bluuebunny/crossref_metadata_2025_split huggingface dataset:
P840 Immunomodulatory effects of two different postbiotics on primary human cell culture
Authors: Mayorgas A 
Published: January 2020

Abstract

Background
Inflammatory bowel disease (IBD) is characterised by chronic, relapsing intestinal inflammation with extensive damage of the colonic mucosa and a remarkable dysbiosis. Since the current treatments show limitations in the response of some patients and many of them are associated with important side effects, new and safer strategies are needed. Postbiotics are any soluble factor resulting from the metabolic activity of a live probiotic bacteria or any released molecule capable of providing health benefits through a direct or indirect mechanism. Nevertheless, the effects of certain postbiotics in the context of intestinal inflammation have not been extensively addressed. Our aim is to study the immunomodulatory properties of two different postbiotics on primary human cell culture and their protective effects on human intestinal ex vivo 2D culture.

Methods
Postbiotics from Streptococcus salivarius subsp. thermophilus and Lactobacillus paracasei Lpc-37 were obtained after the microbial culture of each bacterial strain. Supernatants were collected at OD600 = 0.6, filtered and frozen. Immunostimulatory, immunosuppressor or immunomodulatory effects of each postbiotic were tested in peripheral blood mononuclear cells (PBMCs) isolated from healthy donors (n = 4). PBMCs are a heterogenous cell population that includes myeloid as well as lymphoid immune cells. Postbiotics were used to assess whether bacterial metabolites could modulate the cytokine release in particular IL-12p40 and IL-10 by LPS-stimulated PBMC, mimicking innate immune activation. Dendritic cells (DCs) differentiated from isolated human monocytes were also stimulated with all postbiotics (n = 2) to study the innate-adaptive immune crosstalk by analyzing IL-10 and IL-12p70 secretion. Postbiotics stimulation was also performed in differentiated human intestinal epithelial monolayers derived from EpOCs (Epithelial Intestinal Organoids Cells) to analyse the outcome in an ex vivo organ culture.

Results
Postbiotics derived from S.thermophilus and Lpc-37 were able to increase the secretion of IL10 in both PBMCs and monocyte-derived DCs, while no change was shown in IL-12p40/IL-12p70 production. Interestingly, S. thermophilus also showed a ‘per se’ anti-inflammatory effect due to an increase of IL-10 in non-stimulated PBMCs. On the other hand, postbiotics were able to up-regulate MUC2 expression in the 2D organ culture while down-regulating LGR5.

Conclusion
Overall we conclude that the tested postbiotics show an immunomodulatory effect as well as important properties on intestinal epithelial-cells stemness and differentiation, being S. thermophilus the best candidate due to its remarkable anti-inflammatory effect in both stimulated and non-stimulated cells.
P845 Impact of Clostridium difficile infection in patients admitted with ulcerative colitis
Authors: Gros Alcalde B , Soto Escribano P , Iglesias-Flores E , Marín Pedrosa S , García-Sánchez V , Benítez J M 
Published: January 2020

Abstract

Background
Clostridium diffile (CD) infection it is becoming increasingly more prevalent in general population and especially in patients with inflammatory bowel diseases (IBD). Patients with ulcerative colitis (UC) with CD infection during a flare can present greater morbidity and mortality. The objectives of the study were (a) to evaluate the proportion of CD infection in patients admitted with UC; (b) to compare the rates of colectomy in UC admitted with and without CD infection; (c) to analyse the association between the infection and worse results according to readmissions, need of treatment intensification and hospital stay; and (d) to describe predictive factors associated with worse evolution in patients with CD infections.

Methods
Cases and controls retrospective study. We included patients admitted due to a flare of UC in our hospital from 2000 to 2018. Variables related to hospital stay, adverse events, need of colectomy in the first year and mortality were collected. We analysed the data with SPSS using chi-square test, Kruskal–Wallis and multivariant analysis to identify factors of bad evolution.

Results
We analysed 235 admitted patients with UC flare. 62.1% male, mean age 43.6 years old (SD 12). Seventy-two per cent presented extensive colitis and 22% left coliits. 7.7% had perianal disease and 8.7% extraintestinal manifestations. Endoscopic activity was 75.8% Mayo Index 3 and 23% Mayo Index 2. 15.9% of the patients had complications during their hospitalisation related to their disease: 37.8% had toxic megacolon, 11% perforation and 11.2% of the total needed surgery during the hospitalisation. Twenty-eight patients (12.2%) had CD infection, among them 23.5% suffered recurrence infection of CD. This infection was statistically significant related to a higher rate of readmission (48.1% vs. 23%, p = 0.007) and higher rates of colectomy during the first year from the admission (13% vs. 2.9%, p = 0.05). We did not find differences among both groups of patients in terms of complications of their IBD, neither need of treatment intensification, nor mortality. Predictive factors of bad evolution were not identify with multivariant analysis.

Conclusion
CD infection is prevalent in UC admitted patients, with high rates of recurrence, this infection is related with higher rates of readmission and bigger need of colectomy during the first year.
P850 Comparison of sampling methods in assessing the microbiome from patients with ulcerative colitis
Authors: Lee H S , Kim T O , Jung S H , Baek D H 
Published: January 2020

Abstract

Background
Most of studies have reported a dysbiosis of ulcerative colitis (UC) using readily accessible stool samples. However, the faecal samples might not fully represent mucosa-associated microbiome. We hypothesised that luminal contents including loosely adherent luminal bacteria after bowel preparation may be suitable for diagnosing the dysbiosis of UC.

Methods
Sixteen patients with UC (9 men and 7 women, mean age: 52.13 ± 14.09 years) and 15 sex- and age-matched healthy individuals (8 men and 7 women, mean age: 50.93 ± 14.11 years) participated in the study. The subjects donated faecal samples before colonoscopy and received luminal contents aspiration and endoscopic biopsy during the colonoscopy. The composition of each microbiome samples was analysed by 16S rRNA-based nest-generation sequencing.

Results
Microbiome of stool, luminal contents and biopsy was significantly different from each other in alpha diversity and beta diversity. However, another analysis showed a correlation between the stool and luminal contents in Procrustes test (p = 0.001) and Mantel test (p = 0.0001). Stool microbiome in patients with UC was different from stool microbiome in healthy control. Microbiome of luminal contents microbiome and biopsy samples in patients with UC were not different from that of healthy control. Stool and lavage predicted UC in accuracy of AUC 0.85 and 0.81, respectively

Conclusion
Microbiome of stool, luminal contents and biopsy were significantly different from each other. Further studies would be needed to know optimal sampling of intestinal dysbiosis.
N09 Pain management in inflammatory bowel disease: feasibility of an online therapist-supported CBT-self-management intervention
Authors: Sweeney L , Moss-Morris R , Czuber-Dochan W , Norton C 
Published: January 2020

Abstract

Background
Chronic pain is a poorly managed symptom of inflammatory bowel disease (IBD). Cognitive behavioural therapy (CBT) has an evidence-base in functional gastrointestinal conditions and chronic pain. We aimed to test the feasibility and acceptability of a 9-week online facilitator-supported CBT intervention, tailored for people with chronic IBD-related pain.

Methods
A single arm pre-post design with nested qualitative interviews was used with 20 individuals with IBD and chronic pain. Participants were recruited online through an IBD charity and had consented to research in a previous survey or responded to an online charity advert. Individuals who met the inclusion criteria e.g. reported a pain-interference score of ≥4/10 (Brief Pain Inventory) and had no indicators of acute causes of pain, were invited to take part. Faecal calprotectin was collected. Outcomes included recruitment and retention rates, pain interference and severity (Brief Pain Inventory), quality of life, psychosocial measures and self-reported disease activity (IBD-Control). Follow-up face to face or telephone interviews were conducted following the intervention to obtain feedback on sessions and tasks, facilitator support and areas for improvement.

Results
Of 145 survey respondents contacted, 55 (37.9%) responded. Two additional individuals were recruited from the study advertisement. 20/57 (35.1%) met screening and eligibility criteria. Twenty consented to the study and 60% of those returning a stool sample were in clinical remission (&lt;250ug/g). One individual withdrew after Session 1, 17 (85%) engaged with intervention sessions and 11 (55%) completed at least 5/9 sessions. 16 (80%) of recruited participants completed the post-intervention questionnaire at week 9. Mean score for overall acceptability was 43.4 (0–70). No changes were observed for pain outcomes, but quality of life and pain self-efficacy increased following the intervention. Self-reported disease activity, depression, anxiety, pain catastrophising and avoidance resting behaviour decreased. Qualitative feedback demonstrated the value of particular elements of the intervention, such as thought monitoring and facilitator support. Some participants felt content was oversimplified and that further information was needed on practical management strategies, including diet.

Conclusion
Online CBT for chronic IBD-related pain appears feasible and acceptable. The results demonstrate positive effects for improving quality of life and reducing psychological distress, however online and face to face recruitment methods are recommended. To establish efficacy for reducing pain and improving quality of life, larger randomised controlled trials are required.
N12 An evaluation of the impact of IBDoc in clinical practice 5 years after introduction
Authors: Sugrue K , Gleeson S , McCarthy J , Buckley M 
Published: January 2020

Abstract

Background
Faecal Calprotectin is a well-established biomarker to measure the level of inflammation in the gut. Assessment of calprotectin is important to measure disease activity, effectiveness of treatments as well as predicting relapses in inflammatory bowel disease (IBD). IBDoc® allows reliable testing of faecal calprotectin using a smartphone at home. IBDoc® was introduced at Mercy University Hospital in 2014 and now has 733 users. It has proved hugely popular with patients, has increased medication compliance and promoted self management. The objective of this study was to evaluate the impact of IBDoc® in clinical practice.

Methods
IBDoc® results were monitored over a 6 month period. A total of 240 tests were performed by patients with IBD (age 18–52 years). The results were evaluated to determine suitable clinical interventions, fast track clinic appointments, urgent colonoscopies, change of medical therapy and suitability for Virtual Clinics (VC’s).

Results
Of the 240 tests performed 40% had a normal result, 40% were moderate and 20% were high. All of the normal results avoided clinic appointments which freed up clinic time for patients with active disease and resulted in cost savings for the hospital. 70% of these patients were deemed suitable for future Virtual Clinics which resulted in further cost savings and freed up Consultant time. The majority of patients 60% had moderate or high results. The 20% of results that were high were all booked for urgent colonoscopy. All of the moderate results were fast tracked to clinic and 20% of these had a change of medical therapy.

Conclusion
This study shows the benefits of using IBDoc® in clinical practice. It is central to facilitating a fast track system for patients which results in better outcomes for patients.
90 Transient severe mitral regurgitation caused by an exclusively dopamine secreting paraganglioma
Authors: Stassen J , Verwerft J , Stroobants D , Herbots L 
Published: January 2020

Abstract

INTRODUCTION
A 93 year old woman presented to the hospital because of severe dyspnea with a sudden onset. Her medical history was positive for a sick sinus syndrome for which she received a DDD pacemaker in 2014. Furthermore an intra-abdominal paraganglioma (PGL) was discovered a year earlier which was treated conservatively because of her age and lack of symptoms.
On physical examination, a sinus rhythm of 88 bpm (pacemaker rhythm) and oxygen saturation of 80% was noted. Blood pressure was 66/38 mmHg. An urgent blood gas analysis showed an elevated blood lactate concentration of 5.5 mmol/l. Her signs and symptoms were compatible with a cardiogenic shock.
Transthoracic echocardiography (TTE) revealed a notable hyperdynamic left ventricular (LV) function and a severe mitral regurgitation (MR) (ERO 0,7 cm2), based on restriction and tenting of both the anterior and posterior mitral leaflet with a systolic pulmonary artery pressure (PAPs) of 70mmHg + CVP.
Because of her age and a written declaration of will, only a supportive therapy with oxygen and morphine was given. After 45minutes however, the patient suddenly and completely recuperated. Her vital signs stabilized with a blood pressure of 110/60 mmHg and oxygen saturation of 95%. A second TTE showed only a mild MR without any restriction of the mitral leaflets and a normalized PAPs of 30mmHg +CVP. The patient was hospitalized for further investigation.
COURSE DURING HOSPITALIZATION
During the next 48 hours, four similar episodes with acute dyspnea and signs and symptoms of cardiogenic shock were documented. Each time, TTE revealed a hyperdynamic LV function with a severe MR, based on tenting of both mitral valve leaflets. These episodes always terminated spontaneously with only a mild residual MR afterwards. An angiography was performed and showed no coronary lesions.
DIFFERENTIAL DIAGNOSIS
Because of the paroxysmal episodes, documentation of a hyperdynamic LV function with severe hypotension and the known PGL, a 24h urine collection was performed. The results demonstrated a markedly elevated urine dopamine concentration (5300 µg/l) with normal concentrations of adrenaline (3.5 µg/l) and noradrenaline (64.3 µg/l). 3-Methoxytyramine, the metabolite of dopamine, was also highly elevated (4700 µg/l). As such, the diagnosis of a dopamine producing PGL was made. The patient refused any treatment and she went home in a palliative setting.

CONCLUSION
Dopamine-secreting PGL is a very rare entity without a classic clinical presentation. This is the first case report showing a severe MR with cardiogenic shock, leading to the diagnosis of a dopamine secreting PGL. The mechanism of the MR is still unclear, but strain measurements did show an exacerbation of the RV pacing induced dyssynchrony during the episodes of shock, hypothesizing that dopamine release exacerbated the pacing induced asynchrony of the papillary muscles, leading to a functional MR.
93 A hemodynamic challenge in assessment of echocardiographic mitral regurgitation severity
Authors: Ferreira J , Morais J , Ferreira H , Roque D , Beringuilho M , Faria D , Freitas A , Morais C 
Published: January 2020

Abstract

Mitral regurgitation severity is, in accordance to current recommendations, typically evaluated by echocardiography. Several hemodynamic factors may influence this evaluation, especially systemic arterial blood pressure at the time of echocardiographic evaluation.
A 71-year-old woman was admitted in our Cardiology ward with acute decompensated heart failure. She had been previously admitted about 3 months earlier by acute decompensated heart failure, and at that time, admission transthoracic echocardiography (TTE) demonstrated mitral regurgitation, which was evaluated as severe. Systolic systemic arterial blood pressure at the time of that TTE was registered as 135mmHg. For further evaluation of mitral regurgitation mechanism, the patient underwent transoesophageal echocardiography (TEE), and in that exam mitral regurgitation was assessed as only moderate. For that exam, patient was sedated with 5mg of intravenous Midazolam, a drug with known secondary hypotensive effect. Although systemic arterial blood pressure was not described in the TEE report, retrospective analysis of nursery blood pressure records showed that patient was hypotensive during exam with systolic arterial blood pressure of 80-90mmHg. Patients was discharged, and in actual admission, concern was raised that mitral regurgitation could have been underestimated in previous TEE due to reduced afterload caused by the hypotensive effect of sedation. It was then decided to repeat TEE, and, in order to counterpose the hypotensive effect of Midazolam, TEE was performed under intravenous continuous infusion of Phenylephrine, a selective α-1 receptor antagonist with a significant vasopressor effect and minimal effect on cardiac contractility. Systolic systemic arterial blood pressure during this exam was recorded as 135-140mmHg. In this exam mitral regurgitation was confirmed as severe and patient was patient was oriented for mitral valve surgery.

DIscussion
This case illustrates the importance of assessment of hemodynamic status of the patient during echocardiographic evaluation of mitral regurgitation severity, and presents a pharmacological strategy to compensate hypotensive effects of sedative agents used during TEE.
114 A case of progressive wall thinning of apical myocardium in 5 year- old boy with hypertrophic cardiomyopathy
Authors: Jung J W 
Published: January 2020

Abstract
Hypertrophic cardiomyopathy (HCM) is defined by the presence of increased left ventricular (LV) wall thickness that is not explained by abnormal loading conditions without a priori assumptions about etiology or myocardial pathology even in neonate, children and adults. The diagnosis of HCM is mainly the detection of increased LV wall thickness by any imaging modality. Due to its diverse etiology, the disease phenotype includes chest pain, palpitation, syncope and heart failure. In most patients, there is a life-long process of progressive and adverse cardiac remodeling, characterized by myocardial fibrosis and wall thinning. However, there was no report about cardiac remodeling of progressive wall thinning in children with HCMP.
A 5 year-old boy was evaluated due to familiar HCMP, and finally confirmed with HCMP by echocardiography. His father was diagnosed as asymmetric HCMP and treated with septal alcohol ablation 3 years ago. His family referred for genetic counselling. His symptom was vague because he was very young. Initial electrocardiographic finding was normal sinus rhythm with left ventricular hypertrophy. Ambulatory electrocardiography (ECG) showed isolated premature ventricular contraction. Initial echocardiographic findings revealed asymmetric septal hypertrophy with diffuse hypertrophied LV myocardium, systolic anterior motion of anterior leaflet of mitral valve without LV outflow tract obstruction (LVOTO) and only mild dynamic obstruction on mid-septum of LV. His cardiovascular magnetic resonance imaging (CMR) showed similar to echocardiographic findings and no late gadolinium enhancement (LGE). He started to take medication with beta blocker, and later addon verapamil. After 3 years later, his ambulatory ECG showed non-sustained ventricular tachycardia of 4 episodes. Follow-up echocardiographic findings revealed progressive septal wall thickness from 13mm to 19 mm, marked LVOTO with peak pressure gradient of 128 mmHg and profound dynamic obstruction on mid-septum of LV. Follow-up CMR imaging showed additional progressive apical wall thinning without suspicious or definite LGE on any other myocardium. Urgently he undertook the implantation of implantable cardioverter defibrillatorsfor prevention of sudden cardiac death. Now he is listing and waiting for heart transplantation. Cardiac remodeling is progressively life-long process in most HCMP, but in this case with pediatric HCMP, even though he took medical treatment its progression was rapid cardiac remodeling.
153 Multiparametric assessment of diastolic function in heart failure
Authors: Uejima T , Cho J , Hayama H , Takahashi L , Yajima J , Yamashita T 
Published: January 2020

Abstract

Background
The assessment of diastolic function is still challenging in the setting of heart failure (HF). We tested the hypothesis that applying a machine learning algorithm would detect heterogeneity in diastolic function and improve risk stratification in HF population.

Methods
This study included consecutive 279 patients with clinically stable HF referred for echocardiographic assessment, for whom diastolic function variables were measured according to the current guidelines. Cluster analysis, an unsupervised machine learning algorithm, was undertaken on these variables to form homogeneous groups of patients with similar profiles of the variables. Sequential Cox models paralleling the clinical sequence of HF assessment were used to elucidate the benefit of cluster-based classification over guidelines-based classification. The primary endpoint was a hospitalization for worsening HF.

Results
Cluster analysis identified 3 clusters with distinct properties of diastolic function that shared similarities with guidelines-based classification. The clusters were associated with brain natriuretic peptide level (p &lt; 0.001, figure A). During follow-up period of 2.6 ± 2.0 years, 62 patients (22%) experienced the primary endpoint. Cluster-based classification exhibited a significant prognostic value (c2 = 20.3, p &lt; 0.001, figure B), independent from and incremental to an established clinical risk score for HF (MAGGIC score) and left ventricular end-diastolic volume (hazard ratio = 1.677, p = 0.017, model c2: from 47.5 to 54.1, p = 0.015, figure D). Although guideline-based classification showed a significant prognostic value (c2 = 13.1, p = 0.001, figure C), it did not significantly improve overall prognostication from the baseline (model c2: from 47.5 to 49.9, p = 0.199, figure D).

Conclusion
Machine learning techniques help grading diastolic function and stratifying the risk for decompensation in HF.
Abstract 153 Figure.