A novel nomogram for predicting endoscopic remission in refractory Crohn's disease with ustekinumab administration.

Ustekinumab (UST) is a human IgG1 monoclonal antibody that targets to the share p40 subunit of interleukin-12(IL-12) and IL-23. Evidence has shown that UST therapy is well tolerated and effective in inducing clinical response in refractory CD(Crohn's disease) and dose escalation is effective in recapturing response in over half of the patients. However, no predictive factor has been reported to be helpful for UST treatment in clinical practice. Additionally, there were few reports about therapeutic drug monitoring (TDM) of UST administration in China due to its late launch time in Chinese market and lack of experience in clinical use. Herein, we establish and validate the first UST-trough concentrations (TCs) -related nomogram in China for predicting endoscopic remission in refractory CD to facilitate clinical decision making.

Effect of vitamin D on oxidative stress and serum inflammatory factors in the patients with type 2 diabetes.

The type 2 diabetes mellitus (T2DM) is an urgent global health problem. T2DM patients are in a state of high oxidative stress and inflammation. Vitamin D and glutathione (GSH) play crucial roles in antioxidation and anti-inflammation. However, T2DM patients have lower vitamin D and GSH levels than healthy persons. A randomized controlled trial was conducted to see the effect of the vitamin D supplementation on oxidative stress and inflammatory factors in T2DM patients. In this study, a total of 178 T2DM patients were randomly enrolled, 92 patients received regular treatment (T2DM group) and 86 patients in Vitamin D group received extra vitamin D 400 IU per day in addition to regular treatment. Serum vitamin D, GSH, GSH metabolic enzyme GCLC and GR, inflammatory factor MCP-1, and IL-8 levels were investigated. We found that the T2DM group has significantly higher concentrations of MCP-1 and IL-8 than those in the healthy donor group. After vitamin D supplementation for 90 days, T2DM patients had a 2-fold increase of GSH levels, from 2.72 ± 0.84 to 5.76 ± 3.19 µmol/ml, the concentration of MCP-1 decreased from 51.11 ± 20.86 to 25.42 ± 13.06 pg/ml, and IL-8 also decreased from 38.21 ± 21.76 to 16.05 ± 8.99 pg/ml. In conclusion, our study demonstrated that vitamin D could regulate the production of GSH, thereby reducing the serum levels of MCP-1 and IL-8, alleviating oxidative stress and inflammation, providing evidence of the necessity and feasibility of adjuvant vitamin D treatment among patients with T2DM. On the other hand, vitamin D and GSH levels have important diagnostic and prognostic values in T2DM patients.

Chest tube drainage placement may not be a necessity in paediatric thoracoscopic surgery: a retrospective study.

OBJECTIVE: Chest tube drainage placement, a standard procedure in video-assisted thoracoscopic surgery, was reported to cause perioperative complications like pain and increased risk of infection. The present study was designed to evaluate the necessity of chest tube drainage inpaediatric thoracoscopic surgery. METHODS: Thirty children admitted to our hospital from April 2018 to April 2020 were included in the current study and were grouped as the tube group (children receiving video-assisted thoracoscopic surgery with chest tube drainage) and the non-tube group (children receiving video-assisted thoracoscopic surgery without chest tube drainage). Laboratory hemogram index, length of hospitalisation, post-operative performance of involved children, and psychological acceptance of indicated therapy by guardians of the involved children were investigated. RESULTS: Laboratory examination revealed that the mean corpuscular haemoglobin concentration in the non-tube group was significantly higher than that in the tube group on post-operative day 1 (p < 0.05). Children in the non-tube group had a shorter length of hospitalisation (7-9 days) than that of patients from the tube group. Additionally, the frequency of crying of children was decreased and psychological acceptance by patients' guardians was improved in the non-tube group when compared with the tube group. CONCLUSION: This study showed that chest tube drainage placement may not be necessary in several cases of paediatric video-assisted thoracoscopic surgery. Rapid recovery with decreased perioperative complications in children operated by video-assisted thoracoscopic surgery without tube placement could also reduce the burden of the family and society both economically and psychologically.

Metabolomics reveals the potential metabolic mechanism of infliximab against DSS-induced acute and chronic ulcerative colitis.

Inflammatory bowel disease (IBD) is often accompanied by metabolic imbalance, and infliximab (IFX) can alleviate IBD symptoms, but its metabolic mechanisms remain unclear. To investigate the relationship between IBD, metabolism, and IFX, an acute and chronic ulcerative colitis (UC) model induced by dextran sulfate sodium (DSS) was established. Plasma samples were analyzed using ultra-high-performance liquid chromatography-quadrupole time-of-flight mass spectrometry, followed by multivariate statistical analysis. The results showed that IFX could alleviate colonic shortening and reduce colonic pathological damage in acute and chronic mouse colitis, improve acute and chronic UC, and ameliorate metabolic disturbances. Among the 104 elevated metabolites and 170 decreased metabolites, these metabolites mainly belonged to amino acids, glucose, and purines. The changes in these metabolites were mainly associated with drug metabolism-other enzymes, riboflavin metabolism, phenylalanine, tyrosine and tryptophan biosynthesis, phosphonate and phosphinate metabolism, and phenylalanine metabolism. In summary, this study provides a valuable approach to explore the metabolic mechanisms of IFX in treating acute and chronic UC from a metabolomics perspective.

Causal association between inflammatory bowel disease and acute pancreatitis: a two-sample bidirectional mendelian randomization study.

Background: Acute pancreatitis (AP) is an extraintestinal manifestation of inflammatory bowel disease (IBD). Numerous observational studies have reported an increased risk of AP in patients diagnosed with IBD. However, the causal association and directionality between IBD or its subtypes and the development of AP remains unclear due to the limitations of observational research. This study aims to explore the relationship between IBD or its subtypes and AP risk using Mendelian Randomization (MR) method. Methods: A two-sample bidirectional MR study was conducted, selecting genetic variants associated with IBD and AP as instrumental variables from the International Inflammatory Bowel Disease Genetics Consortium (IIBDGC) and FinnGen databases, respectively. The inverse-variance weighted (IVW) method used as the primary approach for causal inference. The Cochran Q test was employed for heterogeneity assessment. Sensitivity analyses were performed using the MR Egger intercept test, MR-Presso, and Leave-one-out method. Results: The results revealed that IBD (OR = 1.049, 95% CI = 1.010-1.090, p = 0.013) and ulcerative colitis (UC) (OR = 1.057, 95% CI = 1.013-1.102, p = 0.011) were significantly associated with an increased risk of AP. However, Crohn's disease (CD) (OR = 1.023, 95% CI = 0.993-1.055, p = 0.134) did not show a causal association with the risk of AP. Interestingly, AP was suggestively associated with a decreased risk of CD (OR = 0.797, 95% CI = 0.637-0.997, p = 0.047). Furthermore, there was no causal association between AP and the risk of IBD (OR = 0.886, 95% CI = 0.753-1.042, p = 0.144) or UC (OR = 0.947, 95% CI = 0.773-1.159, p = 0.595). Conclusion: In conclusion, this study provides genetic evidence supporting the causal influence of IBD (specifically UC) on AP, while CD does not appear to have a causal impact on AP.