Abstract
Background
Prophylactic medication following ileocecal resection (ICR) is recommended in patients with Crohn’s disease (CD), particularly in patients at increased risk of recurrence. This ...study aimed to evaluate the effect of prophylactic medication on long-term prognosis.
Methods
A retrospective cohort study was performed in patients with CD who underwent a primary ICR. Patients were divided into two groups: prophylaxis (i.e. initiation of prophylactic medication<12 weeks following ICR) versus no prophylaxis. The primary and secondary outcomes were surgical recurrence and severe endoscopic recurrence (modified Rutgeerts score ≥ i3). To compare the outcomes between both groups, inverse propensity score-weighted comparison was used to adjust for confounding and selection bias. The survival and association between prophylaxis and both outcomes were assessed with Kaplan-Meier analyses and Cox proportional hazard models.
Results
811 patients underwent an ICR median follow-up 5.8 years (IQR 2.5 – 10.7)(Table 1). Prophylaxis was initiated in 297/811 37% patients. In 364/514 71% patients without prophylaxis, medication was started after median follow-up 15 months IQR 7.2 – 46.5. Cumulative rates of surgical and endoscopic recurrence at 1, 2, 5 and 10 years were significantly lower in patients with prophylaxis versus no prophylaxis 1%, 3%, 9% and 19%, vs. 3%, 4%, 11% and 23%, p < 0.05 and 4%, 8%, 15% and 27% vs. 10%, 16%, 25% and 40%, p < 0.01. Propensity-scored weighted analysis showed that patients treated with prophylaxis were less likely to experience surgical recurrence aOR 0.52; 95% CI 0.33 – 0.82 and severe endoscopic recurrenceaOR 0.53; 95% CI 0.35 – 0.81. In multivariable analysis, prophylaxis was identified as protective factor for surgical aHR 0.67, 95% CI 0.45 – 0.99 and severe endoscopic recurrence aHR 0.54, 95% CI 0.37 – 0.78 (Table 2).
Conclusion
Surgical and severe endoscopic recurrence up to 10 years following primary ICR are significantly reduced in patients with CD who received prophylaxis as compared to no prophylaxis. Prophylaxis was associated with the prevention of surgical and severe endoscopic recurrence.
Abstract
Background
To learn from the current crisis caused by the COVID-19 pandemic and be prepared for future pandemics, it is important to investigate the impact of this extraordinary period on ...the wellbeing of patients with inflammatory bowel disease (IBD). Therefore, the aim of this research was to describe the self-reported Health-Related Quality of Life (HRQoL) and disease control of patients with IBD from the start of the COVID-19 pandemic and measures in The Netherlands.
Methods
This was a prospective study initiated on March 17, 2020 until July 1st, 2020. All patients aged 18 years and older with IBD that visited the Erasmus MC (Rotterdam, The Netherlands) outpatient clinic between March 2019 to February 2020 received up to date information on COVID-19. Patients were invited to complete online questionnaires at week 0, 2, 6 and 12. The Inflammatory Bowel Disease Questionnaire (IBDQ), the Inflammatory Bowel Disease control-8 (IBD-control-8 and the Numeric Rating Scale (NRS) on fatigue were used. The evolution of the different outcomes over time was measured using mixed models.
Results
Of 1151 invited patients, 851 participants (67% had CD and 33% UC or IBD-U) completed one or more questionnaires (response rate 74%). Median age of the participants was 41 years, with 57% being female. No relevant changes in total scores were found over time for the IBDQ (effect estimate 0.006, 95% CI -0.003–0.015) and IBD-control-8 (effect estimate 0.004, 95% CI 0.998–1.011). There was a slight, increasing trend in fatigue scores over time (effect estimate 0.011, 95% CI 0.004, 0.019).
Conclusion
This first lock down due to the COVID-19 pandemic in The Netherlands did not impact on the HRQoL and disease control of patients with IBD. Up to date information may have contributed to a stable HRQoL in IBD patients even in an extreme period with restrictions and insecurities.
Translational research leaves no-one indifferent and everyone expects a particular benefit. We as EU-LIFE ( www.eu-life.eu ), an alliance of 13 research institutes in European life sciences, would ...like to share our experience in an attempt to identify measures to promote translational research without undermining basic exploratory research and academic freedom.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
The mannose binding lectin (
MBL2) polymorphism is responsible for a common immunodeficiency in the human species. There were suggestions that the
MBL2 polymorphism has been under balancing ...selection, based on the high global frequency of alleles generating MBL deficiency and on the worldwide distribution of diseases negatively associated with them. To describe the distribution of
MBL2 allelic haplotypes in Brazilian populations and to discuss the evolution of this polymorphism, we analyzed six South Brazilian populations (152 Guarani Amerindian, 239 Kaingang Amerindian, 107 admixed, Brazilian 32 Afro-Brazilian, 202 Euro-Brazilian and 16 Oriental-Brazilian). Eight haplotypes were observed:
MBL2*HYPA, LYQA, LYPA, LXPA, LYPB, LYQC, HYPD, and
LYPD. In addition, through sequencing of the promoter and exon 1 from Amerindian and Oriental individuals, three new single-nucleotide polymorphisms (SNPs) were found in the
MBL2 promoter region in the Kaingang. Analysis of the sequencing data by neutrality tests (Tajima’s D and Fu and Li’s D* and F*) revealed no deviation from selective neutrality equilibrium in the Guarani and Kaingang. Significant Fay and Wu’s H results are explained by the recent gene flow in these populations. Contrarily to previous thoughts, stochastic evolutionary factors seem therefore to have had a predominant role in shaping the
MBL2 polymorphism, at least in the Amerindians.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
The accumulation of saxitoxins (STXs) in fish from freshwater aquaculture was investigated for the first time in the present study. Cyanotoxins have been monitored in liver and muscle samples of
...Oreochromis niloticus by chromatographic methods, both before and after the depuration process. The results show that tilapia can accumulate STXs. Our findings suggest that depuration with clean water is an alternative process to eliminate STXs from fish and, therefore, improve the safety of tilapia for consumers.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Sarcopenia is prevalent in patients with liver cirrhosis and is negatively associated with clinical outcomes. In a population screened for liver transplantation we aimed to assess the prevalence of ...abnormal nutritional status and to what extent a clinical screening tool is able to reliably select patients for extensive nutritional assessment including CT. We also evaluated which nutritional parameters are independently associated with clinical outcomes.
Analysis of consecutive patients undergoing detailed nutritional assessment during pre-liver transplantation screening from October 2015 to April 2017.
In 102 included patients (66.7% male; median age of 56.3 years (IQR 43.9–64.0); median MELDNa score of 14.7 (IQR 9.4–19.0)), presarcopenia was diagnosed in 30/102 patients (29.4%), sarcopenia in 20/102 (19.6%), and impaired muscle quality in 19/102 (18.6%). Application of the European association for the Study of the Liver rapid screen tool as the primary instrument for nutritional assessment would have resulted in selection of 40/69 cases, thus 42.0% of patients with actual muscle mass depletion and/or impaired muscle function would not have been selected for further nutritional evaluation.
In contrast to muscle mass depletion, impaired muscle function was a significant predictor for 6-month decompensation-free (p = 0.006) and hospitalization-free (p = 0.003) survival, when adjusted for age and MELDNa score.
In our population the efficacy of a clinical screening tool for malnutrition was unsatisfactory. A detailed nutritional assessment is therefore recommended in all patients undergoing liver transplantation screening. Impaired muscle function might be clinically more relevant than muscle mass depletion, and muscle function testing should be considered an integral part of nutritional assessment in chronic liver disease.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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