Lavage Solution Research Articles

小児大腸内視鏡検査における前処置法の検討 : Golytely 液の投与法と評価

小児大腸内視鏡検査における前処置法の検討 : Golytely 液の投与法と評価

The Influence of Polyethylene Glycol Solution on the Dissolution Rate of Sustained Release Morphine.

Whole bowel irrigation (WBI) is a management option for overdose of medications poorly adsorbed to activated charcoal, with modified release properties, or for body packers. Polyethylene glycol (PEG) is a mixture of ethylene oxide polymers of varying molecular weight. PEG with an average molecular weight of 3350g/mol is used for WBI. PEG electrolyte lavage solution has been shown in vitro to hasten the dissolution of acetaminophen. The impact of PEG on the pharmacokinetics of extended release pharmaceuticals is unknown. Lower average molecular weight PEG mixtures are used as solvents and excipients. We sought to investigate the impact of PEG on the release of morphine from several extended release morphine formulations. An in vitro gastric model was developed. To test the validity of our model, we first investigated the previously described interaction of ethanol and Avinza®. Once demonstrated, we then investigated the effect of PEG with several extended release morphine formulations. In the validation portion of our study, we confirmed an ethanol Avinza® interaction. Subsequently, we did not observe accelerated release of morphine from Avinza® or generic extended release morphine in the presence of PEG. The use of PEG for gastric decontamination following ingestion of these extended release morphine formulations is unlikely to accelerate morphine release and aggravate intoxication.

Studiu privind efectul tratamentului endodontic realizat cu laser dioda 940 nm

The aim of this study is to determine the effect of the laser diode with a wavelength of 940 nm in endodontic treatment, by irradiating channels in several stages of treatment, combined with standard lavage solutions. The study determines the removal of the smear layer and the permeability of the dentinal tubules as seen in scanning electron microscopy. Material and method. The study was conducted on 16 mono-radicular extracted teeth having an orthodontic purpose or which presented periodontal lesions and a 3-4 degree of mobility. The teeth were subjected to an endodontic protocol and a laser protocol, followed by a SEM analysis. Results. Increasing the number of cycles has as result the removal of smear layer and of the debris layer by the opening of the dentinal tubules. Conclusions. 940 nm diode laser can be safely and effectively used in endodontic treatments, without harmful effects on periodontal tissues. Using 940 nm laser diode in endodontic treatment has a synergistic effect which has been achieved with standard lavage.

Analysis of reasons of "incomplete" colonoscopy

The objective of this study was to determine the reasons for incomplete colonoscopy, as well as evaluation of results preparation of patients for colonoscopy in a variety of ways, informative colonoscopy depending on the quality of preparation of the colon for examination. The material of this study was the results 104 of colonoscopies drawn from daily clinical practice. To prepare the colon for the study used the most available ways: 1) lavage solutions, 2) castor oil, 2 enemas in the morning and 2 in the evening, 3) enema, which the patients were chosen after consulting a doctor. To assess the preparedness of the colon to the study used a Boston-scale of assessment of quality of preparation of the colon for a colonoscopy". Preparation of the colon was improved by using a water jet pump of the company "Olympus" AFU100. Statistical analysis was performed using IBM SPSS Statistics 19.0. Analysis of clinical specimens showed that in 13 (12.5%) of the observations to intubate the colon was not possible. The main reason is the poor preparation of the colon to the study, which failed to improve even with the aid of a water jet pump.

Efficacy of polyethylene glycol electrolyte lavage solution with ascorbic acid for bowel preparation for CT colonography

Efficacy of polyethylene glycol electrolyte lavage solution with ascorbic acid for bowel preparation for CT colonography

New Low-Volume Bowel Cleansing Solution (NER1006) Versus Trisulfate, Polyethylene Glycol 3350+Ascorbate or Sodium Picosulfate/Magnesium Salt: 3 Multicenter Randomized Parallel Group Ph3 Studies in 1,865 Colonoscopy Patients

Introduction: A Phase 3 program aims to establish efficacy, safety, tolerability of NER1006, a new oral low-volume polyethylene glycol (PEG) solution with ascorbate (Asc), in a large adult colonoscopy patient population Methods: Three multicenter, randomized, colonoscopist-blinded parallel group studies in males/females (18-85 years) are underway. Main inclusion criteria: screening, surveillance or diagnostic colonoscopy patients. Main exclusion criteria include: history (≤12 months) or current severe constipation episode; known/suspected ileus; gastrointestinal (GI) obstruction; gastric retention; bowel perforation; toxic colitis or megacolon; ongoing severe acute inflammatory bowel disease; previous significant GI surgeries. NOCT (NCT02254486) will randomize (1:1) ≤620 US patients to NER1006 (2-day split dosing starting evening of the day before colonoscopy) or trisulfate solution (per label). MORA (NCT02273167; 2014-002185-78) will randomize (1:1:1) ≤850 European patients to NER1006 (2-day evening/morning splitdosing and 1-day morning on day of colonoscopy) or PEG3350+Asc (per label). DAYB (NCT02273141; 2014-002186-30) will randomize (1:1) ≤530 European patients to NER1006 (1-day, day before-only split dosing starting evening of the day before colonoscopy) or sodium picosulfate/magnesium salt (per label). Study duration: ≤4 clinic visits/patient for ≤40 days. Alternative primary endpoints: 1. NER1006 overall bowel cleansing success rate is non-inferior to comparator using the Harefield Cleansing Scale (HCS); 2. NER1006 ‘Excellent plus Good' cleansing rate in colon ascendens is non-inferior to comparator using HCS segmental cleansing scoring system. Central readers will score colonoscopy videos. Key secondary endpoints include: adenoma and polyp detection rates in colon ascendens and overall. Results: As of May 2015, number of patients randomized were: 610/620 at 12 US sites (NOCT); 507/850 at 30 sites in Belgium, France, Germany, Italy, Poland, Spain and UK (MORA); 369/530 at 20 sites in Germany, Italy, Netherlands, Poland, Spain, and UK (DAYB). Studies are due to complete by September 2015. Conclusion: Quality of bowel preparation is an important factor for a successful colonoscopy but lavage solution volume required to achieve efficacy/tolerability is often a barrier. Findings from these pivotal Phase 3 studies of a new low-volume bowel preparation may provide a better understanding of what is required in an optimal bowel preparation.

An Investigator-Blinded Randomized Controlled Prospective Study Comparing Efficacy, Tolerability, and Safety of Two Bowel Preparations in the Community Setting: Miralax Versus PEG Electrolyte Lavage Solution (PEG-ELS)

Introduction: Although not FDA approved, Miralax (PEG 3350) mixed with Gatorade is a frequently used colonoscopy bowel preparation. There is conflicting data regarding its efficacy and tolerability, and limited data on its safety. We aimed to compare the efficacy, tolerability and safety of Miralax with Gatorade and PEG-ELS (polyethylene glycol electrolyte lavage solution) in the community setting. Methods: Patients undergoing elective screening colonoscopy were randomized to receive either splitdosed Miralax or PEG-ELS. Serum electrolytes, calcium, and phosphorus were determined before and after the preparation. Patients completed a Likert scaled questionnaire (1 = strongly agree; 5 = strongly disagree) evaluating their experience with the preparation just before colonoscopy. Quality of preparation was scored by blinded endoscopists using the Boston Bowel Preparation Scale (BBPS). Results: Sixty seven patients received either Miralax (N=38) or PEG-ELS (N=29). The groups were comparable regarding age, sex, and race.There was no significant difference in efficacy between the Miralax and PEG-ELS groups, with mean total BBPS scores of 7.34 and 7.82, respectively (p=.153). There was no significant difference in the ability to complete at least 75% of the preparation between the groups, but more patients were willing to retake (29.1 vs 40.4; p=.008) and/or recommend (28.5 vs 41.1; p=.003) their Miralax preparation in the future. The Miralax group also found the amount of preparation (27.9 vs 41.9, p=.001) and its taste (26.3 vs 44, p < .001) more acceptable and their preparation to be more tolerable (27.4 vs 42.6, p < .001). The Miralax group experienced less headache than the PEG-ELS group (29.2 vs 40.1, p=.003) but there was otherwise no significant difference in side effects. Finally, there was no significant difference in serum electrolytes before and after taking the preparations in either group. Conclusion: Both split-dosed preparations are effective at colon cleansing without adverse changes in serum electrolytes. However, patients in the Miralax group found their preparation to be more tolerable than those in the PEG-ELS group. Additionally, more patients were in favor of using or recommending Miralax again in the future. This study adds to the growing body of data regarding bowel preparation regimens and supports the effectiveness and safety of Miralax in preparing the bowel for colonoscopy with improved patient acceptance and tolerability.

Effect of lactulose oral solution combined with PEG-4000 electrolyte lavage solution on bowel preparation before colonoscopy

Objective To compare the effectiveness of lactulose oral solution combined with PEG-4000 electrolyte lavage solution with PEG-4000 electrolyte lavage solution only in colonoscopy preparation. Methods A total of 121 patients preparing for colonoscopy were randomly divided into two groups: 61 patients in lactulose oral solution combined with PEG-4000 electrolyte lavage solution group(the experimental group=group A), and 60 patients in PEG-4000 electrolyte lavage solution group(the control group=group B). During the colonoscopy, the endoscopist blindly scored the cleanness of the bowel, and recorded any adverse event to assess the safety. Results According to the Boston bowel preparation scale, the experimental group scored 7.07±0.79, and the control group scored 6.18±1.03, which showed significant significance(P=0.000). There was no significant difference in the time of accessing rectum between the two groups[(8.80±1.74)min VS(9.22±1.94)min, P=0.220]. Polyp detection rate in group A was higher than that in group B, with no significant difference(22.95% VS 15.00%, P>0.05). The small polyp(≤0.5 cm)detection rate in group A was higher than that in group B with significant significance(P=0.038). No adverse event was recorded in either group. Conclusion The bowel preparation with lactulose oral solution combined with PEG-4000 electrolyte lavage solution is more effective than that with PEG-4000 electrolyte lavage solution alone. It will enhance the detection rate of small polyps with no evident adverse reactions. Key words: Colonoscopy; Bowl preparation; Lactulose; Polyethylene Glycols

Effect of Nasal Corticosteroid on Secretory Immunoglobulin A Measured in Rat Nasal Lavage: Experimental Study.

In this study, we aimed to experimentally investigate the effects of nasal corticosteroids on the levels of secretory immunoglobulin A (sIgA) in nasal mucosa in rats. Prospective, randomized control trial. Research laboratory. Twenty-four male Sprague Dawley rats were included in our study. The rats were randomized into 3 groups. In group 1, nasal mometasone furoate was applied to the rats for 30 days. Saline was applied to group 2 for 30 days. Group 3 was the control group and received no treatment throughout the study period. Nasal lavage was conducted on both nasal openings of all rats in the 3 groups at the beginning of the study and on days 15 and 30, and the lavage solution (distilled water) was collected by aspiration. In group 1, the sIgA value was significantly higher at day 15 than at baseline. No significant difference was found between the sIgA values on day 15 and day 30. In groups 2 and 3, there were no significant differences in sIgA values at baseline, day 15, and day 30. The sIgA value of group 1 on day 15 was significantly higher than the values of groups 2 and 3. The sIgA value of group 1 on day 30 was significantly higher than the values of groups 2 and 3. Topical corticosteroids (mometasone furoate) applied to the nasal mucosa significantly increase nasal sIgA levels.

Su1680 First Clinical Evaluation of a Novel Method of Bowel Cleansing Before Colonoscopy, by Intrarectal Infusion of Water: Results of a Randomized Comparative Trial a 4L Split-Dose PEG Protocol

Bowel cleansing before colonoscopy is currently based upon oral administration of lavage solutions of polyethylene glycol (PEG) or NaP with large amounts of fluids ingested in a splitted manner. This prospective randomized study compared a split-dose PEG cleansing protocol and a new method of bowel cleansing by low-pressure water infusion into the colon (Prep System, Angel of Water - Lifestream®, Austin, TX).

Standard bowel cleansing is highly ineffective in cirrhotic patients undergoing screening colonoscopy

BackgroundFew data are available on tolerability and quality of standard bowel cleansing for colonoscopy in patients with chronic disease. AimWe seek to evaluate the tolerability and results of lavage solution for colonoscopy in cirrhotic patients in comparison with controls. MethodsFifty-three cirrhotic and fifty-two normal subjects undergoing colonoscopy were prospectively enrolled in the study. Data regarding tolerability of lavage solution were harvested at the pre-procedure visit. Data on level of bowel cleansing and other endoscopic variables were recorded after the procedure. ResultsRate of failure to complete the prescribed bowel preparation and incidence of side effects during its administration were similar between cirrhotic and normal subjects. Despite this, cirrhotic patients exhibited an insufficient level of bowel preparation with approximately half exhibiting bad colon cleansing level (49% versus 5% control, p<0.001). ConclusionAlternative bowel cleansing protocols are needed for cirrhotic subjects to better match their colonoscopic screening needs.

Polyethylene Glycol (PEG-3350, Colyte) Poisoning due to Intra-Peritoneal Leakage in an Elderly Patient

Polyethylene glycol (PEG)-3350 is the most frequently used lavage solution for bowel cleansing prior to colonoscopy or elective surgery because its large molecular weight means that it is poorly absorbed. However, if it leaks into the peritoneal cavity, complications may arise. Few published studies have assessed the absorption, distribution, metabolism and excretion of PEG. Moreover, no published clinical data regarding complications due to the intra-peritoneal leakage of PEG-3350 could be found. We report on an elderly patient who developed the poisoning caused by leaking of PEG-3350 during bowel preparation. It resulted in severe metabolic acidosis, hypernatremia, hyperosmolality and a high anion gap, but it was effectively treated with early continuous renal replacement therapy after surgery.

A Randomized Controlled Trial Evaluating a Low-Volume PEG Solution Plus Ascorbic Acid versus Standard PEG Solution in Bowel Preparation for Colonoscopy.

Evaluation of polyethylene glycol electrolyte lavage solution containing ascorbic acid (PEG-ASC) has been controversial in the point of its hyperosmolarity, especially in old population. So we therefore designed the present study to compare the efficacy, acceptability, tolerability, and safety of 1.5 L PEG+ASC and 2 L standard PEG electrolyte solution (PEG-ELS), not only in the general population, but also in patients of advanced age. Randomization was stratified by age (<70 years or 70> years), and hematological and biochemical parameters were compared in each age group, especially with respect to the safety profile of each regimen. As a result, the 1.5-L PEG-ASC regimen had higher patient acceptability than the 2-L PEG-ELS regimen. Tolerability, bowel cleansing, and safety were similar between regimens. However, we demonstrated significant statistical changes in the hematological and biochemical parameters after taking bowel preparation solutions, not only in the PEG+ASC group, but also in the PEG-ELS group. No significant differences in the safety profile were found between subjects aged less than 70 years and those aged 70 years or more; nevertheless, regardless of age, proper hydration is needed throughout the bowel preparation process.

アスコルビン酸含有ポリエチレングリコール電解質製剤を用いた大腸内視鏡検査前処置法の検討（ポリエチレングリコール電解質製剤との比較）

目的：アスコルビン酸含有ポリエチレングリコール電解質製剤（PEG-Asc）を用いた大腸内視鏡検査前処置法の有効性や安全性，患者受容性を検証した．対象と方法：PEG-Asc群（255例）とポリエチレングリコール電解質製剤（PEG-ELS）群（237例）での比較試験を行った．結果：前処置所要時間はPEG-Asc群が129.7±55.5分，PEG-ELS群が149.2±61.5分と有意に短く（p＝0.0003），腸管洗浄剤服用量もPEG-Asc群が1,786±421ml，PEG-ELS群が1,906±332mlと有意に少なかった（p＝0.0005）．副作用発現率および腸管洗浄度に有意差は認めなかった．受容性は前処置所要時間が短いと感じた割合がPEG-Asc群で有意に多かった．結論：PEG-Ascを用いた前処置法は有効かつ安全であり，被験者に負担の少ない前処置法として有用と思われる．

腸管洗浄液の胃内洗浄効果に関する臨床研究

腸管洗浄液の胃内洗浄効果に関する臨床研究

Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US Multi-Society Task Force on Colorectal Cancer.

Optimizing Adequacy of Bowel Cleansing for Colonoscopy: Recommendations From the US Multi-Society Task Force on Colorectal Cancer

Rectal effluent as a research tool.

Studies of localized secretions are generally superior to those of blood because they contain higher concentrations of molecules specific to the organ of interest. A common method used to analyze localized secretions is lavage. The flow of fluid over the lining of a cavity picks up both cells and soluble factors, and the effluent can be collected for study. Gastrointestinal (GI) lavage is easily and noninvasively performed by the administration of gut lavage solutions such as those routinely given to patients prior to colonoscopy, with GI lavage fluid being the copious, watery rectal effluent subsequently induced. Residual effluent is currently suctioned from the colon and discarded during colonoscopy. With millions of routine colonoscopies performed per year, GI lavage fluid is a rich and largely untapped resource for basic and clinical research. Rectal effluent can also be easily collected in a toilet receptacle without need for a colonoscopy. Rectal effluent generated in this manner has been used to study diarrheal disease, mucosal immunology, inflammatory bowel disease, celiac disease, and cancer. It is often referred to as gut lavage, colon lavage, GI lavage, or whole gut lavage fluid, which makes it challenging to locate previous studies in the literature and there are currently no comprehensive reviews of its use as a research tool. This review attempts to fill this void by discussing previous applications of rectal effluent in research and the methods that have been developed for its collection, stabilization, and analysis.

Clinical application of a high frequency electric knife with coblation technology for temporomandibular joint arthroscopic surgery

ArthroCare Multi-electrode SystemTM with Coblation technology (bipolar) and Vulcan Electro Thermal Arthroscopy SystemTM (monopolar) has been used in the fields of neurosurgery and orthopaedic surgery. Coblation, derived from cooler, controlled ablation, is a patented process employing bipolar radiofrequency technology to achieve precise and rapid tissue removal with minimal thermal damage to collateral tissue. Radiofrequency power setting and heat loss through lavage solution play a significant role in heat distribution and morphologic alterations in joint capsule after arthroscopic application of monopolar radiofrequency energy. This study examined the efficacy and safety of these instruments to temporomandibular joint arthroscopic surgery.

Comparison between pulsed irrigation enhanced evacuation and polyethylene glycol-electrolyte lavage solution for bowel preparation prior to elective colonoscopy in veterans with spinal cord injury

BackgroundPoor preparation for elective colonoscopy is common in persons with spinal cord injury (SCI). This unsatisfactory outcome is likely due to long-standing difficulty with evacuation and decreased colonic motility. Our objective was to determine the most effective preparation for elective colonoscopy applying a novel and traditional approach to bowel cleansing.MethodsTwenty-four subjects with SCI were consented and scheduled to receive one of the two possible arms: pulsed irrigation enhanced evacuation (PIEE) or polyethylene glycol-electrolyte lavage solution (PEG; CoLyte®). The quality of the preparation was scored during the colonoscopy by applying the Ottawa scoring system.ResultsPatients with SCI who received PIEE tended to have lower Ottawa scores and a higher percentage of acceptable preparations than did those who received PEG; however, the results were not statistically different.ConclusionIn this preliminary study in subjects with SCI, neither PIEE nor PEG produced acceptable bowel preparation for elective colonoscopy. Future studies should confirm our findings and consider studying alternative, more efficacious approaches to bowel cleansing prior to colonoscopic procedures in patients with SCI, which should provide better outcomes.Registration number for clinicaltrials.gov: NCT00745095.

In vitro and in vivo activities of antimicrobial peptides developed using an amino acid-based activity prediction method.

To design and discover new antimicrobial peptides (AMPs) with high levels of antimicrobial activity, a number of machine-learning methods and prediction methods have been developed. Here, we present a new prediction method that can identify novel AMPs that are highly similar in sequence to known peptides but offer improved antimicrobial activity along with lower host cytotoxicity. Using previously generated AMP amino acid substitution data, we developed an amino acid activity contribution matrix that contained an activity contribution value for each amino acid in each position of the model peptide. A series of AMPs were designed with this method. After evaluating the antimicrobial activities of these novel AMPs against both Gram-positive and Gram-negative bacterial strains, DP7 was chosen for further analysis. Compared to the parent peptide HH2, this novel AMP showed broad-spectrum, improved antimicrobial activity, and in a cytotoxicity assay it showed lower toxicity against human cells. The in vivo antimicrobial activity of DP7 was tested in a Staphylococcus aureus infection murine model. When inoculated and treated via intraperitoneal injection, DP7 reduced the bacterial load in the peritoneal lavage solution. Electron microscope imaging and the results indicated disruption of the S. aureus outer membrane by DP7. Our new prediction method can therefore be employed to identify AMPs possessing minor amino acid differences with improved antimicrobial activities, potentially increasing the therapeutic agents available to combat multidrug-resistant infections.