Background:Ideal bowel preparation is the prerequisite for the successful diagnostic and therapeutic colonoscopy.The retention of intestinal bubbles can seriously affect the clarity of the intestinal mucosa and subsequently decrease the detection rate of colonoscopy.Aims:To investigate the application value of dyclonine hydrochloride mucilage in bowel preparation for colonoscopy.Methods:This study was a randomized double-blinded placebo-controlled trial.Patients who underwent colonoscopy from October 2020 to October 2023 at Hainan West Central Hospital were enrolled and randomly allocated into the dyclonine hydrochloride mucilage group and the control group.3 L polyethylene glycol(PEG)+dyclonine hydrochloride mucilage and 3 L PEG+placebo were given for bowel preparation,respectively.The quality of bowel preparation was evaluated by Boston bowel preparation scale(BBPS)score and bubble score.Furthermore,a questionnaire was conducted.The cecal intubation time,withdrawal time,adenoma detection rate and adverse reaction were compared between the two groups.Results:A total of 482 patients who underwent colonoscopy were included.No significant differences in clinical characteristics such as gender,age,body mass index(BMI)and main reasons for colonoscopy were found between the dyclonine hydrochloride mucilage group and the control group(all P>0.05).Compared with the control group,no significant differences existed in total BBPS score and segment scores for right,transverse,and left colon in the dyclonine hydrochloride mucilage group(all P>0.05),but the total bubble score and segment scores for right,transverse,and left colon were significantly decreased(all P<0.001).The withdrawal time in the dyclonine hydrochloride mucilage group was significantly decreased compared to the control group(P<0.001),and the adenoma detection rate was significantly increased(P=0.001).However,no significant differences in cecal intubation time and incidence of adverse reaction were found between the two groups(all P>0.05).Conclusions:Administration of dyclonine hydrochloride mucilage during bowel preparation for colonoscopy can reduce the formation of intestinal bubbles,shorten the withdrawal time and increase the adenoma detection rate.

Objective To explore the effects of Magu Xujin capsule on hip fracture healing and stromal cell-derived factor-1/CXC chemokine receptor 4(SDF-1/CXCR4)signaling pathway in elderly hip fracture rats.Methods The hip fracture model of aged rats was established,and successfully modeled rats were randomly separated into the model group,the low-dose Magu Xujin capsule group,the high-dose Magu Xujin capsule group,the high-dose Magu Xujin capsule+pathway inhibitor group(the high-dose Magu Xujin capsule and AMD3100 group),with 12 rats in each group.An additional 12 healthy rats were selected as the control group.X-ray was used to observe the healing of hip fractures in rats,and Garrett score was performed.Enzyme-linked immunosorbent assay(ELISA)was applied to detect serum levels of inflammatory factors related to fracture healing,such as tumor necrosis factor-alpha(TNF-α)and interleukin-10(IL-10).CT scanning analysis was used to determine bone volume fraction(BV/TV)and bone surface area/volume ratio(BS/BV).Immunohistochemistry was applied to detect the expression of fracture healing factor insulin-like growth factor-1(IGF-1)and bone morphogenetic protein-2(BMP-2).Western blot assay was applied to detect the expression of SDF-1/CXCR4 signaling pathway related proteins.Results Garrett score,IL-10 level,BV/TV,BS/BV,the IGF-1,BMP-2,SDF-1 and CXCR4 expression were lower in the model group than those in the control group,while TNF-α level was higher(P＜0.05).Garrett score,IL-10 level,BV/TV,BS/BV,IGF-1,BMP-2,SDF-1 and CXCR4 expression were higher in the low-dose and high-dose Magu Xujin capsule groups than those in the model group,while TNF-α level was lower(P＜0.05).Garrett score,IL-10 level,BV/TV,BS/BV,IGF-1,BMP-2,SDF-1 and CXCR4 expression were lower in the high-dose Magu Xujin capsule+AMD3100 group than those in the high-dose Magu Xujin capsule group,while TNF-α level was higher(P＜0.05).Conclusion Magu Xujin capsule can promote hip fracture healing in aged rats,and its mechanism may be related to the activation of SDF-1/CXCR4 signaling pathway.

Background:Ideal bowel preparation is the prerequisite for the successful diagnostic and therapeutic colonoscopy.The retention of intestinal bubbles can seriously affect the clarity of the intestinal mucosa and subsequently decrease the detection rate of colonoscopy.Aims:To investigate the application value of dyclonine hydrochloride mucilage in bowel preparation for colonoscopy.Methods:This study was a randomized double-blinded placebo-controlled trial.Patients who underwent colonoscopy from October 2020 to October 2023 at Hainan West Central Hospital were enrolled and randomly allocated into the dyclonine hydrochloride mucilage group and the control group.3 L polyethylene glycol(PEG)+dyclonine hydrochloride mucilage and 3 L PEG+placebo were given for bowel preparation,respectively.The quality of bowel preparation was evaluated by Boston bowel preparation scale(BBPS)score and bubble score.Furthermore,a questionnaire was conducted.The cecal intubation time,withdrawal time,adenoma detection rate and adverse reaction were compared between the two groups.Results:A total of 482 patients who underwent colonoscopy were included.No significant differences in clinical characteristics such as gender,age,body mass index(BMI)and main reasons for colonoscopy were found between the dyclonine hydrochloride mucilage group and the control group(all P>0.05).Compared with the control group,no significant differences existed in total BBPS score and segment scores for right,transverse,and left colon in the dyclonine hydrochloride mucilage group(all P>0.05),but the total bubble score and segment scores for right,transverse,and left colon were significantly decreased(all P<0.001).The withdrawal time in the dyclonine hydrochloride mucilage group was significantly decreased compared to the control group(P<0.001),and the adenoma detection rate was significantly increased(P=0.001).However,no significant differences in cecal intubation time and incidence of adverse reaction were found between the two groups(all P>0.05).Conclusions:Administration of dyclonine hydrochloride mucilage during bowel preparation for colonoscopy can reduce the formation of intestinal bubbles,shorten the withdrawal time and increase the adenoma detection rate.

Objective To explore the effects of Magu Xujin capsule on hip fracture healing and stromal cell-derived factor-1/CXC chemokine receptor 4(SDF-1/CXCR4)signaling pathway in elderly hip fracture rats.Methods The hip fracture model of aged rats was established,and successfully modeled rats were randomly separated into the model group,the low-dose Magu Xujin capsule group,the high-dose Magu Xujin capsule group,the high-dose Magu Xujin capsule+pathway inhibitor group(the high-dose Magu Xujin capsule and AMD3100 group),with 12 rats in each group.An additional 12 healthy rats were selected as the control group.X-ray was used to observe the healing of hip fractures in rats,and Garrett score was performed.Enzyme-linked immunosorbent assay(ELISA)was applied to detect serum levels of inflammatory factors related to fracture healing,such as tumor necrosis factor-alpha(TNF-α)and interleukin-10(IL-10).CT scanning analysis was used to determine bone volume fraction(BV/TV)and bone surface area/volume ratio(BS/BV).Immunohistochemistry was applied to detect the expression of fracture healing factor insulin-like growth factor-1(IGF-1)and bone morphogenetic protein-2(BMP-2).Western blot assay was applied to detect the expression of SDF-1/CXCR4 signaling pathway related proteins.Results Garrett score,IL-10 level,BV/TV,BS/BV,the IGF-1,BMP-2,SDF-1 and CXCR4 expression were lower in the model group than those in the control group,while TNF-α level was higher(P＜0.05).Garrett score,IL-10 level,BV/TV,BS/BV,IGF-1,BMP-2,SDF-1 and CXCR4 expression were higher in the low-dose and high-dose Magu Xujin capsule groups than those in the model group,while TNF-α level was lower(P＜0.05).Garrett score,IL-10 level,BV/TV,BS/BV,IGF-1,BMP-2,SDF-1 and CXCR4 expression were lower in the high-dose Magu Xujin capsule+AMD3100 group than those in the high-dose Magu Xujin capsule group,while TNF-α level was higher(P＜0.05).Conclusion Magu Xujin capsule can promote hip fracture healing in aged rats,and its mechanism may be related to the activation of SDF-1/CXCR4 signaling pathway.

Objective:To investigate the effect of low-dose ketamine on neuroinflammation and microcirculation in mice with traumatic brain injury (TBI).Methods:Sixty adult male C57BL/6 mice, weighing 22-28 g, were randomly divided into sham-operated group, TBI group, Sham+ketamine group, and TBI+ketamine group ( n=15). A controlled cortical impingement (CCI) method was used to establish TBI models in the later 2 groups. Sham+ketamine group and TBI+ketamine group were intraperitoneally injected with 30 mg/kg ketamine once daily for 3 d at 30 min after TBI; sham-operated group and TBI group were intraperitoneally injected same amount of saline at the same time points. Cerebral cortical blood flow in 6 mice from each group was measured by laser speckle contrast imaging (LSCI) before, immediately after, 30 min after, 1 d after and 3 d after modeling, respectively. Three d after modeling, immunohistochemical staining and immunofluorescent double label staining were used to detect the nuclear translocation of microglia markers, ionized calcin-antibody-1 (Iba-1) and nuclear factor (NF)-κB p65 in damaged cortical brain tissues in 6 mice from each group. The remaining 3 mice in each group were sacrificed and tissue plasma was extracted 3 d after modeling; levels of NF-κB p65, phosphorylated (p)-NF-κB p65, p-IκB and inducible nitric oxide synthase (iNOS) in cortical brain tissues were detected by Western blotting. Expressions of tumor necrosis factor-α (TNF-α), interleukin-1-β (IL-1β) and interleukin-6 (IL-6), iNOS, reactive oxygen species (ROS) and reactive nitrogen species (RNS) in cortical brain tissues were detected by ELISA. Results:LSCI indicated that, 3 d after modeling, relative blood flow in local cerebral microcirculation of TBI+ketamine group was significantly increased compared with that of TBI group ( P<0.05). Immunohistochemical staining indicated that compared with the sham-operated group and Sham+ketamine group, the TBI group and TBI+ketamine group had significantly increased number of Iba-1 positive cells in the cerebral cortex ( P<0.05); compared with the TBI group, the TBI+ketamine group had significantly decreased number of Iba-1 positive cells ( P<0.05). ELISA indicated that compared with the sham-operated group and Sham+ketamine group, the TBI group and TBI+ketamine group had significantly increased expressions of TNF-α, IL-1β, IL-6, iNOS, ROS and RNS in damaged cortical brain tissues ( P<0.05); compared with the TBI group, the TBI+ ketamine group had significantly decreased expressions of TNF-α, IL-1β, IL-6, iNOS, ROS and RNS in damaged cortical brain tissues ( P<0.05). Immunofluorescent double label staining indicated obviously inhibited NF-κB p65 nuclear translocation in TBI+ketamine group when it was compared with TBI group. Western blotting indicated that compared with the sham-operated group and Sham+ketamine group, the TBI+ketamine group had significantly increased iNOS, NF-κB p65, p-NF-κB p65 and P-IκB protein expressions in damaged cortical brain tissues ( P<0.05); compared with the TBI group, the TBI+ketamine group had significantly decreased protein expressions of iNOS, NF-κB p65, p-NF-κB p65 and p-IκB in damaged cortical brain tissues ( P<0.05). Conclusion:Low-dose ketamine reduces neuroinflammation and improves cerebral microcirculatory blood flow after open TBI, whose mechanism may be related to inhibition of microglia NF-κB/iNOS pathway.

Objective:To compare the biomechanical properties of different circular external fixators for the fracture site of oblique long bone fractures.Methods:15 polyethylene (PE) plastic rods with the same batch were selected to make the model of oblique fractures in the middle of long bones. According to the connection between PE rods and external fixators, the PE rods were randomly divided into: the group that was simply used kirschner wires (group kirschner wires), the group that was simply used olive wires (group olive wires), the group that was simply inserted half pins (group half pins), the group that was inserted single cortical fixed half pins at either side of the fracture site after being fixed by the tensioned olive wires (group olive wires+ half pin), the group that was inserted tensioned trans-fracture olive wires after being fixed by the tensioned olive wires (group olive wires+ olive wires). The axial compression tests were carried out, and the interfragmentary displacements under axial loads of 200 N, 400 N, 600 N and 800 N were measured and the axial stiffness was calculated. Then, the torsional tests were carried out, and the interfragmentary torsional angles were measured under torsional loads of 4 N·m, 7 N·m and 10 N·m, and the torsional stiffness was calculated.Results:With the increase of axial load from 200 N to 800 N, the axial interfragmentary displacement in each group gradually increased. The interfragmentary axial displacement of each group in ascending order was: group olive wires+ olive wires, group olive wires+ half pins, group half pins, group olive wires, group kirschner wires. The axial stiffness of each configuration under 800 N axial load in descending order was: group olive wires+ olive wires [863.93 (824.32, 875.87) N/mm], group olive wires+ half pins [119.92 (113.16, 123.58) N/mm], group half pins [81.92(79.42, 82.40) N/mm], group olive wires [76.83 (72.45,79.47) N/mm], group kirschner wires [70.80 (67.49, 71.59) N/mm]. The pairwise comparisons of the axial stiffness data of each configuration had statistical significance (all P <0.05). With the increase of the torque load from 4 N·m to 10 N·m, the interfragmentary rotational angle in each configuration gradually increased. The interfragmentary torsion angle of each group in ascending order was: group half pins, group olive wires+ olive wires, group olive wires+ half pins, group olive wires, group kirschner wires. The torsional rigidity of each configuration under 10 N·m torsional load in descending order was: group half pins [1.80 (1.63, 1.85) N·m/°], group olive wires+ olive wires [1.05 (1.02, 1.07) N·m/°], group olive wires+ half pins [0.99 (0.98, 1.03) N·m/°], group olive wires [0.81 (0.78, 0.82) N·m/°], group kirschner wires [0.75 (0.74, 0.76) N·m/°]. The pairwise comparisons of the torsional rigidity data of each configuration had statistical significance (all P < 0.05). Conclusion:The axial stiffness and torsional stiffness of circular external fixators can be increased by using tensioned olive wires or half pins at the fracture site. Due to the insufficient support between oblique fracture site, when the load is applied, the axial displacement and torsion angle of the fracture site will still be fairly large after being fixed the fracture site with half pins. Treating with tensioned trans-fracture olive wires after being fixed by the tensioned olive wires at either side of the fracture site can effectively control the interfragmentary shear and displacement, thus providing an ideal mechanical environment for fracture healing.

Objective To systematically evaluate the correlation between sodium-glucose co-tran-sporter 2(SGLT2)inhibitors and fracture risk in type 2 diabetes mellitus(T2DM)patients. Methods The related databases were searched. The randomized controlled trials(RCTs)which the outcome index included fracture in T2DM patients treated with SGLT2 inhibitors from the inception to August 2017 were enrolled into the study. The documents were selected according to the inclusion and exclusion criteria. After the data extraction and evaluation of methodological quality of RCTs,Meta-analysis was conducted using Rev Man 5.3 software. Results A total of 12 RCTs involving 28 181 patients were entered,including 17 747 patients in the test group(SGLT2 inhibitors)and 10 434 in the control group. The drugs used in the test group were canagliflozin(7 RCTs)and empagliflozin(5 RCTs). The drugs used in the control group were non-SGLT2 inhibitors including metformin,glimetazide and/or placebo. The results of Meta-analysis showed that the incidence of fractures in the test group was significantly higher than that in the control group[5.05%(897/17 747)vs. 4.40%(459/10 434),RR=1.27,95%CI:1.14-1.42,P<0.01]. Subgroup analysis showed that the incidence of fractures in the canagliflozin group was significantly higher than that in the control group[6.21%(679/10 938)vs. 5.28%(365/6 913),RR=1.31,95%CI:1.15-1.48,P<0.01]. There were no significant differences in the incidence of fractures between the empagliflozin group and the control group[3.20%(218/6 809)vs. 2.67%(94/3 521),RR=1.44,95%CI:0.35-5.90, P=0.61]. Conclusions Canagliflozin(a kind of SGLT2 inhibitors)can increase the incidence of fractures. It is suggested that the risk assessment should be done before medication for the benefit of patients.

Objective To systematically evaluate the correlation between sodium-glucose co-tran-sporter 2(SGLT2)inhibitors and fracture risk in type 2 diabetes mellitus(T2DM)patients. Methods The related databases were searched. The randomized controlled trials(RCTs)which the outcome index included fracture in T2DM patients treated with SGLT2 inhibitors from the inception to August 2017 were enrolled into the study. The documents were selected according to the inclusion and exclusion criteria. After the data extraction and evaluation of methodological quality of RCTs,Meta-analysis was conducted using Rev Man 5.3 software. Results A total of 12 RCTs involving 28 181 patients were entered,including 17 747 patients in the test group(SGLT2 inhibitors)and 10 434 in the control group. The drugs used in the test group were canagliflozin(7 RCTs)and empagliflozin(5 RCTs). The drugs used in the control group were non-SGLT2 inhibitors including metformin,glimetazide and/or placebo. The results of Meta-analysis showed that the incidence of fractures in the test group was significantly higher than that in the control group[5.05%(897/17 747)vs. 4.40%(459/10 434),RR=1.27,95%CI:1.14-1.42,P<0.01]. Subgroup analysis showed that the incidence of fractures in the canagliflozin group was significantly higher than that in the control group[6.21%(679/10 938)vs. 5.28%(365/6 913),RR=1.31,95%CI:1.15-1.48,P<0.01]. There were no significant differences in the incidence of fractures between the empagliflozin group and the control group[3.20%(218/6 809)vs. 2.67%(94/3 521),RR=1.44,95%CI:0.35-5.90, P=0.61]. Conclusions Canagliflozin(a kind of SGLT2 inhibitors)can increase the incidence of fractures. It is suggested that the risk assessment should be done before medication for the benefit of patients.

Objective To evaluate the effect of continuous blood purification (CBP) on cardiorenal syndrome (CRS) type Ⅰ.Methods Clinical data of 42 patients with CRS type [at our hospital were collected from January 2012 to June 2014.We observed and compared changes in mean arterial pressure (MAP),heart rate,respiration rate,acute physiology and chronic health evaluation (APACHE) Ⅱ score,and urinary volume before and 5 days after CBP.Meanwhile,levels of serum creatinine (Scr),cysteine proteinase inhibitor Cystatin C (CysC),serum creatinine (cTn) and B-type natriuretic peptid (BNP) were monitored.In addition,dynamic changes in cardiac index (CI),intrathoracic blood volume index (ITBI),global end-diastolic volume index (GEDI),central venous pressure (CVP),and extravascular lung water index (ELVWI) were monitored using the pulse induced contour cardic output plus monitoring system (PiCCO plus),and changes in left ventricular ejection fraction (LVEF) before and 5 days after CBP was measured by color Doppler ultrasound.Results There was no significant difference in MAP in patients with CRS type Ⅰ before and 5 days after CBP (P=0.08).Tacbycardia and tachypnea improved,while urine volume increased and the APACHE Ⅱ score decreased significantly,5 days after CBP(allP＜0.05).Plasma levels of Scr,CysC,cTn and BNP after treatment were lower than those before treatment [(126.8±68.3) μmol/L vs.(413.6±126.1) μmol/L,(1.1±0.8) g/L vs.(4.1±1.1) g/L,(2.6±0.4) μg/L vs.(3.5± 0.7) μg/L,(807.6±427.7) ng/L vs.(3300.3±567.6) ng/L,all P＜0.05)].Myocardial contractility,cardiac preload and lung related parameters also significantly improved after CBP (allP ＜0.05).Conclusions CBP can alleviate clinical symptoms of CRS type Ⅰ,improve cardiac and renal function,and is promising as an important auxiliary measure for the treatment of patients with cardiorenal syndrome type Ⅰ.

Objective To compare the therapeutic effects of continuous veno-venous hemofiltration (CVVH) versus repeated intermittent veno-venous hemofiltration (RIVVH) on patients with severe acute pancreatitis (SAP).Methods Fifty-six patients with SAP were randomly divided into the CVVH group (n =28) and the RIVVH group (n =28).The clinical symptoms and signs,the APACHE Ⅱ and MODS scores,the result of biochemistry including amylase and lipase,and the plasma levels of TNF-α,IL-6,IL8 before and after treatment,the duration of mechanical ventilation,boosting drug application time,the length of stay in ICU,the surgical intervention rate and the mortality were compared between the two groups.Results The clinical symptoms improved in the two groups after treatment (P ＜ 0.05).The APACHE Ⅱ and MODS scores were all reduced in the two groups after treatment (P ＜ 0.05).When compared with the RIVVH group,the result of biochemistry including amylase and lipase,and the plasma levels of TNF-α,IL6,IL-8 were significantly decreased (P ＜ 0.05).The duration of mechanical ventilation,the length of stay in ICU and the mortality were also significantly decreased in the CVVH group (P ＜ 0.05).Conclusions CVVH was more efficacious than RIVVH in the treatment of SAP.