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We report a simple method for the synthesis of Cu2Te NTs under mild conditions without surfactant. The product has good crystallinity and uniform size. The photoelectric response time is significantly faster than that reported in previous studies for other tellurides.

Three models based on patient-related factors have been developed to predict inadequate bowel preparation (BP). However, the performance of the models seems suboptimal. This study aimed to develop a novel preparation-related model and compare it with the available patient-related models.Patients receiving standard BP were prospectively enrolled from five endoscopic centers. Patient-related and preparation-related factors for inadequate BP (defined by segmental Boston Bowel Preparation Scale score 2) were identified by logistic regression. A preparation-related model was derived and internally validated in 906 patients. The comparisons of models were assessed by discrimination and calibration. The preparation-related model was also externally validated.Several patient-related factors (male and American Society of Anesthesiologists Physical Status Classification System score ≥ 3) and preparation-related factors (drinking-to-stool interval ≥ 3 h, preparation-to-colonoscopy interval ≥ 6 h, and poor rectal effluent) were found to be independently associated with inadequate BP (all P 0.05). C-statistics was 0.81 for the preparation-related model in the training cohort (n = 604), significantly higher than three available patient-based models (0.58-0.61). Similar results were observed in the validation cohort (n = 302). Calibration curves showed close agreement in the preparation-related model (RA new preparation-related model (consisting of drinking-to-stool interval ≥ 3 h, preparation-to-colonoscopy interval ≥ 6 h, and poor last rectal effluent) was developed and performed better than three available patient-related models. This easy-to-use model may be a useful decision-support tool on individualized plans in patients undergoing BP.

Functional dyspepsia symptom diary (FDSD) is a newly designed questionnaire of functional dyspepsia (FD). The relationships between FDSD and other FD-related questionnaires and patient-reported severity remain unclear. This study aims to investigate the correlations between FDSD and other questionnaires and to determine the relationships between FDSD and FD severity.Consecutive outpatients with FD were prospectively enrolled in four tertiary hospitals. All patients were evaluated by six FD-related questionnaires, including FDSD, Dyspepsia Symptom Severity Index (DSSI), Gastrointestinal Symptom Rating Scale, Short-Form Nepean Dyspepsia Index, and Hamilton Depression and Anxiety Scale (HAMD and HAMA). The severity of FD was also graded as mild, moderate, and severe by patients themselves. Correlations between different scores were assessed by Spearman correlation coefficient (ρ), and risk factors for patient-reported severity were identified.For 512 enrolled FD patients, the overall median FDSD score was 19 (2-42). FDSD was well correlated with DSSI (ρ = 0.64) and fairly correlated with the other four scores (ρ = 0.32-0.55) (all P 0.001). Mild, moderate, and severe FD were reported by 18.5%, 55.9%, and 25.6% of patients, respectively. There were seven factors associated with the severe FD, including education level, duration, and subtypes of FD, prior treatment, FDSD, HAMD, and HAMA scores (all P 0.10). FDSD ≥ 20 (odds ratio [OR] 3.3, 95% confidence interval [CI]: 2.0-5.2, P 0.001) and HAMD ≥ 13 (OR 2.9, 95% CI: 1.8-4.6, P 0.001) were independently associated with patient-reported severe FD.This study firstly revealed that the newly developed FDSD correlated with other FD-related questionnaires. FDSD ≥ 20 and HAMD ≥ 13 were independently associated with severe FD reported by patients (clinicaltrials.gov number: NCT04953975).

Uniform ZnTe microspheres with 1.7 μm diameter were prepared by a PVP-assisted solvothermal process. By assembling ZnTe microspheres into photodetectors, the rise time and decay time of the photodetector were 96.93 ms and 103.57 ms, respectively.

Exploration of efficient polymerization strategies is critical in polymer science. Alkyne polycyclotrimerization reactions have become powerful synthetic tools for constructing hyperbranched polyarylenes (hb-PAs). However, most of the polymerization reactions suffer...

To explore the efficacy and safety of palbociclib combined with endocrine therapy (ET) in advanced breast cancer (ABC). We conducted a retrospective study involving patients with hormone receptor-positive (HR+) and human epidermal growth factor receptor 2-negative (HER2-) ABC who received palbociclib combined with ET in the first- to third-line at three centers in China between January 2018 and October 2020. A total of 151 patients were included in this study. The median age of the patients at palbociclib initiation was 56 years (range 30-86 years) with a median follow-up of 10.9 months (range 2.0-41.2 months). Among these patients, 88 patients received palbociclib combined with ET as first-line therapy, and achieved a median progression-free survival (mPFS) of 19.8 months and an objective response rate (ORR) of 40.9%, meanwhile, in the first-line setting, 62 patients received palbociclib at an initial dose of 125 mg, achieving a mPFS of 20.9 months and an ORR of 46.8%. There were 39 and 24 patients who received palbociclib combined with ET as second- and third-line therapy, the mPFS were 10.0 months and 6.1 months, respectively. The most common and serious adverse events (AEs) were leukopenia and neutropenia. A total of 64 patients (42.4%) underwent palbociclib dose reduction due to AEs. Palbociclib combined with ET is an effective therapeutic regimen for HR+/HER2- ABC, particularly in the first-line setting with palbociclib initial dose of 125 mg, and AEs were manageable.

Background The 5–5–1 criteria (> 5 minutes – 5 cannulation attempts – 1 unintended pancreas duct cannulation) were proposed by the European Society of Gastrointestinal Endoscopy to define difficult biliary cannulation. However, the criteria may be inappropriate for trainee-involved procedures. We developed criteria for difficult cannulation in trainee-involved procedures. Methods Patients undergoing biliary cannulation with or without trainee involvement were eligible. Procedures that might be too easy (e. g. fistula) or too difficult (e. g. altered anatomy) were excluded. The primary outcome was difficult cannulation, defined as cannulation time, attempts, or inadvertent pancreatic duct (PD) cannulation exceeding the 75 % percentile of each variable. Propensity score matching (PSM) analysis was used. Results After PSM, there were 1596 patients in each group. Trainee-involved procedures had longer median (interquartile range [IQR]) cannulation time (7.5 [2.2–15.3] vs. 2.0 [0.6–5.2] minutes), and more attempts (5 [2–10] vs. 2 [1–4]) and inadvertent PD cannulation (0 [0–2] vs. 0 [0–1]) vs. procedures without trainee involvement (all P Conclusion By using the 75 % percentiles as cutoffs, the proposed 15–10–2 criteria for difficult cannulation could be appropriate in trainee-involved procedures.

An increasing number of researches have shown that cell metabolism regulates cell function. Dendritic cells (DCs), a professional antigen presenting cells, connect innate and adaptive immune responses. The preference of DCs for sugar or lipid affects its phenotypes and functions. In many diseases such as atherosclerosis (AS), diabetes mellitus and tumor, altered glucose or lipid level in microenvironment makes DCs exert ineffective or opposite immune roles, which accelerates the development of these diseases. In this article, we review the metabolism pathways of glucose and cholesterol in DCs, and the effects of metabolic changes on the phenotype and function of DCs. In addition, we discuss the effects of changes in glucose and lipid levels on DCs in the context of different diseases for better understanding the relationship between DCs and diseases. The immune metabolism of DCs may be a potential intervention link to treat metabolic-related immune diseases.

In recent decades, silver telluride has been considered as an excellent thermoelectric material, but its photoelectric conversion performance has received little attention. In this study, we synthesized uniform crooked Ag2Te nanotubes by a homogeneous precipitation method without surfactant under mild conditions. The photoelectrical properties of the Ag2Te nanotube film-based photodetectors were also investigated. In the specific process, TeO2 and AgNO3 were used as the raw materials, KOH as an alkaline environmental provider, L-ascorbic acid as the reducing agent and ethylene glycol as the solvent. The morphology of the products can be regulated effectively by adjusting the amount of reducing agent and the reaction temperature. Ag2Te nanotubes with ∼100 nm outer diameter, ∼15 nm inner diameter and ∼4 μm length were prepared with an aqueous solution of 5.0 mL L-ascorbic acid and 6.7 mL AgNO3 at 120 °C for 2 h. Under illumination of 980 nm pulsed incident infrared light with a period of 600 s under room temperature, laser power of 41.9 μW and bias voltages of +5.0 V, the photodetector exhibits a photocurrent of 7.908 μA, an on/off ratio of 30.95 and a responsivity of 189 mA W−1. All these parameters are superior to the recently reported performance of Ag2Te nanocrystal-based photodetectors.

Combined intravenous and intrathecal administration of norvancomycin (NVCM) is routinely employed in treating methicillin-resistant Staphylococcus aureus (MRSA) ventriculitis in patients following craniotomy. However, the optimal dosing regimen, the pharmacokinetics (PK) of NVCM in cerebrospinal fluid (CSF), and the clinical outcome are yet to be elucidated. Herein, a single-center randomized controlled trial was conducted in the Neurosurgery Department of the Second Hospital of Hebei Medical University (Shijiazhuang, China). Patients with MRSA ventriculitis after craniotomy were randomly assigned to two groups. The control group received 800 mg NVCM intravenously every 12 h, and the experimental group received 800 mg NVCM intravenously every 12 h and 16 mg NVCM intrathecal administration every 24 h. The primary outcome was the length of therapy, while the secondary outcomes included the area under the concentration-time curve in 0-24 h/minimum inhibitory concentration ratio (AUC

Uniform CdTe NRs were synthesized by a one-pot PVP-assisted solvothermal process under mild conditions. By adjusting the reaction temperature and the amounts of surfactant and reducing agent, CdTe NRs of 80 ± 30 nm in diameter and 300–500 nm in length were prepared. It was found that uniform CdTe NRs can be obtained by reacting 0.4 g PVP, 5.0 ml AAAS and 2 mL CdCl2·2.5H2O aqueous solution at 150 °C for 12 h. By assembling the CdTe NRs into photodetectors, a photocurrent of 2.51 μA and a responsivity of 0.106 A W−1 were obtained under the illumination of 650 nm pulsed incident light for a period of 120 s under 300 K, a laser power of 23.7 μW and bias voltage of +1.0 V. The rise time and decay time of the device were found to be 81 s and 84 s, respectively.

BACKGROUND: Epilepsy is a chronic disease that can reduce the quality of life in children because it can cause memory loss, learning difficulties, mental and behavioral abnormalities, and social disorders. The purpose of this study was to explore the effect of the hospital-community-family linkage continuous nursing model in the nursing of children with epilepsy. METHODS: Data for 136 children with epilepsy who were hospitalized in the neurology clinic or neurology ward of Wuxi Children’s Hospital from January 2018 to January 2021 were retrospectively analyzed. According to the nursing mode after discharge, the children were divided into 65 cases in the observation group (hospital-community-family linkage continuous nursing model) and 71 cases in the control group (routine nursing model). The compliance with nursing, cognitive function, resilience, and quality of life of the two groups were compared before and after intervention, and the influencing factors of children’s quality of life were analyzed. RESULTS: The follow-up visit 6 months after discharge found that the scores for compliance, resilience, and quality of life in the observation group were significantly higher than those in the control group (P

The repair of spinal cord injury is a great challenge in clinical. Improving the microenvironment of the injured site is the key strategy for accelerating axon regeneration and synaptic formation. Herein, a kind of silk fibroin microspheres functionalized by metformin through dopamine was developed using water-in-oil emulsification-diffusion method and surface modification technique, and the effect on cortical neuron was evaluated. The results showed that the microspheres showed a uniform size distribution with the diameter of around 60 μm and a concave structure. Moreover, the microspheres possessed good injectability and stability. In addition, the metformin could be successfully immobilized in the silk fibroin microspheres. The cell culture results displayed that the growth and morphology of cortical neurons on the microspheres with metformin concentration of 5 mg/mL and 10 mg/mL were obviously better than that on other samples. Notably, the spread area of single cortical cell on silk fibroin microspheres was increased with the ascending metformin concentration. Therefore, the results indicated that the metformin loaded silk fibroin microsphere could obviously improve the growth and spreading behavior of cortical neuron. The study may provide an important experimental basis for the development of drug loaded injectable biomaterials scaffolds for the treatment of spinal cord injury and have great potential for spinal cord regeneration.

Background: Inadequate bowel preparation (BP) is a major contribution to inefficacy of colonoscopy. Three models based on patient-related factors have been developed to predict inadequate BP. However, the performance of the models seems suboptimal. This study aimed to develop a novel procedure-related model and compare it with the available patient-related models. Methods: Patients receiving standard BP were prospectively enrolled from 5 endoscopic centers in China. Patient-related and procedure-related factors for inadequate BP (defined by segmental Boston Bowel Preparation Scale score

Forest litter accumulation can regulate the soil microclimate and alter nutrient distribution, but the effects of litter quality and seasonal differences on soil nitrogen (N) mineralization are still uncertain. The effects of litter change on the rates of net N mineralization, nitrification, and ammonification were studied through in situ incubation experiments in coniferous, mixed, and broad-leaved forests in the eastern Qinghai–Tibetan Plateau. Two litter treatments were established, one to allow the litter to enter the soil normally (remain litter) and the other to prevent the litter from entering the soil (remove litter). Soil samples were collected at the freezing (FS), thawing (TS), early growing (EGS), late growing (LGS), and early freezing (EFS) seasons during the 1.5-year incubation period. Compared to coniferous forests, the effects of litter removal on the net ammonification, nitrification, and N mineralization rates were more pronounced in broad-leaved forests, mainly during the growing and thawing seasons. Structural equation modeling indicated that microbial biomass N (MBN) was a common factor affecting the net ammonification, nitrification, and N mineralization rates in the three forest soils. The coniferous forest microbial biomass carbon (MBC), mixed forest soil moisture, broad-leaved forest soil N concentration, and C:N ratio were the unique influencing factors of the different forest types. The results showed that the effect of litter distribution on the soil net N mineralization mainly depended on forest type and season, suggesting that the litter composition and productivity in different seasons and forest types may alter the soil N cycling processes in subalpine forest ecosystems.

Background and aim Rectal indomethacin and pancreatic duct stenting (PDS) are recommended for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). However, the effects of the combination of the two methods on preventing PEP are controversial. We hypothesized that some group of difficult patients might benefit from the combination of indomethacin plus PDS (IP) compared with indomethacin alone (IN). Methods Patients with native papilla who underwent endoscopic retrograde cholangiopancreatography in eight tertiary hospitals were screened. They were enrolled if the cannulation proved difficult and post-procedure indomethacin was administered. Propensity score matching (PSM) was used to balance the baseline characteristics between IP and IN groups. The primary outcome was PEP. Results Among 4456 patients with available cannulation-related data, 1889 (42.4%) patients had difficult cannulation and received indomethacin. After PSM, both IP and IN groups included 332 patients. PEP was comparable between the two groups (12.7% vs 10.2%, P = 0.329). By subgroup analysis, the PEP rate was found to be lower in the IP group than in the IN group (7.3% vs 18.2%, P = 0.026) in patients undergoing double-guidewire technique (DGT). The results of an additional analysis using PSM in DGT patients were consistent with the subgroup analysis results (7.8% vs 19.4%, P = 0.036). Conclusions The current study indicated that the combined prevention of PEP with indomethacin plus PDS was useful in PEP prevention in patients undergoing DGT. Other groups of patients with difficult cannulation may not benefit from the combination strategy.

BACKGROUND Gestational diabetes mellitus (GDM) is a common endocrine metabolic disease, involving a carbohydrate intolerance of variable severity during pregnancy. The incidence of GDM-related complications and adverse pregnancy outcomes has declined, in part, due to early screening. Machine learning (ML) models are increasingly used to identify risk factors and enable the early prediction of GDM. OBJECTIVE The aim of this study was to perform a meta-analysis and comparison of published prognostic models for predicting the risk of GDM and identify predictors applicable to the models. METHODS Four reliable electronic databases were searched for studies that developed ML prediction models for GDM in the general population instead of among high-risk groups only. The novel Prediction Model Risk of Bias Assessment Tool (PROBAST) was used to assess the risk of bias of the ML models. The Meta-DiSc software program (version 1.4) was used to perform the meta-analysis and determination of heterogeneity. To limit the influence of heterogeneity, we also performed sensitivity analyses, a meta-regression, and subgroup analysis. RESULTS A total of 25 studies that included women older than 18 years without a history of vital disease were analyzed. The pooled area under the receiver operating characteristic curve (AUROC) for ML models predicting GDM was 0.8492; the pooled sensitivity was 0.69 (95% CI 0.68-0.69; P2=99.6%) and the pooled specificity was 0.75 (95% CI 0.75-0.75; P2=100%). As one of the most commonly employed ML methods, logistic regression achieved an overall pooled AUROC of 0.8151, while non–logistic regression models performed better, with an overall pooled AUROC of 0.8891. Additionally, maternal age, family history of diabetes, BMI, and fasting blood glucose were the four most commonly used features of models established by the various feature selection methods. CONCLUSIONS Compared to current screening strategies, ML methods are attractive for predicting GDM. To expand their use, the importance of quality assessments and unified diagnostic criteria should be further emphasized.

Background Gestational diabetes mellitus (GDM) is a common endocrine metabolic disease, involving a carbohydrate intolerance of variable severity during pregnancy. The incidence of GDM-related complications and adverse pregnancy outcomes has declined, in part, due to early screening. Machine learning (ML) models are increasingly used to identify risk factors and enable the early prediction of GDM. Objective The aim of this study was to perform a meta-analysis and comparison of published prognostic models for predicting the risk of GDM and identify predictors applicable to the models. Methods Four reliable electronic databases were searched for studies that developed ML prediction models for GDM in the general population instead of among high-risk groups only. The novel Prediction Model Risk of Bias Assessment Tool (PROBAST) was used to assess the risk of bias of the ML models. The Meta-DiSc software program (version 1.4) was used to perform the meta-analysis and determination of heterogeneity. To limit the influence of heterogeneity, we also performed sensitivity analyses, a meta-regression, and subgroup analysis. Results A total of 25 studies that included women older than 18 years without a history of vital disease were analyzed. The pooled area under the receiver operating characteristic curve (AUROC) for ML models predicting GDM was 0.8492; the pooled sensitivity was 0.69 (95% CI 0.68-0.69; P Conclusions Compared to current screening strategies, ML methods are attractive for predicting GDM. To expand their use, the importance of quality assessments and unified diagnostic criteria should be further emphasized.

Background Adenomas may be missed in up to 40% of screening colonoscopies. Although the water exchange (WE) method can improve ADR, as shown in several RCTs, it remains uncertain whether it can increase the detection of missing adenomas compared with standard air-insufflated (AI) colonoscopy. Methods Patients aged 18–80 years who underwent selective polypectomy were randomly allocated to the WE or AI group. The primary endpoint was the adenoma miss rate (AMR), defined as the number of patients with one or more additional adenomas during the polypectomy procedure divided by the total number of patients in each group. Results A total of 450 patients were enrolled, with 225 in each group. The overall AMRs were 45.8% (103/225) in the WE group and 35.6% (80/225) in the AI group (p = 0.035). More patients in the WE group had at least one missed adenoma in the proximal colon (38.2% vs 24.4%, p = 0.002). The adenoma-level miss rate was also higher in the WE group than in the AI group (35.1% vs 29.0%, p = 0.036). Subgroup analysis showed that patients in the WE group had more missed adenomas located in the proximal colon or with flat shapes. Conclusions This study confirmed that substantial adenomas were missed in patients undergoing selective polypectomy. The WE method significantly improved the detection of missed adenomas, especially those located in the proximal colon or with flat shapes. (ClnicalTrials.gov number: NCT02880748)

Because of high strength and low breaking rate, 8079 aluminum alloy has become the main material of double zero aluminum foil. However, there are still many problems in the manufacturing process, such as broken belt, pinhole and so on. As the main influencing element, Si has a great influence on the alloy. In this work, the influences of Si with various contents on microstructural evolution and mechanical properties of 8079 aluminum alloy were analyzed by energy dispersive spectrometer (EDS), optical microscope (OM), X-Ray diffraction analyzer (XRD), universal testing machine and Vickers hardness tester. The results showed that the primary Si phase was tiny and dispersed in the alloy when the content of Si is less than 1.3%. As the second phases dispersion strengthening, the Si phase can improve the strength of the alloy. However, when the Si content was too high, the Si phase increased and coarsened. Meanwhile, Fe-rich phase which increased by Si decreased the fine grain strengthening and the second phases strengthening mechanism. The coarse Si phase and the Fe-rich phase are brittle phase, which are easy to become the crack source in the process of material deformation and reduce the strength and toughness of the alloy. The mechanical property test shows that the performance of 8079 aluminum alloy is the best when the Si content is 1.3%.

Atherosclerosis (AS) is characterized by dyslipidemia and chronic inflammation. In the high-fat environment, the lipid metabolism of dendritic cells (DCs) is abnormal, which leads to abnormal immune function, promotes the occurrence of immune inflammatory reactions, and promotes the development of AS. Alisol B 23-acetate (23B) is a triterpenoid in the rhizomes of Alisma, which is a traditional Chinese medicine. Here, we identified cholesterol metabolism-related targets of 23B through a virtual screen, and further transcriptome analysis revealed that 23B can change antigen presentation and cholesterol metabolism pathways in cholesterol-loaded DCs. In vitro experiments confirmed that 23B promoted cholesterol efflux from ApoE-/- DCs, reduced the expression of MHC II, CD80, and CD86, and inhibited the activation of CD4+ T cells and the production of inflammatory cytokines IL-12 and IFN-γ. In advanced AS mice, 23B can decrease triacylglycerol (TG) levels and increase high-density lipoprotein-cholesterol (HDL-C) levels in plasma and the expression of cholesterol efflux genes in the aorta. Neither helper T cells 1 (Th1) nor regulatory T cells (Tregs) in peripheral blood changed significantly in the presence of 23B, but 23B reduced the levels of IL-12 and IFN-γ in serum. However, 23B did not change the total cholesterol (TC) and low-density lipoprotein-cholesterol (LDL-C) levels in serum or lipid accumulation in the aorta. Moreover, 23B did not increase the production of IL-10 and TGF-β1 in vivo or in vitro. These results indicate that 23B promotes cholesterol efflux from DCs, which can improve the immune inflammatory response and contribute to controlling the inflammatory status of AS.

This paper presents a finite element based parametric study of the dynamic response and strength of sandwich steel beams with either sinusoidal or trapezoidal corrugated core subjected to impulsive blast loads. The sandwich steel beams consists of flat top and bottom substrates made of Steel 1018 and four core layers of Steel 1008. The core layers are arranged with uniform and non-uniform thicknesses. The finite element model is validated with a set of shock tube experiments and thus makes it feasible for a present parametric design study of core configurations. Sinusoidal and trapezoidal core shapes as well as various core thickness arrangements are taken into consideration for comparing core crushing and buckling behavior and their performances in mitigating blast load effects onto the main structure. A unit-cell beam and a fully clamped sandwich beam are studied to elucidate the effect of core shapes and arrangement onto its dynamic response.

In this paper the tungsten-fibre-net-reinforced tungsten composites were produced by spark plasma sintering (SPS) using fine W powders and commercial tungsten fibres. The relative density of the samples is above 95%. It was found that the recrystallization area in the fibres became bigger with increasing sintering temperature and pressure. The tungsten grains of fibres kept stable when sintered at 1350°C/16 kN while grown up when sintered at 1800°C/16 kN. The composite sintered at 1350°C/16 kN have a Vickers-hardness of ~610 HV, about 2 times that of the 1800°C/16 kN sintered one. Tensile tests imply that the temperature at which the composites (1350°C/16 kN) begin to exhibit plastic deformation is about 200°C-250°C, which is 400°C lower than that of SPSed pure W. The tensile fracture surfaces show that the increasing fracture ductility comes from pull-out, interface debonding and fracture of fibres.

Water Exchange Method Significantly Improves Adenoma Detection Rate: A Multicenter, Randomized Controlled Trial

In this study, trifold CdTe nanorods and CdTe nanospheres were prepared by the environmentally benign solvothermal process where K2TeO3 and CdCl2 acting as the raw materials, L-ascorbic acid as the reducing agent, ethylene glycol as the solvent and polyvinylpyrrolidone as the surfactant, respectively. The morphology of the products can be regulated by the amount of KOH. Specifically, trifold CdTe nanorods could be prepared with 0.1 g of KOH before the reaction; while CdTe nanospheres were obtained with 0.5 g of KOH. The higher the amount of KOH added, the stronger the reducibility of L-ascorbic acid. For higher reducibility, CdTe crystal nuclei which was continuously generated will first nucleate and grow in the gaps between the rods of the trifold nanorods because of the special morphology and structure of the trifold nanorods. Therefore, with the increasing of the number of CdTe crystal nuclei caused by the accelerated reaction rate, the trifold nanorods will gradually evolve into nanospheres.

Pain during colonoscopy is a critical quality indicator and often a limiting factor for unsedated colonoscopy. This study aimed to identify factors associated with pain during colonoscopy and establish a model for predicting a painful colonoscopy. Patients aged 18 to 80 who underwent unsedated colonoscopy were prospectively enrolled in 2 tertiary endoscopic centers in China. The primary outcome was the rate of painful colonoscopy and then we identify high-risk factors associated with painful colonoscopy. A prediction model with an intubation discomfort score (IDS) was developed and validated. Totally 607 patients participated in this study, including 345 in the training cohort and 262 in the validation cohort. Body mass index (BMI) of

BACKGROUND AND AIM Hands-on endoscopic retrograde cholangiopancreatography (ERCP) training is essential for trainees to grasp the technique. Cannulation success rate (CSR) is considered one of the main indicators of competency of trainees. We aimed to investigate whether patient-related factors had an impact on the CSR of trainees. METHODS A post hoc analysis of data from two multicenter studies (NCT02002650 and NCT03057769) was conducted. Patients aged 18-90 years with native papilla undergoing ERCP were eligible for this study. Only procedures involving trainees in centers strictly following "10-min criteria" for initial cannulation were enrolled. Primary outcome was CSR by trainees. RESULTS From December 2013 to October 2017, 20 trainees in four centers were involved in initial cannulation in 1044 patients with native papilla. Primary CSR by trainees was 61.0% (436/715), 31.5% (70/222) and 44.9% (48/107) in patients with common bile duct stone (CBDS), biliary stricture (BS) and other indications, respectively (P < 0.001). In multivariate analysis, indication of BS (OR, 0.31; 95% CI, 0.22-0.44; P < 0.001) and presence of type A diverticulum (OR, 1.69; 95% CI, 1.23-2.33; P = 0.001) were both independently associated with cannulation success of trainees. Biliary infection was significantly higher in the BS than in the CBDS group (3.6% vs 0.7%, P = 0.004), whereas other post-ERCP complications were comparable between the two groups. CONCLUSIONS Indication of BS and the presence of type A diverticulum were independently associated with the success of cannulation by trainees. These findings indicate that greater effort is needed for trainees to improve the ability of cannulation in BS.

GOALS To assess the factors associated with adenoma detection in propofol-sedated patients. BACKGROUNDS Low adenoma detection rate (ADR) are linked to increased risk of interval cancer and related deaths. Compared with air insufflation (AI) colonoscopy, the method of water exchange (WE) significantly decreased insertion pain and increased ADR in unsedated patients. Deep sedation with propofol has been increasingly used in colonoscopy. One report suggested that WE significantly increased ADR in propofol-sedated patients, but the factors associated with adenoma detection were not analyzed. STUDY Post hoc multiple logistic regression analyses were performed based on pooled data from 2 randomized controlled trials to assess the factors associated with adenoma detection in propofol-sedated patients. RESULTS Propofol-sedated patients (n=510) were randomized to AI and WE. The baseline characteristics were comparable. Multiple logistic regression analyses show that age, withdrawal time, indications (screening vs. diagnostic), and WE were significantly and independently associated with higher ADR. WE had fewer patients with inadequate Boston Bowel Preparation Scale score of

The response of sandwich steel beams with corrugated cores to quasi-static loading is investigated by employing experimental and computational approaches. The sandwich steel beam consists of top and bottom substrates made of AISI Steel 1018 and four corrugated core layers made of AISI Steel 1008. Various arrangements of the corrugated core layers with both uniform and graded layer thicknesses are considered. Three core arrangements with identical relative densities are used to study the effects of uniform versus graded core layer thicknesses onto the quasi-static behavior of corrugated steel beams. Finite element models are validated against quasi-static tests, and lender themselves suitable for a parametric study. A parametric study is also carried out on large-scale structural size beams of a few meters in length. The deformation modes observed in this study include core crushing, and plate bending and shear. It is found that core arrangement and beam span is key factors governing the quasi-static response of sandwich beams with corrugated cores.

Whole-colon water exchange (WWE) reduces insertion pain, increases cecal intubation success and adenoma detection rate, but requires longer insertion time, compared to air insufflation (AI) colonoscopy. We hypothesized that water exchange limited to the left colon (LWE) can speed up insertion with equivalent results.This prospective, randomized controlled study (NCT01735266) allocated patients (18-80 years) to WWE, LWE or AI group (1:1:1). The primary outcome was cecal intubation time.Three hundred subjects were randomized to the WWE (n = 100), LWE (n = 100) or AI group (n = 100). Ninety-four to ninety-five per cent of patients underwent diagnostic colonoscopy. Baseline characteristics were balanced. The median insertion time was shorter in LWE group (4.8 min (95%CI: 3.2-6.2)) than those in WWE (7.5 min (95%CI: 6.0-10.3)) and AI (6.4 min (95%CI: 4.2-9.8)) (both p0.001) groups. The cecal intubation rates in unsedated patients of the two water exchange methods (WWE 99%, LWE 99%) were significantly higher than that (89.8%) in AI group (p = 0.01). The final success rates were comparable among the three groups after sedation was given. Maximum pain scores and number of patients needing abdominal compression between WWE and LWE groups were comparable, both lower than those in AI group (p0.05). No significant difference was observed regarding PDR, although the PDR in right colon tended to be higher in WWE group.By preserving the benefits of WWE and reducing insertion time, LWE is appropriate for diagnostic colonoscopy, especially in settings with tight scheduling of patients. The higher PDR in the right colon in WWE group deserves to be further investigated.

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.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.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 P0.05). 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).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.