Objective:To comparatively evaluate the efficacy of anti-tumor necrosis factor (TNF)-α and anti-interleukin (IL)-12/23 biologics as the first-line treatment in Crohn′s disease (CD).Methods:From January 1, 2016 to December 31, 2024, at the Department of Gastroenterology of the First Affiliated Hospital of Soochow University, the clinical data of patients with CD treated with anti-TNF-α (infliximab or adalimumab) or anti-IL-12/23 biologics (ustekinumab) as first-line treatment were retrospectively collected. All the patients were followed up for 1 year since the initiation of first-line biologic treatment, with the follow-up concluding on December 31, 2024. The primary outcomes were the clinical efficacy (including clinical response rate and clinical remission rate) of anti-TNF-α or anti-IL-12/23 treatment at week 24 and week 48, and the endoscopic efficacy(including endoscopic response rate and endoscopic remission rate) at week 48. The clinical efficacy was assessed based on Crohn′s disease activity index(CDAI). The clinical response was defined as a reduction in CDAI by ≥ 70 from baseline (week 0), and clinical remission was defined as CDAI < 150. The endoscopic efficacy was assessed based on simple endoscopic score for Crohn′s disease (SES-CD), the endoscopic response was defined as a reduction in SES-CD by ≥50% from baseline (week 0), and endoscopic remission was defined as SES-CD ≤2. Chi-square test or Fisher′s exact test was used for statistical analysis.Results:A total of 215 CD patients were enrolled, including 160 males and 55 females, with the age of (31.88±11.55) years old. Among them, 179 patients completed the clinical efficacy evaluation, 110 cases were treated with anti-TNF-α, 69 cases were treated with anti-IL-12/23. The clinical response rates of patients treated with anti-TNF-α and anti-IL-12/23 at week 24 were 95.5%(105/110) and 95.7%(66/69), respectively, and the clinical remission rates at week 24 were 86.4%(95/110) and 85.5%(59/69), respectively; the clinical response rates at week 48 were 95.5%(105/110) and 97.1%(67/69), respectively, and the clinical remission rates at week 48 were 89.1%(98/110) and 88.4%(61/69), respectively; and the differences were not statistically significant(Fisher′s exact test, χ2=0.03, Fisher′s exact test, χ2=0.02; P=1.000, 0.708, 0.872, and 0.887). A total of 76 patients completed endoscopic efficacy evaluation, among which 55 cases were treated with anti-TNF-α, and 21 cases were treated with anti-IL-12/23. The endoscopic response rates of patients treated with anti-TNF-α and anti-IL-12/23 were 74.5%(41/55) and 66.7%(14/21), respectively, and the endoscopic remission rates at week 48 were 49.1%(27/55) and 28.6%(6/21), respectively; and the differences were not statistically significant( χ2=0.47 and 2.60, P=0.492 and 0.107). Conclusion:Both anti-TNF-α and anti-IL-12/23 are effective as first-line biological therapies for CD, and there are no significant differences in both clinical and endoscopic efficacy between these 2 biologics.

Objective:To compare the role of double-balloon enteroscopy (DBE) and dual-energy CT enterography (DCTE) in evaluating the clinical characteristics of Crohn′s disease (CD).Methods:From July 1, 2016 to November 1, 2023, 72 patients with CD who underwent both DBE and DCTE (with an interval of less than 3 months) in the First Affiliated Hospital of Soochow University were enrolled in this retropective study. Among them, 4 patients underwent both DBE and DCTE twice (a total of 76 cases). The data of DBE and DCTE in the diagnosis of 76 CD cases were analyzed, including the diagnostic rate of CD, the consistency of the 2 methods in detecting the lesion location (ileocecal, colonic, ileocolonic, and upper gastrointestinal tract involvement), and the detection rates of stenosis, ulcer and the location, long ulcer (long-diameter≥2 cm), and fistula. Kappa test was performed for the consistency analysis, and Chi-square test was used for statistical analysis.Results:The diagnostic rate of CD by DBE was higher than that by DCTE (80.3% (61/76) vs. 65.8% (50/76)), and the diagnostic rate of combination of the 2 methods (89.5% (68/76)) was higher than that by DCTE alone, and the differences were statistically significant ( χ2=4.04 and 12.28, P=0.044 and <0.001). The result of Kappa consistency test showed that the consistency of CD lesion location detected by DBE and DCTE was poor (Kappa value=0.29, t=3.17, P=0.002). The detection rate of stenosis by DBE was higher than that by DCTE (46.1% (35/76) vs. 13.2% (10/76)), the detection rate of stenosis by combination of the 2 methods (52.6% (40/76)) was higher than that by DCTE alone, and the differences were statistically significant ( χ2=19.73 and 26.82, both P<0.001). There were no statistically significant differences in the detection rates of fistula among DBE, DCTE, and the combination of the 2 methods (3.9%(3/76), 2.6% (2/76), 5.3% (4/76); all P>0.05). The detection rate of ulcer by DBE was higher than that by DCTE(73.7% (56/76) vs. 7.9% (6/76)), the detection rate of ulcer by combination of the 2 methods (76.3%(58/56)) was higher than that by DCTE alone, and the differences were statistically significant ( χ2=68.10 and 72.98, both P<0.001). The detection rates of long ulcer and non-terminal ileum ulcer by DBE were both 17.9% (10/56). All the 6 cases with ulcer detected by DCTE were located in the terminal ileum, and no long ulcers were observed. Conclusions:In the diagnosis of CD, as well as in the detection of stenosis and ulcer, DBE and the combination of DBE and DCTE have more advantages over DCTE alone. The consistency between DBE and DCTE in identifying the location of lesion is poor. DBE has advantages in detecting long ulcer and non-terminal ileum ulcer.

Objective:To comparatively evaluate the efficacy of anti-tumor necrosis factor (TNF)-α and anti-interleukin (IL)-12/23 biologics as the first-line treatment in Crohn′s disease (CD).Methods:From January 1, 2016 to December 31, 2024, at the Department of Gastroenterology of the First Affiliated Hospital of Soochow University, the clinical data of patients with CD treated with anti-TNF-α (infliximab or adalimumab) or anti-IL-12/23 biologics (ustekinumab) as first-line treatment were retrospectively collected. All the patients were followed up for 1 year since the initiation of first-line biologic treatment, with the follow-up concluding on December 31, 2024. The primary outcomes were the clinical efficacy (including clinical response rate and clinical remission rate) of anti-TNF-α or anti-IL-12/23 treatment at week 24 and week 48, and the endoscopic efficacy(including endoscopic response rate and endoscopic remission rate) at week 48. The clinical efficacy was assessed based on Crohn′s disease activity index(CDAI). The clinical response was defined as a reduction in CDAI by ≥ 70 from baseline (week 0), and clinical remission was defined as CDAI < 150. The endoscopic efficacy was assessed based on simple endoscopic score for Crohn′s disease (SES-CD), the endoscopic response was defined as a reduction in SES-CD by ≥50% from baseline (week 0), and endoscopic remission was defined as SES-CD ≤2. Chi-square test or Fisher′s exact test was used for statistical analysis.Results:A total of 215 CD patients were enrolled, including 160 males and 55 females, with the age of (31.88±11.55) years old. Among them, 179 patients completed the clinical efficacy evaluation, 110 cases were treated with anti-TNF-α, 69 cases were treated with anti-IL-12/23. The clinical response rates of patients treated with anti-TNF-α and anti-IL-12/23 at week 24 were 95.5%(105/110) and 95.7%(66/69), respectively, and the clinical remission rates at week 24 were 86.4%(95/110) and 85.5%(59/69), respectively; the clinical response rates at week 48 were 95.5%(105/110) and 97.1%(67/69), respectively, and the clinical remission rates at week 48 were 89.1%(98/110) and 88.4%(61/69), respectively; and the differences were not statistically significant(Fisher′s exact test, χ2=0.03, Fisher′s exact test, χ2=0.02; P=1.000, 0.708, 0.872, and 0.887). A total of 76 patients completed endoscopic efficacy evaluation, among which 55 cases were treated with anti-TNF-α, and 21 cases were treated with anti-IL-12/23. The endoscopic response rates of patients treated with anti-TNF-α and anti-IL-12/23 were 74.5%(41/55) and 66.7%(14/21), respectively, and the endoscopic remission rates at week 48 were 49.1%(27/55) and 28.6%(6/21), respectively; and the differences were not statistically significant( χ2=0.47 and 2.60, P=0.492 and 0.107). Conclusion:Both anti-TNF-α and anti-IL-12/23 are effective as first-line biological therapies for CD, and there are no significant differences in both clinical and endoscopic efficacy between these 2 biologics.

Objective:To compare the role of double-balloon enteroscopy (DBE) and dual-energy CT enterography (DCTE) in evaluating the clinical characteristics of Crohn′s disease (CD).Methods:From July 1, 2016 to November 1, 2023, 72 patients with CD who underwent both DBE and DCTE (with an interval of less than 3 months) in the First Affiliated Hospital of Soochow University were enrolled in this retropective study. Among them, 4 patients underwent both DBE and DCTE twice (a total of 76 cases). The data of DBE and DCTE in the diagnosis of 76 CD cases were analyzed, including the diagnostic rate of CD, the consistency of the 2 methods in detecting the lesion location (ileocecal, colonic, ileocolonic, and upper gastrointestinal tract involvement), and the detection rates of stenosis, ulcer and the location, long ulcer (long-diameter≥2 cm), and fistula. Kappa test was performed for the consistency analysis, and Chi-square test was used for statistical analysis.Results:The diagnostic rate of CD by DBE was higher than that by DCTE (80.3% (61/76) vs. 65.8% (50/76)), and the diagnostic rate of combination of the 2 methods (89.5% (68/76)) was higher than that by DCTE alone, and the differences were statistically significant ( χ2=4.04 and 12.28, P=0.044 and <0.001). The result of Kappa consistency test showed that the consistency of CD lesion location detected by DBE and DCTE was poor (Kappa value=0.29, t=3.17, P=0.002). The detection rate of stenosis by DBE was higher than that by DCTE (46.1% (35/76) vs. 13.2% (10/76)), the detection rate of stenosis by combination of the 2 methods (52.6% (40/76)) was higher than that by DCTE alone, and the differences were statistically significant ( χ2=19.73 and 26.82, both P<0.001). There were no statistically significant differences in the detection rates of fistula among DBE, DCTE, and the combination of the 2 methods (3.9%(3/76), 2.6% (2/76), 5.3% (4/76); all P>0.05). The detection rate of ulcer by DBE was higher than that by DCTE(73.7% (56/76) vs. 7.9% (6/76)), the detection rate of ulcer by combination of the 2 methods (76.3%(58/56)) was higher than that by DCTE alone, and the differences were statistically significant ( χ2=68.10 and 72.98, both P<0.001). The detection rates of long ulcer and non-terminal ileum ulcer by DBE were both 17.9% (10/56). All the 6 cases with ulcer detected by DCTE were located in the terminal ileum, and no long ulcers were observed. Conclusions:In the diagnosis of CD, as well as in the detection of stenosis and ulcer, DBE and the combination of DBE and DCTE have more advantages over DCTE alone. The consistency between DBE and DCTE in identifying the location of lesion is poor. DBE has advantages in detecting long ulcer and non-terminal ileum ulcer.

ObjectiveTo investigate the difference in the level of biliary calprotectin between patients with cholangiocarcinoma and those with choledocholithiasis. MethodsClinical data and bile samples were collected from 34 patients with cholangiocarcinoma and 78 patients with choledocholithiasis who were diagnosed and treated with endoscopic retrograde cholangiopancreatography in The First Affiliated Hospital of Anhui Medical University from May 2021 to September 2022. Fluorescence lateral flow immunoassay was used to measure the levels of calprotectin， hemoglobin， and lactoferrin in bile. The Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups； the Spearman correlation test was used for correlation analysis； the DeLong test was used for comparison of the area under the ROC curve （AUC）. ResultsCompared with the choledocholithiasis group， the cholangiocarcinoma group had significant increases in the levels of calprotectin ［4 795.50 （2 286.79‍ ‍—‍ ‍20 179.73） ng/mL vs 411.16 （67.03‍ ‍—‍ ‍1 991.88） ng/mL， Z=5.572， P<0.001］ and fluoride ［115.70 （109.10‍ — ‍125.50） mmol/L vs 106.60 （98.60‍ ‍—‍ ‍114.40） mmol/L， Z=2.702， P=0.007］. The patients with cholangiocarcinoma were further divided into high cholangiocarcinoma group and low cholangiocarcinoma group， and there was no significant difference between the two groups in the level of calprotectin ［3 867.71 （2 235.66‍ — ‍26 407.40） ng/mL vs 4 795.50 （2 361.15‍ — ‍13 070.53） ng/mL， Z=0.129， P>0.05］. Biliary calprotectin level was correlated with white blood cell count， hemoglobin concentration， and lactoferrin concentration in bile （r=0.316， 0.353， and 0.464， all P<0.05）. The ROC curve analysis showed that biliary calprotectin （with a sensitivity of 79.4% and a specificity of 75.6%）， blood CA19-9 （with a sensitivity of 82.4% and a specificity of 78.2%）， and their combination （with a sensitivity of 88.2% and a specificity of 73.1%） had good sensitivity and specificity in the diagnosis of cholangiocarcinoma. ConclusionThere is an increase in the level of biliary calprotectin in patients with cholangiocarcinoma， and therefore， it might become a biomarker for the diagnosis of cholangiocarcinoma.

Background::Transplant renal artery stenosis (TRAS) is a vascular complication after kidney transplantation associated with poor outcomes. This study aimed to analyze the efficacy and safety of low-dose aspirin for preventing TRAS.Methods::After kidney transplantation, patients were enrolled from January 2018 to December 2020 in Henan Provincial People’s Hospital. A total of 351 enrolled recipients were randomized to an aspirin group with low-dose intake of aspirin in addition to standard treatment ( n = 178), or a control group with only standard treatment ( n = 173). The patients was initially diagnosed as TRAS (id-TRAS) by Doppler ultrasound, and confirmed cases were diagnosed by DSA (c-TRAS). Results::In the aspirin and control groups, 15.7% (28/178) and 22.0% (38/173) of the recipients developed id-TRAS, respectively, with no statistical difference. However, for c-TRAS, the difference of incidence and cumulative incidence was statistically significant. The incidence of c-TRAS was lower in the aspirin group compared with the control group (2.8% [5/178] vs. 11.6% [20/173], P = 0.001). Kaplan–Meier estimates and Cox regression model identified the cumulative incidence and hazard ratio (HR) of TRAS over time in two groups, showing that recipients treated with aspirin had a significantly lower risk of c-TRAS than those who were not treated (log-rank P = 0.001, HR = 0.23, 95% confidence interval [CI]: 0.09–0.62). The levels of platelet aggregation rate ( P < 0.001), cholesterol ( P = 0.028), and low-density lipoprotein cholesterol ( P = 0.003) in the aspirin group were decreased compared with the control group in the third-month post-transplantation. For the incidence of adverse events, there was no statistical difference. Conclusion::Clinical application of low-dose aspirin after renal transplant could prevent the development of TRAS with no significant increase in adverse effects.Trial Registration::Clinicaltrials.gov, NCT04260828.

Objective:To investigate the activation level of neutrophil extracellular trap (NET) in the bile of patients with choledocholithiasis and its clinical significance.Methods:From May 2021 to October 2022, 130 patients underwent endoscopic retrograde cholangiopancreatography (ERCP) at the Department of Gastroenterology, the First Affiliated Hospital of Anhui Medical University were enrolled. The patients were divided into choledocholithiasis group (90 cases) and non-choledocholithiasis group (40 cases), and the choledocholithiasis group was further divided into large stone group (maximum diameter >1 cm, 36 cases) and small stone group (maximum diameter≤1 cm, 54 cases). The bile samples were collected from 130 patients during operation and 16 choledocholithiasis patients with nasobiliary drainage at 24 h after operation.The levels of myeloperoxidase(MPO), neutrophilelastase(NE), and citrullinated histone H3(CitH3) in bile were detected by enzyme-linked immunosorbent assay.The levels of MPO, NE, and CitH3 were compared between choledocholithiasis group and non-choledocholithiasis group, between large stone group and small stone group, as well as between choledocholithiasis patients before ERCP and after ERCP. Mann-Whitney U test and Wilcoxon signed rank test were used for statistical analysis. Results:The levels of MPO, NE and CitH3 in the bile of choledocholithiasis group were 32.6 U/L(28.5 U/L), 30.6 ng/L(35.2 ng/L) and 0.37 μg/L(0.73 μg/L), respectively, which were all higher than those of non-choledocholithiasis group (19.9 U/L(36.4 U/L), 18.2 ng/L(27.4 ng/L), and 0.10 μg/L(0.25 μg/L)), and the differences were statistically significant ( Z=2.91, 3.20 and 3.34; P=0.004, 0.001 and 0.001). The levels of MPO, NE and CitH3 of large stone group were 47.0 U/L(49.4 U/L), 48.4 ng/L(39.5 ng/L) and 0.83 μg/L(1.08 μg/L), respectively, which were all higher than those of small stone group (29.3 U/L(17.5 U/L), 24.0 ng/L(25.8 ng/L), and 0.27 μg/L(0.45 μg/L)), and the differences were statistically significant ( Z=2.01, 3.58 and 3.63; P=0.044, <0.001 and <0.001). The levels of MPO, NE and CitH3 in the bile of choledocholithiasis patients after ERCP significantly decreased compare with those before ERCP (19.4 U/L(19.8 U/L) vs. 33.6 U/L(36.7 U/L), 12.7 ng/L(15.1 ng/L) vs. 22.7 ng/L(25.9 ng/L), 0.05 μg/L(0.12 μg/L) vs. 0.14 μg/L(0.27 μg/L)), and the differences were statistically significant ( Z=3.52, 3.30 and 3.18; all P<0.001). Conclusion:The activation level of NET in the bile of patients with choledocholithiasis increase, while the activation level of NET decrease after ERCP, which indicate that NET may be involved in the formation of choledocholithiasis.

Objective To compare the effect of postoperative between total intravenous anesthesia(TIVA)use of alfentanil and remifentanil undergoing endoscopic sinus surgery.Methods A total of 130 and thirty patients scheduled for endoscopic sinus surgery,62 males and 68 females,aged 18-64 years,BMI 18-30 kg/m2,ASA physical status Ⅰ or Ⅱ,were randomly divided into two groups:alfentanil group(group A)and remifentanil group(group R).Midazolam 0.02 mg/kg,propofol target-controlled infusion(TCI)3 μg/ml,alfentanil 20 μg/kg,and rocuronium 0.6 mg/kg were injected intravenously in group A,and target-controlled infusion of propofol combined with alfentanil was used to maintain anesthesia.Midazo-lam 0.02 mg/kg,propofol TCI 3 μg/ml,remifentanil 1 μg/kg,and rocuronium 0.6 mg/kg were injected intravenously in group R,and target-controlled infusion of propofol combined with remifentanil was used to maintain anesthesia.The number of intraoperative hemodynamic adverse reactions such as hypertension,tachycardia,hypotension,bradycardia during operation,and pain degree at 30 minutes,60 minutes,24 hours after operation,extubation time,and rescue analgesia and adverse reactions such as nausea and vomi-ting,skin pruritus,respiratory depression within 24 hours after operation were recorded.Results Compared with group R,the incidence of intraoperative hypotension in group A was significantly lower(P＜0.05),the incidence of painless in group A 30 and 60 minutes after operation was significantly higher(P＜0.05),the incidence of mild and moderate pain was significantly decreased(P＜0.05),and the recovery time was significantly prolonged(P＜0.05).There was no significant difference in rescue analgesia within 24 hours after operation.There were no significant differences in the incidence of postoperative nausea and vomiting,postoperative skin pruritus,and respiratory depression between the two groups.Conclusion In endoscopic sinus surgery,the effect of total intravenous anesthesia with alfentanil on postoperative analgesia is better than that of remifentanil,and the incidence of perioperative and postoperative adverse reactions in alfentanil is lower than that of remifentanil,while the recovery time of alfentanil is slightly longer than that of remifentanil.

OBJECTIVE: To investigate the efficacy and safety of aromatase inhibitor letrozole in treatment of male children with disorders of sex development (DSD). METHODS: Clinical data of 12 male DSD children with a mean age of 14.6±2.5 years admitted to Peking Union Medical College Hospital from January 2014 to January 2016 were retrospectively analyzed. The patients were treated with letrozole (1.25-2.5 mg, once a day) for 3 months or longer, and followed up for 0.5-2.5 years. Clinical manifestation and laboratory test findings were documented, and the efficacy and safety were evaluated. RESULTS: After half-year treatment, the blood luteinizing hormone (LH), follicle-stimulating hormone (FSH) and testosterone levels of patients increased (all < 0.05), and estrogen levels decreased from baseline ( < 0.05). After 1 year of treatment, the blood testosterone level was significantly higher ( < 0.05); the LH and FSH levels tended to increase and the estrogen level tended to decrease, but there was no significant statistical difference ( >0.05). Semen was routinely detected in 8 patients, and sperms were detected in semen of 3 patients with hypospadias. There were no significant changes in biochemical results after treatment, and no significant adverse event was observed during the treatment. CONCLUSIONS Letrozole can effectively increase testosterone levels in patients with disorders of sex development and promote spermatogenesis, it has no significant adverse effects in short-term administration.
Adolescent ; Child ; Disorders of Sex Development ; drug therapy ; Follicle Stimulating Hormone ; Humans ; Letrozole ; therapeutic use ; Luteinizing Hormone ; Male ; Retrospective Studies ; Testosterone

To explore the status of cancer pain management among hospitalized elderly patients.Pain intensity,use of analgesic drugs and incidence of adverse reactions were surveyed for 620 cancer pain patients.And 218 of them were aged over 65 years.The proportions of mild,moderate and severe pain were 29.8％,36.2％ and 34.0％ respectively.And the corresponding rates in young and middle-aged patients were 28.4％,34.8％ and 36.8％ respectively (P ＞ 0.05).In elders with cancer pain,28％ used no analgesic.For severe pain patients,only 71.6％ received potent opioids and 5.4％ nonsteroidal antiinflammatory drugs.And the corresponding rates in young and middle-aged patients were 26.1％,73.0％ and 4.7％ respectively (P ＞ 0.05).The rates of constipation,dysuria and delirium in elderly patient group were higher than young and middle-aged patient group (P ＜ 0.05).Pain management is unsatisfactory and rational uses of analgesic drugs should be strengthened for preventing the relevant adverse reactions.