bluuebunny/crossref_metadata_2025_split huggingface dataset:
164 Innovative Practice Strategies for Preventing Clostridioides difficile (CDI) in a Community-Based Hospital
Authors: McSharry Doreen , Raskin Jeffrey M. , Stein Aaron A. , Lee Rose , Yalamanchi Vinay , Lopez Frank , Chandy Joel 
Published: October 2019

INTRODUCTION:
The prevalence of hospital-acquired Clostridioides difficile infection (CDI) in a healthcare facility is directly correlated with the efficacy of infection prevention practices. Although associations are well documented between CDI incidence and the exposure to antibiotics and acid-reducing medications, to effectively prevent CDI, all risk factors for transmission must be investigated. This study will demonstrate how innovative practice strategies, created by a multidisciplinary CDI Prevention Team, that were introduced and sustained over a 20 month period of time, resulted in dramatic improvements in CDI rates.

METHODS:
A cohort of 52 patients with a diagnosis of CDI were chosen for the purpose of determining the efficacy of an innovative, multi-disciplinary intervention. The subject lists were obtained from the NHSN reported cases. The study was comprised of three phases: Pre-intervention Period, Transitional Period, and Intervention Period. During the Transitional Period, the innovative, multidisciplinary intervention was introduced, consisting of a series of preventive strategies aimed at eradicating CDI in the patient population and the hospital's physical environment.

RESULTS:
Of the 52 patients studied with CDI, 23 patients were Community-Onset while 29 patients were Hospital-Acquired. With each study period, CDI HAI's were shown to decrease as the innovative practice strategies were incorporated into practice. In fact, during the Pre-intervention Period, there were 17 HAI's with 9461 patient days resulting in a 1.79 infection rate; the Transitional Period, 6 HAI'S/14,697 patient days resulting in a 0.40 infection rate; and the Intervention Period, 6 HAI's/33,603 patient days resulting in a 0.17 infection rate. In summary, the annual CDI rate decreased by 62% over one year after implementation of multidisciplinary interventions, demonstrating a statistically significant trend of reducing the infection rates (P value < 0.0001).

CONCLUSION:
The data analysis identified well-known CDI risk factors that included residing in long-term care institutions, acid suppressive therapy, prior antibiotic use and the management of the patient's environment. The incorporating of a variety of strategies such as: hand washing, isolation precautions, electronic medical record features, diagnostic testing parameters, UV technology, disposable meal trays, cutlery and plates, and managing the patient's environment, could serve as a paradigm for reducing CDI in a Community-based hospital.
165 Effect of Bowel Preparation Volume Size in Inpatient Colonoscopy. Results of a Prospective, Randomized, Comparative Pilot Study
Authors: Hernandez Patricia V. , Horsley-Silva Jennifer L. , Snyder Diana L. , Baffy Noemi , Atia Mary , Koepke Laura , Buras Matthew , Lim Elisabeth , Ruff Kevin , Umar Sarah , Islam Sameer , Ramirez Francisco C. 
Published: October 2019

INTRODUCTION:
Inpatient status has been shown to be a predictor of poor bowel preparation for colonoscopy since these patients are usually older, less mobile, have more medical comorbidities, and often require emergent evaluation. Our aim was to compare the efficacy of bowel preparation volume size in hospitalized patients undergoing inpatient colonoscopy.

METHODS:
This prospective, single blinded (endoscopist), randomized controlled trial was IRB approved and conducted as a pilot study at a Tertiary Referral Medical Center between September 2013 and March 2019. Hospitalized patients aged 18 years or older undergoing inpatient colonoscopy were assigned randomly to receive a high-volume solution (GoLYTELY®, medium-volume solution (MoviPrep®) or a low-volume Prepopik® solution. Adverse effects including unpleasant taste, nausea, and vomiting were scored through a questionnaire using a five-point scale ranging from 0 (no symptoms) to 4 (severe symptoms). Boston Bowel Prep Score (BBPS) was used to evaluate colon cleanliness. Descriptive statistics are presented as mean values ± standard deviation (SD), and P-values were calculated using Chi-Square and Kruskal-Wallis tests.

RESULTS:
Twenty-five colonoscopies were performed in 25 subjects. Mean age was 66.6 years (16.34) and 68% were male (Table 1). Indications for colonoscopy varied and are shown in Table 1. Total BBPS scores were higher in patients who received Prepopik®, 7.4 (1.62), than GoLYTELY® 6.6 (2.19) or MoviPrep® 6.9 (1.55), P = 0.66 (Figure 1). There was no difference in BBPS in right, transverse, or left colon scores. Regarding tolerance to preparation, 100% of the Prepopik® group reported completing the bowel preparation compared to 77.8% of the GoLYTELY® group and 66.4% of the MoviPrep® group (P = 0.24). The Prepopik® group reported fewer side effects than GoLYTELY®/MoviPrep® groups (Table 2).

CONCLUSION:
In this pilot study, a low-volume colon preparation demonstrated at least equivalent quality of bowel preparation measured by BBPS in comparison with traditional higher volume regimens, with less adverse effects, and better compliance for cleansing completion. This study suggests small volume purgative may lead to better patient compliance and therefore, better bowel preparation in the inpatient setting. The lack of statistical significance is likely due to a type II error. Further more robust studies are required to confirm these findings.
167 PDGF-BB and Receptor Augment Epithelial-Mesenchymal Transition in Colorectal Cancers
Authors: Cho Byungha , Son Seung-Myoung , Kim Ki Bae , Lee Eun Jeoung , Lee Sang-Jeon , Park Seon Mee , Choi Jongwook , Kwon Hyeonwoo , Kim Seongmin , Lee Jun Su 
Published: October 2019

INTRODUCTION:
Platelet-derived growth factor (PDGF) and its receptor (PDGFR) signaling are key regulators of the tumor microenvironment and they contribute to tumor progression. We evaluated the correlation of PDGF-BB and PDGFR expression with the activation of epithelial-mesenchymal transition (EMT) and cancer-associated fibroblasts (CAFs) in colorectal cancer (CRC) tissues.

METHODS:
We evaluated PDGF-BB and PDGFR expression, EMT activity (E-cadherin loss and S100A4 gain in tumor cells), and CAFs (aSMA and S100A4 in stromal cells) via immunohistochemistry analysis of 270 CRC tissues. The expression levels of PDGF-BB/PDGFR, EMT, and CAFs were analyzed in the relation to pathological parameters and disease-free and overall survival times.

RESULTS:
PDGF-BB in tumor cells and PDGFR in both tumor and stromal cells were expressed. Spindle-shaped stromal cells exhibited expression of both PDGFR and aSMA. PDGFR expression was related to lymphovascular invasion, lymph node metastasis, AJCC stages, and high number of tumor buds. PDGF-BB was weakly related to lymph node metastasis and perineural invasion. PDGFR expression was related with E-cadherin loss and stromal expression of S100A4 and aSMA. PDGF-BB or PDGFR expression was not associated with the disease-free or overall survival time of CRC patients.

CONCLUSION:
PDGFR expression was related to the activity of CAFs and the EMT process. PDGFR have a crucial role in tumor progression and could be a main target for microenvironment control in CRC treatment.
168 Fecal Microbiota Transplant in Graft-versus-Host Disease of the Intestines: A Comprehensive Pooled Analysis
Authors: Hadi Yousaf , Khan Ali , Naqvi Syeda Fatima , Jannat Rida Ul , Khan Maimoona , Kupec Justin T. 
Published: October 2019

INTRODUCTION:
Graft versus host disease (GVHD) of the intestines is a feared complication after hematopoietic stem cell transplantation (HSCT), and carries high morbidity and mortality. Recently fecal microbiota transplant (FMT) has been explored as a treatment modality for intestinal GVHD. The aim of our study was to pool data from individual feasibility studies to explore the efficacy and safety of FMT for gut GVHD.

METHODS:
A systematic search was performed for studies in PubMed, Embase, Cochrane database and ClinicalTrials.gov. All studies that reported data on FMT in patients who had previously undergone HSCT were included. Two independent authors conducted the systematic search. Pooled analysis was conducted for safety and efficacy of FMT in HSCT patients.

RESULTS:
A total of 15 studies comprising a total of 99 patients reported FMT outcomes after HSCT. Indication of FMT was restoration of microbiome in 41, Clostridium difficile infection in 21, and intestinal GVHD in 37 patients. All studies were single center pilot trials. Five studies with 37 patients reported efficacy outcomes for intestinal GVHD. A total of 57 FMTs were performed. All patients had previously failed at least one immunosuppressant regimen. All patients were either steroid resistant or steroid dependent. Overall complete response rate of 62.1% was observed (23 patients). Three additional patients partially responded to FMT. Positive response was accompanied by a decrease in stool volumes and frequency in all patients; reduction in use of anti-motility agents, and cessation of total parenteral nutrition was observed in all responders. All studies reported successful tapering of immunosuppressant and steroid dosage. FMT was generally well tolerated. No treatment-related mortality was reported. Minor adverse events included abdominal pain, nausea, mucosal tears, and minor aspiration without sequelae. Serious adverse events included bleeding in one patient, and grade 3 abdominal pain in one patient (resolved within 24 hours of capsule ingestion). Infections were reported in three patients after FMT (two with bacteremia), but could not be attributed to FMT with certainty.

CONCLUSION:
FMT is a promising modality for management of intestinal GVHD and carries low morbidity. It appears to be safe and acceptable as a salvage therapy for intestinal GVHD based on the current limited data. The need to withhold antibiotics to allow persistent engraftment may prove challenging in this severely immunocompromised population.
170 The Efficacy of Uceris in the Treatment of Microscopic and Allergic Colitides
Authors: Rzepczynski Allison , Van Jeremy , Lodhi Maham , Keshavarzian Ali , Fogg Louis 
Published: October 2019

INTRODUCTION:
Chronic non-bloody diarrhea is a common complaint seen by gastrointestinal physicians. About 10–20% of these cases are secondary to the microscopic colitides (MC), which include collagenous colitis and lymphocytic colitis, and 30% are due to allergic colitides (AC), including eosinophilic colitis and mast cell enteropathy. Entocort has previously been studied as a treatment option for MC with remission rates as high as 96%. Uceris is a budesonide formulation that does not dissolve in acid and is therefore released at a controlled rate throughout the colon. This study aimed to determine whether Uceris would provide symptomatic response in patients with MC. Additionally, this study aimed to determine whether Uceris would be effective in treating AC, which currently does not have any well-established treatment options.

METHODS:
This was a retrospective study using the electronic medical record (EMR) and an established database of histologic findings on biopsies obtained during colonoscopies performed at Rush University Medical Center. The EMR was used to obtain demographic data and to identify what treatment medication was used (Uceris, Entocort, H1/H2 blockers, other – anti-diarrheal and stool bulking agents). Eligible subjects were contacted by telephone and asked about symptom severity pre- and post-treatment for colitis using the Modified Harvey Bradshaw Index (MHBI, Table 1). Data was analyzed using SPSS analysis of variances.

RESULTS:
There were 50 subjects enrolled in this study. Demographics are listed in Table 2. The mean total MHBI score for the MC subjects was 9.75 pre-treatment with all therapeutic agents and 2.13 post-treatment, and for the AC subjects was 6.83 pre-treatment and 2.89 post-treatment. There was a greater improvement in MHBI scores in the MC group compared to the AC group (P < 0.031, F = 4.97, df = 1,48). For each treatment drug, there was an improvement in MHBI scores after therapy for both MC and AC (Table 3).

CONCLUSION:
For subjects with MC, there was greater improvement in MHBI scores with Entocort. However, the mean MHBI pre-treatment scores for MC subjects were greatest in those treated with Uceris. It is possible that Uceris was reserved for subjects with more significant symptoms or for those who failed treatment with other agents. There was a greater improvement in MHBI scores in subjects with AC that received Entocort and Uceris, suggesting that steroids may be helpful in controlling symptoms. This study was limited by small sample size and recall bias.
172 Multiplex Polymerase Chain Reaction Stool Testing Detects Pathogens Not Frequently Detected on Concurrent Stool Culture With Ova and Parasite Exam
Authors: Main Michael , Hong Soonwook , Hine Ashley M. , Cadwell Ken , Axelrad Jordan E. 
Published: October 2019

INTRODUCTION:
Rapid, highly sensitive and specific multiplex polymerase chain reaction-based stool assays for gastrointestinal pathogens (GI PCR) are increasingly being used alternatively to conventional stool culture. We investigated the concordance between simultaneous GI PCR and stool culture with an ova and parasite (O&P) exam in outpatients presenting with symptoms of infectious gastroenteritis.

METHODS:
We performed a cross-sectional study of outpatients who received a FilmArray GI PCR test for acute diarrhea at an academic medical center from September 2015 to February 2019 to identify patients who had a concomitant stool culture with an ova and parasite exam (conventional testing) at the same time, on the same stool sample. The primary outcome was detection of an infection on GI PCR or conventional stool testing. Correlation was evaluated using McNemar's test for pathogens detected on both tests. Other categorical variables were compared with Chi-square analysis.

RESULTS:
We identified 150 outpatients who received GI PCR and stool culture with an ova and parasite exam for an episode of acute gastroenteritis. 106 (71%) patients had a pathogen isolated on GI PCR for 144 total pathogens including 128 (88%) bacteria, 13 (9%) viruses, and 3 (2%) parasites; 21 (14%) patients had a pathogen isolated on conventional testing for 18 total pathogens including 9 (50%) bacteria and 9 (50%) parasites (Table 1). Multiple pathogens were found in 38 (26%) GI PCR tests. PCR testing most commonly identified Enteropathogenic Escherichia coli (EPEC), representing 42 (33%) positive PCR tests. Conventional testing most commonly identified Campylobacter jejuni with 13 (54%) positive tests. Of 28 total C. jejuni infections, 15 (54%) were positive only on PCR, 3 (10%) only on conventional testing, and 10 (36%) on both modalities, showing that conventional testing missed 54% of all infections (P = 0.008). Conventional testing missed 4/6 (67%, P = 0.125) Salmonella infections and 9/14 (64%, P = 0.0215) Yersinia infections, nor did it detect any viral or diarrheagenic E. coli infections. Overall, PCR detected 144 of 191 (75%) of possible pathogens whereas conventional testing detected 47 of 179 possible pathogens (26%).

CONCLUSION:
GI PCR testing identified multiple pathogens unidentified by conventional testing, such as enteric viruses and pathogenic strains of E. coli. Conventional testing missed 88% of enteric bacteria showing poor concordance between simultaneous GI PCR testing and stool culture with an ova and parasite exam.
174 The Effectiveness of Right vs. Left-lateral Starting Position in Unsedated Colonoscopy With Modified-Water Immersion Method Colonoscopy
Authors: Bayupurnama Putut , Ratnasari Neneng , Indrarti Fahmi , Triwikatmani Catharina , Maduseno Sutanto , Nurdjanah Siti , Leung Felix 
Published: October 2019

INTRODUCTION:
Water immersion (WI) which emphasizes removal of infused water during withdrawal significantly reduced pain and increased willingness to repeat unsedated colonoscopy compared with air insufflation (JIG 2013;3:12). One study in sedated patients with air insufflation colonoscopy method showed that right-lateral (RLP) vs. left-lateral (LLP) starting position improved abdominal discomfort and reduced cecal intubation time (AJG 2015;110:1576). We aim to determine if RLP may reduce the pain score and improve other parameters comparing with LLP in unsedated patients examined with a modified water immersion (m-WI) method which involved episodic water infusion and suction to facilitate insertion.

METHODS:
Consecutive symptomatic patients meeting the inclusion criteria were consented, enrolled and randomized. Both patients and colonoscopists were unblinded. Patients underwent unsedated colonoscopy with m-WI method with room temperature water. The suction procedure during insertion in this study was not only for fecal debris evacuation but also used as a method to facilitate passage through difficult colonic flexures. We infused the water as needed. The air pump was turned off during insertion. The examinations were performed by PB. The primary outcome of insertion pain was recorded by a visual analogue scale (VAS). We proposed bowel visualization scale (BVS) as shown in Figure 1 to evaluate the interference of fecal debris with cecal intubation rate and time (NCT03489824).

RESULTS:
Interim analysis was conducted for 105 recruited patients (54 in RLP and 51 in LLP) (74% of sample size). The procedural parameters are shown in Table 1. Changed patient position during colonoscopy showed that fixed position (RLP or LLP) was found in 8 RLP patients and 2 LLP patients; changed only into supine position: 36 patients in RLP and 30 patients in LLP; 3 RLP patients changed into supine then left lateral decubitus and 12 LLP patients changed into supine then right lateral decubitus. Table 1 shows that there was no significant difference between pain score of RLP and LLP. LLP showed faster cecal intubation time in general, in constipation sub group, and also in scale 2 of BVS as shown in Table 2.

CONCLUSION:
This study support that LLP may a better choice than RLP in performing m-WI colonoscopy examination in unsedated patients. Limitation: The endoscopist (PB) did not have RLP colonoscopy experience before the study was started.
175 Clinical Usefulness of SMOC1 as a Diagnostic Marker for Colorectal Serrated Lesions and Colorectal Precancerous Lesions
Authors: Aoki Hironori , Yamamoto Eiichiro , Takasawa Akira , Yamano Hiro-o , Harada Taku , Sugai Tamotsu , Suzuki Hiromu 
Published: October 2019

INTRODUCTION:
Colorectal serrated lesions (SLs) include hyperplastic polyp (HP), traditional serrated adenoma (TSA) and sessile serrated adenoma/polyp (SSA/P). SSA/Ps are well known precursors of colorectal cancer (CRC) characterized by BRAF mutation and microsatellite instability (MSI). However, clinical and molecular characteristics of TSAs are not fully understood. We have reported that epigenetic silencing of SMOC1 is associated with development of traditional serrated adenomas (TSAs) and that SMOC1 may play a role in neoplastic pathways in TSAs and conventional adenomas.
1
We aimed to clarify the clinical usefulness of SMOC1 in colorectal tumors.

METHODS:
Expression of SMOC1 was analyzed in a series of 127 colorectal tumors and adjacent normal colonic mucosa by immunohistochemistry (IHC). The staining intensity of SMOC1 was assessed as strong (3), moderate (2), weak (1) or negative (0). The proportions of positively stained tumor cells were assessed as 0 to 10 for each staining intensity. Because neoplasm heterogeneity caused varying degrees of immunoreactivity in respective specimens, we used the sum of each intensity × proportion as an IHC score (e.g., intensity × proportion = (3) × 5 + (2) × 3 + (1) × 1 + (0) × 1 = IHC score 22, scale of 0 to 30).

RESULTS:
Our IHC analysis revealed that SMOC1 is abundantly expressed in normal colon, HPs and SSA/Ps, while it was significantly downregulated in TSAs, high-grade adenomas and CRCs. Among serrated lesions, SMOC1 is expressed in HPs, SSA/Ps and SSA/Ps with CRC, while it was significantly downregulated in TSAs and TSAs with CRC. Notably, in TSAs which consisted of flat and protruding subcomponents, SMOC1 expression levels were lower in the protruding portions than those in the flat portions (P < 0.001).

CONCLUSION:
These results suggest that downregulated expression of SMOC1 could be a hallmark of TSAs and conventional adenomas at high risk of developing CRC.
177 The Presence of Clostridioides difficile Strains in the Gut by Next Generation Shotgun Sequencing: Innocent Bystander or Villain?
Authors: Papoutsis Andreas , Campbell Jordana , Hazan-Steinberg Sabine 
Published: October 2019

INTRODUCTION:
Pathogenic Clostridioides difficile (C. difficile) is the most common cause of nosocomial infection in the United States. However, the prevalence of C. difficile colonization in the general population is poorly understood. We sought to determine the presence and nature of various C. difficile strains colonizing a representative sample of 17 asymptomatic adult volunteers, consisting of 10 healthy and 7 stable Crohn's patients.

METHODS:
Next-generation (NGS) shotgun sequencing was performed on fecal samples. Following fecal collection, DNA was extracted from stool samples, before being quantitated and normalized for downstream library fabrication utilizing shotgun methodology. Prepared and indexed libraries were subsequently pooled and sequenced on the Illumina NextSeq 550 System. Sample FASTQ files were analyzed with a computational tool (Kraken) profiling the microbial communities from metagenomic sequencing data with species level resolution. Individual microbiome profiles were then analyzed for the presence of C. difficile and specific categorical strains (Figure 1).

RESULTS:
All 17/17 subjects (100%) were found to possess ≥1 strain of C. difficile (Figure 1). The ATCC 43255 strain was the most common strain (94.1% 16/17), followed by QCD-63q42 (88.2% 15/17), and then M120 and QCD-37x79 strains (both identified in 10/17 [58.8%] individuals).

CONCLUSION:
In our representative sample of 17 adult volunteers, all (100%) were found to possess at least one C. difficile strain in their gut, with many colonized by several strains. While it is recognized that some C. difficile strains are pathogenic, our findings indicate that various non-pathogenic C. difficile species make up an important component of the commensal gut microbiome, and may perhaps play a protective role. Although symptomatic toxigenic CDI is a clear indication for therapy, C. difficile colonization with non-toxigenic strains is not believed to be a direct precursor for CDI. These findings demonstrate our need for awareness that numerous strains of C. difficile exist and the relevance of sequencing (a) prior to hospitalization or antibiotic treatment to help predict those at risk of CDI, and (b) after treatment to identify any loss of potentially protective components of our microbiome.