Background/Aims:Real-world evidence for upadacitinib use in strictly defined difficult-to-treat Crohn's disease (DTT-CD), particularly in Asian populations, remains limited. Herein, we aimed to evaluate the efficacy and safety of upadacitinib in Chinese patients with DTT-CD. Methods:This multicenter, bidirectional cohort study was conducted at 8 Chinese inflammatory bowel disease centers. Patients received upadacitinib 45 mg once daily for 12 weeks induction, followed by 15 mg daily for maintenance. The coprimary endpoints were clinical remission at week 12 and week 24. Results:Among the 151 DTT-CD patients enrolled, the clinical remission rates were 47.0% at week 12 and 62.9% at week 24, with endoscopic remission achieved in 28.1% of patients at week 24. Adverse events occurred in 42 (27.8%) during induction and in 33 (21.9%) during maintenance, with 3 serious events (venous thrombosis, perforation, and hemorrhage) reported during the maintenance phase. Notably, 2 male reproductive system-related adverse events were observed, including blue semen in 2 patients and a suspected case of paternal teratogenicity with fetal anomalies and pregnancy loss. The drug persistence at week 24 was 93.4%. Conclusions:Upadacitinib demonstrated robust efficacy in Chinese patients with DTT-CD, with a manageable safety profile and high treatment persistence.

Background: Although Upadacitinib has proven success in inflammatory bowel diseases (IBD), there is less data on its efficacy and safety in Asian patients with refractory IBD. Methods: This multicenter study evaluated the real-world effectiveness and safety of UPA in patients with refractory IBD. This multicenter retrospective cohort analysis included adult refractory IBD patients who received UPA therapy at three tertiary hospitals from January 2023 to March 2025. Clinical, endoscopic, and laboratory outcomes were effectiveness goals. Safety measures included AEs and and rates of discontinuation. Results: A total of 80 eligible patients were enrolled, including 52 with CD and 28 with UC. During the induction period, for CD: steroid-free clinical remission: 59.6%; clinical response: 61.5%; endoscopic remission: 30.8%; endoscopic response: 57.7%. For UC, steroid-free clinical remission: 67.9%; clinical response: 71.4%; endoscopic remission: 46.4%; endoscopic response: 60.7%. In the maintenance phase (12 months), CD had 78.8% steroid-free clinical remission and 75.0% endoscopic remission. UC had 85.7% steroid-free clinical remission and 78.6% endoscopic remission. Inflammatory indicators and nutritional parameters improved significantly. The incidence of adverse events in CD and UC was 23.1% and 14.3%, respectively, and the discontinuation rates during the 12-month maintenance treatment period were 7.1% and 21.5%, respectively. The most common adverse reaction is acne (8.75%). Conclusion: UPA demonstrated robust real-world effectiveness and an acceptable safety profile in Asian patients with refractory IBD.

Background With the increasing attention paid to transmural healing (TH) in the treatment of Crohn's disease (CD), we aim to investigate the factors associated with ultrasound defined TH. Methods Patients were and classified into TH and non-TH groups according to TH status at 1 year after baseline. Baseline demographic characteristics, disease features, laboratory parameters, and treatment-related factors were compared between groups. Variables with potential associations were screened by univariable analysis and subsequently entered into multivariable logistic regression models. Results A total of 112 patients with CD were included, comprising 52 in the TH group and 60 in the non-TH group at 1 year. Univariable analysis showed that, compared with the non-TH group, the TH group had a lower rate of treatment switching within 12 months [8/52 (15%) vs 21/60 (35%), P = 0.030], a lower proportion of concomitant immunomodulator use [3/52 (5.8%) vs 12/60 (20%), P = 0.049], and lower baseline C-reactive protein (CRP)levels [1 (0, 3) vs 3 (1, 7) mg/L, P = 0.001]. No significant differences were observed for the remaining variables. In the primary multivariable model, concomitant immunomodulator use was associated with a lower likelihood of achieving TH at 12 months (OR = 0.13, 95% CI: 0.02–0.52, P = 0.012). However, this association was not robust after treatment switching was incorporated. Conclusions Ultrasound-defined TH was associated with lower baseline inflammatory burden and greater treatment stability. The association between concomitant immunomodulator use and lower TH rates was not robust after accounting for treatment switching.

Background: Ulcerative colitis (UC), a chronic and relapsing inflammatory bowel disease, has long depended on physician-led objective evaluations for clinical management. However, physicians' assessments of symptoms often differ from patients' subjective experiences, creating a cognitive gap that may influence treatment decisions and overall disease outcomes. Objective: This study aimed to compare the cognitive discrepancy between UC patients and gastroenterologists throughout the diagnosis and treatment process. Design: Multicenter retrospective study. Methods: A nationwide survey was conducted across 39 Inflammatory Bowel Disease centers in China using a convenience sampling method, enrolling 457 UC patients and 170 gastroenterologists. A two-way questionnaire survey was administered to both groups to assess perceptions of disease status, treatment goals, medication use, follow-up preferences, economic burden, and decision-making models. Results: This multicenter study identified significant cognitive gaps between UC patients and gastroenterologists across key domains of disease management. Physicians prioritized objective clinical indicators such as hematochezia (51.18% vs 41.58%, p = 0.031), whereas patients emphasized subjective symptoms like rectal urgency (19.69% vs 4.12%, p < 0.001). Treatment goals also differed: patients valued quality-of-life improvement most, while physicians ranked endoscopic mucosal healing highest. Discrepancies extended to follow-up, with physicians favoring bi-monthly visits and patients preferring intervals exceeding 6 months. In decision-making, although 47.06% of physicians supported shared decision-making, only 10.72% of patients endorsed this model (p < 0.001). Notably, patients' willingness to allocate >50% of household income to treatment (21.44%) substantially surpassed physicians' expectations (5.29%, p < 0.001). Conclusion: These findings indicate a clear disconnect between current clinical management approaches and the lived experience of patients with UC in China. To bridge this gap, practice must shift toward models that actively integrate patient priorities into treatment plans.

BackgroundRisankizumab and guselkumab are two leading interleukin-23 (IL-23) inhibitors for treating immune-mediated inflammatory diseases. While effective, a direct comparison of their real-world safety profiles is lacking. Understanding the distinct differences in their adverse event (AE) profiles is crucial for clinicians to make appropriate treatment decisions.Research Design and MethodsWe conducted a disproportionality analysis on post-marketing data obtained from the FDA Adverse Event Reporting System (FAERS) database from Q3 2017 to Q2 2025 to detect and compare the AE signals of guselkumab and risankizumab.ResultsA total of 22,470 and 48,141 AE reports for guselkumab and risankizumab, respectively, were analyzed. The analysis revealed markedly different safety profiles. Risankizumab showed significant signals for skin cancer (particularly in patients ≥65 years), intestinal obstruction, and other newly identified serious events such as myocardial infarction and cerebrovascular accident. In contrast, guselkumab’s primary signals were dominated by medication management issues like “product dose omission issue” and “accidental exposure to product,” which correlated with reports of decreased therapeutic effect. Unique, unlabeled signals for guselkumab included a different spectrum of AEs, such as Hodgkin’s disease, pemphigoid, and autoimmune thyroiditis. Furthermore, the median time-to-onset was significantly shorter for guselkumab (62 days) compared to risankizumab (168 days).ConclusionGuselkumab and risankizumab exhibit divergent real-world safety profiles, challenging the notion of a uniform class effect. Clinicians should be vigilant for malignancies and serious systemic events with risankizumab, particularly in the elderly, while prioritizing patient education for guselkumab to prevent administration errors. These findings support individualized treatment strategies to minimize drug-specific risks.

Accurate detection of multiple lesions in wireless capsule endoscopy (WCE) images is crucial for gastrointestinal disease diagnosis. However, high inter-class similarity, intra-class variability, and the frequent coexistence of different lesion types within one image make this task highly challenging. To overcome these limitations, we propose a fine-grained multi-lesion classification network (FMC-Net) that enhances lesion discrimination and support single-label/multi-label classification through an innovative attention-guided feature selection module and a flexible classifier. The attention-guided feature selection module adopts two independent branches, one is designed as a weakly supervised selector to select local features, another is built with path augmentation blocks to achieve fused global features. After that, a global-local attention module is implemented to enhance the interaction between global and local features, thus improving the model' s fine-grained recognition and discrimination capability of lesions. Additionally, a flexible classifier with an interchangeable activation function further supports both single-label and multi-label learning. Extensive experiments on private WCE datasets demonstrate that FMC-Net outperforms state-of-the-art methods for sorting different types of images, including normal, bleeding, ulcer, erosion and polyp. In single-label classification, FMC-Net improves accuracy by over 2.68% on independent test dataset and over 5.15% on complete WCE cases. In multi-label classification, FMC-Net achieves an average accuracy of 81.78%, exceeding existing methods by at least 6.29%. The promising results demonstrate that the proposed method achieves competitive and robust detection performance in complex WCE scenarios, highlighting its potential for clinical application in automated gastrointestinal lesion detection and contributing to more accurate and efficient diagnostic workflows.

Objective:To evaluate the efficacy and safety of upadacitinib in the real-world treatment of difficult-to-treat Crohn's disease (DTT-CD) .Methods:This multicenter, retrospective cohort study included patients diagnosed with DTT-CD according to the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) criteria, and treated at eight Chinese inflammatory bowel disease centers between January 2023 and March 2025. Clinical outcomes were assessed after 12 weeks of induction therapy with upadacitinib (45 mg qd), including clinical remission rate, clinical response rate, and incidence of adverse events.Results:Among 151 enrolled DTT-CD patients, the clinical remission rate was 47.0%, and the clinical response rate was 90.7% after 12 weeks of treatment. Adverse events occurred in 42 cases (27.8%) .Conclusion:Upadacitinib demonstrated favorable efficacy in inducing clinical remission in DTT-CD patients, with a good safety profile at the induction dose (45 mg qd) .

Background:Physician assessments of patient symptoms may not align with the patients' subjective experiences, potentially affecting disease management. The key drivers of patients with Crohn's disease (CD) regarding their physicians' engagement in treatment decision-making are unknown. Objective:This study aimed to compare cognitive differences between patients and gastroenterologists in the diagnostic and treatment processes of CD. Design:Retrospective multicenter study. Methods:This study was conducted at 39 inflammatory bowel disease (IBD) centers across China, ultimately recruiting 601 patients with CD and 181 gastroenterologists. Results:Regarding symptom focus, physicians were more concerned about abdominal pain, while patients, particularly inpatients, were more concerned about frequent medical visits. There were also significant differences in the treatment goals. Patients prioritized improving their quality of life, whereas physicians showed a hierarchical difference in their focus: resident and attending physicians emphasized mucosal healing, while deputy chief physicians and above placed greater importance on long-term remission (clinical, endoscopic, and histological). Regarding knowledge gaps about CD, physicians significantly overestimated patients' understanding of biologics (93.37% vs 71.55%, κ = 0.117), with inpatients showing slightly higher awareness than outpatients (73.96% vs 70.42%). Regarding follow-up compliance, the discrepancy was especially prominent: 46.96% of physicians recommended follow-up every ⩽2 months, while 61.73% of patients preferred follow-up every 6 months. The economic burden of CD revealed that 21.30% of patients were willing to spend over 50% of their household income on treatment, which far exceeded physicians' expectations (9.94%). Lastly, there was a significant divergence in decision-making models: 49.17% of physicians advocated for shared decision-making, but only 14.31% of patients agreed with this model (κ = 0.353). Conclusion:There are notable cognitive disparities between patients with CD and physicians in their approaches to disease management, particularly concerning follow-up frequency and treatment options. These differences underscore the need for targeted interventions to bridge the gap between patient and physician perspectives. Therefore, future research should focus on enhancing communication between doctors and patients and enabling them to play a more active role in health management and treatment decisions.

PURPOSE:To investigate the relationship between the consumption of live microbes in the diet and adult periodontitis. MATERIALS AND METHODS:Utilising data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999-2004 and 2009-2014, 16,600 adults who underwent 24-h face-to-face dietary recall and oral health examinations were identified. Dietary live microbe intake was categorised into low, medium, and high levels. To examine the relationship between different levels of dietary live microbe intake and periodontitis, we employed logistic regression, subgroup and restricted cubic spline models. RESULTS:Upon comprehensive covariate adjustment, low dietary live microbe intake (104 CFU/g) demonstrated a positive association with periodontitis prevalence, while medium intake (104 to 107 CFU/g) showed a negative association. Conversely, no significant associations were observed between high dietary live microbe intake (>107 CFU/g) and periodontitis. Restricted cubic spline analysis confirmed a linear association between low dietary live microbe intake. Moreover, a U-shaped dose-response relationship was identified between medium dietary live microbe intake and periodontitis prevalence. CONCLUSIONS:Moderate intake of medium live microbe food may be more conducive to avoiding the occurrence of periodontitis.

BACKGROUND:Lifestyle factors are closely associated with the onset and progression of inflammatory bowel disease (IBD). Studies have demonstrated the positive effects of exercise on clinical outcomes and quality of life in individuals with IBD. Despite the well-documented role of exercise in improving IBD outcomes, the underlying mechanisms remain unclear. AIM:To compare the efficacy of different exercise modalities and explore their potential physiological mechanisms in rodent models of colitis. METHODS:We conducted a comprehensive search of five databases from inception to September 24, 2024, which yielded 19 animal studies in rodent colitis models. We compared the efficacy of various forms of exercise and explored the possible physiological mechanisms. The effects of different exercise modalities, namely forced treadmill running (FTR), voluntary wheel running (VWR), swimming, climbing, and jumping, on both macroscopic symptoms (e.g., body weight, disease activity, and colon length) and microscopic parameters (e.g., histopathology, immune markers, oxidative/antioxidant balance, and gut microbiota) in colitis models were compared. RESULTS:VWR (simulated recreational physical activity), swimming (aerobic exercise), and strength training (climbing and jumping) consistently promoted overall health in animal colitis models. However, evidence for FTR remains inconsistent, with a notable number of studies suggesting potential exacerbation of colitis symptoms, possibly due to stress or fatigue resulting from its coercive nature. Overall, various exercise (e.g., VWR, swimming, strength training) ameliorates colitis symptoms possibly by suppressing immune hyperactivation, enhancing antioxidant defenses, and modulating gut microbiota composition. In contrast, FTR was inconsistent, with several studies indicating a potential exacerbation of colitis symptoms, possibly due to stress or fatigue induced by its coercive nature. CONCLUSION:Exercise modality is critical in influencing colitis outcomes, with voluntary and low-stress forms generally being beneficial, while forced exercise may yield adverse effects. These findings highlight the importance of exercise type and individual tolerance in designing therapeutic exercise interventions for IBD. Further research is warranted to establish a robust therapeutic framework for exercise-based interventions in IBD management.

Background: Autophagy plays an essential role in inflammatory processes and mucosal repair, with Corticotropin-Releasing Hormone (CRH) and Toll-Like Receptor 4 (TLR4) also playing significant roles in regulating cellular autophagy. We hypothesized that disruptions in the CRHR2-mediated CRH-TLR4 signaling axis are associated with altered autophagy in intestinal epithelial cells (IECs) in ulcerative colitis. Furthermore, we investigated how these disruptions impact the mucosal repair mechanisms that are enhanced by Tong-Xie-Yao-Fang(TXYF). Methods: A 3% dextran sodium sulfate (DSS) solution was administered to mice for five days to induce a colitis model. Restraint stress was applied for 2 hours daily. while the CRHR2 antagonist Astressin 2B (Ast2B) at a dose of 20 μg/(kg·day) was given intraperitoneally, the CRHR2 agonist UCN2 at 30 μg/(kg·day) was administered peritoneally. TXYF at 5.6 g/(kg·day) was delivered by gavage, all for nine consecutive days. Body weight, fecal characteristics, and occult blood were monitored across all groups of mice throughout the experiment. The mice were euthanized by cervical dislocation, and the entire colon distal to the ileum was immediately dissected for further analysis. This included histological scoring of the colon, ELISA to detect changes in CRH and TLR4 levels in the colonic mucosa, Western blot analysis to assess autophagy through the LC3II/LC3I ratio and P62 levels, and in situ detection of apoptosis in intestinal epithelial cells using the TUNEL method. Results: Compared to the DSS group, DSS mice subjected to daily restraint stress exhibited increased TLR4 expression (P=0.0241<0.05), greater weight loss (P=0.0343<0.05), higher histological scores (P=0.0171<0.05), and an elevated apoptosis index (P=0.0375<0.05). Additionally, these mice had higher serum IL-6 levels than those given DSS alone (P=0.0004<0.05). The DSS+Ast2B group showed a higher LC3BⅡ/LC3BⅠ ratio compared to the DSS+NS group (P=0.0417<0.05). In contrast, the DSS+Ucn2 group had lower LC3BⅡ/LC3BⅠ (P=0.0011<0.05) and TLR4 (P=0.0025<0.05) protein expression, along with higher p62 protein levels (P=0.0129<0.05) compared to the DSS+NS group. Correlation analysis revealed a significant association between TLR4 and autophagy-related proteins (LC3 and p62) (P<0.05). Compared to the DSS+STRESS+NS group, the DSS+STRESS+TXYF group showed lower expression of CRH (P=0.0031<0.05) and TLR4 (P=0.0058<0.05), with reduced autophagy levels (all P<0.05). Additionally, the DSS+STRESS+TXYF group demonstrated increased colon length (P=0.0004<0.05) and reduced DAI scores (P=0.0384<0.05), histopathological scores (P=0.0015<0.05), and apoptosis levels (P=0.0125<0.05). Compared to the DSS+STRESS+Ast2B group, the DSS+STRESS+TXYF+Ast2B group showed lower expression of CRH (P=0.0109<0.05) and TLR4 (P=0.0057<0.05), along with reduced levels of the autophagy-related protein LC3 (P=0.0146<0.05). Furthermore, the DSS+STRESS+TXYF+Ast2B group exhibited increased colon length (P<0.0001) and reduced DAI scores (P<0.0001), histopathological scores (P<0.0001), and apoptosis levels (P=0.0002<0.05). Conclusion: Restraint stress enhances the expression of TLR4, thereby exacerbating colitis. CRHR2 serves to inhibit TLR4 protein expression, consequently reducing autophagy levels in intestinal epithelial cells. TXYF mediates the effects of CRHR2 on the CRH-TLR4 signaling axis, diminishing apoptosis in intestinal epithelial cells, inhibiting autophagy, preserving the integrity of the intestinal mucosal barrier, and exerting anti-inflammatory effects.

Wireless capsule endoscopy (WCE) plays an important role in diagnosing gastrointestinal tract diseases. Efficiently pinpointing the pylorus and ileocecal valve, which mark the start and end of the small intestine, is vital for clinicians determining the location of abnormalities in gastrointestinal tract as soon as possible during burdensome reviewing work. In this study, a novel and fault-tolerant automatic locating system for pylorus and ileocecal valve was proposed, combining a ResNet-50-based gastrointestinal classification model and the sliding pin algorithm. The classification model classified the WCE images into three categories, separated by the small intestine. And then the sliding pin algorithm was created to pinpoint the location of the pylorus and ileocecal valve even if there were misclassifications. A total of 108,542 WCE images were used to train and test the gastrointestinal classification model. The average accuracy of classification model was 92.21% with recognition rate varying from 88% to 96%. Furthermore, thirty-one independent WCE cases were selected to verify the proposed locating method. The mean locating error was 26 frames for the pylorus and 65 frames for the ileocecal valve, which was notably smaller than those of other state-of-the-art methods. In conclusion, this study presented an innovative approach for automatically locating the boundary of small intestine in WCE. The promising results indicated that this method was able to accurately identify the pylorus and ileocecal valve, which was expected to improve the endoscopic diagnostic efficiency of gastrointestinal diseases.

Objective:This study aimed to investigate the potential benefits of physical activity (PA) on patient-reported outcomes (PROs) in individuals with Crohn's disease (CD) and to examine whether these benefits are associated with gut microbiota. Methods:This cross-sectional study included 251 patients with CD from two inflammatory bowel disease centers in China. Participants with CD provided information on their health background, PA, and PROs using the Global Physical Activity Questionnaire (GPAQ) and the Patient-reported Outcome Measurement Information System (PROMIS). Part of participants also provided a single fecal sample for analysis. Latent profile analysis (LPA) was conducted to categorize individuals with CD into classes based on PROs. Metagenomic sequencing was then performed, followed by bioinformatics assessment of taxonomy and diversity metrics. Results:LPA identified two PRO patterns: low and high symptoms. Univariate and multivariate analyses indicated that disease activity and sedentary behavior were risk factors for symptom severity, whereas recreational PA, rather than work-and travel-related PA, and income served as protective factors (all p<0.05). After controlling for age, gender, disease activity level, and other covariates, recreational PA explained microbiome diversity in patients with CD (p=0.016). The gut microbiota diversity (alpha or beta) significantly varied between patients with CD and low and high levels of recreational PA (all p<0.05). A total of 29 dominant gut microbial taxa, including Oscillospiraceae, Ruminococcus, and Eubacterium rectale, have been identified as associated with recreational PA and primarily function in the butyric acid metabolism pathway. Conclusion:Promoting the incorporation of recreational PA as an indicator of healthy lifestyle management for CD may improve patients' subjective psychological and mental well-being, while also preserving intestinal microbial diversity. Recreational PA is associated with favorable patient-reported outcomes and increased diversity of gut microbiota in CD, supporting its inclusion in lifestyle management strategies.

Background:Second-generation dual-layer spectral computed tomography enterography (DLCTE) provides advanced virtual monoenergetic imaging (VMI) that may overcome conventional computed tomography (CT) enterography limitations in inflammatory bowel disease (IBD). This study aimed to identify the optimal VMI energy level in spectral CT enterography for IBD using quantitative and qualitative image quality assessments. Methods:This case-control study retrospectively analyzed 44 patients with endoscopically confirmed active IBD undergoing DLCTE. Conventional polyenergetic images (PEIs) and VMIs (40-100 keV, 10-keV increments) were reconstructed across non-contrast, arterial, and venous phases. Quantitative metrics [contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), CT attenuation, image noise] and subjective image quality (5-point Likert scale) were compared between PEIs and VMIs. Results:Quantitative analysis revealed that VMI 40 keV achieved peak performance: highest CT attenuation values (AV) [non-contrast: 57.7±13.2 Hounsfield units (HU) vs. PEI 40.4±7.2 HU, P<0.001; arterial: 172.1±34.6 vs. 80.1±13.2 HU; venous: 200.2±46.0 vs. 88.9±19.8 HU], superior SNR [arterial: 12.5±6.1 vs. 5.7 (4.1-6.7)] and CNR [venous: 29.9 (20.0-43.4) vs. 16.2±5.4]. Despite comparable noise levels between VMI 40-50 keV and PEIs (P>0.05), VMI ≥60 keV demonstrated significantly reduced noise (P<0.001). In subjective analyses, 40 keV VMI was consistently identified as the optimal reconstruction parameter among low-energy VMIs, receiving the highest ratings for overall image quality. Conclusions:The dual-layer detector spectral CT low-level VMI can optimize the image quality of CTE in IBD, and is useful to evaluate the intestinal inflammatory range. Among them, the VMI 60 keV imaging has the best display and can increase the diagnostic confidence in active IBD, and it is suitable for clinical promotion and use.

BACKGROUND Ulcerative colitis (UC) is a chronic inflammatory disease affecting the colon. The most common psychological issue in UC patients is varying degrees of depression, which affects the condition and quality of life of UC patients and may lead to deterioration of the patient’s condition. UC drugs combined with antianxiety and antidepression drugs can alleviate symptoms of both depression and UC. Brain-derived neurotrophic factor (BDNF) precursor (proBDNF)/p75 neurotrophin receptor (p75NTR)/sortilin and BDNF/tropomyosin receptor kinase B (TrkB) signalling balance is essential for maintaining brain homeostasis and preventing the development of depressive behaviours. AIM To explore the mechanism by which Wuling powder regulates the proBDNF/ p75NTR/sortilin and BDNF/TrkB pathways in the treatment of UC with depression. METHODS Depression was established in C57BL/6J mice via chronic restraint stress, and the UC model was induced with dextran sodium sulfate (DSS). In the treatment stage, mesalazine (MS) was the basic treatment, Wuling powder was the experimental treatment, and fluoxetine was the positive control drug for treating depression. Changes in intestinal mucosal inflammation, behaviour, and the proBDNFp75NTR/sortilin and BDNF/TrkB pathways were evaluated. RESULTS In the depression groups, Wuling powder decreased the immobility time, increased the distance travelled in the central zone and the total distance travelled, and restored balance in the proBDNF/p75NTR/sortilin and BDNF/TrkB signalling pathways. In the DSS and chronic restraint stress + DSS groups, immobility time increased, distance travelled in the central zone and total distance travelled decreased, activity of the proBDNF/p75NTR/ sortilin pathway was upregulated, and activity of the BDNF/TrkB pathway was downregulated, indicating that mice with UC often have comorbid depression. Compared with those of MS alone, Wuling powder combined with MS further decreased the colon histopathological scores and the expression levels of tumor necrosis factor-alpha and interleukin-6 mRNAs. CONCLUSION This study confirmed that Wuling powder may play an antidepressant role by regulating the balance of the proBDNF/p75NTR/sortilin and BDNF/TrkB signalling pathways and further relieve intestinal inflammation in UC.

BackgroundAlthough large language models (LLMs) such as ChatGPT show promise for providing specialized information, their quality requires further evaluation. This is especially true considering that these models are trained on internet text and the quality of health-related information available online varies widely. ObjectiveThe aim of this study was to evaluate the performance of ChatGPT in the context of patient education for individuals with chronic diseases, comparing it with that of industry experts to elucidate its strengths and limitations. MethodsThis evaluation was conducted in September 2023 by analyzing the responses of ChatGPT and specialist doctors to questions posed by patients with inflammatory bowel disease (IBD). We compared their performance in terms of subjective accuracy, empathy, completeness, and overall quality, as well as readability to support objective analysis. ResultsIn a series of 1578 binary choice assessments, ChatGPT was preferred in 48.4% (95% CI 45.9%-50.9%) of instances. There were 12 instances where ChatGPT’s responses were unanimously preferred by all evaluators, compared with 17 instances for specialist doctors. In terms of overall quality, there was no significant difference between the responses of ChatGPT (3.98, 95% CI 3.93-4.02) and those of specialist doctors (3.95, 95% CI 3.90-4.00; t524=0.95, P=.34), both being considered “good.” Although differences in accuracy (t521=0.48, P=.63) and empathy (t511=2.19, P=.03) lacked statistical significance, the completeness of textual output (t509=9.27, P<.001) was a distinct advantage of the LLM (ChatGPT). In the sections of the questionnaire where patients and doctors responded together (Q223-Q242), ChatGPT demonstrated inferior performance (t36=2.91, P=.006). Regarding readability, no statistical difference was found between the responses of specialist doctors (median: 7th grade; Q1: 4th grade; Q3: 8th grade) and those of ChatGPT (median: 7th grade; Q1: 7th grade; Q3: 8th grade) according to the Mann-Whitney U test (P=.09). The overall quality of ChatGPT’s output exhibited strong correlations with other subdimensions (with empathy: r=0.842; with accuracy: r=0.839; with completeness: r=0.795), and there was also a high correlation between the subdimensions of accuracy and completeness (r=0.762). ConclusionsChatGPT demonstrated more stable performance across various dimensions. Its output of health information content is more structurally sound, addressing the issue of variability in the information from individual specialist doctors. ChatGPT’s performance highlights its potential as an auxiliary tool for health information, despite limitations such as artificial intelligence hallucinations. It is recommended that patients be involved in the creation and evaluation of health information to enhance the quality and relevance of the information.

BackgroundUpadacitinib, a Janus kinase inhibitor, has been increasingly used over the past few years to treat moderate to severe ulcerative colitis and Crohn’s disease in patients who are insufficiently responsive or intolerant to tumor necrosis factor (TNF) antibodies, demonstrating notable clinical efficacy. The long-term safety of upadacitinib in extensive populations remains unexplored. This study evaluates upadacitinib-related adverse events (AEs) utilizing data from the US Food and Drug Administration Adverse Event Reporting System (FAERS).MethodsWe employed disproportionality analyses, including the proportional reporting ratio (PRR), reporting odds ratio (ROR), Bayesian confidence propagation neural network (BCPNN), and empirical Bayesian geometric mean (EBGM) algorithms to identify signals of upadacitinib-associated AEs for treating inflammatory bowel disease (IBD).ResultsFrom a total of 7,037,004 adverse event reports sourced from the FAERS database, 37,822 identified upadacitinib as the primary suspect drug in adverse drug events (ADEs), including 1,917 reports specifically related to the treatment of inflammatory bowel disease (IBD). The most commonly reported AEs were acne, product residue present, haematochezia, frequent bowel movements, flatulence, blood cholesterol increased, aligning with clinical trial outcomes. Notably, significant but unexpected AEs, such as rosacea, proctalgia, polyp, were also reported. Subgroup analysis indicated that the most prevalent AEs among the elderly included pulmonary embolism, cataract, and sepsis, whereas the 18–65 age group most frequently reported acne, abdominal pain, and nasopharyngitis. The median onset time for AEs related to upadacitinib was 41.00 days (interquartile range [IQR] 10–141.5 days), with the majority occurring within 3 months of treatment initiation (n = 269, 66.09%), particularly in the first month (n = 171, 42.01%).ConclusionOur findings affirm clinical observations and reveal potential new AE signals for upadacitinib, underscoring the need for prospective clinical studies to verify these results and clarify their clinical relevance. This study contributes valuable evidence for ongoing safety evaluations of upadacitinib.

背景 维得利珠单抗（VDZ）和乌司奴单抗（UST）均可有效治疗克罗恩病（CD）。然而，两者作为CD患者的初治生物制剂的比较研究较少。目的 比较真实世界中VDZ和UST在中重度活动期CD患者中作为初治生物制剂时的有效性和安全性，并探究与临床疗效相关的预测因素。方法 回顾性收集浙江中医药大学附属第一医院2021年1月—2023年1月使用VDZ或UST作为初治生物制剂治疗中重度CD患者资料。评估治疗14周和52周的临床疗效及治疗52周的内镜疗效和药物维持治疗率，分析治疗52周临床缓解的影响因素，并记录治疗期间药物不良反应发生情况。结果 共纳入72例CD患者，其中VDZ 27例，UST 45例；共67例完成14周治疗（VDZ 24例，UST 43例），57例完成52周治疗（VDZ 18例，UST 39例）。UST和VDZ治疗14周时的临床应答率和临床缓解率比较，差异均无统计学意义（P>0.05）。UST和VDZ治疗52周时的临床应答率和临床缓解率比较，差异均无统计学意义（P>0.05）。UST和VDZ治疗52周时的内镜应答率和内镜缓解率比较，差异均无统计学意义（P>0.05）。在52周药物维持治疗率方面，UST[86.7%(39/45)]高于VDZ[66.7%(18/27)](P=0.043)。多因素Logistic回归分析结果显示，年龄（OR=0.965,95%CI=0.938～0.993）、治疗14周临床应答（OR=8.483,95%CI=1.699～42.352）是UST治疗52周临床缓解的影响因素（P<0.05）。因单因素分析中没有发现VDZ治疗52周临床缓解影响的因素，故未进行多因素分析。VDZ[7.4%(2/27)]和UST[4.4%(2/45)]治疗患者不良事件发生率比较，差异无统计学意义（P>0.05）。结论 UST作为初治生物制剂在中重度活动期CD患者中的临床和内镜疗效与VDZ相当，但UST治疗52周的药物维持治疗率高于VDZ。年龄和UST治疗14周临床应答与UST治疗第52周的临床缓解存在相关性。两者的不良反应发生率相近。