BACKGROUND Sleep disturbances and residual functional impairment are increasingly recognized as important determinants of outcome in mood disorders,even during remission.Persistent disruptions in sleep may reflect und...BACKGROUND Sleep disturbances and residual functional impairment are increasingly recognized as important determinants of outcome in mood disorders,even during remission.Persistent disruptions in sleep may reflect underlying pathophysiological mechanisms and contribute to impaired psychosocial recovery.By comparing remitted bipolar disorder(BD)and major depressive disorder(MDD)patients with healthy controls,the present study sought to clarify the extent of these disturbances and their correlates.AIM To evaluate differences in sleep quality,psychosocial functioning,and insomnia severity among remitted patients with BD and MDD,in comparison with healthy controls.A secondary aim was to examine the clinical and psychosocial factors influencing sleep quality within these groups.METHODS The study included 135 participants:45 remitted BD patients,45 remitted MDD patients,and 45 healthy controls.Sleep quality was assessed with the Pittsburgh Sleep Quality Index,psychosocial functioning with the global assessment of functioning,and insomnia severity with the Insomnia Severity Index.Sociodemographic and clinical characteristics were also recorded.Comparative analyses were conducted to evaluate differences between groups,and regression models were used to identify predictors of sleep quality.RESULTS Both BD and MDD groups demonstrated significantly poorer sleep quality and higher insomnia severity compared with healthy controls.Poor sleep quality was observed in 75.6%of BD patients and 57.8%of MDD patients.Group differences were most pronounced in Pittsburgh Sleep Quality Index subdomains including sleep latency,sleep duration,and habitual sleep efficiency.Regression analysis identified insomnia severity(β=0.510)and functional capacity(β=-0.043)as significant correlates of sleep quality,indicating that greater insomnia severity and lower functioning were independently associated with poorer sleep.CONCLUSION The findings underscore that even during remission,BD and MDD are accompanied by substantial impairments in sleep quality and psychosocial functioning.These results highlight the importance of addressing residual symptoms,particularly insomnia and functional difficulties,in long-term management strategies.Interventions aimed at improving sleep and enhancing daily functioning should be considered essential components of treatment to promote recovery and quality of life in remitted patients.展开更多
BACKGROUND Cirrhotic patients with super-giant hepatocellular carcinoma(HCC)and portal vein invasion generally have a poor prognosis.This paper presents a patient with super-giant HCC and portal vein invasion,who unde...BACKGROUND Cirrhotic patients with super-giant hepatocellular carcinoma(HCC)and portal vein invasion generally have a poor prognosis.This paper presents a patient with super-giant HCC and portal vein invasion,who underwent hepatectomy followed by a combination of sorafenib and camrelizumab,resulting in complete remission(CR)for 5 years.CASE SUMMARY A 40-year-old male with compensated hepatitis B-related cirrhosis was diagnosed with HCC,Barcelona Clinic Liver Cancer stage C.Enhanced computed tomography imaging revealed a 152 mm×171 mm tumor in the right liver,invading the portal vein and hepatic vein.Liver function was normal.The patient successfully underwent hepatectomy on July 18,2019.However,by December 2019,HCC recurrence with lung metastases and portal vein invasion were detected.He started treatment with sorafenib(200 mg twice daily)and camrelizumab(200 mg every 3 weeks).By May 12,2020,the patient was confirmed to have CR.Camrelizumab was adjusted to 200 mg every 12 weeks from June 16,2021,with the last infusion on March 29,2024.Although no further tumor recurrence was observed,he experienced two episodes of gastrointestinal bleeding due to esophagogastric varices,which were managed with endoscopic therapy.To date,the patient has remained in CR for 5 years.CONCLUSION The combination of hepatectomy with sorafenib and camrelizumab can achieve durable CR in patients with supergiant HCC and portal vein invasion.Further research is necessary to address these challenges and improve patient outcomes.展开更多
BACKGROUND Oral 5-aminosalicylic acid(5-ASA)has been a cornerstone treatment for mild to moderate ulcerative colitis(UC),traditionally used to maintain remission.With the rise of advanced therapies(biologics and small...BACKGROUND Oral 5-aminosalicylic acid(5-ASA)has been a cornerstone treatment for mild to moderate ulcerative colitis(UC),traditionally used to maintain remission.With the rise of advanced therapies(biologics and small molecules),the role of 5-ASA has come under renewed scrutiny.While earlier systematic reviews affirmed its efficacy compared to placebo,these did not account for the advent of advanced therapies.AIM To assess the efficacy and safety of oral 5-ASA in maintaining remission in quiescent UC,compared to placebo,alternative 5-ASA formulations,and advanced therapies,in the era of biologics and small molecules.METHODS It was systematically searched MEDLINE,EMBASE,and the Cochrane Library,alongside conference proceedings(European Crohn’s and Colitis Organisation,British Society of Gastroenterology),for randomized controlled trials published between 2003 and 2024 in English.Eligible studies involved oral 5-ASA therapies for quiescent UC with a minimum treatment duration of six months.Outcomes included failure to maintain remission,adverse events,and serious adverse events(SAEs).Data were analyzed using Cochrane methods,with GRADE assessing evidence certainty.RESULTS From 44 studies(9967 participants),5-ASA was superior to placebo in maintaining remission,with 37%of 5-ASA users relapsing at 6-12 months compared to 55%of placebo users[risk ratios(RR):0.68;95%CI:0.61-0.76;high-certainty evidence].SAEs were rare and comparable between groups(RR:0.60;95%CI:0.19-1.84;low-certainty evidence).Comparative analyses suggested 5-ASA remains a viable option alongside advanced therapies,with notable differences in cost and safety profiles.CONCLUSION 5-ASA remains effective and safe for maintaining remission in quiescent UC,even in the advanced therapy era.However,tailored approaches are needed to balance efficacy,safety,and cost in clinical practice.This study provides critical insights to guide therapeutic strategies and underscores the enduring relevance of 5-ASA.展开更多
BACKGROUND Type 2 diabetes(T2D)remission has been widely reported after bariatric surgery,but rarely reported after esophagectomy.AIM To explore the incidence and predictors of T2D remission 1 year after esophagectomy...BACKGROUND Type 2 diabetes(T2D)remission has been widely reported after bariatric surgery,but rarely reported after esophagectomy.AIM To explore the incidence and predictors of T2D remission 1 year after esophagectomy with gastric conduit reconstruction.METHODS In this prospective study,consecutive patients from 2 tertiary hospitals who had esophageal cancer and T2D and underwent esophagectomy with gastric conduit reconstruction were studied preoperatively and at 3 months,6 months,and 12 months postoperatively.Remission of T2D is defined as glycated hemoglobin(HbA1c)values below 6.5%without glucose-lowering medications.Related clinical information were recorded and analyzed.RESULTS A total of 187 patients were included.Of these patients,24(12.8%)discontinued antidiabetic drugs and maintained HbA1c values below 6.5%1 year after surgery.At baseline,patients with T2D remission were younger(63.0±5.2 years vs 67.0±6.1 years,P=0.002),had higher body mass index values(body weight 68.6±11.1 kg vs 61.2±9.3 kg,P=0.001;body mass index 25.5±2.4 kg/m2 vs 23.8±3 kg/m2,P=0.011),shorter duration of T2D(4.9±3.9 years vs 7.1±3.7 years,P=0.008)and higher preoperative HbA1c(8.5%±1.7%vs 7.7%±1.3%,P=0.042).Multivariate logistic regression analysis showed that younger age and greater body weight were independent predictors of T2D remission after surgery.CONCLUSION This study reveals a significant incidence of T2D remission after esophagectomy with gastric conduit reconstruction,and remission is more frequent in patients with younger age and greater body weight.展开更多
BACKGROUND One-anastomosis gastric bypass(OAGB)and sleeve gastrectomy(SG)are surgical procedures increasingly performed for weight loss and to achieve remission of diabetes mellitus.Literature comparing the medium-ter...BACKGROUND One-anastomosis gastric bypass(OAGB)and sleeve gastrectomy(SG)are surgical procedures increasingly performed for weight loss and to achieve remission of diabetes mellitus.Literature comparing the medium-term efficacy of these two procedures is scarce.As such,a meta-analysis comparing OAGB and SG in terms of diabetes remission(DR)and percentage of excess weight loss(EWL)is warranted.AIM To compare OAGB and SG in terms of DR and EWL%in the medium term.METHODS A comprehensive literature search was conducted in PubMed/MEDLINE,Cochran Library,and Web of Science for relevant articles,from inception through April 2025,using the keywords“one-anastomosis gastric bypass”,“sleeve gastrectomy”,“mini-gastric bypass”,“diabetes remission”,“one-anastomosis”,and“excess weight loss”.Clinical trials,prospective,retrospective and case-control studies were included;cross-sectional studies,case reports,editorials,and opinions were excluded.The Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale were used to assess the quality of included studies,and RevMan version 5.4 was used for data analyses.RESULTS A total of 1360 articles were identified,and 35 studies were retrieved of which 32 were included in the final analysis.Three full texts were excluded as they did not include data on DR or EWL%.OAGB achieved higher DR than SG at 1 year following surgery[odds ratio(OR)=1.77,95%confidence interval(CI):1.22-2.57,I^(2)=76%].However,DR rates were similar at 3 years and 5 years following surgery(OR=0.82,95%CI:0.61-1.10,I^(2)=23%and OR=0.92,95%CI:0.31-2.72,I^(2)=75%,respectively).OAGB showed higher EWL%at 1 year(OR=9.30,95%CI:6.45-12.15,I^(2)=91%),3 years(OR=10.02,95%CI:9.40-10.64,I^(2)=22%),and 5 years(OR=11.61,95%CI:3.74-19.48,I^(2)=97%).OAGB showed higher late complications than adjustable SG.The results were not different in sub-group analysis including only clinical trials,observational studies,and removing studies including super-obese patients and studies contributing most to heterogeneity.CONCLUSION In the medium term,DR rates were similar between OAGB and SG;however,OAGB showed higher EWL%than SG,and late complications were higher in OAGB.Clinical trials investigating the predictors of DR and EWL%are recommended.展开更多
We report the case of a newly diagnosed overweight patient with type 2 diabetes mellitus who achieved diabetes remission using continuous glucose monitoring(CGM),which promotes patient engagement in self‐management.K...We report the case of a newly diagnosed overweight patient with type 2 diabetes mellitus who achieved diabetes remission using continuous glucose monitoring(CGM),which promotes patient engagement in self‐management.Key measures included selection of a patient newly diagnosed with type 2 diabetes mellitus,use of CGM,analysis of glucose trends and contributing factors,and patient guidance in maintaining a health diary and developing personalized self‐management strategies(e.g.,dietary modification and exercise regimens).Following 6‐month CGM‐guided self‐management,the patient's glycated hemoglobin level decreased from 7.3%at baseline to 6.0%and his body weight decreased from 83 to 77 kg,a 7%reduction;thus,the patient met the criteria for diabetes remission.展开更多
In operations management, the learning curve has been an effective tool in estimating operator performance. However, discontinuities in work disrupt the learning process and a phenomenon called remission or forgetting...In operations management, the learning curve has been an effective tool in estimating operator performance. However, discontinuities in work disrupt the learning process and a phenomenon called remission or forgetting occurs, resulting in increased time of performing the task upon resumption of work. The study aims to identify variables that significantly affect the remission rate of sewing operations in a manufacturing setting. Four variables--length of stint 1, percent Differenceat stint t, gender, and product family, were identified. Statistical analyses, such as paired t-test, correlation, regression, and analysis of variance （ANOVA） were conducted in order to observe the relationships between the dependent variable and independent variables. For the results of the first general regression, gender was found to be an insignificant variable in predicting remission rate, while product family, length of stint 1, and percent Differenceat stint I were statistically significant. Moreover, the final general regression, which excluded the insignificant gender variable and considered the （regrouped） product families, revealed that product family, length of stint 1, and percent Differenceat stint 1 were still statistically significant. Length of stint 1 had a moderately positive correlation with remission rate, while percent Differenceat stint i had a moderately negative correlation with remission rate. Also, percent Differenceat stint 1 was the largest contributor to the remission rate model. In terms of R2, the goodness-of-fit of the model is moderate. Finally, the model yielded an absolute error of 5.08%, indicating a high accuracy in predicting remission rate.展开更多
AIM: To report 3 of 120 patients on the German MALT lymphoma trial with H. pylori associated gastric MALT lymphoma who developed early gastric cancer 4 and 5 years, after complete lymphoma remission following cure of ...AIM: To report 3 of 120 patients on the German MALT lymphoma trial with H. pylori associated gastric MALT lymphoma who developed early gastric cancer 4 and 5 years, after complete lymphoma remission following cure of H. pylori infection. PATIENTS AND RESULTS: Three patients (two men, 74 and 70 years; one women, 77 years) with H. pylori-associated low-grade MALT lymphoma achieved complete lymphoma remission after being cured. Surveillance endoscopies were performed twice a year in accordance to the protocol. Four years after complete lymphoma remission in two patients, and after 5 years in the other, early gastric adenocarcinoma of the mucosa-type, type IIa and type IIc, respectively, was detected, which were completely removed by endoscopic mucosa resection. In one patient, the gastric cancer was diagnosed at the same location as the previous MALT lymphoma, in the other patients it was detected at different sites of the stomach distant from location of the previous MALT lymphoma. The patients were H. pylori negative during the whole follow-up time. CONCLUSION: These findings strengthen the importance of regular Long-term follow-up endoscopies in patients with complete remission of gastric MALT lymphoma after cure of H. pylori infection. Furthermore, gastric adenocarcinoma may develop despite eradication of H. pylori.展开更多
AIM： Prednisone and azathioprine represent the standard treatment for autoimmune hepatitis （AIH）. However, only 65% of the patients enter complete histological remission. Recently, budesonide （BUD） was reported t...AIM： Prednisone and azathioprine represent the standard treatment for autoimmune hepatitis （AIH）. However, only 65% of the patients enter complete histological remission. Recently, budesonide （BUD） was reported to be a promising alternative. In this study we assessed the efficacy and safety of BUD in AIH. METHODS： Eighteen patients （12 women, 6 men; mean age 45.4±21 years） with AIH were treated with BUD （Budenofalk） 3 mg thrice daily and followed up for at least 24 wk. Seven patients also had features of primary biliary cirrhosis （n = 5） or primary sclerosing cholangitis （n = 2）. Advanced liver fibrosis or cirrhosis was present in RESULTS： Fifteen （83%） patients had a complete clinical and biochemical remission. Ten patients, including five with acute hepatitis, were given BUD as first-line therapy, of which seven enter remission. Three patients, two with liver cirrhosis, did not improve. All patients with second-line therapy experienced long-term remission. A histological remission was also seen in three patients. Clinically relevant BUD-induced side effects were recorded only in patients with liver cirrhosis （n = 4）. CONCLUSION： BUD is effective in remission induction in the majority of our patients with AIH. Side effects and treatment failure was mainly observed in patients with liver cirrhosis.展开更多
Objective： The treatment of Henoch-Schonlein purpura （HSP） with moderate proteinuria remains con- troversial. We retrospectively analyzed the efficacy of immune suppressants, with a particular emphasis on myco- phe...Objective： The treatment of Henoch-Schonlein purpura （HSP） with moderate proteinuria remains con- troversial. We retrospectively analyzed the efficacy of immune suppressants, with a particular emphasis on myco- phenolate mofetil （MMF）. Methods： Ninety-five HSP patients with moderate proteinuria （1.0-3.5 g/24 h） after at least three months of therapy with angiotensin-converting enzyme inhibitor （ACEI） or angiotensin receptor blocker （ARB） were divided into three groups： an MMF group （n=33） that received MMF 1.0-1.5 g/d combined with prednisone （0.4-0.5 mg/（kg.d））, a corticosteroid （CS） group （n=31） that received full-dose prednisone （0.8-1.0 mg/（kg.d））, and a control group （n=31）. Patients in the MMF and CS groups continued to take ACEI or ARB at the original dose. The patients in the control group continued to take ACEI or ARB but the dose was increased by （1.73±0.58）-fold. The patients were followed up for 6-78 months （median 28 months）. Results： The baseline proteinuria was higher in the MMF group （（2.1±0.9） g/24 h） than in the control group （（1.6±0.8） g/24 h） （P=0.039）. The proteinuria decreased sig- nificantly in all groups during follow-up, but only in the MMF group did it decrease significantly after the first month. At the end of follow-up, the proteinuria was （0.4±0.7） g/24 h in the MMF group and （0.4±0.4） g/24 h in the CS group, significantly lower than that in the control group （（0.9±1.1） g/24 h）. The remission rates in the MMF group, CS group, and control group were respectively 72.7%, 71.0%, and 48.4% at six months and 72.7%, 64.5%, and 45.2% at the end of follow-up. The overall number of reported adverse events was 17 in the MMF group, 30 in the CS group, and 6 in the control group （P〈0.001）. Conclusions： MMF with low-dose prednisone may be as effective as full-dose prednisone and tend to have fewer adverse events. Therefore, it is probably superior to conservative treatments of adult HSP patients with moderate proteinuria.展开更多
The use of specific terms under different meanings and varying definitions has always been a source of confusion in science.When we point our efforts towards an evidence based medicine for inflammatory bowel diseases(...The use of specific terms under different meanings and varying definitions has always been a source of confusion in science.When we point our efforts towards an evidence based medicine for inflammatory bowel diseases(IBD)the same is true:Terms such as"mucosal healing"or"deep remission"as endpoints in clinical trials or treatment goals in daily patient care may contribute to misconceptions if meanings change over time or definitions are altered.It appears to be useful to first have a look at the development of terms and their definitions,to assess their intrinsic and context-independent problems and then to analyze the different relevance in present-day clinical studies and trials.The purpose of such an attempt would be to gain clearer insights into the true impact of the clinical findings behind the terms.It may also lead to a better defined use of those terms for future studies.The terms"mucosal healing"and"deep remission"have been introduced in recent years as new therapeutic targets in the treatment of IBD patients.Several clinical trials,cohort studies or inception cohorts provided data that the long term disease course is better,when mucosal healing is achieved.However,it is still unclear whether continued or increased therapeutic measures will aid or improve mucosal healing for patients in clinical remission.Clinical trials are under way to answer this question.Attention should be paid to clearly address what levels of IBD activity are looked at.In the present review article authors aim to summarize the current evidence available on mucosal healing and deep remission and try to highlight their value and position in the everyday decision making for gastroenterologists.展开更多
BACKGROUND It is a crucial issue for patients with refractory ulcerative colitis(UC),including steroid-dependent and steroid-refractory patients,to achieve and maintain steroid-free remission.However,clinical studies ...BACKGROUND It is a crucial issue for patients with refractory ulcerative colitis(UC),including steroid-dependent and steroid-refractory patients,to achieve and maintain steroid-free remission.However,clinical studies focused on the achievement of steroid-free remission in refractory UC patients are insufficient.Cytapheresis(CAP)is a non-pharmacological extracorporeal therapy that is effective for active UC with fewer adverse effects.This study comprised UC patients treated with CAP and suggested the efficacy of CAP for refractory UC patients.AIM To clarify the efficacy of CAP in achieving steroid-free remission in refractory UC patients.METHODS We retrospectively reviewed the collected data from 55 patients with refractory UC treated with CAP.We analyzed the following points:(1)Efficacy of the first course of CAP;(2)Efficacy of the second,third,and fourth courses of CAP in patients who experienced relapses during the observation period;(3)Efficacy of CAP in colonic mucosa;and(4)Long-term efficacy of CAP.Clinical efficacy was evaluated using Lichtiger’s clinical activity index or Sutherland index(disease activity index).Mucosal healing was evaluated using Mayo endoscopic subscore.The primary and secondary endpoints were the rate of achievement of steroidfree remission and the rate of sustained steroid-free remission,respectively.Statistical analysis was performed using the paired t-test and chi-squared test.RESULTS The rates of clinical remission,steroid-free remission,and poor effectiveness after CAP were 69.1%,45.5%,and 30.9%,respectively.There were no significant differences in rate of steroid-free remission between patients with steroiddependent and steroid-refractory UC.The mean disease activity index and Lichtiger’s clinical activity index scores were significantly decreased after CAP(P<0.0001).The rates of steroid-free remission after the second,third,and fourth courses of CAP in patients who achieved steroid-free remission after the first course of CAP were 83.3%,83.3%,and 60%,respectively.Mucosal healing was observed in all patients who achieved steroid-free remission after the first course of CAP.The rates of sustained steroid-free remission were 68.0%,60.0%,and 56.0%at 12,24,and 36 mo after the CAP.Nine patients(36%)had maintained steroid-free remission throughout the observation period.CONCLUSION Our results suggest that CAP effectively induces and maintains steroid-free remission in refractory UC and re-induces steroid-free remission in patients achieving steroid-free remission after the first course of CAP.展开更多
Hepatocellular carcinoma (HCC) is the fifth most common malignant disease worldwide, and curative treatment remains difficult because the majority of cases are diagnosed in the advanced stage. Sorafenib is the only kn...Hepatocellular carcinoma (HCC) is the fifth most common malignant disease worldwide, and curative treatment remains difficult because the majority of cases are diagnosed in the advanced stage. Sorafenib is the only known effective systemic treatment, but patients rarely achieve complete remission (CR). A 66-year-old man with a history of alcoholic liver cirrhosis with a diagnosis of advanced HCC, was initially treated with transarterial chemoembolization on four occasions. However, the disease progressed with portal vein thrombosis. Therefore, sorafenib was started, and 4 mo later, the patient achieved CR. The treatment was continued for 12 mo, and CR was maintained up to 4 mo after sorafenib discontinuation.展开更多
OBJECTIVES Moderate to vigorous physical activity is recommended to prevent hypertension according to the current guidelines.However,the degree to which the total physical activity(TPA)and its changes benefit normoten...OBJECTIVES Moderate to vigorous physical activity is recommended to prevent hypertension according to the current guidelines.However,the degree to which the total physical activity(TPA)and its changes benefit normotensives and hypertensives is uncertain.We aimed to examine the effects of TPA and its changes on the incidence,progression,and remission of hypertension in the large-scale prospective cohorts.METHODS A total of 73,077 participants(55,101 normotensives and 17,976 hypertensives)were eligible for TPA analyses.During a mean follow-up of 7.16 years(394,038 person-years),12,211 hypertension cases were identified.TPA was estimated as metabolic equivalents and categorized into quartiles.Cox proportional hazards regression and multivariable logistic regression were used to estimate associations of TPA and changes in TPA with incident hypertension and progression/remission of hypertension.RESULTS Compared with the lowest quartile of TPA,normotensives at the third and the highest quartile had a decreased risk of incident hypertension,with hazard ratios(HRs)of 0.86[95%confidence interval(CI):0.81−0.91]and 0.81(95%CI:0.77−0.86),respectively.Hypertensives at the highest quartile of TPA demonstrated a decreased risk of progression of hypertension[odds ratio(OR)=0.87,95%CI:0.79−0.95],and an increased probability of hypertension remission(OR=1.17,95%CI:1.05−1.29).Moreover,getting active from a sedentary lifestyle during the follow-up period could reduce 25%(HR=0.75,95%CI:0.58−0.96)risk of incident hypertension,whereas those becoming sedentary did not achieve benefit from initially being active.CONCLUSIONS Our findings indicated that increasing and maintaining TPA levels could benefit normotensives,whereas higher TPA levels were needed to effectively control progression and improve remission of hypertension.Physical activity played undoubtedly an essential role in both primary and secondary prevention of hypertension.展开更多
AIM： To assess the value of long-chain w-3 fatty acids （FAs） supplementation in addition to amino-salicylic-acid （5-ASA） in pediatric patients with Crohn＇s disease （CD）. METHODS： Thirty-eight patients （20 ma...AIM： To assess the value of long-chain w-3 fatty acids （FAs） supplementation in addition to amino-salicylic-acid （5-ASA） in pediatric patients with Crohn＇s disease （CD）. METHODS： Thirty-eight patients （20 males and 18 females, mean age 10.13 years, range 5-16 years） with CD in remission were randomized into two groups and treated for 12 too. Group Ⅰ （18 patients） received 5-ASA （50 mg/kg/d）＋w-3 FAs as triglycerides in gastroresistant capsules, 3 g/d （eicosapentanoic acid, EPA, 400 mg/g, docosahexaenoic acid, DHA, 200 mg/g）. Group Ⅱ （20 patients） received 5-ASA （50 mg/kg/d）＋olive oil placebo capsules. Patients were evaluated for fatty acid incorporation in red blood cell membranes by gas chromatography at baseline 6 and 12 mo after the treatment. RESULTS： The number of patients who relapsed at 1 year was significantly lower in group I than in group Ⅱ （P〈0.001）. Patients in group I had a significant increase in the incorporation of EPA and DHA （P〈0.001） and a decrease in the presence of arachidonic acids. CONCLUSION： Enteric-coated w-3 FAs in addition to treatment with 5-ASA are effective in maintaining remission of pediatric CD.展开更多
BACKGROUND Fecal microbial transplantation(FMT)is a promising new method for treating active ulcerative colitis(UC),but knowledge regarding FMT for quiescent UC is scarce.AIM To investigate FMT for the maintenance of ...BACKGROUND Fecal microbial transplantation(FMT)is a promising new method for treating active ulcerative colitis(UC),but knowledge regarding FMT for quiescent UC is scarce.AIM To investigate FMT for the maintenance of remission in UC patients.METHODS Forty-eight UC patients were randomized to receive a single-dose FMT or autologous transplant via colonoscopy.The primary endpoint was set to the maintenance of remission,a fecal calprotectin level below 200μg/g,and a clinical Mayo score below three throughout the 12-mo follow-up.As secondary endpoints,we recorded the patient’s quality of life,fecal calprotectin,blood chemistry,and endoscopic findings at 12 mo.RESULTS The main endpoint was achieved by 13 out of 24(54%)patients in the FMT group and by 10 out of 24(41%)patients in the placebo group(log-rank test,P=0.660).Four months after FMT,the quality-of-life scores decreased in the FMT group compared to the placebo group(P=0.017).In addition,the disease-specific quality of life measure was higher in the placebo group than in the FMT group at the same time point(P=0.003).There were no differences in blood chemistry,fecal calprotectin,or endoscopic findings among the study groups at 12 mo.The adverse events were infrequent,mild,and distributed equally between the groups.CONCLUSION There were no differences in the number of relapses between the study groups at the 12-mo follow-up.Thus,our results do not support the use of a single-dose FMT for the maintenance of remission in UC.展开更多
AIM: To assess the risk of relapse in ulcerative colitis (UC) patients in clinical remission using mucosal status and fecal immunochemical test (FIT) results.METHODS: The clinical outcomes of 194 UC patients in clinic...AIM: To assess the risk of relapse in ulcerative colitis (UC) patients in clinical remission using mucosal status and fecal immunochemical test (FIT) results.METHODS: The clinical outcomes of 194 UC patients in clinical remission who underwent colonoscopy were based on evaluations of Mayo endoscopic subscores (MESs) and FIT results.RESULTS: Patients with an MES of 0 (n = 94, 48%) showed a ten-fold lower risk of relapse than those with an MES of 1-3 (n = 100, 52%) (HR = 0.10, 95%CI: 0.05-0.19). A negative FIT result (fecal hemoglobin concentrations ≤ 100 ng/mL) was predictive of patients with an MES of 0, with a sensitivity of 0.94 and a specific of 0.76. Moreover, patients with a negative FIT score had a six-fold lower risk of clinical relapse than those with a positive score (HR = 0.17, 95%CI: 0.10-0.28). Inclusion of the distinguishing parameter, sustaining clinical remission > 12 mo, resulted in an even stronger correlation between negative FIT results and an MES of 0 with respect to the risk of clinical relapse (HR = 0.11, 95%CI: 0.04-0.23).CONCLUSION: Negative FIT results one year or more after remission induction correlate with complete mucosal healing (MES 0) and better prognosis. Performing FIT one year after remission induction may be useful for evaluating relapse risk.展开更多
Breast cancer is one of the most common malignancies in women. The post-operative recurrence and metastasis are the leading causes of breast cancer-related mortality. In this study, we tried to explore the role of cir...Breast cancer is one of the most common malignancies in women. The post-operative recurrence and metastasis are the leading causes of breast cancer-related mortality. In this study, we tried to explore the role of circulating tumor cell （CTC） detection combination PET/CT technology evaluating the prognosis and treatment response of patients with breast cancer; meanwhile, we attempted to assess the concept of ＂biological complete remission＂ （bCR） in this regard. A 56-year-old patient with breast cancer （T2N1M1, stage IV left breast cancer, with metastasis to axillary lymph nodes and lungs） received 6 cycles of salvage treatment with albumin-bound paditaxd plus eapecitaabine and trastuzumah. Then, she underwent CTC detection and PET/CT for efficacy evaluation. CTC detection combination PET/CT is useful for the evaluation of the biological efficacy of therapies for breast cancer. The bCR of the patient appeared earlier than the conventional clinical imaging complete remission and promised the histological （pathological） complete remission. The integrated application of the concepts including bCR, imageological CR, and histological CR can achieve the early and prognosis of breast cancer. accurate assessment of biological therapeutic reponse and展开更多
BACKGROUND Previous studies reported hypertension remission after gastrectomy for gastric cancer patients, and the remission rate was 11.1%-93.8%. We have reported the factors of hypertension remission previously, how...BACKGROUND Previous studies reported hypertension remission after gastrectomy for gastric cancer patients, and the remission rate was 11.1%-93.8%. We have reported the factors of hypertension remission previously, however, the follow-up time was six months. It is necessary to identify risk factors for hypertension for a relatively longer follow-up time.AIM To analyze the predictive factors for hypertension remission one year after gastrectomy of gastric cancer patients and to construct a risk model for hypertension remission.METHODS We retrospectively collected the medical information of patients with concurrent gastric cancer and hypertension in a single clinical center from January 2013 to December 2020. Univariate and multivariate logistic regression of hypertension remission were conducted, and a nomogram model was established.RESULTS A total of 209 patients with concurrent gastric cancer and hypertension were included in the current study. There were 108 patients in the remission group and 101 patients in the non-remission group. The hypertension remission rate was 51.7% one year after gastrectomy. The remission group had younger aged patients(P = 0.001), larger weight loss(P = 0.001), lower portion of coronary heart disease(P = 0.017), higher portion of II-degree hypertension(P = 0.033) and higher portion of total gastrectomy(P = 0.008) than the non-remission group. Younger age(P =0.011, odds ratio = 0.955, 95%CI: 0.922-0.990), higher weight loss(P = 0.019, odds ratio = 0.937,95%CI: 0.887-0.989) and total gastrectomy(P = 0.039, odds ratio = 2.091, 95%CI: 1.037-4.216) were independent predictors for hypertension remission. The concordance index of the model was 0.769and the calibration curve suggested great agreement. Furthermore, decision curve analysis showed that the model was clinically useful.CONCLUSION Younger age, higher weight loss and total gastrectomy were independent predictors for hypertension remission after gastrectomy for gastric cancer patients. The nomogram could visually display these results.展开更多
文摘BACKGROUND Sleep disturbances and residual functional impairment are increasingly recognized as important determinants of outcome in mood disorders,even during remission.Persistent disruptions in sleep may reflect underlying pathophysiological mechanisms and contribute to impaired psychosocial recovery.By comparing remitted bipolar disorder(BD)and major depressive disorder(MDD)patients with healthy controls,the present study sought to clarify the extent of these disturbances and their correlates.AIM To evaluate differences in sleep quality,psychosocial functioning,and insomnia severity among remitted patients with BD and MDD,in comparison with healthy controls.A secondary aim was to examine the clinical and psychosocial factors influencing sleep quality within these groups.METHODS The study included 135 participants:45 remitted BD patients,45 remitted MDD patients,and 45 healthy controls.Sleep quality was assessed with the Pittsburgh Sleep Quality Index,psychosocial functioning with the global assessment of functioning,and insomnia severity with the Insomnia Severity Index.Sociodemographic and clinical characteristics were also recorded.Comparative analyses were conducted to evaluate differences between groups,and regression models were used to identify predictors of sleep quality.RESULTS Both BD and MDD groups demonstrated significantly poorer sleep quality and higher insomnia severity compared with healthy controls.Poor sleep quality was observed in 75.6%of BD patients and 57.8%of MDD patients.Group differences were most pronounced in Pittsburgh Sleep Quality Index subdomains including sleep latency,sleep duration,and habitual sleep efficiency.Regression analysis identified insomnia severity(β=0.510)and functional capacity(β=-0.043)as significant correlates of sleep quality,indicating that greater insomnia severity and lower functioning were independently associated with poorer sleep.CONCLUSION The findings underscore that even during remission,BD and MDD are accompanied by substantial impairments in sleep quality and psychosocial functioning.These results highlight the importance of addressing residual symptoms,particularly insomnia and functional difficulties,in long-term management strategies.Interventions aimed at improving sleep and enhancing daily functioning should be considered essential components of treatment to promote recovery and quality of life in remitted patients.
文摘BACKGROUND Cirrhotic patients with super-giant hepatocellular carcinoma(HCC)and portal vein invasion generally have a poor prognosis.This paper presents a patient with super-giant HCC and portal vein invasion,who underwent hepatectomy followed by a combination of sorafenib and camrelizumab,resulting in complete remission(CR)for 5 years.CASE SUMMARY A 40-year-old male with compensated hepatitis B-related cirrhosis was diagnosed with HCC,Barcelona Clinic Liver Cancer stage C.Enhanced computed tomography imaging revealed a 152 mm×171 mm tumor in the right liver,invading the portal vein and hepatic vein.Liver function was normal.The patient successfully underwent hepatectomy on July 18,2019.However,by December 2019,HCC recurrence with lung metastases and portal vein invasion were detected.He started treatment with sorafenib(200 mg twice daily)and camrelizumab(200 mg every 3 weeks).By May 12,2020,the patient was confirmed to have CR.Camrelizumab was adjusted to 200 mg every 12 weeks from June 16,2021,with the last infusion on March 29,2024.Although no further tumor recurrence was observed,he experienced two episodes of gastrointestinal bleeding due to esophagogastric varices,which were managed with endoscopic therapy.To date,the patient has remained in CR for 5 years.CONCLUSION The combination of hepatectomy with sorafenib and camrelizumab can achieve durable CR in patients with supergiant HCC and portal vein invasion.Further research is necessary to address these challenges and improve patient outcomes.
文摘BACKGROUND Oral 5-aminosalicylic acid(5-ASA)has been a cornerstone treatment for mild to moderate ulcerative colitis(UC),traditionally used to maintain remission.With the rise of advanced therapies(biologics and small molecules),the role of 5-ASA has come under renewed scrutiny.While earlier systematic reviews affirmed its efficacy compared to placebo,these did not account for the advent of advanced therapies.AIM To assess the efficacy and safety of oral 5-ASA in maintaining remission in quiescent UC,compared to placebo,alternative 5-ASA formulations,and advanced therapies,in the era of biologics and small molecules.METHODS It was systematically searched MEDLINE,EMBASE,and the Cochrane Library,alongside conference proceedings(European Crohn’s and Colitis Organisation,British Society of Gastroenterology),for randomized controlled trials published between 2003 and 2024 in English.Eligible studies involved oral 5-ASA therapies for quiescent UC with a minimum treatment duration of six months.Outcomes included failure to maintain remission,adverse events,and serious adverse events(SAEs).Data were analyzed using Cochrane methods,with GRADE assessing evidence certainty.RESULTS From 44 studies(9967 participants),5-ASA was superior to placebo in maintaining remission,with 37%of 5-ASA users relapsing at 6-12 months compared to 55%of placebo users[risk ratios(RR):0.68;95%CI:0.61-0.76;high-certainty evidence].SAEs were rare and comparable between groups(RR:0.60;95%CI:0.19-1.84;low-certainty evidence).Comparative analyses suggested 5-ASA remains a viable option alongside advanced therapies,with notable differences in cost and safety profiles.CONCLUSION 5-ASA remains effective and safe for maintaining remission in quiescent UC,even in the advanced therapy era.However,tailored approaches are needed to balance efficacy,safety,and cost in clinical practice.This study provides critical insights to guide therapeutic strategies and underscores the enduring relevance of 5-ASA.
基金Supported by the Technological innovation project of Shapingba District,No.2024111the Research Promotion Fund of Chongqing University Cancer Hospital,No.2023nlts008.
文摘BACKGROUND Type 2 diabetes(T2D)remission has been widely reported after bariatric surgery,but rarely reported after esophagectomy.AIM To explore the incidence and predictors of T2D remission 1 year after esophagectomy with gastric conduit reconstruction.METHODS In this prospective study,consecutive patients from 2 tertiary hospitals who had esophageal cancer and T2D and underwent esophagectomy with gastric conduit reconstruction were studied preoperatively and at 3 months,6 months,and 12 months postoperatively.Remission of T2D is defined as glycated hemoglobin(HbA1c)values below 6.5%without glucose-lowering medications.Related clinical information were recorded and analyzed.RESULTS A total of 187 patients were included.Of these patients,24(12.8%)discontinued antidiabetic drugs and maintained HbA1c values below 6.5%1 year after surgery.At baseline,patients with T2D remission were younger(63.0±5.2 years vs 67.0±6.1 years,P=0.002),had higher body mass index values(body weight 68.6±11.1 kg vs 61.2±9.3 kg,P=0.001;body mass index 25.5±2.4 kg/m2 vs 23.8±3 kg/m2,P=0.011),shorter duration of T2D(4.9±3.9 years vs 7.1±3.7 years,P=0.008)and higher preoperative HbA1c(8.5%±1.7%vs 7.7%±1.3%,P=0.042).Multivariate logistic regression analysis showed that younger age and greater body weight were independent predictors of T2D remission after surgery.CONCLUSION This study reveals a significant incidence of T2D remission after esophagectomy with gastric conduit reconstruction,and remission is more frequent in patients with younger age and greater body weight.
文摘BACKGROUND One-anastomosis gastric bypass(OAGB)and sleeve gastrectomy(SG)are surgical procedures increasingly performed for weight loss and to achieve remission of diabetes mellitus.Literature comparing the medium-term efficacy of these two procedures is scarce.As such,a meta-analysis comparing OAGB and SG in terms of diabetes remission(DR)and percentage of excess weight loss(EWL)is warranted.AIM To compare OAGB and SG in terms of DR and EWL%in the medium term.METHODS A comprehensive literature search was conducted in PubMed/MEDLINE,Cochran Library,and Web of Science for relevant articles,from inception through April 2025,using the keywords“one-anastomosis gastric bypass”,“sleeve gastrectomy”,“mini-gastric bypass”,“diabetes remission”,“one-anastomosis”,and“excess weight loss”.Clinical trials,prospective,retrospective and case-control studies were included;cross-sectional studies,case reports,editorials,and opinions were excluded.The Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale were used to assess the quality of included studies,and RevMan version 5.4 was used for data analyses.RESULTS A total of 1360 articles were identified,and 35 studies were retrieved of which 32 were included in the final analysis.Three full texts were excluded as they did not include data on DR or EWL%.OAGB achieved higher DR than SG at 1 year following surgery[odds ratio(OR)=1.77,95%confidence interval(CI):1.22-2.57,I^(2)=76%].However,DR rates were similar at 3 years and 5 years following surgery(OR=0.82,95%CI:0.61-1.10,I^(2)=23%and OR=0.92,95%CI:0.31-2.72,I^(2)=75%,respectively).OAGB showed higher EWL%at 1 year(OR=9.30,95%CI:6.45-12.15,I^(2)=91%),3 years(OR=10.02,95%CI:9.40-10.64,I^(2)=22%),and 5 years(OR=11.61,95%CI:3.74-19.48,I^(2)=97%).OAGB showed higher late complications than adjustable SG.The results were not different in sub-group analysis including only clinical trials,observational studies,and removing studies including super-obese patients and studies contributing most to heterogeneity.CONCLUSION In the medium term,DR rates were similar between OAGB and SG;however,OAGB showed higher EWL%than SG,and late complications were higher in OAGB.Clinical trials investigating the predictors of DR and EWL%are recommended.
文摘We report the case of a newly diagnosed overweight patient with type 2 diabetes mellitus who achieved diabetes remission using continuous glucose monitoring(CGM),which promotes patient engagement in self‐management.Key measures included selection of a patient newly diagnosed with type 2 diabetes mellitus,use of CGM,analysis of glucose trends and contributing factors,and patient guidance in maintaining a health diary and developing personalized self‐management strategies(e.g.,dietary modification and exercise regimens).Following 6‐month CGM‐guided self‐management,the patient's glycated hemoglobin level decreased from 7.3%at baseline to 6.0%and his body weight decreased from 83 to 77 kg,a 7%reduction;thus,the patient met the criteria for diabetes remission.
文摘In operations management, the learning curve has been an effective tool in estimating operator performance. However, discontinuities in work disrupt the learning process and a phenomenon called remission or forgetting occurs, resulting in increased time of performing the task upon resumption of work. The study aims to identify variables that significantly affect the remission rate of sewing operations in a manufacturing setting. Four variables--length of stint 1, percent Differenceat stint t, gender, and product family, were identified. Statistical analyses, such as paired t-test, correlation, regression, and analysis of variance （ANOVA） were conducted in order to observe the relationships between the dependent variable and independent variables. For the results of the first general regression, gender was found to be an insignificant variable in predicting remission rate, while product family, length of stint 1, and percent Differenceat stint I were statistically significant. Moreover, the final general regression, which excluded the insignificant gender variable and considered the （regrouped） product families, revealed that product family, length of stint 1, and percent Differenceat stint 1 were still statistically significant. Length of stint 1 had a moderately positive correlation with remission rate, while percent Differenceat stint i had a moderately negative correlation with remission rate. Also, percent Differenceat stint 1 was the largest contributor to the remission rate model. In terms of R2, the goodness-of-fit of the model is moderate. Finally, the model yielded an absolute error of 5.08%, indicating a high accuracy in predicting remission rate.
文摘AIM: To report 3 of 120 patients on the German MALT lymphoma trial with H. pylori associated gastric MALT lymphoma who developed early gastric cancer 4 and 5 years, after complete lymphoma remission following cure of H. pylori infection. PATIENTS AND RESULTS: Three patients (two men, 74 and 70 years; one women, 77 years) with H. pylori-associated low-grade MALT lymphoma achieved complete lymphoma remission after being cured. Surveillance endoscopies were performed twice a year in accordance to the protocol. Four years after complete lymphoma remission in two patients, and after 5 years in the other, early gastric adenocarcinoma of the mucosa-type, type IIa and type IIc, respectively, was detected, which were completely removed by endoscopic mucosa resection. In one patient, the gastric cancer was diagnosed at the same location as the previous MALT lymphoma, in the other patients it was detected at different sites of the stomach distant from location of the previous MALT lymphoma. The patients were H. pylori negative during the whole follow-up time. CONCLUSION: These findings strengthen the importance of regular Long-term follow-up endoscopies in patients with complete remission of gastric MALT lymphoma after cure of H. pylori infection. Furthermore, gastric adenocarcinoma may develop despite eradication of H. pylori.
文摘AIM： Prednisone and azathioprine represent the standard treatment for autoimmune hepatitis （AIH）. However, only 65% of the patients enter complete histological remission. Recently, budesonide （BUD） was reported to be a promising alternative. In this study we assessed the efficacy and safety of BUD in AIH. METHODS： Eighteen patients （12 women, 6 men; mean age 45.4±21 years） with AIH were treated with BUD （Budenofalk） 3 mg thrice daily and followed up for at least 24 wk. Seven patients also had features of primary biliary cirrhosis （n = 5） or primary sclerosing cholangitis （n = 2）. Advanced liver fibrosis or cirrhosis was present in RESULTS： Fifteen （83%） patients had a complete clinical and biochemical remission. Ten patients, including five with acute hepatitis, were given BUD as first-line therapy, of which seven enter remission. Three patients, two with liver cirrhosis, did not improve. All patients with second-line therapy experienced long-term remission. A histological remission was also seen in three patients. Clinically relevant BUD-induced side effects were recorded only in patients with liver cirrhosis （n = 4）. CONCLUSION： BUD is effective in remission induction in the majority of our patients with AIH. Side effects and treatment failure was mainly observed in patients with liver cirrhosis.
基金supported by the National Key Technology R&D Program of China(No.2013BAI09B04)the Medical Research Funds from the Bureau of Health of Zhejiang Province(No.2013KYA072),China
文摘Objective： The treatment of Henoch-Schonlein purpura （HSP） with moderate proteinuria remains con- troversial. We retrospectively analyzed the efficacy of immune suppressants, with a particular emphasis on myco- phenolate mofetil （MMF）. Methods： Ninety-five HSP patients with moderate proteinuria （1.0-3.5 g/24 h） after at least three months of therapy with angiotensin-converting enzyme inhibitor （ACEI） or angiotensin receptor blocker （ARB） were divided into three groups： an MMF group （n=33） that received MMF 1.0-1.5 g/d combined with prednisone （0.4-0.5 mg/（kg.d））, a corticosteroid （CS） group （n=31） that received full-dose prednisone （0.8-1.0 mg/（kg.d））, and a control group （n=31）. Patients in the MMF and CS groups continued to take ACEI or ARB at the original dose. The patients in the control group continued to take ACEI or ARB but the dose was increased by （1.73±0.58）-fold. The patients were followed up for 6-78 months （median 28 months）. Results： The baseline proteinuria was higher in the MMF group （（2.1±0.9） g/24 h） than in the control group （（1.6±0.8） g/24 h） （P=0.039）. The proteinuria decreased sig- nificantly in all groups during follow-up, but only in the MMF group did it decrease significantly after the first month. At the end of follow-up, the proteinuria was （0.4±0.7） g/24 h in the MMF group and （0.4±0.4） g/24 h in the CS group, significantly lower than that in the control group （（0.9±1.1） g/24 h）. The remission rates in the MMF group, CS group, and control group were respectively 72.7%, 71.0%, and 48.4% at six months and 72.7%, 64.5%, and 45.2% at the end of follow-up. The overall number of reported adverse events was 17 in the MMF group, 30 in the CS group, and 6 in the control group （P〈0.001）. Conclusions： MMF with low-dose prednisone may be as effective as full-dose prednisone and tend to have fewer adverse events. Therefore, it is probably superior to conservative treatments of adult HSP patients with moderate proteinuria.
基金Supported by Grants from the Swiss National Science Foundation to Rogler G,Grant No.310030-120312to Schoepfer A,Grant No.32003B_135665/1+1 种基金to Vavricka S,Grant No.320000-114009/3 and 32473B_135694/1to the Swiss IBDCohort,Grant No.33CS30_134274
文摘The use of specific terms under different meanings and varying definitions has always been a source of confusion in science.When we point our efforts towards an evidence based medicine for inflammatory bowel diseases(IBD)the same is true:Terms such as"mucosal healing"or"deep remission"as endpoints in clinical trials or treatment goals in daily patient care may contribute to misconceptions if meanings change over time or definitions are altered.It appears to be useful to first have a look at the development of terms and their definitions,to assess their intrinsic and context-independent problems and then to analyze the different relevance in present-day clinical studies and trials.The purpose of such an attempt would be to gain clearer insights into the true impact of the clinical findings behind the terms.It may also lead to a better defined use of those terms for future studies.The terms"mucosal healing"and"deep remission"have been introduced in recent years as new therapeutic targets in the treatment of IBD patients.Several clinical trials,cohort studies or inception cohorts provided data that the long term disease course is better,when mucosal healing is achieved.However,it is still unclear whether continued or increased therapeutic measures will aid or improve mucosal healing for patients in clinical remission.Clinical trials are under way to answer this question.Attention should be paid to clearly address what levels of IBD activity are looked at.In the present review article authors aim to summarize the current evidence available on mucosal healing and deep remission and try to highlight their value and position in the everyday decision making for gastroenterologists.
文摘BACKGROUND It is a crucial issue for patients with refractory ulcerative colitis(UC),including steroid-dependent and steroid-refractory patients,to achieve and maintain steroid-free remission.However,clinical studies focused on the achievement of steroid-free remission in refractory UC patients are insufficient.Cytapheresis(CAP)is a non-pharmacological extracorporeal therapy that is effective for active UC with fewer adverse effects.This study comprised UC patients treated with CAP and suggested the efficacy of CAP for refractory UC patients.AIM To clarify the efficacy of CAP in achieving steroid-free remission in refractory UC patients.METHODS We retrospectively reviewed the collected data from 55 patients with refractory UC treated with CAP.We analyzed the following points:(1)Efficacy of the first course of CAP;(2)Efficacy of the second,third,and fourth courses of CAP in patients who experienced relapses during the observation period;(3)Efficacy of CAP in colonic mucosa;and(4)Long-term efficacy of CAP.Clinical efficacy was evaluated using Lichtiger’s clinical activity index or Sutherland index(disease activity index).Mucosal healing was evaluated using Mayo endoscopic subscore.The primary and secondary endpoints were the rate of achievement of steroidfree remission and the rate of sustained steroid-free remission,respectively.Statistical analysis was performed using the paired t-test and chi-squared test.RESULTS The rates of clinical remission,steroid-free remission,and poor effectiveness after CAP were 69.1%,45.5%,and 30.9%,respectively.There were no significant differences in rate of steroid-free remission between patients with steroiddependent and steroid-refractory UC.The mean disease activity index and Lichtiger’s clinical activity index scores were significantly decreased after CAP(P<0.0001).The rates of steroid-free remission after the second,third,and fourth courses of CAP in patients who achieved steroid-free remission after the first course of CAP were 83.3%,83.3%,and 60%,respectively.Mucosal healing was observed in all patients who achieved steroid-free remission after the first course of CAP.The rates of sustained steroid-free remission were 68.0%,60.0%,and 56.0%at 12,24,and 36 mo after the CAP.Nine patients(36%)had maintained steroid-free remission throughout the observation period.CONCLUSION Our results suggest that CAP effectively induces and maintains steroid-free remission in refractory UC and re-induces steroid-free remission in patients achieving steroid-free remission after the first course of CAP.
文摘Hepatocellular carcinoma (HCC) is the fifth most common malignant disease worldwide, and curative treatment remains difficult because the majority of cases are diagnosed in the advanced stage. Sorafenib is the only known effective systemic treatment, but patients rarely achieve complete remission (CR). A 66-year-old man with a history of alcoholic liver cirrhosis with a diagnosis of advanced HCC, was initially treated with transarterial chemoembolization on four occasions. However, the disease progressed with portal vein thrombosis. Therefore, sorafenib was started, and 4 mo later, the patient achieved CR. The treatment was continued for 12 mo, and CR was maintained up to 4 mo after sorafenib discontinuation.
文摘OBJECTIVES Moderate to vigorous physical activity is recommended to prevent hypertension according to the current guidelines.However,the degree to which the total physical activity(TPA)and its changes benefit normotensives and hypertensives is uncertain.We aimed to examine the effects of TPA and its changes on the incidence,progression,and remission of hypertension in the large-scale prospective cohorts.METHODS A total of 73,077 participants(55,101 normotensives and 17,976 hypertensives)were eligible for TPA analyses.During a mean follow-up of 7.16 years(394,038 person-years),12,211 hypertension cases were identified.TPA was estimated as metabolic equivalents and categorized into quartiles.Cox proportional hazards regression and multivariable logistic regression were used to estimate associations of TPA and changes in TPA with incident hypertension and progression/remission of hypertension.RESULTS Compared with the lowest quartile of TPA,normotensives at the third and the highest quartile had a decreased risk of incident hypertension,with hazard ratios(HRs)of 0.86[95%confidence interval(CI):0.81−0.91]and 0.81(95%CI:0.77−0.86),respectively.Hypertensives at the highest quartile of TPA demonstrated a decreased risk of progression of hypertension[odds ratio(OR)=0.87,95%CI:0.79−0.95],and an increased probability of hypertension remission(OR=1.17,95%CI:1.05−1.29).Moreover,getting active from a sedentary lifestyle during the follow-up period could reduce 25%(HR=0.75,95%CI:0.58−0.96)risk of incident hypertension,whereas those becoming sedentary did not achieve benefit from initially being active.CONCLUSIONS Our findings indicated that increasing and maintaining TPA levels could benefit normotensives,whereas higher TPA levels were needed to effectively control progression and improve remission of hypertension.Physical activity played undoubtedly an essential role in both primary and secondary prevention of hypertension.
文摘AIM： To assess the value of long-chain w-3 fatty acids （FAs） supplementation in addition to amino-salicylic-acid （5-ASA） in pediatric patients with Crohn＇s disease （CD）. METHODS： Thirty-eight patients （20 males and 18 females, mean age 10.13 years, range 5-16 years） with CD in remission were randomized into two groups and treated for 12 too. Group Ⅰ （18 patients） received 5-ASA （50 mg/kg/d）＋w-3 FAs as triglycerides in gastroresistant capsules, 3 g/d （eicosapentanoic acid, EPA, 400 mg/g, docosahexaenoic acid, DHA, 200 mg/g）. Group Ⅱ （20 patients） received 5-ASA （50 mg/kg/d）＋olive oil placebo capsules. Patients were evaluated for fatty acid incorporation in red blood cell membranes by gas chromatography at baseline 6 and 12 mo after the treatment. RESULTS： The number of patients who relapsed at 1 year was significantly lower in group I than in group Ⅱ （P〈0.001）. Patients in group I had a significant increase in the incorporation of EPA and DHA （P〈0.001） and a decrease in the presence of arachidonic acids. CONCLUSION： Enteric-coated w-3 FAs in addition to treatment with 5-ASA are effective in maintaining remission of pediatric CD.
基金Academy of Finland(Reetta Satokari),No.323156Sigrid Juselius Foundation+2 种基金University of Helsinki(A Three-year Grant)The Competitive State Research Financing(Perttu Lahtinen),No.200230042The Ella and Georg Ehrnrooth Foundation(Perttu Arkkila)
文摘BACKGROUND Fecal microbial transplantation(FMT)is a promising new method for treating active ulcerative colitis(UC),but knowledge regarding FMT for quiescent UC is scarce.AIM To investigate FMT for the maintenance of remission in UC patients.METHODS Forty-eight UC patients were randomized to receive a single-dose FMT or autologous transplant via colonoscopy.The primary endpoint was set to the maintenance of remission,a fecal calprotectin level below 200μg/g,and a clinical Mayo score below three throughout the 12-mo follow-up.As secondary endpoints,we recorded the patient’s quality of life,fecal calprotectin,blood chemistry,and endoscopic findings at 12 mo.RESULTS The main endpoint was achieved by 13 out of 24(54%)patients in the FMT group and by 10 out of 24(41%)patients in the placebo group(log-rank test,P=0.660).Four months after FMT,the quality-of-life scores decreased in the FMT group compared to the placebo group(P=0.017).In addition,the disease-specific quality of life measure was higher in the placebo group than in the FMT group at the same time point(P=0.003).There were no differences in blood chemistry,fecal calprotectin,or endoscopic findings among the study groups at 12 mo.The adverse events were infrequent,mild,and distributed equally between the groups.CONCLUSION There were no differences in the number of relapses between the study groups at the 12-mo follow-up.Thus,our results do not support the use of a single-dose FMT for the maintenance of remission in UC.
文摘AIM: To assess the risk of relapse in ulcerative colitis (UC) patients in clinical remission using mucosal status and fecal immunochemical test (FIT) results.METHODS: The clinical outcomes of 194 UC patients in clinical remission who underwent colonoscopy were based on evaluations of Mayo endoscopic subscores (MESs) and FIT results.RESULTS: Patients with an MES of 0 (n = 94, 48%) showed a ten-fold lower risk of relapse than those with an MES of 1-3 (n = 100, 52%) (HR = 0.10, 95%CI: 0.05-0.19). A negative FIT result (fecal hemoglobin concentrations ≤ 100 ng/mL) was predictive of patients with an MES of 0, with a sensitivity of 0.94 and a specific of 0.76. Moreover, patients with a negative FIT score had a six-fold lower risk of clinical relapse than those with a positive score (HR = 0.17, 95%CI: 0.10-0.28). Inclusion of the distinguishing parameter, sustaining clinical remission > 12 mo, resulted in an even stronger correlation between negative FIT results and an MES of 0 with respect to the risk of clinical relapse (HR = 0.11, 95%CI: 0.04-0.23).CONCLUSION: Negative FIT results one year or more after remission induction correlate with complete mucosal healing (MES 0) and better prognosis. Performing FIT one year after remission induction may be useful for evaluating relapse risk.
基金supported by the department of pathology and the PET/CT center of Affiliated Hospital of Academy of Military Medical Sciences
文摘Breast cancer is one of the most common malignancies in women. The post-operative recurrence and metastasis are the leading causes of breast cancer-related mortality. In this study, we tried to explore the role of circulating tumor cell （CTC） detection combination PET/CT technology evaluating the prognosis and treatment response of patients with breast cancer; meanwhile, we attempted to assess the concept of ＂biological complete remission＂ （bCR） in this regard. A 56-year-old patient with breast cancer （T2N1M1, stage IV left breast cancer, with metastasis to axillary lymph nodes and lungs） received 6 cycles of salvage treatment with albumin-bound paditaxd plus eapecitaabine and trastuzumah. Then, she underwent CTC detection and PET/CT for efficacy evaluation. CTC detection combination PET/CT is useful for the evaluation of the biological efficacy of therapies for breast cancer. The bCR of the patient appeared earlier than the conventional clinical imaging complete remission and promised the histological （pathological） complete remission. The integrated application of the concepts including bCR, imageological CR, and histological CR can achieve the early and prognosis of breast cancer. accurate assessment of biological therapeutic reponse and
文摘BACKGROUND Previous studies reported hypertension remission after gastrectomy for gastric cancer patients, and the remission rate was 11.1%-93.8%. We have reported the factors of hypertension remission previously, however, the follow-up time was six months. It is necessary to identify risk factors for hypertension for a relatively longer follow-up time.AIM To analyze the predictive factors for hypertension remission one year after gastrectomy of gastric cancer patients and to construct a risk model for hypertension remission.METHODS We retrospectively collected the medical information of patients with concurrent gastric cancer and hypertension in a single clinical center from January 2013 to December 2020. Univariate and multivariate logistic regression of hypertension remission were conducted, and a nomogram model was established.RESULTS A total of 209 patients with concurrent gastric cancer and hypertension were included in the current study. There were 108 patients in the remission group and 101 patients in the non-remission group. The hypertension remission rate was 51.7% one year after gastrectomy. The remission group had younger aged patients(P = 0.001), larger weight loss(P = 0.001), lower portion of coronary heart disease(P = 0.017), higher portion of II-degree hypertension(P = 0.033) and higher portion of total gastrectomy(P = 0.008) than the non-remission group. Younger age(P =0.011, odds ratio = 0.955, 95%CI: 0.922-0.990), higher weight loss(P = 0.019, odds ratio = 0.937,95%CI: 0.887-0.989) and total gastrectomy(P = 0.039, odds ratio = 2.091, 95%CI: 1.037-4.216) were independent predictors for hypertension remission. The concordance index of the model was 0.769and the calibration curve suggested great agreement. Furthermore, decision curve analysis showed that the model was clinically useful.CONCLUSION Younger age, higher weight loss and total gastrectomy were independent predictors for hypertension remission after gastrectomy for gastric cancer patients. The nomogram could visually display these results.
