Long-Term Mortality of Children with Congenital Heart Disease Admitted to the Departmental University Hospital of Borgou/Alibori from 2011 to 2022

Background: Congenital heart disease is a public health issue due to its incidence and mortality rate. The aim of this study was to investigate the long-term mortality of children with congenital heart disease admitted to the Departmental University Hospital of Borgou/Alibori (CHUD-B/A) from 2011 to 2022. Methods: This descriptive longitudinal study with analytical aims covered 11 years (April 1, 2011 to December 31, 2022). It consisted of a review of the records of children under 15 years of age with echocardiographically confirmed congenital heart disease. This was followed by an interview with the parents to assess the children’s current condition. Data were entered using Kobocollect software and analyzed using R Studio 4.2.2. software. Results: A total of 143 complete files were retained. The median age at diagnosis was 14 months (IIQ: Q1 = 4;Q3 = 60) with a range of 2 days and 175 months, and the sex-ratio (M/F) was 0.96. Left-to-right shunts were the most frequent cardiopathy group (62.9%). Only 35 children (24.5%) benefited from restorative treatment. The mortality rate was 31.5%. Median survival under the maximum bias assumption was 114 months and 216 months under the assumption of minimum bias. Survival was significantly better in children with right-to-left shunts (p = 0.0049) under the assumption of minimum bias. The death risk factors were: age at diagnosis less than 12 months (aHR = 7.58;95% CI = 3.36 - 17.24;p Conclusion: The long-term mortality of congenital heart disease is high and favoured by the absence of restorative treatment. Local correction of congenital heart disease and medical follow-up will help to reduce this mortality.

Risk factors and long-term health consequences of macrosomia:a prospective study in Jiangsu Province,China

We sought to determine risk factors associated with fetal macrosomia and to explore the long-term consequence of infant macrosomia at the age of 7 years.A prospective population based cohort study was designed to examine the associations between maternal and perinatal characteristics and the risk of macrosomia.A nested case-control study was conducted to explore the long-term health consequence of infant macrosomia.The mean maternal age of the macrosomia group was 24.74±3.32 years,which is slightly older than that in the control group（24.35±3.14 years,P = 0.000）.The mean maternal body mass index（BMI） at early pregnancy was 22.75±2.81 kg/m 2,which was also higher than that in the control group（21.76±2.59 kg/m 2,P = 0.000）.About 64.6% of macrosomic neonates were males,compared with 51.0% in the control group（P = 0.000）.Compared with women with normal weight（BMI：18.5-23.9 kg/m 2）,women who were overweight（BMI：24-27.9 kg/m 2） or obese（BMI ≥ 28 kg/m 2）,respectively,had a 1.69-fold（P = 0.000） and a 1.49-fold（P = 0.000） increased risks of having a neonate with macrosomia,while light weight（BMI〈18.5 kg/m 2） women had an approximately 50% reduction of the risk.Furthermore,macrosomia infant had a 1.52-fold and 1.50-fold risk,respectively,of developing overweight or obesity at the age of 7 years（P = 0.001 and P = 0.000）.Older maternal age,higher maternal BMI at early pregnancy and male gender were independent risk factors of macrosomia.Macrosomic infant was associated with an increased predisposition to develop overweight or obesity at the beginning of their childhood.

Analysis on Long-Term Care and Influencing Factors of Empty-Nest Differently Abled Elderly People in China —Based on the Data from the Chinese Longitudinal Healthy Longevity Survey

Purpose: This study aimed to understand the actual needs of empty-nest differently abled elderly people and analyze their long-term care status including the factors affecting choice of care mode so adequate resources can be allocated to meet their healthcare needs. Methods: An empty-nest group was compared with a non-empty-nest group based on data from the 2014 Chinese Longitudinal Healthy Longevity Survey. Individual characteristics, family characteristics, and sociological factors were considered as independent variables, and long-term care model was the dependent variable in the three binary logistic regression method. Results: Age, gender, marriage, and disability were the most important factors influencing the choice of long-term care mode, including the willingness of the differently abled elderly. Family care can no longer meet the needs of the severely disabled elderly. Long-term care for such elderly people should be undertaken by professional and specialized social institutions. Conclusion: Multi-level services should be provided according to the elderly peoples’ needs, and the skill and expertise of professional personnel of care institutions should be strengthened. The government should deploy fund-raising initiatives, actively use the power of non-governmental organizations, and strive to resolve the financial issues faced by the empty-nested elderly people with disability.

Original Article: Prognostic Factors of Long-Term Outcome and Functional Status Following Spontaneous Cerebellar Hemorrhage

Cerebellar hemorrhage (CH) has a higher early mortality rate compared with other types of intracranial hemorrhage and the survivors often suffer from momentous disability. Hence, the prognostic factors of long-term outcome beyond 6 months after CH are clinically valuable, however only three studies were reported in the literature. Sixty-one patients with CH were retrospectively analyzed at least 6 months after hemorrhage. The long-term outcome of all patients and long-term functional status of survivors beyond 6 months (the patients who died within 6 months after hemorrhage were excluded) were assessed using the modified Rankin Scale (mRS): favorable outcome (mRS 0 - 2) and unfavorable outcome (mRS 3 - 6). All of the prognostic factors were analyzed by univariate and multivariate Cox proportional hazards regression models. There were 16 (26.2%) patients in the favorable outcome group and 45 (73.8%) in the unfavorable outcome group with respect of long-term outcome in all patients. The radiological brainstem compression (HR = 3;p = 0.015) was shown to be an independent predictor. On the other hand, 46 out of 61 (75.4%) patients survived beyond 6 months. In total, 16 (34.7%) patients had a favorable functional status, and 65.3% (30/46) had a persistent unfavorable functional status. Moreover, only age 365 years (HR = 3;p = 0.019) was an independent predictor. Radiological brainstem compression and age 365 were respectively shown to be a strong prognostic factor for long-term outcome and functional status among survivors beyond 6 months after hemorrhage in patients with CH.

Relationship of Transforming Growth Factor-β1 and Arginase-1 Levels with Long-term Survival after Kidney Transplantation

In this study, we compared the serum levels of transforming growth factor-β1 （TGF-β1）, interleukin-10 （IL-10）, and arginase-1 in long-term survival kidney transplant recipients （LTSKTRs） with those in short-term survival kidney transplant recipients （STSKTRs）. We then evaluated the relationship between these levels and graft function. Blood samples were collected from 50 adult LTSKTRs and 20 STSKTRs （graft survival approximately 1-3 years post-transplantation）. All patients had stable kidney function. The samples were collected at our institution during the patients＇ follow-up examinations between March 2017 and September 2017. The plasma levels of TGF-β1, IL- 10, and arginase- 1 were analyzed using enzyme-linked immunosorbent assays （ELISA）. The levels of TGF-β1 and arginase-1 were significantly higher in the LTSKTRs than in the STSKTRs. The time elapsed since transplantation was positively correlated with the levels of TGF-β1 and arginase-1 in the LTSKTRs. The estimated glomerular filtration rate was positively correlated with the TGF-β1 level, and the serum creatinine level was negatively correlated with the TGF-β1 level. Higher serum levels of TGF-β1 and arginase-1 were found in LTSKTRs than in STSKTRs, and we found that TGF-β1 was positively correlated with long-term graft survival and function. Additionally, TGF-β1 and arginase-1 levels were positively correlated with the time elapsed since transplantation. On the basis of these findings, TGF-β1 and arginase- 1 may play important roles in determining long-term graft survival. Thus, we propose that TGF-β1 and arginase-1 may potentially be used as predictive markers for evaluating long-term graft survival.

两批试点城市长期护理保险政策比较——基于政策工具-福利要素的二维框架

构建长期护理保险政策工具-福利要素二维分析框架,对两批共28个国家级长期护理保险试点城市的长期护理保险政策文本进行计量分析。研究发现,政策工具维度呈现出使用频次差异大且内部结构不均衡的特点;福利要素维度呈现出要素完整且内部结构较为均衡的特点;各政策工具与福利要素耦合度有待提高;两批试点城市长期护理保险政策差异较小,发展阶段具有相似性。对此,提出合理调整三大类政策工具,优化次级政策工具结构;科学配置政策福利要素,完善要素内容;增强政策工具和福利要素耦合度,整合资源协调发展的优化建议。

基于MRSDAE-KPCA结合Bi-LST的滚动轴承剩余使用寿命预测

针对现有滚动轴承剩余使用寿命预测方法在提取数据特征时没有充分考虑数据的内部分布,且在构建健康因子时还需要专家经验进行人工提取等问题,提出一种基于流形正则化堆栈去噪自编码器、核主成分分析并结合双向长短时记忆网络的滚动轴承剩余使用寿命预测方法。首先采用无监督的堆栈去噪自编码器网络对原始振动数据进行深层特征提取,并使用核主成分分析法进一步降维,以提高健康因子的指标稳定性;然后在堆栈去噪自编码器中加入流形正则化,最大程度保留编码器隐藏层内部的数据分布结构,提高模型提取数据特征的有效性。最后使用双向长短时记忆网络预测轴承的剩余使用寿命,并采用AdaMax优化算法对网络模型的超参数进行自适应寻优。分析结果表明,提出的滚动轴承剩余使用寿命预测方法具有更高的精度。

基于FCM-LSTM的光热发电出力短期预测

对光热电站的出力进行短期预测,可以有效应对太阳能随机性和波动性带来的影响,为电网调度做好准备.该文以青海某光热电站为例,首先使用模糊C均值聚类算法对预处理后的实验数据进行分类,然后通过分析不同聚类类型下出力和气象数据中各因子间的关联程度,充分挖掘出数据间的关系,确定不同类型预测模型的输入变量,进而构建出不同类别下的长短期记忆神经网络预测模型.结果表明,与传统长短期记忆神经网络模型、BP神经网络模型、支持向量机模型和随机森林模型的预测结果相比,基于模糊C均值聚类的长短期记忆神经网络预测模型效果良好,大幅减少了预测误差,验证了该预测模型的有效性.

基于MIMIC-IV构建及评估脓毒症患者近期和远期死亡风险预测模型

目的:鉴于脓毒症的高发病率和高病死率,早期识别高风险患者并及时干预至关重要,而现有死亡风险预测模型在操作、适用性和预测长期预后等方面均存在不足。本研究旨在探讨脓毒症患者死亡的危险因素,构建近期和远期死亡风险预测模型。方法:从美国重症监护医学信息数据库IV(Medical Information Mart for Intensive Care-IV,MIMIC-IV)中选取符合脓毒症3.0诊断标准的人群,按7?3的比例随机分为建模组和验证组,分析患者的基线资料。采用单因素Cox回归分析和全子集回归确定脓毒症患者死亡的危险因素并筛选出构建预测模型的变量。分别用时间依赖性曲线下面积(area under the curve,AUC)、校准曲线和决策曲线评估模型的区分度、校准度和临床实用性。结果:共纳入14240例脓毒症患者,28 d和1年病死率分别为21.45%(3054例)和36.50%(5198例)。高龄、女性、高感染相关器官衰竭评分(sepsis-related organ failure assessment,SOFA)、高简明急性生理学评分(simplified acute physiology score II,SAPS II)、心率快、呼吸频率快、脓毒症休克、充血性心力衰竭、慢性阻塞性肺疾病、肝脏疾病、肾脏疾病、糖尿病、恶性肿瘤、高白细胞计数(white blood cell count,WBC)、长凝血酶原时间(prothrombin time,PT)、高血肌酐(serum creatinine,SCr)水平均为脓毒症死亡的危险因素(均P<0.05)。由PT、呼吸频率、体温、合并恶性肿瘤、合并肝脏疾病、脓毒症休克、SAPS II及年龄8个变量构建的模型,其28 d和1年生存的AUC分别为0.717(95%CI 0.710~0.724)和0.716(95%CI 0.707~0.725)。校准曲线和决策曲线表明该模型具有良好的校准度及较好的临床应用价值。结论:基于MIMIC-IV建立的脓毒症患者近期和远期死亡风险预测模型有较好的识别能力,对患者预后风险评估及干预治疗具有一定的临床参考意义。

基于CNN-LSTM-LOF的过程故障预测模型

在现代工业过程中,故障预测可以及时预测设备的潜在故障,减少事故的发生以及降低经济损失,因此故障预测对于过程系统至关重要。由于过程系统的复杂性以及运行数据集分布不均,使用正常数据集离线预测运行状态的方法没有较好的泛用性,且不太准确。针对以上问题,将卷积神经网络(CNN)与长短期记忆网络(LSTM)相结合,用于提取设备运行数据的特征,在线预测之后的运行状态;随后将预测结果送入在离线状态下训练好的局部异常因子(LOF)模型中,计算预测出时间序列的异常值;最后将异常值与离线状态下训练出的故障阈值进行比较,大于阈值则认为存在潜在故障。将模型用于田纳西-伊斯曼(TE)时间序列进行验证,并与传统的故障预测方法进行比较,实验结果表明:本文所提模型对于多故障以及单故障预测相比传统故障预测方法均具有更好的效果,可以提前1个采样窗口检测到数据异常,有应用于工业故障预测的潜力。

GNSS-IR测量水位的精度评估和站点对比:以中国南海北部和日本南部站点为例

通过南海北部和日本多个实例,量化分析影响近岸全球卫星导航系统干涉反射计(GNSS-IR)反演潮位或风暴潮过程效果的主要影响因素。结果表明:接收机所能接收的卫星信号波段数量、反射信号功率对反演的时间分辨率和精度影响巨大。研究以中国香港HKQT站点为例量化多模多频GNSS-IR监测风暴潮的优势,同时展示日本J425站点在潮位站空缺地区记录完整风暴潮波形的能力。分别针对卫星信号接受波段、硬件配置、台站架设位置和架设高度等因素,对未来架设具有测量海平面能力的近岸GNSS站点提供具体的指导意见。

Long-term temperature variation of the Southern Yellow Sea Cold Water Mass from 1976 to 2006

This paper discusses the long-term temperature variation of the Southern Yellow Sea Cold Water Mass(SYSCWM)and examines those factors that infl uence the SYSCWM,based on hydrographic datasets of the China National Standard Section and the Korea Oceanographic Data Center.Surface air temperature,meridional wind speed,and sea surface temperature data are used to describe the seasonal changes.Mean temperature of the two centers of the SYSCWM had diff erent long-term trends.The temperature of the center in the west of the SYSCWM was rising whereas that of the center in the east was falling.Mean temperature of the western center was related to warm water intrusion of the Yellow Sea Warm Current,the winter meridional wind,and the winter air temperature.Summer process played a primary role in the cooling trend of temperature in the eastern center.A decreasing trend of salinity in the eastern half of the SYSCWM showed that warm water intrusion from the south might weaken,as could the SYSCWM circulation.Weakened circulation provided less horizontal heat input to the eastern half of the SYSCWM.Less lateral heat input may have led to the decreasing trend in temperature of the eastern center of the SYSCWM.Further,warmer sea surface temperatures and less heat input in the deep layers intensifi ed the thermocline of the eastern SYSCWM.A stronger thermocline had less heat fl ux input from upper layers to this half of the SYSCWM.Stronger thermocline and weakened heat input can be seen as two main causes of the cooling temperature trend of the eastern center of the SYSCWM.

Statistical Transformation Indicators of Short-Term to Long-Term Using Flood Regional Coefficients (Case Study: East Azarbaijan Province, Iran)

Changing contexts in a long-term and short-term perspective should be managed within an integrated risk management framework that accounts for both temporary management strategies and permanent preventive measures to reduce the impact of natural hazard processes. In this study, statistical transformation indicators of short-term (20 year) to long-term (30 year) used flood regional coefficients. After the tests of data validation and the reconstruction of missing and outlier data, the data of 18 hydrometric stations were completed for 30 years (1985 to 2014). In the next phase, the return period values were prepared for 20-year and 30-year statistical periods (1985 to 2004 and 1985 to 2014) using the HYFA software. Thus the 20-year to 30-year ratio for various return period discharges obtained and these dimensionless values were plotted for the return periods of 2, 5, 10, 20, 50 and 100 years, also fitted the logarithmic trend line and the values of coefficients of the relationship were obtained. The statistics including average, standard deviation, coefficient of variation (CV), skewness coefficient (CS) and Kurtosis coefficient (CK) were calculated for 20-year data period for each station and we identified the statistics as independent parameters and the coefficients of A and B as dependent parameter, thus analyzed using linear multivariate regression, and regional factors were obtained. In the hydrometric station with 17-027 code, the discharge using the regional factors was calculated and compared with the discharge values of 30 years data. The results showed that there is little difference between the observed and estimated values from regional factors thus this method can be used in projects that require at least 30 years of data.

Long-term survival of more than 3 years among patients with advanced non-small cell lung cancer treated with chemotherapy

AIM: To evaluate the prognostic factors of long-term survival of more than 3 years in patients with advanced non-small cell lung cancer(NSCLC). METHODS: We retrospectively analyzed the records of 474 patients with advanced ⅢB/Ⅳ NSCLC who received chemotherapy as initial treatment between September 2002 and March 2007.RESULTS: The median survival time(MST) was 12.5 mo and the 3 year and 5 year survival rates were 14.6% and 5.3%, respectively. Long-term survival of more than 3 and 5 years was observed in 65 and 16 patients, respectively. The MST for the 65 patients was61.5 mo(range, 60.1-81.0 mo). In the 474 patients, a good performance status(PS), female sex, non-smoking status and adenocarcinoma histology were significantly associated with a favorable outcome. Furthermore, female sex, a good PS, non-smoking status and adenocarcinoma histology were significantly correlated with longterm survival of more than 3 years and most of these patients(89.2%, 58/65) received epidermal growth factor receptor-tyrosine kinase inhibitors as any line treatment. Survival analysis of long-term survivors showed that a PS of 0 was an independent prognostic factor for predicting favorable outcomes. CONCLUSION: Our results suggest that a good PS and adenocarcinoma histology play an important role in long-term survival of more than 3 years. A PS of 0 was an independent prognostic factor for predicting favorable outcomes in patients with advanced NSCLC who survived for more than 3 years.

零碳排放下电-气综合能源系统多能负荷预测

电-气综合能源系统中多能负荷之间的耦合程度不断增加,提升了能源系统调度和运行的难度。为此,对零碳排放下电-气综合能源系统多能负荷预测方法进行了研究。分析零碳排放下电-气综合能源系统的运行架构。以气象因素为影响因子,运用灰色关联度分析法获得多能负荷与各因子的相关性。将相关性分析结果与系统历史多能负荷数据共同作为输入数据,构建基础长短期记忆(LSTM)预测模型。结合樽海鞘群算法(SSA)优化模型关键参数,获得优化LSTM预测模型,实现系统多能负荷预测。试验结果表明:冷负荷与电负荷的关联度为0.88;热负荷与电负荷的关联度为0.681;实际预测平均绝对百分误差低于0.45。该方法预测效果理想,为系统最优调度与运行规划奠定了基础。

胃癌组织Keap-1、Nrf2蛋白表达及与患者远期生存的关系

目的探讨胃癌组织Kelch样环氧氟丙烷相关蛋白-1(Keap-1)、核因子E2相关因子2(Nrf2)蛋白表达及其与患者远期生存的关系。方法回顾性分析2015年1月至2017年2月行根治性手术治疗的147例胃癌患者的临床资料,均于术中留取胃癌组织与癌旁正常组织(距癌≥5 cm),通过免疫组化法检测胃癌组织和相应癌旁正常组织中Keap-1、Nrf2蛋白表达情况并进行比较;术后随访5年,统计患者生存情况,采用Kaplan-Meier法绘制患者生存曲线,比较胃癌组织Keap-1、Nrf2蛋白表达阳性者与表达阴性者的中位生存时间;另依据术后5年随访期间患者生存情况,将其分为生存组和死亡组,比较2组胃癌组织中Keap-1、Nrf2蛋白表达,采用Cox比例风险回归模型分析影响胃癌患者远期生存的因素。结果胃癌组织中Keap-1、Nrf2蛋白阳性表达率均高于癌旁正常组织(P<0.05);147例胃癌患者在5年随访中,共死亡109例,生存38例,生存率25.85%;经Kaplan-Meier生存曲线分析显示,Keap-1蛋白阳性表达患者中位生存期低于Keap-1蛋白阴性表达患者(P<0.01),Nrf2蛋白阳性表达患者中位生存期低于Nrf2蛋白阴性表达患者(P<0.01)。死亡组患者胃癌组织中的Keap-1、Nrf2蛋白阳性表达率均高于生存组(P<0.05);经Cox比例风险回归模型分析,肿瘤≥4.5 cm、TNM分期为Ⅲ~Ⅳ期、低分化程度、淋巴结转移、术后未辅助化疗、Keap-1、Nrf2蛋白阳性表达均是影响胃癌患者远期生存的危险因素(P<0.05)。结论胃癌组织中Keap-1、Nrf2蛋白异常表达均与患者远期生存关系密切,为临床研究提供新方向;此外,肿瘤≥4.5 cm、低分化、TNM分期为Ⅲ~Ⅳ期、淋巴结转移、术后未辅助化疗也是影响胃癌患者远期生存情况的危险因素。临床工作中可针对上述危险因素提前预防,加强治疗,以改善患者远期生存情况。

LSTM-WBLS模型在日降水量预测中的应用

基于长短时记忆网络(Long Short-Term Memory, LSTM)降水量预测模型存在过拟合、时滞现象,而宽度学习系统(Broad Learning System, BLS)无需多次迭代的特点有助于解决LSTM的上述缺点.加权宽度学习系统(Weighted Broad Learning System, WBLS)通过在BLS中引入加权惩罚因子约束分配样本权重,降低噪声和异常值对降水量预测精度的影响.本文提出一种LSTM-WBLS日降水量预测模型,选取湖北省巴东站日降水量进行实证研究,并考虑气压、气温、湿度、风速和日照等因素对降水量的影响.实验结果表明,与现有的预测模型相比,LSTM-BLS模型在RMSE、MAE和R^(2)等评价指标上均有显著提升.不同时间步长下,本文模型预测精度均优于现有模型,验证了其稳定性.与LSTM相比,WBLS直接计算权重的特点使得LSTM-WBLS的运算效率并未降低.

Predictive factors of clinical response in steroid-refractory ulcerative colitis treated with granulocyte-monocyte apheresis

AIM:To identify factors predicting the clinical response of ulcerative colitis patients to granulocyte-monocyte apheresis (GMA). METHODS:Sixty-nine ulcerative colitis patients (39 F,30 M) dependent upon/refractory to steroids were treated with GMA. Steroid dependency,clinical activity index (CAI),C reactive protein (CRP) level,erythrocyte sedimentation rate (ESR),values at baseline,use of immunosuppressant,duration of disease,and age and extent of disease were considered for statistical analysis as predictive factors of clinical response. Univariate and multivariate logistic regression models were used. RESULTS:In the univariate analysis,CAI (P = 0.039) and ESR (P = 0.017) levels at baseline were singled out as predictive of clinical remission. In the multivariate analysis steroid dependency [Odds ratio (OR) = 0.390,95% Confidence interval (CI):0.176-0.865,Wald 5.361,P = 0.0160] and low CAI levels at baseline (4 < CAI <7) (OR = 0.770,95% CI:0.425-1.394,Wald 3.747,P = 0.028) proved to be effective as factors predicting clinical response. CONCLUSION:GMA may be a valid therapeutic option for steroid-dependent ulcerative colitis patients with mild-moderate disease and its clinical efficacy seems to persist for 12 mo.

基于MIC-LSTM-ATT的机场动态容量评估研究

机场容量评估是空中交通管理和机场运行效率的关键,然而由于相关特征呈现非线性、时变性等复杂特性,机场动态容量评估仍具挑战。针对预测精度和可靠性问题,提出一种改进的深度学习机场动态容量评估方法(MIC-LSTM-Attention),主要包括基于最大互信息系数(MIC)进行相关性分析和引入注意力机制改进LSTM模型两部分。模型通过引入MIC确定强关联气象特征作为预测模型的输入,并应用注意力机制进行权重分配使得模型能够将注意力集中于重要气象信息上。实验数据为国内某大型国际机场一年内的航班运行及天气数据,实验建立了多个基线模型与所提模型进行对比分析。结果表明所构建的MIC-LSTM-ATT模型相较于其他3种方法拟合效果更好,准确度更高。

What is left when anti-tumour necrosis factor therapy in inflammatory bowel diseases fails?

The inflammatory bowel diseases(IBDs) are chronic incurable conditions that primarily present in young patients. Being incurable, the IBDs may be part of the patient's life for many years and these conditions require therapies that will be effective over the long-term. Surgery in Crohn's disease does not cure the disease with endoscopic recurrent in up to 70% of patients 1 year post resection. This means that, the patient will require many years of medications and the goal of the treating physician is to induce and maintain long-term remission without side effects. The development of the antitumour necrosis factor alpha(TNFα) agents has been a magnificent clinical advance in IBD, but they are not always effective, with loss of response overtime and, at times, discontinuation is required secondary to side effects. So what options are available if of the anti-TNFα agents can no longer be used? This review aims to provide other options for the physician, to remind them of the older established medications like azathioprine/6-mercaptopurine and methotrexate, the less established medications like mycophenolate mofetil and tacrolimus as well as newer therapeutic options like the anti-inte-gins, which block the trafficking of leukocytes into the intestinal mucosa. The location of the intestinal inflammation must also be considered, as topical therapeutic agents may also be worthwhile to consider in the longterm management of the more challenging IBD patient. The more options that are available the more likely the patient will be able to have tailored therapy to treat their disease and a better long-term outcome.