bluuebunny/crossref_metadata_2025_split huggingface dataset:
MAINTENANCE EFFICACY OF ORAL INDIGO NATURALIS FOR ULCERATIVE COLITIS: A SINGLE-CENTER, OPEN-LABEL, RANDOMIZED, CONTROLLED STUDY
Authors: Matsuno Yuichi , Umeno Junji , Hirano Atsushi , Fuyuno Yuta , Nagasue Tomohiro , Fujioka Shin , Kawasaki Keisuke , Moriyama Tomohiko , Torisu Takehiro 
Published: January 2024

Abstract

BACKGROUND
Indigo naturalis (IN) is one of the herbal medicines in Chinese medicine. Recent reports have demonstrated a strong remission induction efficacy of oral IN in induction therapy for ulcerative colitis (UC), but the efficacy of IN in maintenance therapy for UC is unknown.

OBJECTIVES
We aimed to clarify the maintenance effect of IN.

METHODS
A single-center, open-label, randomized, controlled trial was conducted from August 2017 to August 2020. Patients with UC who received induction therapy with IN and maintenance therapy with IN for at least 1 year were enrolled. Patients with endoscopically confirmed mucosal healing (Mayo endoscopic subscore 0 or 1) were randomized. Patients were randomized to continue or discontinue IN. The primary endpoint was the remission rate at 52 weeks after discontinuation. Patients who relapsed during the observation period were given additional therapy, and remission rates were examined for patients who received an increased dose of IN or resumed oral therapy. The study was registered in the University Hospital Medical Information Network Center Trials registry, UMIN000028574.

RESULTS
A total of 20 patients participated in this study, 10 in the IN-continued group and 10 in the IN-discontinued group. The median age was 32.5 years and 33.5 years in the IN-continued group and IN-discontinued group, respectively, and 6 and 5 patients were male. Two patients in the IN-continued group and three patients in the IN-discontinued group were treated with azathioprine. One patient in the IN-continued group and three patients in the IN-discontinued group were treated with anti-tumor necrosis factor therapy. The remission rates at 52 weeks were 90% (9/10) of patients in the IN-continued group and 20% (2/10) in the IN-discontinued group. The remission rate was significantly higher in the IN-continued group (p = 0.0055). Of the 9 patients who relapsed, 7 were treated with increased or resumed oral IN, and all patients were induced remission again. No serious adverse events were observed during the observation period.

CONCLUSIONS
IN appears to be very effective in maintaining remission; the high efficacy of reintroduction in patients who relapsed after discontinuation of IN suggests that discontinuation of IN in cases of remission may be an option.
THE BURDEN OF INFLAMMATORY BOWEL DISEASE ON COVID-19 HOSPITALIZATIONS: A NATIONWIDE ANALYSIS
Authors: Iqbal Humzah , Haddadin Rakahn , Haidary Hasib , Zhang Patrick , Prajapati Devang 
Published: January 2024

Abstract

BACKGROUND
Inflammatory bowel disease (IBD) is a chronic systemic inflammatory process with primarily gastrointestinal (GI) manifestations, and is comprised of Crohn’s disease (CD) and ulcerative colitis (UC). The COVID-19 pandemic was unprecedented global health crisis that had a profound impact on healthcare burden. Both IBD and COVID-19 are associated with a pro-inflammatory state, however, the relationship between the two disease states remains unclear. Some studies suggest that IBD patients may develop more severe COVID-19 infection. We aim to assess whether patients with a history of IBD have worse outcomes when hospitalized with COVID-19.

METHODS
Patients with a diagnosis of COVID-19 were identified using the 2020 Nationwide Inpatient Sample (NIS). Patients were stratified based on the presence of IBD. Data were collected regarding incidence of shock, sepsis, acute kidney injury (AKI), blood transfusion, mechanical ventilation, and death. Other variables included age, gender, race, primary insurance, median income, hospital region, hospital bed size, and comorbidities. The relationship between outcomes in patients hospitalized with COVID-19 and IBD was analyzed using multivariate regression analysis.

RESULTS
A total of 1,526,805 patients with a diagnosis of COVID-19 were included in the study. Of these, 91,608 (6.0%) had a concurrent diagnosis of either CD or UC. The majority of patients in the IBD group were female (52.2%), White (73.4%), and had Medicare insurance (54.6%). History of IBD was associated with an increased risk of sepsis (aOR 1.15, P = 0.01), shock (aOR 1.26, P = 0.007), and AKI (aOR 1.25, P &lt; 0.001). There was no difference in mechanical ventilation or in-hospital mortality between patients with IBD and those without.

CONCLUSION
Among patients hospitalized with COVID-19 infection, those with a history of IBD had an increased risk of sepsis, shock, and AKI. However, IBD did not confer an increased risk of mechanical ventilation or in-hospital mortality. IBD patients who develop COVID-19 infection should be evaluated diligently as their disease state may predispose them to shock and organ injury. Further studies are needed to elucidate why these patients do not have an increased rate of ventilator-dependent respiratory failure or death.

Inclusion process for the study.
UTILITY OF PR3-ANCA IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Andalucia Carmen , Bentow Chelsea , Aure Mary Ann , Martínez-Prat Laura , Horn Michael P , Mahler Michael 
Published: January 2024

Abstract

BACKGROUND/PURPOSE
Anti-neutrophil cytoplasmic antibodies (ANCA) directed to proteinase 3 (PR3) represent a highly established marker for patients with ANCA-associated vasculitis (AAV). PR3-ANCA have also demonstrated utility in the management of inflammatory bowel disease (IBD) with certain immunoassays. More specifically, PR3-ANCA discriminated patients with ulcerative colitis (UC) from Crohn`s disease (CrD) patients and were associated with disease severity and activity. Lastly, evidence is mounting that PR3-ANCA helps to stratify patients according to treatment response. Here, we aimed to summarize the current data on the diagnostic utility of PR3-ANCA in IBD.

METHODS
A structured systematic literature review including three electronic databases (Pubmed, Scopes, and Web Of Science) was conducted on June 6th 2023 to identify studies assessing the diagnostic accuracy of the QUANTA Flash PR3 assay (RUO for IBD) in UC vs. CrD patients. Electronic searches were supplemented by hand searching. A hierarchical, bivariate, mixed-effect meta-analysis was conducted using metandi function in STATA MP v17.0, as per the Cochrane collaboration recommendations for a review of diagnostic test accuracy studies. Study quality was assessed using QUADAS-2 tool which considers the risk of bias and applicability.

RESULTS
Out of 111 citations retrieved for titles and abstracts screen, a total of 6 studies met the inclusion criteria and reported QUANTA Flash PR3 diagnostic accuracy in UC vs. CrD. Diagnostic test accuracy of individual studies is available in Table 1. The six studies included 667 UC patients and 682 individuals with CrD. Of these, 2 articles (Horn et al. and Laass et al) were case-control studies in children. Sensitivity point estimate for UC was 34.9% [95% confidence interval (CI): 26.2-44.6%]. Specificity point estimate for CrD was 95.9% (95% CI: 92.0-98.0%). This results in a Diagnostic Odds Ratio (DOR) of 12.6 (95% CI: 5.7-27.9%), a positive likelihood ratio of 8.5 (95% CI: 4.2-17.5), and a negative likelihood ratio of 0.68 (95% CI: 0.59-0.78) (Table 2).
The risk of bias was low in the index test and reference standard domains. Four studies (67%) showed an unclear risk of bias in the patient selection and flow and timing domains. All studies had low concerns of applicability in all the domains.

CONCLUSION
In this meta-analysis QUANTA Flash PR3 assay has demonstrated to be able to discriminate between UC from CrD with a sensitivity of 34.9% and a specificity of 95.9%. Due to the limited number of studies published, clinical trials should consider the inclusion of PR3-ANCA as an exploratory biomarker for patient stratification.

Table 1 Summary of diagnostic test accuracy of individual studies.

Table 2 Meta-analysis of diagnostic test accuracy of QUANTA Flash PR3.
EFFECTS OF NUTRITION STATUS AND PERIOPERATIVE NUTRITION SUPPLEMENT COMPLETION ON POSTOPERATIVE OUTCOMES IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE UNDERGOING SURGERY
Authors: Collins Stacey , Castelan Viankail Cedillo , Wernick Rebecca , Banty Andrea , Gwarnicki Colleen , Solomon Theodore , Martirosyan Lilly , Roberts Pamela , Wise Andrea , Hampton Melissa , Nasseri Yosef , Zaghiyan Karen , Fleshner Phil , Melmed Gil , Issokson Kelly 
Published: January 2024

Abstract

BACKGROUND
Malnutrition is common in inflammatory bowel disease, (IBD) and is associated with poor disease activity, greater hospital length of stay (LOS), higher 30-day readmission rates, and increased risk of postoperative complications. Structured, multimodal prehabilitation including nutrition counseling improves various outcomes after elective cancer and orthopedic surgeries. We examined the effects of malnutrition and perioperative nutrition supplementation on surgical outcomes in IBD patients participating in a multimodal prehabilitation program.

METHODS
This was a retrospective study of patients aged 18-80 enrolled in a 10-week prehabilitation program undergoing surgery for IBD. Beginning 4 weeks prior to surgery, patients met with a multidisciplinary team including a nurse practitioner, physical therapist and registered dietitian. Patients were provided 3 preoperative carbohydrate loading oral nutrition supplements (ONS) 48 hours prior to surgery, and 20 perioperative immunonutrition ONS. Malnutrition was defined using the Global Leadership in Malnutrition criteria as moderate or severe. We used Fisher’s exact test to determine associations between malnutrition, ONS use, and postoperative complications (defined by the comprehensive complication index (CCI, with CCI scores &gt;20 classified as severe)), and 30-day readmission. Logistic and linear regression were used to analyze length of stay (LOS), opioid use (defined as morphine milligram equivalents, MME), nutrition status, and ONS completion.

RESULTS
25 patients (48% female, mean age 44, 18 (72%) with Crohn’s disease) completed the prehabilitation program between 05/2022 and 10/2023. 10 patients (40%) met criteria for malnutrition (of these, 50% were moderate and 50% severe). Malnutrition was not significantly associated with CCI severity (p=0.07), LOS (p =0.07), opioid use (p=0.07) or 30 day readmission rates (0.06). Higher ONS use for carbohydrate loading and immunonutrition were more likely to have a LOS&lt;5 days (p=0.05 and p=0.03 respectively).

CONCLUSION
ONS for preoperative carbohydrate loading and perioperative immunonutrition may shorten LOS after surgery among patients with IBD. In our study, higher amounts of ONS consumption led to a shorter LOS. Larger, controlled studies will help to further clarify the effects of malnutrition, carbohydrate loading, and immunonutrition among patients with IBD preparing for surgery.
FIBER-DEFICIENT DIET INHIBITS COLITIS THROUGH REGULATION OF THE NICHE AND METABOLISM OF A GUT PATHOBIONT
Authors: Kuffa Peter , Pickard Joseph , Campbell Austin , Schaus Sadie , Adler Jeremy , Martens Eric , Schmidt Tom , Inohara Naohiro , Núñez Gabriel , Caruso Roberta 
Published: January 2024

Abstract
Fiber free exclusive enteral nutrition (EEN) is an effective steroid-sparing treatment used to induce clinical remission in children with Crohn’s disease (CD). However, the mechanism underlying the beneficial effects of EEN remains obscure. We have generated a novel mouse strain that harbors mutations in two CD susceptibility genes (i.e, NOD2 and CYBB) and found that these mice spontaneously develop an early-onset (4 weeks of age), TH1-type gut inflammation, that closely recapitulates the human disease when exposed to a specific murine microbiota. Disease in Nod2/Cybb (DKO) mutants was triggered by a single mucus-dwelling anaerobe, Mucispirillum schaedleri, which markedly accumulates in the intestinal lumen and mucus layer prior to disease development. Given that our mouse model resembles early-onset CD, we have established a novel humanized mouse model of early-onset CD in which germ-free Nod2/Cybb mutants were colonized with microbiotas from early-onset-CD patients and their healthy first-degree relatives. We have found that the early-onset-CD-associated microbiota triggered intestinal inflammation in gnotobiotic DKO mice with all the hallmarks of the human disease. Using the murine and humanized models of early-onset CD we have found that administration of a fiber-free diet prevents the development of colitis and inhibits intestinal inflammation in colitic animals. Furthermore, identification of Mucispirillum as a trigger in our mouse model has allowed us to study the effects of dietary interventions on disease-causing microbes. Remarkably, we have found that a fiber-free diet alters the intestinal localization of Mucispirillum. Mechanistically, the absence of dietary fiber reduces the availability of nutrients and impairs Mucispirillum’s unique metabolic pathway in the intestinal mucus. Thus, appropriate localization of the pathobiont in the mucus layer is critical for the onset of disease, which can be disrupted by fiber exclusion. These results suggest that probing the intestinal niche and metabolism of disease-causing microbes will likely lead to the discovery of novel, more targeted therapies for the treatment of CD.
PREVALENCE OF MALNUTRITION AND MICRONUTRIENT DEFICIENCIES IN OLDER ADULTS WITH ULCERATIVE COLITIS WHO HAVE UNDERGONE BOWEL SURGERY
Authors: Memel Zoe , Thiemann Anna , Dort Cooper , Beck Kendall 
Published: January 2024

Abstract

BACKGROUND
There is little data on the older adult ulcerative colitis (UC) population. We aimed to evaluate the prevalence of malnutrition and micronutrient deficiencies among older adults who have undergone bowel surgery for their UC.

METHODS
This was a single-center, retrospective study of patients 65 years and older with UC. Malnutrition was defined using the European Society for Clinical Nutrition and Metabolism (ESPEN) definition. Eight micronutrient deficiencies and nutrition-related outcomes were measured. The Saskatchewan Inflammatory Bowel Disease–Nutrition Risk Tool was utilized to identify patients at risk for malnutrition. Descriptive statistics were used to summarize data. Characteristics of patients with and without malnutrition were compared using Fisher’s exact tests (analysis of variance for age).

RESULTS
Eighty-eight patients with a mean age of 74.7 years were included. The most common surgery was total proctocolectomy with end ileostomy (n=40,45%). Seven patients (8%) met criteria for malnutrition, 24 patients (31%) were moderate to high risk for malnutrition, and 55 (70%) of patients were low risk. Sixty-six patients (74%) had at least one micronutrient deficiency: 42% with vitamin D deficiency and 32% with iron deficiency. One-third of patients had bone-related disease (27 patients). No statistically significant associations were found among patients with or without malnutrition or among patients with low, moderate, or high risk of malnutrition. Our small study, however, likely lacked sufficient power to detect any differences which may exist.

CONCLUSIONS
The prevalence of malnutrition was low, however, the incidence of at least one micronutrient deficiency was high. Older adults with UC who have undergone bowel surgery should be followed carefully with annual labs to avoid nutrition-related complications.

Table 1 Characteristics of Older Adults with Ulcerative Colitis who have undergone Surgical Resection

Table 2 Rates of Malnutrition and Micronutrient Deficiencies in Older Adult Ulcerative Colitis Population
PATTERNS AND ASSOCIATED FACTORS OF OBJECTIVE INFLAMMATION ASSESSMENT TO TREAT-TO-TARGET: DATA FROM THE IBD QORUS COLLABORATIVE
Authors: Nguyen Thien-Bao , Siegel Corey , Melmed Gil , Singh Siddharth , Harvey Sarah , Oberai Ridhima , Hou Jason , Fudman David 
Published: January 2024

Abstract

BACKGROUND
A Treat-to-Target (T2T) strategy for inflammatory bowel disease (IBD) improves clinical outcomes. The cornerstone of T2T is the routine assessment of objective markers of inflammation to determine treatment efficacy. Despite this, objective testing is often delayed or not performed. This study aims to describe patterns and associated factors of intended assessment of objective markers of inflammation for patients with IBD within the multicenter quality improvement collaborative, IBD Qorus.

METHODS
Patient and provider survey data from IBD Qorus were prospectively collected from 6/2021 to 10/2022 across 35 academic and community practices during routine clinical care visits. Patients with unknown status of mucosal healing were excluded. The primary outcome of "timely assessment" was defined as provider-reported intent to obtain fecal calprotectin (FC), imaging, or endoscopy within 12 months. Factors associated with the primary outcome were assessed using univariate and multivariate logistic regression, adjusting for age, gender, IBD type, and clinical factors.

RESULTS
4,831 encounter-level surveys from the study period were included for analysis. In 73.9% of encounters, providers reported an intent to assess inflammation within the next 6 months. Of these, 77.1% planned to use FC and 57.7% imaging or endoscopy. 89.3% of visits noted an intent to assess inflammation within 12 months. Providers reported in 29.8% of encounters that patients declined FC and in 8.3% that imaging or endoscopy were declined. In the primary univariate analysis, intent for timely assessment was associated with ulcerative colitis (UC), recent emergency department visit or hospitalization, lack of clinical remission, mild Provider Global Assessment, current steroid use, lack of immunomodulator use, lack of steroid-free mucosal healing, care at an academic site, and intent to change therapy. On multivariate analyses, UC (OR 1.38, 95% CI 1.11-1.71), steroid use (OR 2.1, 95% CI 1.1-4.6), and plans to change therapy (OR 1.84, 95% CI 1.2-2.9) remained significantly associated with higher odds of timely assessment. In contrast, steroid-free mucosal healing (OR 0.52, 95% CI 0.41-0.66) and care in community practice (OR 0.63, 95% CI 0.51-0.77) remained significantly associated with lower odds of timely assessment.

CONCLUSION
In IBD Qorus, there is a strong intent to assess objective markers of inflammation. However, lower odds of intended assessment were found among patients with Crohn’s, patients in steroid-free mucosal healing, and those receiving care in community practice, revealing potential care gaps. Interestingly, providers frequently reported that patients declined FC testing, and declined this at higher rates than that for endoscopy or imaging. This study identifies potential areas to improve testing for inflammation under a T2T strategy.
ROUTINELY COLLECTED BLOODWORK REVEALS IMMUNE CELL PATTERNS THAT REFLECT DISEASE ACTIVITY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Authors: Briand Peyton , Mulder Daniel 
Published: January 2024

Abstract

OBJECTIVE
The standard procedure for evaluation of inflammatory bowel disease (IBD) diagnosis and activity requires endoscopy, but there have been many biomarkers identified that are associated with IBD and are collected much less invasively. White blood cell subsets, also known as “the differential”, is a commonly used test for patients with IBD, but the relationship between the differential and disease activity is unknown. Understanding the connection between the differential and disease activity could provide insight to a patient’s clinical presentation without requiring more invasive testing. The aim of this study was to identify patterns present in the differential of IBD patients and use machine learning to determine how these parameters change with IBD activity.

METHODS
A total of 373 differential counts from 43 patients with IBD were evaluated. All IBD patients with adequate clinical information were included. Disease activity was determined by chart review using the Physician’s Global Activity Score. Binary classification prediction was performed on the training set using multiple supervised machine learning models.

RESULTS
The outcome was balanced, with 56% of the observations experiencing IBD activity at the time of blood collection. A random forest (RF) model performed best with a final fit accuracy of 0.70 and an ROC-AUC score of 0.75. The RF classifier ranked monocytes and neutrophils as having the highest relative importance to the model.

CONCLUSION
The optimal RF model demonstrated an overall correctness in its predictions and as reflected in the ROC-AUC score, can discriminate between active disease state and remission in IBD patients. These results indicate that a pattern is present between the differential and IBD activity and with further exploration, may be used to create a predictive model for IBD diagnosis.
USEFULLNESS OF SERUM LEUCINE-RICH ALPHA2-GLYCOPROTEIN AND FECAL CALPROTECTIN ASSURROGATE MARKERS IN ULCERATIVE COLITIS
Authors: Miyazono Satoshi , Imazu Noriyuki , Umeno Junji , Matsuno Yuichi , Kawatoko Shinichiro , Nagasue Tomohiro , Fujioka Shin , Kawasaki Keisuke , Moriyama Tomohiko , Torisu Takehiro 
Published: January 2024

Abstract

BACKGROUND AND AIM
Serum Leucine-rich alpha-2 glycoprotein (LRG) was identified as a novel biomarker for rheumatoid arthritis and IBD by using a proteomics approach. Several studies have suggested that serum LRG levels and fecal calprotectin (fCal) were correlated with clinical activities in patients with ulcerative colitis (UC). We compared utility of these biomarkers for monitoring disease activity in UC.

METHODS
A single-center observational study was conducted at Kyushu University Hospital. A total of 101 patients who underwent colonoscopy during the period from February to December 2021 were enrolled. The associations between endoscopic and histological activity and biomarkers were investigated. Endoscopic activity was defined as Mayo endoscopic score (MES) of 1 or less for mucosal healing and 0 for complete mucosal healing. For histological activity (n=90), Geboes score of 2 or less was defined as histological remission.

RESULTS
Subjects ranged in age from 16 to 80 years (35 males and 66 females). There were 63 cases of total colitistype, 32 cases of left-sided colitis type, and 6 cases of proctitis type. The MES at enrollment were as follows: MES 0 in 41 cases, MES 1 in 33 cases, MES 2 in 19 cases, and MES 3 in 8 cases. In comparison between the mucosal healing and non-mucosal healing groups, LRG was significantly lower in the mucosal healing group (p&lt;0.0001). The correlation coefficient of LRG with MES was r=0.614 (p&lt;0.0001), which was higher than that of fCal, r=0.414 (p&lt;0.0001). In ROC analysis with mucosal healing as the outcome, the AUC and cut-off value of LRG were 0.781 and 17.9 μg/ml, respectively, and for fCal were 0.850 and 396 μg/g, respectively. In the ROC analysis with complete mucosal healing as the outcome, the AUC for LRG was 0.690, which was lower than the AUC of 0.846 for fCal . When compared by histological remission, LRG was lower in the histological remission group (p&lt;0.001). In the ROC analysis with histological remission as the outcome, the AUC for LRG was 0.722 (cutoff value 14.2 μg/ml) and for fCal was 0.837 (cutoff value 119 μg/g).

CONCLUSION
Both LRG and fCal are valuable biomarkers reflecting disease activity in UC.