Effect of antifoaming agent on benign colorectal tumors in colonoscopy: A meta-analysis

BACKGROUNDAlthough several trials have shown that the addition of antifoaming agents to polyethylene glycol (PEG) can improve bowel preparation, whether PEG plus antifoaming agents have a beneficial role in the detection of benign tumors during colonoscopy has yet to be confirmed. Our aim was to clarify whether adding simethicone to PEG solution could improve the detection of benign colorectal tumors.AIMTo clarify whether adding simethicone to PEG solution could improve the detection of benign colorectal tumors.METHODSThe PubMed, EMBASE, and Cochrane Library databases were searched for articles published prior to September 2019. The outcomes included the detection rates of colorectal adenomas and polyps.RESULTTwenty studies were eligible. Although there was no difference in the colorectal adenoma detection rate (ADR), a significant effect of simethicone for diminutive adenomas (< 10 mm) was revealed in the group taking simethicone. We also found that simethicone could significantly improve the ADR in the proximal colon but did not affect the colorectal polyp detection rate. Furthermore, the subgroup analyses revealed a beneficial effect of simethicone on the ADR among Asians (P = 0.005) and those with an ADR < 25% (P = 0.003). Moreover, it was a significant finding that the low dose simethicone was as effective as the high dose one with respect to the detection of benign colorectal tumors.CONCLUSIONIn summary, the addition of simethicone to PEG might improve the detection of diminutive adenomas in the right colon by colonoscopy in Asia. Low-dose simethicone was recommended for the detection of benign colorectal tumors. However, large clinical trials are necessary to validate our results and determine the ideal dose of simethicone.     

不同给药方式下日间病房结肠镜诊疗患者肠道准备效果比较

目的:探讨不同给药方式在日间病房上午行结肠镜诊疗患者肠道准备中的结果。方法:采用前瞻性、单盲、随机对照、单中心的研究方法,选取2018年11月至2019年2月在复旦大学附属中山医院内镜日间病房下午入院次日上午行结肠镜诊疗患者141例,分为干预组(69例)和对照组(72例)。干预组采用晚间和凌晨2次给药方案行肠道准备,对照组采用深夜1次给药方案。比较2组患者肠道准备质量合格率和不适感受(恶心、呕吐等)。结果:于晚间和凌晨2次口服肠道清洁剂患者,较深夜1次服用的肠道准备合格率更高(87.0%vs 65.3%,P=0.003),且患者恶心、腹胀、肛门刺激、乏力等不适感受更少、程度更轻(P0.05)。结论:分次给药方案可作为下午入院次日上午行结肠镜诊疗的日间病房患者肠道准备的标准方案。     

低容量聚乙二醇电解质散联合首荟通便胶囊在慢性功能性便秘患者结肠镜检查肠道准备中的应用研究

目的 探讨与标准大容量聚乙二醇电解质散（4L PEG-ELS）方案相比,低容量PEG-ELS联合首荟通便胶囊（SHLC）方案对慢性功能性便秘（CFC）患者结肠镜检查前肠道准备的有效性和安全性。方法 采用单中心、观察者盲法、随机对照试验方法,招募2021年1月-2021年12月在山东大学齐鲁医院（青岛）接受结肠镜检查的CFC患者282例,随机分配到SHLC+2 L PEG-ELS组、SHLC+3 L PEG-ELS组和4 L PEG-ELS组。观察患者波士顿肠道准备评分（BBPS）和肠道准备耐受性。结果 最终纳入240例患者。SHLC+2 L PEG-ELS、SHLC+3 L PEG-ELS和4 L PEG-ELS组的BBPS分别为（6.22±1.09）、（6.26±0.97）和（7.06±0.63）分,差异无统计学意义（P> 0.05）。节段性BBPS显示,3组患者在左半结肠[（2.32±0.72）、（2.41±0.64）和（2.58±0.59）分]、中段结肠[（2.18±0.83）、（2.26±0.76）和（2.44±0.81）分]和右半结肠[（1.67±0.71）、（1.72...     

Efficacy of 0.5-L vs 1-L polyethylene glycol containing ascorbic acid as additional colon cleansing methods for inadequate bowel preparation as expected by last stool examination before colonoscopy

BACKGROUND No consensus has been reached in patients suspected of having inadequate bowel preparation regarding optimal salvage methods, which negatively affects the efficacy and quality of colonoscopy. The most ideal and reasonable rescue option involves early suspicion and identification of patients with inadequate preparation before sedation, additional oral ingestion of a suitable preparation formulation, and same-day colonoscopy.AIM To compare 0.5-L and 1-L polyethylene glycol containing ascorbic acid(PEG +Asc) as additional bowel cleansing methods after a 2-L split-dose PEG + Asc regimen in patients with expected inadequate bowel preparation before colonoscopy.METHODS Individuals with expected inadequate bowel preparation based on last stool form, such as turbid liquid, particulate liquid, or liquid with small amounts of feces, were randomized to either a 0.5-L PEG + Asc group or a 1-L PEG + Asc group. The primary endpoint was bowel preparation as assessed using the Aronchick bowel preparation scale(ABPS) and Boston bowel preparation scale(BBPS) scores. The secondary endpoints were cecal intubation time, withdrawal time, polyp detection rate(PDR), adenoma detection rate(ADR), individual compliance with additional PEG + Asc, and patient satisfaction.RESULTS Initially, 98 patients were included, but 8 were later excluded due to withdrawal of consent to participate in the study. Adequate bowel preparation(as assessed by ABPS) was observed in 80.9%(38/47) of subjects in the 0.5-L group and in88.4%(38/43) of subjects in the 1-L group(P = 0.617). Mean total BBPS was 6.7 points in the 0.5-L group and 7.0 points in the 1-L group(P = 0.458). ADRs and PDRs were similar in the two groups, and cecal intubation and withdrawal times were not significantly different. However, mean patient satisfaction score was significantly higher in the 0.5-L group(P = 0.041).CONCLUSION The bowel cleaning efficacy of additional 0.5-L PEG + Asc was not inferior to that of 1-L PEG + Asc. Additional 0.5-L PEG + Asc is worthwhile when inadequate bowel preparation is expected before colonoscopy.     

Efficacy of 1.2L polyethylene glycol plus ascorbic acid for bowel preparations

BACKGROUND A low-volume polyethylene glycol(PEG) solution that combines ascorbic acid with PEG-based electrolyte solution(PEG-ASC) is gaining mainstream acceptance for bowel preparation due to reduced volume and improved taste.Although several reports showed that bowel preparation with PEG-ASC volume lower than 2.0 L with laxative agents could be an alternative to traditional preparation regimen, the cleansing protocols have not been fully investigated.AIM To evaluate the cleansing efficacy of 1.2 L PEG-ASC solution comparing with 2.0 L PEG electrolyte(PEG-ELS) for bowel preparations.METHODS A randomized, single-blinded, open-label, single-center, non-inferiority study was conducted. In total, 312 Japanese adult patients(aged > 18 years) who underwent colonoscopy were enrolled. Patients were randomly allocated to bowel lavage with either 1.2 L of PEG-ASC solution with at least 0.6 L of an additional clear fluid(1.2 L PEG-ASC group) or 2.0 L of PEG-ELS(PEG-ELS group). Then, 48 mg of sennoside was administered at bedtime on the day before colonoscopy, and the designated drug solution was administered at the hospital on the day of colonoscopy. Bowel cleansing was evaluated using the Boston Bowel Preparation Scale(BBPS). The volume of fluid intake and required time for bowel preparation were evaluated. Furthermore, compliance, patient tolerance,and overall acceptability were evaluated using a patient questionnaire, which was assessed using a visual analog scale.RESULTS In total, 291 patients(1.2 L PEG-ASC group, 148; PEG-ELS group, 143) completed the study. There was no significant difference in successful cleansing, defined as a BBPS score ≥ 2 in each segment, between the two groups(1.2 L PEG-ASC group, 91.9%; PEG-ELS group, 90.2%; 95%CI:-0.03-0.09). The required time for bowel preparation was significantly shorter(164.95 min ± 68.95 min vs 202.16 min± 68.69 min, P < 0.001) and the total fluid intake volume was significantly lower(2.23 L ± 0.55 L vs 2.47 L ± 0.56 L, P < 0.001) in the 1.2 L PEG-ASC group than in the PEG-ELS group. Palatability, acceptability of the volume of solution, and overall acceptability evaluated using a patient questionnaire, which was assessed by the visual analog scale, were significantly better in the 1.2 L PEG-ASC group than in the PEG-ELS group(7.70 cm ± 2.57 cm vs 5.80 cm ± 3.24 cm, P < 0.001). No severe adverse event was observed in each group.CONCLUSION The 1.2 L PEG-ASC solution was non-inferior to the 2.0 L PEG-ELS solution in terms of cleansing efficacy and had better acceptability among Japanese patients.     

再次口服缓泻剂与清洁灌肠对普通结肠镜检查肠道准备不充分患者补救效果的对比研究

目的探讨再次口服缓泻剂与清洁灌肠对普通结肠镜检查肠道准备不充分患者的补救效果。方法回顾性分析2018年7月-2019年6月因肠道准备不充分[波士顿肠道准备评分(BBPS)总分<6分或3段结肠中任意一段评分<2分]于当天接受补救措施并继续行结肠镜检查的96例患者的临床资料。其中,采取再次口服2 L聚乙二醇电解质散(PEG)溶液(PEG组)59例,接受人工清洁灌肠37例(灌肠组)。比较两组补救处理后的结肠BBPS评分、肠道准备充分率、盲肠插管时间、息肉检出率、不良反应和患者接受度。结果PEG组全结肠[(7.9±1.8)和(7.1±1.7)分,t=2.17,P=0.033]、右结肠[(2.7±0.8)和(2.2±0.7)分,t=3.12,P=0.002]和横结肠[(2.7±0.8)和(2.3±0.7)分,t=2.50,P=0.014]BBPS评分明显高于灌肠组,肠道准备充分率(93.2%和73.0%,χ^2=7.48,P=0.006)明显高于灌肠组,患者接受度(91.5%和75.7%,χ^2=4.59,P=0.032)明显高于灌肠组,差异均有统计学意义(P<0.05)。两组患者左结肠BBPS评分、盲肠插管时间、息肉检出率和不良反应比较,差异均无统计学意义(P>0.05)。结论再次口服2 L PEG溶液对普通结肠镜检查肠道准备不充分的补救效果优于清洁灌肠,且具有较好的可接受度。     

聚乙二醇电解质溶液分次与单次口服肠道准备方案的清洁效果和耐受性比较

目的 比较结肠镜检查患者分次与单次口服聚乙二醇电解质溶液进行肠道准备的清洁效果和耐受性。 方法 将进行结肠镜检查的120例患者采用随机法分为A组（单次口服）和B组（分次口服）。A组于检查前5 h单次口服3 L聚乙二醇电解质溶液;B组于检查前夜和检查前4 h分次口服1.5 L聚乙二醇电解质溶液。结肠镜检查时分别对结肠的3个解剖分段处（左半结肠、横结肠、右半结肠）进行Boston肠道准备量表评分,并在检查结束后记录120例患者服药期间的耐受性、依从性、不良反应发生率进行比较分析。 结果 两组患肠道准备方案均达到结肠镜检查要求,Boston肠道准备量表评分相似（P>0.05）,但B组Boston肠道准备量表评分较A组有明显差异（P<0.01）。两组患者耐受性及不良反应发生率的结果显示B组优于A组（P<0.05）。 结论 分次口服聚乙二醇电解质溶液的肠道清洁准备方案在取得满意的清洁效果同时患者耐受性更好,不良反应发生率更低,值得临床推广应用。       

以人工智能肠道图像识别模型评估结肠镜检查前肠道准备

目的 观察人工智能肠道图像识别模型用于评估结肠镜检查前肠道准备的价值。方法 回顾性分析190例接受肠道准备评估及结肠镜检查患者，根据评估肠道准备方法将其分为观察组(以人工智能肠道图像识别模型进行判断，n=100)和对照组(仅由患者将末次粪便性状与肠道清洁准备图进行对比而判断，n=90);比较2组肠道清洁度、肠镜检查时间及腺瘤检出率。结果 观察组波士顿肠道准备量表(BBPS)评分及腺瘤检出率高于对照组，而肠镜检查时间短于对照组(P均<0.05)。结论 检查前采用人工智能肠道图像识别模型评估肠道准备情况可提高BBPS评分及腺瘤检出率并缩短肠镜检查时间。     

Cefoperazone sodium/sulbactam sodium vs piperacillin sodium/tazobactam sodium for treatment of respiratory tract infection in elderly patients

BACKGROUNDRespiratory tract infections in the elderly are difficult to cure and can easily recur, thereby posing a great threat to patient prognosis and quality of life.AIMTo investigate the therapeutic effects of different antibiotics in elderly patients with respiratory tract infection. METHODSSeventy-four elderly patients with respiratory tract infection were randomly allocated to a study (n = 37; treated with cefoperazone sodium/sulbactam sodium) or control (n = 37; treated with piperacillin sodium/tazobactam sodium on the basis of routine symptomatic support) group. Both groups were treated for 7 d. Time to symptom relief (leukocyte recovery; body temperature recovery; cough and sputum disappearance; and rale disappearance time), treatment effect, and laboratory indexes [procalcitonin (PCT), C-reactive protein (CRP), white blood cell count (WBC), and neutrophil percentage (NE)] before and 7 d after treatment and the incidence of adverse reactions were assessed.RESULTSIn the study group, the time to WBC normalization (6.79 ± 2.09 d), time to body temperature normalization (4.15 ± 1.08 d), time to disappearance of cough and sputum (6.19 ± 1.56 d), and time to disappearance of rales (6.68 ± 1.43 d) were shorter than those of the control group (8.89 ± 2.32 d, 5.81 ± 1.33 d, 8.77 ± 2.11 d, and 8.69 ± 2.12 d, respectively; P = 0.000). Total effective rate was higher in the study group (94.59% vs 75.68%, P = 0.022). Serum PCT (12.89 ± 3.96 μg/L), CRP (19.62 ± 6.44 mg/L), WBC (20.61 ± 6.38 × 10⁹/L), and NE (86.14 ± 7.21%) levels of the study group before treatment were similar to those of the control group (14.05 ± 4.11 μg/L, 18.79 ± 5.96 mg/L, 21.21 ± 5.59 × 10⁹/L, and 84.39 ± 6.95%, respectively) with no significant differences (P = 0.220, 0.567, 0.668, and 0.291, respectively). After 7 d of treatment, serum PCT, CRP, WBC, and NE levels in the two groups were lower than those before treatment. Serum PCT (2.01 ± 0.56 μg/L), CRP (3.11 ± 1.02 mg/L), WBC (5.10 ± 1.83 × 10⁹/L), and NE (56.35 ± 7.17%) levels were lower in the study group than in the control group (3.29 ± 0.64 μg/L, 5.67 ± 1.23 mg/L, 8.13 ± 3.01 × 10⁹/L, and 64.22 ± 8.08%, respectively; P = 0.000). There was no significant difference in the incidence of adverse reactions between the groups (7.50% vs 12.50%, P = 0.708).CONCLUSIONPiperacillin sodium/tazobactam sodium is superior to cefoperazone sodium/ sulbactam sodium in the treatment of elderly patients with respiratory tract infection with a similar safety profile.     

Retrospective study of effect of whole-body vibration training on balance and walking function in stroke patients

BACKGROUNDDysfunction in stroke patients has been a problem that we committed to solve and explore. Physical therapy has some effect to regain strength, balance, and coordination. However, it is not a complete cure, so we are trying to find more effective treatments.AIMTo observe the effect of whole-body vibration training (WVT) on the recovery of balance and walking function in stroke patients, which could provide us some useful evidence for planning rehabilitation.METHODSThe clinical data of 130 stroke participants who underwent conventional rehabilitation treatment in our hospital from January 2019 to August 2020 were retrospectively analyzed. The participants were divided into whole-body vibration training (WVT) group and non-WVT (NWVT) group according to whether they were given WVT. In the WVT group, routine rehabilitation therapy was combined with WVT by the Galileo Med L Plus vibration trainer at a frequency of 20 Hz and a vibration amplitude of 0+ACY-plusmn+ADs-5.2 mm, and in the NWVT group, routine rehabilitation therapy only was provided. The treatment course of the two groups was 4 wk. Before and after treatment, the Berg balance scale (BBS), 3 m timed up-and-go test (TUGT), the maximum walking speed test (MWS), and upper limb functional reaching (FR) test were performed.RESULTSAfter 4 wk training, in both groups, the BBS score and the FR distance respectively increased to a certain amount (WVT = 46.08 ± 3.41 vs NWVT = 40.22 ± 3.75; WVT = 20.48 ± 2.23 vs NWVT = 16.60 ± 2.82), with P < 0.05. Furthermore, in the WVT group, both BBS score and FR distance (BBS: 18.32 ± 2.18; FR: 10.00 ± 0.92) increased more than that in the NWVT group (BBS: 13.29 ± 1.66; FR: 6.16 ± 0.95), with P < 0.05. Meanwhile, in both groups, the TUGT and the MWS were improved after training (WVT = 32.64 ± 3.81 vs NWVT = 39.56 ± 3.68; WVT = 12.73 ± 2.26 vs NWVT = 15.04 ± 2.27, respectively), with P < 0.05. The change in the WVT group (TUGT: 17.49 ± 1.88; MWS: 6.79 ± 0.81) was greater than that in the NWVT group (TUGT: 10.76 ± 1.42; MWS: 4.84 ± 0.58), with P < 0.05.CONCLUSIONThe WVT could effectively improve the balance and walking function in stroke patients, which may be good for improving their quality of life.     

New indicators in evaluation of hemolysis,elevated liver enzymes,and low platelet syndrome: A case-control study

BACKGROUNDIndices such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), platelet distribution width (PDW), and red cell distribution width (RDW) are considered new markers of the systemic inflammatory response (SIR), and have been widely implemented for the diagnosis of patients with inflammatory diseases. These new indicators have also been widely investigated in preeclampsia (PE) but less analyzed in hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome.AIMTo compare SIR markers among HELLP patients, PE only patients, and healthy gravidae.METHODSThis retrospective case-control study enrolled 630 cases, including 210 patients with HELLP syndrome (HELLP group), 210 patients with only PE (PE group) and 210 healthy gravidae (control group). The three groups were matched by age, parity, status of assisted reproduction, and multiple pregnancies. Birthweight, gestational age at complete blood count collection, gestational age at delivery, mode of delivery, etc. were recorded. The main indices as NLR, PLR, MPV, PDW, and RDW among the groups were compared, as well as some secondary outcomes including neutrophil, platelets, and hemoglobin.RESULTSThe NLR (6.4 vs 4.3 vs 3.5), MPV (11.9 vs 11.2 vs 10.7), PDW (16.4 vs 13.3 vs 14.2), leukocyte (12.4 × 10⁹/L vs 9.7 × 10⁹/L vs 8.7 × 10⁹/L) and neutrophil count (9.9 × 10⁹/L vs 7.3 × 10⁹/L vs 6.1 × 10⁹/L) were highest in the HELLP group, lower in the PE group, and lowest in the control group. Both the overall comparisons between the three groups (all ^bP < 0.01) and pairwise comparisons between every two groups elicited statistically significant differences (all ^dP < 0.01, except control vs PE: ^cP < 0.05 in PDW). The average lymphocyte counts were 1.4 (1.1, 2.0) × 10⁹/L in the HELLP group, 1.6 (1.3, 2.0) × 10⁹/L in the PE group and 1.7 (1.4, 2.0) × 10⁹/L in the control group. The overall comparison of lymphocyte count within the three groups had statistically significant differences (P = 0.000). The pairwise comparisons between every two groups demonstrated that the HELLP group had a lower lymphocyte count than both the PE (P = 0.019) and control groups (P = 0.000), but the difference between the PE and control groups was not statistically significant (P = 0.432). The overall comparisons on platelet counts and the PLR among these three groups also showed statistically significant differences (both P = 0.000), from low to high being those in the HELLP group (43.4 × 10⁹/L, 64.0), control group (180.5 × 10⁹/L, 103.6) and PE group (181.5 × 10⁹/L, 112.8). Pairwise comparisons of neither index displayed statistically significant differences between the PE and control groups (both P > 0.05), while the differences in the two indices between the HELLP group and the two other groups were still statistically significant (all P = 0.000). RDW values were highest in the HELLP group (14.5% [13.6, 15.3]), lower in the control group (14.1% [13.5, 14.8]) and lowest in the PE group (13.9% [13.4, 14.9]). The difference between the PE and control group did not show statistical significance (P = 1.000), while RDW values in the HELLP group were higher than those in the other two groups (^cP < 0.05 vs control, ^dP < 0.01 vs PE).CONCLUSIONSIR markers such as NLR, RDW, MPV, and PDW were increased and PLR was decreased in HELLP. These SIR markers may become new indicators in the evaluation of HELLP syndrome.     

Paricalcitol in hemodialysis patients with secondary hyperparathyroidism and its potential benefits

BACKGROUNDSecondary hyperparathyroidism (SHPT) is a common complication in patients with end-stage renal disease and it is also common in hemodialysis patients. SHPT can increase bone fragility and calcification of blood vessels and soft tissues, which greatly increases the risk of death.AIMTo discuss the outcome, safety and other potential benefits of paricalcitol injection in hemodialysis patients with SHPT. METHODSWe recruited 40 patients who received hemodialysis at our hospital for chronic renal failure with SHPT between March and December 2019. They received paricalcitol injection for 24 wk (starting dose, 0.06–0.08 μg/kg), three times per week. They were followed up at the baseline (week 0), week 4, week 12 and week 24. The primary outcome indicator was the percentage of patients with a > 30% decrease in intact parathyroid hormone (iPTH) levels at week 24 compared with the baseline. The secondary outcome indicators included percentage decrease in iPTH levels at week 24, standard-reaching rate of iPTH (percentage of patients with iPTH down to 130–585 pg/mL), changes in serum levels of calcium (Ca), phosphate (P), Ca × P product, alkaline phosphatase (ALP), creatinine (Cre), hemoglobin (Hb), and C-reactive protein (CRP), and incidence of adverse events (AEs). RESULTSAfter 24 wk of treatment, iPTH levels decreased significantly (598.88 ± 381.29 pg/mL vs 888.84 ± 376.88 pg/mL, P < 0.05). More than 30% decrease of iPTH was found in 21 of 36 (58.33%) patients. The average decrease in iPTH levels was 32.16 ± 4.33%; the standard-reaching rate of iPTH levels was 66.67% (24/36); and ALP levels decreased significantly compared with the baseline (113.72 ± 41.73 IU/L vs 133.45 ± 56.86 IU/L) (t = 2.798, P < 0.05). There were no significant differences in the serum levels of calcium, Hb, Cre and CRP compared with the baseline (P > 0.05). After 24 wk of treatment, serum P levels decreased compared with the baseline (1.91 ± 0.40 mmol/L vs 2.16 ± 0.66 mmol/L) (t = 2.830, P < 0.05). Ca × P product decreased significantly compared with the baseline (56.38 ± 13.22 mg²/dL² vs 63.97 ± 20.30 mg²/dL²) (t = 2.717, P < 0.05). No serious adverse events occurred.CONCLUSIONParicalcitol was a safe and effective treatment for hemodialysis patients with SHPT. It decreased serum levels of iPTH, ALP and P and maintained stability of serum Ca levels.     

Effects of mindful breathing combined with sleep-inducing exercises in patients with insomnia

BACKGROUNDInsomnia is the most common sleep disorder. It disrupts the patient’s life and work, increases the risk of various health issues, and often requires long-term intervention. The financial burden and inconvenience of treatments discourage patients from complying with them, leading to chronic insomnia.AIMTo investigate the long-term home-practice effects of mindful breathing combined with a sleep-inducing exercise as adjunctive insomnia therapy.METHODSA quasi-experimental design was used in the present work, in which the patients with insomnia were included and grouped based on hospital admission: 40 patients admitted between January and April 2020 were assigned to the control group, and 40 patients admitted between May and August 2020 were assigned to the treatment group. The control group received routine pharmacological and physical therapies, while the treatment group received instruction in mindful breathing and a sleep-inducing exercise in addition to the routine therapies. The Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder 7-item (GAD-7) scale, and Insomnia Severity Index (ISI) were utilized to assess sleep-quality improvement in the patient groups before the intervention and at 1 wk, 1 mo, and 3 mo postintervention.RESULTSThe PSQI, GAD-7, and ISI scores before the intervention and at 1 wk postintervention were not significantly different between the groups. However, compared with the control group, the treatment group exhibited significant improvements in sleep quality, daytime functioning, negative emotions, sleep latency, sleep duration, sleep efficiency, anxiety level, and insomnia severity at 1 and 3 mo postintervention (P < 0.05). The results showed that mindful breathing combined with the sleep-inducing exercise significantly improved the long-term effectiveness of insomnia treatment. At 3 mo, the PSQI scores for the treatment vs the control group were as follows: Sleep quality 0.98 ± 0.48 vs 1.60 ± 0.63, sleep latency 1.98 ± 0.53 vs 2.80 ± 0.41, sleep duration 1.53 ± 0.60 vs 2.70 ± 0.56, sleep efficiency 2.35 ± 0.58 vs 1.63 ± 0.49, sleep disturbance 1.68 ± 0.53 vs 2.35 ± 0.53, hypnotic medication 0.53 ± 0.64 vs 0.93 ± 0.80, and daytime dysfunction 1.43 ± 0.50 vs 2.48 ± 0.51 (all P < 0.05). The GAD-7 scores were 2.75 ± 1.50 vs 7.15 ± 2.28, and the ISI scores were 8.68 ± 2.26 vs 3.38 ± 1.76 for the treatment vs the control group, respectively (all P < 0.05).CONCLUSIONThese simple, cost-effective, and easy-to-implement practices used in clinical or home settings could have profound significance for long-term insomnia treatment and merit wide adoption in clinical practice.     

Scrotal septal flap and two-stage operation for complex hypospadias: A retrospective study

BACKGROUNDComplex hypospadias is a surgical challenge. AIMTo present the long-term outcomes of two-stage repair of complex hypospadias using a scrotal septal flap.METHODSThis was a retrospective study of patients with complex hypospadias who were operated on between January 1^st, 2001, and January 1^st, 2019, at a single hospital using a scrotal septal flap (two-stage surgery) or prepuce flap (one-stage surgery; control group). In the scrotal group, the urethra was first repaired using oral mucosa; in the second stage, a scrotal septal flap was used as a second imper-meable layer. Maximal/average urinary flow rates after surgery were compared. All patients were followed for ≥ 6 mo (range: 6-96 mo). RESULTSNinety-seven patients were included (46 in the scrotal group and 51 in the prepuce group). The maximal urinary flow rate was 15.4 ± 2.1 mL/s in the scrotal group and 14.3 ± 3.0 mL/s in the control group (P = 0.035). The average urinary flow rate was 8.4 ± 2.3 mL/s in the scrotal group and 7.5 ± 1.5 mL/s in the control group (P = 0.019). The proportion of patients achieving good therapeutic effects was higher in the scrotal group than in the control group [24 (52.2%) vs 16 (31.4%), P = 0.042; 34 (73.9%) vs 25 (49.0%), P = 0.014]. The scrotal flap two-stage surgery was independently associated with a higher maximal urinary flow rate (OR = 2.416, 95%CI: 1.026-5.689, P = 0.044) and with a higher average flow rate (OR = 2.484, 95%CI: 1.054-5.854, P = 0.038).CONCLUSIONIn complex hypospadias, a scrotal septal flap could be a versatile and reliable option for resurfacing the penis.     

乙酰半胱氨酸在胶囊内镜检查中的临床应用

目的 探讨胶囊内镜(CE)检查前应用乙酰半胱氨酸对CE小肠清洁度及检查结果的影响.方法 将150例行CE检查的患者随机分为观察组和对照组(各75例).对照组在检查前1晚使用复方聚乙二醇电解质散(PEG)3000 mL行肠道准备;观察组在检查前1天给予乙酰半胱氨酸600 mg口服(1天3次),检查前1晚使用PEG 300...     

Effect of intrauterine perfusion of granular leukocyte-colony stimulating factor on the outcome of frozen embryo transfer

BACKGROUNDTreatment of thin endometrium with granular leukocyte-colony stimulating factor (G-CSF) remains controversial.AIMTo investigate the effect of G-CSF on the outcome of frozen embryo transfer in patients with thin endometrium.METHODSA retrospective propensity score matching (PSM) study was performed to assess patients administered frozen embryo transfer at the Reproductive Medicine Center of the Affiliated Drum Tower Hospital of Nanjing University Medical School, in 2012-2018. The patients were divided into G-CSF intrauterine perfusion (G-CSF) and non-G-CSF groups, and clinical pregnancy, implantation, ectopic pregnancy, and early abortion rates between the two groups were compared.RESULTSBefore PSM, 372 cycles were enrolled, including 242 and 130 cycles in the G-CSF and non-G-CSF groups, respectively. Age (34.23 ± 5.76 vs 32.99 ± 5.59 years; P = 0.047) and the blastula/cleavage stage embryo ratio (0.68 vs 0.37; P = 0.011) were significantly elevated in the G-CSF group compared with the non-G-CSF group; however, clinical pregnancy (46.28% vs 51.54%; P = 0.371) and embryo implantation (35.21% vs 35.65%; P = 0.910) rates were similar in both groups. After PSM by age and blastula/cleavage stage embryo ratio, 244 cycles were included (122 cases each in the G-CSF and non-G-CSF groups). The clinical pregnancy (50.82 % vs 48.36%; P = 0.701) and embryo implantation (37.38% vs 34.11%; P = 0.480) remained similar in both groups.CONCLUSIONIntrauterine infusion of G-CSF does not improve the clinical outcome of frozen embryo transfer in patients with thin endometrium.     

Minimally invasive surgery vs laparotomy in patients with colon cancer residing in high-altitude areas

BACKGROUNDColon cancer is associated with a higher incidence among residents in high-altitude areas. Hypoxic environment at high altitudes inhibits the phagocytic and oxygen-dependent killing function of phagocytes, thereby increasing the inflammatory factors, inhibiting the body’s innate immunity and increasing the risk of colon cancer. AIMTo examine the effect of minimally invasive surgery vs laparotomy in patients with colon cancer residing in high-altitude areas. METHODSNinety-two patients with colon cancer in our hospital from January 2019 to February 2021 were selected and divided into the minimally invasive surgery and laparotomy groups using the random number table method, with 46 patients in each group. Minimally invasive surgery was performed in the minimally invasive group and laparotomy in the laparotomy group. Operative conditions, inflammatory index pre- and post-surgery, immune function index and complication probability were measured. RESULTSOperative duration was significantly longer and intraoperative blood loss and recovery time of gastrointestinal function were significantly less (all P < 0.05) in the minimally invasive group than in the laparotomy group. The number of lymph nodes dissected was not significantly different. Before surgery, there were no significant differences in serum C-reactive protein, interleukin-6 and tumor necrosis factor-α levels between the groups, whereas after surgery, the levels were significantly higher in the minimally invasive group (26.98 ± 6.91 mg/L, 146.38 ± 11.23 ng/mL and 83.51 ± 8.69 pg/mL vs 41.15 ± 8.39 mg/L, 186.79 ± 15.36 ng/mL and 110.65 ± 12.84 pg/mL, respectively, P < 0.05). Furthermore, before surgery, there were no significant differences in CD3+, CD4+ and CD4+/CD8+ levels between the groups, whereas after surgery, the levels decreased in both groups, being significantly higher in the minimally invasive group (55.61% ± 4.39%, 35.45% ± 3.67% and 1.30 ± 0.35 vs 49.68% ± 5.33%, 31.21% ± 3.25% and 1.13 ± 0.30, respectively, P < 0.05). Complication probability was significantly lower in the minimally invasive group (4.35% vs 17.39%, P < 0.05). CONCLUSIONLaparoscopic minimally invasive procedures reduce surgical trauma and alleviate the inflammatory response and immune dysfunction caused by invasive operation. It also shortens recovery time and reduces complication probability.     

肠道准备后2h即行无痛肠镜检查的安全性及有效性研究

目的 探讨肠道准备后2 h即行无痛肠镜检查的安全性及有效性.方法 将120名志愿者随机分为观察组和对照组,观察组行快速肠道准备,对照组行常规肠道准备.比较两组患者肠道准备过程中恶心、呕吐发生率、检查完成率、检查时长、检查过程中误吸发生率、息肉检出率和Boston肠道准备量表(BBPS)评分.结果 两组患者均全部完成检查...     

Effects of perioperative rosuvastatin on postoperative delirium in elderly patients: A randomized,double-blind,and placebo-controlled trial

BACKGROUNDExperimental evidence has indicated the benefits of statins for the treatment of postoperative delirium. Previously, clinical trials did not reach definite conclusions on the effects of statins on delirium. Some clinical trials have indicated that statins reduce postoperative delirium and improve outcomes, while some studies have reported negative results.AIMTo evaluate whether perioperative rosuvastatin treatment reduces the incidence of delirium and improves clinical outcomes.METHODSThis randomized, double-blind, and placebo-controlled trial was conducted in a single center in Jiangsu, China. This study enrolled patients aged greater than 60 years who received general anesthesia during elective operations and provided informed consent. A computer-generated randomization sequence (in a 1:1 ratio) was used to randomly assign patients to receive either rosuvastatin (40 mg/d) or placebo. Participants, care providers, and investigators were all masked to group assignments. The primary endpoint was the incidence of delirium, which was assessed twice daily with the Confusion Assessment Method during the first 7 postoperative days. Analyses were performed on intention-to-treat and safety populations.RESULTSBetween January 1, 2017 and January 1, 2020, 3512 patients were assessed. A total of 821 patients were randomly assigned to receive either placebo (n = 411) or rosuvastatin (n = 410). The incidence of postoperative delirium was significantly lower in the rosuvastatin group [23 (5.6%) of 410 patients] than in the placebo group {42 (13.5%) of 411 patients [odds ratios (OR) = 0.522, 95% confidence interval (CI): 0.308-0.885; P < 0.05]}. No significant difference in 30-d all-cause mortality (6.1% vs 8.7%, OR = 0.67, 95%CI: 0.39-1.2, P = 0.147) was observed between the two groups. Rosuvastatin decreased the hospitalization time (13.8 ± 2.5 vs 14.2 ± 2.8, P = 0.03) and hospitalization expenses (9.3 ± 2.5 vs 9.8 ± 2.9, P = 0.007). No significant differences in abnormal liver enzymes (9.0% vs 7.1%, OR = 1.307, 95%CI: 0.787-2.169, P = 0.30) or rhabdomyolysis (0.73% vs 0.24%, OR = 3.020, 95%CI: 0.31-29.2, P = 0.37) were observed between the two groups.CONCLUSIONThe current study suggests that perioperative rosuvastatin treatment reduces the incidence of delirium after an elective operation under general anesthesia. However, the evidence does not reveal that rosuvastatin improves clinical outcomes. The therapy is safe. Further investigation is necessary to fully understand the potential usefulness of rosuvastatin in elderly patients.     

口服肠道清洁剂联合不同时机灌肠对慢性便秘患者肠道准备效果的影响

目的 探讨口服肠道清洁剂联合不同时机灌肠对慢性便秘患者结肠镜检查前肠道准备效果及安全性的影响。方法 选取2020年10月至2022年9月在苏州市立医院东区消化科接受结肠镜检查的186例慢性便秘患者作为研究对象。按照随机数字表法将其分为对照组（n=62）、观察组Ⅰ（n=62）和观察组Ⅱ（n=62）。对照组于检查日7:00服用2 L复方聚乙二醇电解质散溶液，9:00服用0.9%氯化钠溶液500 mL+温开水500 mL,10:00口服二甲硅油散溶液30 mL；观察组Ⅰ在对照组的基础上，于检查日前1 d 19:00实施清洁灌肠；观察组Ⅱ在对照组的基础上，于检查日10:30予以清洁灌肠。比较3组患者肠道准备合格率、排便总次数、各部分结肠的波士顿肠道准备评分及肠道准备不良反应发生情况。结果 观察组Ⅰ和观察组Ⅱ肠道准备合格率均高于对照组（P<0.05）；观察组Ⅰ排便总次数、右侧结肠波士顿肠道准备评分和全结肠波士顿肠道准备总分明显高于观察组Ⅱ和对照组（P<0.05）。3组患者肠道准备后的恶心、呕吐发生率比较，差异无统计学意义（P>0.05）。观察组Ⅰ和观察组Ⅱ的腹痛和腹胀发生率低于...