fatty acid metabolic pathways, HMG-CoA synthase inhibitors were identified using Vero cells cultured in the presence and absence of mevalonate, and anti-atherosclerosis agents were identified using macrophages. (4) IL-6 inhibitors were detected by a combination of IL- 6-dependent and independent murine hybridoma MH60 cells, and (5) Small molecules with TNF-like activities were identified using a mouse neuroblastoma cell line. Some advantages of such screening method and the significance of the identified compounds are discussed.