Crohn's disease (CD) is an autoimmune disease with an unclear pathogenesis, primarily affecting the digestive tract. Perianal involvement represents a complex form of CD. Refractory proctoanal CD is a major cause of rectal resection and permanent anal sphincter dysfunction in patients. The colon pull-through with delayed anastomosis of the anal canal involves the resection of the diseased rectum and the management of the dentate line and anal canal. After the pulled-through colon has adhered to the anal canal, a revision and anastomosis are performed, aiming to preserve anal function and enhance the patients' quality of life. The specific criteria and timing for selecting this surgical approach for refractory proctoanal CD merit further discussion and investigation.

Crohn's disease (CD) is an autoimmune disease with an unclear pathogenesis, primarily affecting the digestive tract. Perianal involvement represents a complex form of CD. Refractory proctoanal CD is a major cause of rectal resection and permanent anal sphincter dysfunction in patients. The colon pull-through with delayed anastomosis of the anal canal involves the resection of the diseased rectum and the management of the dentate line and anal canal. After the pulled-through colon has adhered to the anal canal, a revision and anastomosis are performed, aiming to preserve anal function and enhance the patients' quality of life. The specific criteria and timing for selecting this surgical approach for refractory proctoanal CD merit further discussion and investigation.

Objective::Observational studies indicate that insomnia may increase the risk of developing and/or dying from cardiovascular diseases, especially coronary artery disease (CAD). Our purpose is to explore the underlying causal relationship between genetic variants susceptible to insomnia and the risk of CAD by Mendelian randomization analysis.Methods::The study was conducted using publicly available statistical data on genetic variants identified from a genome-wide association meta-analysis of insomnia ( n = 113,006 individuals) and a genome-wide association meta-analysis of CAD ( n = 184,305 individuals), which consisted of both cases and non-cases. The genetic association between variants and CAD was assessed by the variants’ association with insomnia, and estimations were integrated by an inverse-variance weighted meta-analysis. Results::Among the Mendelian randomized analytical sample, 8 variants were associated with insomnia complaints and CAD. And there was no pleiotropic association with the latent confounders. In addition, in the inverse-variance weighted meta-analysis (the estimations combined from the 8 variants), the odds ratio was 1.15 (95% CI: 1.05-1.25; P= 0.002) for CAD, and in the weighted method analysis, the odds ratio was 1.14 (95% CI: 1.03-1.27; P= 0.015) for CAD. Conclusions::All of the data indicated that some valuable variants might involve in the development of CAD by leading the insomnia. Therefore, insomnia might be a causal factor for CAD, and improving the quality of sleep might be a new way for populations with insomnia to prevent CAD.

Objective::Observational studies indicate that insomnia may increase the risk of developing and/or dying from cardiovascular diseases, especially coronary artery disease (CAD). Our purpose is to explore the underlying causal relationship between genetic variants susceptible to insomnia and the risk of CAD by Mendelian randomization analysis.Methods::The study was conducted using publicly available statistical data on genetic variants identified from a genome-wide association meta-analysis of insomnia ( n = 113,006 individuals) and a genome-wide association meta-analysis of CAD ( n = 184,305 individuals), which consisted of both cases and non-cases. The genetic association between variants and CAD was assessed by the variants’ association with insomnia, and estimations were integrated by an inverse-variance weighted meta-analysis. Results::Among the Mendelian randomized analytical sample, 8 variants were associated with insomnia complaints and CAD. And there was no pleiotropic association with the latent confounders. In addition, in the inverse-variance weighted meta-analysis (the estimations combined from the 8 variants), the odds ratio was 1.15 (95% CI: 1.05-1.25; P= 0.002) for CAD, and in the weighted method analysis, the odds ratio was 1.14 (95% CI: 1.03-1.27; P= 0.015) for CAD. Conclusions::All of the data indicated that some valuable variants might involve in the development of CAD by leading the insomnia. Therefore, insomnia might be a causal factor for CAD, and improving the quality of sleep might be a new way for populations with insomnia to prevent CAD.

Primary biliary cholangitis (PBC) is a chronic progressive cholestatic liver disease of unknown etiology characterized by highly specific anti-mitochondrial antibody in serum and immune-mediated non-pyogenic destructive infection in the small intrahepatic bile ducts,which can lead to portal inflammation and fibrosis and finally progress to liver cirrhosis and liver failure.At present,ursodeoxycholic acid (UDCA) is the only drug approved for the treatment of PBC with a recommended dose of 13-15 mg · kg-1 · d-1.There are significant improvements in the survival rate of patients achieving biochemical response after UDCA treatment.However,about 40％ of PBC patients do not respond to UDCA,and such patients have a risk of disease progression and are in urgent need of other drugs.With reference to recent clinical studies and guidelines,this article summarizes the basic concepts and latest advances in pharmacotherapy for PBC,as well as the perspectives of new drugs in clinical trials,in order to bring new hopes to PBC patients with poor response to UDCA.