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Real-life outcome of anti-tumor necrosis factor α in the ambulatory treatment of ulcerative colitis

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World Journal of Gastroenterology 2015年第11期21卷 3282-3290页

作者： Enayatullah Baki Philipp Zwickel Anna Zawierucha Robert Ehehalt Daniel Gotthardt Wolfgang Stremmel Annika Gauss Division of Gastroenterology University of Heidelberg Outpatient clinic of Gastroenterology

AIM:To evaluate the outcome of anti-tumor necrosis factor alpha(anti-TNFα) therapy in outpatients with ulcerative colitis at a tertiary referral ***:All patients with a confirmed diagnosis of ulcerative colitis undergoing therapy with infliximab and/or adalimumab at the outpatient clinic for inflammatory bowel diseases at the university Hospital Heidelberg between January 2011 and February 2014 were retrospectively *** with a followup period of less than 6 mo from start of anti-TNFα therapy were *** records of all eligible individuals were carefully ***-free clinical remission of a duration of at least 3 mo,colectomy rate,duration of anti-TNFα therapy,need for anti-TNFα dose escalation,and the occurrence of adverse events were evaluated as the main outcome ***:Seventy-two patients were included(35 treated with infliximab,17 with adalimumab,20 with both consecutively).Median follow-up was 27 mo(range:6-87 mo).Steroid-free clinical remission was achieved by 22.2% of the patients(median duration:21 mo until end of follow-up; range:3-66 mo).Patients attaining steroid-free clinical remission displayed lower hemoglobin and albumin blood levels at the start of treatment than those who did not achieve *** overall colectomy rate was 20.8%.Nearly 50% of the patients underwent anti-TNFα dose escalation during the follow-up *** both the infliximab and the adalimumab treated patients,non-response to anti-TNFα therapy was the major reason for treatment discontinuation.18.2% of the infliximab-treated patients and 13.5% of the adalimumab-treated patients had to discontinue their therapy due to adverse ***:Real-life remission rates of ulcerative colitis under anti-TNFα are overall low,but some patients have a clear long-term benefit.

关键词： Inflammatory bowel disease Tumor necrosis factor α

Placido disk-based topography versus high-resolution rotating Scheimpflug camera for corneal power measurements in keratoconic and post-LASIK eyes：reliability and agreement

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International Journal of Ophthalmology(English edition) 2017年第3期10卷 453-460页

作者： Rachele R.Penna Ugo de Sanctis Martina Catalano Luca Brusasco Federico M.Grignolo Department of Surgical Sciences Eye ClinicUniversity of Torino

AIM：To compare the repeatability/reproducibility of measurement by high-resolution Placido disk-based topography with that of a high-resolution rotating Scheimpflug camera and assess the agreement between the two instruments in measuring corneal power in eyes with keratoconus and post-laser in situ keratomileusis（LASIK）. METHODS：One eye each of 36 keratoconic patients and 20 subjects who had undergone LASIK was included in this prospective observational study. Two independent examiners worked in a random order to take three measurements of each eye with both instruments. Four parameters were measured on the anterior cornea：steep keratometry（Ks）,flat keratometry（Kf）,mean keratometry（Km）,and astigmatism（Ks-Kf）. Intra-examiner repeatability and inter-examiner reproducibility were evaluated by calculating the within-subject standard deviation（Sw）the coefficient of repeatability（R）,the coefficient of variation（Co V）,and the intraclass correlation coefficient（ICC）. Agreement between instruments was tested with the BlandAltman method by calculating the 95% limits of agreement（95% Lo A）.RESULTS：In keratoconic eyes,the intra-examiner and inter-examiner ICC were 〉0.95. As compared with measurement by high-resolution Placido disk-based topography,the intra-examiner R of the high-resolution rotating Scheimpflug camera was lower for Kf（0.32 vs 0.88）,Ks（0.61 vs 0.88）,and Km（0.32 vs 0.84）but higher for Ks-Kf（0.70 vs 0.57）. Inter-examiner R values were lower for all parameters measured using the high-resolution rotating Scheimpflug camera. The 95% Lo A were-1.28 to ＋0.55 for Kf,-1.36 to ＋0.99 for Ks,-1.08 to ＋0.50 for Km,and-1.11 to ＋1.48 for Ks-Kf. In the post-LASIK eyes,the intra-examiner andinter-examiner ICC were 〉0.87 for all parameters. The intra-examiner and inter-examiner R were lower for all parameters measured using the high-resolution rotating Scheimpflug camera. The intra-examiner R was 0.17 vs 0.88 for Kf,0.21 vs 0.88 for Ks,0.17 vs 0.86 for Km,and 0.28 vs 0.33 for Ks-

关键词： keratoconus post-LASIK corneal power measurement Placido disk-based topography Scheimpflug camera

Paediatric retinal detachment:a review

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International Journal of Ophthalmology(English edition) 2017年第10期10卷 1592-1603页

作者： Raffaele Nuzzi Carlo Lavia Roberta Spinetta Eye clinic Department of Surgical SciencesUniversity of Turin

Paediatric retinal detachment（PRD）is an uncommon and challenging disease;it differs from adult detachments in etiology,anatomical characteristics,management and *** can be particularly challenging,even for the most expert paediatric surgeons due to the higher prevalence of total retinal detachments,late diagnosis and bilateral involvement with respect to those which occur in ***,the anatomical success,when achieved,is frequently not related to a functional *** adverse events,refractive errors and amblyopia may additionally undermine the final *** to date there are few reviews regarding the approach of retinal detachment in children,mainly dealing with rhegmatogenous retinal *** this review,rhegmatogenous,retinopathy of prematurityrelated and Coats’-related PRDs were *** available literature from the last decades were reviewed and ***,etiology and clinical presentation,together with therapeutic approaches and outcomes have been reviewed and discussed.

关键词： paediatric retinal detachment paediatric rhegmatogenous retinal detachment retinopathy of prematurity Coats' disease

Discussion on Relevance and Studies of Prescription Compatibility in Chinese Medicine

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Chinese Journal of Integrative Medicine 2021年第10期27卷 788-793页

作者： Loh Cheng Toa Steven Goh Xin Yi NTU Chinese Medicine clinic Nanyang Technological UniversitySingapore(637551)

With Chinese medicine(CM)gaining popularity in recent years,researchers and clinicians have put in much interest and effort into the makings and effects of it,especially after the recent announcement of World Health Orgnitation's incorporation of CM into mainstream medical *** herb has complex properties,coming from its pharmacological properties and the Chinese medical principles of organ-directed,taste and dynamic orientational *** use of individual herb in CM is rare,where various herbs/ingredients are mostly found in a prescribed *** fully reveal the effects of CM is a great *** complexity of various herbs in combined effect,the absorption and utility rate by the body,uniqueness of individual physique,sub-types of pathological behaviors and time-line progression of the healing process add on to the complication of understanding the full effect of *** theories such as pathophysiology guidance,pharmacokinetic-pharmacodynamic compatibility method,and Global Systems Biology for Integrative Genomics,Proteomics and Metabolomics,which interactively provide a wider scope,more details,with the consideration of development time-line,may shed more light to revealing the full picture of the effects of compatibility prescription.

关键词： Chinese medicine integrative effects methodologies prescription compatibility

Multiple dose pharmacokinetics of quetiapine and some of its metabolites in Chinese suffering from schizophrenia

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Acta Pharmacologica Sinica 2004年第3期25卷 136-140页

作者： Kun-yan LI,Xin LI,Ze-neng CHENG,Wen-xing PENG,Bi-kui ZHANG,Huan-de LI1 clinic Pharmacy Research Institute,Xiangya Second Hospital,Central South university,Changsha 410011,China clinic Pharmacy Research Institute Xiangya Second Hospital Central South University

AIM: To study the multiple dose pharmacokinetics of quetiapine and its sulfoxide-, 7-hydroxy-, 7-hydroxy-N- dealkyl-metabolites in Chinese suffering from schizophrenia. METHODS: Twenty-one patients (11 females and 10 males) were given quetiapine twice daily to control the symptoms. After the dose reached 200 mg twice daily, blood were sampled to study the pharmacokinetics. The plasma concentrations of quetiapine and its metabolites were assayed by HPLC-MS. RESULTS: The main pharmacokinetic parameters of quetiapine, 7-hydroxy-N-dealkyl- quetiapine, quetiapine sulfoxide, and 7-hydroxy-quetiapine were as follows: tmax were 2.0 (0.3-5.0), 4.0 (1.5-6.0), 3.0 (0.5-5.0), and 3.0 (0.5-5.0) h respectively; t1/2 were (7±3), (9.4±2.7), (7±3), and (8±5) h, respectively; Cm SS ax were (678±325), (19±5), (451±216), and (58±22) μg/L, respectively; CSS were (51±68), (3.3±1.6), (35±36), and min (5±4) μg/L, respectively; Cav were (295±144), (13±4), (209±71), and (28±9) μg/L, respectively; AUC0?12 were SS SS (3 538±1 728), (153±44), (2 512±854), and (335±104) μg·h·L-1, respectively; AUC0 were (5 534±4 198), (287±107), SS -∞ (3 858±2 012), and (529±262) μg·h·L-1, respectively; Ke were (0.11±0.03), (0.079±0.019), (0.11±0.03), and (0.103±0.028) h-1, respectively; CL/F and V/F of quetiapine were (67±25) L·h-1 and (672±394) L, respectively. The plasma concentrations for the four compounds reached a steady state within 48 h at the dose of 200 mg initiation. These parameters were not statistically different between genders. CONCLUSIONS: Quetiapine was absorbed quickly, distributed widely, and metabolized mainly to be quetiapine sulfoxide. The elimination speeds of quetiapine and its three metabolites were similar. Gender had no effect on the pharmacokinetics of quetiapine and its metabolites. The clinical dosage regime caused no drug accumulation.

关键词： quetiapine pharmacokinetics metabolism schizophrenia Chinese

Scintigraphy in laryngopharyngeal and gastroesophageal reflux disease:A definitive diagnostic test?

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World Journal of Gastroenterology 2015年第12期21卷 3619-3627页

作者： Gregory L Falk John Beattie Alvin Ing SE Falk Michael Magee Leticia Burton Hans Van der Wall Sydney Heartburn clinic Gastroenterology Concord Hospital university of Sydney Macquarie university Sydney Ryde Medical Centre Sydney Department of Respiratory Medicine Concord Hospital the university of Sydney Sydney Heartburn clinic Gastroenterology Sydney Concord Nuclear Imaging clinic

AIM: To investigate the utility of scintigraphic studies in predicting response to laparoscopic fundoplication(LF) for chronic laryngopharyngeal reflux ***: Patients with upper aero-digestive symptoms that remained undiagnosed after a period of 2 mo were studied with conventional p H and manometric studies. Patients mainly complained of cough, sore throat, dysphonia and globus. These patients were imaged after ingestion of 99m-technetium diethylene triamine pentaacetic acid. Studies were quantified with time activity curves over the pharynx, upper and lower oesophagus and background. Late studies of the lungs were obtained for aspiration. Patients underwent LF with post-operative review at 3 mo after ***: Thirty four patients(20 F, 14 M) with an average age of 57 years and average duration of symptoms of 4.8 years were studied. Twenty four hour p H and manometry studies were abnormal in all patients. On scintigraphy, 27/34 patients demonstrated pharyngeal contamination and a rising or flat pharyngeal curve. Lung aspiration was evident in 50% of patients. There was evidence of pulmonary aspiration in 17 of 34 patients in the delayed study(50%). Pharyngeal contamination was found in 27 patients. All patients with aspiration showed pharyngeal contamination. In the 17 patients with aspiration, graphical time activity curve showed rising activity in the pharynx in 9 patients and a flat curve in 8 patients. In those 17 patients without pulmonary aspiration, 29%(5 patients) had either a rising or flat pharyngeal graph. A rising or flat curve predicted aspiration with a positive predictive value of 77% and a negative predictive valueof 100%. Over 90% of patients reported a satisfactory symptomatic response to LF with an acceptable sideeffect profile. CONCLUSION: Scintigraphic reflux studies offer a good screening tool for pharyngeal contamination and aspiration in patients with gastroesophageal reflux disease.

关键词： Laryngopharyngeal reflux p H studies Oesophageal m

Comparison of visual acuity, refractive results and complications of femtosecond laser with mechanical microkeratome in LASIK

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International Journal of Ophthalmology(English edition) 2013年第3期6卷 350-355页

作者： Cemile Banu Cosar Tansu Gonen Murat Moray Asim Bozkurt Sener Department of Ophthalmology Acibadem University Department of Ophthalmology Namlk Kemal University Eye clinic Acibadem Bursa Hospital Eye clinic Acibadem Maslak Hospital

AIM: To compare the outcomes of laser in situ keratomileusis (LASIK) performed with a femtosecond laser (Femtec, Technolas Perfect Vision GmbH, Germany) versus a mechanical microkeratome (Hansatome, Bausch and Lomb, USA) for the correction of myopia and astigmatism. ·METHODS: In this retrospective study, patients who had undergone LASIK using the 80 -kHz Femtec femtosecond laser were compared to age- and refraction- matched patients in whom the Hansatome microkeratome was used. Refractive and visual results 1 month and 3 months postoperatively, and complication rates were compared between the two groups. ·RESULTS: A total of 280 eyes were analyzed (140 in each group). At 3 months postoperatively in the Femtec vs Hansatome group, spherical equivalent refraction was within ±1.00D of emmetropia in 140 vs 138 eyes (P = 0.498), the cylinder was within ±0.50D in 137 vs 139 eyes (P =0.622), and the UDVA was 20/20 or better in 136 vs 137 eyes (P =0.724), respectively. There was no statistically significant difference in the complication rates between the two groups (P =0.099). ·CONCLUSION: LASIK performed both with Femtec femtosecond laser and Hansatome microkeratome achieved satisfactory refractive and visual results at 3 months postoperatively, without significant differences in efficacy, safety, and complication rates between the two procedures.

关键词： laser in situ keratomileusis femtosecond laser Femtec microkeratome Hansatome

Diarrhea after bariatric procedures:Diagnosis and therapy

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World Journal of Gastroenterology 2017年第26期23卷 4689-4700页

作者： Yves M Borbély Alice Osterwalder Dino Kroll Philipp C Nett Roman A Inglin clinic for Visceral Surgery and Medicine InselspitalBern University HospitalUniversity of Bern

Diarrhea after bariatric procedures, mainly those with malabsorptive elements including Roux-Y Gastric Bypass and Biliopancreatic Diversion, is common and an essential determinant of quality of life and microand macronutrient deficiencies. Bariatric surgery is the only sustainably successful method to address morbid obesity and its comorbidities, particularly gaining more and more importance in the specific treatment of diabetic patients. Approximately half a million procedures are annually performed around the world, with numbers expected to rise drastically in the near future. A multitude of factors exert their influence on bowel habits; preoperative comorbidities and procedure-related aspects are intertwined with postoperative nutritional habits. Diagnosis may be challenging owing to the characteristics of postbariatric surgery anatomy with hindered accessibility of excluded segments of the small bowel and restriction at the gastric level. Conventional testing measures, if available, generally yield low accuracy and are usually not validated in this specific population. Limited trials of empiric treatment are a practical alternative and oftentimes an indispensable part of the diagnostic process. This review provides an overview of causes for chronic post-bariatric surgery diarrhea and details the particularities of its diagnosis and treatment in this specific patient population. Topics of current interest such as the impact of gut microbiota and the influence of bile acids on morbid obesity and especially their role in diarrhea are highlighted in order to provide a better understanding of the specific problems and chances of future treatment in post-bariatric surgery patients.

关键词： Bariatric surgery Diarrhea Malnutrition Malabsorption Steatorrhea Dumping syndrome Bile acids and salts Gut microbiota Blind loop syndrome

Potential triggering factors of acute liver failure as a first manifestation of autoimmune hepatitis-a single center experience of 52 adult patients

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World Journal of Gastroenterology 2018年第13期24卷 1410-1418页

作者： Matthias Buechter Paul Manka Falko Markus Heinemann Monika Lindemann Hideo Andreas Baba Martin Schlattjan Ali Canbay Guido Gerken Alisan Kahraman Department of Gastroenterology and Hepatology University Clinic of Essen Division of Transplantation Immunology and Mucosal Biology King’s CollegeLondon Institute of Transfusion Medicine University Clinic of Essen Institute of Pathology University Clinic of Essen Department of Gastroenterology Hepatology and Infectious Diseases Otto-von-Guericke University

AIM To investigate potential triggering factors leading to acute liver failure(ALF) as the initial presentation of autoimmune hepatitis(AIH).METHODS A total of 565 patients treated at our Department between 2005 and 2017 for histologically-proven AIH were retrospectively analyzed. However, 52 patients(9.2%) fulfilled the criteria for ALF defined by the "American Association for the Study of the Liver(AASLD)". According to this definition, patients with "acute-on-chronic" or "acute-on-cirrhosis" liver failure were excluded. Following parameters with focus on potential triggering factors were evaluated: Patients' demographics, causation of liver failure, laboratory data(liver enzymes, MELD-score, autoimmune markers, virus serology), liver histology, immunosuppressive regime, and finally, outcome of our *** The majority of patients with ALF were female(84.6%) and mean age was 43.6 ± 14.9 years. Interestingly, none of the patients with ALF was positive for antiliver kidney microsomal antibody(LKM). We could identify potential triggering factors in 26/52(50.0%) of previously healthy patients presenting ALF as their first manifestation of AIH. These were drug-induced ALF(57.7%), virus-induced ALF(30.8%), and preceding surgery in general anesthesia(11.5%), respectively. Unfortunately, 6 out of 52 patients(11.5%) did not survive ALF and 3 patients(5.7%) underwent liver transplantation(LT). Comparing data of survivors and patients with non-recovery following treatment, MELDscore(P < 0.001), age(P < 0.05), creatinine(P < 0.01), and finally, ALT-values(P < 0.05) reached statistical significance. CONCLUSION Drugs, viral infections, and previous surgery may trigger ALF as the initial presentation of AIH. Advanced age and high MELD-score were associated with lethal outcome.

关键词： Acute liver failure Autoimmune hepatitis Drug-induced liver injury Triggering factors MELD-score