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Objective:To evaluate the efficacy and safety of vedolizumab (VDZ) in the treatment of active ulcerative colitis (UC).Methods:From November 1, 2020 to October 30, 2022, at the Department of Gastroenterology, the Sixth Affiliated Hospital of Sun Yat-sen University, 81 UC patients who received VDZ treatment and completed a 14-week follow-up were retrospectively selected. The clinical data of patients, including age, disease duration, disease activity of UC were collected. The VDZ efficacy evaluation included primary and secondary efficacy indicators. The primary efficacy indicator was the clinical remission rate after 14 weeks of VDZ treatment, and the secondary efficacy indicators included the clinical response rate, steroids-free remission rate, endoscopic remission rate after 14 weeks of treatment as well as the clinical response rate, clinical remission rate, steroids-free remission rate, secondary loss of response rate after 52 weeks of treatment. The adverse reactions during the treatment were recored. Taking clinical remission after 14 weeks of treatment as the dependent variable, univariate analysis was performed to identify the risk factors affecting clinical remission of VDZ. Binary logistic regression analysis was used for multivariate analysis to determine the independent risk factors of VDZ-included clinical remission. Chi-square test and Wilcoxon signed-rank test were used for statistical analysis.Results:Among the 81 UC patients, the age was 40.0 years old (29.0 years old, 53.5 years old) and the disease duration was 42.5 months (22.5 months, 94.7 months). The proportion of patients with mild active UC was 21.0% (17/81), the proportion of patients with moderate active UC was 64.2% (52/81), and the proportion of patients with severe active UC was 14.8% (12/81). After 14 weeks of treatment, the total Mayo score decreased from baseline level of 7.0 (6.0, 9.0) to 1.0 (0.0, 3.0), and the difference was statistically significant ( Z=-6.87, P<0.001). The clinical response rate was 84.0% (68/81) and the clinical remission rate was 69.1% (56/81) after 14 weeks of treatment. Of the 17 patients treated with combination of corticosteroid therapy, 10 achieved steroid-free remission, and the endoscopic remission rate was 34.8% (23/66). Of the 43 patients followed up to 52 weeks, the total Mayo score of UC patients decreased from baseline level of 7.0 (6.0, 9.0) to 0.0 (0.0, 1.0) after 52 weeks of treatment, and the difference was statistically significant ( Z=-3.25, P<0.001). The clinical response rate was 69.8% (30/43), and the clinical remission rate was 65.1% (28/43). Of the 13 patients treated with combination of corticosteroid therapy, 10 patients achieved steroid-free remission. The secondary loss of response rate was 15.2%(5/33) .The result of the univariate analysis showed that previous use of glucocorticoids was a risk factor of clinical remission after 14 weeks of VDZ treatment ( χ2=5.88, P=0.015). The result of multivariate logistic regression analysis showed that previous use of glucocorticoids was an independent risk factor of clinical remission after 14 weeks of VDZ treatment ( OR=3.429, 95% confidence interval 1.235 to 9.517, P=0.014). During the follow-up period, 12.3% (10/81) of patients developed Clostridium difficile infections, except for 1 case stopped VDZ treatment because the clinical response was not reached, remaining 9 cases continued VDZ treatment after received anti- Clostridium difficile treatment. Conclusion:VDZ has good clinical efficacy and safety in the treatment of Chinese UC patients, and patients with no history of glucocorticoid use may be more likely to achieve clinical remission after 14 weeks of treatment.
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Background/Aims@#Crohn’s disease (CD) primarily affects young female adults of reproductive age. Few studies have been conducted on this population’s ovarian reserve status. The aim of study was to investigate potential risk factors associated with low ovarian reserve, as reflected by serum anti-Müllerian hormone (AMH) in women of reproductive age with CD. @*Methods@#This was a case-control study. Cases included 87 patients with established CD, and healthy controls were matched by age, height and weight in a 1:1 ratio. Serum AMH levels were measured by enzyme-linked immunosorbent assay. @*Results@#The average serum AMH level was significantly lower in CD patients than in control group (2.47±2.08 ng/mL vs. 3.87±1.96 ng/mL, respectively, P<0.001). Serum AMH levels were comparable between CD patients and control group under 25 years of age (4.41±1.52 ng/mL vs. 3.49±2.10 ng/mL, P=0.06), however, serum AMH levels were significantly lower in CD patients over 25 years of age compared to control group (P<0.05). Multivariable analysis showed that an age greater than 25 (odds ratio [OR], 10.03; 95% confidence interval [CI], 1.90–52.93, P=0.007), active disease state (OR, 27.99; 95% CI, 6.13–127.95, P<0.001) and thalidomide use (OR, 15.66; 95% CI, 2.22–110.65, P=0.006) were independent risk factors associated with low ovarian reserve (serum AMH levels <2 ng/mL) in CD patients. @*Conclusions@#Ovarian reserve is impaired in young women of reproductive age with CD. Age over 25 and an active disease state were both independently associated with low ovarian reserve. Thalidomide use could result in impaired ovarian reserve.
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Objective:To evaluate the therapeutic effect and safety of microwave ablation plus curettage.Methods:Clinical data of a single group of 12 patients admitted to our hospital from June 2015 to June 2019 who underwent microwave ablation for bone metastasis were retrospectively analyzed. There were 7 males and 5 females, with an average age of 59.5±10.1 (range from 43 to 79) years old. Curettage plus bone cement after microwave ablation was performedand when the lesion involved the sacroiliac joint surface and impaired the bearing arch, the internal fixation was performed with plate and screws. 8 among the 12 patients underwent curettage, bone cement and metal internal fixation after microwave ablation. After microwave ablation, and 4 patients underwent curettage and reconstruction with bone cement alone. The patients were followed up aftersurgery. The observational indicators included: patient survival rate, local recurrence rate, perioperative complications, Operation time, intraoperative blood loss, VAS score, SF-36 score, and MSTS function score. VAS scores and SF-36 scores were recorded before surgery, 1 week after surgery and 3 months after surgery.Results:12 patients were followed up for 4-27 months, with an average follow-up time of 14.2 months and a median follow-up time of 9 months. During the follow-up, 7 patients died and 5 survived, with a 6-month survival rate of 81.8%, a 1-year survival rate of 40.9% and a 2-year survival rate of 27.3%. The mean survival time of the dying patients was 8.8 months (5-18 months), and the median survival time was 7 months. Operation time was 101±21 min and intraoperative blood loss was 295±108 ml. During the follow-up period, local recurrence rate was 8.3% (1/12), and the average postoperative time to recurrence was 4 months. There were no complications such as wound nonunion, wound infection, deep infection, vascular nerve heat injury and internal fixation failure. VAS score before surgery was 7.5 (7, 8) points, VAS score 1 week after surgery was 5 (4, 5) points, and VAS score 3 months after surgery was 5 (4, 5.75) points ( P<0.05). Preoperative SF-36 score was 23 (21, 24.75) points, 1 week after surgery SF-36 score was 47 (46, 54) points, and 3 months after surgery SF-36 score was 50.5 (47, 55.25) points ( P<0.05). 3 months after the operation, the MSTS score was 20.5 (16.25, 21.75) points, of which excellent 16.7% (2/12), good 50% (6/12), medium 16.7% (2/12), poor 16.7% (2/12), and the overall excellent and good rate was 66.7% (8/12). Conclusion:Microwave ablation plus curettage for pelvic metastasis of malignant tumor can significantly relieve local pain, rebuild limb function and improve patients' quality of life, and it`s an alternative treatment for pelvic metastases.
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BACKGROUND: Treatment of large bone defects is an important problem faced by orthopedic physicians. Allogeneic bone transplantation is a classic method, but it has many restrictions. The membrane guided bone regeneration technique has become an important method for the research nowadays.OBJECTIVE:To compare the effects of self-made high strength biodegradable nano-hydroxyapatite/multi(amino acid) copolymer (n-HA/MACP) guided bone regeneration membrane tube and allograft bone graft segment in the repair of large segmental bone defect in goats. METHODS: The model of 30 mm large segment bone defect in the middle section of the femur in 32 adult goats was established. Experimental group used self-made n-HA/MACP tube to bridge defects following bone plate fixation. The control group was treated with allograft bone graft bone segments combined with plate fixation. The animals were sacrificed at 4, 8, 12 and 16 weeks after operation, and the bone callus growth was observed in the specimens. The X-ray and histological observations were performed at the same time. Biomechanical measurement of plate fixation of allograft cortical bone segment was done at 12 and 16 weeks after operation. RESULTS AND CONCLUSION: (1) After 4 to 16 weeks, gross and pathological results showed fibrous callus growth inside and outside of the membrane tube, and the fibrous callus gradually hardened into a bony callus. Additionally, the callus was larger in the experimental group than in the control group. X-ray films showed significantly increased lateral callus density in the experimental group as compared with the control group. (2) Maximum bending strength was significantly higher in the experimental group than in the control group at 16 weeks (P < 0.05). Overall, the n-HA/MACP membrane tube used for bridging large segment bone defects in goats can obtain similar repair effects to the allograft cortical bone, and further achieve the better mechanical strength of the new bone segment than the allograft bone.
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BACKGROUND:Bisphosphonates that can suppress osteoclast activity strongly is a powerful inhibitor for bone resorption, which has been reported to have good effects in the treatment of fibrous dysplasia. OBJECTIVE:To evaluate the clinical effect of surgical treatment combined with bisphosphonate therapy in the treatment of fibrous dysplasia. METHODS: Fifteen patients with fibrous dysplasia of the long bone were subjected to surgical treatment and oral bisphosphonate therapy postoperatively. Limb pain, limb function, local X-ray manifestations and blood alkaline phosphatase activity were observed before and at 3, 6, 12, 24 months after treatment. The therapeutic effects were evaluated using modified Macnab standards. RESULTS AND CONCLUSION:Al the 15 patients were folowed up for more than 24 months, and their pain symptoms were significantly relieved after the combined treatment of surgery and bisphosphonates, excelent in 12 cases and effective in 1 case, and the total efficiency was 100%. X-ray films showed that the density slightly decreased in operation areas after 3 months, but at 6 months after treatment, the cortical bone was thickened and the marrow cavity density increased in the operation areas, and non-focal zone was continuously enlarged. No fractures and recurrence were found in al patients. At 6 months after treatment, the serum alkaline phosphatase activity decreased significantly (P < 0.05). The results suggest that surgical operation with bisphosphonate treatment for bone fibrous dysplasia can effectively inhibit the bone resorption, promote bone formation, increase the intensity of the lesion, reduce fractures and recurrence rate, so as to achieve a better therapeutic effect in clinic.
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Objective To evaluate and analyse the effectiveness of surgical treatment for fibrous dysplasia in proximal femur with severe varus deformity.Methods A retrospective study was performed in 21 patients (24 femora)of fibrous dysplasia who were treated in our hospital between August 2000 and May 2009.All patients had severe femoral varus deformity.The four-step procedures were performed orderlv as valgus osteotomy,lesion curettage,impacting of massive bone allograft,and fixation by femoral intramedullary nail.There were 6 patients with monostotic disease,15 with polyostotic diseases,including 12 males and 9 females with a mean age of 22.7 years(range,14-39 years).The average neck-shaft angle and femoral varus angle was 75°(range 55°-105°)and 30°(range,18°-45°),respectively.The average length of thigh shortened 3.4 cm(range,2.0-4.5 cm)compared with the contralateral thigh.Results All of the 21 patients were followed up from 21 months to 7 years with an average period of 3 years and 4 months.There were 30 osteotomy sites in 24 femurs,28 osteotomy sites showed bone union after 3-6 months from surgery.Two distal location of the double-level osteotomy showed nonunion,which received bone grafting again and got bone union after 3 months finally.The femoral mechanical alignments of the 21 patients had been recriticd.The average neck-shaft angle was 118°(range,95°-135°)postoperatively,the femoral varus angle disappeared.The average extremity lengthening was 2.8 cm(range,1.8-3.6 cm)postoperatively.There were no infection,recurrent fracture and progression of deformity.The visual analogue scales(VAS)score of 17 patients decreased to zero postoperatively from 7-10 preoperatively,and that of the other 4 patients decreased to 3-4 postoperatively from 8-10 preoperatively.The result of Harris hip functional score was excellent in 12 cases,good in 6,and fair in 3.Conclusion The valgus osteotomy can rectify varus deformity effectively.The reconstract nail of the fumer can support the stability of femur.Impacting of massive bone allograft can improve the capacity of the femur.