bluuebunny/crossref_metadata_2025_split huggingface dataset:
A250 SYSTEMATIC REVIEW WITH META-ANALYSIS: ADVERSE PREGNANCY-RELATED OUTCOMES WITH INFLAMMATORY BOWEL DISEASE
Authors: Govardhanam V , Tandon P , Leung K , Maxwell C , Huang V 
Published: February 2020

Abstract

Background
Inflammatory bowel disease (IBD) is a chronic inflammatory condition. While it is reported that IBD may result in adverse pregnancy-related outcomes, its effects on placental related diseases are relatively not known.

Aims
The aim of our work was to determine the risk of adverse pregnancy outcomes in patients with IBD.

Methods
Medline, Embase, and Cochrane library were searched for studies that reported adverse maternal and obstetrical outcomes in patients with IBD. Weighted odds ratios (OR) with 95% confidence intervals (CI) were calculated for the risk of these outcomes in patients with IBD compared to healthy controls.

Results
Fifty-three studies were included (7917 patients with IBD and 3253 healthy controls). Cesarean delivery was more common in patients with IBD compared to healthy controls (OR 1.79, 95% CI, 1.16–2.77). This remained significant for UC (OR 1.80, 95% CI, 1.21–2.90) but not CD (OR 1.48, 95% CI, 0.94–2.34). Similarly, gestational diabetes occurred more commonly in IBD (OR 2.96, 95% CI, 1.47–5.98). Furthermore, the incidences of placental diseases were low, 2.0% (95% CI, 0.9–3.1%) for pre-eclampsia, 3.3% (95% CI, 0–7.2%) for placental abruption, 0.5% (95% CI, 0.2–0.9%) for placenta previa, and 0.3% (95% CI, 0–0.5%) for chorioamnionitis. Finally, patients with IBD were more likely to experience preterm premature rupture of membranes (PPROM, OR 12.10, 95% CI, 2.15–67.98), but not an early pregnancy loss (OR 1.63, 95% CI 0.49–5.43). Anti-tumour necrosis factor therapy was not associated with chorioamnionitis (OR 1.12, 95% CI, 0.16–7.67), early pregnancy loss (OR 1.49, 95% CI, 0.83- 2.64), and placenta previa (OR 1.58, 95% CI, 0.30–8.47).

Conclusions
Patients with IBD are more likely to develop adverse pregnancy-related outcomes such as Gestational Diabetes and PPROM. Pregnancy in patients with IBD should be considered a high-risk period and as such, a multi-disciplinary team, including gastroenterologists, obstetricians and maternal-fetal medicine specialists, is necessary to recognize and effectively manage adverse obstetrical outcomes in order to reduce overall morbidity and mortality.

Funding Agencies
None
A256 TRENDS IN THE PREVALENCE AND SEVERITY OF ANEMIA IN PEDIATRIC PATIENTS WITH INFLAMMATORY BOWEL DISEASE IN THE LAST DECADE
Authors: Geng S , Ridha Z , Pham L B , Tran E , Peixoto A , Tchogna S A , Deslandres C , Jantchou P 
Published: February 2020

Abstract

Background
Anemia is one of the most common extraintestinal manifestations in patients with inflammatory bowel disease (IBD) at diagnosis. Studies have shown that anemia was associated with low levels of quality of life, which improves with the correction of anemia in adults. Recent data have shown an increase in the incidence and severity of pediatric IBD.

Aims
To investigate the prevalence of anemia in children at diagnosis of IBD and the trends in the past decade. The secondary aim was to investigate the associations between hemoglobin (Hb) levels and disease characteristics.

Methods
Eligible patients (age ≤18 years, diagnosed with IBD from 2009 to 2018) were retrospectively identified through our IBD database. Disease localization and phenotype were defined according to the Paris Classification of IBD. Anemia was defined by Hb levels according to WHO targets. The annual prevalence of anemia was calculated according to subtype (inflammatory vs iron deficiency). The Pediatric Crohn’s Disease Activity Index (PCDAI) and the Pediatric Ulcerative Colitis Activity Index (PUCAI) were used to assess the disease severity at diagnosis.

Results
We included 887 patients (439 females), mean (SD) age of 13.1 (3.4) years. Of these, 519 (58.5%) were identified with anemia within 30 days of diagnosis. The median (IQR) Hb level was 108 (98 -114) g/dL. Severe anemia (&lt; 70 g/dL) was present in 1.8 % of patients. The prevalence of anemia at diagnosis remained relatively stable ranging from 60.2% in 2009 to 60.4% in 2018. The annual proportion of inflammatory vs iron-deficiency anemia is displayed in figure 1. Anemia was more prevalent in Crohn’s disease (CD) (62.2%) than Ulcerative colitis (UC) (57.9%) or IBD-unclassified (39.6%). The disease severity scores were higher in those with anemia. The median (IQR) PCDAI and PUCAI were respectively 37.5 (27.5–47.5) and 55.0 (40.0–65.0) in the anemic group as compared to 27.5 (20.0–37.50) and 35.0 (25.0–55.0) in the non-anemic group; P&lt;0.0001. Patients with anemia had a lower BMI z-score [median (IQR) -0.84 (-1.84 - 0.08)] than the non-anemic patients [median (IQR) -0.38 (-1.21 - 0.43)]; P&lt;0.001. The prevalence of anemia correlated significantly with disease location: upper intestinal involvement [L4a(67.7%) L4b(63.6%) L4aL4b(60.7%) none (52.8%)] P = 0.024 for CD; for UC [E1(21.1%) E2(44.4%) E3(75.0%) E4 (71.1%)] P&lt;0.0001. A moderate correlation was found between Hb levels and C-reactive protein (r= -0.312, 95% CI: -0.378 to -0.243, P&lt;0.0001).

Conclusions
Anemia remains a prevalent symptom in pediatric patients with IBD, and it is correlated with the extent of intestinal involvement and disease severity. The impact of anemia at Diagnosis and during follow-up on the levels of quality of life and physical activity is currently under investigation.

Funding Agencies
None
A259 HIGH-FAT/HIGH-CHOLESTEROL DIETS PREDISPOSE THE HOST TO EXACERBATED ENTERIC INFECTIONS
Authors: Valdes J , Armas A , Gagné Sansfaçon J , Reyes-Nicolas V , Rivard N , Marrero G , Perreault N , Menendez A 
Published: February 2020

Abstract

Background
High-fat/high-cholesterol diets are a well established risk factor for cardiovascular and metabolic diseases, given their propensity to trigger perturbations ranging from altering whole body lipid profile to the induction of intestinal dysbiosis. However much less is known about their effects on the host’s susceptibility to enteric infections.

Aims
To determine the effects of high-fat/high-cholesterol diets over the host’s susceptibility to enteric bacterial infections and identify the underlying molecular mechanisms.

Methods
C57BL/6 mice were given two different high-fat/high-cholesterol diets; HFHC (40% kcal fat, 1.25% cholesterol) or HFHCC (40% kcal fat, 1.25% cholesterol, 0.5% sodium cholate) and a control, normal diet (ND, 10% kcal fat, 0% cholesterol, 0% sodium cholate). After four weeks of administration, animals were euthanized and colonic tissue samples taken for histology, immunofluorescence, gene expression analyses, total protein lysates and microbiome sequencing (16S). A separated group of animals was gavaged with FITC-dextran to measure intestinal permeability. Mice fed with the diets for three weeks were infected with ~5x108 cfu of Citrobacter rodentium DBS100/StrpR by oral gavage, and kept on the corresponding diets after the infections. Bacterial shedding in the feces was followed for up to 30 days after infection.

Results
Administration of the HFHC and HFHCC diets caused an increase in intestinal permeability. Colonic sections stained with H&E and alcian blue evidenced a decreased in the number of mucin-filled goblet cells and a thinner mucus layer, suggesting a defect in the assembly and/or stability of the mucus layer. Expression analyses revealed a drop in the mRNA levels of Muc1 and Muc2, suggesting reduced mucin production. The concentration of IgA was slightly reduced in colon lysates and the transcript levels of the antimicrobial peptide genes Ang4, Leap2 and Cramp were also significantly reduced. Immunofluorescent microscopy showed that goblet cell granules of HFHC- and HFHCC-fed mice were devoid of Relmβ and Tff3, indicating defective production of those two factors critical for intestinal epithelial defense and homeostasis. Collectively, our results suggest that HFHC and HFHCC diets induce differentiation and functional defects in goblet cells. Fecal shedding of C. rodentium showed an increased bacterial burden in HFHC- and HFHCC-fed animals, indicating a more aggressive bacterial infection, accompanied by increased epithelial damage.

Conclusions
Consumption of high-fat/high cholesterol diets perturb the colonic homeostasis and alter intestinal defenses and the integrity of the intestinal barrier, predisposing the host to a higher susceptibility to enteric infections.

Funding Agencies
CIHRNSERC
A268 PREOPERATIVE EUS-GUIDED FNA IS ASSOCIATED WITH BETTER OVERALL SURVIVAL IN RESECTABLE PANCREATIC CANCER WHEN COMPARED TO UPFRONT SURGERY WITHOUT PREOPERATIVE TISSUE ACQUISITION: A SYSTEMIC REVIEW AND META-ANALYSIS
Authors: Alghamdi A , Palmieri V , Alotaibi N , Martel M , Barkun A N , Zogopoulos G , Chaudhury P , Chen Y 
Published: February 2020

Abstract

Background
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the standard of care in advanced pancreatic cancer. In resectable disease, preoperative EUS-FNA can help to identify benign etiology and other cancers while preventing unnecessary surgery. However, concerns regarding tumor seeding and pancreatitis have led some experts to advocate for upfront surgery without tissue sampling.

Aims
To conduct a systematic review and meta-analysis of the risks and benefits of performing pre-operative EUS-FNA in patients with suspected, resectable pancreatic cancer.

Methods
A literature search was performed up to April 2019 using MEDLINE, EMBASE, and ISI Web of Knowledge databases with terms specified for pancreatic neoplasm and FNA. All fully published adult studies that compared preoperative EUS-FNA to EUS without FNA in resectable pancreatic cancer for short- and long-term outcomes were included. Results were reported as Odds ratios (OR) or weighted mean differences (WMD) with 95% confidence intervals (CI) using a random effects model. Heterogeneity, publication bias and quality of studies were evaluated. Sensitivity analyses were performed. The primary outcome is overall survival. Secondary outcomes include cancer free survival, tumor recurrence and seeding, and post FNA adverse events.

Results
An initial search yielded 2814 citations. Six retrospective studies were included with 1155 patients in the EUS-FNA group vs 2067 patients in the comparator group. Overall survival was reported in three studies (n=2701: 796 EUS-FNA, 1905 non-FNA). Patients with preoperative EUS-FNA had better overall survival compared to the non-FNA group (WMD, 4.40 months [0.02 to 8.78]). In adenocarcinoma patients (2 studies, n=2050), there was no significant difference in overall survival (WMD, 2.94 months [-3.87 to 9.74]). Cancer-free survival did not differ significantly between the two groups (WMD, 2.08 months [-2.22 to 6.38]). Moreover, EUS with FNA was not associated with increased rates of tumor recurrence (OR, 0.55 [0.30–1.02]) or peritoneal carcinomatosis (OR, 0.81 [0.56–1.18]). Post-FNA pancreatitis was rare (1.7%), with all patients treated conservatively. Sensitivity analyses yielded similar findings across the different outcomes tested.

Conclusions
In this meta-analysis, preoperative EUS-FNA in resectable pancreatic cancer was associated with significantly greater overall survival when compared to the non-FNA group with no significant difference in rate of tumour recurrence and/or peritoneal seeding. These findings are limited by the retrospective nature of the included studies; randomized controlled trials are needed to confirm these results.

Funding Agencies
None
A271 ETIOLOGICAL CHARACTERIZATION OF DRUG-INDUCED ACUTE PANCREATITIS
Authors: Gagnon A , Lavoie A , Frigon M , Michaud-Herbst A , Tremblay K 
Published: February 2020

Abstract

Background
Drugs are considered a relatively rare and understudied cause of acute pancreatitis (AP). The lack of convincing and conclusive data on drug-induced AP (DIAP) complicates the diagnosis as well as the identification of the causative drug.

Aims
We hypothesized that documenting the causes of DIAP in the Saguenay-Lac-Saint-Jean (SLSJ) will add new evidence to the current literature and will provide a comprehensive picture of this health condition in the region. The aim of this study is to document causes of DIAP cases that occurred in the SLSJ population.

Methods
We have conducted a retrospective and descriptive population-based study of DIAP cases that occurred between 2006 and 2014 in the six hospitals deserving the SLSJ entire population. Cases were selected from the Quebec Ministry of Health hospitalizations registry (MED-ECHO) administrative public database. Medical chart review was performed in attempt to characterize DIAP hospitalizations and to identify the imputable drugs.

Results
During the studied period, 75 cases (30.7% male, 69.3% female) were included totalling 90 hospitalizations for DIAP. Among them, 51 causative drugs were identified and were distributed in 17 different drug classes. Recurrent DIAP were documented in 13 cases and among them, 6 cases have experimented positive rechallenge. Six drugs (5-fluorouracil, atorvastatin, bortezomib, nilotinib, rosuvastatin and triamcinolone) were associated with the highest degree of evidence. The most common causative drugs of DIAP hospitalization were azathioprine (n = 7), followed by atorvastatin (n =6), hydrochlorothiazide (n = 5), rosuvastatin (n = 4) and codeine (n = 4).

Conclusions
This study has added new evidences about potentially pancreatitis-associated drugs in literature. This is the first study to report definite 5-fluorouracil and triamcinolone-induced AP. An updated version of the evidence-based literature review is needed to support the clinicians in the identification of the causative drugs.

Funding Agencies
None
A276 TOTAL PANCREATIC LIPOMATOSIS AND EXOCRINE PANCREATIC INSUFFICIENCY IN A PATIENT WITH CELIAC DISEASE: AN UNUSUAL ENTITY
Authors: Nassiri S , Tomaszewski M , Ou G 
Published: February 2020

Abstract

Background
Exocrine pancreatic insufficiency (EPI) is characterized by maldigestion and malabsorption of nutrients and is most commonly caused by diseases of the pancreatic parenchyma including chronic pancreatitis and cystic fibrosis (CF). However, EPI is also observed in other conditions including celiac disease (CD).

Aims
We report a case of EPI in a patient with CD found to have total fatty replacement of the pancreas.

Methods
A case report and review of the literature were performed.

Results
Case Report:
A 42-year-old man with CD on gluten-free diet (GFD) presented with a two-year history of increasing bowel frequency (4–6 times daily) and steatorrhea. Quantitative fecal fat over 72 hours confirmed fecal fat excretion of 101g/day; N &lt; 7g) and total stool weight of 3761g. Nadir weight was 67.6 kg. There was a dramatic response to pancreatic enzyme replacement therapy (PERT) with marked improvement in bowel habits and weight gain to 74.8 kg over half a year. There is no history of pancreatitis, abdominal pain or alcohol abuse. He does not smoke but drinks 1–2 units of alcohol per week at most. Family history is negative for pancreatitis and pancreatic malignancy. On examination, following PERT, the patient appeared well-developed and nourished. He did not have clinical features or biochemical evidence of fat-soluble vitamin deficiency following PERT.
Anti-tTG was equivocal (7.6 U/mL; N &lt; 7 U/mL). IgG subclasses were normal. Chromogranin was mildly elevated (100mcg/L; N &lt; 94mcg/L), but gastrin (15ng/L) and 24-hour urine for 5-hydroxyindoleacetate [5-HIAA] (23umol/d) were normal. Endoscopic evaluations including upper endoscopy, colonoscopy, and capsule endoscopy demonstrated intact duodenal villous architecture without inflammation, no microscopic colitis, and no small bowel mucosal disease, respectively.
CT of the abdomen revealed total fatty replacement of the pancreas with no pancreatic parenchyma (Figure 1). Sweat sodium test was positive (67 mmol/L, N &lt; 60 mmol/L) but CFTR gene sequencing was negative. There was no evidence of diabetes, hyperlipidemia, hyperferritinemia, Cushing’s syndrome, or hepatic disease on biochemical investigations.
Literature Review:
Total pancreatic lipomatosis (TPL), or fatty replacement of the pancreas, is a rare cause of EPI which leads to maldigestion, malabsorption, and malnutrition. The pathogenesis of TPL is poorly understood but predisposing factors include obesity, diabetes mellitus, hyperlipidemia, malnutrition, Cushing’s syndrome, hemochromatosis, chronic pancreatitis and CF. EPI can also manifest in patients with CD due to active small bowel inflammation or chronic pancreatitis. Last but not least, there appears to be higher prevalence of CD in CF patients.

Conclusions
Persistent steatorrhea with weight loss despite GFD in patients with CD should prompt other considerations of EPI and trial of PERT.

Funding Agencies
None
Who can benefit from a lymph node boost in definitive chemoradiotherapy for node-positive cervical cancer: an evaluation of nodal failure in patients without nodal boost
Authors: Kim Haeyoung , Park Won , Cho Won Kyung 
Published: February 2020

Abstract
This study was performed to identify risk factors for pelvic nodal failure (PNF) after definitive concurrent chemo-radiotherapy (CCRT) in patients with metastatic pelvic lymph nodes (mPLNs) from squamous cell carcinoma (SCC) of the cervix. We retrospectively reviewed data on 80 patients who received definitive CCRT between 2005 and 2014 at our hospital. All patients underwent brachytherapy and whole-pelvic radiotherapy (WPRT) without nodal boost. mPLNs was diagnosed by magnetic resonance imaging and positron emission tomography. The rate of PNF and factors affecting PNF were analysed. A total of 156 mPLNs were found. The median number of mPLNs was 2 per patient (range 1–6); the median short diameter was 1.7 cm (range 1.0–4.2 cm). After a median follow-up of 64 months, 10 (6.4%) mPLNs failed in 13 (16.3%) patients. The 5-year PNF-free survival (PNFFS), disease-free survival and overall survival rates were 83.4, 62.7 and 74.7%, respectively. The mPLN size was not associated with the risk of PNF. However, pre-radiotherapy SCC antigen (SCC-Ag) &gt;6.8 ng/mL and number of mPLNs &gt;2 were significant risk factors for PNF. Using the two risk factors, we categorized the patients into three risk groups. The 5-year PNFFS rates in patients with 0, 1 and 2 risk factors were 100.0, 78.3 and 44.4%, respectively (P &lt; 0.01). SCC-Ag level and number of mPLNs were significant factors for PNF. Patients with both risk factors developed frequent PNF after WPRT without nodal boost. The two risk factors can be a guide in deciding whether to administer nodal boost radiotherapy.
Variability and transient search in the SUDARE–VOICE field: a new method to extract the light curves
Authors: Liu Dezi , Deng Wenqiang , Fan Zuhui , Fu Liping , Covone Giovanni , Vaccari Mattia , Radovich Mario , Capaccioli Massimo , De Cicco Demetra , Grado Aniello , Marchetti Lucia , Napolitano Nicola , Paolillo Maurizio , Pignata Giuliano , Ragosta Fabio 
Published: February 2020

ABSTRACT
The VLT Survey Telescope (VST) Optical Imaging of the CDFS and ES1 Fields Survey, in synergy with the SUDARE survey, is a deep optical ugri imaging of the CDFS and ES1 fields using the VST. The observations for the CDFS field comprise about 4.38 deg2 down to r ∼ 26 mag. The total on-sky time spans over 4 yr in this field, distributed over four adjacent sub-fields. In this paper, we use the multiepoch r-band imaging data to measure the variability of the detected objects and search for transients. We perform careful astrometric and photometric calibrations and point spread function modelling. A new method, referring to as differential running-average photometry, is proposed to measure the light curves of the detected objects. With the method, the difference of PSFs between different epochs can be reduced, and the background fluctuations are also suppressed. Detailed uncertainty analysis and detrending corrections on the light curves are performed. We visually inspect the light curves to select variable objects, and present some objects with interesting light curves. Further investigation of these objects in combination with multiband data will be presented in our forthcoming paper.
The soft state of the black hole transient source MAXI J1820+070: emission from the edge of the plunge region?
Authors: Fabian A C , Buisson D J , Kosec P , Reynolds C S , Wilkins D R , Tomsick J A , Walton D J , Gandhi P , Altamirano D , Arzoumanian Z , Cackett E M , Dyda S , Garcia J A , Gendreau K C , Grefenstette B W , Homan J , Kara E , Ludlam R M , Miller J M , Steiner J F 
Published: February 2020

ABSTRACT
The Galactic black hole X-ray binary MAXI J1820+070 had a bright outburst in 2018 when it became the second brightest X-ray source in the sky. It was too bright for X-ray CCD instruments such as XMM–Newton and Chandra, but was well observed by photon-counting instruments such as Neutron star Inner Composition Explorer (NICER) and Nuclear Spectroscopic Telescope Array(NuSTAR). We report here on the discovery of an excess-emission component during the soft state. It is best modelled with a blackbody spectrum in addition to the regular disc emission, modelled as either diskbb or kerrbb. Its temperature varies from about 0.9 to 1.1 keV, which is about 30–80 per cent higher than the inner disc temperature of diskbb. Its flux varies between 4 and 12 per cent of the disc flux. Simulations of magnetized accretion discs have predicted the possibility of excess emission associated with a non-zero torque at the innermost stable circular orbit (ISCO) about the black hole, which, from other NuSTAR studies, lies at about 5 gravitational radii or about 60 km (for a black hole, mass is $8\, {\rm M}_{\odot }$). In this case, the emitting region at the ISCO has a width varying between 1.3 and 4.6 km and would encompass the start of the plunge region where matter begins to fall freely into the black hole.
Crystal structure of an Escherichia coli Hfq Core (residues 2–69)–DNA complex reveals multifunctional nucleic acid binding sites
Authors: Orans Jillian , Kovach Alexander R , Hoff Kirsten E , Horstmann Nicola M , Brennan Richard G 
Published: February 2020

Abstract
Hfq regulates bacterial gene expression post-transcriptionally by binding small RNAs and their target mRNAs, facilitating sRNA-mRNA annealing, typically resulting in translation inhibition and RNA turnover. Hfq is also found in the nucleoid and binds double-stranded (ds) DNA with a slight preference for A-tracts. Here, we present the crystal structure of the Escherichia coli Hfq Core bound to a 30 bp DNA, containing three 6 bp A-tracts. Although previously postulated to bind to the ‘distal’ face, three statistically disordered double stranded DNA molecules bind across the proximal face of the Hfq hexamer as parallel, straight rods with B-DNA like conformational properties. One DNA duplex spans the diameter of the hexamer and passes over the uridine-binding proximal-face pore, whereas the remaining DNA duplexes interact with the rims and serve as bridges between adjacent hexamers. Binding is sequence-independent with residues N13, R16, R17 and Q41 interacting exclusively with the DNA backbone. Atomic force microscopy data support the sequence-independent nature of the Hfq-DNA interaction and a role for Hfq in DNA compaction and nucleoid architecture. Our structure and nucleic acid-binding studies also provide insight into the mechanism of sequence-independent binding of Hfq to dsRNA stems, a function that is critical for proper riboregulation.