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BACKGROUND@#Rheumatoid arthritis (RA), a chronic systemic autoimmune disease, is characterized by synovitis and progressive damage to the bone and cartilage of the joints, leading to disability and reduced quality of life. This study was a randomized clinical trial comparing the outcomes between withdrawal and dose reduction of tofacitinib in patients with RA who achieved sustained disease control.@*METHODS@#The study was designed as a multicenter, open-label, randomized controlled trial. Eligible patients who were taking tofacitinib (5 mg twice daily) and had achieved sustained RA remission or low disease activity (disease activity score in 28 joints [DAS28] ≤3.2) for at least 3 months were enrolled at six centers in Shanghai, China. Patients were randomly assigned (1:1:1) to one of three treatment groups: continuation of tofacitinib (5 mg twice daily); reduction in tofacitinib dose (5 mg daily); and withdrawal of tofacitinib. Efficacy and safety were assessed up to 6 months.@*RESULTS@#Overall, 122 eligible patients were enrolled, with 41 in the continuation group, 42 in the dose-reduction group, and 39 in the withdrawal group. After 6 months, the percentage of patients with a DAS28-erythrocyte sedimentation rate (ESR) of <3.2 was significantly lower in the withdrawal group than that in the reduction and continuation groups (20.5%, 64.3%, and 95.1%, respectively; P < 0.0001 for both comparisons). The average flare-free time was 5.8 months for the continuation group, 4.7 months for the dose reduction group, and 2.4 months for the withdrawal group.@*CONCLUSION@#Withdrawal of tofacitinib in patients with RA with stable disease control resulted in a rapid and significant loss of efficacy, while standard or reduced doses of tofacitinib maintained a favorable state.@*TRIAL REGISTRATION@#Chictr.org, ChiCTR2000039799.
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Humans , Quality of Life , China , Arthritis, Rheumatoid/drug therapy , Piperidines/therapeutic use , Treatment Outcome , Antirheumatic Agents/therapeutic use , Pyrroles/therapeutic useABSTRACT
Objective:Anti-synthase syndrome (ASS) is a rare autoimmune disease. To increase the understanding of the disease and reduce the rate of miss diagnosis.Methods:The clinical data of 8 patients with positive anti-synthase antibody afterprimary Sj?gren's syndrome (pSS) were retrospectively analyzed and descriptive statistical analysis was carried out.Results:The diagnosis of Sjogren's syndrome (SS) was in accordance with the revised European criteriaof SS issued by the US-Europe consensus Group in 2002 or the classification criteria of American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) SS in 2016, and the diagnostic ASS was in accordance with the diagnostic criteria of Conners in 2010 or Solomon in 2011. Eight(100%) patients had a history of interstitial lung disease, and 7 (88%) patients had fever (oral temperature >38.5 ℃). All patients were positive for anti-Ro-52 antibody, 4 patients were positive for anti-PL-7 antibody, 2 patients were positive for anti-EJ antibody, 1 patient was positive for both anti-PL-7 antibody and anti-EJ antibody, and 1 patient was positive for anti-PL-12.Conclusion:pSS patients with severe interstitial lung disease or high fever of unknown causes should be screened for anti-synthase antibodies and the possibility of ASS.
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Objective:To observe the clinical efficacy and adverse reactions of rituximab in the treatment of systemic sclerosis (SSc).Methods:Eight SSc patients who received rituximab treatment in the Department of Rheumatology of Shanghai Ruijin Hospital from November 2016 to May 2020 were treated with rituximab at week 0, week 2, week 4, week 24 and week 48. The clinical symptoms and laboratory parameters were evaluated at baseline, week 4, week 24 and week 48 respectively. All data were analyzed by Wilcoxon test.Results:All the patients were diagnosed as diffuse SSc, including seven females and one male, with a median disease course of 2.5 years. At week 0, week 24 and week 48, the modified Rodnon skin scores (MRss) were 16.5 (11.8, 29.5) , 14.5 (9.5, 27) ( Z=0.841) and 10.5 (7, 24.3) ( Z=0.420) respectively, which were significantly improved as compared with the baseline ( P<0.05). The patients' self-scores were 60(50, 77.5), 52.5(41.3, 67.5)( Z=0.113) and 47.5(36.3, 57.5)( Z=0.474) respectively, which were significantly improved at week 24 and week 48, and the High Resolution CT (HRCT) scores at baseline and week 48 were 2.7(1.02, 3.7) and 1.6(0.65, 2.95)( Z=0.964) respectively, significantly improved after treatment ( P<0.05). The pulmonary aterial hypertension (PAH) values were 48(41, 58.5) mmHg and 47(38.5, 57) mmHg ( Z=0.315) respectively. There was no significant difference between the two groups. Clinical observation showed that the condition was improved and no adverse reaction occurred at the same time period. Conclusion:The improvement of skin sclerosis, pulmonary interstitial lesion and pulmonary artery pressure can be observed during the treatment with rituximab, which may be a new choice for the treatment of SSc. There is no serious adverse reaction during the treatment, and the patients are well tolerated and safe.
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Objective To investigate the related factors of systemic inflammatory response syndrome after percutaneous nephrolithotomy in the treatment of upper urinary tract stones.Methods The clinical data of 101 patients after percutaneous nephrolithotomy from August 2016 to April 2018 in Miyun Teaching Hospital,Capital Medical University were retrospectively analysed.Screened the independent variable such as gender,with fever or not,with diabetes or not,with hydronephrosis or not,urine leucocyte count,volume of urinary calculi,CT attenuation value of urinary calculi and presence of intraoperative infection,and analyzed the relationship those with systemic inflammatory response syndrome after surgery.Univariate and multivariate logistic regression analysis the factors related to systemic inflammatory response in patients after surgery.Results Of the 101 patients,62 cases was male,and 39 cases was female,12 (11.9％) suffered postoperative systemic inflammatory response syndrome.Univariate regression analysis indicated that the risk factors of systemic inflammatory response syndrome after percutaneous nephrolithotomy were gender,with diabetes or not,urine leucocyte count,volume of urinary calculi and presence of intraoperative infection.Furthermore,multivariate logistic regression analysis revealed that with diabetes,intraoperative infection,urine leucocyte count and volume of urinary calculi were the independent factors of systemic inflammatory response syndrome after percutaneous nephrolithotomy.Conclusion Patients with diabetes,intraoperative infection,urine leucocyte count and volume of urinary calculi could be predicted as the independent factors of systemic inflammatory response syndrome after percutaneous nephrolithotomy,but it has no relationship with gender,with a history of fever or not,with hydronephrosis or not,and CT attenuation value of urinary calculi.
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Objective To discuss the clinical value of bile reinfusion via nasojejunal tube on liver function after biliary tract surgery. Methods Eighty patients with biliary tract surgery and bile outer drainage were divided into bile reinfusion group and control group by random digits table method with 40 cases each. The clinical data concerning the liver function and volume of biliary drainage were collected. Results The patients were well tolerated for bile reinfusion, and abdominal distension, nausea and vomiting occurred in some patients. The symptoms improved significantly after symptomatic treatment. The alanine aminotransferase (ALT) and total bilirubin (TBIL) levels at the fifth day after operation in bile reinfusion group were significantly reduced than those in control group:(31 ± 18) U/L vs. (48 ± 32) U/L and (51 ± 32)μmol/L vs. (76 ± 38)μmol/L, the aspartate aminotransferase (AST) and ALT levels at the seventh day after operation in bile reinfusion group were significantly reduced than those in control group: (32 ± 19) U/L vs. (43 ± 26) U/L and (20 ± 19) U/L vs. (31 ± 22) U/L, and there were statistical differences (P<0.05). The volume of biliary drainage in the bile reinfusion group was significantly increased compared with that in control group at the third and fourth day after operation:(485 ± 52) ml vs. (428 ± 96) ml and (509 ± 62) ml vs. (458 ± 59) ml, and there was statistical difference (P<0.01). Conclusions Bile reinfusion via the nasojejunal tube may facilitate the recovery of liver function after biliary tract surgery.
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Objective To investigate the effect of preoperative carbohydrate fluid intake on postoperative insulin resistance and immune function.Methods Sixty elective gastroenteric tumor resection patients were randomly divided into test (n =30) and control (n =30) groups.Control group were fasted before surgery,while test group were given oral carbohydrate before surgery.The blood samples were collected to measure the levels of fasting blood glucose (FBG),fasting insulin (FINS),and cellular immunity (CD3 +,CD4 +,CD8 +,and CD4 +/CD8 +) before operation and 1,3,7 day postoperation,respectively.Homeostasis model assessment (HOMA) was applied to assess the status of insulin resistance.Results Compared to preoperation,the levels of CD4 +,CD4 + / CD8 +,and HOMA-IR at 1 day postoperation in both control and test groups were significantly higher (P ＜ 0.05).Compared to test group,the levels of CD4 +,CD4 +/CD8 +,and HOMA-IR at 1,3 day postoperation in control group were significantly higher (P ＜ 0.05).At the seventh day after surgery,HOMA-IR levels in the test group were returned to the preoperative level (P ＞ 0.05),while the control group was still higher than before surgery (P ＜ 0.05).There were no differences in CD4 + and CD4+/CD8 + at seventh days after surgery between two groups (P ＞ 0.05).Conclusions Preoperative carbohydrate administration may shorten the insulin resistance duration after gastrointestinal cancer surgery,reduce the intensity of insulin resistance,and improve immune function.Thus contributes to the rehabilitation of patients.
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Objective To assess the effect of preoperative carbohydrate preconditioning on postoperative insulin resistance and inflammatory response in patients after gastroenteric tumor resection.Methods Sixty patients with elective gastroenteric tumor resection were divided into preoperative carbohydrate preconditioning group and control group by random digits table with 30 cases each.Preoperative carbohydrate preconditioning group was given oral containing 50 g glucose carbohydrate 300 ml 2 h before surgery,and control group was given traditional method,fasting 12 h before surgery and water deprivation 6 h before surgery.The blood samples were collected to measure the level of fasting blood glucose (FBG),fasting insulin (FINS),interleukin (IL)-6 and C-reactive protein (CRP),3 h before surgery and 1,3,7 d after surgery respectively.Homeostasis model assessment insulin resistance index (HOMA-IR) was computed.Results There were no statistical differences in FBG,FINS,IL-6,CRP and HOMA-IR 3 h before surgery between the 2 groups (P ＞ 0.05).The FBG,FINS,IL-6,C RP and HOMA-IR in the 2 groups at 1,3 d after surgery were significantly higher than those 3 h before surgery,but those except for FBG in control group were significantly higher than those in preoperative carbohydrate preconditioning group [1 d after surgery:(39.67 ± 10.37) mU/L vs.(25.78 ± 12.43) mU/L,(98.67 ± 12.42) μg/L vs.(65.36 ± 16.72)μg/L,(121.74 ±11.32) mg/L vs.(82.18 ±4.36) mg/L,19.07 ±5.49 vs.11.67 ±6.32;3 d after surgery:(24.34 ±6.78) mU/L vs.(16.23 ±7.56) mU/L,(116.43 ± 18.57) μg/L vs.(78.53 ± 10.38) μg/L,(151.30 ± 10.46) mg/L vs.(129.29 ± 10.24) mg/L,8.56 ±2.87 vs.5.12 ±2.11],there were statistical differences (P ＜0.05).There were no statistical differences in FINS and HOMA-IR in preoperative carbohydrate preconditioning group between 7 d after surgery and 3 h before surgery (P ＞ 0.05),but there was statistical difference in control group (P＜ 0.05).There were no statistical differences in FBG,IL-6 and CRP in the 2 groups between 7 d after surgery and 3 h before surgery (P ＞ 0.05).There was no aspiration during anesthetic stage.Conclusion Preoperative carbohydrate preconditioning may shorten the insulin resistance time after gastroenteric tumor resection,reduce the intensity of insulin resistance,and improve inflammatory response,thus contributing to the rehabilitation of patients.
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Objective To explore the effect of carbohydrate administration on postoperative insulin resistance after gastroenteric tumor resection.Methods Sixty elective gastroenteric tumor resection patients were divided into observation group and control group by random number table method,with 30 cases in each.Observation group was given carbohydrate administration before surgery,that was 2 h before anesthesia oral carbohydrates 300 ml containing 50 g glucose;control group was treated according to the traditional methods,preoperative fasting 12 h,6 h forbidden to drink.The blood samples were collected to measure the levels of fasting blood glucose (FBG) and fasting insulin (FINS) at 3 h before operation and 1,3,7 d postoperation respectively.Homeostasis model assessment (HOMA) was applied to calculate the insulin resistance index.Results The levels of FBG,FINS,HOMA-IR at 1,3 d postoperation in two groups were significantly higher than those at 3 h preoperation [observation group:(10.65 ± 1.78),(7.32 ± 1.48) mmol/L vs.(5.09 ±0.43) mmol/L,(25.78 ± 12.43),(16.23 ±7.56) mU/L vs.(10.48 ± 1.57) mU/L,11.67 ±6.32,5.12 ± 2.11 vs.2.35 ± 0.54;control group:(11.18 ± 1.25),(8.04 ± 1.53) mmol/L vs.(5.12 ± 0.39) mmol/L,(39.67 ± 10.37),(24.34 ± 6.78) mU/L vs.(9.98 ± 2.04) mU/L,19.07 ± 5.49,8.56 ± 2.87 vs.2.28 ± 0.39](P ＜ 0.05).The levels of FINS,HOMA-IR at 1,3 d postoperation in control group were higher than those in observation group (P ＜ 0.05).The levels of FINS and HOMA-IR at 7 d postoperation in observation group were returned to the 3 h preoperative (P ＞ 0.05),while the levels in control group [(16.32 ± 4.56) mU/L,3.87 ± 1.12] was still higher than those at 3 h preoperation (P ＜0.05).Conclusion Carbohydrate administration may shorten the insulin resistance durion after gastroenteric tumor resection,and reduce the intensity of insulin resistance,thus contributing to the rehabilitation of patients.
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Objective To investigate the efficacy and safety of transrectal ultrasound guided transurethral balloon dilation of the prostate (TUDP) for the treatment of benign prostatic hyperplasia (BPH).Methods A total of 23 men with BPH who had undergone TUDP were retrospectively analyzed,including 16 men with indwelling urinary catheters before the operation.During the TUDP,the prostatic apex and membranous urethra were dilated by inner balloon,and the prostatic urethra and bladder neck were dilated by outer balloon.The patients were followed up at the 1st,3rd,6th and 12th month after the operation,and the observation parameters included subjective symptoms,such as international prostatic symptom score (IPSS) and quality of life (QOL) score,and objective parameters,such as maximum flow rate (Qmax) and post-void residual (PVR).Results The operation time was 30-165 min,and the intraoperative hemorrhage volume was 5-50 ml.The IPSS scores at 1st,3rd,6th and 12th month after the operation were 10.4± 4.2,8.7±3.2,9.5±4.6 and 8.3±1.5 respectively,which were significantly decreased in comparison to the IPSS score (22.0±7.2) before the operation (P＜0.05).The QOL scores at 1st,3rd,6th and 12th month after the operation were 2.1±1.1,1.6±1.0,1.8±1.1 and 1.6±1.0 respectively,which were significantly improved in comparison to the QOL score (4.9±0.9) before the operation (P＜0.05).The Qmax at 1st,3rd,6th and 12th month after the operation were (10.5±3.4),(12.4±4.2),(10.9±3.9) and (12.7±4.6) ml/s respectively,which were significantly increased in comparison to the Qmax(1.9± 1.9 ml/s) before the operation (P＜0.05).There were 5,4,2 cases of urinary incontinence at the 1st,2nd and 3rd month after the operation,but they recovered at the 4th month follow-up.Besides,there were 3 cases suffered from epididymitis.Conclusion Transrectal ultrasound guided TUDP is a safe,effective and cheap option for the treatment of BPH,especially for the primary hospitals.
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ObjectiveTo explore the value of immuomagnetic beads(IMB) technique for detection of intraperitoneal free cancer cells from colorectal cancer.MethodsPeritoneal lavage fluid was obtained from 80 patients with colorectal cancer during laparotomy.Peritoneal lavage cytology (PLC) and IMB were used to detect free cancer cells in peritoneal lavage fluid.10 patients with hysteromyoma during laparotomy were enrolled into the control group.ResultsThe positive rate of PLC was 8.8％ (7/80),the positive rate of IMB was 28.8％ (23/80).The positive case after useing PLC detect,IMB detect also was positive.The detected samples of control group were negative by these two methods.IMB was superior to PLC ( x2 =10.503,P =0.001 ).ConclusionIMB was more sensitive and specific than PLC,which could provide a effective method for finding intraperitoneal free cancer cells.
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Objective To investigate the correlation between quantitative parameters with contrast-enhanced ultrasound-power Doppler(CEUS-PD) and mierovessel density (MVD) in hepatoeellular carcinoma (HCC). Methods Thirty-four cases with HCC underwent CEUS before operation. The satisfactory images were selected through CEUS-PD and analyzed with computer to calculate mean color vessel density(MCVD). The blood flows of focal lesions were graded into 0-Ⅲ based on the numbers of color vessels with CEUS-PD. The correlation between those parameters and MVD counted with immunohistochemistry was analyzed after operation. Results In 34 cases with HCC, the MCVD of focal lesions with CEUS-PD was 0. 17±0.09, the pathologic MVD was (62.59 ±23.96)/400 × after operation. The MCVD was positively correlated to MVD( r = 0. 56, P <0.05). In 34 cases HCC,3 cases were in grade Ⅰ , 12 cases were in grade Ⅱ , 19 cases were in grade Ⅲ. There was significant differences in pathologic MVD of every grade ( F = 8.06, P <0.05). But there was no linear tendency in the grades( F = 7.57, P<0. 05). Conclusions In focal lesions of 34 HCC, MCVD calculated with CEUS-PD was positively correlated to pathologic MVD. It can be used to evaluate tumor blood perfusion exactly before operation.