Efficacy of infliximab in acute severe ulcerative colitis:A single-centre experience

AIM:To suggest infliximab(IFX) is effective for acute severe ulcerative colitis,from real-life clinical practice.METHODS:All patients receiving IFX for the treatment of acute severe ulcerative colitis in a single centre were included.Data were extracted from clinical records in order to assess response to IFX therapy.The primary endpoint was colectomy-free survival,and secondary outcomes included glucocorticosteroid-free remission and safety,which was evaluated by recording deaths and adverse events.Demographic and clinical characteristics of those who underwent colectomy and those who were colectomy-free,both at discharge from their index admission,and during follow-up after an initial response to IFX were compared.RESULTS:Forty-four patients(16 females,mean age 36 years) received IFX between May 2006 and January 2012 for acute severe ulcerative colitis.The median duration of follow-up post-first infusion was 396 d(interquartile range = 173-828 d).There were 21(47.7%) patients with < 1 year of follow-up,10(22.7%) with 1 years to 2 years of follow-up,and 13(29.5%) with > 2 years of follow-up post-first infusion of IFX.Overall,35(79.5%) responded to IFX,avoiding colectomy during their index admission,29(65.9%) were colectomyfree at last point of follow-up(median follow-up 396 d),and 25(56.8%) were in glucocorticosteroid-free remission at end of follow-up.There was one death from post-operative sepsis,20 d after a single IFX infusion.Colectomy rates were generally lower among those "bridging" to thiopurine.Of 18 patients "bridged" to thiopurine therapy,17(94.4%) were colectomyfree,and 15(83.3%) were in glucocorticosteroid-free remission at study end.No predictors of response were identified.CONCLUSION:IFX is effective for acute severe ulcerative colitis in real-life clinical practice.Two-thirds of patients avoided colectomy,and more than 50% were in glucocorticosteroid-free remission.     

Case report of chloroquine therapy and hypoglycaemia in type 1 diabetes: What should we have in mind during the COVID-19 pandemic?

A type 1 diabetes patient experienced remission associated with chloroquine therapy while travelling to a malaria-endemic area. Chloroquine has immunomodulatory and hypoglycaemic effects and may become more frequently used due to the COVID-19 pandemic. Patients with type 1 diabetes treated with chloroquine should be monitored for hypoglycaemia, even after recovery.     

What May we be Learning from So-called Spontaneous Remission in Ethnic Minorities?

This study describes a small-scale attempt to compare people from two populations in an English county who have grown out of alcohol problems without formal assistance from treatment agencies. The populations were the indigenous white population and the ethnic minority population who originated from the Indian sub-continent, although 40% were born in Britain. There may be more spontaneous remitters and less problematic drinkers in need of specialist services than one would expect on the basis of population and consumption levels in the ethnic minority communities. For both white indigenous and ethnic groups, physical health, self-esteem, ability to cope and work were important motivating factors in reduction or cessation of alcohol use. For the ethnic minority group, social networks, including religiously-based ones, family status and honour were important, whereas accommodation and psychological state were more important to the white indigenous sample. Although the study is anecdotal, a case is made to have services for people with alcohol problems which offer treatments and goals consistent with the attitudes and beliefs of the communities of origin of presenters.     

Factors predicting the response to low-dose methotrexate therapy in patients with rheumatoid arthritis: a better response in male patients

Methotrexate (MTX) is the most commonly used disease-modifying antirheumatic drug (DMARD) throughout the world. In Japan, MTX is recommended by the Japanese Ministry of Health, Labour, and Welfare to be given as the second or third DMARD and at a dosage of no more than 8 mg/week. We analyzed the efficacy of MTX in Japanese patients with RA in order to determine whether it is comparable to that in Western countries, where 15–20 mg/week of MTX is used, as well as to elucidate the factors associated with the favorable response to MTX. Around 8 mg/week of MTX was effective in half of the RA patients in the current study, and male sex was the only factor associated with a good response to MTX from a multivariate regression model analysis. Some of the patients who had a poor response to MTX showed an improvement with the addition of bucillamine or prednisolone. For the remaining patients, an increase in the MTX dosage to more than 8 mg/week or the use of biologics such as the anti-tumor necrosis factor (TNF)-α monoclonal antibody may be required.     

社会技能训练对康复期精神分裂症患者认知症状的疗效

目的 探讨社会技能训练对康复期精神分裂症患者的认知症状的疗效.方法 94例康复期患者,按随机数字表法分成实验组(n=47)和对照组(n=47),实验组予12周的社会技能训练.于基线、12周、12个月时进行WCST、TMT-A、TMT-B、P300等认知功能评定,采用重复测定资料的方差分析2组认知功能的差别.结果 训练前,2组认知功能差异无统计学意义(F =0.001～1.711,P=0.207 ～0.973);训练后:实验组WCST总测验次数(63.30±12.45)、正确数(30.90±3.14)、持续错误数(20.53±2.01)、随机错误数(23.00±3.29)、TMT-A(57.33±11.59)、TMT-B(171.15±23.75)、数字广度(10.54±1.54)、P300波幅(9.58±1.88)μV、潜伏期(263.95±20.75)ms的变化优于对照组[(79.41±15.88)、(27.20±2.44)、(22.70±3.65)、(29.20±4.10)、(71.02±8.72)、(242.44±31.28)、(6.15±1.49) μV、(306.00±27.82) ms],差异有统计学意义(F=4.470～6.220,P=0.023 ～0.049).结论 社会技能训练能有效改善康复期精神分裂症患者的认知功能.     

全肠内营养对儿童克罗恩病诱导缓解疗效研究北大核心CSCD

目的观察全肠内营养(exclusive enteral nutrition,EEN)对克罗恩病(Crohn’s disease,CD)患儿诱导缓解的疗效。方法回顾性收集2013年3月至2021年8月在浙江大学医学院附属儿童医院接受EEN治疗的62例CD患儿的临床资料,包括一般资料,治疗前及治疗8周后患儿的身高、体重、儿童CD活动指数、CD内镜严重程度指数、C反应蛋白水平、红细胞沉降率、血清白蛋白水平。比较治疗前后上述指标的变化。结果62例患儿中,男39例(63%),女23例(37%),确诊年龄(11.9±3.0)岁。55例完成至少8周EEN治疗的患儿中,87%(48/55)的患儿在治疗第8周获得临床缓解。第8周儿童CD活动指数显著低于治疗前(P<0.001)。除去17例单纯累及小肠患儿及3例未行结肠镜复查的累及结肠患儿,剩余35例累及结肠患儿在8周EEN治疗后进行了结肠镜复查,83%(29/35)的患儿达到黏膜愈合。在第8周达到临床缓解的48例患儿中,年龄别身高Z评分及年龄别体重指数Z评分较治疗前均显著改善(P<0.01)。在第8周未达到临床缓解的7例患儿中,年龄别身高Z评分和年龄别体重指数Z评分与治疗前比较差异均无统计学意义(P>0.05)。结论8周EEN治疗对儿童CD的诱导缓解及黏膜愈合的疗效良好。对于成功诱导缓解的CD患儿,EEN可改善其身高和体重指数。     

Thalidomide for the treatment of resistant cutaneous lupus: efficacy and safety of different therapeutic regimens

PURPOSE: Thalidomide is effective for the treatment of severe cutaneous lupus. Our aim was to study the safety and efficacy of different doses of thalidomide in this condition. METHODS: We studied patients with severe cutaneous lupus that was unresponsive to antimalarials, prednisolone, methotrexate, azathioprine, and cyclosporin A. Starting doses of 100 mg daily (n = 16 patients), 50 mg daily (n = 17), or 50 mg on alternate days (n = 15) were compared. The response to thalidomide was categorized as complete remission, partial remission, or no visible improvement. All patients received a baseline electromyogram (EMG) followed by repeat EMG every 3 to 6 months, or sooner if neuropathic symptoms developed. RESULTS: Forty-eight patients (46 female; mean [+/- SD] age, 44 +/- 12 years; range, 22 to 71 years) with discoid lupus (n = 18), subacute cutaneous lupus (n = 6), or systemic lupus erythematosus with skin involvement (n = 24) were included. The response rate was 81%, including 29 patients (60%) in complete remission and 10 (21%) in partial remission. Nine patients (19%) failed to respond. Thirteen patients (27%) developed peripheral neuropathy, which was EMG-proven in 11, including 4 patients in the 50-mg alternate-day group. Other side effects included drowsiness, constipation or abdominal pain, and amenorrhea. The relapse rate after stopping thalidomide was 67% (26/39). There was no association between a positive response to the drug and either starting doses or cumulative dose. Similarly, no association was found between peripheral neuropathy and the starting or cumulative dose. CONCLUSION: Thalidomide is effective for the treatment of severe cutaneous lupus. There were no clear dose-dependent effects. However, the high incidence of neurotoxicity, even at low doses, suggests that it may be most useful as a remission-inducing drug.     

DAPTO等方案诱导治疗急性双表型白血病11例报告

报告１１例急性双表型白血病的诱导化疗结果。５例ＡＢＬ经ＤＡＰＴＯ方案诱导化疗，４例于２８－５０天内完全缓解，持续ＣＲ时间７－１４月，存活时间８－１８月，１例仍无病生存，其余６例应用ＤＶＰ等方案化疗，ＣＲ２例，持续ＣＲ分别为４和８月，６例患者作１例生存１６月外，余未超过７月。