bluuebunny/crossref_metadata_2025 huggingface dataset:
The narratives and aesthetics of the civilizational state in the ‘new’ India
Authors: Srivastava Jayati
Published: March 2023

The term ‘civilizational state’ is used by emerging powers, including India, to mark themselves as distinct from the Westphalian states. This article addresses the following questions: why does India invoke this term despite its association with illiberal states? What ideological foundations and resources inform this narrative? And how does the ‘new’ India envision its role in international politics? Using an interpretive analysis of select texts and imagery, the article delineates the intellectual roots and aesthetic resources deployed by ‘new’ India to bring forth a civilizational state narrative which has become an important tool of power projection at both domestic and international levels. It argues that the recent shift from ‘civilization’ to ‘civilizational state’ draws its intellectual roots from early Hindutva idealogues. It is based on a conflict-ridden/homogenous understanding of civilization, making it ambivalent towards an inclusive/plural civilizational narrative articulated and nurtured by the nationalists. Internationally, the civilizational state narrative is geared towards reinforcing ‘new’ India's claim to be in the league of great powers; projecting itself as a power with a difference. Being the world's largest democracy helps in reinforcing this narrative, but signs of a shift towards a homogenous civilizational narrative will have wider implications for India's role in international politics.
Oral delivery of brain-targeted miltefosine-loaded alginate nanoparticles functionalized with polysorbate 80 for the treatment of cryptococcal meningitis
Authors: Spadari Cristina C , Lanser Dylan M , Araújo Marcelo V , De Jesus Daniel F F , Lopes Luciana B , Gelli Angie , Ishida Kelly
Published: March 2023

Objectives

To develop alginate nanoparticles functionalized with polysorbate 80 (P80) as miltefosine carriers for brain targeting in the oral treatment of cryptococcal meningitis.

Methods

Miltefosine-loaded alginate nanoparticles functionalized or not with P80 were produced by an emulsification/external gelation method and the physicochemical characteristics were determined. The haemolytic activity and cytotoxic and antifungal effects of nanoparticles were assessed in an in vitro model of the blood–brain barrier (BBB). A murine model of disseminated cryptococcosis was used for testing the efficacy of oral treatment with the nanoparticles. In addition, serum biomarkers were measured for toxicity evaluation and the nanoparticle biodistribution was analysed.

Results

P80-functionalized nanoparticles had a mean size of ∼300 nm, a polydispersity index of ∼0.4 and zeta potential around −50 mV, and they promoted a sustained drug release. Both nanoparticles were effective in decreasing the infection process across the BBB model and reduced drug cytotoxicity and haemolysis. In in vivo cryptococcosis, the oral treatment with two doses of P80 nanoparticles reduced the fungal burden in the brain and lungs, while the non-functionalized nanoparticles reduced fungal amount only in the lungs, and the free miltefosine was not effective. In addition, the P80-functionalization improved the nanoparticle distribution in several organs, especially in the brain. Finally, treatment with nanoparticles did not cause any toxicity in animals.

Conclusions

These results support the potential use of P80-functionalized alginate nanoparticles as miltefosine carriers for non-toxic and effective alternative oral treatment, enabling BBB translocation and reduction of fungal infection in the brain.
A10 OVEREXPRESSION OF ASCL2 ALTERS DIFFERENTIATION, CELL CYCLE AND RESISTANCE TO ANTI-CANCER TREATMENT IN ESOPHAGEAL ORGANOIDS
Authors: Hamilton M , Mars Z , Sedeuil M , Rolland M , Jean D , Giroux V
Published: March 2023

Background

The esophagus is in constant contact with the austere environment caused by food and gastric reflux. It is protected by a squamous epithelium which maintenance is provided by a rare subpopulation of basal cells: Keratin 15+ (Krt15+) stem cells. However, little is known about the mechanisms underlying the expansion and the function of these stem cells. It was shown that the transcription factor ASCL2 is strongly upregulated in Krt15+ cells compared to Krt15- cells. Interestingly, ASCL2 is a gene target of the Wnt/β-catenin pathway, which acts as a regulator of proliferation and maintenance of the stemness state.

Purpose

The ultimate goal of my research project is to determine the role of ASCL2 in the maintenance of esophageal stem cells. To do so, I will investigate the role of ASCL2 in esophageal epithelial biology.

Method

Lentiviral infection approach was used to obtain mouse esophageal organoids overexpressing ASCL2 (ASCL2OE). Organoid culture, immunostaining (such as IF and H&E), qPCR, WB, mass spectrometry and proliferation assay were used to characterize the effect of ASCL2OE on morphology, differentiation, proliferation, self-renewal, and gene expression.

Result(s)

ASCL2OE severely altered the morphology of organoids, which were smaller and less differentiated. Defects in differentiation was investigated by IF which showed that some cells expressed both p63 and K13, respectively basal and suprabasal markers. Thus, cells seem to be blocked in an intermediate state of differentiation suggesting a default in cell fate decision. Mass spectrometry analysis confirmed a change in biological processes related to differentiation of keratinocytes and of epithelial cells. We also investigated the role of ASCL2 in self-renewal and observed that organoid formation rate (OFR) was reduced in ASCL2OE organoids. Furthermore, proliferation was also reduced in WST-1 and EdU assays. We then observed significant changes in the cell cycle by flow cytometry: there is an increased in the number of cells in G0/G1 and a major decrease in G2/M cells, suggesting a blockade in G1. Interestingly, CDNK2a (p16INK4a), an inhibitor of cell cycle progression, was increased in our mass spectrometry results. Finally, ASCL2 could also play a role in radio and chemoresistance of Krt15+ stem cells, as ASCL2OE organoids are less sensitive to radiation and chemotherapy agents than control.

Conclusion(s)

ASCL2 could play a role in orchestrating cell fate decision in the esophageal epithelium as ASCL2OE organoids showed alteration in differentiation, proliferation, and cell cycle.

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Other

Please indicate your source of funding;

NSERC, Canada Research Chairs and CRCHUS scolarship

Disclosure of Interest

None Declared
A28 TIME-RESTRICTED FEEDING REDUCES INFLAMMATORY BOWEL DISEASE AND IMPROVES EPITHELIUM COLON REGENERATION
Authors: Carmona Alcocer V , Taleb Z , Todorovski A , Macdonald J , Igbokwe T , Karpowicz P
Published: March 2023

Background

The circadian clock is a time keeping mechanism that drives daily rhythms in the body, including behavior and gastrointestinal digestion, inflammation, and metabolism. These daily rhythms are endogenous to cells, and they must adjust themselves to cyclic environmental cues like feeding schedules and light dark cycles. However, when the cyclical environment is chrono-disrupted (ex. shiftwork and jetlag), the temporal organization in the body is lost. Chrono-disruption is linked to an increase in the risk of Inflammatory Bowel Disease (IBD); studies in rodents shown that IBD is more severe in mice without a circadian clock and intestinal regeneration is compromised

Purpose

Recent studies have shown that time-restricted feeding (TRF, the provision of food at times of peak behavior activity – without caloric restriction), that aligns with circadian behavior improves daily organization in the body and health. Therefore, we hypothesized that time-restricted feeding would be an effective strategy to ameliorate IBD and improve regeneration in chrono-disrupted animals.

Method

To test this, we used the DSS induction of colitis in mutant mice without clock function (Bmal1-/-) and controls with an intact clock (Bmal1+/+) and compared ad libitum feeding vs. TRF conditions (food available from 7pm to 7am).

Result(s)

Our results show that TRF ameliorates IBD symptoms and protects against epithelium colon damage in animals without clock function. Our preliminary results suggest that TRF may function by increasing the expression of the anti-inflammatory signal PPARg in the colon. Currently, we are testing if the circadian clock controls the daily expression of PPARg in vivo and in vitro. To further test the effect of TRF during regeneration after colitis, we tested proliferation (Ki67) and regeneration in the colon. (Hopx). Our results show that TRF increases the number of Ki67 positive cells and the expression of fetal-like regenerative precursor Hopx in both animals with and without a functional clock.

Conclusion(s)

Together these data suggest that TRF enhances regeneration in the colon after colitis. Moving forward, we are testing transcriptional pathways that are activated during regeneration in animals under TRF. Our results show that time restricted feeding can ameliorate IBD and highlight the role of circadian rhythms in regeneration and intestinal stem cell biology.

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CIHR, Other

Please indicate your source of funding;

Crohn's and Colitis Canada

Disclosure of Interest

None Declared
A63 TRENDS AND OUTCOMES OF LIVER DISEASE HOSPITALIZATIONS DURING THE CORONAVIRUS PANDEMIC IN THE UNITED STATES: A NATIONWIDE POPULATION-LEVEL ANALYSIS
Authors: Sedarous M , Youssef M , Adekunle A D , Babajide O , Rubens M , Okafor P N
Published: March 2023

Background

The impact of the Coronavirus disease-2019 (COVID-19) pandemic on patients with liver disease is not well described at the population level in the United States.

Purpose

We used the largest, nationwide inpatient dataset to describe inpatient liver disease outcomes in the United States during the first year of the pandemic (2020) using 2018 and 2019 as comparator years.

Method

Using the National Inpatient Sample (2018-2020), we explored year-to-year and 2020 month-to-month trends in hospitalizations, length of stay, and inpatient mortality for liver-related indications including compensated cirrhosis, decompensated cirrhosis, alcohol-associated liver disease (ALD), alcohol-associated hepatitis (AH), hepatocellular carcinoma (HCC), and variceal upper gastrointestinal bleeding (VUGIB) using regression modeling. We also looked at the impact of the COVID-19 pandemic on liver transplantation rates. A p-value <0.05 was considered statistically significant.

Result(s)

Hospitalizations for both compensated and decompensated cirrhosis decreased in 2020 compared to 2019 (relative change [RC] of 1.5%, p <0.001, Table 1). Interestingly, hospitalizations for ALD and AH increased in 2020 compared to pre-pandemic years (ALD RC=15.5% and AH RC 17.0%; p<0.001). Despite the decrease in cirrhosis hospitalizations in 2020, all-cause inpatient mortality among patients with compensated cirrhosis increased from 30,135 in 2019 to 35,220 in 2020 (p<0.001) and from 22,850 in 2019 to 26,390 in 2020 among patients with decompensated cirrhosis (p<0.001). This was accompanied by a 27.8% increase in mortality for ALD (p=0.004) in comparison to pre-pandemic years. Corresponding to the peaks of the pandemic, we observed the fewest cirrhosis hospitalizations in April and December 2020 (Table 2), however, these months had the highest observed mortality rates (p-trend ≤ 0.004). Reassuringly, liver transplantation rates were not significantly impacted by the COVID-19 pandemic (p=0.51).

Image

Conclusion(s)

Cirrhosis hospitalizations, in general, decreased in 2020 compared to pre-pandemic years but were associated with higher all-cause mortality rates particularly in the peak months of the COVID-19 pandemic (April and December 2020) possibly reflecting COVID-19 specific mortality. Alcoholic liver disease admissions also increased during the pandemic while liver transplantation rates were not significant impacted.

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None

Disclosure of Interest

None Declared
A72 LOCAL RECURRENCE RATES AFTER RESECTION OF LARGE COLORECTAL SERRATED LESIONS WITH OR WITHOUT MARGIN ABLATION
Authors: Amar L , Djinbachian R , von Renteln D
Published: March 2023

Background

Endoscopic mucosal resection (EMR) has become the mainstay of therapy with regard to larger polyps. Serrated lesions (SLs) including traditional serrated adenomas (TSA), large hyperplastic polyps (HP) and sessile serrated lesions (SSLs) have been associated with high rates of incomplete resection. There has been an increasing role of margin ablation combined to EMR to reduce local recurrence.

Purpose

Our aim was to evaluate local recurrence rates (LRR) after resection of large colorectal SLs and the use of margin ablation in preventing recurrence

Method

Adult patients who underwent resection colorectal SSL, TSA, or HP polyps ≥ 15 mm from 2010-2019 with a colonoscopy follow-up within 18 months were identified through pathology database and electronic medical records search. Hereditary CRC syndromes, follow-ups longer than 18 months or no follow-up, surgical resection were excluded. The primary outcome was LRRs (either histologic or visual) during the first 18-month follow-up. Secondary outcomes were LRRs for polyps 15-19 mm and ≥20 mm, LRR after margin ablation for polyps ≥20mm.

Result(s)

Polyp resection was performed on 125 polyps in 112 patients (54.1 %women; mean age, 62.9 years). The mean size of polyps was 22.9 mm, with 58.4% ≥20mm. 76.0% of polyps were resected via EMR and 33.3% of polyps ≥20 mm received margin ablation. First surveillance colonoscopy was on average 8.4 months later and the resection scar was seen in 54.4% of lesions. Overall LRR for the first 18-months was 16% [95% confidence interval (CI) 10.5-23.6] (13% for polyps 15-19mm, 18% for ≥20mm, 22% for ≥30 mm). LRR for ≥20mm SLs was significantly lower after margin ablation (5.0% vs 24.0%; p=0.048).

Conclusion(s)

The local recurrence rate for SLs ≥15 mm is high with 16% overall recurrence, and increases with polyp size. Thermal ablation of the margins is superior to no ablation in reducing LRRs for ≥ 20mm SSLs.

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None

Disclosure of Interest

None Declared
A76 PHYSICIANS PERCEIVED VALUE OF COMPUTED TOMOGRAPHY SCANS FOR INFLAMMATORY BOWEL DISEASE PATIENTS IN THE EMERGENCY DEPARTMENT: A SURVEY OF CANADIAN PHYSICIANS
Authors: Roda C , Stiell I , Dube C , Macdonald B , Moloo H , DeBuck A , McCurdy J
Published: March 2023

Background

Despite concerns regarding the risks of ionizing radiation from computed tomography (CT) imaging, the rates of abdominal pelvic CT (APCT) utilization in the emergency department (ED) continues to increase for patients with inflammatory bowel disease (IBD).

Purpose

To determine the factors that drive decisions on when to perform APCT imaging in the ED for patients with IBD and to determine if differences exist between physician specialties.

Method

We performed a quantitative, web-based survey between November 2021 and August 2022. Structured questions for Crohn’s disease (CD) and ulcerative colitis (UC) were developed with input from stakeholders in gastroenterology, surgery, and emergency medicine. Surveys were disseminated to Canadian physicians in each of the three specialities through personal emails, and by newsletter from national specialty organizations. Between specialty comparisons were performed by Chi-squared and Fisher exact tests where appropriate.

Result(s)

A total of 208 participants responded to our survey: median age 44 years (IQR 37-50), 132 (63%) male, and 141 (68%) in an academic practice. Survey participants included 81 (39%) gastroenterologists, 35 (17%) surgeons and 92 (44%) emergency physicians.

There were significant differences between specialties in the perceived rates of positive findings from APCT imaging. In UC, gastroenterologists felt inflammation alone was more common than emergency physicians and bowel obstruction and septic complications less common than surgeons and emergency physicians. In CD, surgeons felt bowel obstructions, septic complications and bowel perforations were more common compared with gastroenterologists and emergency physicians.

There were significant differences between specialties in the types of clinical presentations that drove decisions to arrange APCT imaging (Figure 1a&b). In UC, gastroenterologists were less likely to order APCT imaging for diarrhea with rectal bleeding, abdominal pain without peritoneal findings and fever than surgeons and emergency physicians. In CD, there were similar practice patterns between specialities except gastroenterologists were less likely to order APCT imaging for diarrhea with rectal bleeding than surgeons.

Image

Conclusion(s)

Our survey identified key differences between physician specialties in the perceived rates of positive findings from APCT imaging and practice patterns of CT utilization. These findings will help to guide the development of future multidisciplinary consensus guidelines for the appropriateness of CT imaging in the ED for patients with IBD.

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None

Disclosure of Interest

None Declared
A78 BILIARY STENT USE IN ERCP: A QUALITY ASSURANCE STUDY ASSESSING ADHERENCE TO CLINICAL GUIDELINES AND COST OUTCOMES
Authors: Decanini A , Alhaidari S I S , Alzahrani I , Alhanaee M , Mohamed M , Zepeda-Gomez S , Mathura P , Zhang J , Sandha G
Published: March 2023

Background

A perceived increase in the use of biliary stents during endoscopic retrograde cholangiopancreatography (ERCP) was observed by our nursing team leader and brought to the attention of the Director of Endoscopy.

Purpose

To assess a) biliary stent utilization during ERCP, b) the adherence for stent placement based on published guidelines, and c) the associated cost.

Method

A chart review of all consecutive patients that underwent ERCP for one year (January 2020 to 2021) at the University of Alberta Hospital (UAH) was performed. The need for biliary stent placement was assessed independently by two blinded reviewers and compared with published guidelines. Costs were calculated using Alberta Health Services fee codes.

Result(s)

A total of 598 patients (316 F) with mean age of 60±19 years (range 3-99 years) underwent 842 ERCPs. Clinical indications for the initial ERCP were common bile duct (CBD) stones (376, 63%), malignant stricture (84, 14%), benign stricture (49, 8%), bile leak (27, 5%), stent removal (15, 3%), and others (47, 8%). Of the 244 patients that had a follow-up ERCP, the most common indications were stent removal (126, 52%), stent replacement (61, 25%), stent placement (28, 11%), and stone extraction (8, 3%). A total of 296 biliary stents were inserted, of which 223 stents (114 plastic, 109 metal) were inserted during the first ERCP (223/598, 37%) and 73 stents (43 plastic, 30 metal) during follow-up ERCP (73/244, 30%).

Of the 296 stents, 79 (27%) were inserted for indications not in accordance with published guidelines (63/223 initial ERCP, and 16/73 follow-up ERCP, kappa=0.62). Most of these were placed in CBD stone cases (61/63 initial ERCP, 6/16 follow-up ERCP). In the subgroup of 376 patients with CBD stones, 61 (16%) underwent stent placement not in accordance with published guidelines. The added cost of such stent insertions and follow-up ERCPs for stent removal was $130,000.

Conclusion(s)

Stent insertion not in accordance with published guidelines was identified in some patients with CBD stones presenting for ERCP. To reduce unnecessary follow-up procedures and healthcare resource utilization, ERCP stent insertion education based on published guidelines, as well as regular practice audit and feedback are required.

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None

Disclosure of Interest

None Declared
A85 ASSESSING THE IMPACT OF A DEDICATED RAPID INTERDISCIPLINARY IBD CLINIC ON PATIENT WAIT TIMES, REPORTED OUTCOMES, AND SATISFACTION OF CARE
Authors: Mathiyalagan G , Broni E , Jogendran R , O'Connor K , Kennedy E , Steiman A , Maxwell C , Omar A , Piguet V , Alavi A , Weizman A , Huang V
Published: March 2023

Background

Inflammatory bowel disease (IBD) is a chronic fluctuating condition where patients can experience periods of active disease and remission. Timely access to care has been shown to be impactful on important disease outcomes. In January 2020, we implemented a rapid assessment IBD program consisting of expedited access to interdisciplinary care and close monitoring of patients.

Purpose

To assess the impact of the rapid assessment program on access to care, disease activity, and patient satisfaction.

Method

Once informed consent was obtained, patients were enrolled into the RAPID IBD program. This program consisted of four close monitoring time points at baseline, 1, 2, and 3 months, as well as two follow up time points at 6 and 12 months. At each timepoint patients completed questionnaires that evaluated disease activity, using the Modified Harvey Bradshaw Index (mHBI) for Crohn’s disease (CD), partial Mayo (pMayo) score and Simple Clinical Colitis Activity Index (SCCAI) for ulcerative colitis patients. At baseline, 3, 6, and 12 months, patients were also assessed on mental health, using the Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7), and satisfaction of care, using the CACHE questionnaire.

Result(s)

Between January 2020 – August 2021, 216 patients were referred to the RAPID IBD program. The mean time from referral to clinical assessment was 8.1 days. Of those referred, 143 (71 CD, 62 UC, 6 IBDU, and 4 Query IBD) patients consented to and completed the 12-month RAPID IBD study. 34.9% of patients who had active disease at baseline achieved remission by 3 months (Table 1). At baseline 44.8% and 28.4% of patients experienced moderate to severe depression and anxiety, respectively. The greatest improvement in mental health was seen at 2 months where the proportion of patients experiencing moderate to severe depression and anxiety decreased to 27.5% and 18.3%, respectively (Table 2). Patient satisfaction, specific to clinical care, improved from a baseline score of 69.1% to 74.1% at 3 months (Table 3).

Image

Conclusion(s)

Implementation of a dedicated RAPID IBD clinic program reveals shorter wait times to be seen in clinic. By three months of enrollment, patients demonstrate improvements in clinical response, mental health, and satisfaction of care.

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Other

Please indicate your source of funding;

AMO Innovation Funding

Disclosure of Interest

None Declared
A93 IMPROVING INPATIENT ENDOSCOPY PROCEDURAL THROUGHPUT: A QUALITY IMPROVEMENT INITIATIVE AT AN ACADEMIC MEDICAL CENTER
Authors: Alsager M , Hudson D , hindi Z , Lavalle C , Iablokov V , Alajmi A , khanna N , qumosani K , brahmania M
Published: March 2023

Background

Currently, due to pandemic-related supply and personnel constraints, increased strain is being placed on inpatient endoscopic services. At our academic center, inpatient procedural throughput/efficiency is only 65%, which is leading to excess procedures being completed on-call or on weekends.

Purpose

Our quality improvement study attempted to improve throughput of the inpatient endoscopy suite by 1 additional procedure completed per day, over a period of 12 months of study.

Method

An interprofessional team of gastroenterology fellows, attending physicians, nurses and nurse managers was created to investigate throughput concerns. Baseline data was collected via direct observation and completion of a time study over a period of 1-2 months.

Subsequently, a process flow diagram was completed. A combination of root cause analysis tools (ie. Stakeholder interviews, Pareto chart and Driver Diagram were then utilized to identify areas for improvement. A delay in procedural start time was identified as a strong culprit for reduced patient throughput. Potential interventions proposed included: early physician handover start time, constructing a standardized patient procedure list, and improving timeliness of patient transfer to the endoscopy suite.

Result(s)

Stakeholder Interview(s): Completed via Anonymous Survey/Google Forms:

See

https://docs.google.com/forms/d/e/1FAIpQLSe-PDL31ClU8g-BChdBoBYhPoBhGBZVmlToTTZJnYKlEHz-GQ/viewform?usp=sf_link

Concerns:

- Inpatient procedure list not consistently being completed prior to starting endoscopy

- Physician handover in the morning can cause significant delays in starting inpatient endoscopy

- Concern patient/porter transfer related delays

Conclusion(s)

Our current data identifies that the most effective intervention included developing a standardized procedure list and mandating the first case is an EGD, minimizing delay due to inadequate bowel preparation. Concordantly, arranging timely patient transfer to the endoscopy suite, thereby minimizing delays due to patient portering services, was also found to be effective. Our average procedural time for completion of an EGD and associated recovery is approximately 25-30 minutes. After multiple interventions/PDSA cycles we obtained a more optimized procedural suite start time of 08:22 am, on average, which resulted in the completion of an additional procedure and increased the throughput of our endoscopy unit.

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None

Disclosure of Interest

None Declared
A102 INTERDISCIPLINARY TELEHEALTH REFERRAL PATHWAY AND CONSULTATIONS TO IMPROVE OUTCOMES AMONG CANADIAN OLDER ADULTS WITH LIVER CIRRHOSIS
Authors: Zhu J , Carr F , Tian P , McLeod M , MacFarlane M , De Coutere S , Sun M , Peltekian K
Published: March 2023

Background

Telehealth and telemedicine have become indispensable healthcare delivery tools during the COVID-19 pandemic. Older individuals with cirrhosis have complex medical needs that are currently unmet due to the growing disease burden and decreased access to care. Delivering timely specialist care virtually to older adults with cirrhosis will likely be beneficial and acceptable to such patients; however, this has not yet been prospectively evaluated.

Purpose

The primary goal is to pilot the delivery of dual specialist care from a hepatologist and geriatrician, delivered virtually, for older adults living with liver cirrhosis who are at high risk of geriatric syndromes (age >/= 65 with frailty, undifferentiated cognitive impairment from dementia or hepatic encephalopathy, recurrent falls, risk factors for polypharmacy and moderate to severe malnutrition). Care is delivered using a dedicated hepatology-geriatric referral pathway. Primary objectives include evaluating the impact of this approach on emergency care and inpatient utilization, along with patient attitude and satisfaction to the virtual interdisciplinary care delivery model.

Method

This pilot quality improvement study was conducted in Halifax, Nova Scotia. Ethics approval was obtained from the Nova Scotia Health Research Ethics Board and the University of Alberta Research Ethics Board. Fifty to one hundred participants (age 65 years or older with at least one geriatric syndrome; diagnosis of liver cirrhosis by liver elastography or liver biopsy, or Fibrosis-4 Index for Liver Fibrosis greater than three and having radiological features of cirrhosis and/or portal hypertension) were recruited between September 2022 to December 2022 at the time of their hepatology consultation. After consent and screening, each patient underwent a telehealth appointment by zoom with a geriatrician within four weeks of their initial hepatology assessment. Follow-up by telephone using a standardized survey regarding ease of access and quality of their telehealth experience then occurred at 3-4 weeks, 3 months and 6 months for emergency room visits and hospital admission status.

Result(s)

Pending

Conclusion(s)

Pending

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Other

Please indicate your source of funding;

Pfizer Canada

Disclosure of Interest

J. Zhu Grant / Research support from: Pfizer Canada, F. Carr Grant / Research support from: Pfizer Canada, P. Tian: None Declared, M. McLeod: None Declared, M. MacFarlane: None Declared, S. De Coutere: None Declared, M. Sun: None Declared, K. Peltekian: None Declared
A142 APPROPRIATENESS OF POST-ENDOSCOPY CARE IN PATIENTS PRESENTING WITH FOOD BOLUS IMPACTIONS OVERNIGHT: A POPULATION-BASED MULTICENTER COHORT STUDY
Authors: Guo H , Hamilton P , Enns E , Gupta M , Andrews C , Nasser Y , Bredenoord A , Dellon E , Ma C
Published: March 2023

Background

Appropriate management of esophageal food bolus impactions includes endoscopic evaluation and follow-up for potential underlying esophageal pathology. Patients who present with impactions at night may not receive optimal long-term post-endoscopy care due to patient-, physician-, or system-related factors.

Purpose

We aimed to evaluate the appropriateness of care for patients who present with food bolus impactions after regular daytime hours.

Method

We conducted a retrospective, population-based, multi-center cohort study of adult patients undergoing endoscopy for food impaction between 19:00-06:59 from 2016-2018 in the Calgary Health Zone, Canada. Appropriate post-endoscopy care was defined by a composite of a follow-up clinic visit, repeat endoscopy, other appropriate investigations (e.g., manometry), or appropriate medical treatment (e.g., proton pump inhibitor). Predictors of inappropriate care were assessed using multivariable logistic regression, expressed as adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Result(s)

A total of 323 patients underwent an after-hours or overnight endoscopy for food bolus impaction. 25.4% (82/323) of patients did not receive appropriate post-endoscopy care. Predictors of inappropriate care included rural residence (aOR 2.66 [95% CI: 1.18-6.01], p=0.02), first food bolus presentation (aOR 2.38 [95% CI: 1.04-5.44], p=0.04), and absence of a specific pathology during the index procedure (aOR 3.01 [95% CI: 0.97-9.29], p=0.05), suggesting a potential association with clinician cognitive bias. Among patients who were followed, 18.9% (35/185) had a change in the original diagnosis.

Image

Conclusion(s)

One quarter of patients presenting with a food bolus impaction at night do not receive appropriate post-endoscopy care. System-based interventions should target this high-risk population as the diagnosis and management may change with follow-up.

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None

Disclosure of Interest

None Declared
A161 SYMPTOMATIC GASTRIC SCHWANNOMA DIAGNOSED WITH ENDOSCOPIC ULTRASOUND AND FINE NEEDLE BIOPSY: A CASE REPORT
Authors: Wang D , Stallwood C
Published: March 2023

Background

Gastric schwannomas are exceedingly rare neoplasms that account for 0.2% of all gastric masses. They belong to a group of peripheral nerve sheath tumors, which are typically slow-growing, benign lesions that also include neurofibromas and perineuriomas. These neoplasms are often found incidentally on endoscopy as subepithelial lesions.

Purpose

We aim to outline the presentation and differential diagnosis of gastric peripheral nerve sheath tumors.

Method

We present the case of a 44 year old female with heartburn and dyspepsia who was referred for esophagogastroduodenoscopy, which incidentally found a subepithelial lesion on the greater curve of the stomach. She was then referred for EUS-guided fine needle biopsy of the mass, and the pathology was initially reported as a neurofibroma. Eventually, the lesion was surgically removed with the final pathology report stating that this was a gastric Schwannoma. Both specimens had immunostains positive for S-100 and negative for CD34, desmin, DOG1 and cKit.

Result(s)

While gastric schwannomas are typically benign, they can still cause abdominal pain, gastrointestinal bleeding, and even gastric outlet obstruction and intussusception. The differential diagnosis of gastric schwannoma includes other peripheral nerve sheath tumors, as well as malignant subepithelial lesions such as gastrointestinal stromal tumors or gastric lymphoma.

Conclusion(s)

Gastric schwannoma should always be considered when evaluating subepithelial gastric lesions, and EUS with histologic sampling should be pursued to diagnose and guide the management of these lesions.

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None

Disclosure of Interest

None Declared
A195 DURABILITY OF SEROLOGICAL RESPONSES AFTER SECOND, THIRD AND FOURTH DOSE OF SARS-COV-2 VACCINATION IN INFLAMMATORY BOWEL DISEASE: A PROSPECTIVE COHORT STUDY
Authors: Sharifi N , Ma C , Seow C , Quan J , Hracs L , Caplan L , Markovinović A , Herauf M , Windsor J , Coward S , Buie M , Gorospe J , Panaccione R , Kaplan G
Published: March 2023

Background

Adequate serological responses following two-dose regimens and additional doses of SARS-CoV-2 vaccination have been demonstrated for the vast majority of those with IBD. However, antibody levels following 2nd, 3rd, and 4th dose SARS-CoV-2 vaccination may decrease over time in the IBD population.

Purpose

We assessed the durability of serological responses to 2nd, 3rd, and 4th dose SARS-CoV-2 vaccination over time in a cohort of IBD patients.

Method

Adults with IBD who received at least one dose of a SARS-CoV-2 vaccine (n=559) were evaluated for serological response to the spike protein of SARS-CoV-2 using the Abbott IgG II Quant assay with a seroconversion threshold of ≥ 50 AU/mL. The geometric mean titer (GMT) with 95% confidence intervals (CI) were calculated and stratified by weeks (1–8, 8–16, 16–24, 24+ weeks) after each vaccine dose. We compared stratified GMTs with Mann–Whitney U tests using a significance level of 0.05.

Result(s)

Our cohort (n=559) comprised the following patient characteristics: 82.8% were 18–65 years-old (n = 463), 53.1% were female (n =297), and 71.6% had Crohn’s disease (n =400). IBD medications were classified in the following mutually exclusive groups: No immunosuppressives 10.5% (n = 59), anti-TNF monotherapy 35.8% (n = 200), immunomodulatory monotherapy 2.1% (n =12 ), vedolizumab 11.8% (n =66 ), ustekinumab 20.4% (n =114 ), tofacitinib 1.2% (n =7 ), combination therapy 15.9% (n = 89), and prednisone 2.1% (n =12). For vaccine type, 85.6% and 82.3% had Pfizer for 3rd and 4th dose, respectively, while the remainder had Moderna. Seroconversion rates 1–8 weeks after 3rd and 4th dose were both 99.9%.

Figure 1 compares GMTs with 95% CI by weeks after each vaccine dose. GMTs are highest 1–8 weeks after 2nd dose (4053 AU/mL; 95% CI: 3468, 4737 AU/mL; n=337), 3rd dose (12116 AU/mL; 10413, 14098 AU/mL; n=256), and 4th dose (14337 AU/mL; 10429, 19710 AU/mL; n=67). Subsequently, antibody levels decay from 1–8 weeks to 8–16 weeks (p<0.001) for 2nd dose (mean difference: –2224 AU/mL), 3rd dose (mean difference: –7526 AU/mL), and 4th dose (mean difference: –9715 AU/mL). Compared to 16–24 weeks after 2nd dose, antibody levels 24+ weeks after were similar (GMTs: 795 AU/mL vs. 1043 AU/mL, p=0.52). For third dose, antibody levels 8–16 weeks and 16–24 weeks after vaccination were similar (4590 AU/mL vs. 4073 AU/mL, p=0.73) along with 16–24 weeks compared to 24+ weeks after vaccination (4073 AU/mL vs. 5876 AU/mL, p=0.18).

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Conclusion(s)

Within 1–8 weeks after each dose of vaccine, serological responses spikes with each subsequent dose yielding a higher GMT. While antibody levels decay 8–16 weeks after each dose, similar GMT levels beyond 16 weeks may indicate durability of antibody levels over a longer duration of time.

Disclosure of Interest

None Declared
A217 A REVIEW OF MOBILE HEALTH APPLICATIONS FOR INDIVIDUALS LIVING WITH INFLAMMATORY BOWEL DISEASE USING MOBILE APPLICATION RATING SCALE (MARS)
Authors: Jannati N , Salehinejad S , Kuenzig E , Peña-Sánchez J N
Published: March 2023

Background

Inflammatory bowel disease (IBD) is a chronic disorder that can be managed but not cured. The relapsing and remitting symptoms of IBD impact patients' quality of life and is associated with considerable healthcare costs. Different mobile health apps have been developed around the world for IBD and other chronic medical conditions. These apps can potentially decrease healthcare utilization and the burden of the disease.

Purpose

We aimed to review IBD mobile health apps available in English and evaluate their quality and content.

Method

We searched the Apple Store and Play Store in July 2022 using IBD-related keywords (e.g., “IBD,” “Crohn,” “Crohns,” “colitis,” “ulcerative colitis,” and “inflammatory bowel disease.”) to identify apps for iOS and Android devices, respectively. We included apps available in English, designed specifically for IBD, and free to download and use. Two researchers reviewed, rated, and evaluated the retrieved apps independently. The Mobile App Rating Scale (MARS) was used to rate the included apps. The MARS rates apps on a scale of 1 to 5 and includes an overall score as well as scores for engagement, functionality, information, aesthetics, and subject quality. A score ≥3 is deemed acceptable.

Result(s)

Search queries yielded 88 relevant apps, of which 38 met the inclusion criteria and were included in this review. The included apps for IBD were most tracking and monitoring symptoms of the disease (n=22). Two of the apps were affiliated with universities, and three of the apps were specifically developed for children. In addition, 11 apps were designed for IBD, regardless of disease subtype (Crohn’s disease [CD] or ulcerative colitis [UC]), and 27 apps were designed specifically for either UC or CD. The mean MARS score for IBD apps was 3.3 (SD=0.6), with more than half deemed acceptable. Apps scored highest on the functionality (mean=3.7, SD=0.6) and information (mean=3.6, SD=0.5) dimension of MARS and lowest on the engagement dimension (mean=3, SD=0.8).

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Conclusion(s)

Most IBD-related apps provide acceptable information and functionality but should improve their engagement to be welcomed by users. This review provides a roadmap for improving available apps and future app development for individuals with IBD. App developers in the field of IBD must ensure they create high-quality, engaging, esthetic and evidence-based apps.

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None

Disclosure of Interest

None Declared
A229 THE BACTERIAL VIRULENCE FACTOR NLEA UNDERGOES HOST-MEDIATED O-LINKED GLYCOSYLATION
Authors: Burns L , Giannakopoulou N , Zhu L , Xu Y Z , Khan R H , Bekal S , Schurr E , Schmeing T M , Gruenheid S
Published: March 2023

NOT PUBLISHED AT AUTHOR’S REQUEST

Disclosure of Interest

None Declared
A259 PEDIATRIC ACUTE LIVER FAILURE: A RETROSPECTIVE CROSS-SECTIONAL STUDY FROM A TERTIARY CARE CENTER IN JORDAN
Authors: Altamimi E , Al Sharie A , Al Zu’bi Y , Mahadin R , Mahadin R , Al-Faqih S , Abu-Ekteish F
Published: March 2023

Background

Pediatric acute liver failure (PALF) is a rare, rapidly progressing and life threating condition associated with high mortality rate despite optimal medical management. The clinicopathological characteristics of PALF could harbor new emerging avenues in patients’ stratification and management. Although, PALF is being studied extensively, no data from a Mediterranean cohort were elucidated in the medical literature

Purpose

To analyse the clinical presentation, aetiology, and outcome of children presenting with acute liver failure, admitted to a tertiary hospital (King Abdullah University Hospital, Irbid, Jordan).

Method

The electronic medical records at our center were retroactively accessed to identify PALF patients. Records of all children with acute liver failure over a 5-year period were reviewed retrospectively. Data on age, sex, clinical presentation, underlying cause, medical management, complication development and outcome were collected.

Result(s)

A total of 86 patients were identified, the mean age is 6.64 ± 5.82 years with male predominance (n = 46, 56.98%). The majority of PALF cases were not labeled with a definitive clinical diagnosis (n = 41, 47.67%). PALF etiologies include infections (n = 15, 17.44%), trauma (n = 10, 11.63%), malignancy-related (n = 9, 10.47%), genetic/metabolic (n = 7, 8.14%), and congenital anomalies (n = 4, 4.65%). The overall mortality rate is 43.02% and the average length of stay is 20.67 days. The majority of patients were managed in intensive care units (n = 67, 77.91%) and 20.93% (n = 18) had a positive blood culture during their hospitalization period.

Conclusion(s)

A more robust diagnostic algorithms should be implemented in PALF cases. The establishment of a country-based liver transplantation program is highly endorsed besides the implementation of many diagnostic tools to undercover the indeterminate causes of PALF.

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None

Disclosure of Interest

None Declared
A269 THE MODULATION OF INTESTINAL INFLAMMATION BY PARABACTEROIDES GOLDSTEINII IN MURINE MODELS OF COLITIS
Authors: Gerkins C , Oliero M , Hajjar R , Vennin Rendos H , Fragoso G , Calvé A , Diop K , Routy B , Santos M
Published: March 2023

Background

Inflammatory bowel diseases (IBDs), comprised mainly of Crohn’s disease and ulcerative colitis, are characterized by chronic and relapsing intestinal inflammation. Though the etiology of IBDs is not entirely understood, it is thought that an imbalance of the gut microbiota is one contributing factor, making it a potential target for the treatment of IBDs.

Purpose

This study aims to examine how the potential probiotic Parabacteroides goldsteinii modulates intestinal inflammation in the context of experimental colitis.

Method

Wild type C57BL/6 mice were divided into three groups. One group was given phosphate-buffered saline (PBS) via oral gavage without any further treatment. The second group was treated with 1% dextran sodium sulfate (DSS) for twelve days induce colitis and given PBS every three days. Finally, the third group was also treated with 1% DSS for twelve days and given P. goldsteinii via oral gavage every three days. Weight loss, stool consistency, and intestinal bleeding were monitored and were used to calculate the Disease Activity Index (DAI) daily. Postmortem, colon length was measured, and inflammation score was evaluated on hematoxylin and eosin-stained samples of the colon and spleen. Finally, interleukin (IL)-6 levels were measured in the colon tissue and the serum by ELISA.

Result(s)

Colonization was confirmed at day three after gavage by real-time PCR. Preliminary results show that DSS-treated mice lost significantly more weight by day twelve than mice colonized with P. goldsteinii. Additionally, on days eight and twelve, mice colonized with P. goldsteinii had significantly lower DAI scores than mice that received only PBS. Finally, mice colonized with P. goldsteinii had significantly longer colons than those that received only PBS.

Conclusion(s)

The preliminary data indicates that mice colonized with P. goldsteinii had less severe symptoms of colitis than mice only given PBS. This suggests that P. goldsteinii may attenuate inflammation in mice treated with DSS.

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CIHR, Other

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ICM

Disclosure of Interest

None Declared
A272 EVIDENCE OF SEX DIFFERENCES IMPACTING PAIN SIGNALING BY LUMINAL MEDIATORS IN IRRITABLE BOWEL SYNDROME
Authors: Ables S , Bennett A , Vanner S , Lomax A , Reed D
Published: March 2023

Background

Irritable bowel syndrome (IBS) is more than twice as common in women and female patients report more severe abdominal pain. This suggests that sex-specific mechanisms may contribute to the pathophysiology of IBS. Many IBS patients have altered gut microbiota and luminal meditators, implicating the gut microbiota in abdominal pain. These luminal mediators can alter excitability of visceral nociceptors, thus potentially contributing to abdominal pain in IBS. Furthermore, in a subset of IBS patients a low FODMAP diet (LFD) reduces the effect of luminal mediators on pain sensing neurons. The LFD may improve abdominal pain at greater rates in women, and numerous putative mechanisms contributing to abdominal pain in IBS are susceptible to sex-specific mediators. However, it is unknown whether luminal mediators have similar effects on visceral pain signaling in both males and females. We hypothesize that luminal mediators will cause greater differences in neuronal excitability and pain signaling in female mice due to sex-specific factors.

Purpose

To determine whether FS from IBS patients (IBS FS) affects nociceptors from female mice more than nociceptors from male mice.

Method

Neurons from dorsal root ganglia from male and female mice were incubated overnight in media containing fecal supernatant (FS) from IBS patients (N=2 females) before and after the LFD, or healthy controls (HC, N=1 female and 1 male). Ratiometric Ca2+ imaging with FURA-2-AM was employed to quantify TRPV1 channel sensitization following application of capsaicin (100nM for 1 minute) as a measure of neuronal excitability. Data was analyzed using chi-squared test as well as two-way and mixed-effects model ANOVA as appropriate, followed by Sidak’s multiple comparisons test.

Result(s)

IBS FS caused a 177% larger Ca2+ influx in response to capsaicin compared to HC FS in female mice (p=0.0148, N=6-7 mice, neurons=43-49). In male mice, IBS FS increased Ca2+ influx by only 13% compared to HC FS (p=0.79, N=5 mice, neurons=28-35). In female mice, 117% more neurons responded to capsaicin after incubation with IBS FS versus HC FS (p=0.0004), while in male mice, only 17% more neurons responded following incubation with IBS FS (p=0.46). Finally, FS from the same IBS patients following a LFD reduced neuronal Ca2+ influx by 39% compared to IBS FS in female mice (p=0.0434, N=4-6 mice, neurons=18-49). In male mice, LFD FS reduced Ca2+ influx by 11% versus IBS FS (p=0.98, N=5 mice, neurons=28-35).

Conclusion(s)

Nociceptive neurons from female mice are more sensitive to the pro-nociceptive effects of FS from IBS patients, as well as a reduction of these excitatory effects following the LFD. This suggests a potential role of sex hormones in pain signaling in IBS.

Disclosure of Interest

None Declared