BACKGROUND Fecal microbial transplantation(FMT)is a promising new method for treating active ulcerative colitis(UC),but knowledge regarding FMT for quiescent UC is scarce.AIM To investigate FMT for the maintenance of ...BACKGROUND Fecal microbial transplantation(FMT)is a promising new method for treating active ulcerative colitis(UC),but knowledge regarding FMT for quiescent UC is scarce.AIM To investigate FMT for the maintenance of remission in UC patients.METHODS Forty-eight UC patients were randomized to receive a single-dose FMT or autologous transplant via colonoscopy.The primary endpoint was set to the maintenance of remission,a fecal calprotectin level below 200μg/g,and a clinical Mayo score below three throughout the 12-mo follow-up.As secondary endpoints,we recorded the patient’s quality of life,fecal calprotectin,blood chemistry,and endoscopic findings at 12 mo.RESULTS The main endpoint was achieved by 13 out of 24(54%)patients in the FMT group and by 10 out of 24(41%)patients in the placebo group(log-rank test,P=0.660).Four months after FMT,the quality-of-life scores decreased in the FMT group compared to the placebo group(P=0.017).In addition,the disease-specific quality of life measure was higher in the placebo group than in the FMT group at the same time point(P=0.003).There were no differences in blood chemistry,fecal calprotectin,or endoscopic findings among the study groups at 12 mo.The adverse events were infrequent,mild,and distributed equally between the groups.CONCLUSION There were no differences in the number of relapses between the study groups at the 12-mo follow-up.Thus,our results do not support the use of a single-dose FMT for the maintenance of remission in UC.展开更多
Background Pharmacogenomics(PGx)is a promising tool to realise tailored drug therapy for depression.Aims To investigate the treatment efficacy of PGxfor treatment-resistant depression(TRD)compared with treatmentas usu...Background Pharmacogenomics(PGx)is a promising tool to realise tailored drug therapy for depression.Aims To investigate the treatment efficacy of PGxfor treatment-resistant depression(TRD)compared with treatmentas usual.Methods A systematic search was conducted in PubMed,Embase,the Cochrane Library,Web of Science and PsyclNFO to identify relevant studies published from inception to 15 April 2023.Two-arm randomised controlled trials(RCTs)exploring the efficacy of PGx-guided versus unguided treatment for TRD were included.The risk of bias in the included studies was evaluated using the Cochrane risk of bias assessment tool.The overall quality of evidence was assessed using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach.Results Seven RCTs(n=3003)comparing PGx-guided(n=1492)and unguided(n=1511)groups were identified and analysed.PGx-guided treatment was superior to treatment as usual in response(relative risk(RR)=1.31;95%confidence interval(95%Cl):1.15 to 1.49;p<0.001)and remission(RR=1.40;95%Cl:1.09 to 1.80;p=0.009)improvements.Effect sizes for acceptability(RR=0.90;95%Cl:0.80 to 1.02;p=0.100)and side effect burden(RR=0.58;95%Cl:0.29 to 1.15;p=0.120)between the two groups were not statistically different.The overall quality of evidence was rated from'very low'(25%)to low'(75%)based on the GRADE criteria.Conclusions PGx-guided treatment has shown a small overall effect in improving the response and remission rates for patients with TRD.However,these results should be interpreted cautiously because of the few included studies and the low quality of evidence.Further high-quality clinical trials are warranted to confirm the findings.展开更多
Polyarteritis nodosa (PAN) affects mostly medium-sized arteries and sometimes small ones as well. The primary methods used to make the diagnosis are through physical examinations, biopsies of organs that are affected,...Polyarteritis nodosa (PAN) affects mostly medium-sized arteries and sometimes small ones as well. The primary methods used to make the diagnosis are through physical examinations, biopsies of organs that are affected, and/or angiographic studies. Immunosuppressants like glucocorticoids and cyclophosphamide are usually started as soon as possible after a diagnosis. So, it’s not clear if sudden remission of PAN happens or not. Here we present a 42-year-old male who presented with right upper quadrant, right flank pain and fever. CT angiogram Aorta revealed soft tissue rind around the small to medium sized vessel in the abdomen and bilateral cortical renal infarcts of variable age in the right more than the left. A diagnosis of polyarteritis nodosa was made and the patient achieved spontaneous remission with no need for corticosteroids or immunosuppressive therapy.展开更多
Introduction Psoriasis is a chronic inflammatory systemic disorder which is strongly associated with metabolic syndrome.Erythrodermic psoriasis(EP)is a severe type of psoriasis that causes severe physical and mental i...Introduction Psoriasis is a chronic inflammatory systemic disorder which is strongly associated with metabolic syndrome.Erythrodermic psoriasis(EP)is a severe type of psoriasis that causes severe physical and mental impairment.Evidence-based data on EP treatment are limited in recent years.Although conventional systemic treatments such as acitretin,cyclosporine,methotrexate and steroids show efficacy in patients with EP,these treatments have many limitations and intolerance[1].Improvement of this syndrome can seriously affect patients’quality of life(DLQI).Secukinumab is an interleukin-17A inhibitor human monoclonal antibody which has been approved for the treatment of moderate to severe plaque psoriasis[2].There has been no research on the use of secukinumab in EP patients with metabolic syndrome.We present two EP patients with metabolic syndrome who achieved and maintained successful treatment and remission for more than 52 weeks with secukinumab.展开更多
The use of specific terms under different meanings and varying definitions has always been a source of confusion in science.When we point our efforts towards an evidence based medicine for inflammatory bowel diseases(...The use of specific terms under different meanings and varying definitions has always been a source of confusion in science.When we point our efforts towards an evidence based medicine for inflammatory bowel diseases(IBD)the same is true:Terms such as"mucosal healing"or"deep remission"as endpoints in clinical trials or treatment goals in daily patient care may contribute to misconceptions if meanings change over time or definitions are altered.It appears to be useful to first have a look at the development of terms and their definitions,to assess their intrinsic and context-independent problems and then to analyze the different relevance in present-day clinical studies and trials.The purpose of such an attempt would be to gain clearer insights into the true impact of the clinical findings behind the terms.It may also lead to a better defined use of those terms for future studies.The terms"mucosal healing"and"deep remission"have been introduced in recent years as new therapeutic targets in the treatment of IBD patients.Several clinical trials,cohort studies or inception cohorts provided data that the long term disease course is better,when mucosal healing is achieved.However,it is still unclear whether continued or increased therapeutic measures will aid or improve mucosal healing for patients in clinical remission.Clinical trials are under way to answer this question.Attention should be paid to clearly address what levels of IBD activity are looked at.In the present review article authors aim to summarize the current evidence available on mucosal healing and deep remission and try to highlight their value and position in the everyday decision making for gastroenterologists.展开更多
Hepatocellular carcinoma (HCC) is the fifth most common malignant disease worldwide, and curative treatment remains difficult because the majority of cases are diagnosed in the advanced stage. Sorafenib is the only kn...Hepatocellular carcinoma (HCC) is the fifth most common malignant disease worldwide, and curative treatment remains difficult because the majority of cases are diagnosed in the advanced stage. Sorafenib is the only known effective systemic treatment, but patients rarely achieve complete remission (CR). A 66-year-old man with a history of alcoholic liver cirrhosis with a diagnosis of advanced HCC, was initially treated with transarterial chemoembolization on four occasions. However, the disease progressed with portal vein thrombosis. Therefore, sorafenib was started, and 4 mo later, the patient achieved CR. The treatment was continued for 12 mo, and CR was maintained up to 4 mo after sorafenib discontinuation.展开更多
AIM: To assess the risk of relapse in ulcerative colitis(UC) patients in clinical remission using mucosal status and fecal immunochemical test(FIT) results. METHODS: The clinical outcomes of 194 UC patients in clinica...AIM: To assess the risk of relapse in ulcerative colitis(UC) patients in clinical remission using mucosal status and fecal immunochemical test(FIT) results. METHODS: The clinical outcomes of 194 UC patients in clinical remission who underwent colonoscopy were based on evaluations of Mayo endoscopic subscores(MESs) and FIT results.RESULTS: Patients with an MES of 0(n = 94, 48%) showed a ten-fold lower risk of relapse than those with an MES of 1-3(n = 100, 52%)(HR = 0.10, 95%CI: 0.05-0.19). A negative FIT result(fecal hemoglobin concentrations ≤ 100 ng/m L) was predictive of patients with an MES of 0, with a sensitivity of 0.94 and a specific of 0.76. Moreover, patients with a negative FIT score had a six-fold lower risk of clinical relapse than those with a positive score(HR = 0.17, 95%CI: 0.10-0.28). Inclusion of the distinguishing parameter, sustaining clinical remission > 12 mo, resulted in an even stronger correlation between negative FIT results and an MES of 0 with respect to the risk of clinical relapse(HR = 0.11, 95%CI: 0.04-0.23).CONCLUSION: Negative FIT results one year or more after remission induction correlate with complete mucosal healing(MES 0) and better prognosis. Performing FIT one year after remission induction may be useful for evaluating relapse risk.展开更多
BACKGROUND It is a crucial issue for patients with refractory ulcerative colitis(UC),including steroid-dependent and steroid-refractory patients,to achieve and maintain steroid-free remission.However,clinical studies ...BACKGROUND It is a crucial issue for patients with refractory ulcerative colitis(UC),including steroid-dependent and steroid-refractory patients,to achieve and maintain steroid-free remission.However,clinical studies focused on the achievement of steroid-free remission in refractory UC patients are insufficient.Cytapheresis(CAP)is a non-pharmacological extracorporeal therapy that is effective for active UC with fewer adverse effects.This study comprised UC patients treated with CAP and suggested the efficacy of CAP for refractory UC patients.AIM To clarify the efficacy of CAP in achieving steroid-free remission in refractory UC patients.METHODS We retrospectively reviewed the collected data from 55 patients with refractory UC treated with CAP.We analyzed the following points:(1)Efficacy of the first course of CAP;(2)Efficacy of the second,third,and fourth courses of CAP in patients who experienced relapses during the observation period;(3)Efficacy of CAP in colonic mucosa;and(4)Long-term efficacy of CAP.Clinical efficacy was evaluated using Lichtiger’s clinical activity index or Sutherland index(disease activity index).Mucosal healing was evaluated using Mayo endoscopic subscore.The primary and secondary endpoints were the rate of achievement of steroidfree remission and the rate of sustained steroid-free remission,respectively.Statistical analysis was performed using the paired t-test and chi-squared test.RESULTS The rates of clinical remission,steroid-free remission,and poor effectiveness after CAP were 69.1%,45.5%,and 30.9%,respectively.There were no significant differences in rate of steroid-free remission between patients with steroiddependent and steroid-refractory UC.The mean disease activity index and Lichtiger’s clinical activity index scores were significantly decreased after CAP(P<0.0001).The rates of steroid-free remission after the second,third,and fourth courses of CAP in patients who achieved steroid-free remission after the first course of CAP were 83.3%,83.3%,and 60%,respectively.Mucosal healing was observed in all patients who achieved steroid-free remission after the first course of CAP.The rates of sustained steroid-free remission were 68.0%,60.0%,and 56.0%at 12,24,and 36 mo after the CAP.Nine patients(36%)had maintained steroid-free remission throughout the observation period.CONCLUSION Our results suggest that CAP effectively induces and maintains steroid-free remission in refractory UC and re-induces steroid-free remission in patients achieving steroid-free remission after the first course of CAP.展开更多
OBJECTIVES Moderate to vigorous physical activity is recommended to prevent hypertension according to the current guidelines.However,the degree to which the total physical activity(TPA)and its changes benefit normoten...OBJECTIVES Moderate to vigorous physical activity is recommended to prevent hypertension according to the current guidelines.However,the degree to which the total physical activity(TPA)and its changes benefit normotensives and hypertensives is uncertain.We aimed to examine the effects of TPA and its changes on the incidence,progression,and remission of hypertension in the large-scale prospective cohorts.METHODS A total of 73,077 participants(55,101 normotensives and 17,976 hypertensives)were eligible for TPA analyses.During a mean follow-up of 7.16 years(394,038 person-years),12,211 hypertension cases were identified.TPA was estimated as metabolic equivalents and categorized into quartiles.Cox proportional hazards regression and multivariable logistic regression were used to estimate associations of TPA and changes in TPA with incident hypertension and progression/remission of hypertension.RESULTS Compared with the lowest quartile of TPA,normotensives at the third and the highest quartile had a decreased risk of incident hypertension,with hazard ratios(HRs)of 0.86[95%confidence interval(CI):0.81−0.91]and 0.81(95%CI:0.77−0.86),respectively.Hypertensives at the highest quartile of TPA demonstrated a decreased risk of progression of hypertension[odds ratio(OR)=0.87,95%CI:0.79−0.95],and an increased probability of hypertension remission(OR=1.17,95%CI:1.05−1.29).Moreover,getting active from a sedentary lifestyle during the follow-up period could reduce 25%(HR=0.75,95%CI:0.58−0.96)risk of incident hypertension,whereas those becoming sedentary did not achieve benefit from initially being active.CONCLUSIONS Our findings indicated that increasing and maintaining TPA levels could benefit normotensives,whereas higher TPA levels were needed to effectively control progression and improve remission of hypertension.Physical activity played undoubtedly an essential role in both primary and secondary prevention of hypertension.展开更多
BACKGROUND Previous studies reported hypertension remission after gastrectomy for gastric cancer patients, and the remission rate was 11.1%-93.8%. We have reported the factors of hypertension remission previously, how...BACKGROUND Previous studies reported hypertension remission after gastrectomy for gastric cancer patients, and the remission rate was 11.1%-93.8%. We have reported the factors of hypertension remission previously, however, the follow-up time was six months. It is necessary to identify risk factors for hypertension for a relatively longer follow-up time.AIM To analyze the predictive factors for hypertension remission one year after gastrectomy of gastric cancer patients and to construct a risk model for hypertension remission.METHODS We retrospectively collected the medical information of patients with concurrent gastric cancer and hypertension in a single clinical center from January 2013 to December 2020. Univariate and multivariate logistic regression of hypertension remission were conducted, and a nomogram model was established.RESULTS A total of 209 patients with concurrent gastric cancer and hypertension were included in the current study. There were 108 patients in the remission group and 101 patients in the non-remission group. The hypertension remission rate was 51.7% one year after gastrectomy. The remission group had younger aged patients(P = 0.001), larger weight loss(P = 0.001), lower portion of coronary heart disease(P = 0.017), higher portion of II-degree hypertension(P = 0.033) and higher portion of total gastrectomy(P = 0.008) than the non-remission group. Younger age(P =0.011, odds ratio = 0.955, 95%CI: 0.922-0.990), higher weight loss(P = 0.019, odds ratio = 0.937,95%CI: 0.887-0.989) and total gastrectomy(P = 0.039, odds ratio = 2.091, 95%CI: 1.037-4.216) were independent predictors for hypertension remission. The concordance index of the model was 0.769and the calibration curve suggested great agreement. Furthermore, decision curve analysis showed that the model was clinically useful.CONCLUSION Younger age, higher weight loss and total gastrectomy were independent predictors for hypertension remission after gastrectomy for gastric cancer patients. The nomogram could visually display these results.展开更多
In the course of the study there were examined cytokine levels of pro-inflammatory and anti-inflammatory activity (IL-1b, IL-4, IL-6, IL-8, IL-10, IFN-g, G-GSF), and also the levels of progesterone and estradiol in th...In the course of the study there were examined cytokine levels of pro-inflammatory and anti-inflammatory activity (IL-1b, IL-4, IL-6, IL-8, IL-10, IFN-g, G-GSF), and also the levels of progesterone and estradiol in the blood serum with a view to study the pathogenic characteristics of a chronic inflammatory process of the pelvic organs in remission. It was shown that the remission of the disease is characterized by the significant increase in the concentrations of pro-inflammatory cytokines IL-6, IL-8, and also increase of inducers activation of the immune response of the immune response (IL-4 and IFN-g), accompanied by a decrease in the concentration of sex hormones. In women with chronic inflammatory diseases of urogenital sphere in remission tested active immunological process and violation of the synthesis of sex hormones. Revealed changes predispose to the emergence disorders of reproductive health.展开更多
AIM To assess the effects of probiotic Medilac-S~ as adjunctive therapy for the induction of remission of ulcerative colitis(UC) in a Chinese population through a systematic review and meta-analysis. METHODS A syste...AIM To assess the effects of probiotic Medilac-S~ as adjunctive therapy for the induction of remission of ulcerative colitis(UC) in a Chinese population through a systematic review and meta-analysis. METHODS A systematic literature search was conducted to find randomized, controlled trials in a Chinese population with at least two study arms-a control arm which receives a conventional, oral aminosalicylate drug, and a treatment arm, which administers the same conventional drug in conjunction with the probiotic Medilac-S~ per os. Both English and Chinese databases were searched, including Pub Med, EMBASE, Google Scholar, Chinese National Knowledge Infrastructure, Wanfang Data, and VIP Search, and study data was extracted onto standardized abstraction sheets. Meta-analyses were conducted for primary and secondary outcomes of interest using a fixed or random effects model. The primary outcome was the induction of clinical remission and the secondary outcomes included changes in Sutherland index, endoscopic and histological scores, proportion of reported clinical symptoms and adverse events(AEs). For outcomes with sufficient data, the type of conventional drug therapy was also assessed to determine if the effects of combination therapy with Medilac-S~ was influenced by drug type. All tests were conducted using a type Ⅰ error rate of 0.05 and all confidence intervals(CI) were based on a 95% confidence level. Review protocol was uploaded to PROSPERO(CRD42018085658 upon completion).RESULTS Fifty-three clinical trials with a total of 3984 participants were identified and included in the review. Medilac-S~ adjunctive therapy significantly improved induction of clinical remission(RR = 1.21; 95%CI: 1.18-1.24; P < 0.0001) with the estimated likelihood of effective treatment, on average, 21% higher for those consuming the probiotic. Sutherland index scores showed the control mean was on average 3.10(CI: 2.41-3.78; P = 0.0428) units greater than the treatment mean, thereby demonstrating significant improvement in participants taking the probiotic. Similarly, a significant difference was seen between the overall reduction of endoscopic and histological scores of control and treatment arm participants, with score decreases in the control groups 0.71(CI: 0.3537-1.0742) and 1.1(CI: 0.9189-1.2300) units smaller than treatment group score decreases. The proportion of participants reporting clinical symptoms,(abdominal pain, tenesmus, blood and mucous in stool, and diarrhea) was significantly reduced after combination therapy with Medilac-S~(P < 0.0001) and estimated to be on average 44%(RR = 0.44, CI: 0.32-0.59), 53%(RR = 0.53, CI: 0.38-74), 40%(RR = 0.40, CI: 0.28-0.58) and 47%(RR = 0.47 CI: 0.36-0.42) respectively, of the proportion of individuals reporting the aforementioned symptoms after conventional therapy alone. The risk of AEs was also significantly reduced with adjunctive Medilac-S~ therapy. The proportion of individuals in the treatment groups reporting AEs was an estimated 72% of the proportion of individuals in the control groups reporting AEs(RR = 0.72, CI: 0.55-0.94, P = 0.0175). Upon comparing effect means for different drug types in conjunction with Medilac-S~, evidence of significant variability(P < 0.0001) was observed, and sulfasalazine was found to be the most effective drug in both primary and secondary outcomes. CONCLUSION Evidence suggests Medilac-S~ adjunctive therapy should be considered standard care for UC in a Chinese population because it aids in the induction of clinical remission, improves symptoms of the gastrointestinal tract and reduces risk of AEs.展开更多
BACKGROUND Autoimmune pancreatitis(AIP)is a particular type of chronic pancreatitis,and steroid treatment of AIP is effective.Spontaneous remission(SR)of AIP without steroids is relatively rare.The international conse...BACKGROUND Autoimmune pancreatitis(AIP)is a particular type of chronic pancreatitis,and steroid treatment of AIP is effective.Spontaneous remission(SR)of AIP without steroids is relatively rare.The international consensus for the treatment of autoimmune pancreatitis suggests that patients with AIP with obstructive jaundice,abdominal pain,and back pain related to the pancreas or the bile duct should be treated with steroids;most asymptomatic patients with AIP may improve without steroids.However,in our clinical work,we found that the clinical characteristics of AIP patients with SR vary.Four of these cases are described here.In addition,to our knowledge,there is no previously published report of dynamic imaging before and after SR of AIP at present.CASE SUMMARY We present the cases of four patients with AIP(two females and two males)in which the AIP improved spontaneously without steroid treatment.Two patients were asymptomatic,one patient had abdominal pain with obstructive jaundice,and one patient had intermittent right upper abdominal pain.Three patients presented with localized pancreatic enlargement and one with diffuse pancreatic enlargement.In addition to the pancreatic lesions,bile duct involvement was seen in two patients,and no extra-pancreatic organ involvement was found in the other two patients.The serum IgG4 level of all patients was more than twice the normal level.After SR in the four patients,the affected pancreases exhibited three types of image features:Return to normal,progressive fibrosis,and atrophy and calcification.CONCLUSION The clinical features of SR in our four patients with AIP differ,but the imaging findings share some characteristics.After SR,in some cases the affected pancreas could return to normal,although some patients suffer from progressive fibrosis and atrophy as well as calcification.展开更多
Renal involvement with rapidly progressive glomeru-lonephritis is a common manifestation of antineutrophil cytoplasmic antibody(ANCA) associated vasculitides, which is characterized by end-stage renal disease and high...Renal involvement with rapidly progressive glomeru-lonephritis is a common manifestation of antineutrophil cytoplasmic antibody(ANCA) associated vasculitides, which is characterized by end-stage renal disease and high mortality rates in untreated and/or late referral patients. The long-term renal survival has improved dramatically since the addition of cyclophosphamide(CYC) and recently of rituximab(RTX) in association with corticosteroids in the remission induction thera-peutic regimens. However, renal prognosis remains unfavorable for many patients and the mortality rate is still significantly high. In this review, we analyze the open challenges to be addressed to optimize the induction remission therapy, principally in patients with advanced kidney failure. This concern the first-line therapy(CYC or RTX) based on different parameters(estimated glomerular filtration rate at baseline, new or relapsed disease, ANCA specificity, tissue injury, safety), the role of plasma exchange and the role of new therapies. Indeed, we discuss future perspectives in induction remission therapy by reporting recent advances in new targeted therapies with particular reference to avacopan, an orally administered selective C5a receptor inhibitor.展开更多
As to determine the effect of post-remission therapy in prolonging survival and duration of remission after complete remission, 50 patients with APL In complete remission Induced by retinolc acid (RA) were divided int...As to determine the effect of post-remission therapy in prolonging survival and duration of remission after complete remission, 50 patients with APL In complete remission Induced by retinolc acid (RA) were divided into three groups randomly: (A) 30 cases, treated by alternate chemotherapy with RA; (B) 10 cases, with RA alone; (C) 10 cases, only with chemotherapy.The survival curves showed mat Group A had the survival time more than 1 year In 87. 4 %, more than 2 year in 80.7%. 26/30 cases were survival and still in remission, the survival curve tend to be a plateau at 16 months. In Group B more than 1 year in 45. 7%. In Group C, more than 1 year In 50%. (Keplan-Meler x2 = 8. 93 P 【0. 01).This result showed that the alternate chemotherapy with RA for post- Induction remission therapy could be useful to Improve long-term survivors and to prolong the duration of remission.展开更多
AIM: To evaluate the effectiveness of thiopurines in maintaining steroid-free remission in routine clinical practice.METHODS: The multi-center Pediatric Inflammatory Bowel Disease Network(PIBDNet) cohort study prospec...AIM: To evaluate the effectiveness of thiopurines in maintaining steroid-free remission in routine clinical practice.METHODS: The multi-center Pediatric Inflammatory Bowel Disease Network(PIBDNet) cohort study prospectively collected data on thiopurine naive patients initiating mercaptopurine(6MP) or azathioprine. Patients with a diagnosis of Crohn's disease(CD) were included in our study upon entering remission as determined by physician global assessment(PGA) within 365 d of initiation of thiopurines. The primary outcome of the study was maintenance of steroid-free remission(SFR) at each follow up visit. Patients were considered treatment failures if there had been a change in PGA from remission to mild, moderate or severe disease;disease relapse between visits; need for rescue therapy(biologic therapy, methotrexate, steroids); thiopurine discontinuation, hospitalization or surgical intervention. A secondary outcome defined treatment failure as a change from remission to moderate or severe(not mild) in addition to the previously defined criteria.RESULTS: Sixty-five of 182 patients in the PIBDNet registry met criteria for inclusion in this study. Fortyfive of 65(69%) of included patients achieved remission within 180 d of thiopurine initiation. For the primary outcome, 47% and 23% of patients remained in SFR at 6 and 12 mo. The mean thiopurine dose at initiation for the 65 included patients was 0.89 ± 0.31 mg/kg per day. Metabolite levels were obtained in 48%(31/65) of the included patients with a mean 6TG level of 258 pmole/8 × 108 RBC ± 147. For the secondary outcome, 65% and 42% of patients remained in SFR at 6 and 12 mo.CONCLUSION: Thiopurines were less effective in maintaining remission for pediatric CD in this "real world" cohort than has been previously described. Variation in thiopurine dosing and metabolite measurement was found among practitioners.展开更多
BACKGROUND Inflammatory bowel disease(IBD)is a chronic,relapsing inflammation of the digestive tract.Although fecal and serum biomarkers have been extremely important and supportive for monitoring of IBD,their low sen...BACKGROUND Inflammatory bowel disease(IBD)is a chronic,relapsing inflammation of the digestive tract.Although fecal and serum biomarkers have been extremely important and supportive for monitoring of IBD,their low sensitivity and high variability characteristics limit clinical efficacy.Thus,the establishment of better biomarkers is expected.Fucosylation is one of the most important glycosylation modifications of proteins.Fucosylated haptoglobin(Fuc-Hpt)is used as a biomarker for several cancers and inflammation-related diseases.We recently established a novel glycan monoclonal antibody(mAb),designated 10-7G,which recognizes Fuc-Hpt.We developed an enzyme-linked immunosorbent assay(ELISA)to measure serum levels of Fuc-Hpt(10-7G values).AIM To investigate the usefulness of the serum 10-7G values as a potential biomarker for monitoring disease activity in IBD.METHODS This was a case control study.Intestinal tissues of IBD patients(n=10)were examined immunohistochemically using the 10-7G mAb.We determined 10-7G values using serum from patients with ulcerative colitis(UC,n=110),Crohn’s disease(n=45),acute enteritis(AE,n=11),and healthy volunteers(HVs)who exhibited normal(n=20)or high(n=79)C-reactive protein(CRP)levels at medical check-up.We investigated the correlation between the 10-7G value and various clinical parameters of IBD patients by correlation analysis.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the usefulness of the 10-7G values as a biomarker for clinical and endoscopic remission of UC compared to conventional serum biomarkers.RESULTS In the immunohistochemical analysis,positive 10-7G mAb staining was observed in lymphocytes infiltrating into inflammatory sites of the mucosal layer and lymphoid follicles.The 10-7G values were significantly higher in patients with IBD(P<0.001)and AE(P<0.05)compared with HVs.In addition,10-7G values were correlated with clinical examination parameters related to inflammation in patients with UC,particularly the CRP level(rs=0.525,P=0.003)and clinical activity index score(rs=0.435,P=0.038).However,there was no correlation between 10-7G values and CRP in HVs with high CRP levels,suggesting that the 10-7G values is not the same as a general inflammation biomarker.ROC curve analysis showed that area under the curve(AUC)value of 10-7G values for the diagnosis of endoscopic remission was higher than other biomarkers(AUC value=0.699).CONCLUSION The serum 10-7G value is a novel biomarker for evaluating intestinal inflammation and endoscopic mucosal healing in UC.展开更多
Objective To summarize the clinical features of spontaneous remission in classic fever of unknown origin(FUO).Methods Medical records of 121 patients diagnosed with FUO at admission in Peking Union Medical College Hos...Objective To summarize the clinical features of spontaneous remission in classic fever of unknown origin(FUO).Methods Medical records of 121 patients diagnosed with FUO at admission in Peking Union Medical College Hospital between January 2018 and June 2018 were reviewed retrospectively.Patients who were discharged without etiological diagnoses were followed for 2 years.The clinical features and outcomes of these patients were summarized.Multivariate logistic regression was used to analyze related factors of spontaneous remission of FUO.Results After excluding 2 patients who lost to follow-up,the etiology of 119 FUO patients were as follows:infectious diseases in 30(25.2%)cases,connective tissue diseases in 28(23.5%)cases,tumor diseases in 8(6.7%)cases,other diseases in 6(5.0%)cases,and unknown diagnoses in 47(39.5%)cases.Totally,41 patients experienced spontaneous remission of fever(the median time from onset to remission was 9 weeks,ranging from 4 to 39 weeks).In patients with spontaneous remission in FUO,lymphadenopathy was less common clinical manifestation,the levels of inflammatory markers including leukocyte count,neutrophil count,neutrophil ratio,C-reactive protein,and ferritin were lower,and the proportion of CD8 positive T lymphocytes expressing CD38 was lower.Multivariate logistic regression analysis of factors with a P-value<0.05 in univariate analysis shown that white blood cell count(OR:0.S45,95%CI:0.306-0.971,P=0.039),neutrophil count(OR:2.074,95%CI:1.004-4.284,P=0.049),and proportion of neutrophils(OR:0.928,95%Cl:0.871-0.990,P=0.022)were independent significant factors associated with spontaneous remission in FUO.Conclusions This study suggested that most patients discharged with undiagnosed classic FUO would remit spontaneously.Thus,for patients with stable clinical conditions,follow-up and observation could be the best choice.Patients with lower level of some inflammatory factors may have a high likelihood of spontaneous remission in classic FUO.展开更多
Over the last decade,obesity rates have continued to rise in the United States as well as worldwide and are showing no signs of slowing down.This rise is in parallel with the increasing rates of type 2 diabetes mellit...Over the last decade,obesity rates have continued to rise in the United States as well as worldwide and are showing no signs of slowing down.This rise is in parallel with the increasing rates of type 2 diabetes mellitus(T2DM).Given the association between obesity and T2DM and their strong correlation with increased morbidity and mortality in addition to healthcare expenditure,it is important to recognize the most effective ways to combat them.Thus,we performed a review of literature that focused on assessing the outcomes of T2DM following bariatric surgery.Available evidence suggests that bariatric surgery provides better T2DM resolution in obese patients when compared to best medical management alone.Additionally,Biliopancreatic diversion with duodenal switch as well as Roux-en-Y gastric bypass have demonstrated higher rates of T2DM resolution when compared with other bariatric procedures.展开更多
基金Academy of Finland(Reetta Satokari),No.323156Sigrid Juselius Foundation+2 种基金University of Helsinki(A Three-year Grant)The Competitive State Research Financing(Perttu Lahtinen),No.200230042The Ella and Georg Ehrnrooth Foundation(Perttu Arkkila)
文摘BACKGROUND Fecal microbial transplantation(FMT)is a promising new method for treating active ulcerative colitis(UC),but knowledge regarding FMT for quiescent UC is scarce.AIM To investigate FMT for the maintenance of remission in UC patients.METHODS Forty-eight UC patients were randomized to receive a single-dose FMT or autologous transplant via colonoscopy.The primary endpoint was set to the maintenance of remission,a fecal calprotectin level below 200μg/g,and a clinical Mayo score below three throughout the 12-mo follow-up.As secondary endpoints,we recorded the patient’s quality of life,fecal calprotectin,blood chemistry,and endoscopic findings at 12 mo.RESULTS The main endpoint was achieved by 13 out of 24(54%)patients in the FMT group and by 10 out of 24(41%)patients in the placebo group(log-rank test,P=0.660).Four months after FMT,the quality-of-life scores decreased in the FMT group compared to the placebo group(P=0.017).In addition,the disease-specific quality of life measure was higher in the placebo group than in the FMT group at the same time point(P=0.003).There were no differences in blood chemistry,fecal calprotectin,or endoscopic findings among the study groups at 12 mo.The adverse events were infrequent,mild,and distributed equally between the groups.CONCLUSION There were no differences in the number of relapses between the study groups at the 12-mo follow-up.Thus,our results do not support the use of a single-dose FMT for the maintenance of remission in UC.
基金supported by the 2021 Annual Project of Shanghai Mental Health Center(SMHC)Clinical Research Center(CRC2021ZD02)。
文摘Background Pharmacogenomics(PGx)is a promising tool to realise tailored drug therapy for depression.Aims To investigate the treatment efficacy of PGxfor treatment-resistant depression(TRD)compared with treatmentas usual.Methods A systematic search was conducted in PubMed,Embase,the Cochrane Library,Web of Science and PsyclNFO to identify relevant studies published from inception to 15 April 2023.Two-arm randomised controlled trials(RCTs)exploring the efficacy of PGx-guided versus unguided treatment for TRD were included.The risk of bias in the included studies was evaluated using the Cochrane risk of bias assessment tool.The overall quality of evidence was assessed using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach.Results Seven RCTs(n=3003)comparing PGx-guided(n=1492)and unguided(n=1511)groups were identified and analysed.PGx-guided treatment was superior to treatment as usual in response(relative risk(RR)=1.31;95%confidence interval(95%Cl):1.15 to 1.49;p<0.001)and remission(RR=1.40;95%Cl:1.09 to 1.80;p=0.009)improvements.Effect sizes for acceptability(RR=0.90;95%Cl:0.80 to 1.02;p=0.100)and side effect burden(RR=0.58;95%Cl:0.29 to 1.15;p=0.120)between the two groups were not statistically different.The overall quality of evidence was rated from'very low'(25%)to low'(75%)based on the GRADE criteria.Conclusions PGx-guided treatment has shown a small overall effect in improving the response and remission rates for patients with TRD.However,these results should be interpreted cautiously because of the few included studies and the low quality of evidence.Further high-quality clinical trials are warranted to confirm the findings.
文摘Polyarteritis nodosa (PAN) affects mostly medium-sized arteries and sometimes small ones as well. The primary methods used to make the diagnosis are through physical examinations, biopsies of organs that are affected, and/or angiographic studies. Immunosuppressants like glucocorticoids and cyclophosphamide are usually started as soon as possible after a diagnosis. So, it’s not clear if sudden remission of PAN happens or not. Here we present a 42-year-old male who presented with right upper quadrant, right flank pain and fever. CT angiogram Aorta revealed soft tissue rind around the small to medium sized vessel in the abdomen and bilateral cortical renal infarcts of variable age in the right more than the left. A diagnosis of polyarteritis nodosa was made and the patient achieved spontaneous remission with no need for corticosteroids or immunosuppressive therapy.
文摘Introduction Psoriasis is a chronic inflammatory systemic disorder which is strongly associated with metabolic syndrome.Erythrodermic psoriasis(EP)is a severe type of psoriasis that causes severe physical and mental impairment.Evidence-based data on EP treatment are limited in recent years.Although conventional systemic treatments such as acitretin,cyclosporine,methotrexate and steroids show efficacy in patients with EP,these treatments have many limitations and intolerance[1].Improvement of this syndrome can seriously affect patients’quality of life(DLQI).Secukinumab is an interleukin-17A inhibitor human monoclonal antibody which has been approved for the treatment of moderate to severe plaque psoriasis[2].There has been no research on the use of secukinumab in EP patients with metabolic syndrome.We present two EP patients with metabolic syndrome who achieved and maintained successful treatment and remission for more than 52 weeks with secukinumab.
基金Supported by Grants from the Swiss National Science Foundation to Rogler G,Grant No.310030-120312to Schoepfer A,Grant No.32003B_135665/1+1 种基金to Vavricka S,Grant No.320000-114009/3 and 32473B_135694/1to the Swiss IBDCohort,Grant No.33CS30_134274
文摘The use of specific terms under different meanings and varying definitions has always been a source of confusion in science.When we point our efforts towards an evidence based medicine for inflammatory bowel diseases(IBD)the same is true:Terms such as"mucosal healing"or"deep remission"as endpoints in clinical trials or treatment goals in daily patient care may contribute to misconceptions if meanings change over time or definitions are altered.It appears to be useful to first have a look at the development of terms and their definitions,to assess their intrinsic and context-independent problems and then to analyze the different relevance in present-day clinical studies and trials.The purpose of such an attempt would be to gain clearer insights into the true impact of the clinical findings behind the terms.It may also lead to a better defined use of those terms for future studies.The terms"mucosal healing"and"deep remission"have been introduced in recent years as new therapeutic targets in the treatment of IBD patients.Several clinical trials,cohort studies or inception cohorts provided data that the long term disease course is better,when mucosal healing is achieved.However,it is still unclear whether continued or increased therapeutic measures will aid or improve mucosal healing for patients in clinical remission.Clinical trials are under way to answer this question.Attention should be paid to clearly address what levels of IBD activity are looked at.In the present review article authors aim to summarize the current evidence available on mucosal healing and deep remission and try to highlight their value and position in the everyday decision making for gastroenterologists.
文摘Hepatocellular carcinoma (HCC) is the fifth most common malignant disease worldwide, and curative treatment remains difficult because the majority of cases are diagnosed in the advanced stage. Sorafenib is the only known effective systemic treatment, but patients rarely achieve complete remission (CR). A 66-year-old man with a history of alcoholic liver cirrhosis with a diagnosis of advanced HCC, was initially treated with transarterial chemoembolization on four occasions. However, the disease progressed with portal vein thrombosis. Therefore, sorafenib was started, and 4 mo later, the patient achieved CR. The treatment was continued for 12 mo, and CR was maintained up to 4 mo after sorafenib discontinuation.
文摘AIM: To assess the risk of relapse in ulcerative colitis(UC) patients in clinical remission using mucosal status and fecal immunochemical test(FIT) results. METHODS: The clinical outcomes of 194 UC patients in clinical remission who underwent colonoscopy were based on evaluations of Mayo endoscopic subscores(MESs) and FIT results.RESULTS: Patients with an MES of 0(n = 94, 48%) showed a ten-fold lower risk of relapse than those with an MES of 1-3(n = 100, 52%)(HR = 0.10, 95%CI: 0.05-0.19). A negative FIT result(fecal hemoglobin concentrations ≤ 100 ng/m L) was predictive of patients with an MES of 0, with a sensitivity of 0.94 and a specific of 0.76. Moreover, patients with a negative FIT score had a six-fold lower risk of clinical relapse than those with a positive score(HR = 0.17, 95%CI: 0.10-0.28). Inclusion of the distinguishing parameter, sustaining clinical remission > 12 mo, resulted in an even stronger correlation between negative FIT results and an MES of 0 with respect to the risk of clinical relapse(HR = 0.11, 95%CI: 0.04-0.23).CONCLUSION: Negative FIT results one year or more after remission induction correlate with complete mucosal healing(MES 0) and better prognosis. Performing FIT one year after remission induction may be useful for evaluating relapse risk.
文摘BACKGROUND It is a crucial issue for patients with refractory ulcerative colitis(UC),including steroid-dependent and steroid-refractory patients,to achieve and maintain steroid-free remission.However,clinical studies focused on the achievement of steroid-free remission in refractory UC patients are insufficient.Cytapheresis(CAP)is a non-pharmacological extracorporeal therapy that is effective for active UC with fewer adverse effects.This study comprised UC patients treated with CAP and suggested the efficacy of CAP for refractory UC patients.AIM To clarify the efficacy of CAP in achieving steroid-free remission in refractory UC patients.METHODS We retrospectively reviewed the collected data from 55 patients with refractory UC treated with CAP.We analyzed the following points:(1)Efficacy of the first course of CAP;(2)Efficacy of the second,third,and fourth courses of CAP in patients who experienced relapses during the observation period;(3)Efficacy of CAP in colonic mucosa;and(4)Long-term efficacy of CAP.Clinical efficacy was evaluated using Lichtiger’s clinical activity index or Sutherland index(disease activity index).Mucosal healing was evaluated using Mayo endoscopic subscore.The primary and secondary endpoints were the rate of achievement of steroidfree remission and the rate of sustained steroid-free remission,respectively.Statistical analysis was performed using the paired t-test and chi-squared test.RESULTS The rates of clinical remission,steroid-free remission,and poor effectiveness after CAP were 69.1%,45.5%,and 30.9%,respectively.There were no significant differences in rate of steroid-free remission between patients with steroiddependent and steroid-refractory UC.The mean disease activity index and Lichtiger’s clinical activity index scores were significantly decreased after CAP(P<0.0001).The rates of steroid-free remission after the second,third,and fourth courses of CAP in patients who achieved steroid-free remission after the first course of CAP were 83.3%,83.3%,and 60%,respectively.Mucosal healing was observed in all patients who achieved steroid-free remission after the first course of CAP.The rates of sustained steroid-free remission were 68.0%,60.0%,and 56.0%at 12,24,and 36 mo after the CAP.Nine patients(36%)had maintained steroid-free remission throughout the observation period.CONCLUSION Our results suggest that CAP effectively induces and maintains steroid-free remission in refractory UC and re-induces steroid-free remission in patients achieving steroid-free remission after the first course of CAP.
文摘OBJECTIVES Moderate to vigorous physical activity is recommended to prevent hypertension according to the current guidelines.However,the degree to which the total physical activity(TPA)and its changes benefit normotensives and hypertensives is uncertain.We aimed to examine the effects of TPA and its changes on the incidence,progression,and remission of hypertension in the large-scale prospective cohorts.METHODS A total of 73,077 participants(55,101 normotensives and 17,976 hypertensives)were eligible for TPA analyses.During a mean follow-up of 7.16 years(394,038 person-years),12,211 hypertension cases were identified.TPA was estimated as metabolic equivalents and categorized into quartiles.Cox proportional hazards regression and multivariable logistic regression were used to estimate associations of TPA and changes in TPA with incident hypertension and progression/remission of hypertension.RESULTS Compared with the lowest quartile of TPA,normotensives at the third and the highest quartile had a decreased risk of incident hypertension,with hazard ratios(HRs)of 0.86[95%confidence interval(CI):0.81−0.91]and 0.81(95%CI:0.77−0.86),respectively.Hypertensives at the highest quartile of TPA demonstrated a decreased risk of progression of hypertension[odds ratio(OR)=0.87,95%CI:0.79−0.95],and an increased probability of hypertension remission(OR=1.17,95%CI:1.05−1.29).Moreover,getting active from a sedentary lifestyle during the follow-up period could reduce 25%(HR=0.75,95%CI:0.58−0.96)risk of incident hypertension,whereas those becoming sedentary did not achieve benefit from initially being active.CONCLUSIONS Our findings indicated that increasing and maintaining TPA levels could benefit normotensives,whereas higher TPA levels were needed to effectively control progression and improve remission of hypertension.Physical activity played undoubtedly an essential role in both primary and secondary prevention of hypertension.
文摘BACKGROUND Previous studies reported hypertension remission after gastrectomy for gastric cancer patients, and the remission rate was 11.1%-93.8%. We have reported the factors of hypertension remission previously, however, the follow-up time was six months. It is necessary to identify risk factors for hypertension for a relatively longer follow-up time.AIM To analyze the predictive factors for hypertension remission one year after gastrectomy of gastric cancer patients and to construct a risk model for hypertension remission.METHODS We retrospectively collected the medical information of patients with concurrent gastric cancer and hypertension in a single clinical center from January 2013 to December 2020. Univariate and multivariate logistic regression of hypertension remission were conducted, and a nomogram model was established.RESULTS A total of 209 patients with concurrent gastric cancer and hypertension were included in the current study. There were 108 patients in the remission group and 101 patients in the non-remission group. The hypertension remission rate was 51.7% one year after gastrectomy. The remission group had younger aged patients(P = 0.001), larger weight loss(P = 0.001), lower portion of coronary heart disease(P = 0.017), higher portion of II-degree hypertension(P = 0.033) and higher portion of total gastrectomy(P = 0.008) than the non-remission group. Younger age(P =0.011, odds ratio = 0.955, 95%CI: 0.922-0.990), higher weight loss(P = 0.019, odds ratio = 0.937,95%CI: 0.887-0.989) and total gastrectomy(P = 0.039, odds ratio = 2.091, 95%CI: 1.037-4.216) were independent predictors for hypertension remission. The concordance index of the model was 0.769and the calibration curve suggested great agreement. Furthermore, decision curve analysis showed that the model was clinically useful.CONCLUSION Younger age, higher weight loss and total gastrectomy were independent predictors for hypertension remission after gastrectomy for gastric cancer patients. The nomogram could visually display these results.
文摘In the course of the study there were examined cytokine levels of pro-inflammatory and anti-inflammatory activity (IL-1b, IL-4, IL-6, IL-8, IL-10, IFN-g, G-GSF), and also the levels of progesterone and estradiol in the blood serum with a view to study the pathogenic characteristics of a chronic inflammatory process of the pelvic organs in remission. It was shown that the remission of the disease is characterized by the significant increase in the concentrations of pro-inflammatory cytokines IL-6, IL-8, and also increase of inducers activation of the immune response of the immune response (IL-4 and IFN-g), accompanied by a decrease in the concentration of sex hormones. In women with chronic inflammatory diseases of urogenital sphere in remission tested active immunological process and violation of the synthesis of sex hormones. Revealed changes predispose to the emergence disorders of reproductive health.
文摘AIM To assess the effects of probiotic Medilac-S~ as adjunctive therapy for the induction of remission of ulcerative colitis(UC) in a Chinese population through a systematic review and meta-analysis. METHODS A systematic literature search was conducted to find randomized, controlled trials in a Chinese population with at least two study arms-a control arm which receives a conventional, oral aminosalicylate drug, and a treatment arm, which administers the same conventional drug in conjunction with the probiotic Medilac-S~ per os. Both English and Chinese databases were searched, including Pub Med, EMBASE, Google Scholar, Chinese National Knowledge Infrastructure, Wanfang Data, and VIP Search, and study data was extracted onto standardized abstraction sheets. Meta-analyses were conducted for primary and secondary outcomes of interest using a fixed or random effects model. The primary outcome was the induction of clinical remission and the secondary outcomes included changes in Sutherland index, endoscopic and histological scores, proportion of reported clinical symptoms and adverse events(AEs). For outcomes with sufficient data, the type of conventional drug therapy was also assessed to determine if the effects of combination therapy with Medilac-S~ was influenced by drug type. All tests were conducted using a type Ⅰ error rate of 0.05 and all confidence intervals(CI) were based on a 95% confidence level. Review protocol was uploaded to PROSPERO(CRD42018085658 upon completion).RESULTS Fifty-three clinical trials with a total of 3984 participants were identified and included in the review. Medilac-S~ adjunctive therapy significantly improved induction of clinical remission(RR = 1.21; 95%CI: 1.18-1.24; P < 0.0001) with the estimated likelihood of effective treatment, on average, 21% higher for those consuming the probiotic. Sutherland index scores showed the control mean was on average 3.10(CI: 2.41-3.78; P = 0.0428) units greater than the treatment mean, thereby demonstrating significant improvement in participants taking the probiotic. Similarly, a significant difference was seen between the overall reduction of endoscopic and histological scores of control and treatment arm participants, with score decreases in the control groups 0.71(CI: 0.3537-1.0742) and 1.1(CI: 0.9189-1.2300) units smaller than treatment group score decreases. The proportion of participants reporting clinical symptoms,(abdominal pain, tenesmus, blood and mucous in stool, and diarrhea) was significantly reduced after combination therapy with Medilac-S~(P < 0.0001) and estimated to be on average 44%(RR = 0.44, CI: 0.32-0.59), 53%(RR = 0.53, CI: 0.38-74), 40%(RR = 0.40, CI: 0.28-0.58) and 47%(RR = 0.47 CI: 0.36-0.42) respectively, of the proportion of individuals reporting the aforementioned symptoms after conventional therapy alone. The risk of AEs was also significantly reduced with adjunctive Medilac-S~ therapy. The proportion of individuals in the treatment groups reporting AEs was an estimated 72% of the proportion of individuals in the control groups reporting AEs(RR = 0.72, CI: 0.55-0.94, P = 0.0175). Upon comparing effect means for different drug types in conjunction with Medilac-S~, evidence of significant variability(P < 0.0001) was observed, and sulfasalazine was found to be the most effective drug in both primary and secondary outcomes. CONCLUSION Evidence suggests Medilac-S~ adjunctive therapy should be considered standard care for UC in a Chinese population because it aids in the induction of clinical remission, improves symptoms of the gastrointestinal tract and reduces risk of AEs.
文摘BACKGROUND Autoimmune pancreatitis(AIP)is a particular type of chronic pancreatitis,and steroid treatment of AIP is effective.Spontaneous remission(SR)of AIP without steroids is relatively rare.The international consensus for the treatment of autoimmune pancreatitis suggests that patients with AIP with obstructive jaundice,abdominal pain,and back pain related to the pancreas or the bile duct should be treated with steroids;most asymptomatic patients with AIP may improve without steroids.However,in our clinical work,we found that the clinical characteristics of AIP patients with SR vary.Four of these cases are described here.In addition,to our knowledge,there is no previously published report of dynamic imaging before and after SR of AIP at present.CASE SUMMARY We present the cases of four patients with AIP(two females and two males)in which the AIP improved spontaneously without steroid treatment.Two patients were asymptomatic,one patient had abdominal pain with obstructive jaundice,and one patient had intermittent right upper abdominal pain.Three patients presented with localized pancreatic enlargement and one with diffuse pancreatic enlargement.In addition to the pancreatic lesions,bile duct involvement was seen in two patients,and no extra-pancreatic organ involvement was found in the other two patients.The serum IgG4 level of all patients was more than twice the normal level.After SR in the four patients,the affected pancreases exhibited three types of image features:Return to normal,progressive fibrosis,and atrophy and calcification.CONCLUSION The clinical features of SR in our four patients with AIP differ,but the imaging findings share some characteristics.After SR,in some cases the affected pancreas could return to normal,although some patients suffer from progressive fibrosis and atrophy as well as calcification.
文摘Renal involvement with rapidly progressive glomeru-lonephritis is a common manifestation of antineutrophil cytoplasmic antibody(ANCA) associated vasculitides, which is characterized by end-stage renal disease and high mortality rates in untreated and/or late referral patients. The long-term renal survival has improved dramatically since the addition of cyclophosphamide(CYC) and recently of rituximab(RTX) in association with corticosteroids in the remission induction thera-peutic regimens. However, renal prognosis remains unfavorable for many patients and the mortality rate is still significantly high. In this review, we analyze the open challenges to be addressed to optimize the induction remission therapy, principally in patients with advanced kidney failure. This concern the first-line therapy(CYC or RTX) based on different parameters(estimated glomerular filtration rate at baseline, new or relapsed disease, ANCA specificity, tissue injury, safety), the role of plasma exchange and the role of new therapies. Indeed, we discuss future perspectives in induction remission therapy by reporting recent advances in new targeted therapies with particular reference to avacopan, an orally administered selective C5a receptor inhibitor.
文摘As to determine the effect of post-remission therapy in prolonging survival and duration of remission after complete remission, 50 patients with APL In complete remission Induced by retinolc acid (RA) were divided into three groups randomly: (A) 30 cases, treated by alternate chemotherapy with RA; (B) 10 cases, with RA alone; (C) 10 cases, only with chemotherapy.The survival curves showed mat Group A had the survival time more than 1 year In 87. 4 %, more than 2 year in 80.7%. 26/30 cases were survival and still in remission, the survival curve tend to be a plateau at 16 months. In Group B more than 1 year in 45. 7%. In Group C, more than 1 year In 50%. (Keplan-Meler x2 = 8. 93 P 【0. 01).This result showed that the alternate chemotherapy with RA for post- Induction remission therapy could be useful to Improve long-term survivors and to prolong the duration of remission.
文摘AIM: To evaluate the effectiveness of thiopurines in maintaining steroid-free remission in routine clinical practice.METHODS: The multi-center Pediatric Inflammatory Bowel Disease Network(PIBDNet) cohort study prospectively collected data on thiopurine naive patients initiating mercaptopurine(6MP) or azathioprine. Patients with a diagnosis of Crohn's disease(CD) were included in our study upon entering remission as determined by physician global assessment(PGA) within 365 d of initiation of thiopurines. The primary outcome of the study was maintenance of steroid-free remission(SFR) at each follow up visit. Patients were considered treatment failures if there had been a change in PGA from remission to mild, moderate or severe disease;disease relapse between visits; need for rescue therapy(biologic therapy, methotrexate, steroids); thiopurine discontinuation, hospitalization or surgical intervention. A secondary outcome defined treatment failure as a change from remission to moderate or severe(not mild) in addition to the previously defined criteria.RESULTS: Sixty-five of 182 patients in the PIBDNet registry met criteria for inclusion in this study. Fortyfive of 65(69%) of included patients achieved remission within 180 d of thiopurine initiation. For the primary outcome, 47% and 23% of patients remained in SFR at 6 and 12 mo. The mean thiopurine dose at initiation for the 65 included patients was 0.89 ± 0.31 mg/kg per day. Metabolite levels were obtained in 48%(31/65) of the included patients with a mean 6TG level of 258 pmole/8 × 108 RBC ± 147. For the secondary outcome, 65% and 42% of patients remained in SFR at 6 and 12 mo.CONCLUSION: Thiopurines were less effective in maintaining remission for pediatric CD in this "real world" cohort than has been previously described. Variation in thiopurine dosing and metabolite measurement was found among practitioners.
基金Ministry of Education,Culture,Sports,Science and Technology of Japan,No.19H03562FUJIFILM Wako Pure Chemical Corporation,No.J770701626.
文摘BACKGROUND Inflammatory bowel disease(IBD)is a chronic,relapsing inflammation of the digestive tract.Although fecal and serum biomarkers have been extremely important and supportive for monitoring of IBD,their low sensitivity and high variability characteristics limit clinical efficacy.Thus,the establishment of better biomarkers is expected.Fucosylation is one of the most important glycosylation modifications of proteins.Fucosylated haptoglobin(Fuc-Hpt)is used as a biomarker for several cancers and inflammation-related diseases.We recently established a novel glycan monoclonal antibody(mAb),designated 10-7G,which recognizes Fuc-Hpt.We developed an enzyme-linked immunosorbent assay(ELISA)to measure serum levels of Fuc-Hpt(10-7G values).AIM To investigate the usefulness of the serum 10-7G values as a potential biomarker for monitoring disease activity in IBD.METHODS This was a case control study.Intestinal tissues of IBD patients(n=10)were examined immunohistochemically using the 10-7G mAb.We determined 10-7G values using serum from patients with ulcerative colitis(UC,n=110),Crohn’s disease(n=45),acute enteritis(AE,n=11),and healthy volunteers(HVs)who exhibited normal(n=20)or high(n=79)C-reactive protein(CRP)levels at medical check-up.We investigated the correlation between the 10-7G value and various clinical parameters of IBD patients by correlation analysis.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the usefulness of the 10-7G values as a biomarker for clinical and endoscopic remission of UC compared to conventional serum biomarkers.RESULTS In the immunohistochemical analysis,positive 10-7G mAb staining was observed in lymphocytes infiltrating into inflammatory sites of the mucosal layer and lymphoid follicles.The 10-7G values were significantly higher in patients with IBD(P<0.001)and AE(P<0.05)compared with HVs.In addition,10-7G values were correlated with clinical examination parameters related to inflammation in patients with UC,particularly the CRP level(rs=0.525,P=0.003)and clinical activity index score(rs=0.435,P=0.038).However,there was no correlation between 10-7G values and CRP in HVs with high CRP levels,suggesting that the 10-7G values is not the same as a general inflammation biomarker.ROC curve analysis showed that area under the curve(AUC)value of 10-7G values for the diagnosis of endoscopic remission was higher than other biomarkers(AUC value=0.699).CONCLUSION The serum 10-7G value is a novel biomarker for evaluating intestinal inflammation and endoscopic mucosal healing in UC.
基金funded by the Major National Science and Technology Projects for the Control and Prevention of Major Infectious Diseases of China(2017ZX10201302-003)Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(2016-I2M-1-013).
文摘Objective To summarize the clinical features of spontaneous remission in classic fever of unknown origin(FUO).Methods Medical records of 121 patients diagnosed with FUO at admission in Peking Union Medical College Hospital between January 2018 and June 2018 were reviewed retrospectively.Patients who were discharged without etiological diagnoses were followed for 2 years.The clinical features and outcomes of these patients were summarized.Multivariate logistic regression was used to analyze related factors of spontaneous remission of FUO.Results After excluding 2 patients who lost to follow-up,the etiology of 119 FUO patients were as follows:infectious diseases in 30(25.2%)cases,connective tissue diseases in 28(23.5%)cases,tumor diseases in 8(6.7%)cases,other diseases in 6(5.0%)cases,and unknown diagnoses in 47(39.5%)cases.Totally,41 patients experienced spontaneous remission of fever(the median time from onset to remission was 9 weeks,ranging from 4 to 39 weeks).In patients with spontaneous remission in FUO,lymphadenopathy was less common clinical manifestation,the levels of inflammatory markers including leukocyte count,neutrophil count,neutrophil ratio,C-reactive protein,and ferritin were lower,and the proportion of CD8 positive T lymphocytes expressing CD38 was lower.Multivariate logistic regression analysis of factors with a P-value<0.05 in univariate analysis shown that white blood cell count(OR:0.S45,95%CI:0.306-0.971,P=0.039),neutrophil count(OR:2.074,95%CI:1.004-4.284,P=0.049),and proportion of neutrophils(OR:0.928,95%Cl:0.871-0.990,P=0.022)were independent significant factors associated with spontaneous remission in FUO.Conclusions This study suggested that most patients discharged with undiagnosed classic FUO would remit spontaneously.Thus,for patients with stable clinical conditions,follow-up and observation could be the best choice.Patients with lower level of some inflammatory factors may have a high likelihood of spontaneous remission in classic FUO.
文摘Over the last decade,obesity rates have continued to rise in the United States as well as worldwide and are showing no signs of slowing down.This rise is in parallel with the increasing rates of type 2 diabetes mellitus(T2DM).Given the association between obesity and T2DM and their strong correlation with increased morbidity and mortality in addition to healthcare expenditure,it is important to recognize the most effective ways to combat them.Thus,we performed a review of literature that focused on assessing the outcomes of T2DM following bariatric surgery.Available evidence suggests that bariatric surgery provides better T2DM resolution in obese patients when compared to best medical management alone.Additionally,Biliopancreatic diversion with duodenal switch as well as Roux-en-Y gastric bypass have demonstrated higher rates of T2DM resolution when compared with other bariatric procedures.
