Objective To evaluate the effect of water exchange method versus conventional methods including air insufflation and carbon dioxide insufflation method for the quality of colonoscopy.Methods We searched related randomized controlled trials published up to October 2022 from PubMed,Web of Science,the Cochrane Library,SinoMed databases,CNKI,Wanfang data.Two reviewers independently searched the literatures based on standards to extract the data and evaluate the quality.Meta-analysis was conducted by RevMan 5.4.1.Results 23 studies involving 10654 patients were included.Although cecal intubation time was prolonged in water exchange(MD=1.81,95％CI:1.28～2.35,P=0.000),but water exchange had higher adenoma detection rate(ADR)(O(R)=1.40,95％CI:1.26～1.55,P=0.000),cecal intubation rate(O(R)=1.62,95％CI:1.24～2.10,P=0.000)and scores of bowel preparation quality(MD=0.61,95％CI:0.42～0.79,P=0.000)compared with conventional colonoscopy.In addition,WE had significantly lower pain sores(MD=-1.07,95％CI:-1.39～-0.76,P=0.000),number of abdominal compression(O(R)=0.42,95％CI:0.29～0.60,P=0.000)and number of position change(O(R)=0.59,95％CI:0.42～0.82,P=0.002)than conventional colonoscopy.Conclusion Although water exchange colonoscopy prolongs cecal intubation time,but it can significantly increase ADR,cecal intubation rate and scores of bowel preparation quality.Beyond that,water exchange reduces patient pain,the proportion of abdominal compression and position change.Water exchange is a better choice for high-quality colonoscopy.

Colonoscopy serves as a modality for the early detection and removal of colorectal lesions,playing a pivotal role in colorectal cancer prevention.Health education for patients can enhance the compliance of colonoscopy,improve the participation rate,and optimize the intestinal cleanliness.High-quality bowel preparation is an important guarantee for colonoscopy and is associated with a higher detection rate of colorectal lesions.In recent years,the academic field has put forward that education should not be restricted to patients only.Educating endoscopists also plays a vital role in improving the quality of colonoscopy.The concept of"peri-colonoscopy period"encompasses the continuous process of"before,during,and after colonoscopy".This article reviewed the role and current research status of doctor-patient joint education during the peri-colonoscopy period,aiming to deepen the understanding of colonoscopy for both doctors and patients,so as to improve the quality of colonoscopy and standardize colonoscopy management.

Background:Colonoscopy is the gold standard for diagnosis of colorectal cancer,and the success of colonoscopy is highly depended on the quality of bowel preparation.Aims:To investigate the impact of the last defecation time before colonoscopy on qualities of bowel preparation and colonoscopy.Methods:Consecutive outpatients who underwent painless colonoscopy from June 2023 to December 2023 at 5 medical centers in Jiangsu Province and met the inclusion criteria were enrolled in this multicenter cross-sectional study.These patients were divided into 3 groups according to the time interval between the last defecation and the start of colonoscopy.The time interval was≤2 h,2-5 h,and≥5 h in group A,B,and C,respectively.The primary outcome was the score of the Boston Bowel Preparation Scale(BBPS),and the secondary outcomes included the cecal intubation time(CIT),withdrawal time(WT),cecal intubation length(CIL),adenoma detection rate(ADR),and polyp detection rate(PDR).Results:A total of 298 patients underwent painless colonoscopy were enrolled in the study.There were no significant differences in gender,age,body mass index,abdominal circumference,comorbidities,surgical histories,and other baseline data among the three groups.The total BBPS score declined gradually from 8.27±0.58 in group A to 8.21±0.53 in group B and 8.05±0.37 in group C(P<0.05).Segment-specific analysis showed that significant difference in bowel cleanliness only existed in right colon among the three groups(BBPS score:2.48±0.50,2.40±0.49,and 2.18±0.39,respectively,P<0.05).There were no significant differences in CIT,WT and CIL among the three groups,while the highest ADR and PDR were seen in group B(ADR:45.2%,57.5%,and 35.4%,respectively,P<0.05;PDR:53.4%,63.8%,and 43.1%,respectively,P<0.05).Conclusions:When the time interval between the last defecation and the start of colonoscopy is less than 5 h,more effective bowel preparation and higher ADR and PDR can be achieved.

Colonoscopy serves as a modality for the early detection and removal of colorectal lesions,playing a pivotal role in colorectal cancer prevention.Health education for patients can enhance the compliance of colonoscopy,improve the participation rate,and optimize the intestinal cleanliness.High-quality bowel preparation is an important guarantee for colonoscopy and is associated with a higher detection rate of colorectal lesions.In recent years,the academic field has put forward that education should not be restricted to patients only.Educating endoscopists also plays a vital role in improving the quality of colonoscopy.The concept of"peri-colonoscopy period"encompasses the continuous process of"before,during,and after colonoscopy".This article reviewed the role and current research status of doctor-patient joint education during the peri-colonoscopy period,aiming to deepen the understanding of colonoscopy for both doctors and patients,so as to improve the quality of colonoscopy and standardize colonoscopy management.

Background:Colonoscopy is the gold standard for diagnosis of colorectal cancer,and the success of colonoscopy is highly depended on the quality of bowel preparation.Aims:To investigate the impact of the last defecation time before colonoscopy on qualities of bowel preparation and colonoscopy.Methods:Consecutive outpatients who underwent painless colonoscopy from June 2023 to December 2023 at 5 medical centers in Jiangsu Province and met the inclusion criteria were enrolled in this multicenter cross-sectional study.These patients were divided into 3 groups according to the time interval between the last defecation and the start of colonoscopy.The time interval was≤2 h,2-5 h,and≥5 h in group A,B,and C,respectively.The primary outcome was the score of the Boston Bowel Preparation Scale(BBPS),and the secondary outcomes included the cecal intubation time(CIT),withdrawal time(WT),cecal intubation length(CIL),adenoma detection rate(ADR),and polyp detection rate(PDR).Results:A total of 298 patients underwent painless colonoscopy were enrolled in the study.There were no significant differences in gender,age,body mass index,abdominal circumference,comorbidities,surgical histories,and other baseline data among the three groups.The total BBPS score declined gradually from 8.27±0.58 in group A to 8.21±0.53 in group B and 8.05±0.37 in group C(P<0.05).Segment-specific analysis showed that significant difference in bowel cleanliness only existed in right colon among the three groups(BBPS score:2.48±0.50,2.40±0.49,and 2.18±0.39,respectively,P<0.05).There were no significant differences in CIT,WT and CIL among the three groups,while the highest ADR and PDR were seen in group B(ADR:45.2%,57.5%,and 35.4%,respectively,P<0.05;PDR:53.4%,63.8%,and 43.1%,respectively,P<0.05).Conclusions:When the time interval between the last defecation and the start of colonoscopy is less than 5 h,more effective bowel preparation and higher ADR and PDR can be achieved.

Background:Complete colonoscopy is key to the diagnosis and treatment of colorectal disease,its role in reducing the morbidity and mortality of colorectal cancer is well known.Nonetheless,there are numerous factors,not just from the endoscopist's perspective but also from the patient's,that can potentially increase the difficulty of completing a colonoscopy.Aims:To identify patient-related factors that influenced the difficulty of a colonoscopy.Methods:Through two rounds of expert consultation,the factors that might affect the difficulty of colonoscopy were selected.A total of 1621 consecutive painless colonoscopies from Jan.2021 to Jan.2022 at the endoscopy center of The Affiliated Wuxi People's Hospital of Nanjing Medical University were evaluated in a retrospective manner.Factors including demographic data,cecal insertion time,adenoma detection rate and so on were recorded.These factors were analyzed to determine their association with difficulty by using Logistic regression model.Results:A total of 29 patient-related factors affecting the difficulty of colonoscopy were selected.Through retrospective analysis,the mean age of 1621 cases was(47.45±13.27)years,of which 45.8%were male and the mean body mass index was(23.32±3.11)kg/m2.Logistic regression analysis revealed that age≥60 years(OR=2.890,95%CI:1.957-4.269,P<0.001),female gender(OR=0.324,95%CI:0.217-0.484,P<0.001),history of gynecological surgery(OR=14.895,95%CI:9.741-22.776,P<0.001),constipation for 20-30 years(OR= 1.412,95%CI:0.925-2.156,P=0.010)were independent risk factors for difficult colonoscopy.Conclusions:This retrospective study identified several patient-related factors that influence the technical difficulty of colonoscopy.These findings had implications for practice and teaching of colonoscopy.

Objective:To investigate the clinical effect of combined treatment of comminuted inferior pole patellar fracture with micro-plate and tension-band wire.Methods:A retrospective cohort study was conducted in 50 patients with comminuted inferior pole patellar fracture (AO classification of type 34-A1) admitted to First Affiliated Hospital of University of Science and Technology of China from October 2018 to October 2020, including 28 males and 22 females, aged 17-77 years［(51.4±11.5)years］. A total of 23 patients were treated with micro-plate combined with tension-band wire (Group A) and 27 patients were treated with cable wire looping combined with tension-band wire (Group B). Fracture union, union time and last follow-up evaluation of knee range of motion and Bostman score were compared between the two groups. Complications (infection, internal fixation failure, internal fixation irritation, etc.) were also observed.Results:All patients were followed up for 12-18 months［(14.1±2.1) months］. All patients had bone union, with no statistical difference between Group A［(9.9±1.8)weeks］and Group B［(10.3±1.4)weeks］in union time ( P>0.05). Knee range of motion was (129.2±9.7)° in Group A at the last follow-up, better than (122.3±11.0)° in Group B ( P<0.05). Knee Bostman score was (27.6±1.8)points in Group A, showing no statistical difference from that in Group B［(26.8±1.9)points］( P>0.05). There were no postoperative complications in Group A. Two patients with tension band shedding of Kirschner wire after fracture healing were found in Group B, with no special treatment given due to no obvious discomfort. Conclusions:For comminuted inferior pole patellar fracture, micro-plate combined with tension-band wire is more effective and provides better knee mobility with no complications of implant failure as compared with cable wire looping combined with tension-band wire. Therefore, the technique deserves clinical promotion.

Objective To investigate the correlation between neonatal infectious disease and brain injury.MethodsClinical data of 1266 newborns with infectious diseases were collected from Peking University First Hospital from November 2005 to August 2010.The occurrence of brain injury was summarized.Related factors of brain injury caused by infection and the risk factors for severe brain injury were analyzed by Logistic regression model. Results Among the newborns with neonatal infectious diseases, the incidence of brain injury was 8.6％(108/1266), including 101 (8.0％)mild cases and seven (0.6％) severe cases. The incidence of brain injury for the newborns with severe infectious diseases was higher than those with mild infectious diseases [38.7％(29/75) vs 6.7％(79/1191),x2=92.787,P=0.000].The incidence of brain injury for the newborns withobviousinflammatoryreactionwassignificantlyhigherthanthosewithout [(13.0％(26/200) vs 7.5％ (77/1025),x2=6.544,P=0.011].Severe infection was independent risk factor for severe brain injury by Logistic regression model analysis (OR =15.750,95％ CI:1.756-141.281,P=0.014).ConclusionsIniectious diseases could cause injury on central nervous system,especially when there are severe infections or inflammatory reactions. The severer the infection,the severer the brain injury,especially when complicated by some factors such as asphyxia and hypoglycemia.

Objective To study the preparation of Fructus perrillae oil nanoemulsion and its quality evaluation. Methods The formulations of Fructus Perrillae oil nanoemulsion were optimized by drawing the pseudoternary phase diagrams and investigating the form, viscosity, particle size distribution, stability, conductance, and refractiratio. Results The optimal formulation was composed of wheat oil and cremophor RH40, electron microscopy presented Fructus Perrillae oil nanoemulsion as small spherical drops, viscosity was (5.49?0.02)/mm2?s-1, conductance was 316/ms-1, refractiratio was (1.124?0.002 50), and mean diameter of particle was (50.3?1.1) nm.The average recovery determined by GC was 98.9%, its mean RSD was 0.88%. Conclusion The solubility and stability of Fructus Perrillae oil are promoted by nanoemulsion with better produncibility. It is a favorable medical matrix.