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Objective:To evaluate the efficacy and safety of adalimumab (ADA) in the treatment of Crohn′s disease (CD), and to analyze the predictive factors of ADA efficacy.Methods:From January 2020 to December 2020, 49 CD patients treated with ADA at the Department of Gastroenterology, Tenth People′s Hospital of Tongji University of Shanghai were enrolled. The clinical data before treatment were collected. During 12 weeks of ADA treatment, the patients were followed up every 2 weeks, the laboratory examinations were conducted every 4 weeks, and colonoscopy examination was rechecked at the 12th week. The improvement of the main symptoms of patients was assessed at 2nd, 4th, and 6th week during ADA treatment. At the 12th week after ADA treatment, the clinical response (Crohn′s disease activity index (CDAI) score decreased ≥70 points from baseline), clinical remission (CDAI score < 150 points), endoscopic response (simple endoscopic score for Crohn′s disease (SES-CD) decreased >50% from baseline) and endoscopic remission (SES-CD ≤2 points or Rutgeerts score ≤1 point), closure of anal fistula of CD patients complicated with anal fistula and occurrence of adverse reactions during treatment were recorded. The predictive factors of clinical remission of CD patients after ADA treatment for 12 weeks were analyzed. The Mann-Whitney U test and binary logistic regression analysis were used for statistical analysis. Results:The main symptom improved rates of 49 CD patients received ADA treatment at 2nd, 4th and 6th week were 75.5% (37/49), 95.9% (47/49) and 98.0% (48/49), respectively, and the main symptom improved time was 14.0 d (7.0 d, 17.0 d). After ADA treatment for 12 weeks, the clinical remission rate was 55.1% (27/49), the clinical response rate was 73.5% (36/49), the endoscopic remission rate was 43.3% (13/30), the endoscopic response rate was 55.6% (15/27), the anal fistula closure rate was 7/18, and the overall incidence of adverse reactions was 24.5% (12/49). The baseline of fecal calprotectin (FC) level of patients in the clinical remission group (27 cases) was lower than that of the patients in the active disease group (22 cases) (111.0 μg/g, 26.3 μg/g to 125.6 μg/g vs. 540.5 μg/g, 420.2 μg/g to 866.9 μg/g), and the difference was statistically significant ( Z=-4.44, P<0.001). The results of binary logistic regression analysis showed that baseline FC level was an independent predictive factor of clinical remission in CD patients treated with ADA for 12 weeks ( OR=1.08, 95%confidence interval 1.02 to 1.14, P=0.013). When the baseline FC cut-off value was 172.39 g/g, the sensitivity and specificity of it in predicting clinical remission in CD patients treated with ADA for 12 weeks were 81.48% and 90.91%, and the area under the receiver operator characteristic curve was 0.87 ( P<0.001). Conclusions:ADA is safe and effective in the treatment of CD. The baseline FC level is an independent predictive factor of clinical remission in CD patients treated with ADA for 12 weeks.
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There are many types of fundus diseases and their causes are complex. They can be caused by metabolic factors or inflammatory factors. Fundus examination and imaging examination tools are the main methods for diagnosing fundus diseases. However, in terms of determining the cause and early diagnosis, if the intraocular fluid detection technology can be reasonably combined, the advantages will be greater. Intraocular fluid is the general term for fluid in the eyeball, including aqueous humor, vitreous humor, etc. The molecular components that can be tested include DNA, RNA, antigens, antibodies, and cytokines. With the advancement of molecular testing technology and equipment, intraocular fluid testing as an evidence-based method has gradually been incorporated into the consensus and guidelines of more fundus disease experts, and is mainly used for infectious fundus diseases and camouflage syndromes. Reasonable use of intraocular fluid testing can help improve the personalized diagnosis and treatment of fundus diseases and reduce unnecessary drug overuse. However, it is worth noting that intraocular fluid detection is only one of many tools and cannot replace other examinations and clinical experience. Excessive intraocular fluid testing not only increases the risk of clinical infections because of invasiveness, but also increases the burden on patients.
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Immunomodulators and biological agents are widely used in inflammatory bowel disease (IBD), and induce remission effectively. However, these drugs are related to serious adverse events, and coupled with increasing treatment costs. Therefore, once patients with IBD are in remission, the safety and feasibility of drug de-escalation should be considered, and the risk of continuing medical therapy against the risk of disease relapse must be weighed. This review article analyzed the published literatures on de-escalation of immunomodulators and biological agents in patients with Crohn's disease and ulcerative colitis, identifying the risk factors of relapse after drug withdrawal, such as disease activity, prognostic features and previous disease course, and discussed the strategies for de-escalation and use of proactive therapeutic drug monitoring, so as to provide some guidance for clinical practice.
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Objective To compare the effects of median nerve electrical stimulation on coma patients after traumatic brain injury with different settings. Methods From 2013 to 2015, 161 patients with traumatic brain injury were randomly divided into control group (n=40), experimental group 1 (n=41), experimental group 2 (n=39) and experimental group 3 (n=41). The control group received routine conscious-ness-promoted methods, and the experimental groups received median nerve electrical stimulation with 200μs and 30 Hz, 100 Hz and 50 Hz in sequence, 60 minutes a day for 90 days. They were assessed with Glasgow Coma Scale (GCS) and Coma Recovery Scale-Revised (CRS-R) before, 30 days and 90 days after treatment. Results There was significant difference in the scores of CCS and CRS-R, times of treatment, number of sobered patients and coma time among groups (P0.05). The experimental group 3 was better than the experimental groups 1 and 2 (P<0.05). Conclusion Median nerve electrical stimulation with 200μs, 50 Hz could promote co-ma patients to wake up optimally.
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Objective Primary renal mucosa associated lymphoid tissue lymphoma (MALT lymphoma)is very rare,here dis-cuss the clinical pathological characteristics and diagnosis,differential diagnosis of primary renal MALT lymphoma.Methods A case of primary renal MALT lymphoma was assayed for clinical and histopathological morphology,an well as immuno-histochemical staining,then reviewed the relevant literature.Results The clinical and imaging characteristics of renal lym-phoma lack of specific performance,the tissue section of the kidney biopsy showed diffuse infiltration of small lymphocytes. The small lymphocytes were centrocytes-like,monocytes-like,and plasma cell differentiation was recognized.Lymphoepithe-lial lesions were scattered.Follicular implanted phenomenon could been seen.Immunohistochemically result:the tumor cells were positive for CD20,PAX-5,CD79αand MUM-1,but negative for CD3,CD5,CD45RO,bcl-2,CD10,bcl-6 and CyclinD1. CD2 1 showed damage FDC network,positive for Kappa,negative for lambda,and it showed monoclonal phenotype,the Ki-6 7 index was about 35%.Final pathology diagnosis was primary renal MALT lymphoma.Conclusion Primary renal MALT lymphoma is very rare,the clinical manifestations and imaging characteristic of renal lymphoma are non-specific and misdiag-nosis frequently occurs in clinical practice,definite diagnosis depends on pathological examination,immunohistochemical stai-ning is helpful to differential diagnosis.
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OBJECTIVE:To establish a method for the identification of Chongqing local medicinal material Heracleum hemsley-anum. METHODS:The original plant morphology,morphological characteristics,microscopic characteristics (transverse section and powder),were identified. RESULTS:H. hemsleyanum had cone shape root,brown,many-branched with special fragrance;the microscopic characteristics of taproot a transverse showed no differences with lateral root transverse section,primary xylem was di-arch,secondary phloem was more developed than secondary xylem,secondary phloem was rich in the oil chamber. Vascular tissues contained a large number of parenchyma cells. In TLC chromatrogram,the test sample showed the same color fluorescent spots with-the substance reference of osthole and columbianadin in the corresponding locations. CONCLUSIONS:The established method is simple with high accuracy,and can be used as the basis for identification of H. hemsleyanum.
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Objective:To explore the methods of emergency terminating refractory tachyarrhythmia.Methods:Data of 117 cases,Who received emergency termination of tachyarrhythmia in emergency department of Taihe Hospital in the last five years,Were summarized and revieWed.Results:All 117 cases With tachyarrhythmia Were successfully terminated in emergency.A total of 21 cases (17.9%)Were successfully terminated in emergency using tWo or more methods (12 cases With supraventricular tachycardia,five cases With ventricular tachycardia,one case With atrial flutter and three cases With atrial fibrillation),in these patients concluded as refractory tachyarrhythmia,five pa-tients (23.8%)Were terminated via synchronous electrical cardioversion.Conclusion:Termination of refractory tachyarrhythmia needs individualization treatment strategy,its treatment may be drugs first and then electrical car-dioversion,or electrical cardioversion directly if necessary.
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<p><b>OBJECTIVE</b>To establish a HPLC method of characteristic chromatographic profile for the quality control of Paeoniae Radix.</p><p><b>METHOD</b>The 67 batches of samples were analyzed on a Polaris C18-A column with a gradient elution of acetonitrile and phosphate solution (pH 3.0) at a flow rate of 1.0 mL x min(-1) and detected at 230 nm.</p><p><b>RESULT</b>Nine main marker peaks were identified and semi-quantificated. By the similarity evaluation software for chromatographic fingerprint of traditional Chinese medicine (Version 2004A) and hierarchical clustering analysis, 67 batches of Paeoniae Radix were classified.</p><p><b>CONCLUSION</b>The method can be applied for quality assessment of Paeoniae Radix.</p>
Subject(s)
Chromatography, High Pressure Liquid , Methods , Paeonia , Chemistry , Quality ControlABSTRACT
<p><b>OBJECTIVE</b>To develop a method of quantitative analysis of multi-components by single marker (QAMS) for simultaneously determining paeoniflorin and albiflorin in Paeoniae Radix Alba.</p><p><b>METHOD</b>Using paeoniflorin as the internal reference substance, the relative correction factor (RCF) of albiflorin was determined by HPLC and UPLC with good reproducibility. The contents of paeoniflorin in 16 samples of Paeoniae Radix Alba were authentically determined by the external standard method, and the content of albiflorin was calculated according to the RCF. The contents of these two components in the samples were determined with the external standard method.</p><p><b>RESULT</b>No siginificant differences between the quantitative results of QAMS method and external standard method were observe.</p><p><b>CONCLUSION</b>It is a convenient and accurate method to determine multi-components when some authentic standard substances were unavailable. It can be used to control the quality of Paeoniae Radix Alba</p>
Subject(s)
Benzoates , Bridged-Ring Compounds , Chromatography, High Pressure Liquid , Methods , Glucosides , Monoterpenes , Paeonia , ChemistryABSTRACT
Objective To investigate the therapeutic effect of Jianpi Zengshi Granules(JZG) for children anorexia(CA),and to observe its effect on serum orexin,leptin and neuropeptide Y(NPY) levels.Methods Sixty anorexia children were equally randomized into two groups: the treatment group received JZG and the control group received Jianwei Xiaoshi Tablets.The treatment lasted 4 weeks.The therapeutic effect was evaluated after treatment,and the changes of serum orexin,leptin and NPY levels were observed before and after treatment.Results The comprehensive therapeutic effect,effect on TCM syndromes,and effect on symptoms and signs such as appetite,food in-take volume and body weight in the treatment group were superior to those in the control group(P