1.Comparison of the efficacy of ustekinumab and vedolizumab in achieving transmural healing in active Crohn′s disease
Long JU ; Yujie ZHAO ; Changqin LIU ; Yanhong SHI ; Xiaomin SUN ; Zhanju LIU ; Xiaolei WANG
Chinese Journal of Digestion 2025;45(2):107-116
Objective:To compare the efficacy of ustekinumab (UST) and vedolizumab (VDZ) in achieving transmural healing in active Crohn′s disease (CD).Methods:From March 1, 2020 to November 30, 2024, 112 patients with active CD treated with UST or VDZ at the Department of Gastroenterology, Tenth People′s Hospital of Tongji University were retrospectively enrolled. According to the medication regimen, the 112 patients were divided into UST group (61 cases) and VDZ group (51 cases). Collected the data at baseline, such as the disease phenotype, other medication history, and clinical indicators including C-creative protein (CRP), etc. Clinical disease activity and endoscopic disease activity were assessed by Harvey-Bradshaw index (HBI) and simplified endoscopic score for Crohn′s disease (SES-CD), respectively. Transmural healing was evaluated according to the intestinal wall thickness measured by intestinal imaging examination of the affected intestinal segment. Transmural healing was defined as bowel wall thickness <0.3 cm and 110 obvious signs of inflammation, clinical remission was defined as HBI≤4, and endoscopic remission was defined as a reduction in SES-CD ≥50% or a score of ≤2. The primary endpoint was transmural healing rate within one year after treatment. The secondary endpoints were endoscopic healing rate and clinical remission rate at 13 to 24th week and 30 to 52nd week after treatment. Chi-square test or Fisher′s exact test was used to compare the efficacy of the 2 medications.Results:There was no significant difference in transmural healing rate between UST group and VDZ group within 1 year after treatment (16.4% (10/61) vs. 23.5% (12/51), χ2=0.90, P=0.344). There were no significant differences in the healing rate between UST group and VDZ group in patients with specific baseline characteristics before treatment, including CD with stenosis, with perianal disease, no history of glucocorticoid use, secondary loss of response to anti-tumor necrosis factor (TNF)-α, SES-CD 7 to 15, decreased body mass index, and increased CRP (18.2%(6/33) vs. 19.4%(7/36), 17.9%(7/39) vs. 19.4%(6/31), 17.1%(6/35) vs. 24.2%(8/33), 20.0%(8/40) vs. 3/18, 14.3%(5/35) vs. 19.2%(5/26), 15.0%(3/20) vs. 3/10, 21.4%(6/28) vs. 5/16), all P>0.05). There was no significant difference in the clinical remission rate or endoscopic remission rate between the UST group and the VDZ group from 13 to 24th week (7/14 vs. 9/18, 3/14 vs. 7/18, RR=1.000 and 0.551, 95% confidence interval: 0.497to 2.011, 0.173to 1.755, χ2=<0.01, Fisher′s exact test, both P>0.05). There was no significant difference in clinical remission rate or endoscopic remission rate between UST group and VDZ group from week 30 to week 52 after treatment (68.5% (37/54) vs. 74.4% (32/43), 27.8% (15/54) vs. 32.6% (14/43), RR=0.921 and 0.853, 95% confidence interval: 0.716 to 1.184, 0.464 to 1.568, χ2=0.41 and 0.26, both P>0.05). In UST group, the proportion of patients with normal hemoglobin after transmural healing was higher than that of patients without transmural healing (9/10 vs. 45.1% (23/51), and the difference was statistically significant ( χ2=5.08, P=0.024). However, there were no significant differences in the proportion of patients with normal body mass index, CRP, platelet count, prealbumin, albumin, interleukin-6 or TNF-α levels after treatment between those who achieved transmural healing and those who did not in either UST group or VDZ group (all P>0.05). And in VDZ group there was no significant difference in the proportion of patients with normal hemoglobin between those who achieved transmural healing and who did not (all P>0.05). Conclusion:UST and VDZ exhibit similar efficacy in transmural healing within one year of treatment in patients with active CD.
2.Efficacy and safety of adalimumab originator and biosimilars in the treatment of Crohn′s disease
Xiaohui LI ; Jingyi JU ; Qinglu YANG ; Pengyun YIN ; Jiaolan YANG ; Cui ZHANG ; Changqin LIU ; Zhanju LIU ; Xiaomin SUN
Chinese Journal of Digestion 2025;45(3):177-181
Objective:To evaluate the efficacy and safety of adalimumab (ADA) originator and biosimilars in the treatment of Crohn′s disease (CD).Methods:From January 2020 to January 2023, the clinical data of 73 patients who were diagnosed as CD and received ADA treatment at the Department of Gastroenterology, the Tenth People′s Hospital of Tongji University were retrospectively analyzed. Among them, 30 patients received ADA originator treatment (National Medicine Approval Number SJ20181019; originator group), 23 patients received biosimilar A treatment (Medicine Medicine Approval Number S20190038; biosimilar A group), and 20 patients received biosimilar B (Medicine Medicine Approval Number S20190043; biosimilar B group). At 12 and 48 weeks after treatment, the clinical data of clinical remission (Crohn′s disease activity index(CDAI) score <150), clinical response (CDAI score decreased ≥ 70 from baseline), endoscopic remission (simple endoscopic score for Crohn′s disease (SES-CD) ≤ 2 or Rutgeerts score ≤ 1), endoscopic response (SES-CD decreased > 50% from baseline), and adverse drug reaction (ADR) were collected. Chi-square test or Fisher′s exact test was used for statistical analysis.Results:After 12 weeks of ADA treatment, the overall clinical remission rate was 69.9% (51/73), which of the biosimilar A group was 69.6% (16/23), the biosimilar B group was 75.0% (15/20), and the originator group was 66.7% (20/30). The overall clinical response rate was 83.6% (61/73), which of the biosimilar A group was 82.6% (19/23), the biosimilar B group was 80.0% (16/20), and the originator group was 86.7% (26/30). The overall endoscopic remission rate was 42.5% (31/73), which of the biosimilar A group was 52.2% (12/23), the biosimilar B group was 45.0% (9/20), and the originator group was 33.3% (10/30). The overall endoscopic response rate was 63.0% (46/73), which of the biosimilar A group was 73.9% (17/23), the biosimilar B group was 70.0% (14/20), and the originator group was 50.0% (15/30). And in the above data, there were no statistically significant differences among the 3 groups (all P>0.05). After 48 weeks of treatment, the overall clinical remission rate was 54.2% (32/59), which of the biosimilar A group was 8/18, the biosimilar B group was 9/15, and the originator group was 57.7% (15/26). The overall clinical response rate was 71.2% (42/59), which of the biosimilar A group was 10/18, the biosimilar B group was 12/15, and the originator group was 76.9% (20/26). The overall endoscopic remission rate was 25.4% (15/59), which of the biosimilar A group was 5/18, the biosimilar B group was 3/15, and the originator group was 26.9% (7/26). The overall endoscopic response rate was 40.7% (24/59), which of the biosimilar A group was 7/18, the biosimilar B group was 5/15, and the originator group was 46.2% (12/26). And in the above data, there were no statistically significant differences among the 3 groups (all P>0.05). The overall incidence of ADR was 32.9% (24/73), which of the biosimilar A group was 30.4% (7/23), the biosimilar B group was 30.0% (6/20), and the originator group was 36.7% (11/30); and there was no statistically significant difference among the 3 groups ( P=0.847). Conclusion:ADA biosimilars A and B demonstrate comparable efficacy and safety to the originator medication in the treatment of CD.
3.Efficacy and safety of ferric derisomaltose injection versus iron sucrose injection in the treatment of iron deficiency anemia in patients with inflammatory bowel disease
Changqin LIU ; Xiaomin SUN ; Cui ZHANG ; Liang CHEN ; Zhanju LIU
Chinese Journal of Digestion 2025;45(4):241-246
Objective:To compare and analyze the clinical efficacy and safety of ferric derisomaltose injection (FDI) and iron sucrose injection (ISI) in the treatment of iron deficiency anemia (IDA) in patients with inflammatory bowel disease (IBD).Methods:From January 1, 2023 to August 31, 2024, 89 IBD patients complicated with IDA hospitalized and treated at the Department of Gastroenterology, Tenth People′s Hospital of Tongji University were enrolled and divided into the FDI group (44 cases) and ISI group (45 cases). Patients in the FDI group and ISI group were treated with FDI and ISI, respectively, and the treatment course were both 8 weeks. The iron supplementation dose, number of injections, and efficacy (response rate) were compared between the 2 groups. Hemoglobin (Hb) levels were measured before treatment and at the 2nd, 4th, and 8th week after treatment. After 8 weeks of treatment, the changes in serum iron, C-reactive protein (CRP), Crohn′s disease activity index (CDAI), modified Mayo score, inflammatory bowel disease questionnaire (IBDQ) score, and serum phosphorus levels were compared with those before treatment. Chi-square test, paired t-test, independent sample t-test, Wilcoxon signed-rank test, and Mann-Whitney U test were used for statistical analysis. Results:The difference between required and actual iron supplementation and number of injections of the FDI group were both less than those of the ISI group ((466±264) mg vs. (571±302) mg, 1.0 (1.0, 1.0) vs. 3.0 (2.0, 5.5)), and the differences were statistically significant ( t=3.69, U=104.50; both P<0.001). After 8 weeks of treatment, the efficacy and increase in serum iron of the FDI group were both higher than those of the ISI group (81.8% (36/44) vs. 60.0% (27/45), 7.35 (4.53, 12.68) μmol/L vs. 3.60 (1.10, 8.20) μmol/L), and the differences were statistically significant ( χ2=5.12, U=545.40; P=0.024, <0.001). After 2, 4, and 8 weeks of treatment, the increase in Hb from before treatment of the FDI group were higher than those of the ISI group (22.5 (8.5, 29.0) g/L vs. 7.0 (2.0, 23.5) g/L; 29.5 (22.0, 49.8) g/L vs. 14.0 (6.0, 32.0) g/L; 36.5 (25.5, 60.5) g/L vs. 21.0 (7.0, 42.0) g/L), and the differences were statistically significant ( U=590.00, 518.00, and 584.00; all P<0.001). The reductions in CDAI, modified Mayo score, and CRP, as well as the improvement in IBDQ score before and after treatment were comparable between the FDI group and the ISI group (130.7±70.3 vs. 128.8±74.6, 7.3±2.3 vs. 5.8±3.2, 26.73 (2.44, 63.44) mg/L vs. 7.41 (1.86, 47.39) mg/L, 38.5±28.4 vs. 37.0±28.1), and the differences were not statistically significant (all P>0.05). In the FDI group serum phosphorus levels after 4 and 8 weeks of treatment were both higher than that before treatment (1.27(1.13, 1.45), 1.23(1.13, 1.40) mmol/L vs. 1.21 (1.03, 1.28) mmol/L), and the differences were statistically significant ( Z=539.00 and 454.00, both P<0.001). During the treatment, mild to moderate adverse reactions occurred in 13.6% (6/44) patients of the FDI group and 11.1% (5/45) patients of the ISI group, there were no serious adverse events. Conclusion:FDI can rapidly, effectively, and safely improve IDA in IBD patients without affecting blood phosphate metabolism.
4.Construction of an ultrasound dynamic image segmentation model for thyroid nodules
Junpu HU ; Jialu LI ; Mengjie DOU ; Gang WANG ; Keyan LI ; Xiaofang FU ; Hao SUN ; Changqin SUN ; Duo SHI ; Yan LIAO ; Qiong WANG ; Faqin LYU
Chinese Journal of Ultrasonography 2025;34(6):518-524
Objective:To construct a thyroid nodule segmentation model using ultrasound dynamic images and explore its potential for assisting in the screening of thyroid nodules.Methods:A total of 126 patients with thyroid nodules(comprising 150 nodules)who were diagnosed and treated at Xuzhou Cancer Hospital from April 2024 to December 2024 were prospectively enrolled. Two-dimensional ultrasound was performed to capture short-axis and long-axis video images of thyroid nodules,forming a dynamic ultrasound image dataset. The dataset was divided into training,validation,and test sets in a ratio of 6∶1∶3. After the training loss curve converged,the model that performed well on the validation set was selected for testing. Three-fold cross-validation was employed for training and testing. All 300 ultrasound videos were divided into three subsets. In each experiment,two subsets were used as the training set,and one subset was used as the test set to evaluate the model's generalization ability. A collaborative spatiotemporal diffusion model was established based on the dynamic trends and tissue texture details of thyroid nodules. Six widely used segmentation metrics were employed to evaluate the model's application capabilities.Results:The study included 126 patients with 150 thyroid nodules,300 dynamic ultrasound images,and video lengths of 3-4 seconds per nodule,resulting in 12 312 segmented images. The size of the thyroid nodules was(10.7 ± 10.6)mm(transverse diameter)×(8.4 ± 6.3)mm(anteroposterior diameter). Among the nodules,62(41.3%)had clear boundaries,while 88(58.7%)had indistinct boundaries;61(40.7%)exhibited regular shapes,while 89(59.3%)were irregular;66(44.0%)had a taller-than-wide aspect ratio;and 70(46.7%)showed microcalcifications. The collaborative diffusion model based on dynamic ultrasound image segmentation achieved the following scores:a Jaccard score of(69.22 ± 0.03)%,a Dice score of(79.16 ± 0.18)%,a Precision score of(86.70 ± 0.17)%,a Recall score of(77.82 ± 0.04)%,an Sα score of(85.26 ± 0.01)%,and an Eθmn score of(90.58 ± 0.17)%. Compared to other models,this model demonstrated significant improvements across all evaluation metrics,achieving the highest values in each metric with increments of over 8% and 1%,respectively. Conclusions:The collaborative diffusion model with a dynamic controller,constructed based on dynamic ultrasound images of thyroid nodules,demonstrates excellent performance in ultrasound image segmentation. It improves the accuracy of thyroid nodule screening,thereby providing a valuable auxiliary diagnostic tool for clinical practice.
5.Automatic recognition and segmentation of brachial plexus in ultrasonic images based on deep learning
Duo SHI ; Han ZHANG ; Peipei LIU ; Ruichao ZHANG ; Qingyu LIU ; Hao SUN ; Xiaofang FU ; Mengjie DOU ; Junpu HU ; Changqin SUN ; Keyan LI ; Jianqiu HU ; Guangquan ZHOU ; Ligang CUI ; Ping ZHOU ; Faqin LYU
Chinese Journal of Ultrasonography 2025;34(9):737-744
Objective:To propose a deep learning(DL)-based ultrasound imaging auxiliary tool for automatic segmentation and recognition of the brachial plexus(BP),and to enhance the accuracy and safety of clinical procedures.Methods:It was a multicenter study that collected 773 healthy subjects from Peking University Third Hospital and its branch campuses,the Third Medical Center of the Chinese PLA General Hospital,and Shanghai Eighth People's Hospital between August 2024 and February 2025. Brachial plexus(BP)images in the interscalene groove were captured used high-frequency ultrasound by senior sonographers,a dataset comprising 1 289 standardized images were constructed and the improved model(CHA-TransUNet)was trained. The test set was input into 6 different models(CHA-TransUNet,R50-Unet,TransUnet,SegFormer,SwinUnet,MISSFormer)for segmentation. Segmentation accuracy was evaluated using metrics including the Dice similarity coefficient(DSC),95% Hausdorff distance(HD95)and mean intersection over union(mIoU),and was compared with the segmentation results of 3 ultrasound physicians with varying experience levels(junior physicians and senior physicians)to validate the model's segmentation efficacy.Results:The CHA-TransUNet model established based on a dataset of 1 289 standardized images achieved segmentation results for the BP with a DSC of 90.15%,mIoU of 91.02%,and HD95 of 8.08. Its accuracy was higher than other mainstream models(DSC:90.15% vs. 87.60%,87.77%,81.35%,84.78%,84.55%),significantly better than junior physicians(DSC:90.15% vs. 68.73%, Z=-127.76, P<0.001),and approached the level of senior physician(DSC:90.15% vs. 86.15%, Z=-31.33, P=0.549). The model demonstrated superior boundary recognition in complex anatomical structures(e.g.,C6/C7 nerve roots)compared to ultrasound physicians(junior and senior)(HD95:8.08 vs. 26.34,17.44,56.80). Conclusions:This study proposes an analysis model for BP ultrasound images,CHA-TransUNet. This model achieves segmentation and recognition of the BP with relatively complex pathways and structures. The model exhibits high accuracy and stability,outperforming current mainstream network models and junior physicians while approaching the performance level of senior physicians. It assists junior physicians or trainees in more accurately identifying and localizing the BP.
6.Isolation,identification and antimicrobial susceptibility of a strain of Haemophi-lus parasuis
Xi LIU ; Geng WANG ; Zhengdan LIN ; Xiuxiu SUN ; Xinxin JIN ; Li LI ; Junjie YANG ; Xue-ying HU ; Changqin GU ; Wanpo ZHANG ; Xiaoli LIU ; Teng YU ; Guofu CHENG
Chinese Journal of Veterinary Science 2025;45(2):219-226
Porcine arthritis,one of the common chronic diseases in large-scale pig farms,can signifi-cantly reduce the production performance of meat pigs.In this study,a strain of Haemophilus pa-rasuis(HPS)was isolated from the joint fluid of a lame pig.The HPS was analyzed in terms of se-rotypes,virulence genes,and resistance genes.Additionally,it was treated with sensitive antibiotics to provide a theoretical basis for the comprehensive prevention and treatment of arthritis in meat pigs in future production settings.A strain of HPS type 14 was isolated from the joint fluid of dis-eased pigs.The HPS isolate demonstrated sensitivity to β-lactams and tetracyclines,while florfeni-col and polymyxin effectively inhibited its growth at low concentrations.However,the bacteria ex-hibited resistance to sulfonamides and ciprofloxacin.The treatment of affected pigs with clinical ar-thritis using doxycycline and enrofloxacin injections proved effective.Compared to the infected group,in which the sick pigs experienced difficulty flexing their carpal and tarsal joints and exhibi-ted significant lameness,the pigs in the treatment group showed marked improvement.Their joints were only slightly swollen,and the clinical symptoms of arthropathy were alleviated.
7.Isolation,identification and antimicrobial susceptibility of a strain of Haemophi-lus parasuis
Xi LIU ; Geng WANG ; Zhengdan LIN ; Xiuxiu SUN ; Xinxin JIN ; Li LI ; Junjie YANG ; Xue-ying HU ; Changqin GU ; Wanpo ZHANG ; Xiaoli LIU ; Teng YU ; Guofu CHENG
Chinese Journal of Veterinary Science 2025;45(2):219-226
Porcine arthritis,one of the common chronic diseases in large-scale pig farms,can signifi-cantly reduce the production performance of meat pigs.In this study,a strain of Haemophilus pa-rasuis(HPS)was isolated from the joint fluid of a lame pig.The HPS was analyzed in terms of se-rotypes,virulence genes,and resistance genes.Additionally,it was treated with sensitive antibiotics to provide a theoretical basis for the comprehensive prevention and treatment of arthritis in meat pigs in future production settings.A strain of HPS type 14 was isolated from the joint fluid of dis-eased pigs.The HPS isolate demonstrated sensitivity to β-lactams and tetracyclines,while florfeni-col and polymyxin effectively inhibited its growth at low concentrations.However,the bacteria ex-hibited resistance to sulfonamides and ciprofloxacin.The treatment of affected pigs with clinical ar-thritis using doxycycline and enrofloxacin injections proved effective.Compared to the infected group,in which the sick pigs experienced difficulty flexing their carpal and tarsal joints and exhibi-ted significant lameness,the pigs in the treatment group showed marked improvement.Their joints were only slightly swollen,and the clinical symptoms of arthropathy were alleviated.
8.Construction of an ultrasound dynamic image segmentation model for thyroid nodules
Junpu HU ; Jialu LI ; Mengjie DOU ; Gang WANG ; Keyan LI ; Xiaofang FU ; Hao SUN ; Changqin SUN ; Duo SHI ; Yan LIAO ; Qiong WANG ; Faqin LYU
Chinese Journal of Ultrasonography 2025;34(6):518-524
Objective:To construct a thyroid nodule segmentation model using ultrasound dynamic images and explore its potential for assisting in the screening of thyroid nodules.Methods:A total of 126 patients with thyroid nodules(comprising 150 nodules)who were diagnosed and treated at Xuzhou Cancer Hospital from April 2024 to December 2024 were prospectively enrolled. Two-dimensional ultrasound was performed to capture short-axis and long-axis video images of thyroid nodules,forming a dynamic ultrasound image dataset. The dataset was divided into training,validation,and test sets in a ratio of 6∶1∶3. After the training loss curve converged,the model that performed well on the validation set was selected for testing. Three-fold cross-validation was employed for training and testing. All 300 ultrasound videos were divided into three subsets. In each experiment,two subsets were used as the training set,and one subset was used as the test set to evaluate the model's generalization ability. A collaborative spatiotemporal diffusion model was established based on the dynamic trends and tissue texture details of thyroid nodules. Six widely used segmentation metrics were employed to evaluate the model's application capabilities.Results:The study included 126 patients with 150 thyroid nodules,300 dynamic ultrasound images,and video lengths of 3-4 seconds per nodule,resulting in 12 312 segmented images. The size of the thyroid nodules was(10.7 ± 10.6)mm(transverse diameter)×(8.4 ± 6.3)mm(anteroposterior diameter). Among the nodules,62(41.3%)had clear boundaries,while 88(58.7%)had indistinct boundaries;61(40.7%)exhibited regular shapes,while 89(59.3%)were irregular;66(44.0%)had a taller-than-wide aspect ratio;and 70(46.7%)showed microcalcifications. The collaborative diffusion model based on dynamic ultrasound image segmentation achieved the following scores:a Jaccard score of(69.22 ± 0.03)%,a Dice score of(79.16 ± 0.18)%,a Precision score of(86.70 ± 0.17)%,a Recall score of(77.82 ± 0.04)%,an Sα score of(85.26 ± 0.01)%,and an Eθmn score of(90.58 ± 0.17)%. Compared to other models,this model demonstrated significant improvements across all evaluation metrics,achieving the highest values in each metric with increments of over 8% and 1%,respectively. Conclusions:The collaborative diffusion model with a dynamic controller,constructed based on dynamic ultrasound images of thyroid nodules,demonstrates excellent performance in ultrasound image segmentation. It improves the accuracy of thyroid nodule screening,thereby providing a valuable auxiliary diagnostic tool for clinical practice.
9.Automatic recognition and segmentation of brachial plexus in ultrasonic images based on deep learning
Duo SHI ; Han ZHANG ; Peipei LIU ; Ruichao ZHANG ; Qingyu LIU ; Hao SUN ; Xiaofang FU ; Mengjie DOU ; Junpu HU ; Changqin SUN ; Keyan LI ; Jianqiu HU ; Guangquan ZHOU ; Ligang CUI ; Ping ZHOU ; Faqin LYU
Chinese Journal of Ultrasonography 2025;34(9):737-744
Objective:To propose a deep learning(DL)-based ultrasound imaging auxiliary tool for automatic segmentation and recognition of the brachial plexus(BP),and to enhance the accuracy and safety of clinical procedures.Methods:It was a multicenter study that collected 773 healthy subjects from Peking University Third Hospital and its branch campuses,the Third Medical Center of the Chinese PLA General Hospital,and Shanghai Eighth People's Hospital between August 2024 and February 2025. Brachial plexus(BP)images in the interscalene groove were captured used high-frequency ultrasound by senior sonographers,a dataset comprising 1 289 standardized images were constructed and the improved model(CHA-TransUNet)was trained. The test set was input into 6 different models(CHA-TransUNet,R50-Unet,TransUnet,SegFormer,SwinUnet,MISSFormer)for segmentation. Segmentation accuracy was evaluated using metrics including the Dice similarity coefficient(DSC),95% Hausdorff distance(HD95)and mean intersection over union(mIoU),and was compared with the segmentation results of 3 ultrasound physicians with varying experience levels(junior physicians and senior physicians)to validate the model's segmentation efficacy.Results:The CHA-TransUNet model established based on a dataset of 1 289 standardized images achieved segmentation results for the BP with a DSC of 90.15%,mIoU of 91.02%,and HD95 of 8.08. Its accuracy was higher than other mainstream models(DSC:90.15% vs. 87.60%,87.77%,81.35%,84.78%,84.55%),significantly better than junior physicians(DSC:90.15% vs. 68.73%, Z=-127.76, P<0.001),and approached the level of senior physician(DSC:90.15% vs. 86.15%, Z=-31.33, P=0.549). The model demonstrated superior boundary recognition in complex anatomical structures(e.g.,C6/C7 nerve roots)compared to ultrasound physicians(junior and senior)(HD95:8.08 vs. 26.34,17.44,56.80). Conclusions:This study proposes an analysis model for BP ultrasound images,CHA-TransUNet. This model achieves segmentation and recognition of the BP with relatively complex pathways and structures. The model exhibits high accuracy and stability,outperforming current mainstream network models and junior physicians while approaching the performance level of senior physicians. It assists junior physicians or trainees in more accurately identifying and localizing the BP.
10.Comparison of the efficacy of ustekinumab and vedolizumab in achieving transmural healing in active Crohn′s disease
Long JU ; Yujie ZHAO ; Changqin LIU ; Yanhong SHI ; Xiaomin SUN ; Zhanju LIU ; Xiaolei WANG
Chinese Journal of Digestion 2025;45(2):107-116
Objective:To compare the efficacy of ustekinumab (UST) and vedolizumab (VDZ) in achieving transmural healing in active Crohn′s disease (CD).Methods:From March 1, 2020 to November 30, 2024, 112 patients with active CD treated with UST or VDZ at the Department of Gastroenterology, Tenth People′s Hospital of Tongji University were retrospectively enrolled. According to the medication regimen, the 112 patients were divided into UST group (61 cases) and VDZ group (51 cases). Collected the data at baseline, such as the disease phenotype, other medication history, and clinical indicators including C-creative protein (CRP), etc. Clinical disease activity and endoscopic disease activity were assessed by Harvey-Bradshaw index (HBI) and simplified endoscopic score for Crohn′s disease (SES-CD), respectively. Transmural healing was evaluated according to the intestinal wall thickness measured by intestinal imaging examination of the affected intestinal segment. Transmural healing was defined as bowel wall thickness <0.3 cm and 110 obvious signs of inflammation, clinical remission was defined as HBI≤4, and endoscopic remission was defined as a reduction in SES-CD ≥50% or a score of ≤2. The primary endpoint was transmural healing rate within one year after treatment. The secondary endpoints were endoscopic healing rate and clinical remission rate at 13 to 24th week and 30 to 52nd week after treatment. Chi-square test or Fisher′s exact test was used to compare the efficacy of the 2 medications.Results:There was no significant difference in transmural healing rate between UST group and VDZ group within 1 year after treatment (16.4% (10/61) vs. 23.5% (12/51), χ2=0.90, P=0.344). There were no significant differences in the healing rate between UST group and VDZ group in patients with specific baseline characteristics before treatment, including CD with stenosis, with perianal disease, no history of glucocorticoid use, secondary loss of response to anti-tumor necrosis factor (TNF)-α, SES-CD 7 to 15, decreased body mass index, and increased CRP (18.2%(6/33) vs. 19.4%(7/36), 17.9%(7/39) vs. 19.4%(6/31), 17.1%(6/35) vs. 24.2%(8/33), 20.0%(8/40) vs. 3/18, 14.3%(5/35) vs. 19.2%(5/26), 15.0%(3/20) vs. 3/10, 21.4%(6/28) vs. 5/16), all P>0.05). There was no significant difference in the clinical remission rate or endoscopic remission rate between the UST group and the VDZ group from 13 to 24th week (7/14 vs. 9/18, 3/14 vs. 7/18, RR=1.000 and 0.551, 95% confidence interval: 0.497to 2.011, 0.173to 1.755, χ2=<0.01, Fisher′s exact test, both P>0.05). There was no significant difference in clinical remission rate or endoscopic remission rate between UST group and VDZ group from week 30 to week 52 after treatment (68.5% (37/54) vs. 74.4% (32/43), 27.8% (15/54) vs. 32.6% (14/43), RR=0.921 and 0.853, 95% confidence interval: 0.716 to 1.184, 0.464 to 1.568, χ2=0.41 and 0.26, both P>0.05). In UST group, the proportion of patients with normal hemoglobin after transmural healing was higher than that of patients without transmural healing (9/10 vs. 45.1% (23/51), and the difference was statistically significant ( χ2=5.08, P=0.024). However, there were no significant differences in the proportion of patients with normal body mass index, CRP, platelet count, prealbumin, albumin, interleukin-6 or TNF-α levels after treatment between those who achieved transmural healing and those who did not in either UST group or VDZ group (all P>0.05). And in VDZ group there was no significant difference in the proportion of patients with normal hemoglobin between those who achieved transmural healing and who did not (all P>0.05). Conclusion:UST and VDZ exhibit similar efficacy in transmural healing within one year of treatment in patients with active CD.

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