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.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Objective:To explore the correlation between changing trajectories of serum uric acid and the onset of nonalcoholic fatty liver disease (NAFLD).Methods:A longitudinal cohort study. Total of 3 353 subjects who had routine health examination every year from January 2017 to December 2019 in the Health Management Center of the Second Affiliated Hospital of Dalian Medical University and met the inclusion criteria were selected as the research subjects. Four different serum uric acid trajectory groups were determined by using the group-based trajectory model: the low stability group, medium stability group, medium-high stability group and high stability group. During the follow-up to December 2021, the differences in cumulative incidence of NAFLD in different serum uric acid trajectory groups were calculated and compared. Cox proportional hazard regression model was used to evaluate the hazard ratio ( HR) and 95% confidence interval ( CI) of the NAFLD onset in different serum uric acid trajectory groups. The dose-response relationship between baseline serum uric acid and NAFLD was evaluated by a restricted cubic spline regression model. Results:The cumulative incidence of NAFLD in two years was 10.77%, and the cumulative incidence increased with the rising trajectory of serum uric acid, it was the highestin the high stability group ( P<0.05). Compared that in the low stability group, the risk of NAFLD in the other three groups was as follows: 2.24 (95% CI: 1.59-3.14) in the medium stability group, 2.89 (95% CI: 1.92-4.33) in the medium-high stability group and 4.55 (95% CI:2.83-7.31) in the high stability group (all P<0.05). The risk of NAFLD gradually increased with the rising of serum uric acid level, and the cut-off value of serum uric acid for women and men was 260.32 μmol/L and 365.09 μmol/L, respectively. Conclusions:Long-term moderate and high levels of serum uric acid are independent risk factors for the occurrence of NAFLD. With the rising of serum uric acid trajectory, the risk of NAFLD increases. Attention should be paid to the longitudinal change trend of serum uric acid level in the prevention of NAFLD, and it should be controlled within lower level of the normal range.

Polytrauma represents severe injuries to multiple body regions, which is associated with high risk of complications and mortality. The definition of polytrauma relies on the basic concept of a combination of injuries that cause a life-threatening condition. The authors strongly call on the healthcare community to list polytrauma as a single disease in the international classification of diseases, rather than "disease combination". Because polytrauma has definite etiology and unique pathophysiological changes after polytrauma, treatment models are different from single trauma. Polytrauma can certainly fulfil any practical and nosological criteria of a single disease according to Berlin definition. The authors explore the importance of polytrauma as a single disease in preventive intervention strategies, therapeutic measures and traumatology development in the future.

Blast injury of the chest injury is the most common wound in modern war trauma and terrorist attacks, and is also the most fatal type of whole body explosion injury. Most patients with severe blast injury of the chest die in the early stage before hospitalization or during transportation, so first aid is critically important. At present, there exist widespread problems such as non-standard treatment and large difference in curative effect, while there lacks clinical treatment standards for blast injury of the chest. According to the principles of scientificity, practicality and advancement, the Trauma Society of Chinese Medical Association has formulated the guidance of classification, pre-hospital first aid, in-hospital treatment and major injury management strategies for blast injury of the chest, aiming to provide reference for clinical diagnosis and treatment.

Objective:To investigate the clinical therapy of sacral osteotomy combined with lumbopelvic distraction triangular osteosynthesis for malunion and nonunion of type C longitudinally displaced sacral fracture.Methods:A retrospective study of 9 patients with malunion and nonunion of type C pelvic fractures who had been treated with sacral osteotomy combined with triangular osteosynthesis from April 2015 to January 2020 were analyzed. They were 5 men and 4 women, with an average age of 30.67±10.06 (range 14-45 years). AO/OTA classification at initial pelvic fracture, 8 cases were type C1.3 and one was type C3.3. The period from injury to surgery was 12.8±18.92 months (range 3-60 months). The cranial displacement of one side of the pelvis was 3.8±0.57 cm (range 2.5-4.1 cm). Sacral osteotomy and triangular osteosynthesis were used in all nine patients, combined with osteotomy or no osteotomy of the superior and inferior branches of the anterior ring pubis. The degree of longitudinal displacement of one side of the pelvis was assessed by making a vertical line gap between the acetabular apex on both sides and the central axis of the sacrum on the X-ray of the pelvis. The Majeed scoring and visual analogue scale (VAS) were evaluated preoperatively and at the last follow-up to assess the therapeutic effect of the patients.Results:In all 9 patients, except for 1 case of postoperative pelvic residual displacement 1.5 cm (preoperative 3.2 cm difference compared with the healthy side), the other 8 patients had a postoperative bilateral difference of 0.1-0.7 cm. All the patients were followed up for 12.00±9.95 months. At the last follow-up, the Majeed score of pelvic fracture increased from 44.0(33.5, 76.0) points preoperatively to 91.0(80.5, 92.5) points. The difference before and after operation was statistically significant ( Z=2.67, P<0.001), and the gait was significantly improved. And the VAS score for pain decreased from 6.00±1.41 points preoperatively to 1.22±0.97 points. The difference before and after operation was statistically significant ( t=8.73, P<0.001). None had complications like infection, plate broken, screw loosening, iatrogenic nerve or blood vessel injury, etc. Conclusion:Sacral osteotomy combined with lumbopelvic distraction triangular osteosynthesis for the treatment of pelvic malunion and nonunion caused by sacral fracture can correct pelvic deformity, prolong limb length, and reconstruct the stability of pelvic ring with good clinical results.

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.

A novel coronavirus pneumonia (NCP) epidemic has occurred in Wuhan, Hubei Province since December 2019, caused by a novel coronavirus (2019-nCoV) never been seen previously in human. China has imposed the strictest quarantine and closed management measures in history to control the spreading of the disease. However, severe trauma can still occur in the NCP patients. In order to standardize the emergency treatment and the infection prevention and control of severe trauma patients with hidden infection, suspected or confirmed infection of 2019-nCoV, Trauma Surgery Branch of Chinese Medical Doctors' Association organized this expert consensus. The consensus illustrated the classification of the NCP patients, severe trauma patients in need of emergency surgery, emergency surgery type, hierarchical protection for medical personnel and treatment places. Meanwhile, the consensus standardized the screening, injury severity evaluation, emergency surgical treatment strategy and postoperative management strategy of severe trauma patients during the epidemic period of NCP, providing a basis for the clinical treatment of such kind of patients.

Objective: To understand the current situation of trauma treatment and evaluate the training effect and influencing factors of "China Trauma Care Training (CTCT)" by investigating the trainees who participated in the course. Methods: A total of 1660 trainees who participated in CTCT training from May 2017 to May 2018 were selected as the subjects of this study. Through questionnaires, the general information (gender, occupation, professional title, discipline source, length of time engaged in trauma treatment), the situation of trauma treatment in their hospitals (hospital level, trauma treatment mode, number of severe trauma cases each year), the recommended model of trauma treatment, learning methods of trauma treatment knowledge, and the trauma training interval were obtained. The trainees took tests before and after the training, and the test results were used to evaluate the training effect and analyze the influencing factors. Results: (1) There were 1 230 males (74.10%), 1 356 physicians (81.93%), 1 247 with intermediate title or lower levels (75.12%), 756 from emergency department/emergency surgery (45.54%), and 899 who were engaged in trauma treatment for more than five years (54.16%). (2) There were 1 068 trainees from tertiary hospitals (64.34%). The main mode of severe trauma treatment in hospitals was "emergency+ consultation+ triage" (1 198 trainees, 72.17%). A total of 1014 trainees treated less than 200 severe trauma patients each year (61.08%). A total of 1210 trainees recommended emergency/emergency surgery (72.89%) and 350 trainees recommended trauma surgery/trauma hospital (21.08%) as the main mode of treatment. (3) There were various approaches to acquire trauma treatment knowledge, including 1 029 person-times (61.99%) through department internal guidelines, 924 person-times (55.66%) through case discussion, 879 person-times (52.95%) through self-teaching, 767 person-times (46.20%) through lectures, 382 person-times (23.01%) through trauma courses and 285 person-times through further studies at home and abroad (17.17%). A total of 951 trainees recommended 1-2 years as the training interval (57.3%). (4) The average test score before training was (67.5±14.5)points, which were influenced by the hospital level, discipline source, title of trainees, length of time engaged in trauma treatment, and amount of severe trauma cases each year in their hospitals. The hospital level and discipline source were the main effect factors. (5) The average test score after training was (83.8±11.6)points, which was significantly higher than that before training (P<0.01), and the scores of trainees in different subgroups were all improved. The main factors influencing the test score included hospital level, number of severe trauma cases each year, discipline source, professional title, number of severe trauma cases each year treated in the hospital. The major effect factor was the amount of severe trauma cases each year. Conclusions The main mode of trauma treatment in hospitals involved in this study is "multi-disciplinary consultation+ decentralized treatment" . Few trainees have received systematic trauma treatment training, and their trauma treatment knowledge level and the test scores before training is influenced by hospital level, the case number of severe trauma treatment, discipline source, and trainees’qualifications. After the standardized and standardized trauma treatment training course "CTCT" , the scores of students from different backgrounds have been significantly improved, and the gap between students has been significantly narrowed.

Objective: To investigate the application of the axillary central venous catheterization (CVC) based on Nickalls' landmarks in treating adult multiple injury patients. Methods: A retrospective case control study was conducted to analyze the clinical data of 83 adult multiple injury patients treated in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from August 2017 to August 2018. There were 48 males and 35 females, aged 21-84 years [(56.5±14.3)years]. The body mass index ranged from 19.8 to 43.1 kg/m² [(27.6±6.5)kg/m²]. There were 26 patients with mainly craniocerebral injury, 15 with mainly thoracic injury, 28 with mainly abdominal injury, eight with mainly spinal injury and six with mainly pelvic fracture. The injury severity score (ISS) ranged from 24 to 66 points [(41.8±18.1)points]. All the patients received the axillary CVC based on Nickalls' landmarks. The left axillary vein was used as the puncture vein in 16 patients (left group), and the right axillary vein was used as the puncture vein in 67 patients (right group). A total of 36 patients were combined with the clavicle and/or 1-3 rib fractures at the same side as the puncture site (adjacent fracture group), while 47 patients were not combined with the clavicle and/or 1-3 rib fractures at the same side as the puncture site (non-adjacent fracture group). The success rate of catheterization, pneumothorax, hematoma or artery injury, catheter ectopia, catheter-related infection and catheter-related thrombosis were recorded. Results: A total of 80 patients were successfully intubated, with a success rate of 96%. Subgroup analysis showed that the success rate of right group was [97% (65/67)], slightly higher than that of the left group [94%(15/16)] , but the difference was not statistically significant (P>0.05). And the success rate of adjacent fracture group [94%(34/36)] was similar to that of non-adjacent fracture group [98%(46/47)], and the difference was not statistically significant (P>0.05). Complication incidences were as follows: hematoma or arterial injury [5%(4/83)], pneumothorax 2%(2/83), catheter-related thrombosis [12%(10/83)], and catheter ectopia [1%(1/83)]. No catheter-related infection was observed. Subgroup analysis showed that the incidence of various complications was similar between the left group and the right group (hematoma or arterial injury: 6% vs. 4%, pneumothorax: 0% vs. 3%; catheter ectopic: 0% vs. 1%; catheter-related thrombosis: 13% vs. 12%), and the difference was not statistically significant (P>0.05). The incidence of various complications was also similar between the adjacent fracture group and the non-adjacent fracture group (hematoma or arterial injury: 3% vs. 6%; pneumothorax: 3% vs. 2%; catheter ectopic: 0% vs. 2%; catheter-related thrombosis: 17% vs. 9%), and the difference was not statistically significant (P>0.05). Conclusions Axillary CVC based on Nickalls' landmark has a relatively high catheterization success rate and low complication incidence in adult multiple trauma patients. It is applicable to both left and right sides of axillary vein and suitable for patients with adjacent fracture. However, there still exists a high risk of catheter-related thrombosis, requiring enhanced anticoagulation and regular monitoring of thrombosis during catheterization.