Purpose:Real-world evidence on the effectiveness of upadacitinib in Crohn's disease is increasing; however, data from Chinese populations remain limited. This study aimed to evaluate the real-world effectiveness, persistence, and safety of upadacitinib. Methods:This retrospective study included consecutive patients with Crohn's disease treated with upadacitinib at the First Affiliated Hospital of Anhui Medical University who had at least one follow-up visit. Clinical effectiveness was assessed using the Harvey-Bradshaw Index, and endoscopic effectiveness was evaluated using the Simple Endoscopic Score for Crohn's Disease. Logistic regression analysis was performed to identify factors associated with clinical remission at week 12. Kaplan-Meier analysis and Cox regression analysis were used to evaluate upadacitinib persistence. Results:Total of 108 patients with moderate-to-severe Crohn's disease and prior anti-TNF failure or intolerance were included. The clinical remission rates at weeks 12 and 24 were 55.1% and 52.5%, respectively, whereas the biomarker remission rates were 57.3% and 62.5%, respectively. Endoscopic reassessment was available for 32 patients. Endoscopic response was achieved in 16 patients (50.0%), of whom 8 (25.0%) attained endoscopic remission. Pharmacokinetic data from a small subset of 24 patients showed that higher plasma concentrations of upadacitinib were associated with endoscopic remission (p = 0.023). Stricturing Crohn's disease (OR = 0.32, 95% CI: 0.12-0.84, p = 0.021) and baseline albumin ≤ 35 g/L (OR = 0.22, 95% CI: 0.07-0.62, p = 0.006) were associated with a lower likelihood of clinical remission at week 12. Twenty patients discontinued treatment, and baseline albumin ≤ 35 g/L (HR = 3.05, 95% CI: 1.26-7.36, p = 0.012) was associated with an increased risk of discontinuation. A total of 22 (20.3%) patients experienced 23 adverse events. Conclusion:This real-world study demonstrates that upadacitinib is effective, with acceptable safety and favorable treatment persistence, in Chinese patients with moderate-to-severe anti-TNF-refractory Crohn's disease. Future studies with larger sample sizes should focus on long-term effectiveness and safety and provide more comprehensive pharmacokinetic characterization.

IMPORTANCE:In Crohn's disease (CD) patients treated with biologics preoperatively, the optimal strategy for postoperative biologic management remains unclear. DESIGN:This was a retrospective multicenter study involving CD patients with ileocolonic anastomosis from 9 medical centers. Patients were divided into "the consistent group" (postoperative biologic previously used before surgery) and "the switched group" (postoperative biologic not used preoperatively). The primary endpoint was postoperative endoscopic recurrence (ER), which was defined as the first endoscopy performed between 6 and 18 months after surgery. Propensity score matching (PSM) was used to minimize baseline differences between groups, and conditional logistic regression was applied to identify factors associated with ER. RESULTS:In total, 227 patients were included in the study, of whom 177 were in the consistent group. No significant difference was observed in the rate of ER between the switched group and the consistent group (30.0% vs 40.7%, P = .170). In patients with ≤2 risk factors defined by established guidelines, the switched group showed a lower ER rate (20.6% vs 40.0%, P = .038). After 1:1 PSM, the switched group had a lower ER rate (29.4% vs 61.8%, P = .027). Conditional logistic regression analysis revealed that switching biologics was associated with a lower risk of ER (odds ratio = 0.31, 95% confidence interval, 0.11-0.85, P = .023). CONCLUSIONS:In CD patients with preoperative biologic exposure, both continuing and switching biologic therapy postoperatively were effective in preventing ER, with switching showing improved endoscopic outcomes after adjustment for confounders.

Traditional teaching methods in standardized training for gastroenterology residents face challenges in developing independent clinical abilities and self-learning enthusiasm. This study evaluated the effectiveness of a flipped classroom approach based on micro-videos compared to that of traditional classroom teaching in the training of gastroenterology residents. This study included 112 residents at the First Affiliated Hospital of Anhui Medical University from January to December 2024. The participants were randomly assigned to the flipped classroom (FC, n = 56) or traditional classroom (TC, n = 56) group. The FC group received micro-video-based pre-class materials and participated in interactive in-class discussions, whereas the TC group received traditional lectures. After 4 weeks, both groups were evaluated via theoretical examinations, clinical skills assessments, and perceived teaching effectiveness questionnaires. The FC group additionally completed a perception survey. Compared with the TC group, the FC group showed higher scores on case analysis questions (33.61 ± 2.61 vs. 31.43 ± 3.17, p = 0.010) and clinical practice skills (89.23 ± 2.71 vs. 86.11 ± 3.59, p = 0.001). The flipped classroom approach demonstrated superior outcomes in improving clinical practice skills (p = 0.028), learning interest (p = 0.015), self-learning ability (p = 0.023), problem-solving proficiency (p = 0.002), and team collaboration (p < 0.001). Moreover, in excess of 96

Goals: To identify the association between infliximab trough levels (ITL) and treatment outcomes in small bowel Crohn’s disease (SB-CD) Background: Higher ITL are associated with favorable treatment outcomes in CD. However, the association between ITL and SB-CD treatment outcomes are rarely studied. Study: This was a retrospective cross-sectional study. Patients with SB-CD who received maintenance infliximab therapy were recruited, and treatment efficacy was evaluated through double balloon endoscopy. Serum samples were collected to test ITL. The primary outcome was endoscopic remission (ER), which is defined as a Simple Endoscopic Score of Crohn’s disease (SES-CD) of <3. The secondary outcome was mucosal healing (MH) (SES-CD: 0) and endoscopic response (SES-CD decreased by 50% from baseline). The factors associated with ER were also explored through logistic regression analysis. Results: In total, 111 patients with SB-CD were enrolled. Forty-seven patients (42.3%) achieved ER. Median ITL was significantly higher in patients with ER than patients without ER (2.74 vs. 1.12 µg/mL, P<0.01). In a multivariate model, an elevated ITL was the only independent factor associated with an increased probability of ER [odds ratio (OR): 1.24, 95% CI: 1.08-1.43, P=0.003]. The cutoff level of ITL used to predict ER with a specificity of >80% was 3.45 µg/mL, and the area under the curve (AUC) was 0.790. Meanwhile, the AUC cutoff to predict MH and endoscopic responses was 0.767 and 0.759, respectively. Conclusions: There was a significant association between higher ITL and favorable SB-CD treatment outcomes.

BackgroundVedolizumab (VDZ), a gut-selective anti-integrin therapy, has demonstrated efficacy in ulcerative colitis (UC) clinical trials, but real-world long-term data from Asia, particularly from Chinese populations, remain limited. Therefore, this study aimed to evaluate the long-term effectiveness and safety of vedolizumab in Chinese patients with UC in a real-world setting over a 2-year period.MethodsIn this retrospective cohort study conducted at a tertiary hospital in China, patients aged ≥18 years old who received VDZ for UC between December 2020 and August 2023 were enrolled. Information on the clinical characteristics, prior/concomitant treatment, and safety during the observation period was collected.ResultsThe data obtained from 112 patients (males, n = 62) were analyzed. The median age at VDZ induction was 40.37 years old. VDZ was indicated as the first biologic in 85.71% of patients. Clinical remission rates at weeks 14, 54, and 104 were 61.61, 66.96, and 58.93%, respectively. VDZ persistence was 78.57% at 1 year and 61.61% at 2 years. Concomitant use of 5-ASA or steroids was associated with poorer drug persistence (HR = 3.13 and 5.03, p < 0.01). Clinical response at week 14 predicted sustained remission (OR = 6.07, p < 0.001). Nine adverse drug reactions (ADRs) were noted, none severe.ConclusionThis real-world study confirms vedolizumab’s sustained effectiveness in UC, with durable remission and excellent safety over 2 years. The findings support its position in treatment algorithms and highlight the value of early response assessment in guiding therapeutic decisions.

BACKGROUND:We aimed to elucidate the function of the mechanosensitive ion channel PIEZO1 in intestinal fibrosis, which is invariably associated with Crohn's disease (CD) and often results in strictures and obstructions, requiring surgical intervention. Notably, PIEZO1 is strongly expressed in fibrotic tissues and linked with fibrotic progression. METHODS:Intestinal tissues were procured from 28 patients diagnosed with CD and 8 healthy control subjects. Histological and immunofluorescence assays verified that PIEZO1 is substantially overexpressed in fibrotic intestinal tissues and is involved in epithelial‒mesenchymal transition (EMT). Further gene knockout experiments and transcriptome sequencing elucidated the specific role of PIEZO1 in the pathogenesis of intestinal fibrosis in CD. We generated mice with Piezo1 deletion specifically in intestinal epithelial cells (Piezo1f/fVilcre) to validate in vivo that inhibiting Piezo1 function attenuates or reverses intestinal fibrosis associated with CD. RESULTS:PIEZO1 expression was strongly increased in the fibrotic small intestine of CD patients, thereby promoting EMT and exacerbating intestinal fibrosis. In vivo investigations revealed that the conditional suppression of Piezo1 in intestinal epithelial cells significantly mitigated intestinal fibrosis in dextran sulphate sodium (DSS)- and 2,4,6-trinitrobenzenesulfonic acid (TNBS)-induced chronic colitis model mice. In vitro examinations revealed that Piezo1 expression in intestinal epithelial cells preserved the stability of HIF-1α, induced EMT to stimulate the expression of fibrosis-associated molecules, and promoted fibrosis. CONCLUSION:PIEZO1 plays a pivotal role in the regulation of intestinal fibrosis by maintaining the levels of HIF-1α, thereby promoting EMT. Therapeutic strategies targeting PIEZO1 could be used to prevent intestinal fibrosis in CD patients.

BACKGROUND:Ustekinumab (UST) is an interleukin-12/interleukin-23 receptor antagonist approved for the treatment of Crohn's disease (CD). Although UST has demonstrated good efficacy and safety in CD, long-term real-world data in Chinese patients are relatively scarce. METHODS:A single-center, observational retrospective study was conducted in the First Affiliated Hospital of Anhui Medical University. Comprehensive baseline demographic characteristics, clinical parameters, potential predictors of clinical remission of CD patients treated with UST from January 2020 to January 2024 were collected and analyzed. RESULTS:A total of 348 CD patients were included. At week 52, the clinical remission rate was 70.95%, endoscopic remission 24.68%, C-Reactive Protein (CRP) normalization 54.11%, and fecal calprotectin (FCP) normalization 48.57%. Prior biologic exposure, CRP reduction at week 8, and baseline hemoglobin level were independent predictors of clinical remission. The mean survival duration with UST was 172 weeks (SE = 6, 95% CI: 160-185). CONCLUSIONS:This study demonstrated favorable effectiveness, persistence, and safety of UST in CD patients. Prior biologic exposure, early CRP reduction and hemoglobin level were associated with clinical remission at 52 weeks.

BACKGROUND:Crohn's disease (CD) is an incurable inflammatory bowel disease that can lead to a variety of complications and requires lifelong treatment. However, the diagnosis and management of Crohn's disease exhibit high rates of misdiagnosis and missed diagnoses, along with significant variability, among primary care facilities and novice endoscopists. Therefore, we established an interpretable artificial intelligence (AI) system using double-balloon enteroscopy to facilitate Crohn's disease ulcer identification and grading. OBJECTIVE:To develop an interpretable AI system for the identification and grading of Crohn's disease ulcer images, offering bounding box localization for visual interpretability and factor-specific grading explanations for each ulcer to improve assessment performance. METHODS:We constructed a region and grading model of individual ulcers based on the YOLO-v5 algorithm. By analyzing the predicted results of all ulcers in each image, the clinical interpretation for the screening and assessment of Crohn's disease ulcer images was further achieved. To evaluate the system, we prepared the training and validation datasets (17,036 double-balloon enteroscopy images, 558 patients) and further collected a test cohort (2018 images, 70 patients) and an external validation set. A further reader study was conducted on the internal test set in which nine endoscopists participated to evaluate the auxiliary effectiveness of the explainable system. RESULTS:The Crohn's disease ulcer image detection sensitivity and area under the curve (AUC) were 91.8% and 0.949. The accuracies in assessing the severity of Crohn's disease ulcer images on three factors (size/ulcerated surface/depth) were 94.1%/92.5%/93.0%, respectively. With the system's support of visualized and analyzable predictions, junior endoscopists improved their Crohn's disease ulcer image recognition sensitivity by 12.7% and their accuracy and consistency of severity assessment by 26% and 27.4%. CONCLUSION:The AI system outperformed general endoscopists in approaching expert-level proficiency in Crohn's disease ulcer identification and assessment. Its transparency in decision-making facilitated integration into clinical workflows, enhancing trust and consistency among endoscopists.

BackgroundIn 2023, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant caused a large-scale outbreak of coronavirus disease 2019 (COVID-19) in China. It is not clear the risk factors that lead to the exacerbation of symptoms in patients with inflammatory bowel disease (IBD) after COVID-19 infection. Our study aims to find out the risk factors for the exacerbation of IBD-related symptoms in IBD patients with COVID-19 infection and to provide guidance for the clinical management of IBD.MethodsThis is a retrospective, observational study. The online questionnaire was distributed to conduct a survey to collect demographic, clinical, and IBD related characteristics in IBD patients. Univariate and multivariate regression analyses were conducted to assess the independent effects.ResultsIn total, 534 cases of IBD patients were analyzed in our study. Among them, 466 (87.3%) cases diagnosed with COVID-19, 160 (34.3%) cases experienced exacerbation of IBD symptoms, and 84 (18.0%) patients opted for medication discontinuation. Male sex (OR 2.04, 95% CI 1.34–3.49, p = 0.001), and the decrease in body mass index (BMI) (OR 0.93, 95% CI 0.87–1.00, p = 0.035) were positively correlated with the exacerbation of IBD symptoms. Furthermore, the medication discontinuation (OR 2.60, 95% CI 1.58–4.30, p < 0.001) was strongly positively correlated with the exacerbation of IBD symptoms. No significant association was seen between age, comorbidities, smoking, disease activity, vaccination, therapy for COVID-19 and the worsening of IBD symptoms.ConclusionThis study confirms that the infection rate of COVID-19 in China IBD patients was comparable to the general population. Male sex, the decrease in BMI and medication discontinuation are significant risk factors for the exacerbation of IBD-related symptoms in IBD patients with COVID-19 infection.

Carriage of HLA-DQA1*05 is thought to increase the formation of anti-tumour necrosis factor alpha (TNF-α) antibodies, reducing the drug efficacy in Crohn's disease (CD) patients. However, little data are currently available for small-bowel Crohn's disease (SB-CD). A specific assessment of the impact of HLA-DQA1*05 on the clinical response to treatment with infliximab (IFX), a TNF-α antagonists, in SB-CD patients is necessary. We conducted a single-center retrospective study that included 106 SB-CD patients treated with IFX. The serum samples were collected for antibodies to infliximab (ATI) testing and HLA-DQA1*05 genotyping. Double-balloon enteroscopy (DBE) was performed following the IFX treatment, with endoscopic outcomes evaluated using the partial simple endoscopic score for CD (pSES-CD), whereas the clinical response was assessed with the Crohn's disease activity index (CDAI). Multivariate logistic regression and multivariate COX regression analyses were employed to analyze the correlation of the HLA-DQA1*05 genotypes with other clinical variables. In this study, 30.2% of SB-CD patients carried the HLA-DQA1*05 allele, which significantly increased their risk of ATI generation (odds ratio [OR] = 2.337, p = .043), but it was not associated with the clinical response to IFX and drug persistence (OR = 2.356, p = .145; OR = 0.457, p = .249). The endoscopic remission rates were 40.6% (13/32) and 55.4% (41/74) in HLA-DQA1*05 carriers and non-carriers, respectively. HLA-DQA1*05 was not associated with endoscopic remission (OR = 0.684, p = .414). The HLA-DQA1*05 variant is identified as a significant risk factor of ATI formation in Chinese patients with SB-CD, but is not associated with the clinical response of IFX treatment and endoscopic remission of SB lesions.

BACKGROUND AND AIMS:Evaluation of deep remission in Crohn's disease (CD) can be challenging when the disease is confined to the small intestine. The aim of this study was to evaluate the effectiveness of through-the-scope EUS during double-balloon enteroscopy (DBE-EUS) in distinguishing small-bowel CD patients in endoscopic remission from those with active disease. METHODS:Patients who underwent DBE-EUS were divided into groups of endoscopic remission and endoscopic activity according to segmental Simple Endoscopic Score for Crohn's Disease (SES-CD). The thickness of small intestinal wall layers and other parameters were evaluated by EUS. RESULTS:EUS using an ultrasonic catheter probe by DBE showed that the total wall thickness (TWT) and submucosal thickness (SMT) of the small intestine in the active group were significantly greater than those in the remission group (3.84 ± 1.02 mm vs 2.42 ± .25 mm and 1.23 ± .34 mm vs .79 ± .13 mm, respectively; P < .001). Cutoff values of 2.65 mm for TWT and .95 mm for SMT can distinguish active small-bowel CD from inactive disease (sensitivity 91.5% and specificity 80.8% and sensitivity 70.2% and specificity 88.6%, respectively). The correlation analysis revealed a significant positive correlation between TWT and SES-CD (r =.930, P < .001). Furthermore, TWT was strongly correlated with fecal calprotectin (r = .861, P < .001) and Crohn's Disease Activity Index (r = .805, P < .001). Similar results were observed for SMT. CONCLUSIONS:EUS using an ultrasonic catheter probe during DBE is effective in evaluation of both mucosal and transmural healing in small-bowel CD patients. DBE-EUS could become an important tool in the management of patients with small-bowel CD.

Background: It is unclear how clinical and endoscopic factors affect the attainment of endoscopic remission (ER) in patients with small bowel Crohn’s disease (SB-CD) who are infliximab-naïve. Objectives: We aimed to identify the effect of different factors on attaining ER using double-balloon endoscopy (DBE) evaluation. Design: A single-center retrospective observational study was conducted from 1 January 2018 to 30 November 2022. Among 262 patients who were screened for isolated SB-CD by baseline DBE, 108 patients were assessed for effectiveness during maintenance infliximab therapy by a second DBE evaluation. Methods: DBE findings before and after infliximab therapy were compared. ER was defined as a simple endoscopic score for CD (SES-CD) below 3, and segmental ER as SES-CD activity of 0. Multivariate regression with calculations of odds ratios (OR) was used to determine the impact of different factors on attaining ER. Results: In all, 41 patients (38.0%) achieved ER. An elevated C-reactive protein at week 6 was independently associated with a decreased probability of ER [OR: 0.86, 95% confidence interval (CI) = 0.75–0.98, p = 0.03]. Segmental ER of the terminal ileum, rather than the proximal ileum, was associated with a higher rate of ER (60.9% versus 38.2%, p = 0.01). High baseline SES-CD (⩾16) was unrelated to overall ER. For patients with disease in the terminal ileum, those with moderate/severe disease were less likely to attain segmental ER than those with mild disease [adjusted odds ratios (aOR): 0.27, 95% CI: 0.09–0.83, p = 0.02]. A large ulcer in the terminal ileum was associated with a lower rate of segmental ER (aOR: 0.18, 95% CI: 0.06–0.56, p = 0.01). Conclusion: For infliximab-naïve patients with SB-CD, the overall severity of the endoscopic score was unrelated to attainment of ER. Patients were less likely to attain segmental ER if they had greater endoscopic inflammation or larger ulcers in the terminal ileum.

Purpose To assess the efficacy of double-balloon endoscopy (DBE) for the detection of small-bowel stricture in Crohn’s disease (CD). Methods This Tertiary-referral hospital cohort study was conducted between January 2018 and May 2022. CD patients with symptoms of small-bowel stricture were enrolled sequentially. All of the patients were subjected to both computed tomography enterography (CTE) and DBE, and their symptoms of stricture were assessed using the Crohn’s Disease Obstructive Score (CDOS). DBE diagnostic yield was compared to CTE, and the relationship between DBE findings and CDOS was investigated. The factors influencing DBE diagnosis were examined using Cox regression analysis. Results This study included 165 CD patients. CDOS scores were higher in 95 patients, while lower in 70. DBE detected 92.7% (153/165) and CTE detected 85.5% (141/165) of the strictures, respectively. DBE diagnostic yields were 94.7% (90/95) in high CDOS patients and 91.4% (64/70) in low CDOS patients (P = 0.13). Patients with a history of abdominal surgery and abscess had a lower diagnosis rate in the multivariate analysis. Conclusion DBE has been demonstrated to be an efficient diagnostic method for detecting small-bowel strictures in CD patients. Additionally, there is no difference in diagnostic yields between patients with low and high obstructive scores.

BACKGROUND AND AIMS:Double-balloon endoscopy (DBE) is widely used in diagnosing small-bowel Crohn's disease (CD). However, CD misdiagnosis frequently occurs if inexperienced endoscopists cannot accurately detect the lesions. The CD evaluation may also be inaccurate owing to the subjectivity of endoscopists. This study aimed to use artificial intelligence (AI) to accurately detect and objectively assess small-bowel CD for more refined disease management. METHODS:We collected 28,155 small-bowel DBE images from 628 patients from January 2018 to December 2022. Four expert gastroenterologists labeled the images, and at least 2 endoscopists made the final decision with agreement. A state-of-the-art deep learning model, EfficientNet-b5, was trained to detect CD lesions and evaluate CD ulcers. The detection included lesions of ulcer, noninflammatory stenosis, and inflammatory stenosis. Ulcer grading included ulcerated surface, ulcer size, and ulcer depth. A comparison of AI model performance with endoscopists was performed. RESULTS:The EfficientNet-b5 achieved high accuracies of 96.3% (95% confidence interval [CI], 95.7%-96.7%), 95.7% (95% CI, 95.1%-96.2%), and 96.7% (95% CI, 96.2%-97.2%) for the detection of ulcers, noninflammatory stenosis, and inflammatory stenosis, respectively. In ulcer grading, the EfficientNet-b5 exhibited average accuracies of 87.3% (95% CI, 84.6%-89.6%) for grading the ulcerated surface, 87.8% (95% CI, 85.0%-90.2%) for grading the size of ulcers, and 85.2% (95% CI, 83.2%-87.0%) for ulcer depth assessment. CONCLUSIONS:The EfficientNet-b5 achieved high accuracy in detecting CD lesions and grading CD ulcers. The AI model can provide expert-level accuracy and objective evaluation of small-bowel CD to optimize the clinical treatment plans.

Focusing on the undergraduate specialty construction of big data management and application in medical colleges and universities in the context of New Medical Education, we first analyzed, in this paper, the demand for trained personnel of this specialization and the status of program construction at the national and regional levels. Then, taking Anhui Medical University as an example, a key medical university in Anhui Province, we introduced the preparations made by medical colleges and universities to set up big data management and application specialty. Finally, from the perspectives of the objectives of personnel training, curriculum system, and practical teaching system, we presented in detail the exploratory efforts made by Anhui Medical University to construct a training system for personnel specializing in big data management and application. In this paper, we reported mainly the work done on the exploration of the personnel training curriculum system, covering general education, professional education, and extracurricular activities, highlighting the interdisciplinary characteristics of a personnel training curricular system that integrates medicine, engineering, and management. We also reported on a practice teaching system that combined in-class practical teaching and extracurricular activities, and that incorporated tiered contents of increasing challenge--basic practice level, cognitive practice level, comprehensive practice level, and innovative practice level. This study is expected to provide useful references for the training of personnel specializing in medical big data in the context of New Medical Education.

Purpose Fecal calprotectin (FC) levels can reflect the level of intestinal inflammation. Crohn’s disease (CD), which affects the small bowel, has not been linked to FC levels. We determined if FC levels and endoscopic activity were related by performing double-balloon endoscopy (DBE). Methods Herein, patients with small bowel CD diagnosed by DBE between January 2020 and January 2022 were prospectively observed. Feces and blood samples of patients were collected before performing DBE and checked for the levels of FC and serological biomarkers. The endoscopic activity and mucosal healing (MH) were evaluated using the partial simple endoscopic score (pSES-CD). Results In all 254 CD patients, FC levels were correlated with pSES-CD ( r = 0.775, P < 0.001). Even in patients with isolated small bowel CD, FC levels were strongly correlated with pSES-CD ( r = 0.753, P < 0.001). In all patients, FC as an endoscopic remission indicator was found to have an area under the curve (AUC) of 0.872, with a cut-off value of 156.09 µg/g. In patients with isolated small bowel CD, FC yielded a high AUC of 0.865 for predicting endoscopic remission, with a cut-off value of 211.48 µg/g, sensitivity of 73.95%, and specificity of 91.30%. FC was optimally cut-off at 76.99 µg/g to predict MH in accordance with the AUC of 0.877. Conclusions Using DBE findings, FC was found to be significantly correlated with pSES-CD. Even in isolated small bowel CD, FC may be a more reliable marker of accurately predicting endoscopic remission and MH.

Abstract Objectives Pentraxin 3 (PTX3) may reflect local inflammatory status in tissues and thus serve as a potential biomarker of inflammation. Here, we investigated the utility of serum PTX3 as an index for assessing the 90‐day prognosis of acute minor stroke patients. Materials & Methods Acute minor stroke patients (N = 241) and matched healthy control subjects (N = 241) were prospectively recruited. Clinical, laboratory, and imaging data were assessed. Blood samples were collected within 48h after acute minor stroke onset and serum PTX3 levels were determined. Results Significant increases in stroke patients versus controls were obtained for serum PTX3 (3.14 ± 1.23 vs. 2.44 ± 0.74 ng/ml; p < .001) and C‐reactive protein (CRP – 1.53 ± 0.38 vs. 1.35 ± 0.35 μg/ml; p < .05). Among the four stroke subtypes, as defined by modified Trial of Org 10172 in Acute Stroke Treatment classification, there were no statistically significant differences in serum PTX3 levels (p > .05). Multivariate logistic regression analysis revealed that serum PTX3 and LDL cholesterol could predict unfavorable outcomes at day 90 in Large Artery Atherosclerosis (LAA) patients. Conclusions Serum Pentraxin 3 may serve as an independent predictor for an unfavorable outcome in the LAA subtype of acute minor stroke and may possess a superior prognostic value as compared to CRP in this LAA subgroup.

OBJECTIVE:The aim of this study was to investigate cross-sectional associations between serum levels of citrate and knee structural changes and cartilage enzymes in patients with knee osteoarthritis (OA).METHOD:A total of 137 subjects with symptomatic knee OA (mean age 55.0 years, range 34-74, 84% female) were included. Knee radiography was used to assess knee osteophytes, joint space narrowing (JSN) and radiographic OA assessed by Kellgren-Lawrence (K-L) grading system. T2-weighted fat-suppressed fast spin echo magnetic resonance imaging (MRI) was used to determine knee cartilage defects, bone marrow lesions (BMLs) and infrapatellar fat pad (IPFP) signal intensity alternations. Colorimetric fluorescence was used to measure the serum levels of citrate. Enzyme-linked immunosorbent assay was used to measure the serum cartilage enzymes including matrix metalloproteinase (MMP)-3 and MMP-13.RESULTS:After adjustment for potential confounders (age, sex, body mass index), serum citrate was negatively associated with knee osteophytes at the femoral site, cartilage defects at medial femoral site, total cartilage defects, and total BMLs (odds ratio [OR] 0.17-0.30, all P < .05). Meanwhile, serum citrate was negatively associated with IPFP signal intensity alteration (OR 0.30, P = .05) in multivariable analyses. Serum citrate was significantly and negatively associated with MMP-13 (β -3106.37, P < .05) after adjustment for potential confounders. However, citrate was not significantly associated with MMP-3 in patients with knee OA.CONCLUSION:Serum citrate was negatively associated with knee structural changes including femoral osteophytes, cartilage defects, and BMLs and also serum MMP-13 in patients with knee OA, suggesting that low serum citrate may be a potential indicator for advanced knee OA.

Objective: To investigate cross-sectional associations between serum level of Matrix metalloproteinase (MMP) 13 and knee structural measures and circulating inflammatory factors in patients with symptomatic knee osteoarthritis (OA). Design: A total of 149 subjects with symptomatic knee OA were included. Magnetic resonance imaging was used to measure infrapatellar fat pad (IPFP) volume, IPFP signal intensity alternation, cartilage volume and cartilage defects. Knee radiography was used to assess radiographic OA using the KellgrenLawrence (K-L) grading system. Enzyme-linked immunosorbent assay was used to measure the serum levels of inflammatory factors and MMP13. Results: In multivariable analyses, serum MMP13 was negatively associated with cartilage volume at patellar site (beta: -32.94 mm(3) per 10 ng/ml, P < 0.05), and positively associated with cartilage defect at medial femoral site (OR: 1.13 per 10 ng/ml, P < 0.05). Also, MMP13 was positively associated with K-L grading and IPFP signal intensity alteration (OR: 1.14 and 1.15 per 10 ng/ml, respectively, both P < 0.05), and negatively associated with IPFP volume (beta: -0.34 cm(3) per 10 ng/ml, P < 0.05). Furthermore, serum level of adiponectin was negatively associated serum MMP13 quartiles (OR: 0.66 per 10 mg/ml, P < 0.05), and serum levels of tumor necrosis factor (TNF)-alpha, interleukin (IL)-8 and IL-18 were positively associated with serum MMP13 quartiles (ORs: 1.01-1.18 per 10 pg/ml, all P < 0.05). Conclusions: Serum level of MMP13 was associated with knee structural abnormalities as well as serum inflammatory factors. These suggest that systemic MMP13 may play a role in knee OA, and could be regulated by inflammatory factors. (c) 2018 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.