bluuebunny/crossref_metadata_2025_split huggingface dataset:
A198 EOSINOPHILIC ESOPHAGITIS WITH STRICTURE PRESENTING SHORTING AFTER INITIATION OF ORAL PEANUT IMMUNOTHERAPY
Authors: Al Yaarubi Z , Foster A , Avinashi V , Lam G , Soller L , Chan E 
Published: February 2020

Abstract

Background
Oral immunotherapy (OIT) is increasingly practiced outside of research settings with reasonable success (Soller 2019).
With OIT, a patient eats their food allergen daily, gradually increasing the dose, with the goal to prevent or reduce the severity of an anaphylactic reaction.
One of the described adverse events of OIT is a risk of developing Eosinophilic Esophagitis (EoE), with cited frequency of 2.7% (Lucendo 2014). In addition, OIT is typically contraindicated in patients with known EoE but patients are not routinely screened for EoE prior to initiation of OIT.

Aims
To present a case of a 12 year old boy with peanut anaphylaxis who developed eosinophilic esophagitis and an esophageal stricture shortly after starting peanut immunotherapy

Methods
Patient chart review was conducted. A literature review was done using the words “eosinophilic esophagitis” and “immunotherapy”.

Results
A12 year old boy with asthma, allergic rhinitis and multiple anaphylactic food allergies, started peanut OIT with an allergist. Prior to OIT, the patient had no symptoms suggestive of EoE such as dysphagia, heartburn, chest pain or washing of food. Approximately 3.5 weeks into treatment, the patient developed daily vomiting. The patient was advised to stop the peanut OIT three days after symptom onset, but the vomiting continued for another 8 days. By the time of endoscopy (16 days after onset of vomiting), the vomiting had completely subsided for the previous five days.
The upper GI endoscopy demonstrated signs of EoE throughout the length of the esophagus. In the mid esophagus there was resistance where the 9.8 mm gastroscope was unable to pass. A smaller gastroscope with a 5.9 mm width was easily able to pass through the stricture. Histology showed marked eosinophilia throughout the esophagus with basal cell hyperplasia, spongiosis, superficial microabscesses and stromal fibrosis consistent with EoE. The patient continued to be ‘asymptomatic’ at the time of endoscopy and after despite the presence of a stricture. After discussion, the patient was started on oral viscous budesonide (OVB) 1mg PO BID.
The patient was re-scoped 4 weeks into OVB therapy with complete resolution of the stricture with neither macroscopic nor histologic findings of EoE. Patient is now off OVB for over a month, remains asymptomatic, and will undergo repeat endoscopy in the upcoming month to ensure normal histology

Conclusions
This is the first case describing EoE with an esophageal stricture shortly after initiation of OIT. Pediatric Gastroenterologists need to be increasingly aware that patients undergoing OIT are at an increasing risk of ‘developing’ or at least ‘unmasking’ EoE. More research is required to evaluate whether EoE screening, by symptom questionnaire or endoscopy is warranted prior to beginning OIT, and whether OIT is truly needed.

Upper GI endoscopy showing signs of EoE and an esophageal stricture

Funding Agencies
CAG
A209 ROLE OF SEROTONIN-AUTOPHAGY AXIS IN REGULATION OF EPITHELIAL CELL FUNCTION AND MICROBIOTA COMPOSITION IN GUT
Authors: Haq S , Wang H , Kim J J , Kwon E Y , Banskota S , Grondin J , Hassan N , Brumell J , Philpott D , Khan W I 
Published: February 2020

Abstract

Background
Serotonin (5-hydroxytryptamine; 5-HT), an enteric signalling molecule mainly produced by the enterochromaffin (EC) cells of the intestinal epithelium regulates various processes of the gut. Tryptophan hydroxylase 1 (Tph1) is the rate-limiting enzyme of 5-HT biosynthesis in EC cells. In inflammatory bowel disease (IBD) and experimental colitis, there are alterations in 5-HT content and microbiota composition in the gut. Previously we reported, Tph1-deficient (Tph1-/-) mice with reduced 5-HT in the gut exhibit reduced susceptibility to colitis. The mechanism by which 5-HT regulates colitis is unknown. Autophagy, a catabolic process regulates the function of intestinal epithelial cells (IECs), gut microbiota, and protects against intestinal inflammation. Both aberrant 5-HT signalling and autophagy is implicated in colitis. It is unclear whether they interact in regulation of production of pro-inflammatory cytokines from IECs and gut microbiota composition in relation to colitis. Our hypothesis is, an increase in 5-HT signalling inhibits autophagy in the IECs, which results in up-regulation of colitis by increasing the production of pro-inflammatory cytokines, and by selection for a more colitogenic microbiota.

Aims
To define the role of 5-HT-autophagy axis in the production of pro-inflammatory cytokines from IECs and gut microbiota composition in intestinal inflammation.

Methods
We investigated level of autophagy with or without 5% dextran sodium sulphate (DSS) in colons, mucosal scraping and IECs of Tph1-/- and their wild-type (WT) littermates. In addition, autophagy and proinflammatory cytokine production were investigated in human colonic epithelial cells (HT-29) following stimulation by 5-HT. We evaluated colitis and gut microbiota composition in WT, Tph1-/-, epithelial-specific autophagy gene Atg7 deficient (Atg7ΔIEC), and Atg7ΔIECTph1-/- (double knock out; DKO) mice.

Results
Tph1 -/- mice, with less 5-HT in the gut than WT mice following DSS administration exhibited an up-regulation of autophagy markers in the colon, mucosal scraping and IECs along with reduction of colitis severity. 5-HT treatment of HT-29 cells resulted in down-regulation of autophagy and upregulation of pro-inflammatory cytokine, IL-8. DKO mice exhibited increased severity of DSS-colitis, and altered microbiota composition compared to Tph1-/- mice.

Conclusions
These findings suggest, an increase in 5-HT in colitis inhibits autophagy in the IECs that contribute to alteration of the gut microbiota and disease severity. Blocking 5-HT signalling may promote autophagy in the IECs and alleviate the severity of colitis. Understanding the contribution of 5-HT in autophagy may identify new therapeutic target in IBD and other intestinal inflammatory conditions that exhibit dysregulated autophagy.

Funding Agencies
CAG, CIHR
A210
ADLERCREUTZIA IS DEPLETED IN UC PATIENTS, EVEN BEFORE CLINICAL DIAGNOSIS, AND INVERSELY CORRELATES WITH FECAL ELASTOLYTIC ACTIVITY
Authors: Santiago Badenas A , Libertucci J , Turpin W , Galipeau H J , Croitoru K , Caminero Fernandez A , Verdu E 
Published: February 2020

Abstract

Background
A combination of genetics, environmental, and immune factors contribute to the development of ulcerative colitis (UC). Host proteolytic imbalance has been reported in active UC. Preliminary results from our lab suggest microbial proteolytic activity is increased before as well as after onset of UC, and transfer of this activity to mice contributes to inflammation.

Aims
Our aim was to correlate the elastolytic activity of fecal samples from individuals at risk for IBD, before and after onset of ulcerative colitis, with their fecal microbiota profiles

Methods
We first investigated proteolytic activity in fecal samples from individuals at risk to develop UC (pre-UC, n=12) prior to disease onset and after UC diagnosis (post-UC, n=7) and matched healthy controls (n=66). Microbial community analysis was performed by sequencing the V4 region of the 16S rRNA gene region using Illumina MiSeq platform. Sequences were analyzed with QIIMEv1.9.0. We measured bacterial proteolytic activity, using a FITC-elastin assay.

Results
Microbial community analysis revealed that the overall diversity (both richness and evenness) in UC patients was decreased compared to healthy controls as well as pre-UC patients. The relative abundance of the genus Adlercreutzia was decreased by 3.1 fold in pre-UC patients compared to healthy controls and was further decreased in post-UC (3.8 fold). The presence of Adlercreutzia was also found to be negatively correlated (r=-0.47, p&lt;0.0001) with elastolytic activity in stool supernatant, suggesting a possible protective role in the disease.

Conclusions
We found novel potentially protective bacteria, Adlercreutzia, which was depleted in UC patients, even before clinical diagnosis and correlated negatively with proinflammatory elastolytic activity described previously in IBD. The protective mechanisms are under investigation.
On behalf of the CCC-GEM Project consortiumand Supported by a CCC GIA to EFV

Funding Agencies
CCC
A222 EPIDEMIOLOGICAL, PHENOTYPIC AND CLINICAL PATTERNS OF EXTRAINTESTINAL MANIFESTATIONS IN INFLAMMATORY BOWEL DISEASE
Authors: Lytvyak E , Halloran B , Kroeker K , Peerani F , Wong K , Mason A , Montano-Loza A J , Baumgart D , Dieleman L A 
Published: February 2020

Abstract

Background
Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), may affect multiple organ systems. The extraintestinal manifestations (EIMs) occur frequently, considerably increase morbidity and mortality, and strongly influence the quality of life in IBD patients.

Aims
To establish the all-time prevalence of EIMs in a large cohort of IBD patients and assess risk factors contributing to their development.

Methods
We conducted a retrospective cohort study of IBD patients followed at the Division of Gastroenterology, University of Alberta, diagnosed between 1954 and 2019. We recorded demographic, clinical, and biochemical data. The EIMs included dermatological, musculoskeletal, ophthalmological, hepatobiliary, urogenital, and pulmonary manifestations. The chi-square and Mann-Whitney tests (median, IQR) were used to evaluate differences. Univariate logistic regression was used to determine the association of EIMs with demographic and disease-specific variables across CD and UC, with predictors (p≤0.05) further incorporated into multivariate regression models.

Results
We analyzed data of 4493 IBD patients: 2354 with CD and 2139 – with UC, aged 18–96 years. Males were underrepresented in the CD cohort compared to the UC (47.8% vs 52.8%; p=0.001), with longer disease duration (16.3, IQR 16.1 vs 12.3, IQR 12.4 years; p≤0.001). The EIMs were slightly more prevalent in the CD group compared to UC (22.2% vs 20.4%; p=0.134), along with a significantly higher proportion of patients with over two EIMs (4.1% vs 1.7%; p≤0.001). The EIMs’ pattern varied substantially between the IBD subtypes (Figure). In the CD cohort, the most common EIM was peripheral arthropathy (4.1%), followed by ankylosing spondylitis (4.0%) and nephrolithiasis (3.6%). Among CD patients, disease duration ≥20 years (OR 1.70, 95% CI 1.17–2.48; p=0.006), iron (OR 1.54, 95%CI 1.13–2.09; p=0.006) and calcium (OR 2.28, 95% CI 1.21–4.27; p=0.010) deficiencies were identified as risk factors for EIMs. The UC patients most frequently had primary sclerosing cholangitis (9.6%) with peripheral arthropathy and nephrolithiasis each being present in 2.2% of patients. In the UC cohort, three variables demonstrated the most significant associations with EIMs: male sex (OR 1.75, 95% CI 1.32–2.32; p≤0.001), disease duration ≥20 years (OR 1.93, 95% CI 1.35–2.74; p≤0.001), and pan-colonic disease extent (OR 2.12, 95% CI 1.03–4.36; p=0.041) (Table).

Conclusions
Our data demonstrate that over one-fifth of IBD patients had at least one EIM over the course of the disease and the EIMs pattern varies substantially across CD and UC. Identification of risk factors allowing prediction of EIMs would increase awareness, assist in their early recognition, and tailor further management.

Funding Agencies
AbbVie
A247 VIRAL LOAD OF EPSTEIN-BARR VIRUS IN PEDIATRIC PATIENTS WITH NEW ONSET IBD AT DIAGNOSIS AND ON FOLLOW UP: AN OBSERVATIONAL STUDY
Authors: Kornitzer G A , Rosenstein M , Groleau V , Jantchou P , Touzot F , Godin D , Renaud C , Ovetchkine P , Deslandres C 
Published: February 2020

Abstract

Background
Patients with Inflammatory Bowel Disease are at increased risk for complications associated with Epstein-Barr Virus, such as uncontrolled infection, colitis mimicking IBD, and lymphoproliferative disease. These complications may be due to inherent immune dysfunction or effects of immunomodulating therapies used. We have previously identified that the seroprevalence of EBV in our cohort of IBD patients at time of diagnosis was 44.2%, with prevalence stratified by age as follows: 0 to &lt;10 years 36%, 10 to &lt;17 years 46%, and 17 + years 50%.

Aims
Our objective is to assess the risk of EBV reactivation in this population, to determine whether patients treated with immunomodulators should be more closely monitored for EBV viral load.

Methods
Retrospective chart review was done for all patients with new-onset IBD diagnosed at CHU Sainte-Justine over a two-year period, from Jan. 2016 to Dec. 2017. Serum from time of diagnosis was retrieved from the microbiology laboratory for patients with positive EBV serology, and quantitative PCR was performed to assess viral load at diagnosis. 47 of 53 seropositive patients had available serum at time of retrieval. EBV PCR was subsequently performed on serum drawn one to two years after start of immunosuppressants.

Results
53 patients were EBV positive at time of diagnosis (EBNA/VCA IgG). Two patients were IgM positive, suggesting recent or active infection. The viral load as measured by quantitative PCR on serum drawn at diagnosis was negative in all retroactively tested patients. Of the two IgM-positive patients, one had known positive quantitative PCR at time of diagnosis. PCR previously tested in clinical follow-up of two seropositive, PCR-negative patients became positive at 7 and 17 months from diagnosis, suggesting viral reactivation. Both patients had received anti-TNF’s and systemic corticosteroids. Viral loads on follow-up are to be assessed for the rest of the cohort. Overall, therapies started within 6 months of diagnosis were similar in the seropositive and seronegative groups, the majority receiving some form of immunosuppression. Within the seropositive group: 66% received corticosteroids, 32.1% Infliximab, 5.7% Adalimumab, and 5.7% Azathioprine.

Conclusions
Only one patient had active EBV infection with positive PCR at time of diagnosis. All other patients had no sign of active infection based on retroactive PCR’s. While a majority of patients, regardless of EBV serology, receive immunomodulating agents, we currently do not routinely screen for seroconversion in seronegative patients, or for viral load in seropositive patients. We will be assessing viral loads after start of immunomodulation to better understand the potential impact of these agents on disease progression.

Funding Agencies
None
A258 ASSOCIATION BETWEEN SYMPTOMS AND INFLAMMATORY BOWEL DISEASE ACTIVITY USING INFLAMMATORY BOWEL DISEASE SYMPTOM INVENTORY – A RETROSPECTIVE ANALYSIS FROM THE MANITOBA LIVING WITH IBD STUDY
Authors: Kulyk A , Stone J , Bernstein C N 
Published: February 2020

Abstract

Background
Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the gut and includes predominantly Crohn’s disease (CD) and ulcerative colitis (UC). The Inflammatory Bowel Disease Symptom Inventory (IBDSI), developed at the University of Manitoba is a validated patient self-report symptom inventory which has shown to demonstrate good validity to accepted clinician-based assessments of disease activity. The IBDSI focuses of 5 main symptom clusters: bowel symptoms, abdominal discomfort, fatigue, bowel complications, and systemic complications. While there is good evidence for the presence of these symptoms in IBD, there has yet to be an analysis of the correlation between specific symptom clusters and active IBD.

Aims
Our aim is to identify symptoms experienced by patients with IBD being followed prospectively over one year and further analyze which of these symptoms are correlated with disease activity.

Methods
155 patients enrolled in the Manitoba Living with IBD Study were eligible for the current study. Bi-weekly IBDSI short-form survey results were analyzed to determine which IBD-related symptoms were experienced by each patient over the study period (1 year). Descriptive data for symptoms will be reported, and will then be compared to disease activity (defined in Crohn’s disease as an IBDSI score &gt;14 and in UC&gt;13 and fecal calprotectin level (FCAL) &gt;250 ug/g) to determine which symptoms most correlate with active IBD.

Results
The study population ranged from ages 18–70, with a mean age of 43 years. 30.3% (47) of the population were male. 65.8% (102) of the population consisted of CD, 31.0% (48) had UC, the remaining 3.2% (5) had IBD-type unclassified. Some of the symptoms for analysis will include abdominal pain, frequency and consistency of bowel movements, blood within the stool, and other associated symptoms such as nausea and loss of appetite. The results for the frequency of symptoms reported and which are most correlated with disease activity is still under analysis.

Conclusions
This will be the first study assessing the association between symptoms experienced by subjects contrasted to disease activity using the self-reported measurement IBDSI and FCAL.

Funding Agencies
None
A274 EARLY SINGLE-OPERATOR CHOLANGIOSCOPY ASSISTED ELECTROHYDRAULIC LITHOTRIPSY (SOC-EHL) IN THE MANAGEMENT OF DIFFICULT BILIARY STONES IS COST-EFFECTIVE WHEN COMPARED TO A DELAYED STEP-UP APPROACH TO LATER SOC-EHL
Authors: Alrajhi S , Barkun A N , Adam V , Callichurn K , Martel M , Brewer O , Khashab M , Forbes N , Chen Y 
Published: February 2020

Abstract

Background
Single-operator cholangioscopy assisted electrohydraulic lithotripsy is the standard of care for difficult common bile duct (CBD) stones with failed clearance using standard ERCP. This technology is expensive and optimal timing of its use in terms of cost-effectiveness in the management algorithm of patients with difficult CBD stones remains unclear

Aims
To determine the cost-effective timing of SOC-EHL utilization in the management of difficult CBD stones

Methods
A decision model was developed assessing 4 strategies and progressively delayed introduction of SOC-EHL in relation to ERCP over 6-months. Difficult stones were defined as having failed CBD clearance via standard ERCP. Probability estimates for each health state were obtained from a literature systematic review. For each strategy, outpatients undergoing ERCP underwent different timings of SOC-EHL introduction from the first to the fourth ERCP and were followed for subsequent need for re-intervention, adverse events, need for surgery, and/or successful endoscopic CBD clearance. The unit of effectiveness was complete CBD clearance without need for surgery. Deterministic sensitivity analyses were performed varying all 50 model variables across ranges spanning 30% of their respective values. Costs are in 2018US$ based on US data.

Results
Performing SOC-EHL immediately during the first ERCP is the least expensive approach when compared to delaying SOC-EHL. This strategy costs $15,528 on average per patient with CBD clearance avoiding surgery and can save between $260 to $720 compared to the 3 other strategies, which introduce SOC-EHL during the second to the fourth ERCP. Effectiveness is clinically comparable between the four strategies ranging from 97–99%. Deterministic sensitivity analysis shows changes in the results when the ERCP complication rate (baseline probability of 6%) decreases to 4.5%, when the SOC-EHL (baseline costs of $2,450) costs more than $2,670, or when the ERCP facility fees (baseline costs of $4,292) are less than $3,425. In all 3 scenarios, delaying the first SOC-EHL use to the fourth procedural attempt becomes the dominant strategy. Variations of the other 47 variables did not alter results.

Conclusions
Although SOC-EHL is expensive, this analysis demonstrates that among patients who have failed a prior attempt at stone extraction, utilization of SOC-EHL at the next (first subsequent) ERCP is less costly when compared to its delayed introduction. However, postponing the use of SOC-EHL to the fourth ERCP could be identified as the most cost-effective strategy when facility fees or ERCP complications rates are below certain thresholds, or when the costs of SOC-EHL extend beyond a defined threshold.

Funding Agencies
None
Burrowing-site selection by the soldier crab Mictyris guinotae Davie, Shih & Chan, 2010 (Decapoda: Brachyura: Mictyridae)
Authors: Takeda Satoshi 
Published: February 2020

AbstractThe soldier crab Mictyris guinotae Davie, Shih & Chan, 2010 inhabiting sandy tidal flats in the Ryukyu Is., Japan, are deposit feeders in two regions: its upper habitat where it burrows and the shoreline. The crabs usually migrate between these two regions during the period of emergence at the daytime and night-time low tide. The aim of this study was to determine which kind of sediments are chosen by the crabs when burrowing. Experiments designed to investigate burrowing-site selection revealed that the crabs preferably burrowed in sediment that had been conditioned through feeding by conspecific crabs, but not in sediment that had been conditioned by conspecific crabs walking on its surface. Moreover, the crabs never showed any preference for burrowing in sediment that had been conditioned through feeding by the competitor fiddler crab Austruca perplexa (H. Milne Edwards, 1852); both soldier (prey) and fiddler (predator) crabs sympatrically inhabit the tidal flat, but segregate their habitats with a transition area. These results suggest that chemical cues in sediment conditioned through feeding by conspecific soldier crabs affect where crabs burrow.
Detection of Wolbachia (Rickettsiales: Anaplasmataceae) and Candidatus Liberibacter asiaticus (Rhizobiales: Rhizobiaceae) Associated With Diaphorina citri (Hemiptera: Liviidae) Collected From Citrus reticulata (Sapindales: Rutaceae) and Alternate Host, Cordia myxa (Boraginales: Boraginaceae)
Authors: Guz Nurper , Arshad Muhammad , Cagatay Naciye Sena , Dageri Asli , Ullah Muhammad Irfan 
Published: February 2020

Abstract
The Asian citrus psyllid, Diaphorina citri Kuwayama (Hemiptera: Liviidae), is an important insect pest of the citrus crop worldwide. It vectors the pathogen ‘Candidatus Liberibacter asiaticus’ (CLas) that causes a serious disease known as citrus greening. Here, we tested the infection frequency of Wolbachia and CLas from 100 D. citri individuals collected from two host plants belonging to families Rutaceae (Citrus reticulata Blanco) and Boraginaceae (Cordia myxa L.) using molecular methods. The following trend of endosymbionts infection in adult D. citri was found; 85.4% (35/41) by Wolbachia, and 19.5% (8/41) by CLas collected from C. reticulata plants and 65.4% (17/26) by Wolbachia, and 15.4% (4/26) by CLas in case of C. myxa plant. However, 61.5% (8/13) nymphs collected from C. reticulata and 20.0% (4/20) collected from C. myxa plants were infected by Wolbachia, while no nymph was infected by CLas collected from either host plants. Findings from this work represent the first report of CLas presence in D. citri feeding on C. myxa plants. By studying the presence of CLas with other endosymbiotic bacteria, future basic and applied research to develop control strategies can be prioritized.
The Illicit Benefits of Local Party Alignment in National Elections
Authors: Borcan Oana 
Published: February 2020

Abstract
How do central politicians in young democracies secure electoral support at grassroots level? I show that alignment with local governments is instrumental in swaying national elections through, inter alia, electoral fraud. A regression discontinuity design with Romanian local elections and a president impeachment referendum in 2012 uncovers higher referendum turnouts in localities aligned with the government coalition—the impeachment initiators. Electoral forensics tests present abnormal vote count distributions across polling stations, consistent with ballot stuffing. The alignment effect, driven by rural localities, may explain the clientelistic government transfers found in this context and documented worldwide. (JEL D72, D73, H77)