In-fiber chirped Fabry-Perot cavity for temperature sensing.

Measurement resolution and dynamic range of conventional optical fiber sensors are often mutually restricted. In this work, an in-fiber chirped Fabry-Perot cavity (interferometer) is proposed, for the first time to our knowledge, to resolve the conflict between the resolution and dynamic range. The chirped Fabry-Perot interferometer is constructed by two chirped fiber Bragg gratings inscribed in the opposite directions, resulting in a gradually varied (i.e., chirp) cavity length for different reflection wavelengths. As such, the interference spectrum exhibits high figure of merit (FOM) and large free spectrum range (FSR) at long and short wavelength regions, respectively, enabling high-resolution and large-dynamic-range measurement simultaneously. Temperature tests are then carried out to confirm the validity of the solution. The proposed sensing schema may be developed further and find vital applications in biomedicine fields such as endosomatic temperature monitoring of living bodies. The proposed concept of chirped Fabry-Perot interferometer can provide breakout ideas for other sensing scenarios where high-resolution and large-dynamic range are demanded and can be further generalized to other measurands or even free-space interference metrologies.

Real-Time Cardiac Abnormality Monitoring and Nursing for Patient using Electrocardiographic Signals.

Introduction Cardiovascular disease care is a critical clinical application that necessitates real-time monitoring models. Previous models required the use of multi-lead signals and could not be customized as needed. Traditional methods relied on manually designed supervised algorithms, based on empirical experience, to identify waveform abnormalities and classify diseases, and were incapable of monitoring and alerting abnormalities in individual waveforms. Methods This research reconstructed the vector model for arbitrary leads using the phase space time delay method, enabling the model to arbitrarily combine signals as needed while possessing adaptive denoising capabilities. After employing automatically constructed machine learning algorithms and designing for rapid convergence, the model can identify abnormalities in individual waveforms and classify diseases, as well as detect and alert on abnormal waveforms. Result Effective noise elimination was achieved, obtaining a higher degree of loss function fitting. Afterwards, the detail differences of the electrocardiogram signal were amplified using a single-lead three-dimensional model. A cropping algorithm was used to remove waveforms severely interfered by external factors. Then, automatic neural network recognition was used. The automatic network generation model was designed effectively for different data types. The accuracy of patient identification is 98.2%, and the accuracy for healthy patients is 99.2%. Conclusion The elastic wavelet neural network can automatically denoise. Through the three-dimensional model, the detailed changes of electrocardiogram signals of different diseases can be observed. The cropping algorithm effectively identified the interfered and destroyed waveforms. The automatic neural network is capable of carrying out disease type classification and patient identity classification.

High-Resolution and Large-Dynamic Range Fiber-Optic Sensors Based on Dual-Mode Direct Spectrum Interrogation Method.

Conventional optical fiber temperature/strain sensors often have to make compromises between the resolution and the dynamic range. Here we present a new method that meets the measurement requirements for both high resolution and large dynamic range. A high-quality optical fiber Fabry-Perot Interferometer (FPI) constructed using a pair of chirped fiber Bragg gratings is employed as the sensor and a dual-mode direct spectrum interrogation method is proposed to identify the small drift of external temperature or strain. As a proof-of-concept illustration, a temperature resolution of 0.2 °C within 30-130 °C is demonstrated. For strain sensing, the resolution can be 10 µÎµ within 0-1000 µÎµ. The measurement resolution can be improved further by routinely increasing the reflectivity of the CFBG and the cavity length and the sensor can also be mass-produced. This new sensing schema not only resolves the conflict between the resolution and the dynamic range of fiber-optic temperature/strain sensors but can also be extended to other sensors and measurands.

Temperature-immune Fabry-Perot cavity sensor based on an opened hollow-core anti-resonant fiber.

A new approach to conquer the thermal phase drift of an optical fiber Fabry-Perot interferometer (FPI) sensor is proposed and experimentally demonstrated. By employing a hollow-core anti-resonant fiber (HC-ARF) and optimizing the fusion splicing (includes mode field adaptation) between the lead-in single-mode fiber (SMF) and the HC-ARF, a high spectral resolution (λ/Δλ ≈ 3.8 × 104) optical fiber air-cavity FPI sensor with a fringe visibility higher than 7 dB is constructed. To eliminate the thermal phase drift (i.e. temperature crosstalk) of the sensor that originates from the intrinsic thermal expansion effect of the silica material of the HC-ARF, the FPI air cavity is connected to the external environments, by which the effect of air expelling from the cavity with temperature increasing can well compensate the temperature-induced cavity elongation. As a result, the thermal phase drift of the FPI is reduced to zero at a temperature range of ∼ 80-110 °C and within the temperature range of 40-80 °C, the thermal phase drift is still halved compared with the sealed FPI cavity. The nearly zero thermal phase drift of a FPI at such a temperature range has never been achieved before, to our best knowledge. As a proof of concept, a temperature-immune fiber-optic strain sensor is demonstrated. This work offers a new and efficient approach to eliminate the thermal phase drift (i.e. temperature crosstalk) of a fiber-optic device, which may significantly improve the measurement accuracy and detection limit of fiber-optic FPI sensors. Furthermore, the principle and schema can be generalized to a wide variety of fiber-optic devices.

Identification of Genomic Regions Associated with Vine Growth and Plant Height of Soybean.

Vining growth (VG) and high plant height (PH) are the physiological traits of wild soybean that preclude their utilization for domesticated soybean breeding and improvement. To identify VG- and PH-related quantitative trait loci (QTLs) in different genetic resources, two populations of recombinant inbred lines (RILs) were developed by crossing a cultivated soybean, Zhonghuang39 (ZH39), with two wild soybean accessions, NY27-38 and NY36-87. Each line from the two crosses was evaluated for VG and PH. Three QTLs for VG and three for PH, detected in the ZH39 × NY27-38 population of the RILs, co-located on chromosomes 2, 17 and 19. The VG- and PH-related QTL in the ZH39 × NY36-87 population co-located on chromosome 19. A common QTL shared by the two populations was located on chromosome 19, suggesting that this major QTL was consistently selected for in different genetic backgrounds. The results suggest that different loci are involved in the domestication or adaptations of soybean of various genetic backgrounds. The molecular markers presented here would benefit the fine mapping and cloning of candidate genes underlying the VG and PH co-localized regions and thus facilitate the utilization of wild resources in breeding by avoiding undesirable traits.

Sulourea-coordinated Pd nanocubes for NIR-responsive photothermal/H2S therapy of cancer.

BACKGROUND: Photothermal therapy (PTT) frequently cause thermal resistance in tumor cells by inducing the heat shock response, limiting its therapeutic effect. Hydrogen sulfide (H2S) with appropriate concentration can reverse the Warburg effect in cancer cells. The combination of PTT with H2S gas therapy is expected to achieve synergistic tumor treatment. METHODS: Here, sulourea (Su) is developed as a thermosensitive/hydrolysable H2S donor to be loaded into Pd nanocubes through in-depth coordination for construction of the Pd-Su nanomedicine for the first time to achieve photo-controlled H2S release, realizing the effective combination of photothermal therapy and H2S gas therapy. RESULTS: The Pd-Su nanomedicine shows a high Su loading capacity (85 mg g-1), a high near-infrared (NIR) photothermal conversion efficiency (69.4%), and NIR-controlled H2S release by the photothermal-triggered hydrolysis of Su. The combination of photothermal heating and H2S produces a strong synergetic effect by H2S-induced inhibition of heat shock response, thereby effectively inhibiting tumor growth. Moreover, high intratumoral accumulation of the Pd-Su nanomedicine after intravenous injection also enables photothermal/photoacoustic dual-mode imaging-guided tumor treatment. CONCLUSIONS: The proposed NIR-responsive heat/H2S release strategy provides a new approach for effective cancer therapy.

Organ- and Age-Specific Differences of Dioscorea polystachya Compounds Measured by UPLC-QTOF/MS.

Dioscorea polystachya, named Chinese yam, is widely cultivated as a functional food and natural medicine in China. There is currently little information about the chemical characteristics of Dioscorea polystachya in different organs (tuber cortex and tuber flesh) and at various ages. In this study, an ultra-high-performance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry (UPLC-QTOF/MS) was used to profile chemical compounds in Dioscorea polystachya. As a result, thirty-eight compounds were detected in yam tuber cortex and tuber flesh. More compounds were detected in yam tuber cortex than in tuber flesh. Compounds such as dehydroepiandrosterone, allantoin and flavonoids were selected as biomarker candidates. Dehydroepiandrosterone was found more abundant in tuber flesh, while allantoin and flavonoids showed higher levels in tuber cortex. Furthermore, the levels of dioscin, malvalic acid and sucrose differed significantly among age groups and were highest in the tubers at 2 years. While the levels of allantoin, adenosine and glutamine increased with the growing years and were highest at 4 years. Thus, 2-year old Dioscorea polystachya tubers could be harvested to prepare dioscin, malvalic acid and sucrose supplements. The 4-year-old Dioscorea polystachya tubers would be the best choice for obtaining a large amount of allantoin and adenosine in industrial production.

Risk Factors Associated with Inadequate Bowel Preparation in Patients with Functional Constipation.

BACKGROUND: Constipation is a common reason of poor bowel preparation, which negatively influences the quality of colonoscopy. Risk factors for inadequate bowel preparation in constipated patients remain unclear. AIMS: This study aimed to investigate the high-risk factors that might influence the quality of bowel preparation in patients with functional constipation. METHODS: Consecutive patients with functional constipation who underwent colonoscopy between June 2016 and April 2017 were enrolled. A standard split dose of 4 l polyethylene glycol was used for bowel preparation. Patient- and procedure-related parameters were recorded. The primary outcome was an adequate rate of bowel preparation. Risk factors for inadequate bowel preparation were screened by multivariate logistic regression analysis. RESULTS: A total of 199 patients were included. Adequate bowel preparation was found in 62.8% (125/199) of patients. At multivariate analysis, Bristol stool form scale (BSFS) 1 [odds ratio (OR) 2.73, 95% confidence interval (CI) 1.26-5.90; P = 0.011], rectal pain score during defecation < 2 (OR 4.14, 95% CI 1.22-13.97; P = 0.022), and starting-to-defecation interval ≥ 4 h (OR 3.83, 95% CI 1.34-10.91; P = 0.012) were risk factors for inadequate bowel preparation in patients with constipation. For patients with no, 1, 2, or 3 risk factors, the rates of inadequate bowel preparation were 11%, 23%, 49%, and 65%, respectively. CONCLUSIONS: With the standard preparation regime, > 1/3 of patients with functional constipation had inadequate bowel cleansing. BSFS 1, rectal pain score during defecation < 2, and starting-to-defecation interval ≥ 4 h were identified as independent risk factors for inadequate bowel preparation in constipated patients. TRIAL REGISTRATION: ClinicalTrials.gov number NCT02842411.

High beam quality and high peak power Yb:YAG/Cr:YAG microchip laser.

The prospect for developing a passively Q-switched Yb:YAG/Cr:YAG monolithic microchip laser that operates at cryogenic temperature is theoretically analyzed. It is concluded that such a system has the potential to deliver laser pulses with improved energy and increased peak power in comparison with composite Yb:YAG/Cr:YAG or Nd:YAG/Cr:YAG devices that are operated at room temperature. Consequently, a cryogenically cooled Yb:YAG/Cr:YAG system is built and the emission performances are investigated. Laser pulses with 3.2 mJ energy, 6.1 MW peak power and high beam quality of M2 = 1.8 are achieved. By increasing the pump beam diameter, laser pulses with higher energy 32 mJ are obtained at 25 MW peak power with M2 = 5.4. To our knowledge, these are the best results obtained from passively Q-switched composite Yb:YAG/Cr:YAG monolithic microchip lasers.

Effects of Beta-Blockers on Cardiovascular Events and Mortality in Dialysis Patients: A Systematic Review and Meta-Analysis.

BACKGROUND: The effects of beta-blockers are uncertain in dialysis patients. Except antihypertension, ß-blockers may play a unique cardiovascular protective role in the population. This meta-analysis aimed to explore the effects of ß-blockers therapy in adult patients treated with dialysis. METHODS: We searched MEDLINE, EMBASE, and the Cochrane library from inception to May 2018 for randomized controlled trials (RCTs) and observational studies about the role of ß-blockers on all-cause mortality, cardiovascular mortality, cardiovascular events, or hospitalizations in dialysis population. RESULTS: Three RCTs and 9 observational studies met the predefined inclusion criteria. The RCTs showed significant association between ß-blockers and reduced all-cause mortality (n = 363; risk ratio [RR] 0.73; 95% CI 0.54-0.97), cardiovascular mortality (n = 314; RR 0.44; 95% CI 0.29-0.68), cardiovascular events (n = 363; RR 0.52; 95% CI 0.31-0.88), or hospitalizations (n = 314; RR 0.61; 95% CI 0.48-0.78) in dialysis patients. The observational studies showed significant difference in all-cause mortality (n = 35,233; hazard ratio [HR] 0.86; 95% CI 0.80-0.92) between ß-blockers and no ß-blockers therapy in patients with dialysis, while the studies showed no difference in cardiovascular mortality (n = 19,413; HR 0.79; 95% CI 0.57-1.11), or cardiovascular events (n = 87,060; HR 0.79; 95% CI 0.50-1.26). CONCLUSIONS: ß-blockers seem to be associated with reduced mortality in patients on dialysis. Both the statistical heterogeneity in observational studies and the small number of participants and studies in RCTs limit the strength of these findings. Video Journal Club "Cappuccino with Claudio Ronco" at  https://www.karger.com/Journal/ArticleNews/496083?sponsor=52.

Discrimination of Different Parts of Saffron by Metabolomic-Based Ultra-Performance Liquid Chromatography Coupled with High-Definition Mass Spectrometry.

In this study, the metabolite profiling of three different parts of Crocus sativus L. was measured by using ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC-QTof-MS/MS). Multivariate statistical analysis was used to distinguish among the samples from different parts. A total of 54 compounds were identified in tepals, stigmas and stamens by UPLC-QTof-MS/MS. The results stated that chemical characteristics of saffron were obviously diverse in terms of the parts of flower. Through analysis, coniferin and crocin-2 were special components in stigmas when compared to tepals and stamens. The content of flavonoids was high in tepals when compared with the stigmas. The tepal of saffron may processed as a source of flavonoids in the future. The research provided the basis for the theory that only the stigma can be used as medicine.

Same-Day Single Dose of 2 Liter Polyethylene Glycol is Not Inferior to The Standard Bowel Preparation Regimen in Low-Risk Patients: A Randomized, Controlled Trial.

OBJECTIVES: Split dose of 4 l polyethylene glycol (PEG) is currently the standard regimen for bowel preparation (BP). However, it may be unnecessary for patients without high risks (e.g., old age, constipation, and diabetes, and so on) for inadequate BP. The study aimed to compare the efficacy of bowel cleansing between low-risk patients receiving same-day, single dose of low-volume (SSL) PEG vs. standard regimen. METHODS: This prospective, randomized, observer-blinded, non-inferiority study enrolled low-risk patients in three centers. Patients undergoing colonoscopy were randomized (1:1) to the SSL or standard group. The primary outcome was adequate BP, defined by Boston Bowel Preparation Score (BBPS) ≥6 and each segmental score ≥2. Secondary outcomes included adverse events, cecal intubation rate, and patient willingness to repeat BP, and so on. RESULTS: Among 2,532 patients eligible for the study, 940 (37.1%) were at low risk and 792 (31.3%) at high risk for inadequate BP. The low-risk patients were randomly allocated to the SSL (n=470) or standard group (n=470). The baseline characteristics of the two groups were similar. Intention-to-treat analysis showed that adequate BP was achieved in 88.1% in the SSL group and 87.0% in the standard group (relative risk (RR) 1.10, 95% confidence interval (CI): 0.75-1.63, P=0.621). The overall BBPS was 7.3±1.2 and 7.3±1.3, respectively (P=0.948). No significant differences were found between the two groups with regards to the right, transverse, and left-segmental colon BBPS (all P>0.05). However, in terms of adverse events, patients in the SSL group reported less nausea (19.6% vs. 29.9%), vomiting (5.3% vs. 11.4%), and abdominal discomfort (2.2% vs. 6.0%) compared with those in the standard group. More patients in the SSL group were willing to repeat BP (94.0% vs. 89.5%, P=0.015). CONCLUSIONS: For low-risk patients, the SSL regimen was not inferior to the split dose of 4 l PEG for adequacy of BP. Single dose of low-volume regimen had significantly fewer adverse events. This simplified regimen may be preferable in the "easy-to prepare" population.

Stable ultra-broadband gain spectrum with wide-angle non-collinear optical parametric amplification.

Comparing with the non-collinear optical parametric amplification (NOPA), the gain bandwidth could be significantly enhanced by the wide-angle NOPA (WNOPA), i.e., with a divergent signal (WNOPA-S) or pump (WNOPA-P). In a uniaxial crystal, the spectral symmetry/asymmetry of WNOPA is introduced. In WNOPA-S, the ultra-broadband gain spectrum can be obtained in two phase-matching directions at both sides of the pump, however, the output is heavily angularly dispersed. In WNOPA-P, although the gain bandwidth enhancement is only achieved in one phase-matching direction, i.e., on the opposite side of the crystal axis, it is free of angular dispersion. The stabilities of the gain spectrum in NOPA and in WNOPA-P are experimentally compared and theoretically analyzed. Compared with NOPA, WNOPA-P supports an even broader and more stable gain spectrum, and compared with WNOPA-S, WNOPA-P is angular-dispersion-free. The conversation efficiency of WNOPA-P is the same as NOPA. We suppose WNOPA-P is ideally suitable for the amplification of stable ultra-broadband few-cycle pulse lasers.

12 mJ Yb:YAG/Cr:YAG microchip laser.

We have developed a quasi-continuous wave diode end-pumped cryogenically cooled Yb:YAG/Cr:YAG passively Q-switched microchip laser. A maximum energy of 12.1 mJ with 3.7 MW of peak power was obtained. To the best of our knowledge, this is the highest energy and peak power obtained by an Yb:YAG/Cr:YAG microchip laser so far.

PCSEL pumped coupling optics free Yb:YAG/Cr:YAG microchip laser.

The passively Q-switched operation of a cryogenically cooled Yb:YAG/Cr:YAG microchip laser was demonstrated with end pumping by a photonic crystal surface emitting laser (PCSEL). This laser generated 70 µJ/1.7 ns/3.2 kHz pulses with near diffraction limited beam quality (M2=1.1) at 1029.4 nm. There were no coupling optics between the microchip laser crystal and PCSEL, which made the system simple and compact.

Routine pre-procedural rectal indometacin versus selective post-procedural rectal indometacin to prevent pancreatitis in patients undergoing endoscopic retrograde cholangiopancreatography: a multicentre, single-blinded, randomised controlled trial.

BACKGROUND: Rectal indometacin decreases the occurrence of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). However, the population most at risk and the optimal timing of administration require further investigation. We aimed to assess whether pre-procedural administration of rectal indometacin in all patients is more effective than post-procedural use in only high-risk patients to prevent post-ERCP pancreatitis. METHODS: We did a multicentre, single-blinded, randomised controlled trial at six centres in China. Eligible patients with native papilla undergoing ERCP were randomly assigned in a 1:1 ratio (with a computer-generated list) to universal pre-procedural indometacin or post-procedural indometacin in only high-risk patients, with stratification by trial centres and block size of ten. In the universal indometacin group, all patients received a single dose (100 mg) of rectal indometacin within 30 min before ERCP. In the risk-stratified, post-procedural indometacin group, only patients at predicted high risk received rectal indometacin, immediately after ERCP. Investigators, but not patients, were masked to group allocation. The primary outcome was overall ocurrence of post-ERCP pancreatitis. The analysis followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT02002650. FINDINGS: Between Dec 15, 2013, and Sept 21, 2015, 2600 patients were randomly assigned to universal, pre-procedural indometacin (n=1297) or risk-stratified, post-procedural indometacin (n=1303). Overall, post-ERCP pancreatitis occurred in 47 (4%) of 1297 patients assigned to universal indometacin and 100 (8%) of 1303 patients assigned to risk-stratified indometacin (relative risk 0·47; 95% CI 0·34-0·66; p<0·0001). Post-ERCP pancreatitis occurred in 18 (6%) of 305 high-risk patients in the universal group and 35 (12%) of 281 high-risk patients in the risk-stratified group (p=0·0057). Post-ERCP pancreatitis was also less frequent in average-risk patients in the universal group (3% [29/992]), in which they received indometacin, than in the risk-stratified group (6% [65/1022]), in which they did not receive the drug (p=0·0003). Other than pancreatitis, adverse events occurred in 41 (3%; two severe) patients in the universal indometacin group and 48 (4%; one severe) patients in the risk-stratified group. The most common adverse events were biliary infection (22 [2%] patients vs 33 [3%] patients) and gastrointestinal bleeding (13 [1%] vs ten [1%]). INTERPRETATION: Compared with a risk-stratified, post-procedural strategy, pre-procedural administration of rectal indometacin in unselected patients reduced the overall occurrence of post-ERCP pancreatitis without increasing risk of bleeding. Our results favour the routine use of rectal indometacin in patients without contraindications before ERCP. FUNDING: National Key Technology R&D Program, National Natural Science Foundation of China.

Evolution, gene expression profiling and 3D modeling of CSLD proteins in cotton.

BACKGROUND: Among CESA-like gene superfamily, the cellulose synthase-like D (CSLD) genes are most similar to cellulose synthase genes and have been reported to be involved in tip-growing cell and stem development. However, there has been no genome-wide characterization of this gene subfamily in cotton. We thus sought to analyze the evolution and functional characterization of CSLD proteins in cotton based on fully sequenced cotton genomes. RESULTS: A total of 23 full-length CSLD proteins were identified in Gossypium raimondii, Gossypium arboreum and Gossypium hirsutum. The phylogenetic tree divided the CSLD proteins into five clades with strong support: CSLD1, CSLD2/3, CSLD4, CSLD5 and CSLD6. The total expression of GhCSLD genes was the highest in androecium & gynoecium (mostly contributed by CSLD1 and CSLD4) compared with other CSL genes. CSLD1 and CSLD4 were only highly expressed in androecium & gynoecium (A&G), and showed tissue-specific expression. The total expression of CSLD2/3, 5 and 6 was highest in the specific tissues. These results suggest that CSLD genes showed the different pattern of expression. Cotton CSLD proteins were subjected to different evolutionary pressures, and the CSLD1 and CSLD4 proteins exhibited episodic and long-term shift positive selection. The predicted three-dimensional structure of GrCSLD1 suggested that GrCSLD1 belongs to glycosyltransferase family 2. The amino acid residues under positive selection in the CSLD1 lineage are positioned in a region adjacent to the class-specific region (CSR), ß1-strand and transmembrane helices (TMHs) in the GrCSLD1structure. CONCLUSION: Our results characterized the CSLD proteins by an integrated approach containing phylogeny, transcriptional profiling and 3D modeling. The study added to the understanding about the importance of the CSLD family and provide a useful reference for selecting candidate genes and their associations with the biosynthesis of the cell wall in cotton.

Generation of 300 nm bandwidth 0.5 mJ pulses near 1 µm in a single stage gas filled hollow core fiber.

A simple and compact spectral-broadening system is presented that is based on a single-stage statically pressurized Ar filled hollow core fiber. By optimizing the inner diameter of the hollow core fiber, a bandwidth of 300 nm is obtained. This is the broadest bandwidth known to date with millijoule level energy near the 1-µm wavelength by a single stage gas filled hollow core fiber.

Design and simulation of a single-cycle source tunable from 2 to 10 micrometers.

We present the design of a novel single-cycle infrared source tunable from 2 to 10 µm. We simulate the optical parametric amplification (OPA) in BBO and the difference frequency generation (DFG) in AGS based on coupled second-order three-wave nonlinear propagation equations. We combine this with the unidirectional pulse propagation equation, which models the generation of the initial supercontinuum seed in sapphire and the final self-compression in YAG, ZnS, and GaAs, respectively. The obtained results indicate that single-cycle pulses can be produced in a tunable range of 2 to 10 µm.

Enhanced instructions improve the quality of bowel preparation for colonoscopy: a meta-analysis of randomized controlled trials.

BACKGROUND AND AIMS: The success of a colonoscopy is highly dependent on the quality of bowel preparation (BP). Many patients have poor BP due to non-compliance with regular instructions. Reports concerning the effects of enhanced instructions on BP quality are inconsistent. The aim of this meta-analysis was to compare BP quality between patients receiving enhanced instructions in addition to regular instructions and those who received regular instructions only. METHODS: MEDLINE, EMBASE, Web of Science, and the Cochrane Library were searched to identify relevant studies published for August 2015. The quality of BP (adequate/inadequate), adenoma detection rate, polyp detection rate, willingness to repeat preparation, and adverse events were estimated by using odds ratios (OR) and 95% confidence intervals (CI) with random effects models. RESULTS: Eight randomized controlled trials (n = 3795) were included. Patients who received enhanced instructions showed significantly better BP quality than those receiving only regular instructions (OR, 2.35; 95% CI, 1.65-3.35; P < .001). Subgroup analysis showed that the beneficial effects of enhanced instructions on BP quality were consistent among patients receiving different purgative types, administration methods, or diet restriction (all P < .05). Patients in the enhanced instructions group showed more willingness to repeat the preparation (OR, 1.91; 95% CI, 1.20-3.04; P = .006). CONCLUSIONS: Enhanced instructions significantly improved the quality of BP and willingness to repeat the preparation in patients undergoing colonoscopy. Factors related to patient instructions appear to be as important as the preparation method itself in improving BP quality.