Adalimumab in prevention of postoperative recurrence of Crohn's disease in high-risk patients

AIM:To evaluate the effectiveness of adalimumab in preventing recurrence after intestinal resection for Crohn's disease in high-risk patients.METHODS:A multicenter,prospective,observational study was conducted from June 2009 until June 2010.We consecutively included high-risk Crohn's disease patients who had undergone an ileal/ileocolonic resection.High-risk patients were defined as two or more criteria:smokers,penetrating pattern,one or more previous surgical resections or prior extensive resection.Subcutaneous adalimumab was administered 2 wk(± 5 d) after surgery at a dose of 40 mg eow,with an initial induction dose of 160/80 mg at weeks 0 and 2.Demographic data,previous and concomitant treatments(antibiotics,5-aminosalicylates,corticosteroids,immunomodulators or biologic therapies),smoking status at the time of diagnosis and after the index operation and number of previous resections(type and reason for surgery) were all recorded.Biological status was assessed with C-reactive protein,erythrocyte sedimentation rate and fecal calprotectin.One year(± 3 mo) after surgery,an ileocolonoscopy and/or magnetic resonance enterography was performed.Endoscopic recurrence was defined as Rutgeerts score ≥ i2.Morphological recurrence was based on magnetic resonance(MR) score ≥ MR1.RESULTS:Twenty-nine patients(55.2% males,48.3% smokers at diagnosis and 13.8% after the index operation),mean age 42.3 years and mean duration of the disease 13.8 years were included in the study.A mean of 1.76(range:1-4) resections previous to adalimumab administration and in 37.9% was considered extensive resection.51.7% had previously received infliximab.Immunomodulators were given concomitantly to 17.2% of patients.Four of the 29(13.7%) developed clinical recurrence,6/29(20.7%) endoscopic recurrence and 7/19(36.8%) morphological recurrence after 1-year.All patients with clinical recurrence showed endoscopic and morphological recurrence.A high degree of concordance was found between clinical-endoscopic recurrence(k = 0.76,P < 0.001) and clinical-morphological recurrence(k = 0.63,P = 0.003).Correlation between endoscopic and radiological findings was good(comparing the 5-point Rutgeerts score with the 4-point MR score,a score of i4 was classified as MR3,i3 as MR2,and i2-i1 as MR1)(P < 0.001,r s = 0.825).During follow-up,five(17.2%) patients needed adalimumab dose intensification(40 mg/wk);Mean time to intensification after the introduction of adalimumab treatment was 8 mo(range:5 to 11 mo).In three cases(10.3%),a biological change was needed due to a worsening of the disease after the dose intensification to 40 mg/wk.One patient suffered an adverse event.CONCLUSION:Adalimumab seems to be effective and safe in preventing postoperative recurrence in a selected group of patients who had undergone an intestinal resection for their CD.

The value of postoperative hepatic regional chemotherapy in prevention of recurrence after radical resection of primary liver cancer

INTRODUCTIONIn China,primary liver cancer (PLC) ranks secondin cancer mortality since the 1990s.In the field ofPLC treatment,surgical resection remains the best,which includes large PLC resection,small PLCresection,re-resection of subclinical recurrence,aswell as cytoreduction and sequential resection forunresectable PLC.However,recurrence

Exploration of transmission chain and prevention of the recurrence of coronavirus disease 2019 in Heilongjiang Province due to inhospital transmission

The coronavirus disease 2019(COVID-19)epidemic is a major public health emergency characterized by fast spread,a wide range of infections,and enormous control difficulty.Since the end of December 2019,Wuhan has become the first core infection area of China's COVID-19 outbreak.Since March 2020,the domestic worst-hit areas have moved to the Heilongjiang Province due to the increased number of imported COVID-19 cases.Herein,we reported the major COVID-19 outbreak,which caused a rebound of the epidemic in Harbin,China.After the rebound,different levels of causes for the recurrence of COVID-19,including citylevel,hospital-level,and medical staff-level cause,were investigated.Meanwhile,corresponding countermeasures to prevent the recurrence of the epidemic were also carried out on the city level,hospital level,and medical staff level,which eventually showed the effect of infection control function in a pandemic.In this study,we described the complete transmission chain,analyzed the causes of the outbreak,and proposed corresponding countermeasures from our practical clinical experience,which can be used as a valuable reference for COVID-19 control.

Prevention and Treatment of “Epidemic Toxin, Pathogenic Dampness, and Lung Deficiency” after COVID-19 Recovery Based on the Theory of “Preventive Treatment of Diseases” in Traditional Chinese Medicine

Due to the sequelae and recurrence in patients with COVID-19 after recovery.This article,based on lire theory of“preventive treatment of diseases”in traditional Chinese medicine,winch believes that the three pathogenic factors of epidemic toxin,dampness,and lung deficiency are the fundamental causes of the recurrence of COVID-19.The treatment strategies are to remove pathogenic factors,strengthen qi,nourish yin,clear heat,moisten dryness,and at the same time,reinforce the lung,spleen and kidney,and soothe the liver.Through a variety of treatments such as oral administration,external treatment,and skin absorption,it provides a new idea and method for the management of the recurrence of COVID-19.

Prevention and Treatment of“Epidemic Toxin,Pathogenic Dampness,and Lung Deficiency”after COVID‑19 Recovery Based on the Theory of“Preventive Treatment of Diseases”in Traditional Chinese Medicine

Due to the sequelae and recurrence in patients with COVID-19 after recovery.This article,based on the theory of“preventive treatment of diseases”in traditional Chinese medicine,which believes that the three pathogenic factors of epidemic toxin,dampness,and lung deficiency are the fundamental causes of the recurrence of COVID‑19.The treatment strategies are to remove pathogenic factors,strengthen qi,nourish yin,clear heat,moisten dryness,and at the same time,reinforce the lung,spleen and kidney,and soothe the liver.Through a variety of treatments such as oral administration,external treatment,and skin absorption,it provides a new idea and method for the management of the recurrence of COVID‑19.

The value and limitation of transcatheter arterial chemoembolization in preventing recurrence of resected hepatocellular carcinoma

AIM: To evaluate the value and limitation of postoperative transcatheter arterial chemoembolization (TACE) in preventing recurrence of hepatocellular carcinoma (HCC). METHODS: In the first group, 987 postoperative patients with HCC, who did not have any evidence of recurrence in the first preventative TACE but were found to have recurrence at different times during the follow-up survey, were analyzed. In the second group, 643 postoperative patients with HCC had no TACE for compared study. To study the relationship between the recurrence time and the number of TACE treatments was analyzed. RESULTS: The 6-, 12-, and 18-mo recurrence rates in the first and second groups were 22.2% (210 cases) vs 61.6% (396 cases), 78.0% (770 cases) vs74.7% (480 cases) and 88.6% (874 cases) vs80.1% (515 cases). There were significant differences between the recurrence rates of the two groups at 6 mo (P＜0.0001).CONCLUSION: The principal role of TACE after HCC operation is to suppress, detect early and treat micrometastasis. It has a good effect of preventing recurrence of HCC in 6 mo, but such an effect is less satisfactory in a longer period. When it is uncertain whether HCC is singlecentral or multi-central and if there is cancer residue or metastasis after operation, TACE is valuable to prevent recurrence.

The clinical use of interventional chemotherapy and intravesical instillation for preventing recurrence of superficial bladder cancer

Objective To study the therapeutic efficacy of combined interventional chemotherapy and intravesical instillation of mitomycin on preventing bladder cancers from recurring after local ablation. Methods 28 patients with superficial bladder cancers were randomized into combined interventional chemotherapy and intravesical instillation of mitomycin or intravesical instillation of mitomycin alone for preventing recurrence after local ablation. The result was assessed by x2 test. Results The patients have been followed up for 12-26 months (mean 21 months). 1 case has had tumor recurrence in the combined modality therapy group and 4 in the intravesical instillation alone group, the tumor recurrence rate being 7% (1/14) and 29% (4/14) respectively (P【0.05). Conclusion Combined use of interventional chemotherapy and intravesical instillation of mitomycin is effective in preventing superficial bladder cancer from recurring after local ablation with fewer adverse effects. The ragimen is not only reliable but

The effects of intravesical therapy with elemene in preventing postoperative recurrence of bladder cancer

To investigate the effects of intravesical therapy with elemene in preventing postoperative recurrence of superficial bladder cancer and its toxic and side effects.Methods This series included 123 patients with superficial bladder cancer (T1),consisting of transitional cell carcinoma GⅠ in 37 cases,GⅡ in 73 and GⅢ in 13.They all underwent surgical treatment.Postoperatively,they were randomly assigned to 2 groups;63 patients in elemene group received instillation of elemene (400 mg,once a week) 2 weeks after operation and 60 patients in mitomycin C (MMC) group received instillation of MMC (40 mg,once a week) 2 weeks after operation.The instillations were repeated for 6 weeks and thereafter monthly for 1 year.The recurrence rates,side effects,and NK cell activity before and after treatment were evaluated.Results The recurrence rate of elemene group (mean follow-up of 19.7 months) was 7.9% (5 cases),which was significantly lower than that (25.0%,15 cases) of MMC group (mean follow-up of 19.4 months;P<0.05).The side effect in elemene group (3.2%,2 cases) was significantly milder than that in MMC group (25.0%,15 cases)(P<0.05).In elemene group,the NK cell activity after treatment (28±2)% was significantly higher than that before treatment(20±2)%(P<0.05).Conclusion Instillation of elemene after operation is effective and safe in preventing postoperative recurrence of bladder cancer.8 refs.

Effects of epidermal growth factor receptor inhibitor on proliferative cholangitis in hepatolithiasis

BACKGROUND： There is currently no effective medication to prevent stone recurrence after choledochoscopic lithotomy or to treat proliferative cholangitis（PC）, which is the pathologic basis of hepatolithiasis. This study aimed to investigate whether gefitinib, an epidermal growth factor receptor（EGFR） inhibitor, inhibited cholangio hyperplasia and lithogenesis in PC.METHODS： After cholangioscopic lithotomy, indwelling catheters were placed in the diseased bile duct lumens in 94 patients with hepatolithiasis. Subsequently, 49 of the 94 patients were treated with 250 mg gefitinib solution via a catheter twice a week, and they were subjected to choledochoscopic biopsy at 6 and 12 weeks. The rest 45 hepatolithiasis patients without gefitinib treatment served as controls.RESULTS： The expressions of EGFR, PCNA and procollagen I were significantly reduced in the patients treated with gefitinib in 12 weeks compared with those in the control group. Patients in the gefitinib group had a much lower degree of hyperplasia of the biliary epithelium, submucosal glands and collagen fibers compared with those in the control group. Gefitinib treatment significantly decreased mucin 3 expression and β-glucuronidase activity.CONCLUSION： Postoperative gefitinib treatment could significantly inhibit PC-mediated hyperplasia and lithogenesis, which might provide a novel strategy for the prevention of biliary restenosis and stone recurrence in patients with hepatolithiasis.

Recurrent urinary tract infections in children:Preventive interventions other than prophylactic antibiotics

Urinary tract infection （UTI） is one of the most common childhood infections. Permanent renal cortical scarring may occur in affected children, especially with recurrent UTIs, leading to long-term complications such as hypertension and chronic renal failure. To prevent such damage, several interventions to prevent UTI recurrences have been tried. The most established and accepted prevention at present is low dose long-term antibiotic prophylaxis. However it has a risk of break through in-fections, adverse drug reactions and also the risk of developing antibiotic resistance. The search is therefore on-going to fnd a safer, effective and acceptable alter-native. A recent meta-analysis did not support routine circumcision for normal boys with no risk factors. Vacci-nium Macrocarpon （cranberry）, commonly used against UTI in adult women, is also effective in reducing the number of recurrences and related antimicrobial use in children. Sodium pentosanpolysulfate, which prevents bacterial adherence to the uroepithelial cells in animal models, has shown conflicting results in human trials. When combined with antibiotic, Lactobacillus acidophilus （LA-5） and Bifidobacterium, by blocking the in vitro attachment of uropathogenic bacteria to uroepithelial cells, significantly reduce in the incidence of febrile UTIs. Deliberate colonization of the human urinary tract of patients with recurrent UTI with Escherichia-coli （E. coli ） 83972 has resulted in subjective beneft and less UTI requiring treatment. The non-pathogenic E. coli isolate NU14 DeltawaaL is a candidate to develop live-attenuated vaccine for the treatment and prevention of acute and recurrent UTI. Diagnosing and treating dysfunctional elimination syndromes decrease the incidence of recurrent UTI. A meta-analysis found the lack of robust prospective randomized controlled trials limited the strength of the established guidelines for surgical management of vesicoureteral reflux. In conclusion, several interventions, other than antibiotic prophylaxis, for the prevention of recurrent UTI have been tried and, although showing some promise, they do not provide so far a definitive effective answer. Finding suitable alternatives still requires further high quality research of those seemingly promising interven-tions.

INTRAVESICAL INSTILLATION OF INTERLEUKIN-2 AN EFFECTIVE METHOD FOR PREVENTING THE RECURRENCE OF BLADDER CANCER

The result of intravesical instillation with interleukin-2 (IL-2) for preventing the recurrence of bladder cancer and discussion of its mechanism was reported. 20 patients with histologically confirmed bladder transitional cell carcinoma were investigated. 2 000 u IL 2 was intravesically instillated every day for six days after resection of the neoplasm. The serum level of tumor necrosis factor (TNF) was significantly increased in 17 patients after IL-2 therapy. Recurrence occurred in 4 patients during the follow-up period of 10-18 months. The basic level of serum TNF was low and was not increased or even decreased after IL-2 in these patients. On the contrary, recurrence did not occur in another 5 patients with low basic level of TNF, but it was significantly increased after treatment of IL-2. TNF played a key role in preventing the recurrence of bladder cancer. The patients who had low basic level of TNF, which did not markedly increase or even decrease after IL-2 therapy were at high risk of recurrenc

Study on Preventive and Therapeutic Effect of Radix Salviae Miltiorrhizae on Recurrence and Metastasis of Liver Cancer

Objective: To study the inhibitory effect of Radix Salviae Miltiorrhizae (RSM) on adhesive and invasive ability of SMMC 7721 liver cancer cells, and on the metastasis and recurrence on post hepatectomy liver cancer in nude mice. Methods: Effect of RSM on SMMC 7721 cell membrane intercellular adhesive molecule 1 (ICAM 1) expression was observed by immunofluorescence flow cytometry; effect on invasive ability and of SMMC 7721 cell and the detachment of which attached to fibronectin (FN) by cell migration experiment; effect on adhesion of SMMC 7721 cell with FN by MTT method and effect on adhesion between 7721 7721, 7721 lymphocyte and 7721 endothelial cell by cell adhesion experiment. LCI D20 human liver cancer metastasis model, after hepatectomy, was used to observe the effect of RSM on recurrence and metastasis of liver carcinoma in nude mice. Results: ICAM 1 expression in SMMC 7721 cells incubated with RSM was significantly lower than that in cells did not treated with RSM. RSM could inhibit the invasive ability of SMMC 7721 cell and made the cells already attached to FN exfoliated. It could also inhibit the adhesion of 7721 7721, 7721 lymphocyte and 7721 endothelial cell. And RSM showed preventive and therapeutic effect on intrahepatic and remote metastasis/recurrence of early and late human post hepatectomy liver cancer in nude mice. Conclusion: RSM could inhibit the invasion and adhesion of SMMC 7721 cell and could also prevent and inhibit metastasis and recurrence of human liver cancer after hepatectomy in nude mice.

Elimination of blinding trachoma in China: why is further study necessary?

Sixty years ago,Prof.Feifan Tang and Xiaolou Zhang first discovered and isolated Chlamydia trachomatis,a finding that clarified the cause of trachoma and marked the beginning of a fresh chapter on trachoma research,prevention,and control worldwide（Tang et al.,1956;Tang et al.,1957a;Tang et al.,1957b）.