Designing and Implementing an Advanced Big Data Governance Platform

Contemporary mainstream big data governance platforms are built atop the big data ecosystem components,offering a one-stop development and analysis governance platform for the collection,transmission,storage,cleansing,transformation,querying and analysis,data development,publishing,and subscription,sharing and exchange,management,and services of massive data.These platforms serve various role members who have internal and external data needs.However,in the era of big data,the rapid update and iteration of big data technologies,the diversification of data businesses,and the exponential growth of data present more challenges and uncertainties to the construction of big data governance platforms.This paper discusses how to effectively build a data governance platform under the big data system from the perspectives of functional architecture,logical architecture,data architecture,and functional design.

Optimized Deep Learning Approach for Efficient Diabetic Retinopathy Classification Combining VGG16-CNN

Diabetic retinopathy is a critical eye condition that,if not treated,can lead to vision loss.Traditional methods of diagnosing and treating the disease are time-consuming and expensive.However,machine learning and deep transfer learning(DTL)techniques have shown promise in medical applications,including detecting,classifying,and segmenting diabetic retinopathy.These advanced techniques offer higher accuracy and performance.ComputerAided Diagnosis(CAD)is crucial in speeding up classification and providing accurate disease diagnoses.Overall,these technological advancements hold great potential for improving the management of diabetic retinopathy.The study’s objective was to differentiate between different classes of diabetes and verify the model’s capability to distinguish between these classes.The robustness of the model was evaluated using other metrics such as accuracy(ACC),precision(PRE),recall(REC),and area under the curve(AUC).In this particular study,the researchers utilized data cleansing techniques,transfer learning(TL),and convolutional neural network(CNN)methods to effectively identify and categorize the various diseases associated with diabetic retinopathy(DR).They employed the VGG-16CNN model,incorporating intelligent parameters that enhanced its robustness.The outcomes surpassed the results obtained by the auto enhancement(AE)filter,which had an ACC of over 98%.The manuscript provides visual aids such as graphs,tables,and techniques and frameworks to enhance understanding.This study highlights the significance of optimized deep TL in improving the metrics of the classification of the four separate classes of DR.The manuscript emphasizes the importance of using the VGG16CNN classification technique in this context.

A Water Level Forecast of Pattani River in the Southern of Thailand by Deep Learning

Nowadays, the deep learning methods are widely applied to analyze and predict the trend of various disaster events and offer the alternatives to make the appropriate decisions. These support the water resource management and the short-term planning. In this paper, the water levels of the Pattani River in the Southern of Thailand have been predicted every hour of 7 days forecast. Time Series Transformer and Linear Regression were applied in this work. The results of both were the water levels forecast that had the high accuracy. Moreover, the water levels forecasting dashboard was developed for using to monitor the water levels at the Pattani River as well.

Bisacodyl plus split 2-L polyethylene glycol-citrate-simethicone improves quality of bowel preparation before screening colonoscopy

AIM:To compare the bowel cleansing efficacy,tolerability and acceptability of split 2-L polyethylene glycol(PEG)-citrate-simethicone(PEG-CS)plus bisacodyl(BIS)vs 4-L PEG for fecal occult blood test-positive screening colonoscopy.METHODS:This was a randomised,observer-blind comparative study.Two hundred and sixty-four subjects underwent screening colonoscopy(mean age 62.5±7.4years,male 61.7%).The primary objective of the study was to compare the bowel cleansing efficacy of the two preparations.Interventions:BIS plus PEG-CS:3 tablets of 5-mg BIS at 16:00,PEG-CS 1-L at 19:00 and 1-L at7:00,4-L PEG:3-L at 17:00,and 1-L at 7:00.Colonoscopy was carried out after 11:00,at least 3 h after the completion of bowel preparation.Bowel cleansing was evaluated using the Harefield Cleansing Scale.RESULTS:Bowel preparation was successful for 92.8%of subjects in the PEG-CS group and for 92.1%of subjects in the 4-L PEG(RR=1.01;95%CI:0.94-1.08).BIS+PEG-CS was better tolerated than 4-L PEG.A greater rate of patients in the BIS+PEG-CS group had no difficulty and/or were willing to repeat the same preparation compared to split-dose 4-L PEG group.Subjects in the BIS+PEG-CS group rated the prep as good or satisfactory in 90.6%as compared to 77%in the 4-L PEG(P=0.003).Subjects receiving BIS+PEGCS stated they fully adhered to instructions drinking all the 2-L solution in 97.1%compared with 87.3%in the4-L PEG(P=0.003).CONCLUSION:BIS plus split 2-L PEG-CS was as effective as but better tolerated and accepted than split4-L PEG for screening colonoscopy.This new procedure may increase the positive attitude and participation to colorectal cancer screening colonoscopy.

Combination could be another tool for bowel preparation?

Optimal bowel preparation increases the cecal intubation rate and detection of neoplastic lesions while decreasing the procedural time and procedural-related complications. Although high-volume polyethylene glycol(PEG) solution is the most frequently used preparation for bowel cleansing, patients are often unwilling to take PEG solution due to its large volume, poor palatability, and high incidence of adverse events, such as abdominal bloating and nausea. Other purgatives include osmotic agents(e.g., sodium phosphate, magnesium citrate, and sodium sulfate), stimulant agents(e.g., senna, bisacodyl, and sodium picosulfate), and prokinetic agents(e.g., cisapride, mosapride, and itopride). A combination of PEG with an osmotic, stimulant, or prokinetic agent could effectively reduce the PEG solution volume and increase patients' adherence. Some such solutions have been found in several published studies to not be inferior to PEG alone in terms of bowel cleansing quality. Although combination methods showed similar efficacy and safety, the value of these studies is limited by shortcomings in study design. New effective and well-tolerated combination preparations are required, in addition to rigorous new validated studies.

study to determine guidelines for pediatric colonoscopy

To investigated characteristics, diagnosis, bowel-cleansing preparation, sedation, and colonoscope length and diameter in Japanese pediatric patients receiving total colonoscopy. METHODSThe present study evaluated consecutive patients aged ≤ 15 years who had undergone their first colonoscopy in Kurume University between January 2007 and February 2015. Data were retrospectively analyzed. We identified 110 pediatric patients who had undergone colonoscopy that had reached the cecum, allowing the observation of the total colon. RESULTSHematochezia, abdominal pain, and diarrhea were the most common symptoms. For bowel-cleansing preparation, pediatric patients aged ≤ 12 years were treated with magnesium citrate, and patients aged 13-15 years were treated with polyethylene glycol 4000. For sedation, thiamylal with pentazocine, which has an analgesic effect, was used in patients aged ≤ 6 years, and midazolam with pentazocine was used in patients aged ≥ 7 years. Regarding the choice of endoscope, short and thin endoscopes were selected for younger patients, particularly patients aged ≤ 3 years. Positive diagnoses were made in 78 patients (70.9%). Inflammatory bowel disease (n = 49, 44.5%), including ulcerative colitis (n = 37, 33.6%) and Crohn’s disease (n = 12, 10.9%), was the most common diagnosis. CONCLUSIONColonoscopy offers a high diagnostic capability for pediatric patients with gastrointestinal symptoms. The selection of appropriate management the performance of colonoscopy is important in pediatric patients.

Review of small-bowel cleansing scales in capsule endoscopy: A panoply of choices

Evaluation of the quality of small-bowel cleansing is required to assess the reliability of findings in capsule endoscopy(CE). Moreover, consensus regarding the need of intestinal preparation for CE remains to be achieved. The presence of multiple grading scales for smallbowel preparation in CE, which are time-consuming and complicated, adds difficulty to the comparison of different small-bowel cleansing regimens and their application in clinical practice. Nowadays, a validated scale universally accepted for grading small-bowel cleansing is lacking. In fact, there are numerous grading systems with very different technical characteristics, namely, the parameters and the portion of the CE video that are analyzed, the objectivity of the analysis, the lesser or greater dependency on the operator, and the validation of the score. The authors performed a review which aims to systematize and summarize currently available smallbowel grading scales in CE.

Hyperphosphatemia after sodium phosphate laxatives in low risk patients:Prospective study

AIM:To establish the frequency of hyperphosphate-mia following the administration of sodium phosphate laxatives in low-risk patients. METHODS:One hundred consecutive ASAⅠ-Ⅱindividuals aged 35-74 years,who were undergoing colonic cleansing with oral sodium phosphate(OSP) before colonoscopy were recruited for this prospective study.Exclusion criteria:congestive heart failure, chronic kidney disease,diabetes,liver cirrhosis,intestinal obstruction,decreased bowel motility,increased bowel permeability,and hyperparathyroidism.The day before colonoscopy,all the participants entered a 24-h period of diet that consisted of 4 L of clear fluids with sugar or honey and 90 mL(60 g)of OSP in two 45-mL doses,5 h apart.Serum phosphate was measured before and after the administration of the laxative. RESULTS:The main demographic data(mean±SD) were:age,58.9±8.4 years;height,163.8±8.6 cm; weight,71±13 kg;body mass index,26±4;women, 66%.Serum phosphate increased from 3.74±0.56 to 5.58±1.1 mg/dL,which surpassed the normal value (2.5-4.5 mg/dL)in 87%of the patients.The highest serum phosphate was 9.6 mg/dL.Urea and creatinine remained within normal limits.Post-treatment OSP se-rum phosphate concentration correlated inversely with glomerular filtration rate(P<0.007,R 2=0.0755),total body water(P<0.001,R 2=0.156)and weight(P< 0.013,R 2=0.0635). CONCLUSION:In low-risk,well-hydrated patients, the standard dose of OSP-laxative-induced hyperphos-phatemia is related to body weight.

Novel frontiers of agents for bowel cleansing for colonoscopy

The incidence of colorectal cancer(CRC)is characterized by rapid declines in the wake of widespread screening.Colonoscopy is the gold standard for CRC screening,but its accuracy is related to high quality of bowel preparation(BP).In this review,we aimed to summarized the current strategy to increase bowel cleansing before colonoscopy.Newly bowel cleansing agents were developed with the same efficacy of previous agent but requiring less amount of liquid to improve patients’acceptability.The role of the diet before colonoscopy was also changed,as well the contribution of educational intervention and the use of adjunctive drugs to improve patients’tolerance and/or quality of BP.The review also described BP in special situations,as lower gastrointestinal bleeding,elderly people,patients with chronic kidney disease,patients with inflammatory bowel disease,patients with congestive heart failure,inpatient,patient with previous bowel resection,pregnant/lactating patients.The review underlined the quality of BP should be described using a validate scale in colonoscopy report and it explored the available scales.Finally,the review explored the possible contribution of bowel cleansing in post-colonoscopy syndrome that can be related by a transient alteration of gut microbiota.Moreover,the study underlined several points needed to further investigations.

Colonic preparation before colonoscopy in constipated and non-constipated patients:A randomized study

AIM: To compare the efficacy of different doses of sodium phosphate(NaP) and polyethylenglicol(PEG) alone or with bisacodyl for colonic cleansing in constipated and non-constipated patients.METHODS: Three hundred and forty-nine patients,older than 18 years old,with low risk for renal damage and who were scheduled for outpatient colonoscopy were randomized to receive one of the following preparations(prep): 90 mL of NaP(prep 1);45 mL of NaP + 20 mg of bisacodyl(prep 2);4 L of PEG(prep 3) or 2 L of PEG + 20 mg of bisacodyl(prep 4).Randomization was stratified by constipation.Patients,endoscopists,endoscopists' assistants and data analysts were blinded.A blinding challenge was performed to endoscopist in order to reassure blinding.The primary outcome was the efficacy of colonic cleansing using a previous reported scale.Secondary outcomes were tolerability,compliance,side effects,endoscopist perception about the necessity to repeat the study due to an inadequate colonic preparation and patient overall perceptions.RESULTS: Information about the primary outcome was obtained from 324 patients(93%).There were no significant differences regarding the preparation quality among different groups in the overall analysis.Compliance was higher in the NaP preparations being even higher in half-dose with bisacodyl: 94%(prep 1),100%(prep 2),81%(prep 3) and 87%(prep 4)(2 vs 1,3 and 4,P < 0.01;1 vs 3,4,P < 0.05).The combination of bisacodyl with NaP was associated with insomnia(P = 0.04).In non-constipated patients the preparation quality was also similar between different groups,but endoscopist appraisal about the need to repeat the study was more frequent in the half-dose PEG plus bisacodyl than in whole dose NaP preparation: 11%(prep 4) vs 2%(prep 1)(P < 0.05).Compliance in this group was also higher with the NaP preparations: 95%(prep 1),100%(prep2) vs 80%(prep 3)(P < 0.05).Bisacodyl was associated with abdominal pain: 13%(prep 1),31%(prep 2),21%(prep 3) and 29%(prep 4),(2,4 vs 1,2,P < 0.05).In constipated patients the combination of NaP plus bisacodyl presented higher rates of satisfactory colonic cleansing than whole those PEG: 95%(prep 2) vs 66%(prep 3)(P = 0.03).Preparations containing bisacodyl were not associated with adverse effects in constipated patients.CONCLUSION: In non-constipated patients,compliance is higher with NaP preparations,and bisacodyl is related to adverse effects.In constipated patients NaP plus bisacodyl is the most effective preparation.

A novel cleansing score system for capsule endoscopy

AIM:To suggest a new cleansing score system for small bowel preparation and to evaluate its clinical efficacy.METHODS:Twenty capsule endoscopy cases were reviewed and small bowel preparation was assessed with the new scoring system.For the assessment,two visual parameters were used:proportion of visualized mucosa and degree of obscuration.Representative frames from small bowel images were serially selected and scored at 5-min intervals.Intraclass correlation coefficient(ICC)was obtained to assess the reliability of the new scoring system.For efficacy evaluation and validation,scores of our new scoring system were compared with another previously reported cleansing grading system.RESULTS:Concordance with the previous system,inter-observer agreement,and intra-patient agreement were excellent with ICC values of 0.82,0.80,and 0.76,respectively.The intra-observer agreements at four-week intervals were also excellent.The cutoff value of adequate image quality was found to be 2.25.CONCLUSION:Our new scoring system is simple,efficient,and can be considered to be applicable in clinical practice and research.

Impact of simethicone on bowel cleansing during colonoscopy in Chinese patients

BACKGROUND Four-liter polyethylene glycol(PEG)solutions are effective for bowel cleansing,but their large volume might hinder patient compliance.Due to the unique features of Asians,4 L PEG might be a suboptimal bowel preparation in predominantly ethnically Asian countries.In view of this,a balance should be achieved between the volume and effectiveness.The ideal bowel cleansing regimen for a colonoscopy has yet to be determined in a Chinese population.AIM To compare the cleansing efficacy of 3 L PEG plus simethicone with 4 L PEG.METHODS A total of 291 patients were randomly allocated to two groups:Group 1(n=145)received 4 L split-dose PEG(4-P);group 2(n=146)received 3 L split-dose PEG plus simethicone(3-PS).Bowel-cleansing efficacy was evaluated by endoscopists using the Boston bowel preparation scale(BBPS)and the bubbles score.RESULTS Although there were no significant differences in the total BBPS score or the adequate rate of bowel preparation between the two groups,the BBPS score of the right-side colon was significantly higher in the 3-SP group(2.37±0.54 vs 2.21±0.78;P=0.04).Moreover,the use of simethicone significantly reduced bubbles in all colon segments(P<0.001).The mean withdrawal time was significantly shorter in the 3-PS group(8.8±3.4 vs 9.6±2.3;P=0.02).Furthermore,significantly more proximal adenomas were detected in the 3-PS group(53.6%vs 45.7%;P=0.03).In addition,the proportions of patients with nausea and bloating were significantly lower in the 3-SP group(P<0.01 for both).More patients in the 3-PS group expressed willingness to repeat the bowel preparation(87.7%vs 76.6%,P=0.01).CONCLUSION Three-liter PEG shows satisfactory bowel cleansing despite the decrease in dosage,and addition of simethicone with better bubble elimination and enhanced patient acceptance offers excellent potential impact on the detection of proximal adenomas in Chinese patients.

Efficient and Effective 4D Trajectory Data Cleansing

As the rapid development of aviation industry and newly emerging crowd-sourcing projects such as Flightradar24 and FlightAware,large amount of air traffic data,particularly four-dimension(4D)trajectory data,have become available for the public.In order to guarantee the accuracy and reliability of results,data cleansing is the first step in analyzing 4D trajectory data,including error identification and mitigation.Data cleansing techniques for the 4D trajectory data are investigated.Back propagation(BP)neural network algorithm is applied to repair errors.Newton interpolation method is used to obtain even-spaced trajectory samples over a uniform distribution of each flight’s 4D trajectory data.Furthermore,a new method is proposed to compress data while maintaining the intrinsic characteristics of the trajectories.Density-based spatial clustering of applications with noise(DBSCAN)is applied to identify remaining outliers of sample points.Experiments are performed on a data set of one-day 4D trajectory data over Europe.The results show that the proposed method can achieve more efficient and effective results than the existing approaches.The work contributes to the first step of data preprocessing and lays foundation for further downstream 4D trajectory analysis.

Pre-colonoscopy special guidance and education on intestinal cleaning and examination in older adult patients with constipation

BACKGROUND The prevalence of constipation in the Chinese population over 60 years of age is 11.5%, and this prevalence increases with age, which seriously affects the quality of life in older adults. Therefore, reducing the incidence of constipation in older adults is necessary to promote a healthy lifestyle as well as biochemical health.AIM To explore the value of preoperative guidance and education to improve the effects of bowel cleaning in older adult patients undergoing colonoscopy.METHODS In this study, 160 older adult patients with constipation requiring colonoscopy at Shandong Provincial Hospital between January 2019 and March 2021 were selected and randomly divided into a study group and a control group, with 80patients in each group. The study group received medication guidance and targeted educational guidance before the operation, while the control group received only medication and dietary guidance. The baseline data, colonoscopy duration, bowel preparation compliance, Boston bowel preparation(BBPS)assessment score, intestinal bubble score, the incidence of adverse reactions during bowel preparation, and nursing appointment satisfaction were compared between the two groups.RESULTS The colonoscopy duration times and intestinal bubble scores of the study group were shorter than those of the control group, with statistically significant differences. The BBPS scores for the right, left, and interrupted colon in the study group were also higher than those in the control group, and the difference was statistically significant. Additionally, the study group had a higher rate of liquid diet one day before the examination, higher rate of correct bowel-clearing agent dilution method, higher rate of accurate time of ingesting the bowel-clearing agent, and a higher proportion of patients ingesting bowelclearing agent at the specified time than the control group, with statistically significant differences.The incidence of nausea and vomiting during bowel clearance in the study group was significantly lower than that in the control group. The incidence of abdominal pain, abdominal distension,dizziness, and fatigue was compared between the two groups, but the difference was not statistically significant. The scores of service attitude, detailed notification of dietary precautions, clear and easy-to-understand health educational content, and receiving care and comfort in the study group were significantly higher than those in the control group.CONCLUSION Preoperative special guidance and education were shown to significantly improve bowel clearance and compliance and reduce the incidence of adverse reactions in older adult patients with constipation undergoing colonoscopy. These factors are beneficial for improving patient satisfaction with nursing services.

Cleansing efficacy and safety of bowel preparation protocol using sodium picosulfate/magnesium citrate considering subjective experiences:An observational study

BACKGROUND Research data from patient reports indicate that the least bearable part of colonoscopy is the administration of laxatives for bowel preparation.AIM To observe the intestinal cleansing efficacy and safety of sodium picosulfate/magnesium citrate and to discuss the patients’experiences due to the procedure.METHODS Subjects hospitalized in the International Medical Center Ward of Peking University International Hospital,Beijing,China,from April 29 to October 29,2020,for whom the colonoscopy was planned,were enrolled.Bowel preparation was performed using sodium picosulfate/magnesium citrate.The effect of bowel cleansing was evaluated according to the Ottawa Bowel Preparation Scale,defecation conditions and adverse reactions were recorded,and the comfort level and subjective satisfaction concerning medication were evaluated by the visual analogue scale/score(VAS).RESULTS The bowel preparation procedure was planned for all patients enrolled,which included 42 males and 22 females.The results showed an average liquid rehydration volume of 3000 mL,an average onset of action for the first dose at 89.04 min,an average number of bowel movements of 4.3 following the first dose,an average onset of action for the second dose at 38.90 min and an average number of bowel movements of 5.0 after the second dose.The total average Ottawa Bowel Preparation Scale score was 3.6,with 93.55%of bowel preparations in the“qualified”and 67.74%in the“excellent”grade.The average VAS score of effect on sleep was 0,and the average VAS score of perianal pain was also 0.The average VAS score for ease of taking and taste perception of the bowel cleanser was 10.Side effects included mild to moderate nausea(15.63%),mild vomiting(4.69%),mild to moderate abdominal pain(7.81%),mild to moderate abdominal distension(20.31%),mild palpitation(7.81%)and mild dizziness(4.69%).CONCLUSION Sodium picosulfate/magnesium citrate is effective and safe for bowel preparation before colonoscopy with high subjective patient acceptance,thus improving overall patient compliance.

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.

Pediatric bowel preparation: Sodium picosulfate, magnesium oxide, citric acid vs polyethylene glycol, a randomized trial

BACKGROUND Bowel preparation in children can be challenging.AIM To describe the efficacy, safety, and tolerability of sodium picosulfate, magnesium oxide, and citric acid(SPMC) bowel preparation in children.METHODS Phase 3, randomized, assessor-blinded, multicenter study of low-volume, divided dose SPMC enrolled children 9-16 years undergoing elective colonoscopy. Participants 9-12 years were randomized 1:1:1 to SPMC ? dose × 2, SPMC 1 dose × 2, or polyethylene glycol(PEG). Participants 13-16 years were randomized 1:1 to SPMC 1 dose × 2 or PEG. PEG-based bowel preparations were administered per local protocol. Primary efficacy endpoint for quality of bowel preparation was responders(rating of ‘excellent' or ‘good') by modified Aronchick Scale. Secondary efficacy endpoint was participant's tolerability and satisfaction from a 7-item questionnaire. Safety assessments included adverse events(AEs) and laboratory evaluations.RESULTS 78 participants were randomized, 48 were 9-12 years, 30 were 13-16 years. For the primary efficacy endpoint in 9-12 years, 50.0%, 87.5%, and 81.3% were responders for SPMC ? dose × 2, SPMC 1 dose × 2, and PEG groups, respectively. Responder rates for 13-16 years were 81.3% for SPMC 1 dose × 2 and 85.7% for PEG. Overall, 43.8% of participants receiving SPMC 1 dose × 2 reported it was ‘very easy' or ‘easy' to drink, compared with 20.0% receiving PEG. Treatment-emergent AEs were reported by 45.5% of participants receiving SPMC 1 dose × 2 and 63.0% receiving PEG.CONCLUSION SPMC was an efficacious and safe for bowel preparation in children 9-16 years, with comparable efficacy to PEG. Tolerability for SPMC was higher compared to PEG.

Gastrointestinal endoscopy in cirrhotic patient:Issues on the table

Patients with liver cirrhosis are fragile and present specific clinical hallmarks.When undergoing to gastrointestinal(GI)endoscopy,these subjects require an individual pre evaluation,taking into account:Level of haemostasis impairment,the individual risk of infection,the impact of sedation on hepatic encephalopathy and other factors.The overall assessment of liver function,employing common scoring systems,should be also assessed in the preprocedural phase.Beside some common general problems,regarding GI endoscopy in cirrhotic subjects,also specific issues are present for some frequent indications or procedures.For instance,despite an increased incidence of adenomas in cirrhosis,colon cancer screening remains suboptimal in subjects with this disease.Several studies in fact demonstrated liver cirrhosis as a negative factor for an adequate colon cleansing before colonoscopy.On the other hand,also the routine assessment of gastroesophageal varices during upper GI endoscopy presents some concern,since important inter-observer variability or incomplete description of endoscopic findings has been reported in some studies.In this review we discussed in details the most relevant issues that may be considered while performing general GI endoscopic practice,in patient with cirrhosis.For most of these issues there are no guidelines or clear indications.Moreover until now,few studies focused on these aspects.We believe that targeting these issues with corrective measures may be helpful to develop a tailored endoscopic approach for cirrhosis,in the future.

Modern Mild Skin Cleansing

Surfactant, an abbreviation for the surface-active agent, is utilized in almost every industry. It brings two immiscible phases such as oil and water into one single homogeneous phase, leading to various industrial applications such as food, painting, coating, drug delivery as well as cosmetics. The use of surfactants in skin cleansing is very common to keep skin healthy. Their function herein is to lower the interfacial tension at the dirt/water and skin/water interfaces, thereby detaching dirt, extra sebum or oils from the skin surface. But this application could bring side effects attributed to the penetration of surfactants into the skin, including skin proteins denaturation, stratum corneum lipids removal or even lipids organization disruption in the stratum corneum. This review summarizes modern mild skin cleansing technologies, which address the side effects brought by the surfactants.

Polyethylene glycol 3350 based colon cleaning protocol: 2 d vs 4 d head to head comparison

AIM: To compare between 2 and 4 d colon cleansing protocols. METHODS: Children who were scheduled for colonoscopy procedure (2010-2012) for various medical reasons, were recruited from the pediatric gastroenterology clinic at Marshall University School of Medicine, Huntington, WV. Exclusion criteria were patients who were allergic to the medication used in the protocols [polyethylene glycol (PEG) 3350, Bisacodyl], or chil- dren with metabolic or renal diseases. Two PEG 3350 protocols for 4 d (A) and 2 d (B) were prescribed as previously described. A questionnaire describing the volume of PEG consumed, clinical data, and side effects were recorded. Colon preparation was graded by two observers according to previously described method. Main outcome measurements: Rate of adequate colon preparation. RESULTS: A total of 78 patients were considered for final calculation (group A: 40, group B: 38). Age and stool consistency at the last day was comparable in both groups, but the number of stools/day was significantly higher in group B (P = 0.001). Adequate colonpreparation was reached in 57.5% (A) and 73.6% (B), respectively (P = 0.206). Side effects were minimal and comparable in both groups. There was no difference in children's age, stool characteristics, or side effects between the children with adequate or inadequate colon preparation. Correlation and agreement between observers was excellent (Pearson correlation = 0.972, kappa = 1.0). CONCLUSION: No difference between protocols was observed, but the 2 d protocol was superior for its shorter time. Direct comparison between different colon cleansing protocols is crucial in order to establish the "gold standard" protocol for children.