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Optimizing the use of biological therapy in patients with inflammatory bowel disease

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Gastroenterology Report 2015年第1期3卷 63-68页

作者： alan C.moss Division of Gastroenterology Beth Israel Deaconess Medical Center&Harvard Medical SchoolBostonMAUSA

Biological therapy revolutionized the treatment of inflammatory bowel disease(IBD)during the last decade.These monoclonal antibodies,which target tumor necrosis factor(TNF),integrins or IL12/23,have been approved—or are in development for—both Crohn’s disease(CD)and ulcerative colitis(UC).Early use of these agents taught clinicians that induction and maintenance therapy,coupled with immunomodulator agents,reduced the immunogenicity of these agents,and led to sustained remission in many patients.More recent data has demonstrated that,through dose adjustments,optimizing serum drug levels may also provide more durable maintenance of remission,and improved mucosal healing.This review examines clinical practices that may enhance clinical outcomes from biological therapy in IBD.

关键词： inflammatory bowel disease biological therapy

Impact of inflammatory bowel disease activity and thiopurine therapy on birth weight: A meta-analysis

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World Journal of Gastroenterology 2017年第45期23卷 8082-8089页

作者： Begona Gonzalez-Suarez Shreyashee Sengupta alan C moss Division of Gastroenterology Inflammatory Bowel Disease CenterBeth Israel Deaconess Medical Center

AIM To investigate the effect of disease activity or thiopurine use on low birth weight and small for gestational age in women with inflammatory bowel disease(IBD).METHODS Selection criteria included all relevant articles on the effect of disease activity or thiopurine use on the risk of low birth weight(LBW) or small for gestational age(SGA) among pregnant women with IBD. Sixtynine abstracts were identified,35 papers were full text reviewed and,only 14 of them met inclusion criteria. Raw data were extracted to generate the relative risk of LBW or SGA. Quality was assessed using the Newcastle Ottawa Scale.RESULTS This meta-analysis is reported according to PRISMA guidelines. Fourteen studies met inclusion criteria,and nine reported raw data suitable for meta-analysis. We found an increased risk ratio of both SGA and LBW in women with active IBD,when compared with women in remission: 1.3 for SGA(4 studies,95%CI: 1.0-1.6,P = 0.04) and 2.0 for LBW(4 studies,95%CI: 1.5-2.7,P < 0.0001). Women on thiopurines during pregnancy had a higher risk of LBW(RR 1.4,95%CI: 1.1-1.9,P = 0.007) compared with non-treated women,but when adjusted for disease activity there was no significant effect on LBW(RR 1.2,95%CI: 0.6-2.2,P = 0.6). No differences were observed regarding SGA(2 studies; RR 0.9,95%CI: 0.7-1.2,P = 0.5). CONCLUSION Women with active IBD during pregnancy have a higher risk of LBW and SGA in their neonates. This should be considered in treatment decisions during pregnancy.

关键词：怀孕煽动性的肠疾病 Thiopurines 疾病活动低出生重量为 gestational 年龄小

Failed biliary cannulation: Clinical and technical outcomes after tertiary referral endoscopic retrograde cholangiopancreatography

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World Journal of Gastroenterology 2011年第45期17卷 4993-4998页

作者： Michael P Swan Michael J Bourke Stephen J Williams Sina Alexander alan moss Rick Hope David Ruppin Department of Gastroenterology and Hepatology Westmead Hospital

AIM: Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center. METHODS: Prospective intention-to-treat analysis of patients referred for biliary cannulation following recent unsuccessful ERCP. RESULTS: Fifty-one patients (35 female; mean age: 62.5 years; age range: 40-87 years) with previous failed biliary cannulation were referred for repeat ERCP. The indication for ERCP was primarily choledocholithiasis (45%) or pancreatic malignancy (18%). Successful biliary can- nulation was 100%. The precut needle knife sphincterotomy (NKS) rate was 27.4%. Complications occurred in 3.9% (post-ERCP pancreatitis). An identif iable reason for initial unsuccessful biliary cannulation was present in 55% of cases. Compared to a cohort of 940 nave pa-pilla patients (female 61%; mean age: 59.9 years; age range: 18-94 years) who required sphincterotomy over the same time period, there was no statistical difference in the cannulation success rate (100% vs 98%) or postERCP pancreatitis (3.1% vs 3.9%). Precut NKS use was more frequent (27.4% vs 12.7%) (P = 0.017). CONCLUSION: Referral to a high-volume center following unsuccessful ERCP is associated with high technical success, with a favorable complication rate, compared to routine ERCP procedures.

关键词：技术成果造影插管胆管内镜平均年龄临床胆总管结石

Treatment of Crohn's disease in pregnant women: Drug and multidisciplinary approaches

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World Journal of Gastroenterology 2014年第27期20卷 8790-8795页

作者： Didia Bismara Cury alan C moss Center of Inflammatory Bowel Disease Federal University of S?o Paulo Sao Paulo SP 040023-062 Brazil Center of Inflammatory Bowel Disease Clinica Scope Campo Grande MS 79002212 Brazil Beth Israel Medical Center of Harvard Medical School Sao Paulo CEP 04023-062 Brazil Beth Israel Deaconess Medical Center Division of Gastroenterology Boston MA 02215 United States Harvard Medical School Boston MA 02215 United States

Inflammatory bowel disease affects a substantial number of women in their reproductive years. Pregnancy presents a number of challenges for clinicians and patients; the health of the baby needs to be balanced with the need to maintain remission in the mother. Historically, treatments for Crohn's disease(CD) were often discontinued during the pregnancy, or nursing period, due to concerns about teratogenicity. Fortunately, observational data has reported the relative safety of many agents used to treat CD, including 5-aminosalicylic acid, thiopurines, and tumor necrosis factor. Data on the long-term development outcomes of children exposed to these therapies in utero are still limited. It is most important that physicians educate the patient regarding the optimal time to conceive, discuss the possible risks, and together decide on the best management strategy.

关键词： Pregnancy Drugs Inflammatory bowel disease Crohn’s

冷杉-铁杉林各层盖度在冷箭竹更新恢复中的变化

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生态学杂志 2017年第9期36卷 2403-2411页

作者：周世强李忠黄金燕 alan H.Taylor 刘巅张明春周小平张和民中国大熊猫保护研究中心四川都江堰611830 Department of Geography The Pennsylvania State University

本研究的目的是通过分析不同时期林分各层植物覆盖度的变化,了解冷箭竹(Bashania faberi)的自然恢复进程以及各层植物之间的相互作用。为此,在四川卧龙国家级自然保护区的冷杉-铁杉林内设置固定样地(n=7),1984—2013年分3~4次调查了样... 详细信息

本研究的目的是通过分析不同时期林分各层植物覆盖度的变化,了解冷箭竹(Bashania faberi)的自然恢复进程以及各层植物之间的相互作用。为此,在四川卧龙国家级自然保护区的冷杉-铁杉林内设置固定样地(n=7),1984—2013年分3~4次调查了样地中各层植物的覆盖度。结果表明,更新竹林的竹子盖度逐年增加,2013年达到60%以上;残存竹林的竹子盖度变化呈单峰模式,表现出先增长、到达峰值后下降的趋势;草本植物层和地被层相似,随着竹子的更新恢复,盖度低于开花枯死期;乔木林冠层的覆盖度,虽然1984年和2013年之间的显著性检验差异明显,但两年的绝对值相差较小,大约0.60%~18.89%;样地(或斑块)间的不同变化趋势主要与其所处林分的立地条件差异有关。本文还初步尝试了不同时期竹子盖度空间分布的可视化,有利于人们更为直观地洞察竹子恢复过程中的空间动态格局。

关键词：大熊猫主食竹自然更新植物盖度卧龙自然保护区