A refractory Crohn's disease patient with recurrent perianal fistulas failed to overcome the secondary loss of response to infliximab(IFX)after therapeutic drug monitoring,intensified anti-TNF dosing and in combination with azathioprine.Throughout the treatment process,clinical pharmacists assisted physicians in analyzing the risk factors and causes for loss of response,providing evidence for an individualized treatment strategy,and monitoring the efficacy and safety of the treatment.According to the relevant guidelines and literature,ustekinumab was the preferred biological agent after anti-TNF failure in perianal fistulizing Crohn's disease(pfCD).At the 12-week follow-up,fecal calprotectin and C-reactive protein decreased markedly,and the patient achieved fistula healing.This case provides references for current management strategy and perspective in IFX secondary non-responders with refractory pfCD,especially those who have undergone optimization therapy.

Objective:To compare the perinatal mental health status of women conceived through assisted reproductive technology (ART) and women conceived naturally.Methods:In a prospective China National Birth Cohort study, 2 693 pregnant women were enrolled in the International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, School of Medicine from March 2017 to March 2021. They were divided into ART group ( n=733) and natural conception (NC group, n=1 960) according to the mode of conception. Mental health was assessed in the first trimester (<14 weeks), the second trimester (22-26 weeks), and the third trimester (30-34 weeks) as well as 6 weeks after delivery. Antenatally, mental health status was assessed by using the Center for Epidemiologic Studies Depression Scale (CESD), Self-rating Anxiety Scale (SAS), and Perceived Stress Scale (PSS). Postpartum depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Logistic regression was used to analyze maternal mental health related factors. Results:Logistic regression results showed that women in the ART group were less likely to experience depressive symptoms compared with those in the NC group in the first trimester (a OR=0.81, 95% CI: 0.66-0.99), the second trimester (a OR=0.73, 95% CI: 0.60-0.90), the third trimester (a OR=0.82, 95% CI: 0.68-1.00) and 6 weeks after delivery (a OR=0.57, 95% CI: 0.43-0.75). Meanwhile, women in the ART group felt significantly less stress during pregnancy than women in the NC group (the first trimester, P<0.001; the second trimester, P<0.001; the third trimester, P=0.001). However, the difference in women's anxiety symptoms during pregnancy was not found to be significant between the two groups (all P>0.05). Conclusion:Women who conceived through ART have lower risks of perinatal mental health problems than those who conceived spontaneously.

Objective:To compare the perinatal mental health status of women conceived through assisted reproductive technology (ART) and women conceived naturally.Methods:In a prospective China National Birth Cohort study, 2 693 pregnant women were enrolled in the International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, School of Medicine from March 2017 to March 2021. They were divided into ART group ( n=733) and natural conception (NC group, n=1 960) according to the mode of conception. Mental health was assessed in the first trimester (<14 weeks), the second trimester (22-26 weeks), and the third trimester (30-34 weeks) as well as 6 weeks after delivery. Antenatally, mental health status was assessed by using the Center for Epidemiologic Studies Depression Scale (CESD), Self-rating Anxiety Scale (SAS), and Perceived Stress Scale (PSS). Postpartum depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Logistic regression was used to analyze maternal mental health related factors. Results:Logistic regression results showed that women in the ART group were less likely to experience depressive symptoms compared with those in the NC group in the first trimester (a OR=0.81, 95% CI: 0.66-0.99), the second trimester (a OR=0.73, 95% CI: 0.60-0.90), the third trimester (a OR=0.82, 95% CI: 0.68-1.00) and 6 weeks after delivery (a OR=0.57, 95% CI: 0.43-0.75). Meanwhile, women in the ART group felt significantly less stress during pregnancy than women in the NC group (the first trimester, P<0.001; the second trimester, P<0.001; the third trimester, P=0.001). However, the difference in women's anxiety symptoms during pregnancy was not found to be significant between the two groups (all P>0.05). Conclusion:Women who conceived through ART have lower risks of perinatal mental health problems than those who conceived spontaneously.

Based on next generation sequencing, preimplantation genetic testing (PGT), with novel strategy of mutated allele revealed by sequencing with aneuploidy and linkage analyses (MARSALA) is an economic and effective primary measure to control rare diseases by helping patients to select embryo free of monogenic diseases and aneuploidy (chromosome abnormality). With the commercialization of 5th generation mobile networks (5G) technology, "5G+blockchain" has brought a new development trend to PGT in the field of accurately control rare diseases. Therefore, in the present study, we summarize the current status of PGT and the characteristics of 5G and blockchain, then propose a plan to build a genetic diagnosis cloud service platform, a collaborative diagnosis and treatment platform for rare diseases, and a gene mutation database of Chinese population genetic disease, based on technology of 5G and blockchain in order to grasp the bonus of 5G era and promote the development of prevention and control of rare disease.

Based on next generation sequencing, preimplantation genetic testing (PGT), with novel strategy of mutated allele revealed by sequencing with aneuploidy and linkage analyses (MARSALA) is an economic and effective primary measure to control rare diseases by helping patients to select embryo free of monogenic diseases and aneuploidy (chromosome abnormality). With the commercialization of 5th generation mobile networks (5G) technology, "5G+blockchain" has brought a new development trend to PGT in the field of accurately control rare diseases. Therefore, in the present study, we summarize the current status of PGT and the characteristics of 5G and blockchain, then propose a plan to build a genetic diagnosis cloud service platform, a collaborative diagnosis and treatment platform for rare diseases, and a gene mutation database of Chinese population genetic disease, based on technology of 5G and blockchain in order to grasp the bonus of 5G era and promote the development of prevention and control of rare disease.

Objective     To report our experience with enhanced recovery after surgery (ERAS) protocol in patients undergoing transapical transcatheter aortic valve implantation (TAVI) and to determine perioperative predictors for ERAS failure. Methods     Between May 2018 and January 2019, 80 patients undergoing TAVI in our hospital were recruited. Among them, 40 patients (24 males, 16 females, aged 73.0±5.0 years) successfully received ERAS, defined as successful extubation in operating room (an ERAS group) and the other 40 patients (28 males, 12 females, aged 73.0±7.0 years, a non-ERAS group) failed to perform ERAS.  Results     Compared with the non-ERAS group, patients in the ERAS group were associated with a significantly lower incidence of postoperative complications (30.0% vs. 52.5%, P=0.04), shorter postoperative ICU stay (2.2±0.4 d vs. 4.0±4.8 d, P=0.00) and hospital stay (7.0±2.3 d vs. 9.5±4.8 d, P=0.00), and less medical cost (311±20 thousand yuan vs. 347±80 thousand yuan, P=0.00). Independent predictors of ERAS failure were poor preoperative heart function and elevated B-type natriuretic peptides.  Conclusion     ERAS protocol is feasible and effective in patients undergoing TAVI. Poor preoperative heart function is an independent predictor of failure in early extubation which, in turn, is associated with prolonged ICU and hospital stay and dramatic worsening of patient outcomes.

Objective     To discuss the key points of anesthesia for patients undergoing transcatheter aortic valve implantation (TAVI) surgery. Methods     We retrospectively collected and analyzed the data of 70 patients who underwent TAVI in the Department of Cardiovascular Surgery, West China Hospital from March 2014 to October 2015. There were 39 males and 31 females with an average age of 73.7±4.5 years. The perioperative preparation and anesthesia points of TAVI were summarized. Results     All of the 70 included patients were aged and at high risk severe comorbidities such as ischemic heart disease and stroke. The aortic stenosis and regurgitation occurred in 39 and 31 patients respectively. No patients died during the surgery. The total success rate was 95.7%. Conclusion     TAVI is a complex procedure for high risk patients and need more attention during anesthesia. The successful conduction of the procedure requires the whole team to prepare carefully and cooperate closely.

OBJECTIVE:To observe therapeutic efficacy and safety of infliximab (IFX) in the treatment of Crohn's disease (CD),and to investigate its influential factors. METHODS:In retrospective study,a total of 120 CD patients received IFX treat-ment in our hospital during Jan.-Dec. 2015 were selected as research objects. All patients were given IFX for injection 5 mg/kg intra-venously at 0,2nd,6th week and later every 8 weeks continously. Therapeutic efficacy indexes(body weight,CRP,ESR,WBC, mucosal healing under endoscope),liver and renal indexes (ALT,AST,AKP,γ-GT,TB,DB,Cr),the occurrence time of ADR,organs/systems involved,clinical manifestations and outcomes were compared before and after treatment. Influential factors were analyzed. RESULTS:Compared with before medication,body weight of patients were increased significantly,while ESR were decreased significantly,with statistical significance (P<0.05). There was positively correlation between above two indexes (r=0.275,P=0.016). Mucosal healing was found in 78.57％ of patients by colonoscopy. There was statistical significance in the levels of AST,AKP and Cr before and after treatment(P<0.05),but those indexes were increased slightly. AKP exceeded 2 times the upper limit of normal value in only 1 case,but AST did not exceed 2 times the upper limit of normal limit,Cr did not exceed the upper limit of normal value. There was no statistical significance in CRP,WBC or other liver and renal function indexes before and af-ter treatment(P>0.05). There were 24 cases of ADR with incidence of 20.00％. Respiratory system,digestive system,skin mucous membrane,body defense and other organs/systems were involved,mainly manifestating as uper respiratory tract infetion,liver func-tion indexes order etc. Ten patients(41.67％)delayed the treatment,and 6 cases(25.00％)discontinued. Standard rate of ESR in pa-tients with regular/primary medication (78.21％) was higher than those with intermittent medication history (57.14％),but without statistical significance(P>0.05). Combined use of mesalazine had no significant effect on the increase of AST and AKP(P=0.002). CONCLUSIONS:IFX significantly increases body weight of CD patients,decreases ESR and improves mucosal healing. It shows def-inite therapeutic efficacy. It is suggested that CD patients should use IFX regularly. The overall safety of IFX is good,but it may cause transfusion reaction and transient increase of liver function index. So,the patient's condition should be closely monitored during the in-fusion.

Objective To analyzed the effects of the positioning errors and weight variability of the head and neck cancer patients with intensity modulated radiation therapy (IMRT),or volumetric modulated arctherapy (VMAT) based on the kilovoltage cone-beam computed tomography (kV-CBCT).Methods CBCT images of 102 patients with head and neck cancer patients receiving IMRT or VMAT were screened by CBCT once a week for consecutively 6 weeks.The positioning errors were measured by comparing CBCT and planning CT in left-right (LR),anterior-posterior (AP) and cranio-caudal (CC) directions.Meanwhile,the weight of patients were measured every week.Results The positioning errors were (0.011 5±0.125 3) cm,(-0.017 6±0.123 3) cm and (-0.014 1±0.156 7) cm in LR,AP and CC directions,respectively.The mean systematic errors were all less than 0.02 cm in three axial directions,while the mean random errors were all within 0.2 cm.There was no statistically significant difference was observed among the setup errors in all three axial directions according to different week.Though the body weight of patients continued to drop during the radiation by with the mean weight loss of 3.5 kg and had a negative correlation with treatment course.Bivariate correlation analysis showed just the positioning errors in CC direction were significantly correlated with body weights loss.Conclusion There is no statistical relationship with in position errors of the patients with their treatment course,and the body weight loss seemed to influence the position errors in CC direction.

BACKGROUNDFollicle stimulating hormone is necessary for normal reproduction in men. The biochemical actions of follicle stimulating hormone result from binding to the follicle stimulating hormone receptor in the plasma membrane of Sertoli cells. Here, we investigated the expression of the follicle stimulating hormone receptor in different testicular histological phenotypes of patients with idiopathic azoospermia.

METHODSFifty-seven cases of idiopathic azoospermia were classified into three groups according to the results of testicular biopsy: patients with hypospermatogenesis, patients with maturation arrest, and patients with Sertoli cell-only syndrome. Thirteen azoospermic patients identified by testicular biopsy as being capable of completing spermatogenesis acted as the control group. Immunohistochemistry and real-time quantitative reverse-transcriptase polymerase chain reaction were performed in each case, and the serum hormone level was also measured in all patients.

RESULTSThe serum follicle stimulating hormone level in patients with Sertoli cell-only syndrome was significantly higher than in patients with hypospermatogenesis, maturation arrest, and complete spermatogenesis (P < 0.01). The serum follicle stimulating hormone level in patients with maturation arrest was significantly higher than in patients with hypospermatogenesis and complete spermatogenesis (P < 0.05). There was no difference in serum follicle stimulating hormone levels in patients with hypospermatogenesis and complete spermatogenesis. The follicle stimulating hormone receptor expression level of testicular samples with Sertoli cell-only syndrome was significantly higher than in those with hypospermatogenesis, maturation arrest, and complete spermatogenesis (P < 0.05), but no significant difference was observed among hypospermatogenesis, maturation arrest, and complete spermatogenesis testicular samples.

CONCLUSIONSDifferent serum follicle stimulating hormone levels and follicle stimulating hormone receptor expression were found in the different testicular histology phenotypes in azoospermic patients. Differential follicle stimulating hormone receptor expression in testicular tissue of patients with idiopathic azoospermia may be associated with the degree of spermatogenesis.

Adult ; Azoospermia ; blood ; metabolism ; Follicle Stimulating Hormone ; blood ; Humans ; Male ; Oligospermia ; blood ; metabolism ; Receptors, FSH ; genetics ; metabolism ; Spermatogenesis ; physiology ; Testis ; metabolism