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Dr., Hassan Shoaib Dr. Awais Nazir Tarar Dr. Muhammad Zain Ul Abideen. "CELIAC DISEASE: A GLUTEN FREE DIET AND DIET QUALITY." INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES 05, no. 06 (2018): 5435–38. https://doi.org/10.5281/zenodo.1293947.
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<strong><em>Objective:</em></strong><em> Celiac Disease (CD) is one of the biggest issues of the medical world. The immune system of the body releases antibodies that target the mucosa of the small intestine. Intake of food containing gluten protein containing gluten protein provokes the immune system to react. The need is to find a gluten-free balance diet plan for the patient CD that prevents the secondary diseases in the patient. </em> <strong><em>Patient and methods:</em></strong><em> For CD, a molecular study was conducted in which structures and functioning of protein was analyzed on the molecular level. After determining the nature of gluten, its role normal functioning and effect caused by gluten-free diet on the body, new drugs and strategies can be discovered [1]. </em> <strong><em>Result:</em></strong><em> In the analysis, a connection is established between CD support groups, its patients, and treatment of disease.</em> <strong><em>Purpose of study: </em></strong><em>The purpose of research is to discover new technologies and methods for treatment of CD. It helps in forming connection between the influences of CD support groups on patients.</em> <strong><em>Conclusion:</em></strong><em> A balanced diet and CD support groups are effective tools for reducing the symptoms of the CD.</em> <strong>Keywords</strong>:<em> Celiac disease, small intestine inflammation, CD support groups</em>
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Majsiak, Emilia, Magdalena Choina, and Bożena Cukrowska. "The Opinion of Polish Coeliac Patients on the Knowledge of Medical Professionals and Support Groups about Coeliac Disease—A Pilot Study." International Journal of Environmental Research and Public Health 20, no. 5 (2023): 3990. http://dx.doi.org/10.3390/ijerph20053990.
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A high quality of knowledge and how it is communicated by healthcare professionals (HCPs) let the patient understand coeliac disease (CD) and result in better adherence to therapeutic recommendations. Therefore, the aim of the current study was to assess the opinion of Polish respondents with CD on the comprehension of CD among Polish HCPs. The analysis was based on 796 responses from patients (the members of the Polish Coeliac Society) with confirmed CD diagnosis (224; 28.1% children and 572; 71.9% adults). The most frequently consulted HCPs regarding CD symptoms in the analysed group were gastroenterologists, and various support groups and associations for CD patients. Furthermore, their comprehension of CD was rated best, as 89.3% (n = 552) of the patients who had contact with support groups and associations classified their knowledge on CD as good. More than a half of the respondents (n = 310, 56.6%) who had contact with general practitioners (GPs) due to their symptoms, rated the doctor’s knowledge on CD as bad. Nurses’ comprehension on CD was classified as bad by 45 (52.3%) respondents who had contact with a nurse. Out of 294 Polish patients with CD who had contact with a dietician, 247 (84.0%) assessed that the dietician communicated their knowledge on CD well. The respondents rated that GPs and nurses communicated their knowledge on CD in the worst manner (60.4% and 58.1%, respectively). Out of 796 respondents, 792 (99.5%) provided information about the number of appointments with GPs due to symptoms that occurred prior to CD diagnosis. The respondents had contact with GPs 13 863 times before obtaining a CD diagnosis due to their symptoms. After the establishment of a CD diagnosis, the number of appointments with GPs decreased to 3850, and the average number of appointments decreased from 17.8 to 5.1. The respondents assessed that the knowledge on CD of HCPs is not satisfactory. The work of support groups and associations on CD, who promote reliable CD diagnosis and treatment methods, should be promoted. The cooperation between various HCPs needs to be encouraged, which may lead to better compliance.
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Cocheci, Laura, Lavinia Lupa, Aniela Pop, Aurelia Visa, Bianca Maranescu, and Adriana Popa. "Photocatalytical Degradation of Congo Red Azo Dye Using Phosphono-Aminoacid-Cd(II) Pendant Groups Grafted on a Polymeric Support." Revista de Chimie 70, no. 10 (2019): 3473–76. http://dx.doi.org/10.37358/rc.19.10.7578.
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In the present study, a new compound was used for decontaminating water polluted by Congo Red dye. Phosphono-aminoacid-Cd(II) pendant groups grafted on a polymeric support was prepared using impregnation of a polymer support functionalized with phosphono-aminoacid groups with an aqueous solution of Cd(NO3)2x4H2O. The catalyst was characterized by Fourier transform infrared ray, scanning electron microscope, termogravimetric analysis UV-Vis spectroscopy. The results suggest that the studied material could efficiently be used as photocatalyst in the degradation process of waters containing organic dyes under UV-Vis light irradiation.
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Marín de Jesús, Sergio, Rosa María Vigueras-Villaseñor, Edith Cortés-Barberena, et al. "Early Zinc Supplementation Enhances Epididymal Sperm Glycosylation, Endocrine Activity, and Antioxidant Activity in Rats Exposed to Cadmium." International Journal of Molecular Sciences 26, no. 10 (2025): 4589. https://doi.org/10.3390/ijms26104589.
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Sperm maturation involves changes in plasma membrane glycosylation for fertilization. Cadmium (Cd) exerts a negative effect by disrupting testicular and epididymal function, altering antioxidant activity. Zinc (Zn) is an essential element known for its antioxidant properties, role in testosterone synthesis, and support of spermatogenesis. However, its effect on sperm membrane glycosylation, as well as endocrine and antioxidant activity, after exposure to Cd has remained unexplored. This study evaluated the impact of Zn on epididymal sperm glycosylation, endocrine activity, and antioxidant activity in Cd-exposed rats. Four groups of male Wistar rats were analyzed: control, Cd-exposed, Zn-supplemented, and Zn + Cd groups. On postnatal day 90, tissues and blood were collected for Zn and Cd quantification, testosterone levels, antioxidant activity, histological analysis, and sperm quality. The results showed that Cd concentration increased significantly, reduced testosterone levels, modified antioxidant activity, and caused structural damage in the epididymis. The Cd-exposed group showed disrupted glycosylation and distribution patterns and reduced sperm quality. The Zn + Cd group showed lower Cd accumulation, preserved testosterone levels, restored antioxidant activity, and preserved glycosylation patterns and sperm quality. This study highlights the protective role of Zn in mitigating Cd-induced reproductive toxicity, probably through the competitive inhibition of Cd uptake and antioxidant support, thereby preserving fertility.
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Ocepek, A., N. Molinari, and P. Maček. "P1028 Clinical decision support tool for vedolizumab can predict treatment persistence in Crohn's disease but not in ulcerative colitis." Journal of Crohn's and Colitis 18, Supplement_1 (2024): i1856. http://dx.doi.org/10.1093/ecco-jcc/jjad212.1158.
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Abstract Background Vedolizumab (VDZ) has displayed up to 82.9% treatment persistence as a first-line biologic for ulcerative colitis (UC) and ranked third in the second line. It ranked fourth in treatment persistence as the first or second-line biological therapy in Crohn's disease (CD). Factors most commonly associated with treatment outcomes have been indicators of more aggressive disease, like refractoriness to corticosteroids and tumour necrosis factor (TNF) alpha inhibitors, elevated baseline patient-related outcomes (PROs), comorbidities in CD and faecal calprotectin. Pre-treatment prediction of response and long-term persistence could help optimise treatment in an individual patient. Methods We performed a retrospective single-centre cohort study based on the UR-CARE registry. Data for 129 patients treated with VDZ from July 2016 until April 2023 were analysed. A validated clinical decision support tool (CDST) for CD and UC was used to stratify patients according to the probability of response to VDZ. We used Kaplan-Meier survival curves to analyse treatment persistence at week 52, depending on the CDST group for CD and UC. The association between the CDST group and the optimisation of VDZ therapy was evaluated using the chi2 test. Results The study included 57 CD patients, median age 34 years, 38.6% male, and 72 UC patients, median age 32.1 years, 59.7% male. Patients with CD had longer disease duration (4.1 years) than UC patients (2.6 years). 33.3% of CD patients had ileo-colonic disease, 24.6% had upper GI involvement, 33.3% had fistulising disease, and 56.1% had prior surgery. 63.9% of patients with UC had pancolitis, and 34.7% had concomitant corticosteroids at baseline. Before VDZ, more than half of patients were exposed to TNF alpha inhibitors in both CD and UC (57.9% and 52.8%, respectively). We found significantly higher treatment persistence in CD patients stratified into groups with intermediate (group 1) and high (group 2) probability of response, according to CDST compared to the group with low (group 0) probability of response. The VDZ therapy was discontinued in 76.9%, 28.6% and 6.3% of patients within CDST groups 0, 1, and 2, respectively. The association was statistically significant (p &lt; 0.001). In UC, however, we could not confirm any significant difference in treatment persistence between CDST groups. The VDZ therapy was discontinued in 50.0%, 34.9%, and 21.9% in groups 0, 1, and 2, respectively. While the trend between discontinuation of the VDZ and CDST groups can be observed, the association was not statistically significant (p = 0.165). Conclusion In our study, treatment persistence for VDZ could be predicted using CDST for CD, but not for UC.
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Konecny, S., F. Tichanek, L. Prokopova, et al. "P1152 Single center study of using clinical decision support tool to predict outcomes of vedolizumab therapy in Crohn’s disease patients." Journal of Crohn's and Colitis 19, Supplement_1 (2025): i2109. https://doi.org/10.1093/ecco-jcc/jjae190.1326.
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Abstract Background There is a need to identify Crohn’s Disease (CD) patients who will be most suitable and obtain most clinical benefit from treatment with vedolizumab (VDZ), an anti-α4β7 integrin inhibitor for the treatment of ulcerative colitis and Crohn’s Disease (CD). Previously, a clinical decision support tool (CDST) has been developed and validated to guide treatment decisions in CD patients treated with VDZ.1 In this study, we analyzed the ability of the CDST to predict clinical outcomes in CD patients. Methods Patients with moderate to severe CD receiving maintenance treatment with VDZ in single center were retrospectively analyzed using the CDST. We divided patient by CDST into low (≤13 points), intermediate (&gt;13 and ≤19 points) and high response probability groups (&gt;19 points) based on the previously developed scoring system. Clinical outcomes assessed included persistence on therapy and CD-related hospitalizations and surgery rates. Results We included 174 patients who were treated with VDZ for at least 6 months in our center. Using the CDST, at baseline, 23 patients (13%) had a low, 81 (47%) had an intermediate, and 70 (40%) had a high probability of treatment response with VDZ. Patients with low probability showed a trend toward reduced persistence on therapy, though this difference did not reach statistical significance (p=0.13). However, when patients were analyzed according to disease location by Montreal classification, a clearer pattern emerged in those with isolated ileal (L1) or colonic (L2) CD. In this subgroup, patients with high probability of treatment response to VDZ demonstrated significantly longer treatment persistence (p=0.038); 91% of these patients remained on therapy after two years compared to 55% in the intermediate group. This trend was not observed in ileocolonic (L3) CD, where persistence rates were similar across groups (83% in high and intermediate groups and 75% in the low probability group; p=0.23). We tried to assess the ability of CDST in prediction of complications of CD and we observed that number of hospitalization days was significantly lower in the high probability group (median: 0; third quartile: 4 days) compared to the intermediate group (median: 17; third quartiles: 9 and 21 days; p&lt;0.001), while surgery rates showed no significant differences across groups (p=0.5). Conclusion The CDST partially identifies CD patients likely to benefit from VDZ. Patients with low CDST scores demonstrate poorer persistence, particularly in the subgroup with L1/L2 localization, and a higher risk of hospitalization, while those with high CDST scores exhibit better treatment persistence. These findings further validate the CDST as a valuable tool for guiding treatment decisions in CD. References 1.Dulai PS, Boland BS, Singh S, et al. Development and Validation of a Scoring System to Predict Outcomes of Vedolizumab Treatment in Patients With Crohn's Disease. Gastroenterology. 2018;155(3):687-695.e10.
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John, Sufna Gheyara, Nicola Edge, Michael Cucciare, and Nicholas Long. "3015 Enhancing Outcomes in Childcare Settings for Young Children with Behavior Disorders: An Examination of Conscious Discipline Implementation." Journal of Clinical and Translational Science 3, s1 (2019): 88. http://dx.doi.org/10.1017/cts.2019.203.
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OBJECTIVES/SPECIFIC AIMS: 1. Identify the extent of CD implementation for trained childcare teachers. 2. Explore teacher perspectives on the impact of CD. 3. Explore teacher perspectives on barriers and facilitators to full implementation of CD. METHODS/STUDY POPULATION: We conducted a survey with 267 childcare teachers who had been trained in CD across the state, representing early childhood educational environments in urban and rural settings. Specific questions were asked related to level of CD implementation, perceived benefit, and facilitators/barriers to full implementation. A random subset of the sample (8 teachers) participated in a subsequent focus group to explore survey themes in greater depth. Focus group members were asked about their rationale for attending CD training, CD implementation (including barriers/facilitators to full implementation), and perceived impact on their classrooms. The focus group was recorded and transcribed to capture questions and comments. RESULTS/ANTICIPATED RESULTS: Objective 1: 1. 30% of teachers reported full implementation of CD. 2. 50% of teachers reported partial implementation of CD. Objective 2: 1. The vast majority of teachers (95%) agreed that CD had a positive impact on their classroom, including better structure and enhanced relationships with the children. 2. The vast majority of teachers (85%) agreed that CD had a positive impact on the children in their classroom, including increases in problem-solving abilities and self-control. Objective 3: 1. Most teachers (71%) reported experiencing barriers to CD implementation, with the majority of those surveyed (93%) stating that additional implementation support would be helpful. 2. The top three barriers to implementation elicited in survey and focus groups included uncertainty regarding how to begin implementing CD in the classroom, lacking materials for CD implementation, and lacking time to focus on applying knowledge from training into the classroom. 3. The top three facilitators for implementation elicited in survey and focus groups included coaching support for teachers, training agency leadership in CD, and greater perceived impact of CD. DISCUSSION/SIGNIFICANCE OF IMPACT: Childhood disruptive behaviors are among the most frequent reasons for referral to specialized services in and out of the classroom (Sukhodolsky, Smith, McCauley, Ibrahim, & Piasecka, 2016). Disruptive and aggressive behaviors are problematic, not only for victims of children who are aggressive but also for aggressive children as they age. Although effective treatments exist, the level of effective implementation of these interventions are understudied. These results demonstrate that 2/3 of teachers trained in CD are not fully implementing the model and provides concrete barriers and facilitators to current implementation. These data will provide the initial foundation for the development of a targeted implementation strategy that supports full implementation of CD within early childhood education settings.
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Kreitschmann-Andermahr, Ilonka, Sonja Siegel, Christa Gammel, et al. "Support Needs of Patients with Cushing’s Disease and Cushing’s Syndrome: Results of a Survey Conducted in Germany and the USA." International Journal of Endocrinology 2018 (October 9, 2018): 1–8. http://dx.doi.org/10.1155/2018/9014768.
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Background. Cushing’s disease (CD) and Cushing’s syndrome (CS) are chronic illnesses, characterized by symptoms of prolonged hypercortisolism, which often changes to hypocortisolism after successful treatment. In view of the high disease burden of CD/CS patients and long-term impaired quality of life, the present survey was conducted to gain information about subjective illness distress and patients’ specific needs in terms of supportive measures beyond medical interventions. Patients and Methods. Cross-sectional questionnaire study including patients with CD treated in 2 German neurosurgical tertiary referral centers and CD/CS patient members of a US-based patient support group completed a survey inquiring about disease burden, coping strategies, and support needs. Additionally, the degree of interest in different offers, e.g., internet-based programs and seminars, was assessed. Results. 84 US and 71 German patients answered the questionnaire. Patients in both countries indicated to suffer from Cushing-related symptoms, reduced performance, and psychological problems. 48.8% US patients and 44.4% German patients stated that good medical care and competent doctors helped them the most in coping with the illness. US patients were more interested in support groups (p=0.035) and in courses on illness coping (p=0.008) than the German patients, who stated to prefer brochures (p=0.001). 89.3% of US patients would attend internet-based programs compared to 75.4% of German patients (p=0.040). There were no differences between groups for the preferred duration of and the willingness to pay for such a program, but US patients would travel longer distances to attend a support meeting (p=0.027). Conclusion. Patients in both countries need skilled physicians and long-term medical care in dealing with the effects of CD/CS, whereas other support needs differ between patients of both countries. The latter implies that not only disease-specific but also culture-specific training programs would need to be considered to satisfy the needs of patients in different countries.
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Baron Nelson, Mary, Kathy Riley, and Kimberly Arellano. "Adding a Parent to the Brain Tumor Team: Evaluating a Peer Support Intervention for Parents of Children With Brain Tumors." Journal of Pediatric Oncology Nursing 35, no. 3 (2018): 218–28. http://dx.doi.org/10.1177/1043454218762797.
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Childhood brain tumors often present profound challenges to patients and families. To address these challenges, the California Chapter of the Pediatric Brain Tumor Foundation provides hospital-based support services to parents of children with brain tumors from a Veteran Parent (VP). This mixed-methods, cross-sectional study was designed to evaluate the effectiveness of the intervention using validated tools to compare parental resilience and impact of illness on the family between parents who met with the VP and those who did not. Two-tailed t tests assessed significant differences in scores on the PedsQL Family Impact module and Connor–Davidson Resilience Scale (CD-RISC-25). Additional qualitative data gleaned from focus groups with stakeholders (health care providers and parents) were analyzed using key constructs of social support theory with Atlas.ti. Although there were no significant differences in overall scores on the PedsQL Family Impact module or CD-RISC-25 between groups, parents in the intervention group scored better on items related to handling difficult decisions and painful feelings. Overarching themes emerged from focus groups around participants’ experiences with the program and included informational and emotional support, peer parent relatedness, changed outlook, and empowerment. Results reveal the impact of peer parent support and need for emotional and instrumental support.
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Yang, Tao, and Leon O. Chua. "Applications of Chaotic Digital Code-Division Multiple Access (CDMA) to Cable Communication Systems." International Journal of Bifurcation and Chaos 08, no. 08 (1998): 1657–69. http://dx.doi.org/10.1142/s0218127498001327.
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In this paper the technical details of chaotic digital code-division multiple access ((CD)2MA) communication systems used in cable communication systems are presented. The cable communication system may be a pure coaxial RF cable network, a hybrid fiber-coax network, or a pure optical fibre network for high-capacity data link. As an example of its many potential applications in cable communication systems, (CD)2MA is used to support the upstream digital data communications in cable TV systems occupying the very noisy 5–40 MHz portion of spectrum. Although the (CD)2MA proposed in this paper is only used to support current Internet services via cable TV networks, it can also be used to support the high-speed data-link provided in the 550–750 MHz band in hybrid fiber-coax networks. (CD)2MA is a new communication framework which uses band-limited chaotic carriers insted of linear ones. For the purpose of generality, in this paper the band-limited chaotic carriers are approximated by groups of linear sub-carriers, which distribute within the same bandwidth with a fixed amplitude, random phases and uniformly distributed frequencies. The theoretical result of the performance of (CD)2MA is given. We also provide the simulation results of the bit-error-rate (BER) performances of a synchronous (CD)2MA used in cable communication systems. The results show that the (CD)2MA system has a better performance than the synchronous CDMA system proposed for the same cable communication system. Technical details of (CD)2MA are also presented for the future design of prototype systems. We present the framework of the whole (CD)2MA system including carrier syncronization, timing recovery and the details of nonlinear carrier generators.
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Markowitz, James, Ellen Kahn, and Fredric Daum. "Prognostic Significance of Epithelioid Granulomas Found in Rectosigmoid Biopsies at the Initial Presentation of Pediatric Crohn's Disease." Journal of Pediatric Gastroenterology and Nutrition 9, no. 2 (1989): 182–86. http://dx.doi.org/10.1002/j.1536-4801.1989.tb09853.x.
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The prognostic significance of epithelioid granulomas in Crohn's disease (CD) remains controversial. We have determined the prognostic significance of epithelioid granulomas noted in endoscopic rectosigmoid biopsies obtained from untreated pediatric patients at initial presentation of CD. Data collected from 19 subjects with rectosigmoid granulomas and inflammation (Group 1) were compared to those obtained from another 37 subjects (Group 2) with CD of the rectosigmoid, but in whom no granulomas were present. Both groups had similar ages at disease onset [Group 1: 11.6 + 3.6; Group 2: 10.4 + 4.0 years (X + SD)]. At diagnosis, Group 1 had more extensive CD (small bowel and colon involvement, with Group 1 74% versus Group 2 30%; isolated rectosigmoid involvement, with Group 1 11% versus Group 2 35%; p < 0.01). Perianal disease was also more common in Group 1 (58% versus 27% Group 2; p < 0.05). However, CD activity scores and clinical laboratory findings were comparable. Duration of follow‐up was identical (5.6 + 3.3 years) for both groups. By the end of the period of follow‐up, 43% of Group 2 had developed small bowel involvement, but Group 1 continued to have more extensive CD (p < 0.05). Perianal fistulae and abscesses and anal stenosis were more frequent in Group 1. Throughout this period, the need for oral and parenteral corticosteroids, 6‐mercaptopurine, and nutritional support modalities were similar in the two groups. Although the number of subjects requiring hospitalization and the number of hospitalizations per patient were similar in both groups, Group 1 had more surgery (p < 0.05). Rectosigmoid epithelioid granulomas appear, therefore, to be a finding associated with a poorer prognosis when discovered at the time of initial diagnosis of CD in children.
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Kim, K., S. W. Hong, J. H. Park, et al. "P560 Application of a clinical decision support tool for predicting outcomes with vedolizumab therapy in patients with inflammatory bowel disease: A KASID multicenter study." Journal of Crohn's and Colitis 16, Supplement_1 (2022): i503—i504. http://dx.doi.org/10.1093/ecco-jcc/jjab232.686.
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Abstract Background A clinical decision support tool (CDST) has been developed and validated for predicting outcomes of vedolizumab (VDZ) therapy for patients with Crohn’s disease (CD) and ulcerative colitis (UC), respectively. We aimed to validate each CDST for predicting outcomes and need for drug optimisation in patients with inflammatory bowel disease (IBD). Methods We retrospectively analysed 166 patients with IBD (71 with CD, and 95 with UC) treated with VDZ from January 2017 through November 2021 at 6 tertiary referral centres in Korea. We assessed clinical remission (CREM) and response (CRES), corticosteroid-free clinical remission (CfCREM) and response (CfCRES), biochemical response (BioRES), endoscopic healing (EH), and need for drug optimisation by CDST-defined response groups (low vs. intermediate to high probability group with a cut-off of 13 points in CD, Table 1A, and 26 points in UC, Table 2A, respectively). CDST was evaluated by area under the receiver operating characteristics curve (AUC) and test performance. Results Patients were classified as low (27 with CD, and 28 with UC) and intermediate to high probability group (44 with CD, and 67 with UC). Among CD patients, there showed no significant difference in the response rate of any outcomes between CDST-defined groups. Among UC patients, the rates of CREM (41.0 vs. 18.5%, p=0.040) and EH (56.5 vs. 33.3%, p=0.045) at week 14 were higher among intermediate to high probability group. The rate of drug optimisation during maintenance therapy was also higher in low probability group (54.2 vs. 30.2%, p=0.038). At week 26, CDST for CD discriminated CfCREM with an AUC of 0.656 (sensitivity 87.5%, specificity 43.8%) (Table 1B). Meanwhile, CDST for UC identified CREM with an AUC of 0.606 (sensitivity 83.3%, specificity 37.9%) at week 14 (Table 2B). BioRES of FC was identified with an AUC of 0.649 (sensitivity 84.6%, specificity 45.2%) at week 26. BioRES of CRP was identified with an AUC of 0.660 (sensitivity 68.8%, specificity 63.2%) at week 26, and with an AUC of 0.642 (sensitivity 70.0%, specificity 58.3%) at week 54. Drug optimisation during maintenance therapy was identified with an AUC of 0.620 (sensitivity 54.2%, specificity 69.8%). Conclusion Both CDST for CD and UC can be used to help guide VDZ therapy for Korean patients to predict BioRES with a fair discriminant function and moderate sensitivity.
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Hall, Sophie W., and Andrew S. Day. "An Overview of International Guidelines Focusing on the Long-Term Management of Coeliac Disease." Gastrointestinal Disorders 2, no. 2 (2020): 152–63. http://dx.doi.org/10.3390/gidisord2020016.
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Coeliac disease (CD) is an autoimmune disorder characterised by, but not isolated to, intestinal enteropathy in response to exposure to gluten in predisposed individuals. The mainstay of the management of CD is a strict, lifelong gluten free diet (GFD). Although numerous publications have focused on pathways to guide the diagnosis of CD, recommendations for the care of patients after diagnosis are less well established. This manuscript aimed to review the available published guidelines focusing on the ongoing management and follow-up of patients after diagnosis with CD and commencement of a GFD. All available guidelines recommend strict adherence to a GFD with most recommending an annual review by a specialist clinician, focusing on symptoms, adherence and growth. In addition to monitoring micronutrient status, some guidelines suggest monitoring bone mineral density in at-risk groups and screening for other autoimmune disorders. The benefit of multi-disciplinary input was outlined in many guidelines, in particular, the involvement of a specialist dietitian to provide nutritional counselling and support. While the available guidelines provide key messages, they highlight a lack of strong evidence and some inconsistences. Further evidence is required to support high quality, best-practice management strategies that will optimise the outcomes of patients with CD.
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Biederman, J., C. R. Petty, C. Dolan, et al. "The long-term longitudinal course of oppositional defiant disorder and conduct disorder in ADHD boys: findings from a controlled 10-year prospective longitudinal follow-up study." Psychological Medicine 38, no. 7 (2008): 1027–36. http://dx.doi.org/10.1017/s0033291707002668.
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BackgroundA better understanding of the long-term scope and impact of the co-morbidity with oppositional defiant disorder (ODD) and conduct disorder (CD) in attention deficit hyperactivity disorder (ADHD) youth has important clinical and public health implications.MethodSubjects were assessed blindly at baseline (mean age=10.7 years), 1-year (mean age=11.9 years), 4-year (mean age=14.7 years) and 10-year follow-up (mean age=21.7 years). The subjects' lifetime diagnostic status of ADHD, ODD and CD by the 4-year follow-up were used to define four groups (Controls, ADHD, ADHD plus ODD, and ADHD plus ODD and CD). Diagnostic outcomes at the 10-year follow-up were considered positive if full criteria were met any time after the 4-year assessment (interval diagnosis). Outcomes were examined using a Kaplan–Meier survival function (persistence of ODD), logistic regression (for binary outcomes) and negative binomial regression (for count outcomes) controlling for age.ResultsODD persisted in a substantial minority of subjects at the 10-year follow-up. Independent of co-morbid CD, ODD was associated with major depression in the interval between the 4-year and the 10-year follow-up. Although ODD significantly increased the risk for CD and antisocial personality disorder, CD conferred a much larger risk for these outcomes. Furthermore, only CD was associated with significantly increased risk for psychoactive substance use disorders, smoking, and bipolar disorder.ConclusionsThese longitudinal findings support and extend previously reported findings from this sample at the 4-year follow-up indicating that ODD and CD follow a divergent course. They also support previous findings that ODD heralds a compromised outcome for ADHD youth grown up independently of the co-morbidity with CD.
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Dulai, P., D. Lindner, C. Agboton, H. Alric, G. Bamias, and L. Peyrin-Biroulet. "P354 Application of the clinical decision support tool to predict treatment outcomes in Crohn’s Disease patients treated with vedolizumab subcutaneous formulation." Journal of Crohn's and Colitis 17, Supplement_1 (2023): i490—i491. http://dx.doi.org/10.1093/ecco-jcc/jjac190.0484.
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Abstract Background There is a need to identify Crohn’s Disease (CD) patients who will obtain most clinical benefit from treatment with vedolizumab (VDZ), an anti-α4β7 integrin inhibitor for the treatment of ulcerative colitis and Crohn’s Disease (CD). Previously, a clinical decision support tool (CDST) has been developed and validated to guide treatment decisions in CD patients (pts) treated with intravenous VDZ.1 In this study, we aimed to test the ability of the CDST to predict clinical outcomes in CD pts receiving maintenance treatment with the subcutaneous (SC) formulation of VDZ. Methods Pts with moderate to severe CD receiving maintenance treatment with VDZ SC in the VISIBLE 2 study were categorized using the CDST into low (≤13 points), intermediate (&gt;13 and ≤19 points) and high response probability groups (&gt;19 points) based on the scoring system detailed in Table 1. Clinical outcomes evaluated included clinical remission: CD Activity Index (CDAI) ≤ 150 at Week 6, 14, 30, and 52, and enhanced clinical response: decrease from baseline in CDAI score ≥ 100 points at Week 52. All outcomes were evaluated as observed. Results There were 275 pts who completed induction treatment with VDZ 300 mg IV and continued into maintenance treatment with VDZ 108 mg SC until Week 52. Using the CDST, at baseline, 14 pts (5.1%) had a low, 98 (35.6%) had an intermediate, and 163 (59.3%) had a high probability of treatment response with VDZ. Due to the low number of pts in the low probability group, the low and intermediate groups were combined. At Week 6, 99 pts (61.1%) in the high probability group had achieved clinical remission vs 38 pts (33.9%) in the low/intermediate probability group (Fig 1). Rates of clinical remission in the high probability group continued to exceed those of the low/intermediate group through until Week 52 when 89 pts (86.4%) in the high probability group were in clinical remission vs 43 pts (79.6%) in the low/intermediate probability group (Fig 1). In the high probability group, 97 pts (94.2%) had an enhanced clinical response at Week 52 compared with 46 pts (85.2%) in the low/intermediate group. Conclusion Compared with the low/intermediate group, pts categorized by the CDST as having the highest probability of treatment response to VDZ achieved clinical remission sooner, as early as Week 6. These findings provide further confirmation of the CDST as a means of identifying pts with CD likely to benefit from treatment with VDZ in either IV or SC formulations. References: 1. Dulai PS et al. (2018) Gastroenterology 155:687-695.e10.
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Taylor, Caroline M., Rita Doerner, Kate Northstone, and Katarzyna Kordas. "Maternal Diet During Pregnancy and Blood Cadmium Concentrations in an Observational Cohort of British Women." Nutrients 12, no. 4 (2020): 904. http://dx.doi.org/10.3390/nu12040904.
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Few studies have investigated the extent to which diet predicts body Cd concentrations among women of reproductive age, and pregnant women in particular. The aim of this study was to examine diet as a predictor of blood Cd concentrations in pregnant women participating in the UK Avon Longitudinal Study of Parents and Children (ALSPAC). Whole blood samples were analysed for Cd (median 0.26 (IQR 0.14–0.54) µg/L). Dietary pattern scores were derived from principal components analysis of data from a food frequency questionnaire. Associations between dietary pattern scores and foods/food groups with blood Cd ≥ median value were identified using adjusted logistic regression (n = 2169 complete cases). A health conscious dietary pattern was associated with a reduced likelihood of B-Cd ≥0.26 µg/l (OR 0.56 (95% CI 0.39–0.81)). There were similarly reduced likelihoods for all leafy green and green vegetables (0.72 (0.56–0.92) when consumed ≥4 times/week vs ≤1 to ≥3 times/week) and with all meats (0.66 (0.46–0.95) when consumed ≥4 times/week vs ≤ once in 2 weeks). Sensitivity analysis excluding smokers showed similar results. The evidence from this study provides continued support for a healthy and varied diet in pregnancy, incorporating foods from all food groups in accordance with national recommendations, without the need for specific guidance.
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Torres, Esther A., Abdiel Cruz, Mariola Monagas, et al. "Inflammatory Bowel Disease in Hispanics: The University of Puerto Rico IBD Registry." International Journal of Inflammation 2012 (2012): 1–5. http://dx.doi.org/10.1155/2012/574079.
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A registry of patients with inflammatory bowel diseases, ulcerative colitis (UC) and Crohn's disease (CD), was created at the University of Puerto Rico in 1995. Subjects with a documented diagnosis of IBD by clinical, radiologic, endoscopic, and/or pathologic criteria were recruited from the IBD clinics, support groups, and community practices, and demographic and medical data was collected. All entries from 1995 to 2009 were analyzed for demographics, family history, disease extent, extraintestinal manifestations, surgery, and smoking history. Results were described using summary statistics. 635 Hispanics living in Puerto Rico, 299 with UC and 336 with CD, were included. Mean ages were 40.3 for UC and 30.9 for CD. Over half (56%) of UC and 41% of CD were females. Family history was present in 19.3% of UC and 17.5% of CD. Surgery for IBD had been performed in 31.9% of UC and 51.2% of the CD patients. Over one-fourth of the patients reported extraintestinal manifestations, most frequently arthropathies. Our findings contribute to the limited epidemiologic and clinical data on Hispanics with IBD.
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Hasani, F., Z. Norouzi, S. Besharat, et al. "A Systematic Review and Meta-Analysis for Association of Celiac Disease and Thyroid Disorders." Series of Clinical and Medical Case Reports and Reviews 2, no. 2 (2024): 1–11. http://dx.doi.org/10.54178/2993-3579.v2i2a2030.
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People who have celiac disease (CD) are probably more likely to have thyroid disorders. A comprehensive systematic review and meta-analysis were conducted to assess the link between thyroid disorders and CD. Articles were selected from PubMed, Web of Science, Scopus, Ovid, Embase, Cochrane, ProQuest, and Wiley from February 2022 and earlier. A meta-analysis was conducted to evaluate the outcomes, using odds ratios (ORs) and corresponding 95% confidence intervals (95% CIs). The meta-analysis comprised 31 articles with 3310256 participants including 101253 individuals with thyroid disorders. Overall, the frequency of thyroid disease was notably higher in patients with CD compared to the control groups (OR: 3.06, 95% CI: 2.51 – 3.72, P<0.001). The findings of our meta-analysis support the notion that patients with CD are more likely to have autoimmune thyroid disease (ATD) and other thyroid disorders than the control group, thus indicating that regular screening for thyroid disease is necessary for CD patients. Further cohort research is required to investigate the relationship between thyroid disorders and CD.
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Soler-Andrés, Marina, Alexandre Díaz-Pons, Víctor Ortiz-García de la Foz, et al. "A Proxy Approach to Family Involvement and Neurocognitive Function in First Episode of Non-Affective Psychosis: Sex-Related Differences." Healthcare 11, no. 13 (2023): 1902. http://dx.doi.org/10.3390/healthcare11131902.
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Schizophrenia spectrum disorders (SSD) often show cognitive deficits (CD) impacting daily life. Family support has been shown to be protective against CD, yet the relationship between these in psychotic patients remains complex and not fully understood. This study investigated the association between a subdomain of family support, namely, family involvement (estimated through a proxy measure), cognitive functioning, and sex in first-episode psychosis (FEP) patients. The sample included 308 patients enrolled in the Program for Early Phases of Psychosis (PAFIP), divided into 4 groups based on their estimated family involvement (eFI) level and sex, and compared on various variables. Women presented lower rates of eFI than men (37.1% and 48.8%). Higher eFI was associated with better cognitive functioning, particularly in verbal memory. This association was stronger in women. The findings suggest that eFI may be an important factor in FEP patients’ cognitive functioning. This highlights the importance of including families in treatment plans for psychotic patients to prevent CD. Further research is needed to better understand the complex interplay between family support, sex, and cognitive functioning in psychotic patients and develop effective interventions that target these factors.
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De Marchi, Giulia, Giovanna Zanoni, Maria Conti Bellocchi, et al. "There Is No Association between Coeliac Disease and Autoimmune Pancreatitis." Nutrients 10, no. 9 (2018): 1157. http://dx.doi.org/10.3390/nu10091157.
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Autoimmune pancreatitis (AIP) is a rare disorder whose association with coeliac disease (CD) has never been investigated, although CD patients display a high prevalence of both endocrine and exocrine pancreatic affections. Therefore, we sought to evaluate the frequency of CD in patients with AIP and in further medical pancreatic disorders. The screening for CD was carried out through the detection of tissue transglutaminase (tTG) autoantibodies in sera of patients retrospectively enrolled and divided in four groups: AIP, chronic pancreatitis, chronic asymptomatic pancreatic hyperenzymemia (CAPH), and control subjects with functional dyspepsia. The search for anti-endomysium autoantibodies was performed in those cases with borderline or positive anti-tTG values. Duodenal biopsy was offered to all cases showing positive results. One patient out of 72 (1.4%) with AIP had already been diagnosed with CD and was following a gluten-free diet, while one case out of 71 (1.4%) with chronic pancreatitis and one out of 92 (1.1%) control subjects were diagnosed with de novo CD. No cases of CD were detected in the CAPH group. By contrast, a high prevalence of cases with ulcerative colitis was found in the AIP group (13.8%). Despite a mutual association between CD and several autoimmune disorders, our data do not support the serologic screening for CD in AIP. Further studies will clarify the usefulness of CD serologic screening in other pancreatic disorders.
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Vasincu, Ioana Mirela, Maria Apotrosoaei, Florentina Lupascu та ін. "Complexes of Ibuprofen Thiazolidin-4-One Derivatives with β-Cyclodextrin: Characterization and In Vivo Release Profile and Biological Evaluation". Pharmaceutics 15, № 10 (2023): 2492. http://dx.doi.org/10.3390/pharmaceutics15102492.
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Generally, NSAIDs are weakly soluble in water and contain both hydrophilic and hydrophobic groups. One of the most widely used NSAIDs is ibuprofen, which has a poor solubility and high permeability profile. By creating dynamic, non-covalent, water-soluble inclusion complexes, cyclodextrins (CDs) can increase the dissolution rate of low aqueous solubility drugs, operating as a drug delivery vehicle, additionally contributing significantly to the chemical stability of pharmaceuticals and to reducing drug-related irritability. In order to improve the pharmacological and pharmacokinetics profile of ibuprofen, new thiazolidin-4-one derivatives of ibuprofen (4b, 4g, 4k, 4m) were complexed with β-CD, using co-precipitation and freeze-drying. The new β-CD complexes (β-CD-4b, β-CD-4g, β-CD-4k, β-CD-4m) were characterized using scanning electronic microscopy (SEM), differential scanning calorimetry (DSC), X-ray diffraction and a phase solubility test. Using the AutoDock-VINA algorithm included in YASARA-structure software, we investigated the binding conformation of ibuprofen derivatives to β-CD and measured the binding energies. We also performed an in vivo biological evaluation of the ibuprofen derivatives and corresponding β-CD complexes, using analgesic/anti-inflammatory assays, as well as a release profile. The results support the theory that β-CD complexes (β-CD-4b, β-CD-4g, β-CD-4k, β-CD-4m) have a similar effect to ibuprofen derivatives (4b, 4g, 4k, 4m). Moreover, the β-CD complexes demonstrated a delayed release profile, which provides valuable insights into the drug-delivery area, focused on ibuprofen derivatives.
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Caminero, Alberto, Esther Nistal, Alexandra R. Herrán, et al. "Differences in gluten metabolism among healthy volunteers, coeliac disease patients and first-degree relatives." British Journal of Nutrition 114, no. 8 (2015): 1157–67. http://dx.doi.org/10.1017/s0007114515002767.
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AbstractCoeliac disease (CD) is an immune-mediated enteropathy resulting from exposure to gluten in genetically predisposed individuals. Gluten proteins are partially digested by human proteases generating immunogenic peptides that cause inflammation in patients carrying HLA-DQ2 and DQ8 genes. Although intestinal dysbiosis has been associated with patients with CD, bacterial metabolism of gluten has not been studied in depth thus far. The aim of this study was to analyse the metabolic activity of intestinal bacteria associated with gluten intake in healthy individuals, CD patients and first-degree relatives of CD patients. Faecal samples belonging to twenty-two untreated CD patients, twenty treated CD patients, sixteen healthy volunteers on normal diet, eleven healthy volunteers on gluten-free diet (GFD), seventy-one relatives of CD patients on normal diet and sixty-nine relatives on GFD were tested for several proteolytic activities, cultivable bacteria involved in gluten metabolism, SCFA and the amount of gluten in faeces. We detected faecal peptidasic activity against the gluten-derived peptide 33-mer. CD patients showed differences in faecal glutenasic activity (FGA), faecal tryptic activity (FTA), SCFA and faecal gluten content with respect to healthy volunteers. Alterations in specific bacterial groups metabolising gluten such as Clostridium or Lactobacillus were reported in CD patients. Relatives showed similar parameters to CD patients (SCFA) and healthy volunteers (FTA and FGA). Our data support the fact that commensal microbial activity is an important factor in the metabolism of gluten proteins and that this activity is altered in CD patients.
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Agin, Mehmet, Aylin Yucel, Meltem Gumus, Hasan Ali Yuksekkaya та Gokhan Tumgor. "The Effect of Enteral Nutrition Support Rich in TGF-β in the Treatment of Inflammatory Bowel Disease in Childhood". Medicina 55, № 10 (2019): 620. http://dx.doi.org/10.3390/medicina55100620.
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Background and Objective: Malnutrition is a major complication of inflammatory bowel disease (IBD). Our aim of the study was to examine the effects of Modulen IBD supplementation, which was administered to IBD patients without limiting their daily diet in addition to medical treatment, on the clinical, laboratory, anthropometric values, and disease activities of these patients. Materials and Methods: Seventy three children with IBD were evaluated retrospectively. The cases were classified as those who had Crohn disease receiving (CD-M; n = 16) or not receiving Modulen IBD (CD; n = 19) and those who had ulcerative colitis receiving (UC-M; n = 13) or not receiving Modulen IBD (UC; n = 25). Disease activities, laboratory values, remission rates, and anthropometric measurements of the groups were compared. In addition to IBD treatment, Modulen IBD in which half of the daily calorie requirement was provided was given for eight weeks. Results: In the third month of treatment, 14 (88%) patients were in remission in CD-M group and eight (42%) patients were in remission in CD group. The height and weight z scores, which were low at the time of diagnosis, improved in the first week in CD-M group. Inflammatory parameters (UC) were significantly lower in the UC-M group compared to the UC group in first and third months. In the third month, eight (62%) patients in the UC-M group and four (16%) in the UC group were remitted clinically and in terms of laboratory values. Conclusions: TGF-β-rich enteral nutrition support in children with IBD is an easy, effective, and reliable approach. It was shown that TGF-β-rich enteral nutritional supplementation enabled the disease to enter the remission earlier, and contributed to the early recovery of weight and height scores.
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Maček, P., N. Molinari, and A. Ocepek. "P773 Clinical decision support tool for vedolizumab is useful in predicting endoscopic remission in Crohn's disease – a retrospective real-life single-centre cohort study." Journal of Crohn's and Colitis 18, Supplement_1 (2024): i1443. http://dx.doi.org/10.1093/ecco-jcc/jjad212.0903.
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Abstract Background Early control of inflammation could modify the disease course and improve outcomes in patients with Crohn's disease (CD). Positioning of advanced therapies is becoming more important as treatment options expand. Dulai et al. derived and externally validated a clinical decision support tool (CDST) for predicting response to vedolizumab (VDZ). They noticed that the high probability group, according to CDST, has the highest probability of achieving clinical remission (CR), corticosteroid-free remission (CSFR) and mucosal healing. In contrast, low and intermediate-probability groups are more likely to need surgery. Methods We performed a retrospective single-centre cohort study based on the UR-CARE registry. Data for 57 CD patients treated with VDZ from July 2016 until April 2023 were analysed. We stratified patients according to CDST for CD into three response probability groups: group 0 with low (≤13 points), group 1 with intermediate (14-19 points) and group 2 with high (&gt;19 points) probability of response to VDZ. CDST was calculated using five variables: no prior bowel surgery, no prior tumour necrosis factor (TNF) alpha antagonist exposure, no prior fistulising disease, baseline albumin and baseline C-reactive protein (CRP). For analysis of the association between CDST, CR (defined as PRO2 ≤1 with rectal bleeding score 0), CSFR and endoscopic activity (defined as no change in endoscopic activity, endoscopic improvement (EI), or endoscopic remission (ER)) chi2 test was used. Results In our cohort, 38.6% of CD patients were male, the median age was 34 years at the time of diagnosis, and the median duration of disease until VDZ treatment was 4.1 years. Fistulising disease was present in 33.3%, 24.6% had upper gastrointestinal involvement, 56.1% had prior surgery, and 57.9% had prior anti-TNF exposure. The average follow-up duration was 27.0 (standard deviation = 19.2 months). We found a significant association between the CDST group and endoscopic activity at follow-up endoscopy but no statistically significant association between the CDST group and CR nor CSFR at weeks 14 and 52. The majority (69.2%) of patients stratified into CDST group 0 had endoscopically active disease, while in contrast, 68.8% of patients in CDST group 2 achieved ER. In group 1, EI was found in 45.8% and ER in 41.7% of patients. Conclusion In our retrospective study, CDST for VDZ predicted ER and EI in our cohort of patients with CD. We could not confirm the association between CDST and CR or CSFR, probably due to the definition used in a retrospective design, namely PRO2, which does not correlate well with endoscopic activity in CD.
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Korat, Ofra, and Hila Blau. "Repeated Reading of CD-ROM Storybook as a Support for Emergent Literacy: A Developmental Perspective in Two Ses Groups." Journal of Educational Computing Research 43, no. 4 (2010): 445–66. http://dx.doi.org/10.2190/ec.43.4.b.
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Huang, Lixia, Yifei Jiang, Xinying Chen, et al. "Supramolecular Responsive Chitosan Microcarriers for Cell Detachment Triggered by Adamantane." Polymers 15, no. 19 (2023): 4024. http://dx.doi.org/10.3390/polym15194024.
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Supramolecular responsive microcarriers based on chitosan microspheres were prepared and applied for nonenzymatic cell detachment. Briefly, chitosan microspheres (CSMs) were first prepared by an emulsion crosslinking approach, the surface of which was then modified with β-cyclodextrin (β-CD) by chemical grafting. Subsequently, gelatin was attached onto the surface of the CSMs via the host–guest interaction between β-CD groups and aromatic residues in gelatin. The resultant microspheres were denoted CSM-g-CD-Gel. Due to their superior biocompatibility and gelatin niches, CSM-g-CD-Gel microspheres can be used as effective microcarriers for cell attachment and expansion. L-02, a human fetal hepatocyte line, was used to evaluate cell attachment and expansion with these microcarriers. After incubation for 48 h, the cells attached and expanded to cover the entire surface of microcarriers. Moreover, with the addition of adamantane (AD), cells can be detached from the microcarriers together with gelatin because of the competitive binding between β-CD and AD. Overall, these supramolecular responsive microcarriers could effectively support cell expansion and achieve nonenzymatic cell detachment and may be potentially reusable with a new cycle of gelatin attachment and detachment.
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Meadowcroft, Gael, and Denise Charman. "A psychological study of homeless young women." Australian Educational and Developmental Psychologist 17, no. 2 (2000): 70–81. http://dx.doi.org/10.1017/s0816512200028169.
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AbstractLittle is known about individual differences in homeless young women.The aim of this study was to investigate these differences in an Australian context and to examine specifially the impact of level of completed education and length of time spent homeless.Two groups of homeless young women aged between 16 and 19 years were contacted through outreach, housing, and juvenile justice workers. A conduct disordered (CD) group (n = 15) and a not-conduct disordered (NCD) group (n = 16) completed a demographic questionnaire as well as six CPI subscales of responsibility, socialization, tolerance, achievement via conformance, good impression, and well-being. Their CPI profiles were significantly lower and different in pattern to an American female CD profile. A one-way MANOVA showed that the CD group had lower mean scores on all subscales than the NCD group. Logistic regression showed that the socialization subscale predicted group membership. Socialization differences between CD and NCD groups of homeless young women were linked to level of completed educotion rather than to length of time out of home. Higher levels of completed education were associated with absence of conduct disorder and greater socialization. These results support previous research showing that homeless young women are at risk of endangering their physical and psychosocial health.This research also reveals that extra time spent at school can mediate these effects.
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Choon, X. Y., J. H. Yeo, C. White, et al. "P0836 Real-world application of the Crohn’s disease clinical decision support tool (CDST) in both intravenous and subcutaneous vedolizumab." Journal of Crohn's and Colitis 19, Supplement_1 (2025): i1598—i1599. https://doi.org/10.1093/ecco-jcc/jjae190.1010.
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Abstract Background The clinical decision support tool (CDST) was developed from GEMINI II to help inform patient selection for intravenous (IV) vedolizumab (VDZ) in Crohn’s disease (CD). The tool’s applicability in the subcutaneous (SC) formulation of VDZ was tested post-hoc in VISIBLE-2 and also appears valid. Our aim was to examine its predictive performance in a real-world cohort of patients treated with either IV or SC VDZ. Methods We retrospectively collected data on all CD patients commenced on VDZ from January 2015 to October 2023 in two tertiary IBD centres. Baseline data was retrieved to calculate the CDST: prior exposure to tumour necrosis factor (TNF) antagonists, prior surgery for CD, prior fistulating disease, baseline albumin and C reactive protein (CRP). All patients with a minimum of 12 months follow up were included. Patients were categorised into the SC group if they switched to SC within 6 months of commencing VDZ. Our primary outcome was treatment persistence at 12 months. In addition, we looked at clinical, biochemical and endoscopic outcomes at 12 months, requirement for dose escalation and progression to CD-related surgery. Kaplan Meier analysis with logrank test for trend was used for treatment persistence. Categorial outcomes and continuous variables were compared using the chi square test for trend and ANOVA respectively. Results 408 patients were included, 278 (68%) received IV VDZ and 130 (32%) SC. 336 (82%) had prior exposure to TNF antagonists, 107 (26%) had fistulating disease, 191 (47%) had prior resectional surgery for CD. The CDST stratified patients into 3 groups by probability of treatment response: low (n=35, 9%), intermediate (n=152, 37%) and high (n=221, 54%). The low and intermediate groups were combined in the analysis of treatment persistence due to lower numbers in the former. In both IV and SC cohorts, CDST was able to predict greater treatment persistence in the high probability group versus the low/intermediate group. The high probability cohort was also statistically more likely to achieve mucosal healing (p&lt;0.0001) and surgery-free survival (p&lt;0.0001) at 12 months. Conclusion This is to our knowledge the first application of CDST to a real-world cohort of CD patients receiving either IV and/or SC VDZ. Our data demonstrates that the tool has predictive ability for long term treatment persistence regardless of the method of administration, as well as outcomes at 12 months. Our study supports a role for CDST in guiding treatment selection in clinical practice. References 1.Dulai PS et al. Development and Validation of a Scoring System to Predict Outcomes of Vedolizumab Treatment in Patients With Crohn’s Disease. Gastroenterology. 2018 Sep;155(3):687-695.e10. doi: 10.1053/j.gastro.2018.05.039. Epub 2018 May 30. PMID: 29857091; PMCID: PMC6419724. 2.P Dulai, D Lindner, C Agboton, H Alric, G Bamias, L Peyrin-Biroulet. P354 Application of the clinical decision support tool to predict treatment outcomes in Crohn’s Disease patients treated with vedolizumab subcutaneous formulation, Journal of Crohn’s and Colitis, Volume 17, Issue Supplement_1, February 2023, Pages i490–i491, https://doi.org/10.1093/ecco-jcc/jjac190.0484
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Germani, Ross M., Francisco J. Civantos, and Elizabeth J. Franzmann. "Molecular Markers of Micrometastasis in OCSCCA." Otolaryngology–Head and Neck Surgery 139, no. 2_suppl (2008): P91—P92. http://dx.doi.org/10.1016/j.otohns.2008.05.498.
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Problem To report our experience in analysis of immunohistochemical markers for detection of micrometastasis in patients with oral cavity squamous cell carcinoma (OCSCCA)who have undergone lymphoscintigraphy and sentinel lymph node biopsy(SLNB). Staining results and analysis for CD-44, MT1-MMP, FAK and E-cadherin will be presented. Methods Paraffin embedded specimens (N=30) were retrospectively studied by immunohistochemical analysis. Applied monoclonal antibodies were anti-CD-44(Bender Med-Systems Inc., Burlingame, CA), anti-MT1-MMP(Calbiochem, San Diego, CA), anti-FAK (Upstate Biotechnology Inc, Lake Placid, NY) and anti-E-cadherin (Transduction Laboratories, Lexington, Ky). Staining patterns were analyzed by 2 independent pathologists. Differences between groups for each staining pattern were analyzed by the Fisher exact method. Results 2 groups were identified based on results of SLNB: patients with negative sentinel lymph node biopsies who represented true N0 necks (N = 19; group I) and those with evidence of occult lymph node metastasis (N =11; group II). There was no significant difference in staining patterns between groups for CD-44, although three distinct staining patterns were identified. For MT1-MMP there was a striking difference in staining between groups I (20%) and II (67%) that did not reach statistical significance (p=0.13). Specimens are currently undergoing staining for FAK and E-cadherin as described. Staining results for these markers will be analyzed and compared to those for CD-44 and MT1-MMP. Conclusion Lymphoscintigraphy followed by SLNB has been established as a sensitive tool to detect early tumor metastasis to proximal nodal basins. By comparing sentinel node status with molecular events at the primary tumor site we hope to identify a molecular marker for metastasis. We will report results of immunohistochemical analysis for CD-44, MT1-MMP, FAK and E-cadherin in this manuscript. Significance By studying this unique subset of patients we hope to identify a reliable molecular marker for metastasis, which may ultimately change the way we manage the neck for early oral cavity cancer. Support Resident research stipend.
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Baldi, Simone, Marta Menicatti, Giulia Nannini, et al. "Free Fatty Acids Signature in Human Intestinal Disorders: Significant Association between Butyric Acid and Celiac Disease." Nutrients 13, no. 3 (2021): 742. http://dx.doi.org/10.3390/nu13030742.
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Altered circulating levels of free fatty acids (FFAs), namely short chain fatty acids (SCFAs), medium chain fatty acids (MCFAs), and long chain fatty acids (LCFAs), are associated with metabolic, gastrointestinal, and malignant diseases. Hence, we compared the serum FFA profile of patients with celiac disease (CD), adenomatous polyposis (AP), and colorectal cancer (CRC) to healthy controls (HC). We enrolled 44 patients (19 CRC, 9 AP, 16 CD) and 16 HC. We performed a quantitative FFA evaluation with the gas chromatography–mass spectrometry method (GC–MS), and we performed Dirichlet-multinomial regression in order to highlight disease-specific FFA signature. HC showed a different composition of FFAs than CRC, AP, and CD patients. Furthermore, the partial least squares discriminant analysis (PLS-DA) confirmed perfect overlap between the CRC and AP patients and separation of HC from the diseased groups. The Dirichlet-multinomial regression identified only strong positive association between CD and butyric acid. Moreover, CD patients showed significant interactions with age, BMI, and gender. In addition, among patients with the same age and BMI, being male compared to being female implies a decrease of the CD effect on the (log) prevalence of butyric acid in FFA composition. Our data support GC–MS as a suitable method for the concurrent analysis of circulating SCFAs, MCFAs, and LCFAs in different gastrointestinal diseases. Furthermore, and notably, we suggest for the first time that butyric acid could represent a potential biomarker for CD screening.
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Hou, Ling, Ming Min, Rui Hou, Wei Tan, Minghua Zhang, and Qianfei Liu. "Prediction of clinical deterioration within one year in chronic obstructive pulmonary disease using the systemic coagulation-inflammation index: a retrospective study employing multiple machine learning method." PeerJ 13 (February 25, 2025): e18989. https://doi.org/10.7717/peerj.18989.
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Background Inflammatory response and the coagulation system are pivotal in the pathogenesis of clinical deterioration in chronic obstructive pulmonary disease (COPD), prompting us to hypothesize that the systemic coagulation-inflammation (SCI) index is associated with clinical deterioration in COPD. Methods A cohort of 957 COPD patients (mean age: 68.4 ± 7.8 years; 74.4% male) from January 2018 to December 2021 was analyzed. Six machine learning models (XGBoost, logistic regression, Random Forest, elastic net (ENT), support vector machine (SVM), and K-nearest neighbors (KNN)) were evaluated using accuracy, precision, recall, F1-score, and the area under the receiver operating characteristic curve (AUC-ROC). Results Our study encompassed 957 patients, out of which 171 were classified in the clinical deterioration of COPD (cd-COPD) cohort. Significant disparities in age, comorbidities like respiratory failure, C-reactive protein, lymphocyte count, red blood cell distribution width (RDW), SCI, procalcitonin (PCT), and D-dimer were depicted between the cd-COPD and non-cd-COPD groups. Concerning machine learning and model comparison, the SVM model showcased consistent performance and strong generalization capabilities on both the training and testing sets compared to the other five machine learning (ML) models. The SCI index, as the most influential predictor, demonstrated a median of 93.08 in cd-COPD compared to 81.67 in non-cd-COPD patients. Conclusion The SCI is markedly elevated in cd-COPD patients compared to COPD patients, and SVM demonstrates reliable performance in cd-COPD prediction.
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Roca, María, Ester Donat, Natalia Marco-Maestud, et al. "Efficacy Study of Anti-Endomysium Antibodies for Celiac Disease Diagnosis: A Retrospective Study in a Spanish Pediatric Population." Journal of Clinical Medicine 8, no. 12 (2019): 2179. http://dx.doi.org/10.3390/jcm8122179.
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The aim of this study was to assess the efficacy of anti-endomysium antibodies (EMA) as a serological marker for celiac disease (CD) diagnosis in a pediatric population. A retrospective study of pediatric patients who underwent a CD serological markers study: EMA and anti-tissue transglutaminase antibodies (anti-TG2). Clinical symptomatology, degree of histological lesion, human leukocyte antigen (HLA) haplotype compatible with CD (HLA DQ2 and/or DQ8), and final diagnosis were taken into account. We included 445 patients who were classified in two groups according to the final diagnosis. Group 1: 232 children with CD, 91.4% of whom exhibited small intestinal villous atrophy, 228 being EMA-positive and four EMA-negative. Group 2: 213 children with a non-CD diagnosis, 212 EMA negative and one EMA positive. Both antibodies, EMA and anti-TG2, reached similar sensitivities, 98% and 99% respectively, while EMA had a higher specificity (99%) than anti-TG2 (93%). By using both markers combined, compared to using anti-TG2 alone, 5.7% of patients are better diagnosed. However, when we compare the efficacy of EMA and anti-TG2 in asymptomatic and symptomatic patients, the sensitivity of EMA is 98% irrespective of symptoms, thus higher than for anti-TG2 ≥10 × upper limit of normal (ULN) (respectively 77% and 84%). Our results support the use of EMA to increase CD diagnostic accuracy in a non-biopsy approach, especially in asymptomatic children.
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Romanchuk, A., C. Valle, A. Ghirardi, et al. "P273 Defining the prognosis of children with Crohn Disease with the support of magnetic resonance enterography: a multi-center multi-reader study." Journal of Crohn's and Colitis 18, Supplement_1 (2024): i639. http://dx.doi.org/10.1093/ecco-jcc/jjad212.0403.
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Abstract Background Ileocolonoscopic assessment is the most accurate method for detecting intestinal inflammation in Crohn disease (CD), but it allows the assessment only of a limited tract of the small intestine and does not provide data on inflammation beyond the mucosa. The auxiliary use of magnetic resonance enterography (MRE) can overcome these limitations and allow to predict the course of CD. Paediatric Inflammatory Crohn's MRE Index (PICMI) is a multi-point index of intestinal inflammation (mucosal and transmural) in children with CD created on the basis of MRI. The aim of the present study is to assess whether this completely non-invasive index at diagnosis could predict the course of CD in children and to test the inter-reader agreement as surrogate of index reproducibility. Methods All children diagnosed with CD in two tertiary referral centres with a 1-year minimum follow-up were enrolled in the study. MRE at diagnosis was blindly evaluated by 3 expert radiologists and PICMI was calculated for all patients. Children’s disease was stratified according to PICMI at diagnosis into remission (&lt;10), mild (11-55), moderate (56-120) and severe (&gt;120). Inter-observer agreement among radiologist was calculated. Data at follow-up were collected at 6-8 weeks, 1 year, 3 years and 5 years after CD diagnosis. Association between PICMI at diagnosis and CD prognosis was evaluated. Results A total of 71 children (52 males) with proven CD were enrolled in the study and PICMI was calculated for 68. PICMI at diagnosis was stratified into remission 6 (8.8%), mild 29 (42.6%), moderate 24 (35.3%), severe 9 (13.2%). Inter-observer agreement was calculated with an intraclass correlation coefficient of 0.65 which indicates moderate reliability between the 3 raters. PICMI score at diagnosis significantly correlated with PCDAI (Paediatric Crohn's Disease Activity Index) at diagnosis (p: 0.036). Steroid-free remission at 1, 3 and 5 years was comparable between PICMI groups: remission + mild vs moderate + severe (p: 0.606). CRP and calprotectin negative steroid free remission at 1,3,5 was also comparable (p: 0.578). PICMI at diagnosis was associated with the probability of biologic introduction at 1 year: incidence rate ratio IRR: 2.17 (1.09-4.42); p=0.019, 3-year IRR: 2.12 (1.15-3.96); p=0.011, and 5 years: 2.21 (1.20-4.08); p=0.007 (figure 1). Conclusion PICMI score is a reliable and reproducible index to determine activity in children with Crohn’s disease. Children with more active disease at diagnosis according to PICMI have shown an increased need to progression to biologic treatment in order to gain a comparable rate of steroid free remission and inflammatory marker negativity if compared with children with lower PICMI scores.
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Rogers, Courtney C., Thomas J. Moutinho Jr, Xiaoyue Liu, and Rupa S. Valdez. "Designing Consumer Health Information Technology to Support Biform and Articulation Work: A Qualitative Study of Diet and Nutrition Management as Patient Work." JMIR Human Factors 8, no. 3 (2021): e27452. http://dx.doi.org/10.2196/27452.
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Background Diet and nutrition management is an integral component of Crohn disease (CD) management. This type of management is highly variable and individualized and, thus, requires personalized approaches. Consumer health information technology (CHIT) designed to support CD management has typically supported this task as everyday life work and, not necessarily, as illness work. Moreover, CHIT has rarely supported the ways in which diet and nutrition management requires coordination between multiple forms of patient work. Objective The purpose of this study was to investigate diet and nutrition management as biform work, identify components of articulation work, and provide guidance on how to design CHIT to support this work. Methods We performed a qualitative study in which we recruited participants from CD-related Facebook pages and groups. Results Semistructured interviews with 21 individuals showed that diet and nutrition management strategies were highly individualized and variable. Four themes emerged from the data, emphasizing the interactions of diet and nutrition with physical, emotional, information, and technology-enabled management. Conclusions This study shows that the extent to which diet and nutrition management is biform work fluctuates over time and that articulation work can be continuous and unplanned. The design guidance specifies the need for patient-facing technologies to support interactions among diet and nutrition and other management activities such as medication intake, stress reduction, and information seeking, as well as to respond to the ways in which diet and nutrition management needs change over time.
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Marcon, P., A. Clarke, K. Pace, et al. "A191 PERSISTENT BENEFIT OF DIETITIAN-LED GLUTEN-FREE DIET EDUCATION AT CD DIAGNOSIS ON DIETARY ADHERENCE IN CHILDREN AND ADULTS WITH TYPE 1 DIABETES AND CELIAC DISEASE." Journal of the Canadian Association of Gastroenterology 5, Supplement_1 (2022): 75–76. http://dx.doi.org/10.1093/jcag/gwab049.190.
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Abstract Background Celiac disease (CD) is a common autoimmune comorbidity of type 1 diabetes (T1D) with a gluten-free diet (GFD) being the current gold standard treatment for this condition. Adherence to a GFD can be impacted by several factors including dietetic counselling, yet little is known about the impact of clinic-based interventions on long-term GFD adherence in this population. Aims To prospectively evaluate the impact of a dietitian-led GFD education intervention on adherence to a GFD in children and adults with T1D and CD over a 3-year period. Methods A cohort of N=62 pediatric and adult subjects who screened seropositive for CD as part of the CD-DIET clinical trial were followed over a 3-year period post-CD diagnosis and assessed on the basis of the GFD education regimen they received at initial CD diagnosis. This included 3 groups: 1) intensive dietitian training (IDT = 5 dietitian visits over 1 year while following GFD), 2) single dietitian training (SDT = 1 GFD training session after 1 year of following GCD) and 3) no dietitian training (NDT) at CD diagnosis. Annual visits included serologic testing of TTG-IgA titres, anthropometric assessments and the completion of questionnaires evaluating diet and adherence to a GFD. Data was analysed longitudinally using linear mixed effects and generalized estimating equations (GEE) regression modeling adjusting for the fixed effects of age, sex, duration of diabetes and time. Results At baseline, participants who received IDT (n=15), SDT (n=16) and NDT (n=31) represented 24.2%, 25.8%, and 50.0% of the cohort, respectively. Over the 3-year study period, participants in the IDT group had the greatest odds of self-reporting being a GFD, with odds 4.3 (95%CI: 1.1 to 16.4; P=0.033) and 9.5 (95%CI: 2.7 to 33.7; P&lt;0.001) greater than the SDT and NDT groups, respectively. The assessment of daily gluten intakes less than 10mg, as recommended for a GFD, revealed a lack of differences between the IDT and SDT groups. In contrast, the NDT group had significantly lower odds of meeting this threshold relative to those who received IDT (OR=0.2; 95%CI: 0.04 to 0.56; P=0.004). No longitudinal differences in TTG-IgA levels were seen between groups over the 3-year period. Conclusions In diabetes patients greater contact with a dietitian at CD diagnosis was associated with higher levels of GFD adherence over time, which was not reflected in follow-up Serologic evaluation. These findings highlight the importance of nutritional support in patients with both diabetes and celiac disease at the time of CD diagnosis. In addition, following TTG-IgA alone does not fully inform dietary compliance to a GFD. Diet teaching stratification Diet assignment Funding Agencies Juvenile Diabetes Research Foundation / PSI
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Dulai, P., Y. Wan, Z. Huang, and M. Luo. "P802 Probability of vedolizumab response as defined by clinical decision support tool is associated with lower healthcare utilisation in patients with Crohn’s disease." Journal of Crohn's and Colitis 14, Supplement_1 (2020): S628—S629. http://dx.doi.org/10.1093/ecco-jcc/jjz203.930.
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Abstract Background A clinical decision support tool (CDST) has been developed and validated for predicting treatment effectiveness of vedolizumab (VDZ) in Crohn’s disease (CD). We evaluated this tool’s ability to predict healthcare resource utilisation using real-world data. Methods CD patients treated with VDZ were identified using real-world data from the Optum (n = 358) and Truven MarketScan (n = 1445) databases. The full CDST with 3 clinical variables (prior bowel surgery, prior fistulising disease, prior TNF-antagonist exposure) and 2 lab values (albumin and CRP) was applied to the Optum dataset with available lab data, and patients were stratified into low (n = 27), intermediate (n = 152), or high (n = 179) probability of response groups. A modified weighting of the 3 clinical variables was created for application in Truven MarketScan due to the lack of availability of lab data. To assess the coherence with the full 5-variable CDST, the modified 3-variable CDST was used to stratify Optum patients into low (n = 137) or high (n = 221) probability of response, and then subsequently validated in the Truven MarketScan dataset (low, n = 510; high n = 935; response probability groups). Rates of hospitalisation, surgery, emergency department (ED) visits and annualised per patient costs were compared across response probability groups. Results Using the full 5-variable CDST, we observed a linear trend of significantly lower rates of ED visits, hospitalisation, surgery, and healthcare-related costs with increasing probability of response (Table). These results were consistent when using the modified 3 variable CDST in the Optum patient dataset where we observed a 3-fold higher rate of per patient healthcare costs in the low probability of response group compared with the high probability of response group ($6535 vs. $1900, p = 0.016). In the Truven patient dataset, the modified 3 variable CDST was also associated with a significantly lower rate of hospitalisation, surgery, and healthcare costs in the high probability of response group (Table). The majority of cost differences between high and low response groups was driven by costs related to hospitalisation and surgery. Conclusion A simple CDST can identify CD patients treated with VDZ who present a higher risk for healthcare resource utilisation, especially for hospitalisation and surgery. This tool could be integrated into population health monitoring algorithms using real-world data and offer flexibility on requirements of lab data.
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Amos, Hannah, BeiLi Chng, Alexandra Kazaks, Terri Stilson, and Maribeth Evezich. "Barriers to Long-Term Maintenance of a Gluten-Free Diet in People With Celiac Disease." Current Developments in Nutrition 5, Supplement_2 (2021): 958. http://dx.doi.org/10.1093/cdn/nzab051_002.
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Abstract Objectives Currently the only treatment for celiac disease (CD), an autoimmune disease triggered by ingestion of the protein gluten, is a gluten-free (GF) diet. This study aimed to examine some barriers (GF food accessibility, social support, GF food knowledge) to maintaining a GF diet. Methods A deidentified online survey with REDCap was shared with people with celiac disease via social media (celiac disease group and research survey exchange group via Reddit, research survey exchange groups via Facebook, celiac disease Discord server). The survey included questions about diagnosis, symptoms, social support, eating habits, GF food access, disease impact, gluten-free knowledge, and demographics. Analysis included descriptive statistics and qualitative measures were used to determine themes. Results Of the 123 responses, 54.5% were diagnosed with CD by small intestine biopsy, 85.1% maintained a GF diet, and 35.2% had CD symptoms for 1–4 years before receiving a diagnosis. Concerning accessibility, 47.9% reported having some difficulty affording GF foods and 49.2% that local grocery stores had limited selection of GF foods. An analysis of GF bread cost in one Washington State county showed a mean cost per loaf of $6.52 which was $4.98 higher than the average cost of all bread in the U.S. When it came to checking food labels for gluten, 59% reported feeling very confident and most participants were able to correctly identify foods that may contain gluten; however, less than half (47.5%) identified kamut (a type of wheat) as a gluten containing grain. 46.7% reported feeling that having CD impacts their life daily. The majority (64.2%) of participants stated that family and friends are supportive of needs, and 62.3% also shared that they did not live in a home that was free of gluten. Conclusions The results from this study suggest that there may be several types of barriers to maintaining a GF diet in people with CD. This study aims to bring better awareness of the prevalence of food accessibility, social support, and GF food knowledge barriers to those living with CD, and to the nutrition professionals who provide their healthcare. Funding Sources Bastyr University Faculty Student Research Grant
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Joo, Y. H., Y. Park, E. M. Song, et al. "P0072 Unveiling mesenteric and intestinal changes in Crohn’s disease: insights into fibrosis from surgical specimens." Journal of Crohn's and Colitis 19, Supplement_1 (2025): i434. https://doi.org/10.1093/ecco-jcc/jjae190.0246.
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Abstract Background Recent studies have emphasized the role of mesenteric changes, including creeping fat, alongside intestinal alterations in the progression of Crohn's disease (CD). This study aims to investigate intestinal fibrosis and mesenteric changes using tissues obtained from CD patients who underwent surgery for complications such as strictures and perforations. Methods From September 2023 to September 2024, intestinal (CD-Inflamed-Bowel/CD-Uninflamed-Bowel) and mesenteric tissues (CD-Inflamed-Mes/CD-Uninflamed-Mes/ CD-Uninvolved-Mes) were collected from nine CD patients who underwent surgery. Additionally, intestinal (Normal-Bowel) and mesenteric tissues (Normal-Mes) were obtained from one patient who underwent anterior resection for adenoma. Specimens were obtained from the small intestine (4 patients) and the colon (5 patients). Samples were analyzed for morphological changes (H&E staining), collagen deposition (Masson’s trichrome), and fibrosis marker expression (qPCR). Results Preoperative CT or MR enterography revealed the presence of creeping fat in all nine CD patients, with five showing strictures accompanied by upstream bowel dilatation. In intestinal tissues, increased collagen fiber deposition was observed in CD-Inflamed-Bowel compared to CD-Uninflamed-Bowel, whereas mesenteric tissues showed no significant differences in collagen deposition among Uninvolved, Uninflamed, and Inflamed groups. qPCR analysis of intestinal tissues revealed significantly higher expression of the fibrosis marker COL1A1 in CD-Inflamed-Bowel compared to Normal-Bowel and CD-Uninflamed-Bowel (119.9 ± 260 vs. 1.0 ± 0.0 vs. 1.0 ± 0.7, P = 0.041). In mesenteric tissues, COL1A1 expression was significantly elevated in CD patients compared to controls (28.0 ± 7.7 vs. 1.0 ± 0.0, P = 0.002), though no significant differences in COL1A1 expression were found among Uninvolved, Uninflamed, and Inflamed mesenteric tissues within the same patient (17.7 ± 3.7, 25.1 ± 9.2, 41.0 ± 21.2, P = 0.9372). Other fibrosis markers (Vimentin, TGF-β, MMP-1, CHI3L1, CXCL1, and PDPN) showed similar trends. Conclusion This study highlights inflammatory and fibrotic changes in the intestine and mesentery during CD progression. Notably, mesenteric fibrosis was evident even in uninvolved intestinal segments without active inflammation, suggesting mesenteric inflammation and fibrosis may precede intestinal involvement. These findings support the mesentery as a novel potential target for early treatment for disease progression of CD.
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Mérida-Ortega, Ángel, Lizbeth López-Carrillo, Karla Rangel-Moreno, Natalia Ramirez, and Stephen J. Rothenberg. "Tobacco Smoke Exposure and Urinary Cadmium in Women from Northern Mexico." International Journal of Environmental Research and Public Health 18, no. 23 (2021): 12581. http://dx.doi.org/10.3390/ijerph182312581.
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Cadmium (Cd), a carcinogenic metal also related to reproductive and cardiovascular diseases, is contained in tobacco and elevated concentrations of it in humans have been consistently associated with first-hand tobacco smoke; however, there is scarce and inconclusive evidence of the relationship between Cd and secondhand smoke (SHS) exposure. Our aim was to evaluate the association between exposure to tobacco, both active and SHS, with urinary Cd concentrations in Mexican women. In a cross-sectional analysis that included 998 women living in northern Mexico, we measured the concentration of creatinine-adjusted urinary Cd (µg-cadmium/g-creatinine) using inductively coupled plasma triple quadrupole (ICP-QQQ) in tandem mass spectrometry mode (MS/MS). We gathered tobacco smoking information through an in-person interview and formed seven groups: non-smokers without SHS exposure; non-smokers with SHS exposure; ex-smokers without SHS exposure <1 year of quitting; ex-smokers without SHS exposure ≥1 year of quitting, ex-smokers with SHS exposure <1 year of quitting; ex-smokers with SHS exposure ≥1 year of quitting and current smokers. The interview also yielded sociodemographic characteristics. We used linear multivariable regression models to estimate the association between Cd concentrations and tobacco smoke exposure. Compared to non-smokers without SHS exposure, we found higher Cd concentrations in ex-smokers with SHS exposure <1 year of quitting and current smokers (adjusted geometric means 0.51 vs. 1.01 and 0.69 µg-cadmium/g-creatinine, respectively). Our results do not support a conclusion that SHS exposure is a source of Cd body burden.
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Sasson, A. N., J. Noelting, K. Schwenger, et al. "A287 HOME PARENTERAL NUTRITION FOR INDIVIDUALS WITH SHORT BOWEL SYNDROME SECONDARY TO CROHN’S DISEASE VERSUS OTHER ETIOLOGIES: A PROSPECTIVE COHORT STUDY." Journal of the Canadian Association of Gastroenterology 6, Supplement_1 (2023): 96–97. http://dx.doi.org/10.1093/jcag/gwac036.287.
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Abstract Background Individuals with short bowel syndrome (SBS) have reduced intestinal absorptive capacity and many require home parenteral nutrition (PN) support. One of the common causes of SBS is secondary to intestinal resections in the management of Crohn’s disease (CD). Complication rates and survival in SBS secondary to CD on PN versus other etiologies remains unknown. Purpose To determine whether patients with SBS secondary to CD versus SBS secondary to other etiologies on home PN, have increased risk of hospitalizations and complications including central line associated bloodstream infection (CLABSI) and venous thromboembolism and whether there is a difference in overall survival between groups. Method This is a multicentre prospective cohort study using the Canadian Home Parenteral Nutrition (HPN) Registry on individuals with defined SBS separated into two cohorts: 1) Patients with SBS secondary to Crohn’s disease vs. 2) Patients with SBS secondary to other aetiologies (trauma, surgical complication, vascular event, volvulus, malignancy). Patient characteristics and clinical factors are presented as mean (standard deviation) for continuous variables and as frequency (percentage) for categorical variables. Comparison between groups (SBS CD vs SBS other) were performed using 2-sample t-test for continuous variables and Chi-square or Fisher exact tests when appropriate for categorical variable. Survival probabilities will be estimated using the Kaplan-Meier method. Result(s) The study included a total of 379 patients with short bowel syndrome on home PN. There are 170 (45%) patients with SBS secondary to CD and 209 (55%) patients with SBS from other secondary causes. The average age of those with CD is 52 and 65% female patients. The average age of those with other causes of SBS is 56 with similar percentage of female patients (65%). There were significant differences in baseline medications with higher use of immunosuppressant therapy (39% vs. 7%, p&lt;0.001) in those with CD. There was no significant difference in total number of hospitalizations, hospitalizations related to PN and CLABSI. Image Conclusion(s) Individuals with SBS secondary to CD do not appear to be at increased risk of central line infections or hospitalizations compared those with SBS from other causes. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Gülcü Taşkın, Didem, and Arzu Gülseren. "Retrospective analyses of antibody titers in the diagnosis of pediatric Celiac Disease." Medical Science and Discovery 10, no. 3 (2023): 182–86. http://dx.doi.org/10.36472/msd.v10i3.912.
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Objective: We aimed to evaluate the relationship between Tissue Transglutaminase IgA titer (tTGIgA) and Endomisium antibody (EMA) positivity and the stage of duodenal mucosal damage at Celiac disease (CD). Material and Methods: The study group consisted of 233 children (2-18 years old) who were diagnosed with CD and admitted to our XXX Hospital, Pediatric Gastroenterology Outpatient Clinic, between September 2017 and November 2022. All patients underwent an endoscopy, and a histopathological diagnosis was made. In upper gastrointestinal endoscopy, one biopsy sample were taken from the duodenum bulb and four samples from the second part of the duodenum. Histological patterns were evaluated according to the Marsh-Oberhuber classification. Results: A total 233 patients with CD were included in the study. The mean age of the patients at the time of diagnosis was 97.0 ± 57.1 months. The patients' mean tissue transglutaminase (tTG) IgA value was 172 ± 133. The most common Marsh-Oberhuber classification was found to be Marsh 3b (47.6%) in CD patients. According to the Marsh-Oberhuber classification, the mean tTGIgA values were significantly different compared to the groups. Conclusion: We recommend starting a diet with a diagnosis of CD without endoscopy for patients with a tTGIgA value of 10 X ULN (upper limit of normal) or more recommended by ESPGAN, and we even support randomized prospective studies to reduce this value to 7-10 times or less.
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Tee, Oswald S., N. Rani Iyengar та Bryan K. Takasaki. "Catalysis of the deprotonation of β-keto esters by cyclodextrins". Canadian Journal of Chemistry 71, № 12 (1993): 2139–43. http://dx.doi.org/10.1139/v93-265.
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The rates of deprotonation of several β-keto esters in basic aqueous solution are elevated by α- and β-cyclodextrin (α- and β-CD). In most cases saturation kinetics are observed that indicate fairly strong binding of the esters to the CDs (Kd = 0.22–11 mM); catalytic ratios (kc/ku) are in the range 1.9–17. For esters of the form RCO-CH2COOEt with both α- and β-CD the values of Kd and kc/ku show little sensitivity to the acyl group, RCO (R = Me, Et, Pr, i-Pr), and for 2-carboethoxycyclopentanone, a cyclic analogue, these parameters are similar. In contrast, for R-COCH2CO-OR′ (R = Me or Et; R′ = Me, Et, allyl) there is a marked dependence of the parameters on the alkoxyl group, OR′. These results suggest that the β-keto esters studied bind to the CDs with their alkoxyl groups in the CD cavity and that the catalysis ensues from the complexes thus formed. Variations in two other kinetic parameters, k2 = kc/Kd (substrate selectivity) and KTS = ku/k2 (apparent constant for dissociation of CD from the transition state) support this interpretation. Apparent second-order rate constants for the reaction of the esters with neutral CD (k2 = kc/Kd) are 1900–360 000 M−1 s−1 (at pH ≈ 10), whereas for hydroxide ion attack on ethyl acetoacetate kOH = 5500 M−1 s−1. Assuming the pKas of the CDs are 12.2 and 12.3, deprotonation of the esters by the CD anions has rate constants of 105 to 5 × 107 M−1 s−1. Thus, binding of the β-keto esters in the CD cavities, adjacent to a basic oxyanion site, enhances the reactivity of the CD anions towards these weak carbon acids by at least 2–4 orders of magnitude.
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Koliji, Tara. "A Comparison of Personality Traits, Social Support, and Resilience in Pregnant Women Seeking Normal and Cesarean Deliveries." Applied Family Therapy Journal 2, no. 1 (2021): 309–25. https://doi.org/10.61838/kman.aftj.2.1.16.
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Aim: The present study aimed to compare personality traits, social support, and resilience in two groups of pregnant women seeking normal and cesarean deliveries. Methods: The research was a causal-comparative study which selected 30 pregnant women seeking normal childbirth, and 30 pregnant women seeking cesarean section using the convenience sampling method, and they responded to the big-five personality traits questionnaire by McCrae & Costa (1992), Connor-Davidson Resilience Scale (CD-RIS) (2003), and Social Support Questionnaire by Wax et al.'s (1986). The results were analyzed using SPSS-22, statistical models of multivariate analysis of variance, and one-way ANOVA. Results: There was a difference between the two groups in all three variables, namely personality traits, social support, and resilience (P=0.05). Conclusion: The results indicated that pregnant women seeking normal childbirth scored higher in enthusiasm for new experiences and conscience components, and pregnant women seeking cesarean section scored higher in psychosis and extraversion. Furthermore, social support and resilience were higher in pregnant women seeking normal delivery than pregnant women seeking cesarean section.
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Zuurbier, Coert J., Vanessa M. Emons, and Can Ince. "Hemodynamics of anesthetized ventilated mouse models: aspects of anesthetics, fluid support, and strain." American Journal of Physiology-Heart and Circulatory Physiology 282, no. 6 (2002): H2099—H2105. http://dx.doi.org/10.1152/ajpheart.01002.2001.
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This study evaluates the effects of anesthesia and fluid support on hemodynamic parameters of the mechanically ventilated mouse of four different strains. All experiments were performed at a similar surgical level of anesthesia, as indicated by the probing of the pedal withdrawal reflex. Three anesthetic regimens [fentanyl-fluanisone-midazolam (FFM), ketamine-medetomidine-atropine (KMA), and isoflurane (ISO)], four commonly used mouse strains (Swiss, CD-1, BalbC, and C57Bl6), and three different fluid support strategies (no fluid, 0.2 ml · h−1 · 10 g−1 of 6% polystarch solution, and 0.5 ml · h−1 · 10 g−1 saline) were studied. Mean arterial pressure (MAP) or heart rate (HR) was similar among the four strains of mice except a trend toward lower HR for the BalbC mice. In terms of MAP, KMA is the preferred anesthetic for the Swiss and CD-1 mice, whereas KMA or ISO are recommended for BalbC or C57Bl6 mice. In terms of HR, ISO is the preferred anesthetic for the Swiss, CD-1, and C57Bl6 strains. No differences in HR for the three anesthetics were observed for the BalbC strain. Compared with administration of no fluid, both saline and polystarch administration similarly increased MAP by 7 ± 2, 10 ± 2, and 11 ± 2 mmHg at t = 1, 2, and 3 h, respectively, whereas fluid administration was without effect on HR. Saline supplementation resulted in an increased dry-to-wet ratio of the heart and both fluid regimens decreased total hemoglobin in the blood from 12.6 ± 0.5 to 10.4 ± 0.5 g/100 ml. Saline administration was associated with blood acidosis (pH 7.20 ± 0.03) compared with the Haes (pH 7.29 ± 0.02) or no-fluid group (pH 7.34 ± 0.03), whereas Pco 2 was ∼30 mmHg for all groups. We conclude that at similar surgical levels of anesthesia, the preferable type of anesthesia (ISO or KMA, but never FFM) depends on the strain used and whether MAP or HR is the focus of study. Additional fluid support is beneficial in terms of raising arterial blood pressure, although this is at the cost of changes in organ water content and increased anemia.
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Muller, Katia, José Morais, and Jocelyne Feine. "Nutritional and anthropometric analysis of edentulous patients wearing implant overdentures or conventional dentures." Brazilian Dental Journal 19, no. 2 (2008): 145–50. http://dx.doi.org/10.1590/s0103-64402008000200011.
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As masticatory efficiency diminishes drastically in edentulous patients, several researchers have studied over the past two decades how dietary intake varies when different types of oral rehabilitation are provided. Since the use of implants to support prostheses in edentulous mandibles has been shown to significantly improve masticatory performance, the question remains as to whether this improvement will influence the nutritional status. The purose of this study was to evaluate the nutritional status of edentulous patients who randomly received either a mandibular conventional denture (CD) or an implant-supported overdenture (IP) 1 year previously. Weight, height, body composition and handgrip strength measurements were collected for analysis. Blood tests were performed to measure plasma parameters of diet intake. Participants responded to a Food Frequency Questionnaire and a Masticatory Function Questionnaire. Fifty-three people participated (58% men, 42% women; mean age = 53). Body composition indicators as well as plasma parameters were generally within normal range, and no statistically significant difference (p>0.05) was found between the groups. Patients in the CD group had significantly lower ratings for items regarding difficulty in chewing (p<0.05), but no significant difference was found for dietary intake (p>0.05). Although the CD wearers reported having more difficulty in chewing hard foods, both groups appeared to have a similar nutritional status.
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Toskas, Alexandros, Stefanos Milias, Georgios Delis, Soultana Meditskou, Antonia Sioga, and Theodora Papamitsou. "Expression of IL-21 and IL-33 in Intestinal Mucosa of Inflammatory Bowel Disease: An Immunohistochemical Study." Diagnostics 13, no. 13 (2023): 2185. http://dx.doi.org/10.3390/diagnostics13132185.
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Interleukins are considered to be potential therapeutic targets that can alter the prognosis and disease progression of IBD. IL-21 has proven to be involved in effector Th1, Th2 and Th17 responses. Similarly, IL-33, a newly identified cytokine, has been shown to control the Th1 effector response and the action of the colonic Tregs in animal models of colitis and patients with IBD. In this retrospective study, we have studied the expression of these interleukins, using immunohistochemistry, in 121 patients with moderate to severe IBD before and after treatment with biologics. The results were statistically processed using SPSSTM. Increased IL-21 expression was found in the UC and CD groups versus the controls. The IL-33 expression was found to be increased in the post-treatment UC and CD groups, suggesting a protective role of this interleukin against bowel inflammation. The IL-33 expression post-treatment was reversely correlated with the activity index score in CD patients, suggesting a better response to treatment in patients with higher IL-33 mucosa levels. This is the first immunohistochemical study of the expression of those interleukins in bowel mucosa before and after treatment with biologics. These data support a possibly promising future use of these interleukins as biomarkers of severe disease and response to treatment and as potential therapeutic targets for novel monoclonal antibodies.
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Sperling, Jeffrey, Phinnara Has, Todd Lovgren, Brendan Connealy, Dwight Rouse, and Joshua Dahlke. "Peripartum Morbidity after Cesarean Delivery for Arrest of Dilation at 4 to 5 cm Compared with 6 to 10 cm." American Journal of Perinatology 35, no. 12 (2018): 1173–77. http://dx.doi.org/10.1055/s-0038-1642063.
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Objective Given that recent consensus guidelines established to decrease cesarean delivery (CD) rates use 6 cm to define the onset of the active phase of labor, our objective was to evaluate maternal and neonatal outcomes after CD for the indication of arrest of dilation at 4 to 5 cm compared with ≥ 6 cm. Study Design We performed a secondary analysis using data from the Maternal Fetal-Medicine Units Network Cesarean Registry. We included nulliparous women with term, singleton, vertex gestations who underwent primary CD for arrest of dilation. We compared those who reached a maximum cervical dilation of 4 to 5 cm with those of ≥6 cm. Our primary outcome was composite maternal morbidity that included chorioamnionitis, endometritis, transfusion, wound complication, operative injury, intensive care unit admission, or death. Results Of the 73,257 women in the dataset, 5,681 met the inclusion criteria. After adjusting for confounders, there was no difference in composite maternal (adjusted odds ratio [aOR]: 1.19; 95% confidence interval [CI]: 0.94–1.52) or neonatal morbidity (aOR: 0.94; 95% CI: 0.79–1.10) between the groups. Conclusion In this historical cohort, maternal and neonatal outcomes after CD for arrest of dilation ≥ 6 cm were comparable to those performed at 4 to 5 cm and support recent labor management guidelines.
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Agrawal, M., A. Ebert, G. Poulsen, et al. "OP11 Ileocecal resection for recently diagnosed ileocecal Crohn’s disease is associated with improved long-term outcomes compared to anti-tumor necrosis factor therapy: a population-based study." Journal of Crohn's and Colitis 17, Supplement_1 (2023): i16—i17. http://dx.doi.org/10.1093/ecco-jcc/jjac190.0011.
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Abstract Background Early treatment of Crohn’s disease (CD) often involves biologics such as anti-tumor necrosis factor (anti-TNF) agents. Ileocecal resection (ICR), while a therapeutic option in early CD, is generally reserved for complicated CD or when medical treatment fails. We aimed to compare long-term outcomes of ICR and anti-TNF therapy as index treatment for ileocecal CD, initiated within one year of diagnosis, in the Danish nationwide cohort. Methods Using cross-linked nationwide registers, we identified all individuals who lived in Denmark and were diagnosed with ileal CD between 2003 and 2018. We included individuals who underwent ICR or received anti-TNF drugs as index treatment for ileocecal CD within one year of diagnosis. We excluded patients who did not have pathology information confirming disease in the ileocecal region. The primary outcome was a composite of CD-related hospitalization, systemic corticosteroid exposure, CD-related surgery, and perianal CD diagnosis. We conducted Cox proportional hazards regression analyses to compare outcomes in the two groups after adjusting for potential confounders. We also determined the proportion of individuals initiated on immunomodulator (IMM), anti-TNF, or no therapy at 5 years after ICR. Results Of the 16,443 individuals diagnosed with ileocecal CD between 2003 and 2018, 581 (3.5%) and 698 (4.2%) individuals with confirmed disease in the ileocecal region underwent ICR and received anti-TNF as the index treatment, respectively. The composite outcome occurred in 273 individuals (IR 110.3/100,0 person years (PY)) in the ICR group and in 318 individuals (IR 201.9/100,0 PY) in the anti-TNF group. The risk of the composite outcome was 33% lower in the ICR group compared to the anti-TNF group (aHR 0.67; 95% CI 0.54, 0.83), after adjusting for demographic and clinical variables. On analysis of individual outcomes, ICR was associated with reduced risk of systemic corticosteroid exposure and CD-related surgery, but not CD-related hospitalization or perianal CD diagnosis. Of individuals who underwent ICR, the proportion that was initiated on IMM, anti-TNF treatment or no treatment at 5 years of follow up was 47.5%, 17.1%, and 50.3%, respectively. Conclusion These data support the role of ICR as an index treatment for ileocecal CD and challenge the current paradigm of reserving surgery for complicated CD refractory or intolerant to medications. Further studies will help identify characteristics of individuals who needed no treatment after ICR.
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Iskandar, Adhi Teguh Perma, Mulyadi Muhammad Djer, Bambang Supriyatno, et al. "Effects of lung recruitment maneuver using mechanical ventilator in preterm infant microcirculation: a clinical trial." Medical Journal of Indonesia 34, no. 1 (2025): 21–9. https://doi.org/10.13181/mji.oa.247472.
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BACKGROUND Preterm infants often require continuous positive airway pressure due to immature respiratory tracts. Bronchopulmonary dysplasia (BPD) manifests as prolonged oxygen dependence until 28 days of age and is classified into mild, moderate, or severe forms. The lung recruitment maneuver (LRM) aims to reopen collapsed alveoli, enhancing oxygenation during mechanical ventilation using the assist control volume guarantee mode (MV-AC/VG). This study aimed to evaluate the impact of LRM on alveolar and endothelial injuries, neonatal microcirculation, and its relation to BPD reduction or mortality in preterm infants. METHODS This study was conducted from March 2021 to April 2022 at Cipto Mangunkusumo and Bunda Menteng Hospitals, Jakarta. The participants are <32 weeks infants with severe respiratory distress syndrome requiring MV-AC/VG, divided into LRM and control groups (n = 55 each). The alveolar injury was assessed using plasma surfactant protein-D (SP-D), endothelial injury by flow cytometry for endothelial microparticles (CD-31⁺/CD-42-), and neonatal microcirculation via transcutaneous-artery CO2 gap (TcPCO₂-PaCO₂) and transcutaneous O2 index (TcPO₂/PaO₂) measurements at 1 and 72 hours post-ventilation. RESULTS LRM did not negatively affect preterm infants (24–32 weeks) undergoing invasive mechanical ventilation. At 72 hours, no significant differences were observed in alveolar (SP-D) and endothelial injury (CD-31+/CD-42-), nor in BPD reduction or mortality by 36 weeks. CONCLUSIONS LRM is a beneficial intervention for enhancing respiratory support and microcirculation in preterm infants. Among survivors, LRM reduced the time to achieve the lowest FiO2 (60.0 versus 435.0 hours, p<0.0001), shortened respiratory support duration (25.0 versus 36.83 days, p = 0.044), and improved TcO2 index (1.00 versus 1.00, p = 0.009).
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Bokemeyer, B., S. Plachta-Danielzik, R. di Giuseppe, et al. "P601 Real World Evidence on the comparative effectiveness of Ustekinumab vs anti-TNF in Crohn’s disease with Propensity Score adjustment: maintenance phase results from the prospective observational RUN-CD study." Journal of Crohn's and Colitis 16, Supplement_1 (2022): i534—i535. http://dx.doi.org/10.1093/ecco-jcc/jjab232.727.
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Abstract Background Observational real world studies are required in addition to RCTs which typically represent selected patients not reflecting everyday clinical practice. Between 2017–2020 patients with Crohn’s disease (CD) receiving a newly initiated biologics therapy were consecutively enrolled into the prospective, observational RUN-CD registry from 44 IBD-experienced German centres to assess effectiveness and safety of ustekinumab (UST) with a 3 years follow-up. Here, the results on the effectiveness of the maintenance therapy over 12 months are presented as a real world evidence (RWE) comparison of UST vs anti-TNF. Methods After exclusion of other biologics than UST and anti-TNF and missing outcomes, the final sample consisted of 607 CD-patients. Clinical remission (HBI ≤ 4) was the predefined endpoint at month 12. Patients were analyzed on a modified intent-to-treat basis (mITT; switchers considered as outcome failure). To reduce the effect of confounders, propensity score (PS) adjustment with inverse probability of treatment weighting (IPTW) was implemented. A weighted logistic regression was used, and the results were reported as odds ratio (OR) and 95% confidence interval (CI). Results 343 UST (naïve: 35) and 264 anti-TNF (naïve: 175) (ADA 61%, IFX 39%) CD-patients were included. PS removed systematic differences between both groups (mean of both groups: 15% perianal disease, 36% surgical resection, 41% EIM). Overall, the number of switches was lower in the UST group than in the anti-TNF group (Tab. 1). However, the number of switches within 12 months was significantly lower in the UST group only when compared to the IFX group (16.3% vs 27.2%; p=0.045) (Fig. 1). Clinical remission rates at 1 year (Tab. 2) were not statistically different for the overall UST vs. anti-TNF groups (65.8% vs 60.0%). Remission rates were similar for UST vs ADA, while these were significantly higher for UST vs. IFX (61.6% vs 41.8%; p=0.009). Looking at clinical remission in the week 16 responder group (Tab. 3), a statistically significantly higher remission rate was found in the overall group for UST (77.6%) vs anti-TNF (65.4%) (p=0.041), which was mainly driven by the higher UST remission rate in biologic-naïve CD patients (p=0.026). Conclusion This 1-year maintenance phase RWE-comparison with UST vs anti-TNF showed remarkably high clinical remission rates in both groups. Also due to a more frequent switching within the IFX group, the clinical remission rate at 1 year was significantly higher with UST than with IFX and higher with UST vs anti-TNF in the biologic-naïve groups. These results support together with the known favorable safety profile consideration of UST as a first-line targeted therapy for CD.