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.

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.

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.

This paper summarized nursing experience of one patient with diffuse esophageal spasm(DES) undergoing peroral endoscopic myotomy (POEM).Key points of nursing included:preoperative training of use of medical bedpan;respiratory functional exercises;postoperative management of body position,nursing of gastrointestinal decompression,management of refined diet and prevention and nursing of complications.The patient recovered well and no complication occurred.The patient was discharged on the eighth day after surgery.

This study aims to elucidate the underlying molecular mechanisms of artemisinin accumulation induced by cadmium (Cd).The effects of different Cd concentrations (0,20,60,and 120 μmol/L) on the biosynthesis ofArtemisia annua L.were examined.Intermediate and end products were quantified by HPLC-ESI-MS/MS analysis.The expression of key biosynthesis enzymes was also determined by qRT-PCR.The results showed that the application of treatment with 60 and 120 μmol/L Cd for 3 days significantly improved the biosynthesis of artemisinic acid,arteannuin B,and artemisinin.The concentrations of artemisinic acid,arteannuin B,and artemisinin in the 120 μmol/L Cd-treated group were 2.26,102.08,and 33.63 times higher than those in the control group,respectively.The concentrations of arteannuin B and artemisinin in 60 μmol/L Cd-treated leaves were 61.10 and 26.40 times higher than those in the control group,respectively.The relative expression levels of HMGR,FPS,ADS,CYP71AV1,DBR2,ALDH1,and DXR were up-regulated in the 120 μmol/L Cd-treated group because of increased contents of artemisinic metabolites after 3 days of treatment.Hence,appropriate doses of Cd can increase the concentrations of artemisinic metabolites at a certain time point by up-regulating the relative expression levels of key enzyme genes involved in artemisinin biosynthesis.

Objective To evaluate the prognostic value of intraoperalive detection in rib bone marrow micmmetastasis(BMMs)of patients with non-small-cell lung cancer(NSCLC)and the relationship between the micROmetast ases and clinicopathologic factors.Method From April 2004 to May 2007,146 patients undergoing surgical treatment for NSCLC were prospectively investigated for the presence of BMMs by the immunohistochemisury method.Remits 30.82%(45/146)of NSCLC patients were detected with BMMs,15(33.33%)patients developed remote metastases of the 45 patients with BMMs,14(13.86%)patients developed metastases of the 101 patients without BMMs.Patients with BMMs demonstrated an earlier metastasis and a lower survival rate compared with patients without BMMs(P＜0.05).There Was trend for ahigher frequency and the occurrence of BMMs changed with tumor stages and the histologic differentiation of the tumor.No relationship was found between BMMs and age,T grade,as well as tumor dimension.Conclusions The detection of BMMs can predict the prognosis of NSCLC patients and identifies patients withNSCLC who are at significantly increased risk for metastasis and survival,which may be useful in evalnatingpatients for adjuvant treatment