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OBJECTIVE：To investigate the ru les and characteristics of pembrolizumab-induced immune-related myocarditis ， and to provide reference for rational drug use in clinic. METHODS ：Using“pembrolizumab/keytruda”“myocarditis”“cardiotoxicity” “Pembrolizumab/Keytruda”“Cardiac toxicity ”“Myocarditis”“Cardiotoxity”“Cardiotoxicity”as Chinese and English retrieval words ， CBM，VIP，CNKI，Wanfang database ，PubMed，Wiley Online Library and Embase database were searched on the case reports of pembrolizumab-induced immune-related myocarditis during the inception to Aug. 2020. After eliminating the suspected case literature and repetitive literature ，gender，age，medication cause ，medical history ，drug combination ，drug dosage ，occurrence time of ADR ，clinical manifestation ，intervention measure and outcome of patients in the included literature were analyzed. RESULTS & CONCLUSIONS：A total of 15 literatures were included ，involving 13 English literatures and 2 Chinese literatures. Totally 15 patients were involved ，including 12 males and 3 females，with an average age of 71.35 years. There were 4 cases of non-small cell lung cancer ，4 cases of melanoma ，2 cases of bladder cancer ，1 case of urothelial cancer ，1 case of multiple osteosarcomas，1 case of gastric cancer ，1 case of thymic cancer ，1 case of nasopharyngeal carcinoma. There were 6 patients with previous medical history ，of which 5 had no history of heart disease and 1 had hypertension and hyperlipidemia ；there were 9 patients recorded the combined use of drugs ；the dosage and frequency of pembrolizumab were recorded in 12 patients. Immunological myocarditis of 93.3％ patients occurred after the first to second cycle of pembrolizumab administration ，and the average occurrence time was 15.5 days after the last administration. The most common clinical symptoms were dyspnea ，fatigue， dizziness or syncope. 9 patients showed cardiac block on electrocardiogram. All patients were treated with glucocorticoids when they developed immune-associated myocarditis ，and 5 patients died after hospitalization ；another one patient was restarted with pembrolizumab for one cycle after control of immune-related myocarditis ，but developed a recurrence of myocarditis and died of myocarditis ADR. It is suggested that baseline examination and routine monitoring of cardiac function should be done well when patients are treated with pembrolizumab. Once the patient is su spected to have immune-related myocarditis ，they should timely improve the cardiograms and other cardiac function-relatedtests，and start the treatment of high-dose glucocorticoids as 198177） soon as possible ，and are alert to the risk of death due to recurrence of myocarditis after readministration.
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Background:Cytapheresis has been used gradually in the treatment of ulcerative colitis( UC),however,its efficacy is still controversial. Aims:To systematically evaluate the efficacy and safety of cytapheresis on UC. Methods:PubMed, Embase,Web of Science,Cochrane Library,CNKI,Wanfang and VIP database were retrieved to collect the randomized controlled trials( RCTs)using cytapheresis for UC. Article selection,data extraction and quality evaluation were conducted independently by two reviewers. Meta-analysis was conducted by using RevMan 5. 3 software. Results:A total of 20 RCTs involving 1 354 UC patients were included. The results of the meta-analysis showed that cytapheresis was superior to conventional therapy or sham procedure in inducing clinical response(RR=1. 36,95% CI:1. 20-1. 55,P﹤0. 000 01), clinical remission(RR=1. 38,95% CI:1. 15-1. 66,P=0. 000 5)and maintenance of remission(RR=2. 92,95% CI:1. 40-6. 08,P=0. 004 ),and no differences in adverse events were found( RR =0. 37,95% CI:0. 11-1. 24,P =0. 110). Conclusions:Cytapheresis has porfound effect on induction of clinical response, clinical remission and maintenance of remission,and is safe as well. However,the conclusion should be verified by more large-scale and multi-center RCTs.
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Inflammatory bowel disease (IBD)is a non-specific,chronic intestinal inflammatory disease,and the pathogenesis of IBD is not completely clear. Mesenchymal stem cell (MSC)is a kind of pluripotent stem cell and has been widely used in the treatment of blood system diseases. Recent studies have shown that MSC has a unique advantage in the treatment of IBD. This article reviewed the advances in study on MSC in the treatment of severe IBD.
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Objective To evaluate the methodology, feasibility, safety and efficacy of cap-assisted endoscopic sclerotherapy(CAES)for hemorrhoids. Methods Patients with grade Ⅰ to Ⅲ internal hemorrhoids underwent CAES from September 2014 to May 2016. According to the methodology of CAES, reasons for blooding were identified and polypectomy and excision of anal papilla fibroma was performed. Efficacy,intraoperative and postoperative complications and patient satisfaction were evaluated during and after CAES. The follow-up was more than three months. Results A total of 48 patients with gradeⅠ toⅢinternal hemorrhoids underwent CAES,including 25(52.1%)patients with grade Ⅰ,21(43.8%)patients with grade Ⅱ,and 2(4.2%)grade Ⅲ. During the whole procedure of CAES, colon and terminal ileum examination was performed in 48(100.0%)patients, polypectomy was performed in 14(29.2%)patients, excision of anal papilla fibroma was performed in 1(2.1%)patient, excision of external hemorrhoids was performed in 1(2.1%)patient,biopsy for the polyps on dentate line was performed in 2(4.2%)patients, and sclerotherapy for rectal mucosal prolapse was performed in 2(4.2%)patients. No bleeding was observed during and after CAES. Infection occurred in one(2.1%)patient, who recovered with a one-week anti-infective therapy. One(2.1%)patient claimed mild tenesmus within four days after CAES.No complications were observed within the three-month follow-up. All patients(100.0%)were satisfied with this novel procedure. Conclusion CAES, as a novel endoscopic sclerotherapy, is a safe and effective endoscopic therapy with high patient satisfaction for internal hemorrhoids.
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Inflammatory bowel disease(IBD)is a chronic nonspecific intestinal inflammatory disease and the etiology and pathogenesis are not fully clarified. Studies showed that immune factors play an important role in the pathogenesis of IBD. Cytapheresis(CAP)is a new blood purification method which can selectively filter or adsorb the inflammatory cells and cytokines in systemic circulation. Many studies confirmed that CAP had some therapeutic effect on IBD. This article reviewed the advances in study on CAP in treatment of IBD.
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Inflammatory bowel disease(IBD)is a group of chronic and nonspecific intestinal inflammatory diseases of unknown etiology. A growing body of evidence indicated that the intestinal microflora might play an important role in the pathogenesis of IBD. As a microecological therapy,fecal microbiota transplantation(FMT)has been used in various of gastrointestinal and metabolic diseases for reconstruction of intestinal flora and achieved favorable results. This article mainly reviewed the progress of technical innovation in FMT and its application in the treatment of IBD.
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Penetrating catheterization is an advanced catheterization technique. With the help of guide wire penetrating manipulation, multi-channel or better channel interventional therapies can be successfully carried out. This catheterization technique was first employed in the treatment of patent ductus arteriosus. Thereafter, its clinical application has been gradually extended into the interventional field for the treatment of large artery disease, peripheral artery and vein disease, and it has been also used in non-vascular interventional treatment. Being a unique interventional technique that reflects characteristic clinical thinking, penetrating catheterization technique can fully play the interventional device performance, solve many problems involved in interventional operation, improve the success rate of operation and reduce the complications. This paper aims to introduce the current situation of its clinical practice.
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Background:Inflammatory bowel disease(IBD)is a chronic,non-specific,relapsing inflammatory bowel disorder. Prediction of prognosis and relapse is of great importance for disease control. Aims:To analyze the characteristics and related factors for relapse in IBD patients. Methods:Four hundred and seventy-nine hospitalized patients diagnosed as ulcerative colitis(UC,n = 301)or Crohn’s disease( CD,n = 178)from Jan. 2004 to Jun. 2014 were enrolled and divided into relapse group and non-relapse group. The clinical characteristics were collected and univariate and multivariate analysis were performed to identify the influencing factors for relapse. Results:The relapse rates for UC and CD were 52. 49% and 77. 53% ,respectively. In stepwise Logistic regression analysis,younger onset age( < 40 years old,OR =0. 825,95% CI:0. 777-0. 876,P = 0. 000),longer disease duration(OR = 1. 186,95% CI:1. 089-1. 291,P = 0. 000) and extensive colitis(OR = 16. 993,95% CI:2. 670-108. 170,P = 0. 003)were independent risk factors for relapse of UC,while younger onset age( < 40 years old,OR = 0. 944,95% CI:0. 915-0. 974,P = 0. 000)and poor medication adherence(OR = 31. 074,95% CI:10. 456-92. 343,P = 0. 000)were independent risk factors for relapse of CD. Conclusions:Patients at high risk for relapse of IBD can be identified by referring to the related risk factors. Early identification and intervention,persistence for maintenance therapy and improving medication adherence by health education may reduce the clinical relapse of IBD.
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Objective To study the diagnosis and treatment of omental torsion.Methods 73 patients with omental torsion from Jan 1995 to Dec 2009 in literatures together with the one we reported were reviewed and analyzed The range of ages was from 3 to 65 years,and the median age was 25.3 years.Among them,35 cases were less than 18 years old(47%,and 27 with obesity) and others more than 18 years old(53%,1 with obesity).The accurate diagnosis before operation exsited in 9 patients.49 patients(66%) were diagnosed as primary omental torsion,and childhood obesity was the most related factor.Conversely,25(34%) were diagnosed as secondary omental torsion,while the most common reason was adhersion.In contrast with other clinical symotoms and signs,abdominal pain and tenderness were occurred in almost every people.Bultro sonography(positive rate:24%,6/25) was hardly useful in diagnosis but CT (positive rate:96%,23/24) and MRI(positive rate:100%,2/2) were beniticial.Operation was applied in all patients,while laparoscopy was uesed in 23 patients.As a rule,the appendix was removed together in 61 persons.The cobort of patients was recoverd fully without serious complications such as hemorrhage and intestinal infarction.Conclusion Omental torsion was a relatively rare disease,and the diagnosis should be easy with the help of CT and MRI,and the laparoscopy was the better choice for surgeons.