关键词： Vedolizumab   Sperm DNA Fragmentation   Semen Quality  

关键词： anti-TNF therapy   loss of response   inflammatory bowel disease   monotherapy   combination therapy  

摘要： Background Recent prospective studies suggest combination therapy with immunomodulators improves efficacy, but long-term data is limited. Aim To assess whether anti-tumour necrosis factor alpha (anti-TNF) monotherapy was associated with earlier loss of response (LOR) than combination therapy in a real-world cohort with long-term follow up. Methods A retrospective audit was conducted of inflammatory bowel disease patients receiving anti-TNF therapy in a tertiary centre and specialist private practices. All patients with accurate data for anti-TNF commencement and adequate correspondence to determine end-points were included. Outcomes measured included time to first LOR, causes and biochemical parameters. Results Two hundred and twenty-four patients were identified;139 (62.1%) on combination therapy and 85 (37.9%) on monotherapy. Forty-five percent of patients had LOR during follow up until a maximum of 8.5 years;59.4% on combination therapy and 40.6% on monotherapy (P = 0.533). The median time to LOR was not different between groups;1069 days for combination therapy and 1489 days for monotherapy (P = 0.533). There was no difference in time to LOR between patients treated with different combination regimens or different anti-TNF agents. Conclusion In this large cohort of patients in a real-world setting, patients treated with anti-TNF monotherapy had similar rates of LOR as patients on anti-TNF combination therapy, at both short- and long-term follow up.

关键词： 肠疾病   研究  

ISBN: (纸本)9787547844625

摘要： 在内脏器官中，肠组织是对缺血性损伤极为敏感的器官。严重创伤、大面积烧伤、休克、重症胰腺炎等应激状态均存在不同程度肠缺血再灌注损伤。肠缺血再灌注损伤作为一种常见的病理生理过程，在许多疾病的病程中都会不同程度地伴随缺血再灌注损伤，肠道在遭受缺血再灌注时，富含氧的血液回流后造成缺血肠组织的损伤继而出现细菌及内毒素移位，其诱发的全身炎症反应及多器官功能衰竭具有较高的发生率和死亡率，因而成为临床中一个棘手的问题。本书内容包括肠缺血再灌注损伤概论、肠缺血标志物研究进展、肠缺血与肠道屏障、肠缺血与炎症因子、microRNA在肠缺血中的作用等。本书的读者对象为急诊科或消化科临床及基础医学教学科研和实践人员，可为从事肠缺血相关疾病临床和基础的教学和科研人员提供有效的参考。

摘要： The article presents a case study of a 48-year-old male patient who was admitted with erythematous skin lesions in the face. The patient received clindamycin and adapalene with benzoyl peroxide topical treatment. The patient was diagnosed with rosacea fulminans, based on characteristic clinical picture and the typical course of the disease.

摘要： The authors comment on a study by Dubash et al that investigated the emergence of severe spondyloarthropathy (SpA)-related entheseal pathology after successful vedolizumab treatment for inflammatory bowel disease (IBD). They claim that the SpA reported in the study could have been facilitated by previous discontinuance of tumor necrosis factor (TNF) inhibitor. It stresses the need to use new combined therapeutic protocols in such category of IBD patients.

关键词： Crohn's disease   Research gaps   Ulcerative colitis  

摘要： BackgroundClinical practice guidelines help practitioners manage patients in an effective and systematic way, and they assist in making evidence-based decisions related to diagnosis and treatment. Each recommendation is ranked based on evidence. The goal of this study is to determine gaps in research for inflammatory bowel diseases (IBD)by using the low-level evidence *** extracted low-level evidence recommendations set forth by the American College of Gastroenterology inIBD, ulcerative colitis(UC), and Crohn's disease. ***, the World Health Organization's International Clinical Trials Registry Platform and PubMed were then used to locate studies relevant to the *** were 30 low-level evidence recommendations, and 23 had recent or ongoing studies addressing them. We screened 2938 trials and 4321 published articles, 221 of which addressed low-quality recommendations. There were five recommendations that received the majority of research attention (143/221, 65%).ConclusionThis study used clinical practice guidelines to help determine areas of needed research inIBD,UC, and Crohn's disease. By searching trial registries and articles indexed on PubMed, we identified the extent to which studies were being conducted to address research gaps. Of the gaps identified, five recommendations received most of the attention. While most of the significant gaps had some recent or ongoing research, our study found several areas where investigation is still needed. Clinical practice guidelines are an effective method to prioritize future research.

摘要： Background Patients with inflammatory bowel disease (IBD) are at increased risk of venous thromboembolism (VTE) during hospitalisation and potentially post-discharge. Aims To determine the incidence and risk factors for post-discharge VTE in IBD patients and create a point of care predictive model to assess VTE risk. Methods Hospitalised IBD patients were identified from our institutional discharge database between 2009 and 2016, and were assessed for VTE by chart review. Risk factors for VTE within 3 months of discharge were determined by univariable and multivariable logistic regression. A point of care model was created using variables from the univariate analysis with P < 0.05, and internally validated by bootstrap methods. Results Sixty-six of 2161 eligible discharges (3%) were associated with VTE within 6 months of hospitalisation. The median time to event was 37 days (range 3-182 days). On multivariable analysis age >45 years (OR 3.76;95% CI 1.80-7.89) and multiple admissions (OR 2.62;95% CI 1.34-5.11) were independently associated with VTE risk. Our final model incorporated age >45 years, multiple admissions, intensive care unit admission, length of admission >7 days and central catheter and was able to discriminate between discharges associated with and without VTE (optimism-corrected c-statistic, 0.70;95% CI 0.58-0.77). By limiting treatment to a high-risk group, extended thromboprophylaxis could be avoided in 92% of discharges with a miss rate of 1.6% (32/1982 discharges). Conclusion Patients with IBD remain at risk of VTE after hospital discharge. Our model may help clinicians stratify which patients will benefit most from extended thrombophrophylaxis.