Objective:To investigate the correlation of antinuclear antibody (ANA) with clinical response to infliximab (IFX) in patients with Crohn′s disease (CD) .Methods:Patients who were diagnosed as CD and treated with IFX in Nanjing Drum Tower Hospital from January 2018 to September 2021 were retrospectively studied. The correlation analysis was used to explore the correlation between ANA and clinical response. These patients were divided into two groups according to the ANA titer after 25 weeks of IFX treatment. The differences in clinical data between the two groups were assessed by univariate analysis. The variables with P<0.15 in univariate analysis and having clinical significance were further analyzed by multivariate Logistic regression to determine the independent risk factors of the induction of ANA. Results:A total of 82 patients with CD were included. Forty-one (50.0%) patients were set as positive group, and 41 (50.0%) patients were set as negative group. In terms of clinical response, the clinical response rates of two groups were 68.3% and 41.5%, and the difference was significant (χ 2 = 5.959, P = 0.015) . Positive group was divided into 1∶100 subgroup ( n = 17) , 1∶320 subgroup ( n = 11) and ≥1∶1000 subgroup ( n = 13) . The clinical response rates of three groups were 41.2%, 45.5% and 7.7% respectively, and the difference was not statistically significant (χ 2 = 5.334, P = 0.084) . The incidences of adverse events in the two groups were 17.1% and 7.3%, and the difference was not significant (χ 2 = 1.822, P = 0.177) . Univariate analysis showed that the difference of total protein (TP) before IFX treatment between the positive group and negative group was statistically significant ( P<0.05) . Multivariate logistic regression analysis showed that age ( OR = 1.060, 95% CI: 1.015 ~ 1.107, P = 0.008) and the baseline TP ( OR = 1.110, 95% CI: 1.023 ~ 1.205, P = 0.012) were the independent risk factors for the induction of ANA. Conclusions:The formation of ANA may affect the clinical response of IFX, so the ANA titer should be monitored regularly during the IFX therapy. In addition, age and baseline TP are related to the formation of ANA.

Objective:To evaluate the efficacy and outcomes of early removal of lumen-apposing metal stent (LAMS) in the treatment of pancreatic wall-off necrosis (WON).Methods:A retrospective analysis was performed on 51 patients with WON who underwent endoscopic ultrasound (EUS)-guided transluminal drainage (ETD) and direct endoscopic necrosectomy (DEN) using LAMS at Nanjing Drum Tower Hospital from January 2018 to December 2022. Patients were divided into the early removal group (within two weeks, n=24) and the traditional removal group (after two weeks, n=27) based on the timing of LAMS removal. The short-term effects, safety and long-term outcomes of WON were compared between the two groups. Results:The technical success rate of LAMS placement in 51 patients reached 100%, and all patients underwent ETD and DEN. The median number of necrosectomy sessions in the early removal group was significantly lower than in the traditional removal group, 2.0 sessions vs 3.0 sessions and the difference was statistically significant ( P<0.05). Postoperatively, 15.7% of patients required percutaneous catheter drainage (PCD) and 5.9% required surgery, with no significant difference between the two groups. The clinical success rate and mortality rate in the early removal group were 79.2% and 8.3%, respectively, compared to 81.5% and 3.7% in the traditional removal group, with no statistically significant difference. In terms of safety, the early removal group exhibited a significantly lower rate of adverse events during stent retention with statistically significant difference (12.5% vs 37.0%, P<0.05) compared to the traditional removal group. A total of 46 patients were followed up for six months. In the early removal group, the rates of disease recurrence, need for endoscopic reintervention and occurrence of long-term complications were 20.0%, 10.0% and 20.0%, respectively. These rates did not show a significant increase compared to the traditional removal group, which were 7.7%, 3.8% and 38.5%, respectively, without significant differences between the groups. Conclusions:In the treatment of WON, early removal of LAMS is safe and effective to a certain extent. In comparison to the traditional practice of removing LAMS after two weeks, early removal does not reduce clinical success rates, nor does it increase the rates of disease-related mortality, recurrence, or long-term complications. On the contrary, it may reduce the occurrence of adverse events during stent retention and decrease the number of necrosectomy procedures subsequently.

Objective:To investigate the correlation of antinuclear antibody (ANA) with clinical response to infliximab (IFX) in patients with Crohn′s disease (CD) .Methods:Patients who were diagnosed as CD and treated with IFX in Nanjing Drum Tower Hospital from January 2018 to September 2021 were retrospectively studied. The correlation analysis was used to explore the correlation between ANA and clinical response. These patients were divided into two groups according to the ANA titer after 25 weeks of IFX treatment. The differences in clinical data between the two groups were assessed by univariate analysis. The variables with P<0.15 in univariate analysis and having clinical significance were further analyzed by multivariate Logistic regression to determine the independent risk factors of the induction of ANA. Results:A total of 82 patients with CD were included. Forty-one (50.0%) patients were set as positive group, and 41 (50.0%) patients were set as negative group. In terms of clinical response, the clinical response rates of two groups were 68.3% and 41.5%, and the difference was significant (χ 2 = 5.959, P = 0.015) . Positive group was divided into 1∶100 subgroup ( n = 17) , 1∶320 subgroup ( n = 11) and ≥1∶1000 subgroup ( n = 13) . The clinical response rates of three groups were 41.2%, 45.5% and 7.7% respectively, and the difference was not statistically significant (χ 2 = 5.334, P = 0.084) . The incidences of adverse events in the two groups were 17.1% and 7.3%, and the difference was not significant (χ 2 = 1.822, P = 0.177) . Univariate analysis showed that the difference of total protein (TP) before IFX treatment between the positive group and negative group was statistically significant ( P<0.05) . Multivariate logistic regression analysis showed that age ( OR = 1.060, 95% CI: 1.015 ~ 1.107, P = 0.008) and the baseline TP ( OR = 1.110, 95% CI: 1.023 ~ 1.205, P = 0.012) were the independent risk factors for the induction of ANA. Conclusions:The formation of ANA may affect the clinical response of IFX, so the ANA titer should be monitored regularly during the IFX therapy. In addition, age and baseline TP are related to the formation of ANA.