Objective:To treat the Crohn's disease(CD)patients with ustekinumab(UST),to eva-luate their clinical and endoscopic remission,and to evaluate their transmural response(TR)and trans-mural healing(TH)condition using intestinal ultrasonography(IUS).Methods:Retrospective analysis was made on patients diagnosed with CD in Peking University People's Hospital from January 2020 to Au-gust 2022,who were treated with UST for remission induction and maintenance therapy.All the patients were evaluated on both week 8 and week 16/20 after treatment,including clinical,biochemical indica-tors,colonoscopy and IUS examination.Results:A total of 13 patients were enrolled in this study,inclu-ding 11 males and 2 females.The minimum age was 23 years,the maximum age was 73 years and the mean age was 36.92 years.All the patients were in the active stage of disease before treatment,and the average Best Crohn's disease activity index(Best CDAI)score was 270.12±105.55.In week 8,the Best CDAI score of the patients decreased from 270.12±105.55 to 133.16±48.66(t=4.977,P＜0.001).Eight patients achieved clinical remission while 5 patients remained in the active stage.Nine patients underwent colonoscopy evaluation.The average simple endoscopic score for Crohn's disease(SES-CD)score decreased from 10.71±7.14 before treatment to 6.00±7.81(t=2.483,P=0.048)in week 16/20.Four patients achieved endoscopic remission while 5 patients did not.In week 8,5 pa-tients achieved TR,2 patients achieved TH,the other 6 patients did not get TR or TH.In week 16/20,6 patients achieved TR,3 patients achieved TH while the other 4 patients did not get TR or TH.There was no significant statistical difference in the TR effect of UST between small intestine and colon lesions(Fisher test,P＞0.999).The rate of UST transmural response in the patients who had had previous bio-logical agent therapy was lower than those with no previous biological agent therapy,but there was no sig-nificant statistical difference(Fisher test,P=0.491).Conclusion:After treatment of UST,the clinical and endoscopic conditions of the CD patients had been improved,and some patients could achieve clini-cal remission and endoscopic remission.UST had good TR and TH effects on CD.TR might appear in week 8,and the TR effect increased in week 16/20.There was no significant statistical difference in the TR effect between small intestine and colon lesions.TR effect of UST was better in the patients who had no previous biological agent therapy than those who had had other biological agents,but the result had no significant statistical difference.

Objective:To study the risk factors of venous thromboembolism(VTE)and the predictive value of the improved VTE score model to identify the risk of VTE in gynecological surgery patients.Methods:From Janu-ary 1,2020 to December 31,2022,41 patients with VTE after gynecological surgery were selected as the VTE group,and a total of 164 patients with adjacent gynecological surgeries during the same period were selected as the non-VTE group with a ratio of 1 :4.Univariate and multivariate Logistic regression analysis were used to ana-lyze the risk factors of VTE after gynecological surgery,and a modified VTE risk factor rapid assessment model(referred to as the improved VTE score model)was constructed.The receiver operating characteristic(ROC)curve was used to study the predictive value for VTE for in gynecological surgery,and compared with the Caprini score model(Caprini table for short).Results:①Multivatiate Logistic regression analysis showed that there were independent risk factors for postoperative VTE in gynecology surgery(OR＞1,P＜0.05),including age≥60 years,BMI≥28 kg/m2,malignant tumors,surgery time＞3 hours,history of thrombosis,and the increased D-di-mer difference before and after surgery.②The Area under Curve(AUC)of ROC was 0.963 in the improved VTE score model with a Youden index 81.10％,sensitivity 87.80％and specificity 93.29％.The AUC of the Caprini score model was 0.888 with Youden index 63.41％,sensitivity 73.17％and specificity 90.24％.The improved VTE score model the Caprini score model identified 92.68％and 85.37％of VTE patients as high-risk or ex-tremely high-risk,respectively,but the difference was not statistically significant(P＜0.05).Conclusions:More attention should be paid to the six independent risk factors for postoperative VTE in gynecology surgery.The two score models showed a similar identified level.However,the improved VTE score model is more simple and easier to operate,has better practicality,and has certain clinical promotion value.

Objective:To explore the significance of laboratory parameters in predicting the endoscopic manifestations of ulcerative colitis (UC) after treatment.Methods:From January 2015 to December 2020, the clinical data of 68 patients with UC hospitalized and treated in Peking University People′s Hospital were retrospectively and continuously collected. According to the degree of bleeding, vascular pattern, erosion and ulcer under endoscopy before and after treatment, they were divided into progressive group (post-treatment ulcerative colitis endoscopic index of severity (UCEIS) score higher than pre-treatment) and non-progressive group (post-treatment UCEIS score equal to or lower than pre-treatment). The baseline platelet count, platelet volume, platelet hematocrit, platelet distribution width, serum albumin, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and related laboratory parameters were compared between the two groups. And analyzed the significance of related laboratory indexes in predicting the endoscopic manifestations of UC after treatment. Independent sample t test and receiver operating characteristic curve (ROC) analysis were used for statistical analysis. Results:According to the degree of bleeding under endoscopy before and after treatment, the patients were divided into progressive group (12 cases) and non-progressive group (56 cases). The baseline platelet count and platelet volume of the progressive group were higher than those of the non-progressive group ((375.58±154.30) ×10 9/L vs. (288.22±103.76) ×10 9/L, (9.29±1.13) fL vs.(8.52±1.29) fL), and the differences were statistically significant ( t=2.40 and 2.08, P=0.019 and 0.049). According to the degree of vascular texture under endoscopy before and after treatment, the baseline platelet volume and serum albumin level of the progressive group (9 cases) were higher than those of the non-progressive group (59 cases) ((9.58±1.18) fL vs. (8.54±1.26) fL, (41.49±5.08) g/L vs. (36.63±6.14) g/L), and the baseline CRP of the progressive group was lower than that of the non-progressive group (2.26 mg/L(0.95 mg/L) vs.8.64 mg/L (26.08 mg/L) ), and the differences were statistically significant ( t=2.32, 2.32, and z=-2.27, P=0.022, 0.047 and 0.045). According to the degree of erosion and ulcer under endoscopy before and after treatment, CRP and ESR of the progressive group (16 cases) were lower than those of the non-progressive group (52 cases) ((2.21 mg/L(5.26 mg/L) vs. 10.63 mg/L(29.97 mg/L), 14.50 mm/1 h (15.25 mm/1 h) vs.17.00 mm/1 h (11.00 mm/1 h)), and the differences were statisticaly significant ( z=-3.64 and -2.42, P=0.001 and 0.020). The cutoff value of baseline platelet count to assess the progression of bleeding under endoscopy after treatment was 336×10 9/L (sensitivity=0.636, specificity=0.852, area under the curve=0.698). The cutoff value of baseline CRP to assess the progression of erosion and ulcer under endoscopy after treatment was 3.44 mg/L (sensitivity=0.750, specificity=0.727, area under the curve=0.727). Conclusions:The baseline platelet volume, serum albumin and ESR are suggestive of endoscopic mucosal changes in patients with UC after treatment. The baseline platelet count and CRP can predict the efficacy in patients with UC.

Iodine accumulation represents a differentiation marker of thyroid cancer (TC) and a cornerstone of benefits from 131I therapy. However, dedifferentiation phenotypes occur in nearly 70% of recurrent or metastatic TCs driven by oncogenic mutations such as B-Raf proto-oncogene, serine/threonine kinase (BRAF), telomerase reverse transcriptase (TERT) promoters, and tumor proten p53 (TP53). Beyond genetic alterations, epigenetics, autophagy, tumor microenvironment and other pathways are also involved in the dedifferentiation of TC and the tolerance to 131I therapy. Targeting the above-mentioned pathways has potential to improve the malignant phenotype of TC and restore sensitivity to 131I therapy, which is of great clinical significance. Based on the relevant mechanisms of dedifferentiation, this paper elaborates on the progress of preclinical experiments and clinical studies related to differentiation therapies of TC.

OBJECTIVE: To determine the efficacy of second generation endometrial ablation (NovaSure) combined with levonorgestrel-releasing intrauterine system (Mirena) in the treatment of adenomyosis. METHODS: Clinical data of patients with adenomyosis admitted in Women's Hospital, Zhejiang University School of Medicine from January 2015 to December 2018 were retrospectively analyzed. Among 66 patients, 44 received Mirena placement only (control group) and 22 received Mirena placement and NovaSure treatment (study group). The menstruation blood loss, dysmenorrhea score, uterine size, expulsion rate of Mirena and the patients' satisfaction rate were assessed in two groups. RESULTS: There was a significant reduction in menstruation blood loss (<0.05) and significant improvement in dysmenorrhea (<0.05) after the treatment in both groups. The patients in study group had more marked improvement in menstruation blood loss than those in control group (<0.05). The patients' satisfaction was higher and the expulsion rate of Mirena was lower in study group than that in control group (all <0.05). The score of dysmenorrhea and the size of uterine had no significant difference between two groups (all >0.05). CONCLUSIONS NovaSure can improve the efficacy of Mirena in treatment of adenomyosis.
Adenomyosis ; therapy ; Dysmenorrhea ; Endometrial Ablation Techniques ; Female ; Humans ; Levonorgestrel ; administration & dosage ; Organ Size ; Retrospective Studies ; Uterus ; anatomy & histology

Objective To evaluate the application value of absorbable hemostat textile as submucosal injection of endoscopic submucosal dissection(ESD). Methods Twelve New Zealand rabbits were injected with absorbable hemostat textile solution,glycerol fructose and normal saline. The uplift effect was measured after injection. Simulated ESD was performed in the rabbit stomach and bleeding amount was measured. The injection site was pathologically examined at 30 minutes after the soluble hemostat textile and normal saline were injected. Fifteen pigs were injected with absorbable hemostat textile at two locations of 20-30 cm from the anus,and injected normal saline at another two locations of 20-30 cm from the anus.One site was performed simulated ESD and the other was not. Fifteen simulated ESD were performed in the soluble hemostatic group and the normal saline group, respectively. Operation time was recorded and difference in wound healing was compared between the two groups. Results In the uplift experiment, the absorbable hemostat textile group had higher uplift height(4.3±1.4 mm,4.1±1.9 mm,3.8±0.7 mm, 3.3±0.9 mm, respectively)at 0 min,10 min,20 min,30 min than that of the glycerol fructose group(4.3±2.2 mm,4.1± 2.0 mm,3.6±1.4 mm, 3.2±0.8 mm, respectively, P<0.05), and the glycerol fructose group was higher than that of the normal saline group(3.8±1.6 mm,2.6±1.4 mm,1.9±1.9 mm,1.1±0.7 mm, P<0.05). There was no significant difference in uplift height between the absorbable hemostat textile group and the glycerol fructose group(P>0.05). In the bleeding experiment, the bleeding amount of absorbable hemostat textile group was significantly less than that of the glycerol fructose group(0.36±0.07 mL VS 0.42±0.06 mL, P<0.05);the bleeding amount of glycerol fructose group was significantly lower than that of the normal saline group(0.42±0.06 mL VS 0.55±0.07 mL,P<0.05). There was no obvious tissue necrosis and other adverse complications in the absorbable hemostat textile group and the normal saline group. In simulated ESD experiment,complete resection rate of the absorbable hemostat textile group was higher than that of the normal saline group[86.7%(13/15)VS 46.7%(7/15), P<0.05], and mean operation time of the absorbable hemostat textile group was less than that of the normal saline group(3.2± 0.3 min VS 3.8± 0.5 min, P<0.05). No hemorrhage, perforations or other related adverse events occurred in non-ESD lesions. Conclusion Absorbable hemostat textile is safe and effective as submucosal injection of ESD.

Aim To investigate the effect of SM-1 on seven main cytochrome P450(CYP450)in human liver microsomes.Methods Substrate or SM-1 was incubated with human liver microsomes for 30 min in vitro,and divided into control group and experimental group.The effects of SM-1 on the main phase I metabolic enzymes in human liver microsomes was detected by HPLC.Phenacetin,bupropion,paclitaxel,tolbutamide,omeprazole,dextromethorphan,testosterone were investigated as probe drugs.Results Inhibition rate of SM-1 on the classical substrate of human liver microsomal CYP was 0.05％,3.37％,0.08％,2.07％,4.20％,-0.15％and 10.84％,respectively.Conclusions SM-1 may have inhibitory effect on CYP3A4.Attention should be paid to the interaction of clinical drug induced by CYP enzyme inhibition.

Objective To investigate the clinical value of hemostatic silk in prevention of wound bleeding and wound healing after endoscopic submucosal dissection (ESD). Methods Experiment group: animal model was made by rabbit underwent ESD simulation in its' stomach and laying hemostatic silk on its' wound;control group: animal model was made by pig underwent ESD simulation in its' colon without any healing management. All the ulcers sites were endoscopically and pathologically examined to evaluate the hemorrhage and healing of the wound on 3 days, 1 week, 2 weeks and 4 weeks after the procedure. Results The blood loss in experiment group was significantly lower than that in control group. The wounds of all the experimental pigs underwent colon ESD successfully covered with hemostatic silk postoperatively. Endoscopic pathological examination shown better healing procedure in experiment group. No procedure-related adverse event occurred in both groups. Conclusions Hemostatic silk has potential application value in healing the wound after ESD demonstrated by animal experiment.

Objective:To investigate the immune mechanism of Shengxian decoction in experimental autoimmune myasthenia gravis(EAMG) rats. Methods:Lewis rats were immunized with the rat sequence 97-116 of the AChRαsubunit(Rα97-116) in CFA, 25 of which were successful. They were randomly divided into 5 groups:EAMG model group,prednisone group(5. 4 mg/kg),Shengxian decoction low, medium, high dose groups ( dosage 2. 6 g/kg, 5. 2 g/kg, 10. 4 g/kg ) . Clinical symptoms, weight, and the decrement percentage of RNS(5 Hz) were evaluated,and ELISA were adopted to determine the titers of AChR Ab,TGF-β,IFN-γ,IL-2,IL-4 and IL-17 in serum. Results:After molding,the percentage of decrement of RNS in each group noticeably increased by more than 10% in comparison with that in the CFA control group ( P<0. 01 or P<0. 05 ) . At the same time, they were also subjected to progressive decreasing weight and typical myasthenia symptoms,showing the successful molding. With medication,the decrement percentage of RNS of rats in the groups with low,medium and high dose of Shengxian decoction were all on obvious decline with alleviated weight decrease (P<0. 01),testifying to the symptom improvement. Compared with the CFA control group,the groups with low,medium and high dose of Shengxian decoction were coupled with decreasing AChR Ab content(P<0. 05),rising TGF-βlevel and reducing IFN-γ,IL-2,IL-4 and IL-17 level(P<0. 01 or P<0. 05). Conclusion: Shengxian decoction can turn the decrement percentage of RNS around,improve the progressive weight decrease in EAMG rats and increase the weight gains. By up-regulating the TGF-βlevel,lowering IFN-γ,IL-2,IL-4 and IL-17 level,preventing B cells from producing AChR Ab and reducing the content of AChR Ab in serum,it will soothe the damage of NMJ to AChR and cure EAMG.