ABSTRACT
Objective:The current evidence suggests that tumor necrosis factor-inhibitor (TNFi) treatment can be used to achieve clinical remission or low disease activity in patients with ankylosing spondylitis (AS). After achieving remission / low disease activity, however, the follow-up treatment options are unclear. The purpose of this review is to conduct an extensive and systematic literature review of the studies conducted from September 2014 to July 2020 to assess the feasibility and effectiveness of tapering of biological agents.Methods:After searching for the related papers and abstracts and applying inclusion/exclusion criteria, a structured extraction process was used to include the studies into this study.Results:A total of 13/93 studies were included into the analysis of the tapering of biological agents in AS patients, in which 7/13 adopted the dose reduction regimen, 3/13 adopted the extended interval between doses regimen, and 5/13 did not provide or formulate the detailed reduction regimen. We summarized the feasibility of TNFi tapering schemes in the published studies and summarized the tapering rules. Only one study showed that reduced TNFi levels worsened the quality of life and resulted in a relapse within 12 months.Conclusion:More research is needed to understand the long-term effects of these strategies on efficacy, safety, and cost in the treatment of AS.
ABSTRACT
Objective To discuss the application of early time window modified stereotaxic aspiration in converting operation therapy on the specified acute epidural hematoma.Methods 21 patients with the specified acute epidural hematoma were treated with early time window modified stereotaxic aspiration drainage,using YL-1 hematoma puncture needle with silica gel ventricular drainage tube.Results The successful rate of puncture was 100％.Hematoma was completely cleared in 19 cases.A small amount of epidural effusion was remained in 2 cases.1 case had concomitant rebleeding during the puncture,and shifted to craniotomy.Conclusion Early time window modified stereotaxic aspiration drainage is a minimally invasive,safe and effective treatment on the specified acute epidural hematoma when mastering the indications,timing and skills of puncture.
