Research Progress of Bowel Preparation for Colonoscopy

Colorectal cancer ranks third in the global cancer data in 2020. Colorectal scope is the most effective method to diagnose colorectal diseases such as benign and malignant colorectal tumors. The poor quality of intestinal preparation causes an increased rate of missed diagnosis of colorectal tumors, reduces the rate of cecal intubation for colorectal examination, increases the discomfort, and reduces the compliance of re-examination. Therefore, we should try our best to improve the quality of intestinal preparation. This study reviewed the latest advances related to the preoperative preparation for colonoscopy. Recent research shows that smartphone apps can provide more detailed education and guidance on bowel preparation;Pre-packaged foods are more suitable as a way to eat before colonoscopy. The use of smaller doses, better taste of cathartic agents, and some auxiliary measures, combined with the patient’s situation to provide personalized intestinal preparation measures to improve the quality of intestinal preparation. Starting from the quality of colonoscopy bowel preparation, continuous improvement of patients’ tolerance to bowel preparation, continuous improvement of bowel preparation plan based on individual factors’ needs, and better communication with examined subjects by using existing scientific information technology, may be the hot spot of colonoscopy bowel preparation research in the next few years.

Research Progress of Bowel Preparation for Colonoscopy

Colorectal cancer ranks third in the global cancer data in 2020.Colorectal scope is the most effective method to diagnose colorectal diseases such as benign and malignant colorectal tumors.The poor quality of intestinal preparation causes an increased rate of missed diagnosis of colorectal tumors,reduces the rate of cecal intubation for colorectal examination,increases the discomfort,and reduces the compliance of re-examination.Therefore,we should try our best to improve the quality of intestinal preparation.This study reviewed the latest advances related to the preoperative preparation for colonoscopy.Recent research shows that smartphone apps can provide more detailed education and guidance on bowel preparation;Pre-packaged foods are more suitable as a way to eat before colonoscopy.The use of smaller doses,better taste of cathartic agents,and some auxiliary measures,combined with the patient’s situation to provide personalized intestinal preparation measures to improve the quality of intestinal preparation.Starting from the quality of colonoscopy bowel preparation,continuous improvement of patients’tolerance to bowel preparation,continuous improvement of bowel preparation plan based on individual factors’needs,and better communication with examined subjects by using existing scientific information technology,may be the hot spot of colonoscopy bowel preparation research in the next few years.

Withdrawal time in excellent or very poor bowel preparation qualities

AIM: To evaluate association(s) between withdrawal time and polyp detection in various bowel preparation qualities. METHODS: Retrospective cohort analysis of screening colonoscopies performed between January 2005 and June 2011 for patients with average risk of colorectal cancer. Exclusion criteria included patients with a personal history of adenomatous polyps or colon cancer, prior colonic resection, significant family history of colorectal cancer, screening colonoscopy after other abnormal screening tests such as flexible sigmoidoscopy or barium enema, and screening colonoscopies during in-patient care. All procedures were performed or directly supervised by gastroenterologists. Main measurements were number of colonic segments with polyps and total number of colonic polyps.RESULTS: Multivariate analysis of 8331 colonosco-pies showed longer withdrawal time was associated with more colonic segments with polyps in good(adjusted OR = 1.16; 95%CI: 1.13-1.19), fair(OR = 1.13; 95%CI: 1.10-1.17), and poor(OR = 1.18; 95%CI: 1.11-1.26) bowel preparation qualities. A higher number of total polyps was associated with longer withdrawal time in good(OR = 1.15; 95%CI: 1.13-1.18), fair(OR = 1.13; 95%CI: 1.10-1.16), and poor(OR = 1.20; 95%CI: 1.13-1.29) bowel preparation qualities. Longer withdrawal time was not associated with more colonic segments with polyps or greater number of colonic polyps in bowel preparations with excellent(OR = 1.07, 95%CI: 0.99-1.26; OR = 1.11, 95%CI: 0.99-1.24, respectively) and very poor(OR = 1.02, 95%CI: 0.99-1.12; OR = 1.05, 95%CI: 0.99-1.10, respectively) qualities.CONCLUSION: Longer withdrawal time is not associated with higher polyp number detected in colonoscopies with excellent or very poor bowel preparation quality.

Quality of colonoscopy performed by medical or surgical specialists and trainees in five Australian hospitals

BACKGROUND Ensuring colonoscopy procedure quality is vital to the success of screening and surveillance programmes for bowel cancer in Australia. However, the data on the performance of quality metrics, through adequate adenoma detection, bowel preparation, and procedure completion rates, in the Australian public sector is limited. Understanding these can inform quality improvement to further strengthen our capacity for prevention and early detection of colorectal cancer.AIM To determine the quality of colonoscopy in Australian teaching hospitals and their association with proceduralist specialty, trainee involvement, and location.METHODS We retrospectively evaluated 2443 consecutive colonoscopy procedure reports from 1 January to 1 April, 2018 from five public teaching tertiary hospitals in Australia(median 60 years old, 49% male). Data for bowel preparation quality,procedure completion rates, and detection rates of clinically significant adenomas, conventional adenomas, and serrated lesions was collected and compared to national criteria for quality in colonoscopy. Participating hospital, proceduralist specialty, and trainee involvement indicators were used for stratification. Data was analysed using Chi-squared tests of independence, MannWhitney U, One-way ANOVA, and multivariate binary logistic regression.RESULTS Fifty-two point two percent(n = 1276) and 43.3%(n = 1057) were performed by medical and surgical proceduralists respectively, whilst 29.8%(n = 728) involved a trainee. Inadequate bowel preparation affected 7.3% of all procedures. The procedure completion rate was 95.1%, which increased to 97.5% after adjustment for bowel preparation quality. The pooled cancer, adenoma, and serrated lesion detection rates for all five hospitals were 3.5%, 40%, and 5.9% respectively. Assessed hospitals varied significantly by patient age(P < 0.001), work-force composition(P < 0.001), adequacy of bowel preparation(P < 0.001), and adenoma detection rate(P < 0.001). Two hospitals(40%) did not meet all national criteria for quality, due to a procedure completion rate of 94.5% or serrated lesion detection rate of 2.6%. Although lower than the other hospitals, the difference was not significant. Compared with surgical specialists, procedures performed by medical specialists involved older patients [65 years(inter-quartile range, IQR 58-73) vs 64 years(IQR 56-71);P = 0.04] and were associated with a higher adenoma detection rate [odds ratio(OR) 1.53;confidence interval: 1.21-1.94;P < 0.001]. Procedures involving trainee proceduralists were not associated with differences in the detection of cancer, adenoma, or serrated lesions, compared with specialists, or according to their medical or surgical background. On multivariate analysis, cancer detection was positively associated with patient age(OR 1.04;P < 0.001) and negatively associated with medical compared to surgical proceduralists(OR 0.54;P = 0.04). Conventional adenoma detection rates were independently associated with increasing patient age(OR 1.04;P < 0.001), positively associated with medical compared to surgical proceduralists(OR 1.41;P = 0.002) and negatively associated with male gender(OR 0.53;P < 0.001).CONCLUSION Significant differences in the quality of colonoscopy in Australia exist, even when national benchmarks are achieved. The role of possible contributing factors, like procedural specialty and patient gender need further evaluation.

Colometer:A real-time quality feedback system for screening colonoscopy

AIM:To investigate the performance of a new software-based colonoscopy quality assessment system.METHODS:The software-based system employs a novel image processing algorithm which detects the levels of image clarity,withdrawal velocity,and level of the bowel preparation in a real-time fashion from live video signal.Threshold levels of image blurriness and the withdrawal velocity below which the visualization could be considered adequate have initially been determined arbitrarily by review of sample colonoscopy videos by two experienced endoscopists.Subsequently,an overall colonoscopy quality rating was computed based on the percentage of the withdrawal time with adequate visualization(scored 1-5;1,when the percentage was 1%-20%;2,when the percentage was 21%-40%,etc.).In order to test the proposed velocity and blurriness thresholds,screening colonoscopy withdrawal videos from a specialized ambulatory colon cancer screening center were collected,automatically processed and rated.Quality ratings on the withdrawal were compared to the insertion in the same patients.Then,3 experienced endoscopists reviewed the collected videos in a blinded fashion and rated the overall quality of each withdrawal(scored 1-5;1,poor;3,average;5,excellent) based on 3 major aspects:image quality,colon preparation,and withdrawal velocity.The automated quality ratings were compared to the averaged endoscopist quality ratings using Spearman correlation coefficient.RESULTS:Fourteen screening colonoscopies were assessed.Adenomatous polyps were detected in 4/14(29%) of the collected colonoscopy video samples.As a proof of concept,the Colometer software rated colonoscope withdrawal as having better visualization than the insertion in the 10 videos which did not have any polyps(average percent time with adequate visualization:79% ± 5% for withdrawal and 50% ± 14% for insertion,P < 0.01).Withdrawal times during which no polyps were removed ranged from 4-12 min.The median quality rating from the automated system and the reviewers was 3.45 [interquartile range(IQR),3.1-3.68] and 3.00(IQR,2.33-3.67) respectively for all colonoscopy video samples.The automated rating revealed a strong correlation with the reviewer's rating(ρ coefficient= 0.65,P = 0.01).There was good correlation of the automated overall quality rating and the mean endoscopist withdrawal speed rating(Spearman r coefficient= 0.59,P = 0.03).There was no correlation of automated overall quality rating with mean endoscopists image quality rating(Spearman r coefficient= 0.41,P = 0.15).CONCLUSION:The results from a novel automated real-time colonoscopy quality feedback system strongly agreed with the endoscopists' quality assessments.Further study is required to validate this approach.

A Rapid and Efficient Method for Preparing Genomic DNA from Microbacterium sp.

A new method was used to preparing genomic DNA from Microbacterium sp.quickly and efficiently.DNA quantity and purity was measured by UV absorbance.Integrity of the genomic DNA was tested by agarose gel eletrophoresis.The DNA prepared by this method was sufficiently pure for PCR.This method saves time and cost,practices easily as well.

Relationship of chemical properties of different peanut varieties to peanut butter storage stability

This study examined the effect of peanut quality on the storage stability of peanut butter. The quality of 17 varieties of peanuts was analyzed, and each was used to prepare peanut butter. For different storage temperatures and durations, stability of the peanut butter was measured according to three indicators： peroxide value, acid value, and centrifugal rate. The correlation between peanut components and peanut butter storage stability was also investigated. The results indicated significant differences in fatty acid composition between different varieties of peanut. Peanut butter prepared with high oleic peanuts（Kainong 17-15） had a significantly longer shelf life than that of other varieties. The significant correlation between the stability of peanut butter and peanut quality suggests that oleic acid and linoleic acid were the main influencing factors on stability. This study finds that the high oleic peanuts（HOP） is the most suitable variety for making peanut butter, which can allow farmers and processors to choose the specific variety for better product and shelf life.

THE DEVELOPMENT OF TCM AND QUALITY CONTROL OF TCM HERBS AND HERBAL PREPARATIONS IN TAIWAN

Traditional Chinese Medicine has been very popular in Taiwan in the past.TCM was incorporated in the National Insurance since 1995.Starting 2012,all new TCM physicians had to be graduated from TCM Department in Medical University.Currently,there are 6,442 TCM physicians practiced in 3,372 clinics and 95 hospitals.TCM only accounts for less than 4%of total National Health