• Humans
• Colonoscopy/methods
• Cathartics/administration & dosage
• Cathartics/adverse effects
• Polyethylene Glycols/administration & dosage
• Colorectal Neoplasms/diagnosis
• Electrolytes/administration & dosage
• Therapeutic Irrigation/methods
• Early Detection of Cancer/methods

• adenoma detection rate
• bowel preparation
• colonoscopy
• colorectal cancer
• individualized regimen

• Humans
• Colonoscopy/methods
• Cathartics/administration & dosage
• Colorectal Neoplasms/diagnosis
• Adenoma/diagnosis
• Polyethylene Glycols
• Citrates
• Organometallic Compounds
• Picolines

• Bowel preparation
• Colonoscopy
• Efficacy
• Mini-oral sulfate tablet
• Oral sulfate tablet

• bowel preparation
• colonoscopy
• meta-analysis
• polyethylene glycol electrolyte lavage solution
• sodium phosphate
• systematic review

• bowel preparation
• chlorohexidine bathing
• oral antibiotics
• preoperative
• surgical site infection

• Adenoma detection rate
• Bowel preparation
• Colonoscopy
• Colorectal cancer
• Polyethylene glycol

• Humans
• Aged
• Cathartics/adverse effects
• Colonoscopy/methods
• Polyethylene Glycols/adverse effects
• Colon
• Ascorbic Acid

• Adenoma detection
• Colonoscopy
• Oral sulfate tablet
• Propensity score analysis
• Simethicone

• Adult
• Humans
• Aged
• Polyethylene Glycols/adverse effects
• Simethicone
• Cathartics/adverse effects
• Sulfates
• Propensity Score
• Retrospective Studies
• Colonoscopy/methods
• Adenoma/diagnosis
• Adenoma/chemically induced
• Tablets

• Fibulin7
• acute kidney injury
• calcium crystal
• calcium oxalate
• heparin

Colonoscopy represents the most widespread and effective tool for the prevention and treatment of early stage preneoplastic and neoplastic lesions in the panorama of cancer screening. In the world there are different approaches to the topic of colorectal cancer prevention and screening: different starting ages (45-50 years); different initial screening tools such as fecal occult blood with immunohistochemical or immune-enzymatic tests; recto-sigmoidoscopy; and colonoscopy. The key aspects of this scenario are composed of a proper bowel preparation that ensures a valid diagnostic examination, experienced endoscopist in detection of preneoplastic and early neoplastic lesions and open-minded to upcoming artificial intelligence-aided examination, knowledge in the field of resection of these lesions (from cold-snaring, through endoscopic mucosal resection and endoscopic submucosal dissection, up to advanced tools), and management of complications.

• Colorectal lesions
• Colorectal tumor
• Endoscopic submucosal dissection
• Endoscopic mucosal resection
• Cold-endoscopic mucosal resection
• FTRD^®
• Complications
• Adverse events
• Polypectomy

Chronic kidney disease (CKD) is a global health problem, affecting more than 850 million people worldwide. The number of patients receiving renal replacement therapy (dialysis or renal transplantation) has increased over the years, and it has been estimated that the number of people receiving renal replacement therapy will more than double from 2.618 million in 2010 to 5.439 million in 2030, with wide differences among countries. The main focus of CKD treatment has now become preserving renal function rather than replacing it. This is possible, at least to some extent, through the optimal use of multifactorial therapy aimed at preventing end-stage kidney disease and cardiovascular events. Sodium/glucose cotransporter 2 inhibitors (SGLT2i) reduce glomerular hypertension and albuminuria with beneficial effects on progression of renal damage in both diabetic and non-diabetic CKD. SGLT2 inhibitors also show great benefits in cardiovascular protection, irrespective of diabetes. Therefore, the use of these drugs will likely be extended to the whole CKD population as a new standard of care.

• CDK
• Diabetes
• ESKD
• SGLT2i

• Acute phosphate nephropathy
• Hypophosphatemia
• Kidney transplantation

• cathartics
• colonoscopy
• endoscopy
• laxatives
• meta-analysis

The complexity of the interaction between metabolic dysfunction and cardiovascular complications has long been recognized to extend beyond simple perturbations of blood glucose levels. Yet, structured interventions targeting the root pathologies are not forthcoming. Growing evidence implicates the inflammatory changes occurring in perivascular adipose tissue (PVAT) as early instigators of cardiovascular deterioration.

We used a nonobese prediabetic rat model with localized PVAT inflammation induced by hypercaloric diet feeding, which dilutes inorganic phosphorus (Pi) to energy ratio by 50%, to investigate whether Pi supplementation ameliorates the early metabolic impairment. A 12‐week Pi supplementation at concentrations equivalent to and twice as much as that in the control diet was performed. The localized PVAT inflammation was reversed in a dose‐dependent manner. The increased expression of UCP1 (uncoupling protein1), HIF‐1α (hypoxia inducible factor‐1α), and IL‐1β (interleukin‐1β), representing the hallmark of PVAT inflammation in this rat model, were reversed, with normalization of PVAT macrophage polarization. Pi supplementation restored the metabolic efficiency consistent with its putative role as an UCP1 inhibitor. Alongside, parasympathetic autonomic and cerebrovascular dysfunction function observed in the prediabetic model was reversed, together with the mitigation of multiple molecular and histological cardiovascular damage markers. Significantly, a Pi‐deficient control diet neither induced PVAT inflammation nor cardiovascular dysfunction, whereas Pi reinstatement in the diet after a 10‐week exposure to a hypercaloric low‐Pi diet ameliorated the dysfunction.

Our present results propose Pi supplementation as a simple intervention to reverse PVAT inflammation and its early cardiovascular consequences, possibly through the interference with hypercaloric‐induced increase in UCP1 expression/activity.

• inorganic phosphorous
• perivascular adipose inflammation
• prediabetes
• uncoupling protein 1

• CKD-MBD
• cardiovascular disease
• chronic kidney disease
• parathyroid hormone
• phosphate

• acute kidney injury
• acute tubular injury
• acute tubular necrosis
• histology
• pathology

• R01 HL085757 NHLBI NIH HHS
• UL1 TR001863 NCATS NIH HHS
• R01 DK093770 NIDDK NIH HHS
• P30 CA008748 NCI NIH HHS
• UH3 DK114866 NIDDK NIH HHS

• Bowel prep
• NER1006
• PEG
• magnesium-based prep
• phosphate-based prep
• ultra-low volume

Acute phosphate nephropathy (APN) is a disease that can occur when exposed to high doses of phosphate. The most common cause of APN is the use of oral sodium phosphate for bowel cleansing preparations. However, there are other less commonly known sources of phosphate that are equally important. To date, our literature search did not identify any report of excessive dietary phosphate as a cause of APN.

We report an unusual case of a 39-year-old diabetic male who presented with epigastric pain and oliguria. Work-up showed elevated serum creatinine, potassium, and calcium-phosphate product, and metabolic acidosis. The patient was admitted in the intensive care unit and received emergent renal replacement therapy. Kidney biopsy revealed tubular cell injury with transparent crystal casts positive for Von Kossa staining, which established the diagnosis of APN.

This case confirmed that APN may occur with other sources of phosphorus, highlighting the importance of good history taking and kidney biopsy in patients with predisposing factors for APN. Raising awareness on the possibility of APN and its timely recognition and management is imperative so that appropriate measures can be instituted to prevent or delay its progression to end stage renal disease.

• Hyperphosphatemia
• Nephrocalcinosis
• Acute phosphate nephropathy
• Renal insufficiency
• Chronic kidney disease
• Biopsy
• Case report

Excessive phosphorus intake adversely affects bone and mineral metabolism. Estrogen is one of the factors affecting fibroblast growth factor 23 (FGF23), a phosphorus-regulating hormone. However, the interaction between excess phosphorus and estrogen status has not been fully elucidated. This study investigated the involvement of estrogen in the effects of high phosphorus intake on bone metabolism and ectopic calcification in ovariectomized (OVX) rats. The interaction between high phosphorus diet and OVX was not observed in bone mineral density and aortic calcium. In contrast, high phosphorus intake markedly increased renal calcium concentration in sham rats, whereas the effect was attenuated in OVX rats, which was reversed by a selective estrogen-receptor modulator treatment. A strong positive correlation between renal calcium and serum FGF23 was observed. In addition, fibroblast growth factor receptor 1 (FGFR1: a predominant receptor of FGF23) inhibitor treatment partially decreased renal calcium concentrations in rats with high phosphorus intake. In conclusion, the effect of high phosphorus intake on bone metabolism and aortic calcification did not depend on the estrogen status; in contrast, high phosphorus intake synergistically induced nephrocalcinosis in the presence of estrogenic action on the bone. Furthermore, FGF23 was involved in the nephrocalcinosis induced by high phosphorus intake partially through FGFR1 signaling.

• Colonoscopy
• Laxatives
• Picosulfate sodium
• Polyethylene glycols
• Sodium sulfate

Felids have a high incidence of chronic kidney disease (CKD), for which the most common renal lesion is chronic interstitial nephritis (CIN). CIN can be induced by tissue oxidative stress, which is determined by the cellular balance of pro- and anti-oxidant metabolites. Fish-flavoured foods are more often fed to cats than dogs, and such foods tend to have higher arsenic content. Arsenic is a pro-oxidant metallic element. We propose that renal accumulation of pro-oxidant elements such as arsenic and depletion of anti-oxidant elements such as zinc, underpin the high incidence of CIN in domestic cats. Total arsenic and other redox-reactive metal elements were measured in kidneys (after acid-digestion) and urine (both by inductively-coupled plasma-mass spectrometry) of domestic cats (kidneys, n = 56; urine, n = 21), domestic dogs (kidneys, n = 54; urine, n = 28) and non-domesticated Scottish Wildcats (kidneys, n = 17). Renal lesions were graded by severity of CIN. In our randomly sampled population, CIN was more prevalent in domestic cat versus domestic dog (51%, n = 32 of 62 cats; 15%, 11 of 70 dogs were positive for CIN, respectively). CIN was absent from all Scottish wildcats. Tissue and urinary (corrected for creatinine) arsenic content was higher in domestic cats, relative to domestic dogs and wildcats. Urine arsenic was higher in domestic cats and dogs with CIN. Arsenobetaine, an organic and relatively harmless species of arsenic, was the primary form of arsenic found in pet foods. In summary, the kidneys of domestic cats appear to have greater levels of pro-oxidant trace elements, as compared to dogs and wildcats. Since there was no difference in renal arsenic levels in cats with or without CIN, renal arsenic accumulation does not appear a primary driver of excess CIN in cats. Given clear differences in renal handling of pro vs. anti-oxidant minerals between cats and dogs, further in vivo balance studies are warranted. These may then inform species-specific guidelines for trace element incorporation into commercial diets.

• Calcium oxalate
• Calcium phosphate
• Crystalline nephropathies
• MGRS
• Urate

• cathartics
• colonoscopy
• simethicone
• sulfates
• tablets

• Administration, Oral
• Adult
• Aged
• Cathartics/administration & dosage
• Colonoscopy
• Female
• Humans
• Male
• Middle Aged
• Solutions
• Sulfates/administration & dosage
• Tablets
• Young Adult

• NA Pharmbio Korea Inc.

• Aged
• Clinical Decision-Making
• Colorectal Neoplasms/diagnosis
• Early Detection of Cancer/methods
• Early Detection of Cancer/standards
• Humans
• Risk Assessment

High dietary phosphorus (P) and low calcium‐to‐phosphorus ratio (Ca:P) are associated with kidney damage in cats. There are no established guidelines for dietary P maximum for cats.

To quantify crude protein, P, Ca, and magnesium (Mg) concentrations in cat foods and compare among food formats (dry, canned, raw), primary protein ingredients, protein concentrations (low, moderate, high), grain‐free versus grain‐containing foods, foods intended for adult maintenance versus all life stages, and cost.

Eighty‐two commercial nonprescription cat foods.

Descriptive study. Mineral concentrations were measured using inductively coupled argon plasma‐optical emission spectroscopy. Crude protein was measured using the Dumas nitrogen combustion method. Mineral and crude protein concentrations were compared among food categories.

Twenty‐seven foods contained ≥3.6 g P/1000 kcal metabolizable energy (ME), of which 7 exceeded 4.8 g/1000 kcal ME. Thirteen foods had low Ca:P ratio (≤1.0). The low‐protein diet group had no products ≥3.6 g P/1000 kcal ME, which was significantly different compared to the high‐protein diet group (52% of products had ≥3.6 g P/1000 kcal ME; P = .01). No significant differences in P content and Ca:P ratio were found among other diet categories. Canned foods had significantly lower Mg compared to dry (P < .001) and raw (P = .007) foods. Declared minimum P and Ca were significantly lower than analyzed concentrations (P = .0005 and P = .003, respectively).

The high number of foods with high P and low Ca suggest that pet food regulatory reform should be considered.

• adult
• calcium
• commercial
• diets
• feline
• foods
• phosphorus

• CKD progression
• Chronic kidney disease (CKD)
• biomarker
• dialysis
• disease trajectory
• end-stage renal disease (ESRD)
• fibroblast growth factor 23 (FGF-23)
• kidney failure
• kidney function decline
• renal replacement therapy (RRT)
• transplant

• Enhanced Recovery after Surgery
• fluid management
• goal-directed fluid therapy

A low-volume polyethylene glycol (PEG) solution that combines ascorbic acid with PEG-based electrolyte solution (PEG-ASC) is gaining mainstream acceptance for bowel preparation due to reduced volume and improved taste. Although several reports showed that bowel preparation with PEG-ASC volume lower than 2.0 L with laxative agents could be an alternative to traditional preparation regimen, the cleansing protocols have not been fully investigated.

To evaluate the cleansing efficacy of 1.2 L PEG-ASC solution comparing with 2.0 L PEG electrolyte (PEG-ELS) for bowel preparations.

A randomized, single-blinded, open-label, single-center, non-inferiority study was conducted. In total, 312 Japanese adult patients (aged > 18 years) who underwent colonoscopy were enrolled. Patients were randomly allocated to bowel lavage with either 1.2 L of PEG-ASC solution with at least 0.6 L of an additional clear fluid (1.2 L PEG-ASC group) or 2.0 L of PEG-ELS (PEG-ELS group). Then, 48 mg of sennoside was administered at bedtime on the day before colonoscopy, and the designated drug solution was administered at the hospital on the day of colonoscopy. Bowel cleansing was evaluated using the Boston Bowel Preparation Scale (BBPS). The volume of fluid intake and required time for bowel preparation were evaluated. Furthermore, compliance, patient tolerance, and overall acceptability were evaluated using a patient questionnaire, which was assessed using a visual analog scale.

In total, 291 patients (1.2 L PEG-ASC group, 148; PEG-ELS group, 143) completed the study. There was no significant difference in successful cleansing, defined as a BBPS score ≥ 2 in each segment, between the two groups (1.2 L PEG-ASC group, 91.9%; PEG-ELS group, 90.2%; 95%CI: -0.03-0.09). The required time for bowel preparation was significantly shorter (164.95 min ± 68.95 min vs 202.16 min ± 68.69 min, P < 0.001) and the total fluid intake volume was significantly lower (2.23 L ± 0.55 L vs 2.47 L ± 0.56 L, P < 0.001) in the 1.2 L PEG-ASC group than in the PEG-ELS group. Palatability, acceptability of the volume of solution, and overall acceptability evaluated using a patient questionnaire, which was assessed by the visual analog scale, were significantly better in the 1.2 L PEG-ASC group than in the PEG-ELS group (7.70 cm ± 2.57 cm vs 5.80 cm ± 3.24 cm, P < 0.001). No severe adverse event was observed in each group.

The 1.2 L PEG-ASC solution was non-inferior to the 2.0 L PEG-ELS solution in terms of cleansing efficacy and had better acceptability among Japanese patients.

• Ascorbic acid
• Bowel preparation
• Colonoscopy
• Efficacy
• Polyethylene glycol
• Tolerability

Recent clinical studies indicate that the disturbed phosphate metabolism in chronic kidney disease (CKD) may facilitate kidney injury; nonetheless, the causal role of phosphate in CKD progression remains to be elucidated. Here, we show that intestinal phosphate binding by sucroferric oxyhydroxide (SF) ameliorates renal injury in the rat remnant kidney model. Sprague-Dawley rats received 5/6 nephrectomy (RK) and had a normal chow or the same diet containing SF (RK + SF). RK rats showed increased plasma FGF23 and phosphate levels, which were suppressed by SF administration. Of note, albuminuria in RK rats was significantly ameliorated by SF at both 4 and 8 weeks. SF also attenuated glomerulosclerosis and tubulointerstitial injury. Moreover, several different approaches confirmed the protective effects on podocytes, explaining the attenuation of glomerulosclerosis and albuminuria observed in this study. As a possible mechanism, we found that SF attenuated renal inflammation and fibrosis in RK rats. Interestingly, von Kossa staining of the kidney revealed calcium phosphate deposition in neither RK nor RK + SF rats; however, plasma levels of calciprotein particles were significantly reduced by SF. These data indicate that latent positive phosphate balance accelerates CKD progression from early stages, even when overt ectopic calcification is absent.

• Cathartics/administration & dosage
• Cathartics/standards
• Colonic Polyps/surgery
• Colonoscopy/methods
• Colonoscopy/standards
• Colorectal Neoplasms/prevention & control
• Health Services Research
• Humans
• Precancerous Conditions/surgery
• Preoperative Care/methods
• Preoperative Care/standards

• acute kidney injury
• chronic renal insufficiency
• endoscopy
• nephrocalcinosis
• sodium phosphate

• Calcification
• Elastogenesis
• Fibulin
• Kidney
• Pericellualr matrix

• Animal Feed/analysis
• Animal Nutritional Physiological Phenomena
• Animals
• Body Weight
• Cats/metabolism
• Diet/veterinary
• Feces/chemistry
• Kidney/metabolism
• Phosphorus/metabolism
• Phosphorus, Dietary/administration & dosage
• Renal Insufficiency, Chronic/veterinary

Capsule endoscopy has been the first-line examination for small bowel diseases, yet its diagnostic yield is restricted by unsatisfactory bowel preparation. To evaluate the clinical effectiveness of different dosages of polyethylene glycol in patients undergoing capsule endoscopy, we performed a comprehensive meta-analysis of all randomized controlled trials involving polyethylene glycol in preparation for capsule endoscopy. The methodological quality of the trials was evaluated using the Cochrane Risk of Bias assessment instrument. In this study, 12 RCTs involving 2072 patients were included in this review. Our review indicated that 4 L and 2 L polyethylene (PEG) before capsule endoscopy (CE) and 500 mL PEG after CE increase the small bowel image quality, whereas 1 L PEG did not improve the small bowel image quality. PEG accelerated the gastric emptying time. There was no significant difference between the PEG group and control group in small bowel transit time, completion rates, and diagnostic yield.

• capsule endoscopy
• colonoscopy
• colorectal cancer
• diagnosis
• sensitivity

To compare the tolerability and quality of bowel cleansing between 2 L polyethylene glycol (PEG) and reduced-dose sodium phosphate (NaP) tablets as a preparation for colonoscopy.

Two hundred patients were randomly assigned to the PEG or NaP groups at the same ratio. The NaP group patients took 30 tablets with 2 L of clear liquid, while the PEG group patients took 2L of PEG. Tolerability was assessed by a questionnaire about taste, volume, and the overall impression. The bowel cleansing quality was evaluated by colonoscopists.

Although NaP showed better tolerability in terms of taste, volume and overall impression (P < 0.01, P < 0.01 and P = 0.02, respectively), the overall cleansing quality was better in the PEG group (P < 0.01). A subgroup analysis, stratified by sex and age, indicated that NaP was associated with better tolerability and equivalent bowel cleansing quality in females of < 50 years of age.

Despite the better tolerability, the use of 30 NaP tablets with 2 L of clear liquid should be limited due to its lower cleansing quality; however, in certain cases the regimen may deserve consideration, particularly in cases involving young women.

• Colonoscopy
• Sodium phosphate tablets
• Polyethylene glycol
• Preparation

• Administration, Oral
• Adult
• Age Factors
• Cathartics/administration & dosage
• Colonoscopy
• Colorectal Neoplasms/diagnostic imaging
• Female
• Humans
• Male
• Middle Aged
• Phosphates/administration & dosage
• Polyethylene Glycols/administration & dosage
• Prospective Studies
• Sex Factors
• Surveys and Questionnaires
• Tablets
• Treatment Outcome
• Young Adult