remission

摘要： BACKGROUND Treatment efficacy for attention-deficit/hyperactivity disorder(ADHD)is reported to be poor,possibly due to heterogeneity of ADHD symptoms.Little is known about poor treatment efficacy owing to ADHD heterogeneity.AIM To use generalized structural equation modeling(GSEM)to show how the heterogeneous nature of hyperactivity/impulsivity(H/I)symptoms in ADHD,irritable oppositional defiant disorder(ODD),and the presentation of aggression in children interferes with treatment responses in ADHD.METHODS A total of 231 children and adolescents completed ADHD inattention and H/I tests.ODD scores from the Swanson,Nolan,and Pelham,version IV scale were obtained.The child behavior checklist(CBCL)and parent’s satisfaction questionnaire were completed.The relationships were analyzed by GSEM.RESULTS GSEM revealed that the chance of ADHD remission was lower in children with a combination of H/I symptoms of ADHD,ODD symptoms,and childhood aggressive behavior.ODD directly mediated ADHD symptom severity.The chance of reaching remission based on H/I symptoms of ADHD was reduced by 13.494%[=exp(2.602)]in children with comorbid ADHD and ODD[odds ratio(OR)=2.602,95%confidence interval(CI):1.832-3.373,P=0.000]after adjusting for the effects of other factors.Childhood aggression mediated ODD symptom severity.The chance of reaching remission based on ODD symptoms was lowered by 11.000%[=1-exp(-0.117)]in children with more severe baseline symptoms of aggression based on the CBCL score at study entry[OR=-0.117,95%CI:(-0.190)-(-0.044),P=0.002].CONCLUSION Mediation through ODD symptoms and aggression may influence treatment effects in ADHD after adjusting for the effects of baseline ADHD symptom severity.More attention could be directed to the early recognition of risks leading to ineffective ADHD treatment,e.g.,symptoms of ODD and the presentation of aggressive or delinquent behaviors and thought problems in children with ADHD.

摘要： Remission作为急性期的治疗目标是切实可行的,然而,由于Remission的中文翻译存在一定的误区,Remission常常被误解为全病程的目标,从而影响全病程治疗的策略。为此,本文梳理了抑郁障碍Remission的发展过程、Remission时期残留的症状以及定义的缺陷,提出了Remission的适宜翻译。

摘要： Introduction: Vasculitis associated with anti-neutrophil cytoplasm antibodies (ANCA) can be grouped with granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MAP), and eosinophilic granulomatosis with polyangiitis (EGPA). Diagnosis of these rare pathologies is based on clinical presentation, the positivity of ANCA, and, if possible, histological proof of vasculitis. Our study describes a series of six cases of ANCA-associated vasculitis where due to the severity of symptoms apheresis sessions were started from the beginning of the therapy. Patients and methods: We conducted a retrospective, single-center observational, monocentric study on all patients treated by apheresis for ANCA vasculitis in the period January 01, 2016 to December 01, 2019. Results: We identified six cases of ANCA vasculitis treated by apheresis over a 3-year period. The mean age was 61 ± 19 years;M/F gender ratio was 1:1. Initial renal damage in all patients was rapidly progressive glomerulonephritis. Inflammatory syndrome occurred in all patients with average CRP of 82 mg/L. All patients had positive ANCA at diagnosis. Four patients required renal replacement therapy at the time of diagnosis. The induction regimen consisted of rituximab associated with IV boluses of methylprednisolone. The apheresis techniques used were the same for all patients, i.e. plasmapheresis. Outcomes were favorable for five patients;only one patient became dependent on hemodialysis. No mortality occurred. Conclusion: This study analyzed practices for the management of patients with ANCA vasculitis. No patient was treated with cyclophosphamide as a first approach but rituximab instead. Plasmapheresis was given because of symptoms severity at initial diagnosis.

摘要： BACKGROUND Previous studies reported hypertension remission after gastrectomy for gastric cancer patients, and the remission rate was 11.1%-93.8%. We have reported the factors of hypertension remission previously, however, the follow-up time was six months. It is necessary to identify risk factors for hypertension for a relatively longer follow-up time.AIM To analyze the predictive factors for hypertension remission one year after gastrectomy of gastric cancer patients and to construct a risk model for hypertension remission.METHODS We retrospectively collected the medical information of patients with concurrent gastric cancer and hypertension in a single clinical center from January 2013 to December 2020. Univariate and multivariate logistic regression of hypertension remission were conducted, and a nomogram model was established.RESULTS A total of 209 patients with concurrent gastric cancer and hypertension were included in the current study. There were 108 patients in the remission group and 101 patients in the non-remission group. The hypertension remission rate was 51.7% one year after gastrectomy. The remission group had younger aged patients(P = 0.001), larger weight loss(P = 0.001), lower portion of coronary heart disease(P = 0.017), higher portion of II-degree hypertension(P = 0.033) and higher portion of total gastrectomy(P = 0.008) than the non-remission group. Younger age(P =0.011, odds ratio = 0.955, 95%CI: 0.922-0.990), higher weight loss(P = 0.019, odds ratio = 0.937,95%CI: 0.887-0.989) and total gastrectomy(P = 0.039, odds ratio = 2.091, 95%CI: 1.037-4.216) were independent predictors for hypertension remission. The concordance index of the model was 0.769and the calibration curve suggested great agreement. Furthermore, decision curve analysis showed that the model was clinically useful.CONCLUSION Younger age, higher weight loss and total gastrectomy were independent predictors for hypertension remission after gastrectomy for gastric cancer patients. The nomogram could visually display these results.

摘要： Over the last decade,obesity rates have continued to rise in the United States as well as worldwide and are showing no signs of slowing down.This rise is in parallel with the increasing rates of type 2 diabetes mellitus(T2DM).Given the association between obesity and T2DM and their strong correlation with increased morbidity and mortality in addition to healthcare expenditure,it is important to recognize the most effective ways to combat them.Thus,we performed a review of literature that focused on assessing the outcomes of T2DM following bariatric surgery.Available evidence suggests that bariatric surgery provides better T2DM resolution in obese patients when compared to best medical management alone.Additionally,Biliopancreatic diversion with duodenal switch as well as Roux-en-Y gastric bypass have demonstrated higher rates of T2DM resolution when compared with other bariatric procedures.

摘要： This review summarizes the definition and surgical methods of oncometabolic surgery according to previous studies.Then,the authors discuss the beneficial effects observed after gastrectomy in gastric cancer(GC)patients with concurrent hypertension or type 2 diabetes mellitus(T2DM).The authors summarize the current studies analyzing the remission rate and the hypotheses of the mechanisms underlying these effects.The remission rate ranged from 42.5%-65.4%in T2DM patients and from 11.1%-57.6%among those with hypertension.Furthermore,the remission of T2DM could have an impact on overall survival rates as well.The mechanisms underlying the remission of hypertension and T2DM is unclear in current studies,but oncometabolic surgery is expected to be applied in clinical practice.In addition,the effect of oncometabolic surgery on other chronic metabolic comorbidities is expected to be proven in further studies.Therefore,the purpose of this review is to discuss the effects of oncometabolic surgery reported in current studies with a primary focus on the remission of hypertension and T2DM after gastrectomy in GC patients.The possibility of the remission of other metabolic comorbidities in GC patients who undergo oncometabolic surgery is also discussed.

摘要： Infliximab(IFX),as a drug of first-line therapy,can alter the natural progression of Crohn’s disease(CD),promote mucosal healing and reduce complications,hospitalizations,and the incidence of surgery.Perianal fistulas are responsible for the refractoriness of CD and represent a more aggressive disease.IFX has been demonstrated as the most effective drug for the treatment of perianal fistulizing CD.Unfortunately,a significant proportion of patients only partially respond to IFX,and optimization of the therapeutic strategy may increase clinical remission.There is a significant association between serum drug concentrations and the rates of fistula healing.Higher IFX levels during induction are associated with a complete fistula response in these patients.Given the apparent relapse of perianal fistulizing CD,maintenance therapy with IFX over a longer period seems to be more beneficial.It appears that patients without deep remission are at an increased risk of relapse after stopping anti-tumor necrosis factor agents.Thus,only patients in prolonged clinical remission should be considered for withdrawal of IFX treatment when biomarker and endoscopic remission is demonstrated,especially when the hyperintense signals of fistulas on T2-weighed images have disappeared on magnetic resonance imaging.Fundamentally,the optimal timing of IFX use is highly individualized and should be determined by a multidisciplinary team.

摘要： Graves’ disease is the most common cause of hyperthyroidism. Adequate management is an area of controversy, especially when it comes to children. The objective of our study was to assess the outcome of Graves’ disease treatment in Albert Royer Children Hospital of Dakar. This was a retrospective study conducted from 2001 to 2015, and which involved all children between 0 to 15 years of age who were being monitored in the Albert Royer National Children Hospital. The evolutionary modalities were: stability, remission, failure, relapse, lost to follow-up and death. The data were analyzed with SPSS software version 20.0. For the comparisons, the KHI 2 or Fisher test was used with a significance threshold (p < 0.05). During the study period, 88 children were enrolled. The average age was 8.6 years [ranging from 8 months to 15 years]. The consultation delay was 11.36 months. In our study, 61.4% of the patients were regular in the follow-up, the observance was good in 40.9% of the cases and 19 patients (21.6%) were lost to follow-up. Clinical courses of 69 children after treatment with Carbimazole for 37 months were promising in 21 cases (30.43%), with 17 cases of remission (24.63%) and 4 cases of stability (5.8%). Age older than 10, the initial ATD dose greater than 1 mg/kg/day and the initial free T4 lower than 50 pmol/l were significantly associated with remission with a p value of 0.01;0.024 and 0.004.

摘要： The knowledge about factors contributing to remission among individuals with schizophrenia is still missing. Studies show that the number of individuals’ reaching remission is varying among psychiatric outpatient care centres. Therefore, the purpose was to investigate case managers (CM) perception of care interventions promoting remission. Semi-structured interviews were conducted with CM (n = 12) and data were analysed with qualitative content analysis. The results show that CM needs to possess competence, master assessment structure and process. These key-points appear to be of crucial importance for a successful promotion of remission among individuals with schizophrenia.

摘要： Mycophenolic acid, the active metabolite for mycophenolate mofetil and mycophenolic sodium, is a strong, noncompetitive, reversible inhibitor of inosine monophosphate dehydrogenase, the key enzyme in de novo synthesis of guanosine nucleotides leading to selective inhibition of lymphocyte proliferation. Mycophenolic acid has been evaluated as induction and remission maintenance agent in the treatment of antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Since the course of disease of AAV usually requires long term immunosuppression, mycophenolate has been explored as a less toxic agent compared to cyclophosphamide and azathioprine. Mycophenolate is a potent immunosuppressive agent in the therapy of AAV, non-inferior to other available drugs with comparable side effect profile. Therefore, it could be a valuable alternative in cases of toxicity with life threatening side effects or intolerance to cyclophosphamide or azathioprine, in cases with high cumulative dose of cyclophosphamide, but also in cases with insufficient response. Several studies have shown a higher relapse rate following discontinuation of mycophenolate or in mycophenolate treated subjects that raises concerns about its usefulness in the treatment of AAV. This review describes the efficacy of mycophenolate in AAV as remission induction agent, as remission maintenance agent, and as therapeutic option in relapsing AAV disease, the relapse rate following discontinuation of mycophenolate, and the adverse events related to mycophenolate treatment.