Preoperative automatic reminder systems and impact on quality and compliance with colonoscopy preparation: A multicenter randomized controlled trial.

OBJECTIVES: Traditional preoperative reminding services have been applied to enhance the quality of bowel preparation for colonoscopy. In this study we aimed to evaluate the effectiveness of an automated electronic reminder system (E-reminder) on improving bowel preparation and the quality of preoperative education before colonoscopy. METHODS: From August 2021 to March 2022, 833 outpatients aged 50-75 years who underwent colonoscopy were included and randomly assigned to the E-reminder group and the control group. While the control group received routine preoperative education. The E-reminder group received automatic phone call, text message reminders and web services regarding the details of bowel preparation before the colonoscopic examination. The quality of bowel preparation was evaluated by the Boston Bowel Preparation Scale (BBPS) score and the previously validated objective evaluation scale of automatic BBPS (e-BBPS). RESULTS: In manual assessment, the rate of adequate bowel preparation was improved in the E-reminder group of intention-to-treat population using BBPS (60.7% vs 54.5%, P = 0.01). The percentage of objective evaluated adequate bowel preparation using e-BBPS in the E-reminder group of per-protocol population was significantly higher than that in the control group (76.9% vs 69.2%, P = 0.02). CONCLUSIONS: E-reminder was an effective tool to improve the quality of bowel preparation and compliance with medical instructions. It may be regarded as an efficient and convenient education tool, improving the quality of medical service.

Use of tunnel endoscopy for diagnosis of obscure submucosal esophageal adenocarcinoma: A case report and review of the literature with emphasis on causes of esophageal stenosis.

BACKGROUND: The tunnel endoscopic technique is the treatment of choice for submucosal tumors. However, the use of tunnel endoscopy to diagnose adenocarcinoma of the esophagus originating from the submucosa has not been well studied. CASE SUMMARY: A 74-year-old man who presented with dysphagia for half a year underwent a series of checks, such as gastroendoscopy, X-ray contrast examination of the upper digestive tract, endoscopic ultrasonography, high-resolution esophageal manometry, and positron emission computed tomography. It should be noted that the stenosis of the esophagus was too narrow for endoscopic ultrasound-guided fine needle aspiration. The cause remained undiagnosed. Eventually, the tunnel endoscopic technique was perform for the pathological examination in the submucosa and the final diagnosis was adenocarcinoma of the esophagus. The patient and family members chose expectant treatment due to the patient's age and the high costs of surgical treatment. CONCLUSION: Tunnel endoscopy could be used to diagnose tumors. Moreover, we review the literature to provide guidance regarding the causes of esophagostenosis.

[Effect of Fuzi Lizhong decoction in reducing liver injury of rats with non-alcoholic fatty liver via activating AMPK and suppressing NF-κBp65 pathway].

To investigate the protective effect and relevant mechanism of Fuzi Lizhong decoction (FZLZD) on liver of rats with non-alcoholic fatty liver disease (NAFLD), totally 32 male SPF Wistar rats were randomly divided into 4 groups: control group, model group, Yishanfu (YSF) group (200 mg·kg⁻¹·d⁻¹) and FZLZD group (10 g·kg⁻¹·d⁻¹), with 8 rats in each group. Rat model of NAFLD was prepared through the intragastric administration with fat emulsion for 4 weeks. After the successful modeling, rats in each administration group were continuously administered for 4 weeks. After 8 weeks, the rats in each group were put to death, and the pathological changes in liver tissue were detected by HE staining. Automatic biochemical analyzer was used to detect fasting serum lipid levels (T-Chol, TG, LDL-C, HDL-C) and liver functions (ALT, TP, ALB) of rats in each group. The rat liver index was calculated by weighing method. Enzyme-linked immunosorbent assay (ELISA) was used to detect the secretion of inflammatory cytokines TNF-α and IL-6 in liver tissue. Real-time quantitative PCR (qRT-PCR) was used to detect the mRNA expressions of fat metabolism-related factors SREBP-1c and FASN in liver tissue. Western blot was used to detect the p-AMPK and p-NF-κBp65 protein expressions in liver tissue. The results of HE staining showed that compared with the control group, the pathological changes in liver tissue in the model group rats were obvious; specifically, the outline of hepatic lobule was unclear, the hepatic cells showed diffuse steatosis of adipose tissue, and were accompanied by inflammatory infiltration, nuclear condensation, coloring deep; compared with the model group, liver lesions of all of the treatment groups were significantly alleviated; especially, the FZLZD group showed the most significant degree of remission. The results of serum test showed that the levels of serum lipids (T-Chol, TG, LDL-C, HDL-C), liver functions (ALT, TP, ALB) and liver index in model group were significantly higher than those in control group (P<0.01); compared with the model group, the indexes of serum lipid and liver function of rats in each treatment group were significantly decreased (P<0.01), and those in FZLZD group were significantly decreased (P<0.05), while those in YSF group were not significantly changed. The results of ELISA and qRT-PCR showed that compared with the control group, the secretion levels of TNF-α, IL-6 and the mRNA levels of SREBP-1c and FASN in the liver tissue of model group rats were significantly increased (P<0.01); compared with model group, the secretion levels of TNF-α, IL-6 and the mRNA levels of SREBP-1c, FASN in liver tissue of rats in each treatment group were significantly decreased (P<0.01); compared with YSF group, the secretion levels of TNF-α and IL-6 and the mRNA levels of SREBP-1c and FASN in FZLZD group were significantly different (P<0.01). Western blotting showed that compared with the model group, the protein expression of p-AMPK in liver tissue of rats in FZLZD group was significantly increased (P<0.01), while the protein expression of p-NF-κBp65 was significantly decreased (P<0.01). FZLZD can significantly improve hepatic pathological changes, reduce serum lipid levels, promote liver function and liver index in NAFLD rats, which may be associated with the activation of the AMPK pathway and thereby the inhibition of the expressions of SREBP-1c and FASN, and the inhibition of the NF-κBp65 pathway and thereby the reduction of the release of inflammatory factors.

Efficacy and safety of Xiangsha Liujunzi granules for functional dyspepsia: A multi-center randomized double-blind placebo-controlled clinical study.

AIM: To assess the efficacy and safety of a Chinese herbal medicine (CHM), Xiangsha Liujunzi granules, in the treatment of patients with functional dyspepsia (FD). METHODS: We performed a randomized, double-blind, placebo-controlled trial with patients from three centers. Two hundred and sixteen subjects diagnosed with FD according to ROME III criteria and confirmed by upper gastrointestinal endoscopy and spleen-deficiency and Qi-stagnation syndrome were selected to receive Xiangsha Liujunzi granules or placebo for 4 wk in a 2:1 ratio by blocked randomization. The subjects also received follow-up after the 4-wk intervention. Herbal or placebo granules were dissolved in 300 mL of water. Participants in both groups were administered 130 mL (45 °C) three times a day. Participants were evaluated prior to and following 4 wk of the intervention in terms of changes in the postprandial discomfort severity scale (PDSS) score, clinical global impression (CGI) scale score, hospital anxiety and depression scale (HADS) score, traditional Chinese medicine symptoms score (SS), scores of various domains of the 36-item short form health survey (SF-36), gastric emptying (GE) and any observed adverse effects. RESULTS: Compared with the placebo group, patients in the CHM group showed significant improvements in the scores of PDSS, HADS, SS, SF-36 and CGI scale (P < 0.05 or P < 0.01). They also showed the amelioration in the GE rates of the proximal stomach and distal stomach (P < 0.05 or P < 0.01). CONCLUSION: Xiangsha Liujunzi granules offered significant symptomatic improvement in patients with FD.

[Efficacy of tongfu mixture for treating post-ERCP pancreatitis: a clinical study].

OBJECTIVE: To observe the clinical efficacy of Tongfu Mixture (TM) for post-ERCP pancreatitis (PEP). METHODS: Totally 54 PEP patients were randomly assigned to the control group (treated by routine therapy, 26 cases) and the TM treatment group (treated by TM, 28 cases). Clinical indices including the alleviation time of abdominal pain/distention, gastrointestinal function recovery time, and the post-surgical length of stay were observed. Blood amylase (AMY), C-reactive protein (CRP), plasma endotoxin (PLS), TNF-alpha, and IL-6 were detected before surgery, 12 h, 48 h, and 96 h after surgery. RESULTS: The alleviation time of abdominal pain/distention, the gastrointestinal function recovery time, and the post-surgical length of stay were obviously shorter in the TM treatment group than those in the control group (P < 0.05). The recovery of AMY and CRP were better in the TM treatment group than in the control group at post-operative 48 h and 96 h (P < 0.05). The levels of LPS, TNF-alpha, and IL-6 were lower in the TM group than in the control group at post-operative 96 h (P < 0.05). CONCLUSION: TM showed better clinical efficacy and could significantly decrease the post-surgical length of stay. post-ERCP pancreatitis; integrative medicine; Tongfu Mixture

[Effects of low salinity stress on the antioxidant enzyme activities in juvenile Pampus argenteus liver and the APTase activities in its gill and kidney].

By decreasing water salinity gradually, the Pampus argenteus juveniles were cultured at water salinity 25, 20, 15 and 10, for 24 h, 48 h, 96 h and 120 h, respectively, with the activities of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPX), glutathione-S-transferase (GST), and glutathione reductase (GR) in liver and the activities of Na+/K+- and Ga2+/Mg2+ -ATPase in gill and kidney determined. With the lowering of water salinity and the elongation of treated time, the liver SOD and GST activities had a trend of decreasing after an initial increase (P < 0.05), while the CAT activity was lower than the control except that it had a slight increase at salinity 20 cultured for 24 h and at salinity 15 cultured for 48 h (P < 0.05). The liver GPX activity had an increasing trend (P < 0.05), while the GR activity at salinity 15 cultured for 24 h increased first and then fell down to a relatively low level (P < 0.05). The Na+/K+ - and Ga2+/Mg2+-ATPase activities in the gill and kidney also decreased after an initial increase (P < 0.05), only the increase of ATPase activity at the thresholds of water salinity and treated time differed between the two organs. The results indicated that the decrease of water salinity could effectively stimulate and enhance the antioxidant enzyme activities in juvenile P. argenteus liver and the ATPase activities in its gill and kidney, and thereby, could effectively eliminate the excessive reactive oxygen species (ROS), sustain the intracellular homeostasis, and minimize the body damage. However, characterized by certain specificity and time sequentiality, the activation of test enzymes could also be inhibited when the salinity varied beyond the tolerance range of the body.

[Therapeutic effects of Tiaozhong Granule on esophagus mucous membrane in rats with mixed reflux esophagitis and the mechanisms].

OBJECTIVE: To explore the mechanism of Tiaozhong Granule (TZG), a compound traditional Chinese herbal medicine, in treating rats with mixed reflux esophagitis. METHODS: Fifty-eight SD rats were randomly divided into untreated group (n=12), sham-operated group (n=10), TZG-treated group (n=12), Banxia Xiexin Decoction (BXXXD)-treated group (n=12) and cisapride-treated group (n=12). Mixed reflux esophagitis was induced by esophago-duodenum end-to-side anastomosis. Four weeks later, the rats were orally administered twice daily for 12 days. Pathological changes of esophagus mucous membrane were observed by using HE staining. The expressions of proliferating cell nuclear antigen (PCNA) and p53 in the esophagus tissue were detected by immunohistochemical SABC method. Spectrophotometric method was used to detect the content of malondialdehyde (MDA) and the activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in serum. RESULTS: Compared with the untreated group, pathological changes of esophagus mucous membrane were relieved in different degrees in TZG-treated group, BXXXD-treated group and cisapride-treated group. Content of MDA and expressions of PCNA and p53 were obviously decreased in the three treated groups (P<0.01), and the activities of SOD and GSH-Px were significantly increased in the three treated groups (P<0.05, P<0.01). TZG had better effects than cisapride in decreasing the content of MDA and increasing the activities of SOD and GSH-Px (P<0.05). TZG was better in aspect of reducing the expressions of PCNA and p53 than BXXXD and cisapride tablets (P<0.05). CONCLUSION: Tiaozhong Granule can treat mixed reflux esophagitis in rats, and its action mechanisms may be associated with decreasing the expressions of PCNA and p53 in esophagus mucous membrane, reducing the content of MDA and increasing the activities of SOD and GSH-Px in serum.