Long-term efficacy of infliximab maintenance therapy for perianal Crohn’s disease

AIM:To assess the long-term efficacy of seton drainage with infliximab maintenance therapy in treatment of stricture for perianal Crohn’s disease(CD). METHODS:Sixty-two patients with perianal CD who required surgical treatment with or without infliximab between September 2000 and April 2010 were identified from our clinic’s database.The activities of the perianal lesions were evaluated using the modified perianal CD activity index(mPDAI)score.The primary endpoint was a clinical response at 12-15 wk after surgery as a shortterm efficacy.Secondary endpoints were recurrence as reflected in the mPDAI score,defined as increased points in every major element.The clinical responses were classified as completely healed(mPDAI=0),partially improved(mPDAI score decreased more than 4 points),and failure or recurrence(mPDAI score increased or decreased less than 3 points). RESULTS:There were 43 males and 19 females,of whom 26 were consecutively treated with infliximab after surgery as maintenance therapy.Complete healing was not seen.Failure was seen in 10/36(27.8%) patients without infliximab and 4/26(15.4%)patients with infliximab(P=0.25).Partial improvement was seen in 26/36(72.2%)patients without infliximab and 22/26(88.5%)patients with infliximab(P=0.25). Short-term improvement was achieved in 48/62(77.4%) patients.Although the mPDAI score improved significantly with surgery regardless of infliximab,it decreased more from baseline in patients with infliximab(50.0%) than in those without infliximab(28.6%),(P=0.003). In the long-term,recurrence rates were low regardless of infliximab in patients without anorectal stricture.In patients with anorectal stricture,cumulative recurrence incidences increased gradually and exceeded 40%at 5 years regardless of infliximab.No efficacy of infliximab treatment was found(P=0.97).Although the cumulative rate of ostomy creation was also low in patients without stricture and high in patients with stricture,no protective efficacy was found with infliximab treatment(P =0.6 without stricture,P=0.22 with stricture). CONCLUSION:Infliximab treatment was demonstrated to have short-term efficacy for perianal lesions.Longterm benefit with infliximab was not proven,at least in patients with anorectal stricture.

The cardiotoxicity and long-term efficacy of different doses of epirubicin in the adjuvant treatment of breast cancer patients: A case control study

Abstract Objective： The aim of the study was to observe the cardiac toxicity caused by different doses of epirubicin in the adjuvant treatment of breast cancer and to evaluate the long-term efficacy. Methods： The 180 cases of breast cancer patients received epirubicin based adjuvant chemotherapy. The patients were randomly assigned to high-dosage group （90 rag/m^2）, medium-dosage group （70 mg/m^2） and low-dosage group （50 rag/m^2）, the primary endpoint was cardiac toxicity. The secondary outcomes were the 5-year overall survival （OS） and 5-year disease-free survival （DFS）. Results： During chemo- therapy, the clinical symptoms such as palpitation, dyspnea and paroxysmal nocturnal dyspnea occurred in 6 patients with the high-dosage group, 4 patients with the medium-dosage group and 3 patients with the low-dosage group. The number of patients who had changed in electrocardiogram （ECG） was 7, 5 and 4 in three groups, respectively. The echocardiographic showed each group had only one case with LVEF 〈 50%, there was no significantly difference （P 〉 0.05）. In the three groups, the 5-year DFS rates were 73.3% （44/60） in high-dose group, 53.3% （32/60） in medium-dose group and 41.6% （25/60） in low dose group. The 5-year OS rates were 85.0% （51/60）, 68.3% （41/60） and 58.3% （35/60） in three groups, respectively. The differences were statistically significant （P 〈 0.05）. Conclusion： The high-dose epirubicin in adjuvant chemotherapy with CEF （cyclophosphamide, epirubicin and fluorouracil） regimen could improve the 5-year OS rate and 5-year DFS rate on patients of breast cancer. The cardiotoxicity was mild-moderate and well tolerated.

Network meta-analysis of long-term efficacy of acupuncture-related therapies and SSRIs in treating post-stroke depression

Objective:To evaluate the effect of existing acupuncture-related therapies on the longterm effects of post-stroke depression(PSD)by using a network meta-analysis with SSRIs as a common reference.Methods:The published randomized controlled clinical trials of acupuncture-related therapies and SSRIs for PSD in PubMed,The Cochrane Library,EMbase,CNKI,CBM,VIP and wan-fang databases were comprehensively searched.The literature retrieval period was from The database establishment to July 31,2020.Cochrane Handbook 5.1.0 was used to assess the risk of bias in included studies.Data analysis is conducted through ADDIS,Review Manager 5.3,and STATA 13.1 software.Results:A total of 3115 patients with PSD were included in 30 RCTs,involving 10 therapeutic methods.Results of network meta-analysis showed that:in terms of total effective rate,body acupuncture+SSRIs was superior to body acupuncture[OR=2.85,95%CI(1.51,5.90)]and SSRIs[OR=5.37,95%CI(3.03,10.33)].In terms of HAMD score,body acupuncture+SSRIs was superior to body acupuncture[MD=1.69,95%CI(0.33,3.06)]and SSRIs[MD=3.87,95%CI(2.68,5.08)].The above ranking predicted that moxibustion+SSRIs was the best.In terms of NIHSS score,body acupuncture[MD=2.15,95%CI(1.10,3.26)]and body acupuncture+SSRIs[MD=1.77,95%CI(0.19,3.37)]were better than SSRIs.Conclusion:Moxibustion combined with SSRIs is the best for the long-term efficacy of acupuncture and moxibustion on PSD.Body acupuncture combined with SSRIs is better than SSRIs alone.The other therapies have their own advantages and disadvantages.Based on the defects of existing studies,this conclusion still needs to be verified by more high-quality RCTs.

Long-Term Efficacy of Parathyroidectomy onHyperparathyroid Bone Disease

This is a retrospective analysis of long-term efficacy of parathyroidectomy on hyperparathyroid bone disease. The clinical manifestations, bone structure, and bone mineral density in 16 patients averaged 5.1 (1. 0-10. 5) years after parathyroidectomy were assessed. The results showed that although the bone disease could be markedly relieved after surgery, yet at terminal point of follow-up, 10/16 cases (62. 5% ) got incomplete recovery of bone disease, the ratio of incomplete recovery in Y1 group with severe bone disease was higher than that of Y2 group with mild bone disease (P <0. 05). The concentrations of serum BGP and morning void urine pyridinoline were within the refer ence ranges of young and middle aged controls. These imply that the osteoblastic and osteoclastic activities had reached a balancing state. The results suggested that hyperparathyroid patients should be operated on as early as possible, and intensively followed up after operation. subsequent therapy should be given to patients with incomplete recovery of bone disease.

Long-term efficacy of microvascular decompression on trigeminal neuralgia and multi-factor research of recurrence

Objective To research the factors that affects the efficacy of 2 826 cases of of trigeminal neuralgia after microvascular decompression during follow-up more than 1 year. Methods The patients with trigeminal meuralgia were followed-up for 1-25 years ( mean 9. 8 years) after microvascular decompression from January 1984 to

Long-term efficacy and safety of cap-assisted endoscopic sclerotherapy with long injection needle for internal hemorrhoids

BACKGROUND Hemorrhoids are a common anal condition and can afflict an individual at any age.Epidemiological survey results in China show that the prevalence of anorectal diseases is as high as 50.1%among which 98.08%of patients have hemorrhoid symptoms.AIM To assess long-term efficacy and safety of cap-assisted endoscopic sclerotherapy(CAES)with long injection needle for internal hemorrhoids.METHODS This study was retrospective.Data from patients with symptomatic internal hemorrhoids treated with CAES using endoscopic long injection needle from April 2016 to December 2019 were collected.Patients were telephoned and followed at two time points,December 2020 and 2021,to evaluate the improvements in symptoms,complications,recurrence,and satisfaction.RESULTS Two hundreds and one patients with internal hemorrhoids underwent CAES with the long needle.The first median follow-up was performed 33 mo postoperatively.Symptoms improved in 87.5%of patients after the first CAES.Efficacy did not decrease with treatment time extension.Fifty-four patients underwent colonoscopy after the first CAES treatment of which 21 underwent CAES again,and 4 underwent hemorrhoidectomy.At the first follow-up,62.7%of patients had both improved hemorrhoid grades and symptoms,and 27.4%had a significant improvement in both parameters.At the second follow-up,61.7%of the patients showed satisfactory improvement in their hemorrhoid grade and symptoms when compared with pre-surgery values.90%of patients reported CAES was painless,and 85%were satisfied/very satisfied with CAES treatment outcomes.CONCLUSION The present study based on the largest sample size reported the long-term follow-up of the treatment for internal hemorrhoid with the CAES using endoscopic long injection needle.Our findings demonstrate that CAES should be a micro-invasive endoscopic technology yields satisfactory long-term efficacy and safety.

Effects of Medicated Bamboo Cupping Therapy of Zhuang Nationality Medicine on Long-term Efficacy and Quality of Life in the Treatment of Functional Dyspepsia with Stagnation of Liver Qi and Spleen Deficiency Syndrome

Objective:To investigate the effect of medicated bamboo cupping therapy of Zhuang nationality medicine on long-term efficacy and quality of life in the treatment of functional dyspepsia with stagnation of liver Qi and spleen deficiency syndrome,and to provide a new,effective and easy to promote treatment method for functional dyspepsia.Methods:A total of 150 cases of functional dyspepsia treated in our hospital from March 2014 to October 2015 were selected as research subjects,and they were divided into the treatment group(medicated bamboo cupping therapy),the control A group(Omeprazole Enteric-coated Tablets+Domperidone Tablets)and the control B group(acupuncture),50 cases in each group.The clinical efficacy,the gastric electrical index,the recurrence rate and the quality of life were observed and compared.Results:The total effective rate in the treatment group was higher than that in the control A group and the control B group(P<0.05).Compared with before treatment,the main frequency and electrical amplitude in each group was significantly improved,and the rhythm disorder coefficient was significantly reduced(P<0.05).After treatment,compared with the control A group and the control B group,the difference of rhythm disturbance coefficient in the treatment group was statistically significant(P<0.05).The recurrence rate in the treatment group was lower than that in the control A group and the control B group at 1 month,3 months and 6 months after drug discontinuance,with no significant difference(P>0.05).Compared with before treatment,scores of each physiological function after treatment had no significant change(P>0.05),and the scores of physiological function,body pain,general health,vitality,social function,emotional function and mental health were significantly improved(P<0.05).The comparison of scores in each group had no significant difference(P>0.05).Conclusion:The medicated bamboo cupping therapy of Zhuang nationality medicine on functional dyspepsia with stagnation of liver Qi and spleen deficiency syndrome can significantly improve clinical efficiency,and reduce the coefficient of rhythm.The long-term recurrence rate is low,and the quality of life is significantly improved.It is a convenient and effective treatment,which is worthy of promotion.

Long-term efficacy and predictors of pembrolizumab-based regimens in patients with advanced esophageal cancer in the real world

BACKGROUND Pembrolizumab combined with chemotherapy has been proven effective as firstline therapy in patients with advanced esophageal cancer.Few trials have assessed the safety and efficacy of this treatment in patients with locally advanced disease.AIM To analyze long-term outcomes of pembrolizumab in locally advanced or metastatic esophageal squamous cell carcinoma(ESCC)in the real world.METHODS Patients with advanced ESCC admitted to our center from October 2019 to October 2021 were enrolled in this study.Clinical staging of the patients was based on the 8th edition of the American Joint Committee on Cancer TNM staging system.The patients received different treatments based on clinical stage.In brief,patients with locally advanced and resectable ESCC received neoadjuvant therapy combined with surgery.For those who were not candidates for resection,radical concurrent chemoradiotherapy plus pembrolizumab was more preferable.Patients with metastatic ESCC or who were unsuitable for radiotherapy underwent chemotherapy in combination with pembrolizumab.Long-term survival outcomes such as overall survival(OS),progression-free survival,disease-free survival,long-term adverse effects(AEs),immune maintenance therapy and predictors of immune checkpoint inhibitors(ICIs)efficacy were evaluated.RESULTS A total of 55 patients with advanced ESCC were enrolled in this retrospective,observational study.The median age was 61 years(range 44-74),with 47.3%(26/55)of the patients in stage IV and 45.5%of the patients had the tumor(25/55)located in the middle third of the esophagus.The median OS in all patients was not reached.The 12-mo OS rate among all patients was 78.8%and the 18-mo OS rate was 72.7%.9 patients died due to tumor progression and 7 patients died due to treatment-related complications.The therapeutic effect evaluated at the interim evaluation was significantly reflected in the long-term outcome.Patients with complete response or partial response in all patients(P=0.005)and in the chemoradiotherapy plus pembrolizumab group(P=0.007)obtained a better prognosis than non-responders.A total of 20 patients(20/55,36%)received immune maintenance therapy.Baseline peripheral blood biomarkers of the neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,and neutrophil-to-(leukocyte-neutrophil)ratio did not predict the efficacy of ICIs.CONCLUSION Pembrolizumab combined with chemotherapy or radiotherapy resulted in favorable long-term survival in patients with locally advanced or metastatic ESCC,with safe and manageable long-term AEs.

Long-term efficacy of capecitabine plus oxaliplatin chemotherapy on stage Ⅲ colon cancer: A meta-analysis

BACKGROUND Many clinical studies for the long-term survival or efficacy of capecitabine plus oxaliplatin(XELOX)in colon cancer have already been studied,but its clinical benefit is controversial.AIM To evaluate the long-term efficacy of XELOX regimen in comparison with other adjuvant chemotherapy protocols in colon cancer.METHODS By searching the PubMed,EMBASE and Cochrane databases,a total of 12 randomized controlled trials involving 6698 stageⅢcolon cancer cases(XELOX protocol:n=3298 cases;other adjuvant chemotherapy protocol:n=3268 cases)were included.The parameter outcomes included the overall survival and the disease-free survival.The quality control of selected literature was based on the Jadad scale and the GRADE system.RESULTS In comparison to other adjuvant chemotherapy regimen,XELOX regimen showed a better overall survival(odds ratio=1.29,95% confidence interval:1.15-1.44,P<0.0001)and a better disease-free survival(odds ratio=1.32,95%confidence interval:1.18-1.46,P<0.0001)for colon cancer patients,suggesting the XELOX regimen can be a good option for postoperative treatment of stage III colon cancer.CONCLUSION The XELOX regimen can be a preferred option for adjuvant treatment of stageⅢcolon cancer after surgery.

Long-Term Efficacy Analysis of Exclusive Enteral Nutrition for the Treatment of Abdominal Abscess in Crohn’s Disease

Objective: The objective is to explore the long-term efficacy of total enteral nutrition in the treatment of abdominal abscess in Crohn’s disease. Methods: Patients treated with EEN in our hospital and whose abdominal abscess disappeared after 12 weeks of treatment were included, and the data of abscess recurrence and surgical treatment during follow-up were included. Results: A total of 44 consecutive cases meeting the criteria were included. The 1-year and 2-year recurrence rates were 22.5% and 39.9% respectively. Among the patients with recurrence, 10 patients chose EEN treatment again, and 5 patients received direct surgical treatment. Of the patients who chose to undergo EEN treatment again, 8 still eventually required surgery. The 1-year operative rate was 16.9%, and the 2-year operative rate was 35.6%. The median operative time was 33.3 (95% CI: 21.3, 45.4) months. Conclusions: The 2-year cumulative incidence of recurrence of abdominal abscess in CD patients whose abdominal abscess disappeared after EEN was 39.9%, and the 2-year cumulative surgical rate was 35.6%. The operative stomy rate decreased after EEN, and the primary anastomosis rate increased significantly.

Recent efficacy and long-term survival of Astragalus polysaccharide combined with gemcitabine and S-1 in pancreatic cancer

BACKGROUND Pancreatic cancer is a highly malignant tumor with a rapid progression rate and a high susceptibility to infiltration and metastasis.Astragalus polysaccharide(APS),a pure Chinese medicine preparation primarily made from the traditional Chinese herb Astragalus,plays a positive role in the treatment of many malignant tumors.AIM To explore the recent efficacy of APS combined with gemcitabine plus tegafur gimeracil oteracil potassium capsule(S-1)(GS)regimen in the treatment of pancreatic cancer and assess its effect on the immune function and long-term survival of patients.METHODS A total of 97 patients who were diagnosed with pancreatic cancer and received GS chemotherapy at The First Affiliated Hospital of Zhejiang Chinese Medical University(Zhejiang Provincial Hospital of Chinese Medicine)from March 2021 to December 2021 were included in the retrospective analysis.Among them,41 patients received APS combined with GS chemotherapy,and 56 patients received GS chemotherapy only.The recent efficacy,immune function,adverse reactions,and long-term survival were compared among these patients.RESULTS After 4 cycles of treatment,the objective response rate of patients receiving the combined therapy of APS and GS was 51.22%,and the disease control rate(DCR)was 56.10%,higher than those of patients receiving the monotherapy with GS alone(30.36%and 35.71%,respectively).Besides,the percentages of CD3+T cells(50.18%±9.57%)and CD4+T cells(31.52%±5.33%)in the peripheral blood of patients receiving the combined therapy of APS and GS were higher compared with those treated with GS regimen alone[(44.06%±8.55%)and(26.01%±7.83%),respectively].Additionally,the incidences of leukopenia,thrombocytopenia,and fatigue in patients receiving the combined therapy of APS and GS were significantly lower than those in patients receiving the monotherapy of GS alone(17.07%,9.76%,31.71%vs 37.50%,28.57%,60.71%).Moreover,the median survival time of patients receiving the combined therapy of APS and GS was 394 days,significantly longer than that of patients receiving the mono-therapy of GS alone(339 days)(hazard ratio:0.66;95%CI:0.45-0.99;P=0.036).All these differences were statistically si-gnificant(P<0.05).CONCLUSION The combined therapy of APS and GS improved the recent efficacy and long-term survival of patients with pancreatic cancer and alleviated chemotherapy-induced immune suppression and adverse reactions.

Imperative for long-term management and surveillance in Kawasaki disease

Kawasaki disease(KD)is a significant pediatric vasculitis known for its potential to cause severe coronary artery complications.Despite the effectiveness of initial treatments,such as intravenous immunoglobulin,KD patients can experience long-term cardiovascular issues,as evidenced by a recent case report of an adult who suffered a ST-segment elevation myocardial infarction due to previous KD in the World Journal of Clinical Cases.This editorial emphasizes the critical need for long-term management and regular surveillance to prevent such complications.By drawing on recent research and case studies,we advocate for a structured approach to follow-up care that includes routine cardiac evaluations and preventive measures.

Systematic review of long-term Xingnao Kaiqiao needling efficacy in ischemic stroke treatment

OBJeCTIve：To systematically evaluate the long-term effect and safety ofXingnao Kaiqiao nee-dling method in ischemic stroke treatment. DATA ReTRIevAL： We retrieved relevant random and semi-random controlled trials that used theXingnao Kaiqiao needling method to treat ischemic stroke compared with various control treatments such as conventional drugs or other acupuncture therapies. Searched databases included China National Knowledge Infrastructure, Weipu Information Resources System, Wanfang Medical Data System, Chinese Biomedical Literature Database, Cochrane Library, and PubMed, from May 2006 to July 2014. SeLeCTION CRITeRIA： Two authors independently conducted literature screening, quality evaluation, and data extraction. The quality of articles was evaluated according to the Cochrane Reviewers’ Handbook 5.1, and the study was carried out using Cochrane system assessment methods. RevMan 5.2 was used for meta-analysis of the included studies. MAIN OUTCOMe MeASUReS： Mortality rate, recurrence rate, and disability rate were observed. ReSULTS：Nine randomized and semi-randomized controlled trials treating 931 cases of ischemic stroke were included in this review. Meta-analysis results showed that there were no sig-niifcant differences in mortality reduction （risk ratio （RR） = 0.58, 95% conifdence interval （CI）： 0.17–1.93,Z = 0.89,P = 0.37） or recurrence rate （RR = 0.55, 95%CI： 0.18–1.70,Z = 1.04,P = 0.30） of ischemic stroke patients between theXingnao Kaiqiao needling and control treatment groups. However, theXingnao Kaiqiao needling method had a tendency towards higher efifcacy in mor-tality reduction and recurrence rates. TheXingnao Kaiqiao needling method was signiifcantly better than that of the control treatment in reducing disability rate （RR = 0.51, 95%CI： 0.27–0.98, Z = 2.03,P 〈 0.05）. CONCLUSION：TheXingnao Kaiqiao needling method has a better effect than control treatment in reducing disability rate. The long-term effect ofXingnao Kaiqiao needling against ischemic stroke is better than that of control treatment. However, the limitations of this study limit the strength of the conclusions. Randomized controlled trials with a strict, reasonable design, and multi-center, large-scale samples and follow-up are necessary to draw conclusions aboutXingnao Kaiqiao needling.

Comparison of safety,efficacy,and long-term follow-up between“one-step”and“step-up”approaches for infected pancreatic necrosis

BACKGROUND Although the“Step-up”strategy is the primary surgical treatment for infected pancreatic necrosis,it is not suitable for all such patients.The“One-step”strategy represents a novel treatment,but the safety,efficacy,and long-term follow-up have not yet been compared between these two approaches.AIM To compare the safety,efficacy,and long-term follow-up of two surgical approaches to provide a reference for infected pancreatic necrosis treatment.METHODS This was a retrospective analysis of infectious pancreatic necrosis patients who underwent“One-step”or“Step-up”necrosectomy at Xuan Wu Hospital,Capital Medical University,from May 2014 to December 2020.The primary outcome was the composite endpoint of severe complications or death.Patients were followed up every 6 mo after discharge until death or June 30,2021.Statistical analysis was performed using SPSS 21.0 and GraphPad Prism 8.0,and statistical significance was set at P<0.05.RESULTS One-hundred-and-fifty-eight patients were enrolled,of whom 61 patients underwent“One-step”necrosectomy and 97 patients underwent“Step-up”necrosectomy.During the long-term follow-up period,40 patients in the“Onestep”group and 63 patients in the“Step-up”group survived.The time from disease onset to hospital admission(53.69±38.14 vs 32.20±20.75,P<0.001)and to initial surgical treatment was longer in the“Step-up”than in the“One-step”group(54.38±10.46 vs 76.58±17.03,P<0.001).Patients who underwent“Step up”necrosectomy had a longer hospitalization duration(65.41±28.14 vs 52.76±24.71,P=0.02),and more interventions(4.26±1.71 vs 3.18±1.39,P<0.001).Postoperative inflammatory indicator levels were significantly lower than preoperative levels in each group.Although the incisional hernia incidence was higher in the“One-step”group,no significant difference was found in the composite outcomes of severe complications or death,new-onset organ failure,postoperative complications,inflammatory indicators,long-term complications,quality of life,and medical costs between the groups(P>0.05).CONCLUSION Compared with the“Step-up”approach,the“One-step”approach is a safe and effective treatment method with better long-term quality of life and prognosis.It also provides an alternative surgical treatment strategy for patients with infected pancreatic necrosis.

A Long-Term Study of Efficacy of Patients with Macular Edema Secondary to BRVO Treated with Ranibizumab Combined with Compound Salvia

Purpose: To study the long-term efficacy of intravitreal ranibizumab injection combined with in-travenous compound salvia injection drip in the treatment of patients with macular edema sec-ondary to branch retinal vein occlusion(BRVO). Methods: Sixty-five patients of branch retinal vein occlusion with macular edema were analyzed retrospectively. Thirty-seven patients in the treat-ment group were treated with ranibizumab injection combined with intravenous compound salvia injection drip, twenty-eight patients in the control group were treated with ranibizumab injection only. All patients were recorded and analyzed changes of clinical efficacy after 3 months, 6 months after a course of treatment of 6 months. Results: During 3 months after 6 months’ treatment, there were 5 patients having recurrence in the treatment group, while there were 9 in control group, the rate of recurrence between the two groups had significant difference (P < 0.05);during 3 - 6 months after a course of treatment, there were 2 patients having recurrence in the treatment group, while there were 4 in control group, the rate of recurrence between the two groups had significant difference (P < 0.05);however, the treatment group’s BCVA was better than control group, and the difference between the two groups had significance (P < 0.05). Conclusion: Ranibizumab injection combined with intravenous compound salvia injection drip could effectively reduce the impossibility of recurrence, improve the visual activity and bring better therapeutic efficacy in patients with macular edema secondary to branch retinal vein occlusion. The treatment showed great potential in the clinical use.

Long-term cost and efficacy analysis of latanoprost versus timolol in glaucoma patients in Germany

AIM: To evaluate 5-year effectiveness and cos between latanoprost or timolol monotherapy in a pilot trial.METHODS: A retrospective, multi-center trial performed at 6 sites in Germany of patients who had a diagnosis of primary open-angle or pigmentary glaucoma, in at least one eye, initiated on monotherapy with latanoprost or timolol maleate. Qualified consecutive charts were reviewed in which 5-year efficacy, safety and cost data was abstracted.RESULTS: Seventy-seven latanoprost and 49 timolo patients were included, at the final visit no difference existed between the two groups in disc parameters including: rim area, rim area/disc area ratio, cup volume or vertical cup/disc ratio (P 】0.05). There was no difference in intraocular pressure (IOP) between the initial latanoprost (17.4 ±2.6) and timolol (16.3 ±2.8mmHg) groups. There was less change in medicines over the follow-up period (0.1 vs 0.8) and fewer medications at the final visit (1.2 vs 1.8) with latanoprost compared to timolol. No patient treated with latanoprost discontinued therapy during follow-up, while 12% discontinued timolol mostly due to inadequate IOP control. Cost/year was less with initial timolol ($458±236) as compared to latanoprost ($552±202). CONCLUSION: Patients begun on latanoprost o timolol and followed over 5 years may have similar clinical outcomes. However, timolol patients may require more medicines and medicine changes to control IOP for long-term, but at a lower cost.

Efficacy and predictive factors of transarterial chemoembolization combined with lenvatinib plus programmed cell death protein-1 inhibition for unresectable hepatocellular carcinoma

BACKGROUND The efficacy and safety of transarterial chemoembolization(TACE)combined with lenvatinib plus programmed cell death protein-1(PD-1)for unresectable hepato-cellular carcinoma(HCC)have rarely been evaluated and it is unknown which factors are related to efficacy.AIM To evaluate the efficacy and independent predictive factors of TACE combined with lenvatinib plus PD-1 inhibitors for unresectable HCC.METHODS This study retrospectively enrolled patients with unresectable HCC who received TACE/lenvatinib/PD-1 treatment between March 2019 and April 2022.Overall survival(OS)and progression-free survival(PFS)were determined.The objective response rate(ORR)and disease control rate(DCR)were evaluated in accordance with the modified Response Evaluation Criteria in Solid Tumors.Additionally,the prognostic factors affecting the clinical outcome were assessed.RESULTS One hundred and two patients were enrolled with a median follow-up duration of 12.63 months.The median OS was 26.43 months(95%CI:17.00-35.87),and the median PFS was 10.07 months(95%CI:8.50-11.65).The ORR and DCR were 61.76%and 81.37%,respectively.The patients with Barcelona Clinic Liver Cancer Classification(BCLC)B stage,early neutrophil-to-lymphocyte ratio(NLR)response(decrease),or early alpha-fetoprotein(AFP)response(decrease>20%)had superior OS and PFS than their counterparts.CONCLUSION This study showed that TACE/lenvatinib/PD-1 treatment was well tolerated with encouraging efficacy in patients with unresectable HCC.The patients with BCLC B-stage disease with early NLR response(decrease)and early AFP response(decrease>20%)may achieve better clinical outcomes with this triple therapy.

Clinical manifestations,diagnosis and long-term prognosis of adult autoimmune enteropathy:Experience from Peking Union Medical College Hospital

BACKGROUND Autoimmune enteropathy(AIE)is a rare disease whose diagnosis and long-term prognosis remain challenging,especially for adult AIE patients.AIM To improve overall understanding of this disease’s diagnosis and prognosis.METHODS We retrospectively analyzed the clinical,endoscopic and histopathological characteristics and prognoses of 16 adult AIE patients in our tertiary medical center between 2011 and 2023,whose diagnosis was based on the 2007 diagnostic criteria.RESULTS Diarrhea in AIE patients was characterized by secretory diarrhea.The common endoscopic manifestations were edema,villous blunting and mucosal hyperemia in the duodenum and ileum.Villous blunting(100%),deep crypt lymphocytic infiltration(67%),apoptotic bodies(50%),and mild intraepithelial lymphocytosis(69%)were observed in the duodenal biopsies.Moreover,there were other remarkable abnormalities,including reduced or absent goblet cells(duodenum 94%,ileum 62%),reduced or absent Paneth cells(duodenum 94%,ileum 69%)and neutrophil infiltration(duodenum 100%,ileum 69%).Our patients also fulfilled the 2018 diagnostic criteria but did not match the 2022 diagnostic criteria due to undetectable anti-enterocyte antibodies.All patients received glucocorticoid therapy as the initial medication,of which 14/16 patients achieved a clinical response in 5(IQR:3-20)days.Immunosuppressants were administered to 9 patients with indications of steroid dependence(6/9),steroid refractory status(2/9),or intensified maintenance medication(1/9).During the median of 20.5 months of followup,2 patients died from multiple organ failure,and 1 was diagnosed with non-Hodgkin’s lymphoma.The cumulative relapse-free survival rates were 62.5%,55.6%and 37.0%at 6 months,12 months and 48 months,respectively.CONCLUSION Certain histopathological findings,including a decrease or disappearance of goblet and Paneth cells in intestinal biopsies,might be potential diagnostic criteria for adult AIE.The long-term prognosis is still unsatisfactory despite corticosteroid and immunosuppressant medications,which highlights the need for early diagnosis and novel medications.

A Study on Long-term Efficacy and Immunologic Persistence of Hepatitis B Plasma Vaccine Made in China

In order to demonstrate the long term protective efficacy and immunologic persistence of domestically made hepatitis B plasma derived vaccine, 371 children had been followed up for 5 to 8 years after primary vaccination (10 μg×3). The results showed that the positive rate of antibody to hepatitis B surface antigen (anti HBs) in 371 subjects was 77.6% and the geometric mean titre (GMT) of anti HBs was 47.32 IU/L. The anti HBs positive rates in the subjects who had been vaccined for five, six, seven and eight years remained 83.91%, 73.68%, 81.25% and 72.24%, respectively, while the GMTs were 59.53, 43.64, 42.21 and 46.20 IU/L, respectively. The protective efficacy rate of hepatitis B vaccine was 94.26% if both HBsAg and anti HBc were considered as infective indicators, and 88.28%, if only HBsAg positive cases were taken into account. The study indicated that the domestically made hepatitis B vaccine could provide at least 5 to 8 years protection against hepatitis B infection.