Ideal bowel preparation is fundamental for a successful colonoscopy.High-quality bowel preparation mainly includes diet management and bowel cleansing,and should be both effective and well tolerated.Among them,diet management is the key point of bowel preparation and plays a non-negligible role.This article reviewed the various dietary management schemes used in the clinical practice of bowel preparation.

Objective:To investigate the role and mechanism of chemokine receptor type 4 (CXCR4) in renal injury and fibrosis caused by calcium oxalate crystals in mice.Methods:In June 2021, Fifteen male C57/BL6 mice were divided into control group (5 mice), model group (5 mice), and AMD3100 intervention group (5 mice) by random number table method. In model group and AMD3100 intervention group, glyoxylate (100 mg/kg) was injected intraperitoneal for 7 consecutive days for modeling. Meanwhile, the AMD3100 intervention group was also given intraperitoneal injection of AMD3100 (1 mg/kg) for 7 days. The control group was continuously injected with equal volume saline intraperitoneally. After 7 days, peripheral blood was collected from each group to determine the levels of serum urea nitrogen (BUN) and creatinine (Scr) to assess the renal function; HE, Von-Kossa, Picrosirius Red staining was also taken from the left kidney to observe the pathological changes of renal tissue. CXCR4, transforming growth factor β1 (TGF-β1) were detected by immunohistochemistry and western blot. The expression levels of PI3K/AKT pathway-related proteins were detected by western blot.Results:The results of biochemical indexes showed that the serum Scr [(108.03±13.56) μmol/L vs. (39.50±4.48)μmol/L, P<0.01)] and BUN[(5.66±0.48)mmol/L vs. (0.77±0.10)mmol/L, P<0.01) levels were significantly increased in model group compared with the control group. The AMD3100 intervention group was significantly lower than the model group in terms of Scr [(65.77±3.27)μmol/L vs. (108.03±13.56)μmol/L, P<0.05) and BUN [(2.97±0.44)mmol/L vs. (5.66±0.48)mmol/L, P<0.05) levels. The results of kidney pathology in mice showed that renal tubules were significantly dilated with inflammatory cell infiltration in the model group compared with the control group, and a large number of calcium oxalate crystals and collagen fibers were deposited. The extent of kidney damage, calcium oxalate crystals and collagen fibers deposition were significantly reduced in the AMD3100 intervention group compared with the model group. The results of western blotting showed that the relative expression of CXCR4(0.639±0.019 vs. 0.158±0.012, P<0.01) and TGF-β1(0.698+ 0.018 vs. 0.314+ 0.015, P<0.05) was significantly increased in the model group compared with the control group. The relative expression of CXCR4(0.322±0.231) in the AMD3100 intervention group compared with the model group (0.322±0.231 vs. 0.639±0.019, P<0.05) and TGF-β1(0.445+ 0.017 vs. 0.698+ 0.018, P<0.05) were significantly decreased. The results of immunohistochemical staining showed the trend of CXCR4 and TGF-β1 expression in each group consistent with the results of protein blotting assay. Western blotting results showed that the expression of p-PI3K (0.613±0.016 vs. 0.213±0.011, P<0.01) and p-AKT(0.149±0.013 vs. 0.047±0.014, P<0.01) was significantly increased in the model group compared with the control group. The expression of p-PI3K in the AMD3100 intervention group compared with the model group (0.292±0.020 vs. 0.613±0.016, P<0.05) and p-AKT (0.098±0.021 vs. 0.149±0.013, P<0.05)was significantly decreased. Conclusion:CXCR4 inhibits calcium oxalate crystal-induced kidney injury and interstitial fibrosis in mice by targeting the PI3K/AKT pathway.

Objective:To investigate the value of neck circumference (NC) for identifying metabolic syndrome (MS) in patients with type 2 diabetes.Methods:a total of 413 type 2 diabetic patients (188 male and 225 female) in Qinhuangdao Chinese Medicine Hospital from August 2018 to July 2019 were recruited. Waist circumference (WC), NC and metabolic indicators were measured. The association between WC, NC and metabolic indicators was explored. Area under the curve (AUC) was used to evaluate the abilities of NC.Results:The average age of male was (55.35 ± 14.15) years, and the detection rate of MS was 74.47% (140/188). The average age of female was (60.19 ± 10.29) years, and the detection rate of MS was 71.11% (160/225). In male group, WC showed a negative correlation with age and high density lipoprotein-cholesterol (HDL-C) ( P<0.05); NC showed a negative correlation with glycated hemoglobin, total cholesterol (TC) and HDL-C ( P<0.05), and a positive correlation with diastolic blood pressure (DBP) ( P<0.05). In female group, WC showed a positive correlation with fasting plasma glucose (FPG) and systolic blood pressure (SBP), and a negative correlation with HDL-C; NC showed a positive correlation with FPG and SBP. WC and HC were good indexes for identifying metabolic syndrome in type 2 diabetes (WC: AUC male 0.862, female 0.870; NC: AUC male 0.745, female 0.752). After applying the ROC analysis, neck circumferences ≥ 34.5 cm in males and ≥ 31.75 cm in females were determined as the best cutoff values to predict MS in type 2 diabetes. Conclusions:NC is a helpful tool to detect MS in type 2 diabetes.

Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.

Objective:To evaluate the application of flipped classroom based on rain classroom in standardized residency training of orthopedics.Methods:Sixty-two orthopedics residents were randomly divided into flipped classroom teaching group and traditional teaching group, with 31 residents in each group. The flipped classroom teaching group the flipped classroom teaching mode based on rain classroom, including three aspects: learning in advance before rain classroom, personalized discussing cases in class and teaching after class. The theoretical knowledge, clinical skills and evaluation of teaching activities were compared between the two groups. SPSS 19.0 was used for rank sum test and chi-square test.Results:All the residents completed the evaluation of theoretical knowledge, clinical skills and effect. The results showed that the scores of theoretical knowledge and clinical skills in the flipped classroom teaching group were (88.7±10.3) points and (26.8±2.2) points, which were significantly higher than those of the traditional teaching group (79.2±18.6) points and (20.4±2.9) points, with statistical significance ( P<0.05). The evaluation of teaching activities, including participation, satisfaction, enthusiasm and learning effect, was significantly better than that of the traditional teaching group ( P<0.05). Conclusion:In the orthopedics standardized residency training and teaching activities, the application of flipped classroom teaching mode based on rain classroom is conducive to improving students' learning performance, cultivate their autonomous learning ability, and improve their learning satisfaction and enthusiasm.

Objective: To investigate the expression differences of serum tumor markers, such as CEA, CA125 and CA15-3, in different molecular subtypes of breast cancer and their correlations with recurrence and metastasis. Methods: The medical records and follow-up data from 212 patients with breast cancer were retrospectively analyzed. According to the expression of hormone receptor, breast cancer were divided into four molecular subtypes: Luminal A, Luminal B, Her-2 overexpression and Basal-like. The clinical characteristics and levels of CEA, CA125 and CA15-3 in different molecular subtypes of breast cancer patients before operation were compared, and the factors influencing the recurrence and metastasis of breast cancer were analyzed. Results: There were differences in the expression levels of tumor markers for different molecular subtypes of breast cancer. The expression levels of CA15-3 in patients with Her-2 overexpression were significantly higher than that with Luminal A, Luminal B or Basal-like (χ 2 =7.98,P=0. 04). The differentiation degree of tumor cells in different molecular subtypes of breast cancer was different, and the proportion of low differentiation in the patients with Her-2 overexpression was significantly higher than that with Luminal A, Luminal B or Basal-like (χ 2 =12.42,P=0.006). There was also differences in the recurrence and metastasis of tumor for 4 subtypes of breast cancer, and the highest recurrence and metastasis rate existed in the patients with Her-2 overexpression (F=8.69,P=0.034). The multivariate Cox regression analysis showed that tumor diameter, degree of tissue differentiation and presence or absence of vascular tumor thrombus were independent risk factors for the recurrence and metastasis of breast cancer patients (all P＜0.05). Conclusion The breast cancer patients with Her-2 overexpression have high levels of CA15-3 and poor prognosis, which suggests that the individualized treatment of breast cancer should be combined with molecular subtyping, tumor markers and related risk factors.

Objective To evaluate the mid-to-long term therapeutic effect of endoscopic pneumatic dilation for achalasia of cardia (AC).Methods Endoscopic pneumatic dilation was used in 45 AC patients, with follow-up of 2-12 years. Eckardt score and Stooler grading were used before and after the operation for evaluation of curative effect of dilation. Results The operation success rate was 97. 8%( 44/45) and the effective remission rate was 93. 2%( 41/44 ). No massive hemorrhage, perforation or other serious complications occurred.The longest follow-up time was up to 144 months.Ten cases were followed up for over 60 months. Patients′symptoms relieved significantly (P＜0. 01). Eckardt scores in 24 months and 60 months after operation significantly decreased compared with those before the operation ( P＜0. 01). But Eckardt score in 60 months was higher than that in 24 months ( P＜0. 01). The length of the disease history was positively related to post-operative scores, and negatively related to efficacy ( P＜0. 01). Conclusion Endoscopic balloon dilation is a satisfactory therapy to AC with good efficacy and safety.

Objective To analyze the risk factors of delayed post-polypectomy bleeding ( DPPB) of colonoscopy. Methods The data of 459 patients who underwent colonoscopic polypectomy between January 2014 and May 2017 were summarized, and the risk factors of DPPB were analyzed. Results Among the 459 patients, a total of 572 polyps were removed, and DPPB occurred in 27 patients with 42 polyps. Univariate analysis revealed that gender (male 85. 2%), number of polyps removed (≥3 polyps, 59. 3%), complicated with hyperlipidemia (29. 6%), polyps′diameter (≥10 mm, 66. 7%), morphology (pedunculated, 81. 0%), pathological type ( adenoma, 95. 2%), and excision method ( endoscopic mucosal resection, 90. 5%) were significantly correlated with DPPB ( all P＜0. 05). Logistic regression analysis showed that gender, with hyperlipidemia, number of polyps removed, polyps′ size, and morphology were independent risk factors of DPPB (P＜0. 05). Conclusion The risk factors of DPPB include male, complicated with hyperlipidemia, excision of more than 3 polyps, more than 10 mm in diameter, and pedunculated morphology.

Objective To summarize the prenatal ultrasonographic characteristics of unroofed coronary sinus( URCS) for improving the prenatal echocardiography diagnostic accuracy of URCS . Methods The retrospective review for prenatal ultrasonogram of 7 fetuses was applied ,which were diagnosed as URCS . The prenatal ultrasonographic characteristics of 7 fetuses with URCS were reviewed and comparatively analyzed with postpartum autopsy findings or postnatal echocardiography . The relevant literatures referring to the prenatal diagnosis of URCS were reviewed . The experience of prenatal diagnosis of URCS were summarized . Results In 7 cases with URCS ,5 cases of completely URCS were associated with right atrial isomerism syndrome and confirmed by postpartum autopsy ,and 2 cases of partially URCS were only with persistent left superior vena cava and confirmed by postnatal echocardiography . The karyotype analysis of 2 cases of partially URCS on amniotic fluid was normal . Conclusions There are some characteristic signs in ultrasonic features of URCS . URCS can be diagnosed by prenatally ultrasonography . A long axial section of the coronary sinus is the most important view for prenatal ultrasonic diagnosis of U RCS .

Cerebrolysin is an aqueous mixture of amino acids extracted from porcine brain, and mainly composed of 85% free amino acids and 15%small peptides. Cerebrolysin increase the metabolism of amino acids and glucose transport in the brain, improve the anti-anoxia ability of cells, and to enhance the brain's resistance to various types of malignant stimulation like stress and damage. Cerebrolysin can also promote synapse formation, induce neuronal differentiation, and help reverse brain injury. Because of its efficacy and safety, cerebrolysin has been widely used in the pediatric clinical practice, and primarily to treat neonatal hypoxic ischemic encephalopathy, childcerebral palsy, hyperactivity disorder, speech communication disorders, etc.The clinical symptoms were improved to some extent after the treatment of cerebrolysin. The recovery of consciousness, enhancement of comprehensionand memory, and improvement of the extremity motor function were observed. The treatment of cerebrolysincan not only enhance the cure rate, but also reduce the incidence of sequelae. This paper systematically summarized the clinical application of cerebrolysin in the pediatric population and relevant preclinical studies, to provide more guidance for clinical application of cerebrolysin in the treatment of pediatric diseases.