Evaluation of Efficacy and Safety of Vedolizumab in Treatment of Active Inflammatory Bowel Disease / 胃肠病学

Background: Inflammatory bowel disease (IBD) is a non-specific inflammatory disease of the gastrointestinal tract with a course of repeated episodes and remissions. Vedolizumab (VDZ), a selective blocker of interaction between leukocytes and vascular endothelium of the gut, has been demonstrated effective in treatment of active IBD. Aims: To systematically evaluate the efficacy and safety of VDZ for active IBD. Methods: PubMed, Embase, Cochrane Library and Google Scholar were retrieved to collect randomized controlled trials (RCTs) comparing VDZ and placebo in patients with IBD published in English before Aug. 2018. Meta-analysis was conducted by using RevMan 5.30 software. Results: Eight RCTs involving 3 159 active IBD patients were included. Meta-analysis showed that VDZ was superior to placebo in inducing clinical response, clinical remission and endoscopic remission in active UC (RR=1.62, 95% CI: 1.33-1.97, P<0.000 01; RR=2.45, 95% CI: 1.56-3.83, P<0.000 1; RR=1.75, 95% CI: 1.29-2.37, P=0.000 3, respectively) and in maintenance of clinical remission in inactive UC (RR=2.43, 95% CI: 1.73-3.41, P<0.000 01). Also, VDZ was superior to placebo in inducing clinical response and clinical remission in active CD (RR=1.47, 95% CI: 1.21-1.79, P=0.000 1; RR=1.87, 95% CI: 1.37-2.56, P<0.000 1, respectively). Subgroup analysis revealed that clinical remission was only achieved in CD patients naive to anti-tumor necrosis factor-α (TNF-α) therapy. Only one trial described the clinical remission in inactive CD, the results showed that VDZ was superior to placebo. Except for nasopharyngitis, adverse events were similar between VDZ group and placebo group. Conclusions: VDZ is safe and effective for induction and maintenance of remission in active IBD, but may be not more effective than placebo in CD patients failure to anti-TNF-α therapy.

Quantitative chemical shift-encoded MRI is an accurate method to quantify marrow fat / 实用放射学杂志

Objective To validate a chemical shift-encoded MRI(CSE-MRI)water-fat imaging for quantifying vertebral marrow fat content using MRS as the reference standard.Methods MRS and CSE-MRI were performed to calculate proton density fat fraction(PDFF) in 83 subjects,including 41 normal bone mass,26 osteopenia and 16 osteoporosis.Eight participants were scanned three times with repositioning to assess the repeatability of CSE-MRI PDFF measurements.Agreements of intra-observer and inter-observer were evaluated by intraclass correlation coefficient(ICC).Linear regression,Bland-Altman 95% limit of agreement and Lin's concordance correlation coefficient were calculated.Results The repeatability for CSE-MRI PDFF measurements expressed as absolute precision error was 1.45%.PDFF was 62.1%±11.1% by MRS and 60.4%±10.1% by CSE-MRI in 83 subjects.There were significant differences in PDFF among the normal bone mass,osteopenia and osteoporosis groups after adjusting for age,years since menopause and body mass index (all P<0.001).The intra-and inter-rater reliability for duplicate measurements at CSE-MRI PDFF were more than 0.993.Pearson correlation coefficient was 0.979 and Lin's concordance correlation coefficient was 0.962.All data points calculated using the Bland-Altman method were within the limits of agreement.Inverse associations were observed between BMD (r=-0.560--0.710)and CSE-MRI-based PDFF,and between BMD (r=-0.539--0.706)and MRS-based PDFF in various groups.Conclusion CSE-MRI with multiple lipids peak model and T2?-correction is equally accurate in characterizing marrow fat content as MRS.

Opportunistic screening for colorectal cancer / 中华健康管理学杂志

Objective To retrospectively analyze medical data of patients with colorectal cancer (CRC) so as to provide evidence for clinical use of opportunistic screening.Methods A total of 2450 CRC patients (male 1377,female 1073) who were treated at five hospitals in North China during October 2001 and September 2011 and had complete medical records and pathological results were recruited.The correlations of incidenceofCRCwithage,gender,tumorlocationandhistologicaltypeswere analyzed.Results Of all the CRC patients,those less than 50 years old accounted for 18.14％ ; and the incidence of CRC was substantially increased in those over 50 years old.Seventy-three percent of tumor occurred at the rectum and sigmoid colon,6％ at descending colon,7％ at transverse colon and 14％ at ascending colon.Moderately,well or poorly differentiated adenocarcinoma accounted for 50.33％,40.35％and 9.32％,respectively.Histological differentiation was not correlated with age and gender ( P ＞ 0.05 ).Conclusions Age and gender should not be considered a determination of opportunistic screening for CRC.Colonoscopy is recommended as an alternative CRC screening procedure.