Effects of Vedolizumab Therapy on Extraintestinal Manifestations in Inflammatory Bowel Disease

Background

Approximately 15–20% of ulcerative colitis patients and 20–40% of those with Crohn’s disease experience extraintestinal manifestations (EIMs) of their inflammatory bowel disease (IBD). Clinicians who treat IBD must manage EIMs affecting multiple organs that variably correlate with intestinal disease activity. Vedolizumab is a monoclonal antibody for the treatment of IBD with a gut-selective mechanism of action.

Aims

This report evaluates whether vedolizumab is an effective treatment of EIMs, given its gut-specific mechanism of action.

Methods

We report 8 case studies of patients with various EIMs, including pyoderma gangrenosum, peripheral arthralgia/arthritis, axial arthropathies, erythema nodosum, and uveitis, who received vedolizumab therapy.

Results

Vedolizumab therapy was effective for pyoderma gangrenosum in ulcerative colitis, uveitis, erythema nodosum, polyarticular arthropathy, and ankylosing spondylitis/sacroiliitis but did not provide sustained benefit for the treatment of pyoderma gangrenosum in a patient with Crohn’s disease.

Conclusions

These cases demonstrate the potential of vedolizumab as a treatment of EIMs in patients with IBD.

     

Initial Survey of Microplastics in Bottom Sediments from United States Waterways

Bulletin of Environmental Contamination and Toxicology - Given the reported extent of microplastics in the aquatic environment, environmentally relevant exposure information for sediments dredged...     

Thoracic reirradiation with SBRT for residual/recurrent and new primary NSCLC within or immediately adjacent to a prior high-dose radiation field

Purpose

Local failure following concurrent chemoradiation and in-lobe failures following stereotactic body radiation therapy (SBRT) are common. We evaluated our institutional experience using SBRT as salvage in this setting.

Results of a prospective phase 2 clinical trial of induction gemcitabine/capecitabine followed by stereotactic ablative radiation therapy in borderline resectable or locally advanced pancreatic adenocarcinoma

Purpose

Stereotactic ablative radiation therapy’s (SABR’s) great conformity and short duration has become an attractive treatment modality. We report a phase 2 clinical trial to evaluate efficacy and safety of induction chemotherapy (ICT) followed by SABR in patient with borderline resectable (BR) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC).

Pain control and cultural norms and expectations after closed femoral shaft fractures

The purpose of this observation-cohort survey study was to compare the analgesia given and satisfaction with analgesia after a uniform orthopedic injury and operation in culturally disparate settings. Twenty-five patients with isolated closed femoral shaft fractures treated with intramedullary rod fixation within 1 week of injury were retrospectively evaluated at two urban hospitals in the United States. They were compared with a matched group from three urban hospitals in Vietnam (two in Hanoi and one in Ho Chi Minh City [Saigon]). Ages and sex did not differ significantly between the two groups. The mean weight of the Vietnamese group was significantly less than that of the US group (58 vs. 81 kg). During the 14 days following injury, the Vietnamese and American groups were given a mean of 0.9 mg/kg per day versus 30.2 mg/kg per day of morphine equivalent units, respectively. Two (8%) of the Vietnamese group felt their pain control had been inadequate, versus 20 (80%) of the US group. Similarly, 2 (8%) of the US group and 7 (28%) of the Vietnamese group felt they had received "too much" pain medication. Mean heart rates during the first 5 days after surgery were not significantly different in the two groups. Only 4% of the US group felt they had had an accurate impression of how much a femur fracture would hurt prior to the injury, whereas 76% of Vietnamese patients responded that they imagined such an injury would be approximately as painful as it was. Results were similar for preconceptions of pain as a result of surgery and during the postoperative period. More than 50% of patients from the US group felt there must be some explanation other than the femur fracture to explain the severity of their pain, such as infection, missed injury, hardware failure, or inappropriate medical care. Despite much higher administration of narcotic analgesia, American patients with femoral shaft fractures were much more dissatisfied with their analgesic results. In assessing the recommended dosing for "adequate analgesia" and "analgesic requirements," determinations may depend less upon tissue injury than upon cultural norms and patient expectations.     

Sarcomere length behaviour along single frog muscle fibres at different lengths during isometric tetani

Summary A detailed investigation of sarcomere lengthening and shortening during fixed-end tetani has been made along frog muscle fibres stretched over a large range of sarcomere lengths. A variety of sources of error common in such measurements are quantitated and give an uncertainty in sarcomere length of about 53–62 nm. The difference in sarcomere length calculated from the left and right first orders at rest was 21 nm ±16 nm and this is suggested to be a measure of Bragg artefact. The laser diffraction measurements showed that the shortening end regions decrease in size during contraction and that the magnitude of shortening is increased at greater fibre extensions. The average length change and sarcomere length of the central and end regions was 0.10 m (2.85 m) and –0.37 m (2.66 m), respectively. The sarcomere length of the end regions at the end of creep was regularly observed to be <2.1 m. An unexpected finding was the occasional observation of striations in the transition zone between lengthening and shortening regions which remained nearly isometric during a period of tension rise during creep. Measurements of diffraction order linewidth do not suggest increased sarcomere length dispersion in these areas. A smooth transition from shortening to lengthening was always observed. Although our data are in general agreement with the models proposed by Morgan, Mochon and Julian (Biophys. J. 39 (1982) 189–96) and Edman and Reggiani(J. Physiol. (Lond.) 351 (1984) 169–98), specific differences which do exist are discussed.