In the pre-biologic era,immunomodulators such as azathioprine,6-mercaptopurine,and methotrexate(MTX)were widely used as first-line maintenance therapies in Crohn’s disease.However,in the current era shaped by biologi...In the pre-biologic era,immunomodulators such as azathioprine,6-mercaptopurine,and methotrexate(MTX)were widely used as first-line maintenance therapies in Crohn’s disease.However,in the current era shaped by biologics,their role has shifted toward adjunctive use,primarily in combination with anti-tumor necrosis factor agents to reduce immunogenicity.Amid growing concerns about thiopurine-associated risks,MTX is receiving renewed attention for its favorable safety profile;however,this agent remains inconsistently utilized in gastroenterology despite its frontline status in rheumatology.This discrepancy was highlighted in a recent nationwide survey by Bonnaud et al published in the World Journal of Gastroenterology,which offers timely insights into MTX prescribing behaviors among French gastroenterologists.Although 71%of respondents reported using MTX,primarily via subcutaneous injection,it is still perceived as a secondary choice after thiopurines.Importantly,this underuse appears to be driven more by clinical inertia and limited guidance rather than by lack of efficacy or safety concerns.Clinicians increasingly recognize the value of MTX,particularly in patients with joint involvement,Epstein-Barr virus negativity,or increased malignancy risk.Notably,even non-prescribers viewed the drug favorably,suggesting that usage barriers may be modifiable.In light of evolving treatment goals that prioritize safety,cost-effectiveness,and individualized care,this editorial argues that MTX should no longer be viewed as a fallback but as a strategic first-line option in well-defined high-risk populations.The survey underscores a persistent gap between guidelines and real-world practice,reinforcing the urgent need for clearer algorithms and education to support the repositioning of MTX in modern Crohn’s disease management.展开更多
BACKGROUND Second-line treatment of Crohn’s disease(CD)commonly involves immunosuppressants such as azathioprine,mercaptopurine,or methotrexate(MTX),used either alone or in combination.AIM To investigate the current ...BACKGROUND Second-line treatment of Crohn’s disease(CD)commonly involves immunosuppressants such as azathioprine,mercaptopurine,or methotrexate(MTX),used either alone or in combination.AIM To investigate the current use of MTX among French gastroenterologists.METHODS An online questionnaire was distributed between March and August 2023 to 116 French gastroenterologists managing CD.A total of 87 respondents completed the survey and were included in the analysis.RESULTS Respondents reported a mean annual caseload of 140 CD patients(median:50).Overall,71%prescribed MTX,predominantly in injectable form(92%),either as monotherapy or in combination with biologics or cyclosporin.MTX was prescribed for mild-to-moderate CD by 64%of respondents,and for severe CD by 58%,often in combination with an anti-tumor necrosis factor agent(89%and 94%,respectively).Injectable MTX was favored(84%)in specific clinical scenarios:Patients with articular manifestations(77%),Epstein-Barr virus-negative status(65%),or aged over 65 years(58%).Among the 29%of non-prescribers,the primary reason cited was lack of familiarity with MTX use(60%).Both prescribers and non-prescribers expressed the need for clearer guidelines and real-world data to support MTX use.CONCLUSION Regardless of prescribing habits,most respondents had a favorable opinion of MTX and recognized its good longterm safety profile.French learned societies and medical associations should provide consensus guidelines on MTX use,supported by validated real-world safety and effectiveness data.展开更多
Xi Jinping Thought on Ecological Civilization contains new concepts,ideas,and strategies that feature Chinese characteristics and the spirit of the times and promote the progress of human civilization.Xi Jinping Thoug...Xi Jinping Thought on Ecological Civilization contains new concepts,ideas,and strategies that feature Chinese characteristics and the spirit of the times and promote the progress of human civilization.Xi Jinping Thought on Ecological Civilization is also the fundamental guide for compliance and action in terms of China’s practices in building an ecological civilization in the new era.Since the 18th National Congress of the Communist Party of China(CPC),Xi Jinping,general secretary of the Communist Party of China Central Committee,has made several inspection tours to Sichuan and given a series of important instructions on green development and building an ecological civilization in Sichuan province.This paper reviews the contemporary meaning and theoretical significance of Xi Jinping Thought on Ecological Civilization and uses them to systematically examine the overall performance of building a beautiful Sichuan,following the guidance of Xi Jinping’s important instructions for the governance of Sichuan.This paper selects and analyzes typical cases that demonstrate the national effect in Sichuan to summarize Sichuan’s unique experiences in the practice of Xi Jinping Thought on Ecological Civilization.展开更多
Objective:To investigate the effect of an information-knowledge-attitude-practice(IKAP)nursing intervention on the caregiving capacity of family caregivers of elderly dementia patients.Methods:Sixty-nine family caregi...Objective:To investigate the effect of an information-knowledge-attitude-practice(IKAP)nursing intervention on the caregiving capacity of family caregivers of elderly dementia patients.Methods:Sixty-nine family caregivers of elderly dementia patients attending the neurology outpatient clinic of a hospital between October 2024 and March 2025 were selected.They were randomly divided into a control group(n=35)and an observation group(n=34).The control group received routine health education,while the observation group additionally underwent a systematic Information-Knowledge-Attitude-Practice(IKAP)nursing intervention.Care competence and self-efficacy scores were compared between groups before intervention and after 12 weeks.Results:Pre-intervention,no statistically significant difference existed in care competence or self-efficacy scores between groups(p>0.05).Following the 12-week intervention,all scores significantly increased in both groups,with the observation group demonstrating superior outcomes compared to the control group(p<0.001).Conclusion:The care intervention program based on the IKAP model effectively enhances caregivers’care competence and self-efficacy,thereby positively promoting the quality of life for patients with dementia.展开更多
文摘In the pre-biologic era,immunomodulators such as azathioprine,6-mercaptopurine,and methotrexate(MTX)were widely used as first-line maintenance therapies in Crohn’s disease.However,in the current era shaped by biologics,their role has shifted toward adjunctive use,primarily in combination with anti-tumor necrosis factor agents to reduce immunogenicity.Amid growing concerns about thiopurine-associated risks,MTX is receiving renewed attention for its favorable safety profile;however,this agent remains inconsistently utilized in gastroenterology despite its frontline status in rheumatology.This discrepancy was highlighted in a recent nationwide survey by Bonnaud et al published in the World Journal of Gastroenterology,which offers timely insights into MTX prescribing behaviors among French gastroenterologists.Although 71%of respondents reported using MTX,primarily via subcutaneous injection,it is still perceived as a secondary choice after thiopurines.Importantly,this underuse appears to be driven more by clinical inertia and limited guidance rather than by lack of efficacy or safety concerns.Clinicians increasingly recognize the value of MTX,particularly in patients with joint involvement,Epstein-Barr virus negativity,or increased malignancy risk.Notably,even non-prescribers viewed the drug favorably,suggesting that usage barriers may be modifiable.In light of evolving treatment goals that prioritize safety,cost-effectiveness,and individualized care,this editorial argues that MTX should no longer be viewed as a fallback but as a strategic first-line option in well-defined high-risk populations.The survey underscores a persistent gap between guidelines and real-world practice,reinforcing the urgent need for clearer algorithms and education to support the repositioning of MTX in modern Crohn’s disease management.
文摘BACKGROUND Second-line treatment of Crohn’s disease(CD)commonly involves immunosuppressants such as azathioprine,mercaptopurine,or methotrexate(MTX),used either alone or in combination.AIM To investigate the current use of MTX among French gastroenterologists.METHODS An online questionnaire was distributed between March and August 2023 to 116 French gastroenterologists managing CD.A total of 87 respondents completed the survey and were included in the analysis.RESULTS Respondents reported a mean annual caseload of 140 CD patients(median:50).Overall,71%prescribed MTX,predominantly in injectable form(92%),either as monotherapy or in combination with biologics or cyclosporin.MTX was prescribed for mild-to-moderate CD by 64%of respondents,and for severe CD by 58%,often in combination with an anti-tumor necrosis factor agent(89%and 94%,respectively).Injectable MTX was favored(84%)in specific clinical scenarios:Patients with articular manifestations(77%),Epstein-Barr virus-negative status(65%),or aged over 65 years(58%).Among the 29%of non-prescribers,the primary reason cited was lack of familiarity with MTX use(60%).Both prescribers and non-prescribers expressed the need for clearer guidelines and real-world data to support MTX use.CONCLUSION Regardless of prescribing habits,most respondents had a favorable opinion of MTX and recognized its good longterm safety profile.French learned societies and medical associations should provide consensus guidelines on MTX use,supported by validated real-world safety and effectiveness data.
文摘Xi Jinping Thought on Ecological Civilization contains new concepts,ideas,and strategies that feature Chinese characteristics and the spirit of the times and promote the progress of human civilization.Xi Jinping Thought on Ecological Civilization is also the fundamental guide for compliance and action in terms of China’s practices in building an ecological civilization in the new era.Since the 18th National Congress of the Communist Party of China(CPC),Xi Jinping,general secretary of the Communist Party of China Central Committee,has made several inspection tours to Sichuan and given a series of important instructions on green development and building an ecological civilization in Sichuan province.This paper reviews the contemporary meaning and theoretical significance of Xi Jinping Thought on Ecological Civilization and uses them to systematically examine the overall performance of building a beautiful Sichuan,following the guidance of Xi Jinping’s important instructions for the governance of Sichuan.This paper selects and analyzes typical cases that demonstrate the national effect in Sichuan to summarize Sichuan’s unique experiences in the practice of Xi Jinping Thought on Ecological Civilization.
文摘Objective:To investigate the effect of an information-knowledge-attitude-practice(IKAP)nursing intervention on the caregiving capacity of family caregivers of elderly dementia patients.Methods:Sixty-nine family caregivers of elderly dementia patients attending the neurology outpatient clinic of a hospital between October 2024 and March 2025 were selected.They were randomly divided into a control group(n=35)and an observation group(n=34).The control group received routine health education,while the observation group additionally underwent a systematic Information-Knowledge-Attitude-Practice(IKAP)nursing intervention.Care competence and self-efficacy scores were compared between groups before intervention and after 12 weeks.Results:Pre-intervention,no statistically significant difference existed in care competence or self-efficacy scores between groups(p>0.05).Following the 12-week intervention,all scores significantly increased in both groups,with the observation group demonstrating superior outcomes compared to the control group(p<0.001).Conclusion:The care intervention program based on the IKAP model effectively enhances caregivers’care competence and self-efficacy,thereby positively promoting the quality of life for patients with dementia.
