Zimberelimab plus chemotherapy as the first-line treatment of malignant peritoneal mesothelioma:A case report and review of literature

BACKGROUND Malignant peritoneal mesothelioma(MPeM)is a rare cancer with a poor prognosis at advanced stage,and the standard first-line treatment for inoperable patients is chemotherapy.Although combining programmed cell death 1(PD-1)inhibitors with chemotherapy is generally considered safe and effective in several malignant solid tumors,there are few reports regarding initial immunochemotherapy in advanced MPeM.CASE SUMMARY Here,to our knowledge,we present the first case of a patient with epithelioid subtype MPeM,who was treatment-naïve and benefited from initial PD-1 inhibitor plus standard chemotherapy with a prolonged progression-free survival(PFS)and good tolerance.A 49-year-old man was admitted to our hospital for a persistent burning sensation in the abdomen.Computed tomography revealed a solid mass in the lower abdomen,which was subsequently diagnosed histologically as epithelioid subtype MPeM by core needle biopsy.The patient received eight cycles of pemetrexed 800 mg(day 1),cisplatin 60/50 mg(day 1–2),and zimberelimab(PD-1 inhibitor)240 mg(day 1)every 3 wk.He achieved significant reduction of peritoneal tumors with remarkable improvement in symptoms.The best tumor response was partial remission with a final PFS of 7 mo.No immunerelated adverse event occurred during the combination treatment.CONCLUSION The outcome of the present case demonstrates the promising anti-tumor activity of immunochemotherapy to treat inoperable MPeM in the future.

Coronary Physiology in the Management of CAD Patients: Position Paper Regarding the Current Scenario in India

Fractional flow reserve (FFR), a physiology-based diagnostic method, has emerged as an important decision-making tool in determining the borderline or intermediate coronary lesions requiring revascularization. As per the guidelines recommended by European and American cardiology associations, functional assessment of indeterminate lesions is to be considered strongly prior to PCI. However, in India, FFR continues to be a much-underutilized tool due to limited facilities, and many times, physicians are reluctant to advise FFR because of its time-consuming nature with additional cost implications of simple diagnostic tests. Notably, for stenoses ranging between 50% - 70% where the choice between revascularization and medication becomes ambiguous, FFR provides invaluable insight. Without such guidance, there is a risk of improper decisions and strategies while planning revascularization procedures, which might adversely influence clinical outcomes, escalation of the cost due to unnecessary procedures, and prolonged hospitalization as a result of simple vs complex procedures. Landmark studies have validated the efficacy of FFR in enhancing outcomes in coronary artery disease (CAD) patients, especially when paired with a coronary angiogram. This combination provides robust evidence of the functional significance of stenosis in stable CAD. Additionally, non-hyperemic pressure ratio indices correlate well with conventional FFR. Hence, adopting FFR-guided management can have transformative effects on the clinical and economic facets of treating severe CAD with intermediary lesions in Indian settings.

A Prospective, Multicentric, Post Marketing Surveillance to Evaluate Efficacy & Safety of Ranitidine HCl (150 & 300 mg IR/CR) in Indian Patients with Gastroesophageal Reflux Disease (PROGRADE)

Purpose: Ranitidine hydrochloride (HCl) remains an important medication for treating acid-peptic ailments such as Gastroesophageal reflux disease (GERD). The main objective of this Post Marketing Surveillance (PMS) clinical study was to test the efficacy and safety of Ranitidine HCl in Indian patients suffering from GERD. Patients and Methods: Data of 2446 patients (1307 males;1121 females) from 21 centers across India were analyzed. Patients received either of the three treatments: Ranitidine HCl 150 mg twice a day (BID) (ARM-A), Ranitidine HCl 300 mg once daily (OD) or BID (ARM-B), and Ranitidine HCl 300 mg OD (ARM-C). Gastroesophageal Reflux Disease Symptom Assessment Scale (GSAS) score and Heartburn Severity score were used to assess the drug’s efficacy. The adverse events reported by patients or investigators were analyzed to assess the safety profile of Ranitidine. Results: Of the 2446 subjects screened, 2428 were enrolled. There was a significant reduction in GSAS scores from baseline to the end of the study visit in all three ARMs. The GSAS scores reduced from 2.02 to 0.23 in ARM-A, 2.01 to 0.24 in ARM-B, and 2.07 to 0.26 in ARM-C patients. In ARM A, 72.82% had 24 hours heartburn-free days, and 66.89% had 7 consecutive heartburn-free days, which was more significant than the other two ARMs. 128 (5.27%) patients reported ADRs due to Ranitidine HCl at different doses. The most frequently reported ADR was constipation (17.18%), followed by oliguria (14.06%), cold (13.28%), and dysuria (12.5%). Of 128 ADRs, 113 (88.28%) were mild, and only 11 (8.59%) ADRs were related to the study drug. No severe ADRs were reported during the study. Conclusion: Ranitidine HCl 150/300 mg tablet was found to be an effective and safe H2-receptor antagonist for treating GERD in Indian Patients.

Effects of Adalimumab Entering National Reimbursement on Medical Costs for Patients With Psoriasis:A 4-Year Single-Center Retrospective Study in China

Objective:Adalimumab(ADA)is expensive and rarely used among patients.However,its cost for moderate to severe chronic plaque psoriasis can now be reimbursed since its addition to the National Reimbursement Drug List(NRDL)in January 2020.Therefore,we conducted this study to estimate the medical cost of ADA and its influencing factors in patients with psoriasis using ADA and thus gain a better understanding of the effect of the NRDL adjustment in China.Methods:This retrospective study evaluated the medical cost of ADA before and after the addition of ADA to the NRDL(2018—2022)among 320 patients in a large professional dermatology specialty hospital.Descriptive analysis,Welch’s analysis of variance,and multiple regression analysis were used to evaluate the medical cost and influencing factors.Results:Before ADA was added to the NRDL,patients’mean total cost and ADA cost were¥24,243.56±16,346.53 and¥20,391.11±14,440.69,respectively.After ADA became covered by the NRDL,the above 2 expenses decreased to¥10,461.19±7,554.66 and¥8,775.27±7,092.16,respectively.This significant decrease in the cost of ADA resulted in a significant 110.5-times increase in ADA use.Statistically significant differences were found in the total cost,patient type(outpatient/inpatient),insurance status(yes/no),reimbursement status(before/after),and age.Medical insurance reimbursement(P<0.001,β=-0.468,before reimbursement=1,after reimbursement=2)was the most significant influencing factor,followed by patient type(P=0.018,β=-0.215,outpatient=1,inpatient=2)and age(P=0.0046,β=-0.174).Conclusion:Medical insurance reimbursement is the most important factor affecting patients’total cost of ADA by reducing the economic burden,enhancing the availability of ADA,and stimulating the need for treatment.

Study on effect of Traditional Chinese Medicine Jianpi Chushi decoction and ointment on chronic eczema

Objective:To study the effects of Traditional Chinese Medicine Jianpi Chushi decoction and ointment on chronic eczema.Methods:DNCB acetone solution was used to sensitize the skin of back and ears of 36 rats in order to establish chronic eczema model.A total of 36 rats were divided into four groups of 9 randomly including oral medicine group,external inunctum group,combination therapy group,and model control group respectively.Besides,the blank group of 4 healthy rats were set.The oral medicine group was given Traditional Chinese Medicine Jianpi Chushi decoction [(Poria cocos,Chinese yam,Cortex dictamni,Zaocys dhumnade,Rhizoma atractylodis,Pericarpium citri reticulatae,Scutellaria baicalensis,Radix Sophorae Flavescentis,Raw Radix Paeoniae Alba,Licorice roots(Northwest Origin)] by gastric infusion(1.6 g/m L·5 m L/d); the external inunctum group was given Qingpeng ointment on the skin,the combination therapy group was given Jianpi Chushi decoction by gastric infusion and Qingpeng ointment combination therapy.The model control group was given normal saline(NS) of the same volume by gastric infusion and vaseline on skin.Continuous administration 15 d and stopped for 3 d.The thickness difference and weight difference of left and right ear of every group were measured and the degree of ear swelling were evaluated.The CD4^+ and CD8^+ content and the IL-2,IL-4 level of serum were detected,and the inflammatory cells counts of back skin were recorded.Results:After treatment,the degree of ear swelling of oral medicine group,external inunctum group and combination therapy group significant decreased compared with model control group(P<0.05).The CD4^+,CD8^+ cell content and IL-2 level of oral medicine group,external inunctum group,combination therapy group and model control group significant decreased compared with blank group,and IL-2 level and the inflammatory cells count increased.After 15 d of treatment,the CD4^+,CD8^+ cell content and IL-2 level of serum of oral medicine group,external inunctum group and combination therapy group raised and the IL-4 level and the inflammatory cells count had significant decreased compared with model control group,and the effect of combination therapy group was more obvious(P<0.05).Conclusions:Qral Jianpi Chushi decoction could treat chronic eczema effectively,and oral Chinese medicine combined with ointment could enhance and speed up the efficacy.

Psychological reaction in members of medicine rescue team for Wenchuan earthquake in 2008 and its management

This paper reviews the rescue experience of our medical rescue team during the relief of Wenchuan earthquake in 2008 in Sichuan province, China, and analyzes the psychological reaction of team members. Based on the rescuers' distinctive psychological reaction in different phases of the rescue operation, we aims to propose measures for administration of the team in order to better fulfill the rescue duties and provide references for future medical service in non-war operations such as an earthquake relief.

Comparable outcomes but higher risks of prolonged viral RNA shedding duration and secondary infection in cancer survivors with COVID-19: A multi-center, matched retrospective cohort study

Results Sixty-one cancer survivors and 183 matched non-cancer patients were screened from 2,828 COVID-19 infected patients admitted to 4 hospitals in Wuhan,China.The median ages of the cancer survivor cohort and non-cancer patient cohort were 64.0(55.0–73.0)and 64.0(54.0–73.5),respectively(P=0.909).Cancer survivors reported a higher incidence of symptom onset than non-cancer patients.Fever(80.3%vs.65.0%;P=0.026)was the most prevalent symptom,followed by cough(65.6%vs.37.7%;P<0.001),myalgia,and fatigue(45.9%vs.13.6%;P<0.001).The risks of the development of severe events(adjusted hazard ratio[AHR]=1.25;95%confidence interval[CI]:0.76–2.06;P=0.378)and mortality(relative risk[RR]=0.90,95%CI:0.79–1.04;P=0.416)in the cancer survivor cohort were comparable to those of the matched non-cancer patient cohort.However,the cancer survivor cohort showed a higher incidence of secondary infection(52.5%vs.30.1%;RR=1.47,95%CI:1.11–1.95;P=0.002)and a prolonged viral RNA shedding duration(32 days[IQR 26.0–46.0]vs.24.0 days[IQR 18.0–33.0];AHR=0.54;95%CI:0.38–0.80;P<0.05).Conclusion Compared to non-cancer patients,cancer survivors with COVID-19 exhibited a higher incidence of secondary infection,a prolonged period of viral shedding,but comparable risks of the development of severe events and mortality.It is helpful for clinicians to take tailored measures to treat cancer survivors with COVID-19.

Fosfomycin—A Promising Oral Antibiotic for the Treatment of Urinary Tract Infection (UTI)

Background: Among the common morbid causes that are prevalent among all age groups, urinary tract infections top the list. In our country, most of the UTI patients visiting hospitals (OPD or IPD) are already on empirical antibiotics even before getting the sensitivity report in their hand. The purpose of this research was to examine the susceptibility patterns of commonly used antibiotics, particularly fosfomycin, against common uropathogens. Methodology: This was a prospective observational study conducted between January and March 2021 in four private tertiary hospitals in Dhaka, Bangladesh. All the urine samples referred to these four laboratories, obtained from patients of all ages and both genders, clinically diagnosed to have UTI, were included. Urine culture was performed by a semiquantitative method on blood agar media and MacConkey agar media. Following identification, antimicrobial sensitivity testing was performed using the modified Kirby Bauer disk diffusion method in accordance with CLSI standards. The data was put into Statistical Package for Social Sciences (SPSS) statistical software version 25 for the analysis. Results: A total of 5389 urine samples were received from four private hospitals in Dhaka over three months, and of these, 934 (17.33%) isolates were obtained from culture. About 95% of the isolates were gram-negative bacilli (GNBs). The most common isolate was Escherichia coli 615 (65.85%), followed by Klebsiella spp. 154 (16.49%), Pseudomonas spp. 64 (6.85%) and 51 (5.46%) isolates of Enterobacter. Among the gram-positive cocci, the most common were Enterococci fecalis 18 (1.93%) and Staphylococcus aureus 17 (1.82%). Of all the antibiotics tested, fosfomycin sensitivity was 98.4%, 88.88%, and 100% for Escherichia coli, Enterococci fecalis, and Staphylococcus aureus, respectively. All the isolates tested were susceptible to Meropenem (77% - 100%), Amoxiclav (78% - 100%) and Nitrofurantoin (45% - 94%). Sensitivity amongst all the uropathogens for ceftriaxone, ciprofloxacin, and cotrimoxazole was nearly 50% - 77%. Conclusion: The positivity of urinary isolates is 17.33%, with the most common pathogen being Escherichia coli. Common uropathogens show the highest in vitro susceptibility to fosfomycin. So, fosfomycin should be considered as a highly potent and promising alternative oral antibiotic treatment for UTI.

Estimation of the actual disease burden of human H7N9 infection in Jiangsu of eastern China from March 2013 to September 2017

The actual incidence of human H7N9 infection is supposed to be much higher than the documented laboratoryconfirmed cases.In this study,we estimated the number of the actual H7N9 cases in Jiangsu,China using a probabilistic multiplier model.Then,disability adjusted life years(DALYs),direct and indirect economic loss caused by this disease were calculated and analyzed.Till September 2017,the estimated total number of H7N9 cases was 2952[median,90%probability range(PR):1487-22094],which was 11.8 times(5.9-88.4)as large as the reported number.The median morbidity was estimated to be 4(90%PR:2-29)per 100000 population.The total DALYs loss was 16548 years,and the total economic loss(direct and indirect)was estimated to be RMB 1044618758(US$16.7 M).The average economic loss for per case and for per year was RMB 353868(US$56440)and RMB 232137502(US$37.0 M),respectively.The actual burden of human H7N9 infections was much heavier than what was documented.Our study provided an approach to estimate actual burden of infectious diseases using laboratory-confirmation.

Case Series of 10 Drug-Refractory IBS Patients Who Respond to Oral Serum-Derived Bovine Immunoglobulin/Protein Isolate (SBI)

Aim: The responses of 10 patients with long-standing, symptomatic, intractable drug-refractory histories of irritable bowel syndrome with diarrhea (IBS-D) and with abdominal pain, gas/bloating and distention, termed IBS undefined (IBS-U), were evaluated when administering a medical food product containing serum-derived bovine immunoglobulin/protein isolate (SBI). Methods: Patients in this case series were chosen based on their lack of satisfactory response to a variety of drugs, including antidiarrheal and antispasmodic medications, serotonin 5-HT3 receptor antagonists, selective serotonin re-uptake inhibitors (SSRIs), proton pump inhibitors (PPIs), antibiotics, and antidepressive drugs. Patients met Rome III criteria and were administered 5 g/day of SBI as standard-of-care nutritional support. A scale of 0% - 25%, 25% - 50%, 50% - 75%, 75% - 100% response to SBI was used for patient-reported improvement in overall IBS symptoms following administration for one month. Exact methods for calculating confidence intervals and p-values were used to assess complete management of symptoms and response to therapy. Adverse events were also monitored for this nutritional product. Results: The onset of gastrointestinal (GI) symptom reduction utilizing nutritional management with SBI occurred within an average time of 2-4 weeks with improved or near complete management in all 10 patients who were refractory to previous drug therapies by 4 weeks. When prompted, patients reported significant IBS symptom improvement which averaged between 50% - 100% (p = 0.002) with an average for complete management in all patients of 69%. No side effects were reported after SBI administration even when taken for up to 28 weeks. Conclusion: Based on the safety profile and reported outcomes in this case report, SBI should be considered as a nutritional option for management in IBS-D and IBS-U.

Acute headache in general neurology of China: Cause changes and predictors of short-term outcome

Background: Although patients with acute headache frequently present in emergency department, the causes and predictors of short-term outcome in patients with acute headache in general neurology have not been adequately investigated. Methods: We prospectively reviewed the medical records of 130 hospitalized acute headache pa-tients in general neurology of China. Their initial CT scan was assessed, as was their lumbar puncture (LP) examination if performed. Results: The main cause of acute headache was acute secondary headache (80.8%), which was mainly attributable to acute cerebrovascular events (72.4%) followed by intracranial infection (19.0%). Among the 10.8% of patients who died during hospitalization most (85.7%) had subarachnoid hemorrhage (SAH). Significant predictors of survival were severe headache versus thunderclap headache, meningismus, de-layed loss of consciousness, and hypertension (all p < 0.05). Multiple logistic regression analyses showed significant differences in severe headache or thunderclap headache (OR, 0.255;95%CI, 0.066 - 0.990;p = 0.048) and delayed loss of consciousness (OR, 0.060;95%CI, 0.016 - 0.224, p = 0.000) between patients who died and those who survived. Conclusions: The main underlying cause of hospitalized acute headache was acute cerebrovascular events. Severe headache and delayed loss of consciousness are predictors for poor outcome of acute headache.

Heme Iron Polypeptide in Iron Deficiency Anemia of Pregnancy: Current Evidence

Iron deficiency is the most common nutritional deficiency leading to anemia in pregnancy. Conventionally, non-heme form of iron salts has been the mainstay of treatment. However, patient compliance is an important concern with existing oral iron therapy due to gastrointestinal side effects. Heme iron, a better bioavailable and tolerable form of iron can be suitable form of iron for supplementation in pregnancy. Evidence suggests its utility in pregnancy for treatment of iron deficiency anemia with benefits extending to postpartum period. Effective transfer across placenta to fetus further supports its utility in pregnancy. This review discusses in details the absorption kinetics along with clinical evidence on efficacy, safety, and tolerability of heme-iron supplementation in iron deficiency anemia of pregnancy.

Liposomal Iron for Iron Deficiency Anemia in Women of Reproductive Age: Review of Current Evidence

Iron deficiency anemia is the most frequent nutritional deficiency disorder. Conventionally administered oral iron is associated with gastrointestinal intolerance that affects the outcomes and compliance. Liposomal iron is associated with increased absorption without causing significant adverse effects. In this review, we have discussed the technology of liposomal iron preparation, mechanisms of its absorption and clinical evidence on its utility in iron deficiency states in pregnant and non-pregnant women. Based on the available evidence, we compared liposomal iron to conventional oral iron. Encapsulation of micronized iron in liposomes is associated with lesser exposure to gastric contents, lesser interaction with food contents, no exposure to different digestive juices, targeted delivery of iron and allows lower doses to be administered in lieu of direct absorption without need for protein carriers. The available evidence suggests that liposomal iron significantly increases hemoglobin, ferritin levels in pregnant women as well as in women with iron deficiency.

Assessment of Patient Perceptions about Use of Wepox Pen^TM(Recombinant Erythropoietin Delivery Device with 30,000 IU Cartridge) in the Management of Anemia in Chronic Kidney Disease Patients

Objective: To assess perceptions about ease of use and other benefits of Wepox PenTM (loaded with 30,000 IU cartridge of recombinant erythropoietin) in the management of anemia in adult chronic kidney disease (CKD) patients. Material and methods: In this prospective, observational, multicentric post marketing surveillance, adult CKD patients treated with erythropoietin were enrolled from November 2015 to December 2016 to understand their opinions about Wepox PenTM. Ease of use of pen, ease of administering accurate dose, confidence in administration and ease of storage and disposal of cartridge were assessed on five points Likert scale: 1. very easy;2. somewhat easy;3. neither easy nor difficult;4. somewhat difficult;5. very difficult. Global assessment was performed on five points scale: 1. excellent;2. very good;3. good;4. average;5. not good. Safety was recorded by checking pain and discomfort and adverse events. Results: A total of 263 patients (mean age 32.87 years;66% male;34% female) were enrolled. Number of patients reporting ease of use as “very easy” from 209 (80.7%) at baseline increased to 245 (94.6%) and 249 (96.1%) at visit 2 (p = 0.001) and visit 3 (p = 0.001) respectively. Number of “very easy” response for accurate dose increased from 236 (91.1%) at visit 1 to 246 (95%) at visit 2 (p = 0.84) and 249 (96.1%) at visit 3 (p = 0.001). Number of the patients with “no pain” at injection site increased from 177 (68.3%) at visit 1 to 205 (79.2%) and 212 (81.9%) at visit 2 (p = 0.001) and visit 3 (p = 0.001) respectively. Improvement in number of patients with “no hurt” at visit 2 (p = 0.538) and visit 3 (p = 0.286) was not statistically significant. Number of patients reporting “somewhat easy” to “very easy” confidence in self injection increased from 251 (96.9%) at visit 2 to 255 (98.5%) at visit 3. Number of patients reporting ease of storage and disposal of cartridge as “somewhat easy” to “very easy” increased from 254 (98.1%) at visit 2 to 256 (98.9%) at visit 3. According to the global assessment, 144 (56.3%) cases reported “excellent” response. “Very good” and “Good” responses were reported by 106 (41.4%) and 6 (2.3%) patients respectively. A total of 230 (98.7%) patients said that they would prefer to use erythropoietin pen device for further treatment too. Conclusion: Wepox PenTM(recombinant erythropoietin) is easy to use and does not cause significant pain or discomfort. Ability to self-administer recombinant erythropoietin with Wepox PenTM is a great advantage which can make a significant difference for both CKD patients and doctors. Storage and disposal of cartridge is also easy.

The exploration of cell population data in clinical use: Beyond infectious diseases

Cell population data(CPD)is regarded as the fingerprint of a blood cell at a given moment.CPD parameters harbor information associated with cell morphology and can be automatically generated using modern hematological analyzers.Various studies have revealed many unique clinical applications for CPD,especially for infectious diseases,such as sepsis.For example,one monocyte-related CPD parameter is the monocyte distribution width(MDW),which can be generated using a Beckman Coulter hematological analyzer.MDW has received FDA and CE approval for aiding in sepsis diagnosis in adult patients in the emergency department.Additionally,MDW can serve as a diagnostic biomarker in patients infected with SARS-CoV-2.CPD has also been widely explored for possible clinical applications beyond infectious dis-eases,such as for predicting myelodysplastic syndromes,screening for he-matological malignancies,and detecting sterile inflammation.CPD parameter measurements are easily obtained and quite cost-effective,making them practical for clinical use.However,there are some potential drawbacks of CPD parameters.Some pre-analytical conditions can affect CPD values.Further-more,CPD are specific to certain hematological analyzers and the result cannot be transferred between different analyzers.The practical usefulness of CPD reference intervals is also still questionable.In this review,wesummarize the current studies related to CPD and its clinical applications.Additional well-designed clinical studies related to CPD are still expected.

Conventional therapy for moderate to severe inflammatory bowel disease: A systematic literature review

BACKGROUND Despite the advent of biological drugs, conventional therapy continues to be used in moderate to severe inflammatory bowel disease(MS-IBD). This study hypothesized that as a standard of treatment and the primary alternative to biologics, conventional therapy should present robust effectiveness results in IBD outcomes.AIM To investigate the effectiveness of conventional therapy for MS-IBD.METHODS A systematic review with no time limit was conducted in July 2017 through the Cochrane Collaboration, MEDLINE, and LILACS databases. The inclusion criteria encompassed meta-analyses, systematic reviews, randomized clinical trials, observational and case-control studies concerning conventional therapy in adult patients with MS-IBD, including Crohn's disease(CD) and ulcerative colitis(UC). Corticosteroids(prednisone, hydrocortisone, budesonide, prednisolone,dexamethasone), 5-aminosalicylic acid(5-ASA) derivatives(mesalazine and sulfasalazine) and immunosuppressants [azathioprine(AZA), methotrexate(MTX), mycophenolate, cyclosporine, tacrolimus, 6-mercaptopurine(6-MP)] were considered conventional therapy. The exclusion criteria were sample size below50; narrative reviews; specific subpopulations(e.g., pregnant women,comorbidities); studies on postoperative IBD; and languages other than English,Spanish, French or Portuguese. The primary outcome measures were clinical remission(induction or maintenance), clinical response and mucosal healing. As secondary outcomes, fecal calprotectin, hospitalization, death, and surgeries were analyzed. The quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation criteria.RESULTS The search strategy identified 1995 citations, of which 27 were considered eligible(7 meta-analyses, 20 individual studies). For induction of clinical remission, four meta-analyses were selected(AZA and 6-MP showed no advantage over placebo,MTX or 5-ASA in CD; MTX showed no statistically significant difference versus placebo, 6-MP, or 5-ASA in UC; tacrolimus was superior to placebo for UC in two meta-analyses). Only one meta-analysis evaluated clinical remission maintenance, showing no statistically significant difference between MTX and placebo, 5-ASA, or 6-MP in UC. AZA and 6-MP had no advantage over placebo in induction of clinical response in CD. Three meta-analyses showed the superiority of tacrolimus vs placebo for induction of clinical response in UC. The clinical response rates for cyclosporine were 41.7% in randomized controlled trials(RCTs) and 55.4% in non-RCTs for UC. For induction of mucosal healing,one meta-analysis showed a favorable rate with tacrolimus versus placebo for UC. For secondary outcomes, no meta-analyses specifically evaluated fecal calprotectin, hospitalization or death. Two meta-analyses were retrieved evaluating colectomy rates for tacrolimus and cyclosporine in UC. Most of the twenty individual studies retrieved contained a low or very low quality of evidence.CONCLUSION High-quality evidence assessing conventional therapy in MS-IBD treatment is scarce, especially for remission maintenance, mucosal healing and fecal calprotectin.

Correlation between muscular strength and basal nuclei ischemic/hemorrhagic stroke-induced corticospinal tract injury,as detected by diffusion tensor imaging and tractography

BACKGROUND： Conventional neuroimaging diagnosis does not assist with the monitoring or evaluation of basal nuclei ischemic and hemorrhagic stroke, or motor functional recovery. Magnetic resonance, diffusion tensor imaging, and diffusion tensor tractography have all been used to observe features of cerebral white matter fibrous structures. In addition, diffusion tensor tractography is the only non-invasive imaging method to display the corticospinal tract in vivo. OBJECTIVE： To evaluate the impairment degree of corticospinal tract induced by basal nuclei ischemic and hemorrhagic stroke through the use of magnetic resonance, diffusion tensor imaging, and diffusion tensor tractography, and to analyze the correlation to muscular strength. DESIGN, TIME AND SETTING： A retrospective case analysis was performed at the Department of Medical Imaging, Neurology and Neurosurgery, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA between November 2002 and June 2008. PARTICIPANTS： A total of 15 patients with acute or subacute cerebral ischemic stroke and nine with hemorrhagic stroke in the basal nuclei were selected. METHODS： Magnetic resonance, diffusion tensor imaging, and diffusion tensor tractography results and data were analyzed. Fractional anisotropy and directionally encoded color maps were obtained. Three-dimensional tractography of bilateral corticospinal tract was created, and corticospinal tract integrity was graded. Fractional anisotropy of infarct region and corresponding contralateral normal regions were measured, and hematoma volume in hemorrhagic stroke patients was determined. Hand motor function ability was evaluated using Brunstorm criteria. MAIN OUTCOME MEASURES： Fractional anisotropy of infarct region and corresponding contralateral normal regions; hematoma volume in hemorrhagic stroke patients; correlation between muscular strength and corticospinal tract impairment degree in ischemic stroke and hemorrhagic stroke patients before and after treatment. RESULTS： In ischemic stroke patients, the fractional anisotropy value was significantly lower in the infarct area of white matter than in the normal hemisphere （P 〈 0.01）. The impairment degree of corticospinal tract negatively correlated with muscular strength of the corresponding hand （r = -0.97 P 〈 0.01）. The hematoma volume of hemorrhagic stroke patients significantly negatively correlated with Spearman test results for muscular strength of the corresponding hand （r = -0.88, P 〈 0.01）. CONCLUSION： Corticospinal tract impairment severity negatively correlated with muscular strength and motor functional recovery, which suggested that diffusion tensor imaging and diffusion tensor tractography could be used to evaluate corticospinal tract motor function.

Malaria

The authors were the peackkeepers of the Chinese level 2hospital MONUSCO,Bukavu,DRC mission area.Under the instructions of deputy commander of South Kivu Brigade,they did a survey to find out the prevalence of malaria in Chinese level 2hospital,and found out a total of 42.9%inpatients were suffuring from malaria.To further help the UN troops and all MONUSCO staff for a better understanding of early prevention,accurate diagnosis,and proper treatment of this infectious disease,they refered relevant UN documents and based on level 2hospital successful experience of prevention and treatment of malaria,they finished this article.It has been approved by CFMO(chief of force medical officer)of MONUSCO and the pamphlet has been published all over the mission area in e-copy.

New therapeutic option for irritable bowel syndrome:Serum-derived bovine immunoglobulin

Oral prescription medical foods have long been used in hospital settings but are also appropriate therapies for gastrointestinal disorders in outpatient medical practice.Oral serum-derived bovine immunoglobulin/protein isolate(SBI) has been shown in clinical studies to reduce loose stools and improve stool consistency as well as other symptoms(i.e.,abdominal pain,bloating,and urgency) in patients with irritable bowel syndrome with diarrhea(IBS-D) and human immunodeficiency virus-associated enteropathy.This case series reports the outcomes of 14 IBS patients who received SBI as an addition to standard of care at an individual physician's clinical practice.The patients:2 IBS with constipation(IBS-C),7 IBS-D,2 mixed diarrhea and constipation IBS(IBS-M) and 3 undefined IBS(IBS-U; also described by some physicians as IBS-Bloating),ranged in age from 22-87 years.SBI(5 g or 10 g daily dose) was added to the patient's current standard care and followed for several weeks to determine if symptoms were improved with the addition of SBI.Overall,12 of the 14 patients indicated some level of improvement through direct questioning of the patients regarding changes from the prior visit.One IBS-Bloating patient had a resolution of symptoms and two patients(1 IBS-Bloating and 1 IBS-C) discontinued therapy because of insufficient relief.The 12 patients who continued on therapy reported an overall improvement in symptoms with better stool consistency,decreased frequency as well as reductions in abdominal pain,bloating,distention,and incontinence.In most cases,therapeutic effects of SBI were seen within the first four weeks of therapy with continued improvements at subsequent visits.SBI has a multifaceted mechanism of action and may help to manage IBS by providing a distinct protein source required to normalize bowel function,gastrointestinal microbiota,and nutritionally enhance tight junction protein expression between intestinal epithelial cells.SBI as a medical food provides a safe option for patients with IBS-D but may have application in other forms of IBS.

Pre-endoscopic screening for Helicobacter pylori and celiac disease in young anemic women

AIM:To evaluate the usefulness of pre-endoscopic serological screening for Helicobacter pylori(H pylori) infection and celiac disease in women aged<50 years affected by iron-defi ciency anemia(IDA).METHODS:One hundred and fi fteen women aged<50 years with IDA were tested by human recombinant tissue transglutaminase IgA antibodies(tTG) and anti-H pylori IgG antibodies.tTG and H pylori IgG antibody were assessed using an enzyme-linked immunosorbent assay(ELISA).All women were invited to undergo upper GI endoscopy.During gastroscopy,biopsies were collected from antrum(n=3),gastric body(n=3) and duodenum(n=4) in all patients,irrespective of test results.The assessment of gastritis was performed according to the Sydney system and celiac disease was classifi ed by Marsh's System.RESULTS:45.2% women were test-positive:41 patients positive for H pylori antibodies,9 patients for tTG and 2 patients for both.The gastroscopy compliance rate of test-positive women was significantly increased with respect to those test-negative(65.4% vs 42.8%;Fisher test P=0.0239).The serological results were confi rmed by gastroscopy in 100% of those with positive H pylori antibodies,in 50% of those with positive tTG and in 81.5% of testnegative patient.Sensitivity and specif icity were 84.8% and 100%,respectively for H pylori infection and,80% and 92.8% for tTG.Twenty-eight patients had positive H pylori antibodies and in all the patients,an active H pylori infection was found.In particular,in 23 out of 28(82%) patients with positive H pylori antibodies,a likely cause of IDA was found because of the active inflammation involving the gastric body.CONCLUSION:Anti-H pylori IgG antibody and tTG IgA antibody testing is able to select women with IDA to submit for gastroscopy to identify H pylori pangastritis and/or celiac disease,likely causes of IDA.