BACKGROUND: Rheumatoid arthritis (RA), a chronic systemic autoimmune disease, is characterized by synovitis and progressive damage to the bone and cartilage of the joints, leading to disability and reduced quality of life. This study was a randomized clinical trial comparing the outcomes between withdrawal and dose reduction of tofacitinib in patients with RA who achieved sustained disease control. METHODS: The study was designed as a multicenter, open-label, randomized controlled trial. Eligible patients who were taking tofacitinib (5 mg twice daily) and had achieved sustained RA remission or low disease activity (disease activity score in 28 joints [DAS28] ≤3.2) for at least 3 months were enrolled at six centers in Shanghai, China. Patients were randomly assigned (1:1:1) to one of three treatment groups: continuation of tofacitinib (5 mg twice daily); reduction in tofacitinib dose (5 mg daily); and withdrawal of tofacitinib. Efficacy and safety were assessed up to 6 months. RESULTS: Overall, 122 eligible patients were enrolled, with 41 in the continuation group, 42 in the dose-reduction group, and 39 in the withdrawal group. After 6 months, the percentage of patients with a DAS28-erythrocyte sedimentation rate (ESR) of <3.2 was significantly lower in the withdrawal group than that in the reduction and continuation groups (20.5%, 64.3%, and 95.1%, respectively; P  < 0.0001 for both comparisons). The average flare-free time was 5.8 months for the continuation group, 4.7 months for the dose reduction group, and 2.4 months for the withdrawal group. CONCLUSION: Withdrawal of tofacitinib in patients with RA with stable disease control resulted in a rapid and significant loss of efficacy, while standard or reduced doses of tofacitinib maintained a favorable state. TRIAL REGISTRATION Chictr.org, ChiCTR2000039799.
Humans ; Quality of Life ; China ; Arthritis, Rheumatoid/drug therapy* ; Piperidines/therapeutic use* ; Treatment Outcome ; Antirheumatic Agents/therapeutic use* ; Pyrroles/therapeutic use*

Objective:To analyze the clinical efficacy of surgical treatment of elderly patients with type A aortic dissection(TAAD).Methods:A retrospective study including 139 elderly patients(age≥60 years) with TAAD between August 2016 to August 2018 in Beijing Anzhen Hospital was performed. There were 90 male patients(64.7%) and 49 female patients(35.3%), aged 60-80(65.1±3.8)years. All patients completed the necessary preoperative examination, 123 patients underwent emergency surgery and the other 16 patients underwent elective surgery. Deep hypothermia circulatory arrest(DHCA) and selective cerebral perfusion(SCP) were used in arch surgery. The root surgery was divided into Bentall, Wheat, David and ascending aorta replacement and the arch surgery was divided into partial aortic arch replacement, classic Sun's procedure, and modified Sun's procedure. Bypass surgery was done when pressure difference(≥40 mmHg, 5.33 kPa) between upper and lower extremities existed. Other combined heart diseases were treated at the same time.Results:Operative mortality rate was 5.0%(7 cases), 5 case(3.6%)with multiple organ dystuaction syndrome, 1 case(0.7%)with respiratory failure and 1 case(0.7%) with heart failure. The postoperative complications were hypoxemia(12.2%), neurological complications(10.8%), acute kidney injury(13.7%).Conclusion:Surgical treatment is the first choice for aged patients with TAAD and individualized treatment is safe and effective.

Objective: To find out what the exact impact of renal malperfusion on short- and long-term postoperative prognosis of ATAAD patietns. Methods: 218 patients with ATAAD undergoing surgical repair from June 2009 to May 2012 . Mean age was(47.8±10.7) years and 170 were male(78.0%). Based on computed tomographic angiography and laboratory test, 48 patients were diagnosed with preoperative renal malperfusion(22.0%). Clinical data were compared between two groups and risk factors for short- and long-term mortality identified using Cox regression. Results: Patients with renal malperfusion showed significantly higher incidences of short-term mortality(22.9% vs 8.3%, P=0.023), long-term mortality(87.0% vs 72.9%, P=0.003) and postoperative acute kidney failure(20.8% vs 4.1%, P<0.001). Renal malperfusion was the risk factor for short-term mortality(OR 2.92, 95%CI 1.31-6.63, P=0.009) and long-term mortality(OR 2.56, 95%CI 1.32-4.94, P=0.005). Conclusion Renal malperfusion significantly increases the postoperative risk of short-term mortality, long-term mortality and incidence of postoperative acute renal failure in patients with ATAAD.

Objective To retrospectively analyze perioperative and early outcomes after Sun's procedure of type A aortic dissection patients with different tear size ratia.Methods To retrospectively analyze the general information of 120 patients with acute Stanford type A aortic dissectiontreatedin our center from November 2014 to December 2016.Patients were divided into three group according to proximal and distal tear sizeratio(PDTSR):35 patients in Group A(PDTSR≥2),44 patients in Group B (1/2 ＜ PDTSR ＜ 2)and 41 patients in Group C (PDTSR ≤ 1/2).Retrospectively reviewed the data of perioperativeand follow-up period.Results Preoperative mortality was significantly higher in Group A (37.1％ vs.2.3％ vs.2.4％;P ＜ 0.001).Preoperative morbidity higher in Group A,but there was no significant difference.Ventilator support of duration ＞ 5 days in Group A is significantly higher in Group A (P =0.006).Three-month closure rate of false lumen was higher in Group A (85.0％ vs.65.0％ vs.72.7 ％,P =0.263).Proximal tear significantly larger than distal tear was found associated with preoperative death in logistic regression analysis.Conclusion Acute type A aortic dissection patients with larger proximal tear size need more urgent surgery to fix the dissection.Sun's procedure was an effective way to cure type A aortic dissection,while patients with relatively larger distal tears need more strict postoperative follow-up.

Objective To identify the risk factors for acute kidney injury (AKI) in overweight patients who underwent surgery for the treatment of acute type A aortic dissection(TAAD).Methods A retrospective study including 108 consecutive overweight patients(body mass index(BMI) ≥24) between January 2010 and May 2013 in Beijing Anzhen Hospital was performed with Sun's procedure of total aortic arch replacement and frozen elephant trunk implantation.AKI was as defined according to Acute Kidney Injury Network (AKIN) criteria based on serum creatinine(sCr) or urine output.Results The mean age of the patients was(43.69 ± 9.66) years.During the postoperative period seventy-two patients(66.7％) developed AKI.The overall postoperative mortality rate was 7.4％,8.3％ in AKI group and 5.6％ in non-AKI group.There is no statistically significant difference between the two groups(P =0.32).A logistic regression analysis was performed to find out the independent risk factors for AKI:elevated preoperative sCr level and postoperative drainage volume.Renal replacement therapy(RRT) was performed in fifteen patients (13.9 ％).Conclusion A higher incidence of AKI (66.7 ％) in overweight patients following acute TAAD was identified.The logistic regression model found out elevated preoperative sCr level and 72 hour drainage volume as the two independent risk factors for AKI in overweight patients.More attention should be paid to prevent AKI in overweight patients following TAAD.

Objective To investigate the effectiveness of target intervention in preventing catheter -related bloodstream infection ( CRBSI ) .Methods The targeted monitoring was launched by changing venepuncture site , reinforcing instructions in aseptic insertion technique and hand hygiene supervision ,avoiding femoral access and remo-ving unnecessary catheters ,venous puncture implemented by high qualification anesthesiologist ,then the incidence of CRBSI before and after the project was compared .Results The incidence of CRBSI after the project decreased signif-icantly from 17.97%to 4.32%,the difference was statistically significant (χ2 =40.82,P<0.05).Chi-square test and logistic regression analysis showed that the incidence of infection was increased in patients with catheter for longer than 10 days (χ2 =4.33,P<0.05),the incidence of CRBSI was decreased in patients that central venous puncture implemented by high qualification anesthesiologist (χ2 =9.21,P<0.05),and patients received catheter indwelling into femoral vein had increased incidence of CRBS (χ2 =7.45,P<0.05).Conclusion Indwelling catheter time, unskilled operator ,catheter site are risk factors in patients with CRBSI .In response to these factors ,we should develop interventions to maximize establish a protective barrier , improve the quality of the medical operation , prevent the occurrence of CRBSI more efficiently .

Objective To investigate the effects of different types of anesthesia on the incidence rates of low-er respiratory tract infections of elderly patients in orthopedic department.Methods Clinical data from 445 elderly patients in orthopedic department were collected and retrospectively analyzed.We also investigated the relationship be-tween the types of anesthesia and the lower respiratory tract infections.Results The incidence rates of lower respira-tory tract infections were 23.08%in 169 cases,12.14%in 173 cases,and 4.85%in 103 cases after general anesthe-sia with tracheal intubation,intraspinal anesthesia,and nerve blocking anesthesia,respectively.There was statistically significant difference in the infection rates among the three groups (χ2 =13.784,P=0.001).Conclusion Different ways of anesthesia is critically correlated with the incidence of the lower respiratory tract infections in elderly patients.

Objective To investigate the effect of Tongqiao Yinao decoction ( TYD) on postoperative cogni-tive dysfunction in elderly patients and its underlying mechanisms .Methods 100 anesthetic patients for orthopedic surgery were randomly divided into the TYD-treated group and control group ,50 patients in each group .In TYD-trea-ted group,patients received 150mL TYD orally,twice daily for constitutive 15 days,beginning from the day of admis-sion in addition to conventional symptomatic and supportive treatment .While patients in control group received no TYD.Mini-mental state examination ( MMSE) was used to evaluate the patients′cognitive function before and after anesthesia.Meanwhile,blood samples of patients were also collected to test the expression levels of IL -6.Results There was no significant difference between the two groups before operation .However ,TYD-treated patients had signif-icantly lower incidence rate of POCD than the controls ( 20% in the control group , and 12% in the TYD-treated group;χ2 =4.332,P=0.037) 7 days after operation.The incidence rates of POCD in the TYD-treated group and control group were 30%and 38%1 day after operation ( P>0.05),28% and 20% 3 days after operation ( P>0.05),respectively.Compared with that before operation ,the blood levels of IL-6 in the two groups significantly increased 3 days after operation (control group,t=2.412,P=0.009;TYD-treated group,t=1.429,P=0.039).In contrast to the control group,the level of IL-6 in TYD-treated group declined to the baseline (the control group,t=0.851,P=0.049;TYD-treated group,P=0.404).Interestingly,compared with the controls,the TYD-treated patients had a significant lower level of IL-6 after operation (t=1.198,P=0.035).Furthermore,Pearson correlation analysis showed that change of IL-6 level in blood was negatively correlated with MMSE score (r=-0.782,P=0.022). Conclusion TYD can improve postoperative cognitive dysfunction in elderly patients ,presumably through decreasing the level of IL-6 in blood.

ObjectiveTo evaluate the feasibility and outcome of overnight laparoscopie cholecystectomy (OLC).MethodsThe clinical data of 149 patients with cholecystolithiasis or gallbladder polyps who were admitted to the Tianjin People's Hospital from October 2008 to December 2010 were retrospectively analyzed.All the patients underwent LC in the morning and were discharged 24 hours later.Modified Aldrete scoring was done 4-6hours after LC.Patients were contacted by telephone 3 days after LC and reexamined in the out-patient department 7 days after LC.The hospital cost of patients who underwent OLC or LC was compared using the t test.Results OLC was successfully performed on 149 patients,and the modified Aldrete scores of 130 patients were above 9.The visual analogue scale (VAS) of 118 patients were under 4,and the VAS of 31 patients were above 4.The condition of the 31 patients were closely monitered,and were administered morphine.Of the 149 patieuts,144were discharged 24 hours after operation,and the remaining 5 patients were admitted to general ward because of fever,peritoneal effusion or abdominal pain.The incidence of postoperative complication was 2.0％ (3/149) and the mortality was 0.All the patients were followed up,and none of the patients had an emergency readmission.The duration of incapacity was 5.2 days (range,2-7 days).The mean hospital cost of patients who received OLC was ( 7888 ± 396 ) yuan,which was significantly lower than ( 12121 ± 960) yuan of patients who received LC ( t =38.97,P ＜ 0.05 ).ConclusionOLC is effective and safe,and meets the requirement of health insurance policy.

Objective To evaluate the feasibility and curative effect of extracorporeal liver perfusion (ECLP) in treatment of acute liver failure (ALF) in pigs. Methods The experiments were carried out in healthy pigs (weight 20-30 kg) under general anesthesia. All of the pigs were randomly divided into 3 groups. ALF model was established by liver blood supply obstructing and portal-systemic shunting. ALF group (n=5): ALF pigs were killed 8 h after establishing. ALF+ECLP group (n=5): ALF pigs were perfused with ECLP for 4 h and killed 8 h after establishing. Normal liver+ECLP group (n=4): normal pigs were dealt with just as ALF+ECLP group. The data of PT, AST, TNF, blood ammonia were collected in all groups. Pathologic changes in liver and brain were detected. Results The levels of PT, AST, TNF, blood ammonia, RBC and HCT in the ALF+ECLP group were lower than those in the ALF group (P