Prevention Of Postoperative Recurrence Research Articles

Impact of capsule endoscopy on prevention of postoperative recurrence of Crohn’s disease

Capsule endoscopy (CE) can detect lesions outside the scope of ileocolonoscopy in postoperative patients with Crohn's disease (CD). However, the impact of such findings on patient outcomes remains unknown. This study is intended to evaluate the impact of CE findings on clinical management and outcomes in asymptomatic patients with CD without pharmacologic prophylaxis after ileocolonic resection. In this retrospective cohort study, 37 patients (group 1) received ileocolonoscopy together with CE within 1 year after surgery, whereas 46 patients (group 2) only received ileocolonoscopy. Patients with endoscopic recurrence detected by either ileocolonoscopy or CE received pharmacologic therapy with azathioprine or infliximab. One year later, disease activity was re-evaluated. In group 1, all patients with ileocolonoscopy-identified recurrence also had CE-identified recurrence. In addition, CE detected endoscopic recurrence in 11 patients missed by ileocolonoscopy. Endoscopic remission identified by ileocolonoscopy was confirmed by CE in 13 patients. One year later, endoscopic remission identified by ileocolonoscopy was maintained in all 24 patients, and none had clinical recurrence. Conversely, in group 2, of those with ileocolonoscopy-identified remission, both ileocolonoscopy-identified recurrence and clinical recurrence occurred in 9 of 31 patients 1 year later. The total clinical recurrence rate was 2.7% (1/37) in group 1 versus 21.7% (10/46) in group 2 (P= .019). If endoscopic remission identified by ileocolonoscopy was confirmed by CE, patients could remain free of pharmacologic prophylaxis. If recurrence outside the scope of ileocolonoscopy was detected by CE, initiation of active pharmacologic therapy would be needed.

Postoperative therapy with infliximab for Crohn's disease: a 2-year prospective randomized multicenter study in Japan.

The prevention of postoperative recurrence is a critical issue in surgery for Crohn's disease. Prospective randomized trials in Western countries have shown that the postoperative use of anti-tumor necrosis factor α-antibodies was effective in reducing the recurrence rate. We investigated the efficacy of infliximab (IFX) for the prevention of postoperative Crohn's disease recurrence. We performed a prospective randomized multicenter study. Patients who underwent intestinal resection were assigned to groups treated with or without IFX. Immediately after surgery, patients in the IFX group received IFX at 5mg/kg at 0, 2, and 6weeks, followed by every 8weeks for 2years. The primary study outcome was the proportion of patients with endoscopic and/or clinical recurrence at 2years after surgery. Thirty-eight eligible patients participated in this study: 19 in the IFX group and 19 in the non-IFX group. The disease recurrence rate in the IFX group was 52.6% (10/19), which was significantly lower than that in the non-IFX group (94.7% [18/19]). The postoperative use of IFX is effective in preventing Crohn's disease recurrence for 2years.

P663 Primary prevention of post-operative recurrence of Crohn’s disease with anti-TNF agents in real life. Preliminary data from the Spanish ENEIDA registry

P663 Primary prevention of post-operative recurrence of Crohn’s disease with anti-TNF agents in real life. Preliminary data from the Spanish ENEIDA registry

P697 Thiopurines vs. anti-TNFa for the prevention of postoperative recurrence in Crohn’s disease—a meta-analysis

P697 Thiopurines vs. anti-TNFa for the prevention of postoperative recurrence in Crohn’s disease—a meta-analysis

Recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) on the monitoring, prevention and treatment of post-operative recurrence in Crohn's disease

Despite the availability of new, powerful drugs for Crohn's disease, a significant proportion of patients will undergo an intestinal resection to control the disease as it develops. In the absence of an effective preventative treatment, the appearance of new intestinal lesions after surgery for Crohn's disease is the norm; this is known as post-operative recurrence and may appear very early on, even a few weeks after the surgical resection. Furthermore, the drugs that are currently available for the prevention of post-operative recurrence have a limited effect; up to 50% of cases present recurrent Crohn's disease activity despite the preventative treatment, which may require further surgery with the consequent loss of intestinal function, leading some patients to suffer from short bowel syndrome as an irreversible complication. The management of Crohn's disease patients who undergo an intestinal resection should thus be geared towards prevention, early detection and, in the worst case scenario, the treatment of post-operative recurrence. This article reviews the natural history, diagnostic measures, monitoring, prevention and treatment of post-operative recurrence, and proposes recommendations based on existing knowledge.

Recomendaciones del Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa (GETECCU) sobre la monitorización, prevención y tratamiento de la recurrencia posquirúrgica en la enfermedad de Crohn

Despite the availability of new, powerful drugs for Crohn's disease, a significant proportion of patients will undergo an intestinal resection to control the disease as it develops. In the absence of an effective preventative treatment, the appearance of new intestinal lesions after surgery for Crohn's disease is the norm; this is known as post-operative recurrence and may appear very early on, even a few weeks after the surgical resection. Furthermore, the drugs that are currently available for the prevention of post-operative recurrence have a limited effect; up to 50% of cases present recurrent Crohn's disease activity despite the preventative treatment, which may require further surgery with the consequent loss of intestinal function, leading some patients to suffer from short bowel syndrome as an irreversible complication. The management of Crohn's disease patients who undergo an intestinal resection should thus be geared towards prevention, early detection and, in the worst case scenario, the treatment of post-operative recurrence. This article reviews the natural history, diagnostic measures, monitoring, prevention and treatment of post-operative recurrence, and proposes recommendations based on existing knowledge.

Вибір методів хірургічного лікування ехінококозу печінки

Метою даного дослідження було поліпшення результатів хірургічного лікування хворих на ехінококоз печінки. В основу роботи покладено досвід хірургічного лікування 427 хворих на ехінококоз печінки різної локалізації, оперованих у II клініці саміті з 2003 по 2015 р 2003-2006 рр. ми оперували 154 (36,1%) хворих. Ці пацієнти склали контрольну групу. До групи порівняння включені 134 (31,4%) хворих, оперованих в 2007-2010 рр. До основної групи увійшли 139 (32,5%) хворих, оперованих в 2011-2015 рр. У порівнянні з 2003-2006 рр. частота післяопераційних ускладнень знизилася майже в 5 разів - з 18,4 до 4,0%. Рецидиви ехінококозу у віддалені терміни після оперативного втручання виникли у 12,9% пацієнтів, причому в групі осіб, оперованих в 2003-2006 рр., Цей показник досяг 28,2%. У наступні роки на тлі інтра- і післяопераційної профілактики захворювання кількість рецидивів в групі порівняння вдалося знизити до 8,8%, а в основній групі звести до нуля. Серед основних Герміцід найбільш яскраве і швидке сколексоцідное вплив надає 80-100% гліцерин, підігрітий до 70 ° С, який не викликає деструктивних змін прилеглої паренхіми. У хірургії ехінококозу печінки перевагу слід віддавати топічної міні-доступу, можливості якого можна значно розширити шляхом проведення інтраопераційного УЗД і відеоендоскопічних асистування.

DOP034 Serum adalimumab concentration 3 months after surgery is correlated with endoscopic recurrence in Crohn's disease patients treated with adalimumab for prevention of postoperative recurrence

DOP034 Serum adalimumab concentration 3 months after surgery is correlated with endoscopic recurrence in Crohn's disease patients treated with adalimumab for prevention of postoperative recurrence

P420 Anti-TNF for post-operative prevention in Crohn's disease: the detection of anti-drug antibodies at time of surgery is associated with an increased risk of endoscopic recurrence

Background: Anti-TNF monoclonal antibodies (mAb) are efficient for the prevention of postoperative recurrence in Crohn's disease (CD). Measurement of trough serum levels and anti-drug antibodies may help to determine the mechanisms of anti-TNF failure. We previously identified two risk factors associated with endoscopic recurrence in the REMIND cohort: tobacco (OR =2.3) and anti-TNF (OR =0.35). The aim of our study was to correlate efficacy of anti-TNF mAb with their pharmacokinetics within the same cohort. Methods: The REMIND group conducts a prospective nationwide study in nine French academic centers of ileal and/or ileocolic CD patients. Samples are taken from the surgical specimen at the time of surgery (M0) and at the time of endoscopy (M6), stored centrally in a bio-bank, and analyzed to identify factors associated with recurrence. This study was performed in the 60 patients treated post-operatively with anti-TNF in the REMIND cohort (198 patients included on the date of the analysis). The trough levels of infliximab (IFX) and adalimumab (ADA) and anti-drug antibodies (ATI and ATA) were analyzed by ELISA method. Limits of detection were 10 ng/ml for both ATI and ATA. Trough levels of detection of anti-TNF drugs was 0.3 μg/ml. Therapeutic thresholds levels were 3 μg/ml for IFX and 4,9 μg/ml for ADA. Endoscopic recurrence was defined by a Rutgeerts ≥ i2 score. The fisher test was used for the bivariate analysis. Results: Sixty subjects received an anti-TNF agent (ADA n=47, IFX n=8) after surgery. Only 14 patients (23%) were naive of anti-TNF. Twenty-six patients (43%) had an endoscopic recurrence and 34 (57%) had a normal colonoscopy. ATA or ATI were detected in 8 patients at M0; 6 of them (75%) had an endoscopic recurrence. In contrast, of the 41 patients who did not have anti-drug antibodies at the time of surgery, 13 (32%) had endoscopic recurrence (p=0.04). At M6, the trough drug levels were analyzed in 32 patients. In the group of patients with endoscopic recurrence, trough drug levels were below therapeutic threshold in 10 of 15 patients (67%) compared to the 3/17 patients (18%) in the group of patients with endoscopic remission (p=0.01). Conclusions: The presence of anti-drug antibodies at the time of surgery is associated with a higher risk of endoscopic recurrence. Infra-therapeutic trough levels at M6 were associated with a higher risk of endoscopic recurrence. In clinical practice, these results demonstrate that detection of anti-drug antibodies may influence the choice of postoperative therapy.

Second Korean guidelines for the management of Crohn's disease

Crohn's disease (CD) is a chronic, progressive, and disabling inflammatory bowel disease (IBD) with an uncertain etiopathogenesis. CD can involve any site of the gastrointestinal tract from the mouth to the anus, and is associated with serious complications, such as bowel strictures, perforations, and fistula formation. The incidence and prevalence rates of CD in Korea are still lower compared with those in Western countries, but they have been rapidly increasing during the recent decades. Although there are no definitive curative modalities for CD, various medical and surgical therapies have been applied for the treatment of this disease. Concerning CD management, there have been substantial discrepancies among clinicians according to their personal experience and preference. To suggest recommendable approaches to the diverse problems of CD and to minimize the variations in treatment among physicians, guidelines for the management of CD were first published in 2012 by the IBD Study Group of the Korean Association for the Study of Intestinal Diseases. These are the revised guidelines based on updated evidence, accumulated since 2012. These guidelines were developed by using mainly adaptation methods, and encompass induction and maintenance treatment of CD, treatment based on disease location, treatment of CD complications, including stricture and fistula, surgical treatment, and prevention of postoperative recurrence. These are the second Korean guidelines for the management of CD and will be continuously revised as new evidence is collected.

Second Korean Guidelines for the Management of Crohn's Disease

Crohn's disease (CD) is a chronic, progressive, and disabling inflammatory bowel disease (IBD) with an uncertain etiopathogenesis. CD can involve any site of the gastrointestinal tract from the mouth to the anus, and is associated with serious complications, such as bowel strictures, perforations, and fistula formation. The incidence and prevalence rates of CD in Korea are still lower compared with those in Western countries, but they have been rapidly increasing during the recent decades. Although there are no definitive curative modalities for CD, various medical and surgical therapies have been applied for the treatment of this disease. Concerning CD management, there have been substantial discrepancies among clinicians according to their personal experience and preference. To suggest recommendable approaches to the diverse problems of CD and to minimize the variations in treatment among physicians, guidelines for the management of CD were first published in 2012 by the IBD Study Group of the Korean Association for the Study of the Intestinal Diseases. These are the revised guidelines based on updated evidence, accumulated since 2012. These guidelines were developed by using mainly adaptation methods, and encompass induction and maintenance treatment of CD, treatment based on disease location, treatment of CD complications, including stricture and fistula, surgical treatment, and prevention of postoperative recurrence. These are the second Korean guidelines for the management of CD and will be continuously revised as new evidence is collected.

Colonoscopy-guided therapy for the prevention of post-operative recurrence of Crohn’s disease

Colonoscopy-guided therapy for the prevention of post-operative recurrence of Crohn’s disease

Clinical study on the role of immunosuppressant agents in prevention of postoperative recurrence of Crohn's disease

Objective To investigate the effects of different therapeutic strategies on recurrence of postoperative Crohn's disease (CD) patients. Methods From September 2009 to September 2014, 85 CD patients with intestinal resection were enrolled. The clinical features and maintenance therapeutic medication were retrospectively analyzed. The patients were divided into non-treatment group (induding continuously or cumulatively taking medicine less than three months), 5-aminosalicylic acid (5-ASA) group and immunosuppressant agents group (including azathioprine, methotrexate and thalidomide). Kaplan-Meier method was performed to compare the recurrence rate in postoperative CD with different therapeutic medication and the risk factors of postoperative recurrence were also analyzed. Results Among 85 CD patients, there were 32, 21 and 32 patients in non-treatment group, 5-ASA group and immunosuppressive agents group, respectively. After surgery, the one year accumulated clinical recurrence rate of immunosuppressant agents group was 12.5% (4/32), which was significantly lower than that of non-treatment group (56.3%, 18/32) and 5-ASA group (38.1%, 8/21), and the differences were statistically significant (χ2=12.250, P 0.05). Penetrating lesion was an risk factor of postoperative clinical recurrence in CD patients (χ2=4.963, P=0.026, odds ratio (OR)=2.221, 95%confidence interval (CI) 1.121 to 5.775). Conclusions Immunosuppressive agents rather than 5-ASA have remarkable effects in preventing postoperative clinical recurrence in CD patients. Postoperative clinical recurrence is more likely to happen in patients with penetrating lesions. Key words: Crohn disease; Postoperative recurrence; Immunosuppressive agents; Retrospective studies

The nursing of THP bladder instillation for the prevention of postoperative recurrence of bladder cancer

Objectives To analyze the nursing methods and measures of THP bladder instillation for the prevention of postoperative recurrence of bladder cancer. Methods 47 cases of patients treated with THP bladder instillation after surgeries from November 2012 to November 2014 were included to perform the retrospective analysis. The nursing during the treatment was intensified. The period time of follow-up was 3 years. Results Tumor free survival rates after 1, 2 and 3 years of follow-up was 89.4%, 83.0% and 78.7% respectively. The occurrence rates of adverse effects after 1, 2 and 8 weeks of bladder instillation was 29.8%, 10.6% and 2.1% respectively. Conclusions The instillation of THP can efficiently prevent the recurrence of bladder caner. In the meantime, comprehensive and careful nursing can better observe the patient's condition, the toxic effects and side effects. The extensive nursing plays an important role in the prevention of bladder cancer treated with instillation of THP, which should be paid more attention. Key words: Urinary Bladder Neoplasms; Cystectomy; Neoplasm Recurrence, Local

Isoquercitrin inhibits bladder cancer progression in vivo and invitro by regulating the PI3K/Akt and PKC signaling pathways.

Bladder cancer is the most common malignancy of the urinary system and is also one of the 10 most common cancers of the human body. Currently, clinical treatment of bladder cancer mainly utilizes partial or total cystectomy, supplemented by conventional chemotherapy. However, such treatment has not fully improved the prognosis of patients and is associated with various side effects. Studies have found that flavonoids extracted from plants can be used in radiotherapy and chemotherapy for the prevention of postoperative recurrence and metastasis but also alone for the treatment of advanced tumors. Both applications can ameliorate clinical symptoms, improve the quality of life, and prolong the survival of patients. Based on the above information, the present study investigated the effect of isoquercitrin, a type of flavonoid found in BidenspilosaL. extracts, on bladder cancer progression, with the goal of understanding the biological characteristics of isoquercitrin by which it participates in bladder cancer progression. Using invitro experiments, we found that therapeutic doses of isoquercitrin significantly inhibited cell proliferation and induced apoptosis in human bladder cancer cells and that the cell cycle was arrested in the G1 phase. Isoquercitrin inhibited phosphatidylinositol 3-kinase (PI3K) and Akt phosphorylation expression levels, thus inhibiting proliferation and inducing apoptosis in the cancer cells. In addition, we found that isoquercitrin reduced protein kinaseC (PKC) protein expression levels in the human bladder cancer cell lines. We also showed via invivo experiments that isoquercitrin inhibited xenograft tumor growth in nude mice. In conclusion, our study confirmed that isoquercitrin inhibits bladder cancer progression invivo and demonstrated that the molecular mechanism of this inhibition may be closely associated with the PI3K/Akt and PKC signaling pathways.

Role of antibiotics for treatment of inflammatory bowel disease.

Inflammatory bowel disease is thought to be caused by an aberrant immune response to gut bacteria in a genetically susceptible host. The gut microbiota plays an important role in the pathogenesis and complications of the two main inflammatory bowel diseases: Crohn's disease (CD) and ulcerative colitis. Alterations in gut microbiota, and specifically reduced intestinal microbial diversity, have been found to be associated with chronic gut inflammation in these disorders. Specific bacterial pathogens, such as virulent Escherichia coli strains, Bacteroides spp, and Mycobacterium avium subspecies paratuberculosis, have been linked to the pathogenesis of inflammatory bowel disease. Antibiotics may influence the course of these diseases by decreasing concentrations of bacteria in the gut lumen and altering the composition of intestinal microbiota. Different antibiotics, including ciprofloxacin, metronidazole, the combination of both, rifaximin, and anti-tuberculous regimens have been evaluated in clinical trials for the treatment of inflammatory bowel disease. For the treatment of active luminal CD, antibiotics may have a modest effect in decreasing disease activity and achieving remission, and are more effective in patients with disease involving the colon. Rifamixin, a non absorbable rifamycin has shown promising results. Treatment of suppurative complications of CD such as abscesses and fistulas, includes drainage and antibiotic therapy, most often ciprofloxacin, metronidazole, or a combination of both. Antibiotics might also play a role in maintenance of remission and prevention of post operative recurrence of CD. Data is more sparse for ulcerative colitis, and mostly consists of small trials evaluating ciprofloxacin, metronidazole and rifaximin. Most trials did not show a benefit for the treatment of active ulcerative colitis with antibiotics, though 2 meta-analyses concluded that antibiotic therapy is associated with a modest improvement in clinical symptoms. Antibiotics show a clinical benefit when used for the treatment of pouchitis. The downsides of antibiotic treatment, especially with recurrent or prolonged courses such as used in inflammatory bowel disease, are significant side effects that often cause intolerance to treatment, Clostridium dificile infection, and increasing antibiotic resistance. More studies are needed to define the exact role of antibiotics in inflammatory bowel diseases.

Low Dose Infliximab for Prevention of Postoperative Recurrence of Crohn's Disease: Long Term Follow-Up and Impact of Infliximab Trough Levels and Antibodies to Infliximab.

ObjectiveIn patients with postoperative recurrence of Crohn’s disease endoscopic and clinical remission can be maintained for up to 1 year with low infliximab doses (3 mg/Kg). However, in theory low-dose infliximab treated patients could develop subtherapeutic trough levels, infiximab antibodies, and might loose response to therapy. To verify this hypothesis infliximab pharmacokinetics and clinical/endoscopic response were checked in a group of patients treated in the long term with low infliximab doses.DesignInfliximab antibodies, infliximab levels, highly-sensitive CRP and fecal calprotectin were measured during the 8-week interval in 5 consecutive patients in clinical (Crohn’s Disease Activity Index < 150) and endoscopic (Rutgeerts scores 0–1) remission after one year of therapy with infliximab 3 mg/Kg. For comparison with reported standards, infliximab pharmacokinetics and inflammatory parameters were also tested in 6 Crohn’s disease patients who did not undergo surgery and who were in clinical remission while on infliximab 5 mg/Kg. Patients on low infliximab dose also underwent colonoscopy after 18 additional months of therapy.ResultsHighly sensitive CRP and fecal calprotectin increased in all patients during the 8-week interval. Infliximab trough levels were lower in patients treated with the low dose compared to controls (mean±SE: 2.0±0.3 vs 4.75±0.83 μg/mL respectively p<0.05). Infliximab antibodies were present in two of the subjects treated with low infliximab dose and in none of the controls. However, in low dose-treated patients after 18 additional months of therapy endoscopy continued to show mucosal remission and none of them developed clinical recurrence or side effects.ConclusionsPatients treated with low infliximab doses had lower trough levels compared to patients treated with 5 mg/Kg and some developed antibodies to infliximab. However, low infliximab doses sustained clinical and endoscopic remission for a total of 30 months of treatment.

Effectiveness of Polyglycolic Acid Sheet Covering and Platelet-Rich Plasma after Video-Assisted Thoracic Surgery for Spontaneous Pneumothorax.

Background Video-assisted thoracic surgery (VATS) is widely used for the treatment of spontaneous pneumothorax, and the recurrence rate is high. The goal of the study was to examine the use of polyglycolic acid (PGA) sheets, together with platelet-rich plasma (PRP) from autologous blood for the prevention of postoperative recurrence of spontaneous pneumothorax. Materials and Methods We performed a retrospective study of 65 patients who underwent VATS for spontaneous pneumothorax from March 2008 to November 2011. The patients were divided into groups: without reinforcement (Group A, n = 33) and with reinforcement of the visceral pleura around the staple lines with the PGA sheet and PRP (Group B, n = 32). The postoperative follow-up period was 18 months. Results Chest tubes were used for 3.4 and 3.1 days in Groups A and B, respectively, with no significant difference between the groups. However, the recurrence rate (18.2%; 6 cases) in Group A was significantly higher than that in Group B (p = 0.02). The recurrence rates in patients younger than 25 years in Group A and Group B were 26.1 and 0.0%, respectively (p = 0.03). In Group A, the mean age with recurrence (18.3 years old) was significantly lower than the mean age without recurrence (p = 0.03). Conclusion These results suggest that the use of PGA sheets and PRP might be effective for the prevention of postoperative recurrence of spontaneous pneumothorax.

A biodegradable thermo-responsive hybrid hydrogel: therapeutic applications in preventing the post-operative recurrence of breast cancer

Smart hydrogels that undergo structural changes in response to stimuli (for example, pH, heat, light) have promising biomedical applications as delivery systems, especially for the locally controlled release of drugs. Early prevention of locoregional recurrence (LRR) is critical for patients who have undergone breast-conserving therapy. This work reports the preparation of a hybrid hydrogel system in which gold nanorods (GNRs) were doped into a thermally responsive hydrogel. A near-infrared (NIR) laser was used to trigger the release of loaded Doxorubicin (DOX) by utilizing the photothermal effect of GNRs to induce the contraction of the thermo-responsive hydrogels. In a 4T1 breast cancer model of the in vivo locoregional prevention of post-operative recurrence, we found that after NIR irradiation, DOX/GNR-embedded Methoxylpoly(ethylene glycol)-poly(ɛ-caprolactone)-acryloyl chloride (PECA)/glycidylmethacrylated chitooligosaccharide (COS-GMA)/N-isopropylacrylamide (NIPAm)/acrylamide (AAm) (PCNA) hydrogels (DOX-PCNA-GNR hydrogels) significantly reduced tumor recurrence to 16.7%, compared with 50% for DOX-PCNA-GNRs without NIR irradiation, 83.3% for PCNA-GNRs with NIR irradiation, 100% for PCNA-GNRs without NIR irradiation, 83.3% for single systemic or local administration of Dox, 100% for intravenous DOX administration once or three times, and 100% for the blank control. This study demonstrates that these DOX-PCNA-GNR hybrid hydrogels with NIR-triggered thermo-responsive drug release exhibit great potential in preventing post-operation cancer relapse. A thermoresponsive hydrogel containing gold nanorods can reduce breast cancer recurrence by delivering thermotherapeutic and chemotherapeutic drug. Effective inhibition of breast cancer relapse remains an important challenge. Now, Zhi Yong Qian and co-workers at the State Key Laboratory of Biotherapy and Cancer Center and Tsinghua University in China have demonstrated that the combination of photothermal therapy and chemotherapy considerably inhibits the postoperative relapse of breast cancer. They synthesized the hydrogel by heat-initiated free-radical polymerization. The researchers found that applying near-infrared radiation simultaneously heated the gold nanorods and caused the thermoresponsive hydrogel to contract; this ‘squeezing’ of the hydrogel caused it to release the chemotherapy drug faster. This combined approach has the advantage of reducing systemic toxicity since it limits non-selective application of the drug. We prepared a hybrid hydrogel system by doping the gold nanorods (GNRs) into the thermal responsive hydrogel. The near-infrared (NIR) laser was used to trigger the release of loaded Doxorubicin (DOX) by utilizing the photothermal effect of GNRs to induce the contraction of thermo-responsive hydrogels. The development of the hydrogel as the carrier is for the chemo-photothermal co-therapy of local breast cancer recurrence. The DOX-PCNA-GNRs hydrogel effectively prevented breast cancer recurrence after primary tumor resection in a mouse model.

Systematic Review with Meta-analysis of Prospective Studies: Anti-tumour Necrosis Factor for Prevention of Postoperative Crohn's Disease Recurrence.

Although promising, the evidence supporting the use of anti-tumour necrosis factor agents [anti-TNFs] in postoperative Crohn's disease [CD] is still based on limited experience. We aimed to conduct a meta-analysis of prospective studies evaluating the efficacy and safety of anti-TNFs for prevention of postoperative recurrence [POR] in CD. MEDLINE, EMBASE, Web of Science, the Cochrane database and conference proceeding abstracts were searched. The primary outcome measure was the number of patients who developed POR as defined by the primary studies. Six prospective studies were included. The rate of endoscopic recurrence [ER] was significantly lower using anti-TNFs [9.2%, 7/76] compared with the non-biologicals group [61.5%, 83/135] (odds ratio [OR] 0.05, 95% confidence interval [CI] 0.02-0.13; p < 0.001]. The rate of severe ER was also lower in the anti-TNFs group [1.6%, 1/64] than that in the non-biologicals group [32.7%, 18/55, OR 0.10; p = 0.04]. A significantly lower proportion of patients in the anti-TNFs group developed clinical recurrence [3.4%, 2/59] compared with the non-biologicals arm [41.1%, 49/119, OR 0.1; p < 0.001]. More anti-TNFs-treated patients [86.5%, 45/52] were maintained in clinical remission compared with the non-biologicals group [58.1%, 43/74, OR 4.05, 95% CI 1.60-10.29; p < 0.01]. The adverse events were similar between the two groups [anti-TNFs 44.9% [22/49] vs control 52.5% [42/80]; p = 0.69]. Anti-TNFs are superior to non-biological agents in preventing endoscopic and clinical recurrence of CD without causing more adverse events.