bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Small Bowel Ultrasound to Predict Response to Infliximab Induction in Pediatric Crohn’s Disease
Authors: Dolinger Michael T. , Choi Jungwhan J. , Phan Becky L. , Rosenberg Henrietta K. , Rowland John , Dubinsky Marla C. 
Published: May 2020

Goal:
The goal of this study was to explore the utility of small bowel ultrasound (SBUS) as a noninvasive tool to assess induction response to infliximab (IFX) in pediatric Crohn’s disease (CD).

Background:
Inflammatory bowel disease management has shifted to a treat-to-target and tight control strategy utilizing noninvasive serum and fecal markers to monitor disease activity in response to therapy. Bowel wall changes as seen on cross-sectional imaging may be a more accurate marker of treatment success.

Materials and Methods:
Pediatric patients with CD with small bowel involvement initiating IFX were prospectively enrolled. Clinical activity, biomarkers, and SBUS findings were evaluated at baseline (T0) and postinduction at week 14 (T1). The primary outcome was to describe the changes in SBUS parameters pre and post IFX induction and how they associate with clinical and biomarker response. Descriptive statistics summarized the data and univariate analysis tested associations.

Results:
All 13 CD patients achieved steroid-free clinical remission (P<0.001) and a decrease in C-reactive protein (P=0.01) postinduction. Bowel wall hyperemia (BWH) (P=0.01) and bowel segment length involved (P=0.07) decreased postinduction. Decrease in fecal calprotectin at T1 moderately correlated with a decrease in bowel segment length (r=0.57; P=0.04). No correlation was seen with a change in bowel wall thickness or BWH postinduction.

Conclusions:
Our pilot study suggests that SBUS is a feasible, noninvasive tool to measure early treatment response to IFX. BWH, not bowel wall thickness, is the first parameter to change. Larger longitudinal studies are warranted to validate the utility of SBUS as part of a disease monitoring strategy.
Role of antioxidants in the treatment of gastroesophageal reflux disease-associated idiopathic pulmonary fibrosis
Authors: Nelkine Lauryna , Vrolijk Misha F. , Drent Marjolein , Bast Aalt 
Published: May 2020

Purpose of review
Idiopathic pulmonary fibrosis (IPF) is a terminal lung disease of largely unknown cause. Gastroesophageal reflux disease (GERD) was recently discovered to be a trigger for the development of IPF. The current pharmaceutical approach to IPF falls short and there is a pressing need for improved therapeutic options. The present review describes the currently available knowledge regarding the role of oxidative stress and inflammation in the pathophysiology of IPF and GERD and determines the potential use of antioxidants as a treatment option for GERD-associated IPF.

Recent findings
IPF and GERD share a similar pathophysiology, as oxidative stress and inflammation play a pivotal role in both conditions. This raises the question whether antioxidant treatment could be a well-tolerated and effective means to alleviate at least some of the symptoms of both conditions. In IPF, antioxidant supplementation complements the inadequately working antioxidant defense system of the lung, reducing oxidative stress and inflammation. In GERD, antioxidants increase levels of endogenous antioxidants, decrease pepsin and gastric acid production, lipid peroxidation, and ulceration, and alleviate subsequent damage to the gastric mucosa.

Summary
The increased comorbidity of GERD in IPF patients makes it clear that there is a connection between GERD and IPF. As current treatment options are still inadequate to improve the condition and increase the survival rate of IPF patients, alternative treatment options are crucial. Based on the reviewed scientific evidence, antioxidant supplementation could complement standard IPF treatment, certainly in GERD-associated IPF.
Albumin–bilirubin score is associated with in-hospital mortality in critically ill patients with acute pancreatitis
Authors: Shi Lin , Zhang Dan , Zhang Jie 
Published: May 2020

Objective
Acute pancreatitis is one of the most common causes of inpatient care among gastrointestinal conditions. Few easy and commodious biomarkers are used in clinical practice to predict the prognosis of patients with acute pancreatitis. This study was aimed at examining the association of albumin–bilirubin (ALBI) score and in-hospital mortality in critically ill patients with acute pancreatitis.

Methods
We enrolled all critically ill patients with acute pancreatitis retrospectively in Monitoring in Intensive Care Database III database. Clinical data and demographic information were collected for each patient in our study. Multivariate logistic regression models and smooth curve fitting were used to determine whether ALBI score could be an independent indicator for the prognosis of patients with acute pancreatitis. Predictive performance of ALBI was assessed by receiver operating characteristic analysis.

Results
A total of 284 patients with acute pancreatitis met the inclusion criteria, and 35 patients died in hospital. The ALBI in nonsurvived group was much higher than survived group (−1.0 vs. −1.5; P < 0.001). The association of ALBI and in-hospital mortality was almost linear by smooth curve fitting (P < 0.001) and positive associations were observed between ALBI and RDW and WBC in patients with acute pancreatitis. Multivariate logistic regression indicated ALBI could be independent risk factors to predict the prognosis of patients with acute pancreatitis (odds ratios = 1.60; P = 0.02). The area under curve of in-hospital mortality prediction (0.86; P < 0.001) were superior to Sequential Organ Failure Assessment (SOFA) score (0.72; P < 0.001), Simplified Acute Physiology Score II (SAPS-II) (0.71; P < 0.001), Acute Physiology and Chronic Health Evaluation II (APACHE-II, 0.83; P < 0.001), Ranson score (0.75; P < 0.001) and Glasgow score (0.72; P < 0.001).

Conclusion
ALBI could be a useful marker of in-hospital mortality for patients with acute pancreatitis, which was better than SOFA, SAPS-II, APACHE-II, Ranson score and Glasgow score in our study.
Magnifying endoscopy with narrow-band image for diagnosing diffuse type of gastric antral vascular ectasia in cirrhotic patients
Authors: Chang Chung-Yu , Chen Ping-Hsien , Hou Ming-Chih , Chang Wei-Chin , Yang Tsung-Chieh , Hsin I-Fang , Liao Wei-Chih , Lee Fa-Yauh 
Published: May 2020

Objective
Gastric antral vascular ectasia (GAVE) and portal hypertensive gastropathy (PHG) can cause gastrointestinal bleeding in cirrhotic patients. Distinguishing diffuse-type GAVE and severe PHG is important but difficult by conventional endoscopy and endoscopic biopsy. The aim of this study is to evaluate the value of magnifying endoscopy with narrow-band image for diagnosing diffuse-type GAVE in cirrhotic patients.

Methods
From January 2010 to December 2013, cirrhotic patients with diffuse red spots of stomach in suspicion of diffuse-type GAVE on conventional endoscopy in a tertiary medical center were included. The detection of diffuse red spots on magnifying endoscopy with narrow-band image (NBI) was classified into ring-pattern which suggested GAVE and mosaic-pattern which suggested non-GAVE. The golden diagnosis of GAVE was based on histological criteria of GAVE score ≥3 by any one of two endoscopic sessions.

Results
Total 27 cirrhotic patients were included. Twenty-two patients reached the diagnosis of GAVE and five patients were diagnosed of non-GAVE by histology. The diagnostic rate of conventional endoscopy was 81.5% (22/27). The positive rate of initial endoscopic biopsy was 77.2%. On magnifying endoscopy with NBI, the sensitivity, specificity, positive, negative predicted rate and accuracy of ring-pattern for the diagnosis of GAVE were 100, 90, 96.4, 100 and 97.3%. Kappa coefficient of inter-observer agreement for differentiating the ring and mosaic-pattern was 0.92.

Conclusions
The efficacy and accuracy of magnifying endoscopy with NBI for diagnosing diffuse-type GAVE in cirrhotic patients have been demonstrated. It can avoid repeated endoscopy to confirm diagnosis and obviate the invasive biopsy in cirrhotic patients.
Challenging diagnosis of gastrointestinal tuberculosis made simpler with multi-targeted loop-mediated isothermal amplification assay
Authors: Sharma Megha , Sinha Saroj Kant , Sharma Megha , Singh Anupam Kumar , Samanta Jayanta , Sharma Aman , Kochhar Rakesh , Sharma Kusum 
Published: May 2020

Background
Prompt and accurate diagnosis of gastrointestinal tuberculosis (GITB) is highly challenging. Current conventional techniques lack sensitivity and are time-consuming. Multi targeted loop-mediated isothermal amplification (LAMP) using two targets (IS6110 and MPB64) is a promising technique for rapid diagnosis of TB.

Methods
LAMP test using IS6110 and MPB64 targets for M. tuberculosis complex was performed on ileocecal biopsy samples of 35 clinically suspected patients of GITB and 30 ileocecal biopsy samples of non-tuberculosis control subjects. Results of IS6110 LAMP and MPB64 LAMP were compared with IS6110 PCR and culture

Inference
Overall LAMP test (using any of the two targets) had a sensitivity and specificity of 100 and 100%, respectively, for confirmed GITB (five culture positive) cases and 85.71 and 100%, respectively, for clinically suspected 30 ileocecal biopsy samples of GITB. Sensitivity of IS6110 LAMP, MPB64 LAMP and IS6110 PCR for clinically suspected cases was 22 (73.33%), 24 (80%) and 21 (70%), respectively. In total 35 GITB patients, the overall sensitivity of microscopy, culture, IS6110 PCR, IS6110 LAMP, MPB64 LAMP and the multi-targeted LAMP assay (if any of the two targets were used) were 5.71, 14.28, 68.57, 74.28, 82.85 and 85.71%, respectively. Specificity of all the tests was 100%. There were three cases which were missed by IS6110 LAMP and two cases by MPB64 LAMP.

Conclusion
Multi-targeted LAMP is a promising technique for rapid and accurate diagnosis of GITB.
Gastroenterologists’ preference and risk perception on the use of immunomodulators and biological therapies in elderly patients with ulcerative colitis: an international survey
Authors: Chan Webber , Kariyawasam Viraj C. , Kim Shin , Pudipeddi Aviv V. , Paramsothy Sudarshan , Shim Hang Hock , Mourad Fadi H. , Ding Nik , Ferrante Marc , Leong Rupert W. 
Published: May 2020

Background and aims:
Comorbidities, polypharmacy, malignancies, and infections complicate management of elderly patients with inflammatory bowel diseases (IBD). This study assessed gastroenterologists’ preference in the prescription of medications or surgery to elderly patients with IBD, and the factors associated with their choices.

Methods
An international case-based survey was conducted that presented three cases of steroid-dependent ulcerative colitis assessing young-age versus elderly-age patients, with and without comorbidity. Physician characteristics and practice demographics were collected. Factors associated with selection of different choices of therapy were determined by logistic regression analysis.

Results
A total of 424 respondents from 41 countries were included. Vedolizumab (53.2%) and thiopurines (19.4%) were the top treatment preferences for moderate-to-severe ulcerative colitis (P < 0.0001). Comorbidity and older age were independently associated with more frequent use of vedolizumab (P < 0.0001), and less frequent use of immunomodulators and anti-tumour necrosis factor (TNF; P < 0.0001). Comorbidity was the only independent predictor for selecting colectomy (P < 0.0001). A history of lymphoma (94%) and opportunistic infection (78.3%) were the most frequent conditions precluding the use of thiopurine and anti-TNF in elderly patients with IBD. Only 6.1% of respondents considered patient age a limit for vedolizumab, while 37.9% considered age as a limiting factor in prescribing thiopurines (P < 0.001). Geographical heterogeneity was identified with significantly more physicians from Oceania and North America favouring the use of vedolizumab.

Conclusion
Vedolizumab was the preferred first-line agent in the treatment of elderly patients with IBD with steroid-dependent moderate-to-severe ulcerative colitis. Older age and presence of comorbidity influenced the selection of medication. Comorbidity was the main predictor of colectomy. Geographical heterogeneity in prescribing habits may relate to medication reimbursement in individual countries.
Comparison of Single-Dose and Extended-Duration Empiric Aminoglycoside Combination Therapy in Patients With Septic Shock
Authors: Sacha Gretchen L. , Srinivas Pavithra , Lam Simon W. , Bass Stephanie N. 
Published: May 2020

Background:
Empiric combination antimicrobial therapy is often used in patients with decompensating septic shock. However, the optimal duration of combination therapy is unknown.

Study Question:
The goal of this study was to compare the clinical effects of a single dose of an aminoglycoside to an extended duration of aminoglycosides for combination therapy in patients with septic shock without renal dysfunction.

Study Design:
Retrospective, single-center evaluation of patients with septic shock who received empiric combination therapy with an aminoglycoside.

Measures and Outcomes:
Two patient cohorts were evaluated: those who received a single dose of an aminoglycoside and those who received more than 1 dose of an aminoglycoside. The primary outcome was shock-free days at day 14. Secondary outcomes included mortality, length of stay, clinical cure, and nephrotoxicity. A post hoc subgroup analysis including only patients who received more than 2 doses of an aminoglycoside compared with a single dose was conducted.

Results:
One hundred fifty-one patients were included in this evaluation, 94 in the single-dose aminoglycoside group and 57 in the extended duration group. There was no difference in shock-free days at day 14 between patients who received a single dose of an aminoglycoside or those who received an extended duration (12.0 vs. 11.6 days; P = 0.56). There were no differences in mortality, length of stay, clinical cure rates, or rates of nephrotoxicity between groups (28% for single dose vs. 26% for extended duration; P = 0.86). No differences in outcomes were detected when evaluating patients who received more than 2 doses of an aminoglycoside compared with a single dose.

Conclusions:
Patients with septic shock and normal renal function who received a single dose of an aminoglycoside for combination antimicrobial therapy had no differences detected in shock duration or nephrotoxicity development compared with those who received an extended duration of aminoglycoside combination therapy.
In vivo and ex vivo haematopoietic stem cell expansion
Authors: Yamamoto Ryo , Wilkinson Adam C. , Nakauchi Hiromitsu 
Published: May 2020

Purpose of review
Haematopoietic stem cells (HSCs) are characterized by two key features: self-renewal ability and multilineage differentiation potential. Through these cellular activities, HSCs sustain blood and immune system homeostasis throughout life and can also reconstitute the entire haematopoietic system within a bone marrow ablated recipient. This approach of HSC transplantation is used clinically as a curative treatment option for numerous haematological diseases, both malignant and nonmalignant.

Recent findings
Elucidation of the mechanism of HSC expansion represents a major focus within haematology. Here, we review the recent progress towards understanding HSC expansion in vivo and ex vivo, including a discussion of recent clonal transplantation assays and the development of novel ex vivo culture systems.

Summary
Recent findings provide exciting promise for improving the safety and efficacy of current HSC-based therapies as well as for the development of new therapeutic paradigms.
Artificial neural network and bioavailability of the immunosuppression drug
Authors: Naushad Shaik Mohammad , Kutala Vijay Kumar 
Published: May 2020

Purpose of review
The success of organ transplant is determined by number of demographic, clinical, immunological and genetic variables. Artificial intelligence tools, such as artificial neural networks (ANNs) or classification and regression trees (CART) can handle multiple independent variables and predict the dependent variables by deducing the complex nonlinear relationships between variables.

Recent findings
In the last two decades, several researchers employed these tools to identify donor-recipient matching pairs, to optimize immunosuppressant doses, to predict allograft survival and to minimize adverse drug reactions. These models showed better performance characteristics than the empirical dosing strategies in terms of sensitivity, specificity, overall accuracy, or area under the curve of receiver-operating characteristic curves. The performance of the models was dependent directly on the input variables. Recent studies identified protein biomarkers and pharmacogenetic determinants of immunosuppressants as additional variables that increase the precision in prediction. Accessibility of medical records, proper follow-up of transplant cases, deep understanding of pharmacokinetic and pharmacodynamic pathways of immunosuppressant drugs coupled with genomic and proteomic markers are essential in developing an effective artificial intelligence platform for transplantation.

Summary
Artificial intelligence has a greater clinical utility both in pretransplantation and posttransplantation periods to get favourable clinical outcomes, thus ensuring successful graft survival.
Female neurogenic stress urinary incontinence
Authors: Farag Fawzy , Doherty Ruth , Arlandis Salvador 
Published: May 2020

Purpose of review
The aim of this article is to look into recent updates on the management of neurogenic stress urinary incontinence (NSUI) in adult females.

Recent findings
Recently, a small number of studies have investigated different surgical modalities in treatment of NSUI in adult females including artificial urinary sphincter (AUS), suburethral tapes (SUT) and adjustable slings and urethral bulking agents. Up to 70% of neurogenic patients who received AUS implants are continent and have not required surgical revision over a 20-year follow-up period. However, the risk for explantation of AUS may be twice as high in neurogenic patients compared with nonneurogenic patients. SUT have success and improvement in quality of life rates of up to 52 and 68%, respectively. However, complications may be as high as 24%. Early data on adjustable slings may suggest up to 80% continence with low complication rates.

Summary
AUS can provide satisfactory continence levels with acceptable rates of revision and explantation. SUT are effective but more than half of patients may require additional procedures. Adjustable slings could be a promising option. Further high-quality studies with careful attention to methodology and standardization of both definitions used and outcome reporting are required to help us reach safe conclusions.
The Evolving Role of the Professional Case Manager
Authors: Tahan Hussein M. , Kurland MaryBeth , Baker Michelle 
Published: May 2020

Purpose:
The purpose of the national role and function study was to identify the essential activities and necessary knowledge areas for effective professional case management practice from the perspective of those directly involved. The study also aimed to inform the relevance and currency of the blueprint for the case management certification examination.

Primary Practice Settings:
The national study covered the diverse case management practices and/or work settings across the full continuum of health and human services and numerous professional disciplines.

Methodology and Sample:
This cross-sectional descriptive study used the practice analysis method and online survey research design. It employed a purposive sample of 2,810 certified and not yet certified case managers who responded to an open participation link made available as an online survey. The final study sample supported the conduct of meaningful statistical analyses including multiple subgroup comparisons.

Results:
The study identified the common activities (6 domains) and knowledge areas (5 domains) necessary for effective performance by professional case managers. Part I of this 2-part article series described the background of the participants and their perspectives of the practice and the knowledge applied by those responsible for the case manager's role. Part II, as shared in this article, reports on the factor/principal component analysis and how such activity informed the needed update of the test specifications for the Certified Case Manager (CCM) certification examination. The update reflects the continued evolution of the professional case management practice and ensures that the examination remains current and relevant. Of special note is the maturation of the case management practice; for example, greater emphasis on quality, safety, and outcomes; baccalaureate or higher education; and recognition of the value of certification. In addition, the 2019 role and function study has revealed that utilization review/management is evolving potentially as a function that is separate from that of the case manager.

Implications for Case Management Practice:
The study has identified the essential activities and knowledge areas of case management practice at both the micro and macro levels. These findings represent the substantive evidence of practice, keeping the CCM credentialing examination evidence-based and maintaining its validity for evaluating the competency of professional case managers. They have also documented the evolution of the practice over the past 5 years. Moreover, the findings may inform the development of programs and curricula for the training and advancement of case managers. The study instrument also is beneficial for use in further research into professional case management practice.
Reliability and Concurrent Validity of Life Space Assessment in Individuals With Vestibular Disorders
Authors: Alshebber Kefah M. , Dunlap Pamela M. , Whitney Susan L. 
Published: May 2020

Background and Purpose:
The Life Space Assessment (LSA) is a self-report measure that allows clinicians to determine how often someone moves around in his or her environment with or without assistance. Presently, there are no reliable and valid measures that capture all 3 aspects of mobility (ie, mobility frequency, distance, and assistance needed) for individuals with vestibular disorders. The purpose of this study was to describe life space and to determine the reliability and concurrent validity of the LSA as a tool to measure mobility and function in individuals with balance and vestibular disorders.

Methods:
One hundred twenty-eight participants (mean age of 55 ± 16.7 years) experiencing dizziness or imbalance who were seeking the care of an otoneurologist were recruited. Participants completed the LSA, Dizziness Handicap Inventory (DHI), and the 12-Item Short Form Health Survey (SF-12).

Results:
The mean LSA score of the sample was 75/120 ± 30. The LSA demonstrated excellent test-retest reliability (intraclass correlation coefficient = 0.91). The LSA was negatively correlated with the DHI total score (ρ = −0.326, P < 0.01), DHI physical subscore (ρ = −0.229, P = 0.02), DHI functional subscore (ρ = −0.406, P < 0.01), and DHI emotional subscore (ρ = −0.282, P < 0.01). The LSA was positively correlated with both the physical (ρ = 0.422, P < 0.01) and mental (ρ = 0.362, P < 0.01) composite scores of the SF-12.

Discussion and Conclusions:
Similar to the findings in community-dwelling older adults, the LSA demonstrated excellent test-retest and internal consistency in individuals with vestibular disorders. The LSA is a valid and reliable tool for measuring mobility and function in individuals with vestibular disorders.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A317).