Jun 2010, Volume 4 Issue 2
    

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  • Research articles
    Linda S. BIRNBAUM PhD, DABT, ATS,
    When considering disease etiology, we need to view the role of the environment along the continuum from health to disease for individuals because we know that there are complex interactions between genes, their molecular expression, and environmental factors over a person’s lifetime. We clearly have huge gaps in our knowledge along this continuum, and these gaps are natural opportunities for research. There are many factors to consider as we assess the relationship between environmental exposures over a lifetime. One factor is persistence of chemicals that “live” beyond their initial intended use. Another factor is the fact that “inert ingredients” are not really inert. “Low dose” is also another consideration. We need to understand the biological effect of low dose exposure and we should clearly define what they mean by low dose research. For example, are we measuring the administered dose, or the internal/circulating dose? There are new types of toxicity as well. For example, endocrine disruptors and engineered nanomaterials are significant classes of materials deserving significant research. Timing of exposure is a significant feature in characterizing toxicity. Environmental exposures can have a greater impact in early or later life-stages. Finally, mixtures of chemicals are an important consideration. Humans are always exposed to multiple chemicals. In short, we must remember that there is no such thing as “not exposed.” Everyone has been exposed to many and various environmental agents.
  • Research articles
    Kan ZHANG MM, Wei DONG MM, Ying-Yao CHEN MD,
    This article discusses the concept of health management and stresses that community health management should be the starting point of community health service, necessitating a paradigm shift from observing the treatment-oriented medical model to observing the prevention-and-health management-based medical model. Community health construction has entered a new phase, one which highlights the need to train general practitioners in practice-based life cycle health management. In addition, general practitioners should assume the mission of implementing community health management.
  • Research articles
    Lan-Juan LI MD,
    Hand, foot and mouth disease (HFMD) is an acute viral illness that primarily affects infants and young children, and often occurs in clusters or outbreaks. The major causative agents of HFMD are coxsackievirus A16 (CVA16), human enterovirus 71 (HEV71) and coxsackievirus A10 (CVA10), of the genus Enterovirus in the family Picornaviridae. HFMD caused by EV71 is associated with severe neurological complications and death. Since the late 1990s, several major epidemics of EV71 HFMD have swept through the Asia-Pacific region, associated with a rapid fulminant course, severe neurological complications, and a large number of fatalities. Until now, little has been known about the genetics and transmission trends of the fast-mutation virus, and there is no effective and specific antiviral therapy or vaccine for HFMD. It is time to step up efforts to understand the molecular epidemics and pathogenesis so that we can develop effective management strategies and surveillance programs.
  • Research articles
    Kelvin Kai-Wang TO FRCPath, Iris Wai-Sum LI FRCP, Ivan Fan-Ngai HUNG FRCP, Vincent Chi-Chung CHENG FRCPath, Kwok-Yung YUEN MD,
    The pandemic H1N1 2009 influenza virus has caused the first influenza pandemic of the 21st century, leading to disproportionate fatalities in the low-risk population despite the generally mild nature of the illness. Advances in sci
  • Research articles
    Ze-Guang HAN MD,
    Human schistosomiasis, caused mainly by three principal species including Schistosoma japonicum, S. mansoni, and S. hematobium, remains a major public health concern worldwide. S. japonicum is prevalent in southern China, being a major disease risk for 66 million people. The blood fluke has a complex life cycle for survival: as a free-living form in fresh water and as a parasite in the snail intermediate and vertebrate definitive hosts. Systems-based biomedical analyses, including genomic, transcriptomic, proteomic and metabonomic approaches, have been performed on the schistosome. These comprehensive investigations have not only characterized the genomic features but also chartered gene and protein expression profiles across genders and developmental stages. The integration of the huge information will lay a global and solid foundation for the molecular architecture of the biology, pathogenesis, and host-parasite interactions of the human blood fluke, which will facilitate the development of a new antischistosomal vaccine and drugs as well as diagnostic markers for the treatment and control of schistosomiasis.
  • Research articles
    Xiao-Yong ZHAN MD, Chao-Hui HU PhD, Qing-Yi ZHU MD,
    Legionella is a causative agent of legionellosis or Legionnaires’ disease. Infection with Legionella spp. is an important cause of community and hospital-acquired pneumonia. Moreover, infection with Legionella is one of the most common causes of severe pneumonia in community settings, and Legionella is isolated in 40% of hospital-acquired pneumonia cases. The clinical features of legionellosis or Legionnaires’ disease are not unique, which makes the diagnosis challenging. Macrolides and fluoroquinolones are the most widely used drugs in treatment. Early recognition, treatment and effective measures for prevention and control of the disease are important and required. Although there have been a lot of methods for diagnosis of Legionella infection, they were often time-consuming or complex, not suitable for clinical purposes. This review summarizes available information regarding the microbiology, taxonomy, epidemiology, pathogenesis and diagnosis of Legionnaires’ disease, with an emphasis on the laboratory diagnosis of infection with Legionella spp.
  • Research articles
    Ya-Song WU MD, PhD, Xin-Yue CHEN MD, Ying SHI PhD, Hao WU MD, De-Xi CHEN MD, PhD, Yu SUN MD, Fu-Jie ZHANG MD,
    Potent combination antiretroviral therapy (cART) has significantly improved the life expectancy of people living with human immunodeficiency virus (HIV), but it has many side effects such as lipodystrophy (LD), hepatic steatosis, and lactic acidosis. Nucleoside reverse transcriptase inhibitors (NRTIs) could damage the mitochondria by inhibiting the human DNA polymerase gamma, leading to mtDNA deletion. However, it remains uncertain whether NRTIs could induce the hypervariable region (HV) mutations of the D loop of mitochondria in Chinese HIV/AIDS patients, and whether that effect is different between individuals with and without LD. Hereby, 30 Chinese AIDS patients who were receiving antiretroviral drugs were recruited, among which 16 had symptomatic LD and 14 did not. Blood samples were collected prior to and after 96 weeks of treatment. Total DNA was extracted from peripheral blood mononuclear cells (PBMCs). Fragments of 728 bp in length containing HV 2 were amplified by standard polymerase chain reaction (PCR). Direct DNA-sequencing analysis techniques were used to detect mitochondrial sequence variants between paired longitudinal samples. Alterations were compared with the revised Cambridge Reference Sequence (rCRS) to determine mutation or polymorphism. Results showed that two years after ART, totally seven cases exhibited sequence variations, five individuals showed 73€A→G revised variation (two with and three without LD), while two cases of LD were found to have other nucleotide alterations. There was no new alteration in individuals without LD. In conclusion, NRTIs could induce mutation of mtDNA HV 2, which might contribute to the development of LD.
  • Research articles
    Shi-Ming CHENG MD, Yu-Ji LAI MS, Er-Yong LIU MS, Lin ZHOU MD, Xue-Jing WANG MS, Qiu-Lan CHEN MS, Dong-Ming LI MS, Ning WANG MD,
    The factors affecting case detection of tuberculosis (TB)/human immunodeficiency virus (HIV) co-infection cases were explored in order to provide evidence-based formulation of a TB/HIV co-infection control strategy in China. Four counties with different modes of HIV transmission and varying cooperation mechanisms between TB and HIV institutions were selected. HIV test among TB patients and TB examination among people living with HIV/acquired immunodeficiency syndrome (AIDS) were conducted. Patients also completed questionnaires on potential factors affecting TB/HIV co-infection. The results showed that 19 (1.7%) were HIV-positive among 1089 cases of people living with active TB who received HIV testing. Conversely, there were 126 (10%) cases of active TB among 1255 cases of people living with HIV/AIDS. Among the newly discovered 145 cases of TB/HIV co-infection, AIDS institutions found 86.9% of these co-infections and 14.1% came from TB institutes. In different registration categories, there were 31 (21.4%) cases of smear positive TB, 104 (71.7%) cases of smear negative TB, and extrapulmonary cases accounted for 10 (6.9%). Gender, occupation, marital status, ethnic group, education, HIV transmission route, CD4 level, and type of TB susceptible symptoms had significant effects on whether HIV/AIDS patients were co-infected with TB disease (P<0.01). Sex, age, ethnic group, occupation, and type of tuberculosis had no significant influence on whether TB patients had HIV infection. AIDS institutions could find more TB/HIV co-infection patients in comparison with TB institutions, particularly in patients with smear negative pulmonary tuberculosis and extrapulmonary tuberculosis. Therefore, a cooperation mechanism should be built up between TB and HIV control systems, and routine TB checks should be conducted for HIV/AIDS patients. In areas where sex or drug use is the major transmission mode of HIV infection, antiretroviral therapy should be expanded, treatment adherence should be improved and patients’ immunity level should be increased in order to decrease TB incidence. Cough and expectoration of more than two weeks, bloody sputum, and recurrent fevers could be revealing symptoms in TB screening of HIV/AIDS patients.
  • Research articles
    Li-Guang TIAN MPH, Jia-Xu CHEN PhD, Yu-Chun CAI BM, Jian GUO MPH, Xiao-Mei TONG, Qin LIU DVM, Xiao-Nong ZHOU PhD, Tian-Ping WANG PhD, Xiao-Mei YIN, Wei-Duo WU, Li ZHOU, Feng-Feng WANG, Zhen-Li WANG MSc, Guo-Jin CHENG, Peter STEINMANN PhD, Lan-Hua LI MSc,
    The aim of this study was to investigate epidemiological characteristics of co-infection of HIV and intestinal parasites in a HIV/AIDS highly endemic area in China. A cross-sectional survey was carried out in two villages where HIV/AIDS prevalence in residents was over 1%. Stool samples of all residents in the two targeted villages were examined for the presence of intestinal parasites. Blood examination was performed for the HIV infection detection and anemia test. A questionnaire survey was carried out in all residents participating in the study. A total of 769 individuals were enrolled in the investigation, 720 of whom were involved in stool examination of intestinal parasites. The infection rates of parasites in the residents of the targeted villages were as follows: 0.56% for Ascaris lumbricoides, 4.03% for Hookworm, 0.28% for Trichuris trichiura, 0.42% for Clonorchis sinensis, 21.39% for Blastocystis hominis, 3.89% for Giardia lamblia, 1.67% for Entamoeba spp., 4.44% for Cryptosporidium spp., and no infection for Strongyloides stercoralis. The overall infection rate of intestinal worms was 4.72%, intestinal parasite infection rate was 24.31%, the anemia prevalence rate was 34.68%, the co-infection rate of HIV and intestinal helminthes 2.17%, the co-infection rate of HIV and intestinal protozoa 28.26%, of which the co-infection rates of HIV and Blastocystis hominis, and HIV and Cryptosporidium spp. were 19.57% and 13.04%, respectively. A significant difference of Cryptosporidium spp. infection rate was found between HIV-positive group (13.04%) and HIV-negative group (4.70%) (P<0.05). Higher prevalence of anemia (34.68%) occurred in the study villages, particularly in children (>50%) and women (>39%). It was concluded that the infection rate of intestinal protozoa in the residents was higher than that of intestinal helminthes in the local setting, and a same pattern appeared in the co-infection rate of HIV and parasites. An interesting finding is that the infection rate of Cryptosporidium spp. among the HIV-positives was significantly higher than that in the HIV-negatives, and children and women had higher anemia prevalence.
  • Research articles
    Fu-Rong WEI MS, Shan LV PhD, He-Xiang LIU, Ling HU, Yi ZHANG MS,
    Pooling field specimens could reduce the number of assay and thus increase the efficiency in detecting and screening pathogen infections by polymerase chain reaction (PCR)-based assay. We investigated a pooling strategy in diagnosis of Angiostrongylus cantonensis in Pomacea canaliculata. Two settings of specimens were prepared, divided into portions and detected by multiplex PCR. Specimens A was 0.4490 g positive lung tissue of 28 larval nodes from four snails mixed with 1.310€g negative lung tissue from six snails and divided into 32 portions. Specimens B was 0.5448 g positive lung tissue with 26 larval nodes from two snails mixed with 1.092 g negative lung tissue from seven snails and divided into 48 portions. Repeated sampling was performed and sample size-accumulated positive rate curves were drawn. According to the sample size-accumulated positive rate curves, the appropriate sample size of the two specimens were 18 and 15, respectively, which is 0.36–0.58 to the total sample size. These test characteristics and the relevant factors to the sample size would need to be determined in much larger studies and more appropriately in field populations. The result indicates that the number of larval node is not the most important, nor the only factor to the sample size. It also implies the feasibility to detect A.€cantonensis in P. canaliculata by pooling strategies.
  • Research articles
    Cun-Lei FANG MD, Zhao-Hui HU PhD, Qing-Yi ZHU MD, Ya-Jun SONG PhD, Ya-Fang TAN PhD, Rui-Fu YANG PhD,
    One hundred and fifty-three isolates from the environment and 36 reference strains of the Legionella were studied with regards to their composition of cellular fatty acids as determined by gas chromatography, and then were classified into 41 groups by numerical analysis. Most reference strains formed only a single group, except L. micdadei, L. jamestowniensis, L. parisiensis, L. jordanis, L. feeleii and L. longbeachae, which were clustered into two or three groups. Even serological types of L. pneumophila could be clearly identified. Therefore, in this study, numerical analysis of cellular fatty acid composition is an effective method for identifying Legionella species.
  • Research articles
    Zhen-Xiang ZHAO MS, Hai JIANG MD, Bu-Yun CUI MS, Hong-Yan ZHAO, Dong-Ri PIAO MS, Lan-Yu LI, Su-Zhen HAO MS,
    To acquire data of Brucella cellular fatty acids (CFAs) and probe into the possibility of utilizing CFAs information in typing Brucella, 19 reference strains were subjected to CFAs study. After all strains were inoculated on Brucella Agar plates, the cells were harvested, saponificated, methylated and extracted to provide fatty acid methylesters for gas chromatography (GC) analysis. Based on the CFAs data matrix, a dendrogram of 19 reference strains was generated by SPSS11.5 software package. The results showed that 19 reference strains were divided into five clusters: cluster 1 included B. suis (bv. 1, 2, 3, 5) and B. ovis; cluster 2 included B. abortus (bv. 3, 4, 5, 6) and B. melitensis (bv. 1, 2, 3); cluster 3 included B. abortus (bv. 1, 2, 7, 9) and B. neotomae; cluster 4 was B. suis (bv. 4); and cluster 5 was B. canis. Typing Brucella by GC analysis of CFAs is a good method to reflect drug resistance of Brucella, and the classification is beneficial for clinical therapy. It also provides a new result of typing and demonstrates that the traditional classification is not completely reasonable. CFAs analysis may identify B. suis (bv. 4) and B. canis.
  • Research articles
    Xiu-Liang TAO MM, Sheng-Hao TU MD, Ri-Bo XIONG MM, Yong-Hong HU BM,
    This study examined the inhibitory effect of triptolid (TP) on tumor necrosis factor-α (TNF-α) secreted from peripheral blood monocular cells (PBMCs) and the association of the inhibitory effect with TNF-α-308 gene polymorphisms in rheumatoid arthritis (RA) patients. Gene polymorphism at A-G site 308 in the promoter region of TNF-α gene was detected in 42 RA patients by using allele specific polymerase chain reaction (AS-PCR) assay. PBMCs were harvested from these patients and treated first with lipopolysaccharides (LPS) and then with different doses of TP (1, 5.4 and 15 ng/mL). The TNF-α level in the supernatants was measured by enzyme-linked immunosorbent assay (ELISA). The results showed that TNF-α level in the supernatants of TP (1 ng/mL)-treated PBMCs was decreased by 3.80% and 4.91%, respectively, in the patients with AA and AG genotypes, when compared with those treated with LPS alone (P>0.05). Moreover, the TNF-α level in the patients with GG genotype was reduced by 20.74% (P<0.05). When PBMCs were treated with TP at 5.4 ng/mL, TNF-α levels in the patients with AA, AG, and GG genotypes were decreased by 20.42%, 34.73%, and 41.69%, respectively (P<0.05). The TNF-α level was slightly higher in the PBMCs treated with 15 ng/mL of TP than those in the two TP groups in the patients carrying AA, AG, and GG genotypes (P>0.05). It was concluded that gene polymorphism at TNF-α-308 sites may relate to the secretion of TNF-α in RA patients. TP has different inhibitory effects on the secretion of TNF-α in the patients harboring different genotypes, which may be one of the reasons for individual variation in response to TP.
  • Research articles
    Wen YAN MD, Min FENG MD, Pei-Hua WANG MD, Dao-Wen WANG MD,
    The aim of this paper is to study the effect of bradykinin (BK) on bradykinin-B2 receptor as well as the possible involved signal transduction pathways in cultured rat aortic vascular smooth muscle cells (VSMCs). Rat aortic VSMCs were cultured. Cells after 4–6 passages were used in the experiment. VSMCs were incubated with BK, BK+ B2 receptor inhibitor (HOE-140), BK+ MEK inhibitor (PD98059), BK+ mitogen-activated protein kinase (MAPK) inhibitor (apigenin), BK+ phosphoinositide 3-kinase (PI3K) inhibitor (LY294002), and BK+ Akt inhibitor to evaluate the expression of B2 receptor and phosphorylation of signaling molecules MAPK, Akt, and PI3K by Western blot. (1) BK markedly up-regulated the expression of B2 receptor in VSMC. (2) Apigenin, PD98059, Akt inhibitor, and LY294002 inhibited up-regulation of B2 receptor induced by BK. (3) Signal transduction pathways of MAPK and PI3K were involved in the up-regulation of B2 receptor by BK mediation. Results suggest that bradykinin can up-regulate the expression of B2 receptor in VSMCs.
  • Research articles
    Ling-Yan XU PhD, Xin-Ran MA PhD, Xiao-Ying LI PhD, MD, Shu WANG PhD, Guang NING PhD, MD, Jie-Li LI PhD, Jian-Ming XU PhD,
    Obesity is a medical condition in which excess body fat has accumulated to an extent and may have an adverse effect on health, leading to reduced life expectancy, impaired energy homeostasis and increased health problems. The p160 steroid receptor coactivator (SRC) gene family members have been suggested to be involved in energy homeostasis, but the impact of SRC-3 ablation on white and brown adipose tissue needs to be elucidated. In the current study, we collected in vivo data and carried out morphological studies on the effect of SRC-3 deficiency on white adipose tissue (WAT) and brown adipose tissue (BAT). Primary cells were cultured to investigate the differentiation ability of both adipocytes. Western blot was applied to detect the expression of master genes governing adipogenesis and thermogenesis. We observed that SRC-3−/− mice were lean, with reduced WAT and decreased serum leptin levels, mainly due to the smaller white adipocyte size caused by impaired adipogenesis, presented by decreased peroxisome proliferator activated receptor g (PPARg) expression. In the BAT, the lipid droplets decreased significantly in SRC-3−/− mice as demonstrated by histological analysis and electron microscopic observation, which could be explained by enhanced thermogenesis. The expression of thermogenic marker gene PPARg coactivator 1α and uncoupling protein-1 increased in BAT of SRC-3−/− mice, which proved our observations. Collectively, these results demonstrate that SRC-3 plays a key role in adipogenesis and energy expenditure.
  • Research articles
    Geqing XIA MD, Zehua WANG MD, Li ZOU MD, Chaoying WU MS, Yu HU MD,
    This study was aimed to detect maternal serum levels of thromboxane B2 (TXB2) in different durations of pregnancy and explore the predictive value of TXB2 for preeclampsia. By employing a prospective and double-blind study method, 180 pregnant women with previously normal blood pressures during their progestation were included in the study. Peripheral venous blood samples were obtained during 10+0–14+6 (period I), 20+0–24+6 (period II) and 30+0–34+6 (period III) weeks of gestation. Maternal serum levels of TXB2 were measured by enzyme-linked immunoassay. The pathogenetic condition and pregnancy outcomes of these cases were observed. (1) Among the 180 previously normotensive women, ten developed preeclampsia (case group; four severe and six mild preeclampsia). One hundred and seventy remained normal till the end of pregnancy (control group). (2) With development of pregnancy, the levels of maternal serum TXB2 in the 180 cases gradually ascended as seen through the Wilcoxon Signed Ranks Test. There was a statistical significance in maternal TXB2 levels between two different gestational stages (P<0.01). (3) The levels of maternal serum TXB2 were slightly higher in the case group than in the control group during period I of gestation, but the difference was not statistically significant (P>0.05); the levels of TXB2 were significantly higher in the case group than in the control group during periods II and III of gestation (both P<0.05). (3) The best cutoff points of maternal TXB2 were 3750 and 4400ng/mL during periods II and III of gestation by receiver operator characteristic (ROC) curve; and the sensitivity, specificity, positive predictive value, negative predictive value and odds radio of TXB2 in predicting preeclampsia were 80%, 69.5%, 13.3%, 98.33%, 9.11 and 90%, 68.82%, 13.84%, 99.13, 19.86, respectively. Higher levels of maternal serum TXB2 were detected a long time before clinical symptoms appeared. The maternal serum TXB2 after 20 weeks of gestation had predictive value, and the index after 30 weeks was superior to that prior to 30 weeks .
  • Research articles
    Jian XIN BM, Ze-Feng XIA MD, Kai-Xiong TAO MD, Kai-Lin CAI PhD, Gao-Xiong HAN MD, Xiao-Ming SHUAI MD, Ji-Liang WANG MD, Han-Song DU MD, Guo-Bin WANG PhD, Yan LUO MM,
    The key to successful gene therapy is to find a suitable method and carrier for transfection to allow a gene to be transferred into a cell and integrated into the target gene. The aim of this study was to determine whether biomagnetic material could be combined with the nucleic acid for gene transfection. Dextran-coated iron oxide nanoparticles (DCIONPs) were prepared and mixed with the plasmid pGenesil-1 containing the test gene, which expresses enhanced green fluorescent protein (eGFP). PGenesil-1 empty vector was used as a control. The binding ability was assessed by electrophoresis of the DNA on agarose gels and quantification using BANDSCAN software. Using different gene carriers, Lipofectamine 2000, Sofast, and DCIONPs, the large intestine cancer (Lovo) cell line was transfected in vitro with or without a magnetic field. The expression of eGFP was observed by fluorescence microscopy, and the transfection efficiency was compared. The results showed there was a rapid increase in combining rate when the quality ratio of DCIONPs and pGenesil-1 ascended from 1∶1 to 5∶1. However, the combining rate increased less rapidly as the quality ratio continued ascending. The expression of eGFP showed that the early transfection rate could be improved by applying a magnetic field. In conclusion, the DCIONPs we synthesized are able to carry plasmid DNA and enhance the early transfection efficiency when using a magnetic field.
  • Research articles
    Ling XU MM, Feng WANG MM, Xuan-Fu XU MD, Wen-Hui MO BM, Rong WAN MD, Chuan-Yong GUO MD, Xing-Peng WANG MD,
    Tumor metastasis is the leading cause of death for gastric cancer. Metastasis is the main reason for the failure of clinical treatment for gastric cancer. In order to find metastasis-related genes and abnormal signal transduction pathway of high-invasive gastric cancer, samples of gastric cancer with liver metastasis were collected for microarray detection; up-regulated or down-regulated genes in all three cases were simultaneously screened out. Subsequently, from the preliminary screened genes, molecular pathways possibly impacting liver metastasis from gastric cancer were investigated by the Gene Cluster with Literature Profiles (GenCLip) analysis software. Many biological effects including apoptosis have been validated. Functional analysis of differentially expressed genes revealed that a variety of biological pathways, such as blood circulation and gas exchange, vasodilation and vasoconstriction regulation, and immune defense, could be significantly activated. Besides, gene sequences, specific keywords or gene regulatory networks were further searched by GenCLiP. We conclude that data mining allows to quickly identify a series of special signal transduction pathways involving abnormally expressed genes.
  • Research articles
    Zhong-Gao WANG MD, FACS, Feng JI MD, PhD, Yun-Gang LAI MD, PhD, Xiang GAO MD, PhD, Cheng-Chao ZHANG MD, PhD, Ji-Min WU MD, PhD, Xiu CHEN MD, PhD, Ibrahim M. IBRAHIM MD, FACS,
    Gastroesophageal reflux disease (GERD) was diagnosed and fundoplication was performed, which relieved the symptoms. This paper explores the effect of fundoplication on GERD-related respiratory symptoms. From January 2007 to October 2008, 64 patients with respiratory symptoms related to GERD were consecutively enrolled for laparoscopic fundoplication. Of these, 60 patients had respiratory symptoms mainly combined with gastroesophageal reflux, while four had respiratory symptoms only. All patients had GERD confirmed, and medical treatment provided before surgery resulted in an insufficiently favorable effect or even producing further complications. All the patients were requested to fill a questionnaire form regarding the severity of symptoms and their medication so as to make an evaluation score for the follow-up. The outcome of respiratory symptoms after surgery was as follows: excellent in 23 cases (35.9%); good in 28 (43.8%); fair in 5 (7.8%); poor in 8 (12.5%). The mean respiratory symptom score decreased from 6.3±2.65 to 2.33±2.37. Laparoscopic fundoplication can be an effective treatment for the majority of patients with GERD-related respiratory symptoms.