bluuebunny/crossref_metadata_2025_split huggingface dataset:
A NOVEL APPROACH TO THE ENDOSCOPIC REPAIR OF AN ENTEROCUTANEOUS FISTULA IN A PATIENT WITH CROHN’S DISEASE
Authors: McKay Cortney , Brown Patrick , Schairer Jason 
Published: January 2021

Abstract

Introduction
Enterocutaneous fistula (ECF) is an abnormal connection that develops anywhere between the gastrointestinal tract and the skin. Fistulae most commonly occur in the context of inflammatory bowel disease. Standard definitive management involves surgery and biologic therapy. We present a case of an ECF treated with endoscopic and medical management.

Case Presentation
A 34-year-old man with Crohn’s disease with prior colectomy and ileorectal anastomosis presented with abdominal pain. CT enterography demonstrated a fistulous tract from the bowel to the anterior abdominal wall concerning for ECF. He subsequently underwent sigmoidoscopy with confirmation of ECF on the ileal side of his anastomosis. He was started on metronidazole 500 mg three times a day, azathioprine at 175 mg daily, and adalimumab 40 mg every other week in attempts to close the fistulous tract, however the patient reported continued drainage. Surgical correction was offered. However, in attempts to avoid surgical resection, he underwent sigmoidoscopy, where the tract was identified. A cytology brush was introduced into the fistula and used to irritate the epithelial layer to promote scarring. Next, doxycycline was injected through a scleroneedle into the track as a sclerosing agent. Argon plasma coagulation (APC) of the fistula internal os and surrounding tissue was performed, followed by deployment of 2 hemoclips to promote closure of the internal os. Initially there was closure but 2 months later there was recurrence of ECF. Sigmoidoscopy was repeated with administration of doxycycline to sclerose the tract, followed by APC to the tissue adjacent to the internal os, and the placement of a hemoclip to oppose the tissue around the internal os. Following endoscopic treatment, the patient’s ECF has remained healed. Since ECF closure, he has been in endoscopic and clinical remission for over 4 years.

Discussion
This approach was successful in the treatment of ECF. Doxycycline has been used for treatment of recurrent pleural effusions, lymphatic malformations and lymphoceles due to its sclerosing properties. Mechanism of action is unknown, but it is believed to be due to the induction of an inflammatory reaction that results in fibrosis and ablation of endothelial-lined cavities. APC has been used in the treatment of gastrointestinal conditions, including angiodysplasias and colonic polyps post polypectomy. There is limited evidence discussing its effectiveness of endoscopic fistulous repairs.
Our experience reviews that the combination of biologic therapy and endoscopic therapeutic options are a successful option in the treatment of ECF. While surgical resection remains a treatment option, patient’s typically favor less invasive strategies. Further studies should investigate endoscopic closure of fistulous tracts in order to provide more treatment modalities to our patients.
AMERICAN GASTROENTEROLOGICAL ASSOCIATION’S QUALITY LEADERSHIP COUNCIL’S PRACTICE WORK GROUP: A NATIONWIDE INITIATIVE TO REDUCE THE USE OF PRESCRIPTION OPIOID AMONG PATIENTS WITH INFLAMMATORY BOWEL DISEASE AT A LOCAL LEVEL
Authors: Siva Shivi , Tse Chung Sang , Coelho-Prabhu Nayantara , Jain Rajeev 
Published: January 2021

Abstract

Background and aims
The use of opioids among patients with inflammatory bowel disease (IBD) in the United States is increasing and it is associated with higher mortality, re-admissions, healthcare utilization, and disability. The American Gastroenterological Association’s (AGA) Quality Leadership Council’s practice workgroup developed educational materials to educate and modify narcotic prescribing habits of providers treating IBD and change the attitudes and expectations of patients who require analgesics.

Methods
Council members participated in two 1-hour virtual planning meetings to develop a key driver diagram to illustrate the aims, theories to achieve the aims, and specific action items to change ideas of opioid prescribing practices. Four working groups were created to perform a literature search and create educational resources for providers and patients regarding the risks of opioid use and non-opioid alternatives for pain management. The educational resources were reviewed by the Crohn’s and Colitis Foundation prior to online publication electronic and dissemination to the AGA membership.

Results
We developed a key driver diagram (Figure 1) to illustrate the components of promoting non-opioid pain management in patients with IBD. Educational materials were developed to 1) Delineate the risk factors for opioid abuse among patients with IBD to prescribers of a controlled substance including; Crohn’s disease, functional gastrointestinal disorders, anxiety, depression, female sex, a history of narcotic abuse, ≥2 previous surgeries, moderate to severe pain, clinical disease activity, sexual, emotional and physical abuse, 2) Recommend alternative therapies for opioids including medications and non-pharmacological treatment alternatives (Table 1), 3) Address salient key points that patients should discuss with their provider if an opioid is prescribed including complications associated with prolonged use of narcotic medications, and 4) Illustrate alternate medical therapy and other techniques for patients including yoga and mindfulness-based techniques, cognitive behavioral therapy, and medical hypnosis.

Conclusions
Using quality improvement methods, we developed educational materials for patients with IBD and providers treating IBD on opioid avoidance and non-opioid alternative therapy utilizing an evidence-based approach.
GUT-DIRECTED SELF-HYPNOSIS FOR INFLAMMATORY BOWEL DISEASE PROTOCOL: COMPLIMENTARY PSYCHOTHERAPY FOR REMISSION AUGMENTATION, IBS-LIKE SYMPTOMS, AND SURGERY RECOVERY
Authors: Paulton Joshua , Gill Amanjot , Prevost Joelle 
Published: January 2021

Abstract

Background
Gut-directed hypnosis (GDH) is a complimentary therapy for Inflammatory Bowel Disease (IBD), that can be learnt by patients to practice self-hypnosis. GDH in IBD has augmented remission and improved inflammation. GDH has a history of successful use for Irritable Bowel Syndrome (IBS). In IBD it may also improve IBS-like symptoms in remission and recovery from surgery. GDH is suitable for youth and adult IBD patients. In hypnosis, a relaxed state is inducted then suggestions to subconscious mind processes are made. In IBD, the mechanism of action of GDH is unknown but may influence the disease stress response.

Aims
Aims are the development of a GDH self-hypnosis protocol for IBD, with appropriate target symptoms. Patients first learn to practice with a clinician, then as complimentary psychotherapy for remission augmentation, IBS-like symptoms, and surgery recovery.

Methods
GDH is practiced first with a clinician, and then by patients as self-hypnosis (table 1). Patients receive psycho-education on GDH for IBD. Next, appropriate treatment goals are made, based on target symptoms. Relaxation techniques induce patient to a deeply relaxed state. Therapeutic suggestions specific to patient goals are given: verbal suggestions, visualizations, and post-hypnotic suggestions. Suggestions can focus on having a healthy digestive system, inflammation and symptoms reduction, and achievement and sustainment of remission. Patients emerge from hypnosis, are debriefed, and encouraged to practice ongoing self-hypnosis.

Results
In IBD, GDH self-hypnosis can be learnt from clinicians and practiced by patients as a complimentary therapy. Patients’ achievement and sustainment of remission, with clinical markers of inflammation can be monitored. Patients can monitor subjective improvement of IBS-like symptoms and post surgery, recovery progress can be monitored.

Conclusions
GDH has a history of use for IBS. In IBD, it has been shown to modulate remission, and may improve IBS-like symptoms, and in surgery recovery. The mechanism of action of GDH in IBD may influence the disease stress response. Clinicians trained in GDH are limited currently. Patients may learn GDH self- hypnosis to as a complimentary psychotherapy.
SELF-COMPASSION IN ADOLESCENTS AND YOUNG ADULTS WITH INFLAMMATORY BOWEL DISEASE: RELATIONSHIP OF SELF-COMPASSION TO PSYCHOLOGICAL AND PHYSICAL OUTCOMES
Authors: Neiman Nicole , Yeh Ann Ming , Bensen Rachel , Sanjines Elvi , Wren Anava 
Published: January 2021

Abstract

Background
Adolescents and young adults (AYA) with Inflammatory Bowel Disease (IBD) are at increased risk for poor psychological and physical well-being. Self-compassion (i.e., understanding and acceptance towards oneself) has been associated with better psychological and physical outcomes in AYA with chronic health conditions. There is limited research exploring self-compassion in AYA with IBD.

Aims
To examine: 1) the reliability of a Self-Compassion Scale (SCS-SF), and 2) how self-compassion relates to physical (i.e., pain interference, fatigue) and psychological (i.e., stress, anxiety, depression) outcomes in a sample of AYA with IBD.

Methods
This study was a collaboration with ImproveCareNow, and all procedures were approved by Stanford’s Institutional Review Board. Study participants included 85 AYA (mean=18 yrs) with IBD (52% Crohn’s; 55% female; 61% White). Participants completed a one-time online survey. The internal reliability of SCS-SF was a = 0.88, indicating high internal consistency. Hierarchical linear regression (HLR) analyses examined the unique contribution of self-compassion to pain interference, fatigue, physical stress, psychological stress, anxiety, and depression after controlling for significant demographic and medical variables (sex, IBD diagnosis, mental health diagnosis).

Results
The overall HLR models were significant for all dependent variables. For physical outcomes, the overall model examining pain interference was significant (F(3, 72) = 4.517; P = 0.003), with sex, IBD diagnosis, and mental health diagnosis accounting for 13% of the variance in pain interference. Self-compassion accounted for an additional 20% of the variance in pain interference over and above demographic/medical variables. For psychological outcomes, the overall model examining anxiety was significant (F(3, 73) = 15.54; P &lt; 0.001), with sex, IBD diagnosis, and mental health diagnosis accounting for 33% of the variance in anxiety. Self-compassion accounted for an additional 46% of the variance in anxiety over and above demographic/medical variables. HLR also demonstrated that self-compassion was a significant independent predictor of pain interference (b = -0.30, P = 0.015), fatigue (b = -0.38, P = 0.001), psychological stress (b = -0.51, P = &lt; 0.001), anxiety (b = -0.41, P = &lt; 0.001), and depression (b = -0.59, P = &lt; 0.001). Participants reporting higher levels of self-compassion had less pain interference, fatigue, stress, anxiety, and depression.

Conclusion
Preliminary results suggest self-compassion may be an important factor in explaining the variability of key physical and psychological outcomes among AYA with IBD. Research should investigate self-compassion in diverse IBD populations, and explore if feelings of kindness and acceptance towards oneself can be a protective factor for AYA by supporting positive coping and adjustment to IBD.
BLOOD-BASED PROGNOSTIC BIOMARKERS IN CROHN’S PATIENTS TREATED WITH BIOLOGICS: A NEW PROMISING TOOL TO PREDICT ENDOSCOPIC OUTCOMES
Authors: Grova Mauro , Crispino Federica , Maida Marcello , Renna Sara , Mocciaro Filippo , Casa Angelo , Giulia Rizzuto , Scimeca Daniela , Di Mitri Roberto , Macaluso Fabio Salvatore , Orlando Ambrogio 
Published: January 2021

Abstract

Background and aims
There is a growing need for biomarkers of inflammation to monitor and predict therapeutic outcome in Crohn’s disease (CD) patients. We aimed to evaluate whether the level of circulating blood cells, expressed as ratios (NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; ELR, eosinophil-to-lymphocyte ratio and ENLR, eosinophil*neutrophil-to-lymphocyte ratio), could be used as early prognostic biomarker of endoscopic response (ER) in patients starting biological therapy with infliximab, adalimumab, vedolizumab and ustekinumab. Association with steroid-free clinical remission at week 54 and endoscopic disease activity at baseline, as well as other variables related with ER were also evaluated as secondary outcomes.

Methods
Consecutive patients with CD who started biological therapy between June 2016 and July 2019 in two Italian tertiary centers were enrolled. We used multivariate analysis to evaluate whether NLR, PLR, ELR and ENLR at baseline and after 12 weeks of treatment could predict ER (SES-CD ≤ 2 or SES-CD ≤ 2 and Rutgeerts score i0-i1) after 54 weeks of treatment. Receiver operating characteristic (ROC) curves were generated to identify the area under the curve (AUC) and find the best cut-off values of NLR, PLR, ELR and ENLR for the prediction of ER. To enhance the diagnostic performance, these ratios were combined with baseline Harvey Bradshaw Index (HBI) in a prognostic model.

Results
107 patients were included. Patients who achieved ER had significantly lower baseline NLR (p = 0.025), ELR (p = 0.013) and ENLR (p = 0.021) compared with those without ER; similar results were confirmed after 12 weeks of treatment for ELR (p = 0.006) and ENLR (p = 0.026). AUC was 0.64 (p = 0.003), 0.67 (p = 0.006) and 0.65 (p=0.014) for NLR, ELR and ENLR, respectively. The best cut-offs values were included in the HBI-based prognostic model: 81.8% of patients with HBI ≥ 5 and higher ratios did not achieve ER, while all patients with HBI &lt; 5 and lower ratios reached ER. Interestingly, ENLR was found to be linearly associated with SES-CD at baseline (p= 0.035).

Conclusions
To the best of our knowledge, this is the first study assessing NLR, ELR and ENLR as predictive markers of therapeutic response in CD patients. Low levels of these ratios can predict endoscopic response and could be used in clinical practice for a better management of CD patients needing biological therapy. Further prospective studies are needed to confirm these results in larger cohorts.
EFFICACY OF INFLIXIMAB DOSE ESCALATION IN PATIENTS WITH REFRACTORY IMMUNOTHERAPY-RELATED COLITIS: A CASE SERIES
Authors: Harris Jessica , Faleck David 
Published: January 2021

Abstract

Introduction
Immune checkpoint inhibitor (ICI)-related colitis (irColitis) is a frequent complication of ICI use in cancer. Treatment algorithms have been adapted from the treatment of inflammatory bowel disease (IBD), including the use of infliximab (IFX) for patients with irColitis refractory to corticosteroids. The efficacy of IFX dose-escalation in patients not responding to standard dose IFX, a common practice in patients with severe IBD, has not been reported in irColitis.

Methods
We describe a retrospective study of patients treated with IFX dose escalation (i.e. 10mg/kg dose) after failure of standard dose IFX (5mg/kg) for irColitis at a tertiary care center in New York City between 2016–2020. Clinical response was defined as improvement in diarrhea to CTCAE Grade ≤1.

Results
Ten patients were treated with high dose IFX for refractory irColitis. High dose IFX was started after a median of 2 (IQR 2-2) doses of standard dose IFX for non-response (n=2) or incomplete response (n=8). Five (50%) patients had a clinical response to high dose IFX after a median of 4 (IQR 3–6) days. Five (50%) patients were refractory to high dose IFX and were treated with Vedolizumab (n= 5) and/or fecal microbiota transplantation (n=2). Patients were followed for a median 457 (IQR 325–567) days from initiation of ICI therapy. No adverse events attributed to IFX were observed in any of the patients.

Discussion
In this series of patients with irColitis refractory to standard dose IFX, high dose IFX was successful in inducing response in 50% of patients. Prospective studies are needed to further elucidate the role and optimal dosing of IFX in irColitis.
Operationalizing ensemble models for scientific advice to fisheries management
Authors: Jardim Ernesto , Azevedo Manuela , Brodziak Jon , Brooks Elizabeth N , Johnson Kelli F , Klibansky Nikolai , Millar Colin P , Minto Cóilín , Mosqueira Iago , Nash Richard D M , Vasilakopoulos Paraskevas , Wells Brian K 
Published: January 2021

AbstractThis paper explores the possibility of using the ensemble modelling paradigm to fully capture assessment uncertainty and improve the robustness of advice provision. We identify and discuss advantages and challenges of ensemble modelling approaches in the context of scientific advice. There are uncertainties associated with every phase in the stock assessment process: data collection, assessment model choice, model assumptions, interpretation of risk, up to the implementation of management advice. Additionally, the dynamics of fish populations are complex, and our incomplete understanding of those dynamics and limited observations of important mechanisms, necessitate that models are simpler than nature. The aim is for the model to capture enough of the dynamics to accurately estimate trends and abundance, and provide the basis for robust advice about sustainable harvests. The status quo approach to assessment modelling has been to identify the “best” model and generate advice from that model, mostly ignoring advice from other model configurations regardless of how closely they performed relative to the chosen model. We discuss and make suggestions about the utility of ensemble models, including revisions to the formal process of providing advice to management bodies, and recommend further research to evaluate potential gains in modelling and advice performance.
Interaction frequency of seabirds with longline fisheries: risk factors and implications for management
Authors: Zhou Can , Brothers Nigel 
Published: January 2021

Abstract
Fishery bycatch poses a serious threat to seabird populations globally. Traditional haul-only post-capture observations are inadequate and inefficient to document seabird bycatch due to the substantial bycatch loss known to occur. Pre-capture observations offer an alternative by documenting seabird interactions leading up to captures. Based on the long-term large-scale dedicated field observations, this study revealed significant risk factors for the pre-capture stages of the seabird bycatch process in pelagic longline fisheries using Bayesian methods. Rough sea conditions were found to correlate with more seabirds following fishing vessels. Species identity, density effect, inter-species effect, and sea condition were found to significantly affect how frequently seabirds aggregated around a fishing vessel engage in bait-taking interactions. Intra-species competition was found to be the dominant type of density effect. Moreover, a web of inter-species interactions was identified to facilitate the bait-taking of superior competitors at the expense of inferior ones. The findings of this study are relevant to fishery managers in updating current data collection protocols to alleviate data issues caused by bycatch loss, to conservation biologists in quantifying bycatch risks for susceptible seabird populations, and in aiding the design and evaluation of bycatch mitigation measures.
Superior Efficacy of a Bedaquiline, Delamanid, and Linezolid Combination Regimen in a Mouse Tuberculosis Model
Authors: Pieterman Elise D , Keutzer Lina , van der Meijden Aart , van den Berg Sanne , Wang Han , Zimmerman Matthew D , Simonsson Ulrika S H , Bax Hannelore I , de Steenwinkel Jurriaan E M 
Published: January 2021

Abstract

Background
The treatment success rate of drug-resistant (DR) tuberculosis is alarmingly low. Therefore, more effective and less complex regimens are urgently required.

Methods
We compared the efficacy of an all oral DR tuberculosis drug regimen consisting of bedaquiline (25 mg/kg), delamanid (2.5 mg/kg), and linezolid (100 mg/kg) (BDL) on the mycobacterial load in the lungs and spleen of tuberculosis-infected mice during a treatment period of 24 weeks. This treatment was compared with the standard regimen of isoniazid, rifampicin, pyrazinamide, and ethambutol (HRZE). Relapse was assessed 12 weeks after treatment. Two logistic regression models were developed to compare the efficacy of both regimens.

Results
Culture negativity in the lungs was achieved at 8 and 20 weeks of treatment with BDL and HRZE, respectively. After 14 weeks of treatment only 1 mouse had relapse in the BDL group, while in the HRZE group relapse was still observed at 24 weeks of treatment. Predictions from the final mathematical models showed that a 95% cure rate was reached after 20.5 and 28.5 weeks of treatment with BDL and HRZE, respectively.

Conclusion
The BDL regimen was observed to be more effective than HRZE and could be a valuable option for the treatment of DR tuberculosis.
Digital phenotyping and sensitive health data: Implications for data governance
Authors: Perez-Pozuelo Ignacio , Spathis Dimitris , Gifford-Moore Jordan , Morley Jessica , Cowls Josh 
Published: January 2021

Abstract
In this perspective we want to highlight the rise of what we call “digital phenotyping” or inferring insights about peopleãs health and behavior from their digital devices and data, and the challenges this introduces. Indeed, the collection, processing, and storage of data comes with significant ethical, security and data governance considerations. The COVID-19 pandemic has laid bare the importance of scientific data and modeling, both to understand the nature and spread of the disease, and to develop treatment. But digital devices have also played a (controversial) role, with track and trace systems and increasingly “vaccine passports” being rolled out to help societies open back up. These systems epitomize a wider and longer-standing trend towards seeing almost any form of personal data as potentially health data, especially with the rise of consumer health trackers and other gadgets. Here, we offer an overview of the risks this introduces, drawing on the earlier revolution in genomic sequencing, and propose guidelines to help protect privacy whilst utilizing personal data to help get society back up to speed.