Search

To investigate the feasibility of integrating radiomics and morphological features based on computed tomography enterography (CTE) for developing a noninvasive grading model for mucosal activity and surgery risk of Crohn's disease (CD) patients. A total of 167 patients from three centers were enrolled. Radiomics and image morphological features were extracted to quantify segmental and global simple endoscopic score for Crohn's disease (SES-CD). An image-fusion-based support vector machine (SVM) classifier was used for grading SES-CD and identifying moderate-to-severe SES-CD. The performance of the predictive model was assessed using the area under the receiver operating characteristic curve (AUC). A multiparametric model was developed to predict surgical progression in CD patients by combining sum-image scores and clinical data. The AUC values of the multicategorical segmental SES-CD fusion radiomic model based on a combination of luminal and mesenteric radiomics were 0.828 and 0.709 in training and validation cohorts. The image fusion model integrating the fusion radiomics and morphological features could accurately distinguish bowel segments with moderate-to-severe SES-CD in both the training cohort (AUC = 0.847, 95% confidence interval (CI): 0.784–0.902) and the validation cohort (AUC = 0.896, 95% CI: 0.812–0.960). A predictive nomogram for interval surgery was developed based on multivariable cox analysis. This study demonstrated the feasibility of integrating lumen and mesentery radiomic features to develop a promising noninvasive grading model for mucosal activity of CD. In combination with clinical data, the fusion-image score may yield an accurate prognostic model for time to surgery. [ABSTRACT FROM AUTHOR]

To investigate the feasibility of integrating radiomics and morphological features based on computed tomography enterography (CTE) for developing a noninvasive grading model for mucosal activity and surgery risk of Crohn's disease (CD) patients. A total of 167 patients from three centers were enrolled. Radiomics and image morphological features were extracted to quantify segmental and global simple endoscopic score for Crohn's disease (SES-CD). An image-fusion-based support vector machine (SVM) classifier was used for grading SES-CD and identifying moderate-to-severe SES-CD. The performance of the predictive model was assessed using the area under the receiver operating characteristic curve (AUC). A multiparametric model was developed to predict surgical progression in CD patients by combining sum-image scores and clinical data. The AUC values of the multicategorical segmental SES-CD fusion radiomic model based on a combination of luminal and mesenteric radiomics were 0.828 and 0.709 in training and validation cohorts. The image fusion model integrating the fusion radiomics and morphological features could accurately distinguish bowel segments with moderate-to-severe SES-CD in both the training cohort (AUC = 0.847, 95% confidence interval (CI): 0.784–0.902) and the validation cohort (AUC = 0.896, 95% CI: 0.812–0.960). A predictive nomogram for interval surgery was developed based on multivariable cox analysis. This study demonstrated the feasibility of integrating lumen and mesentery radiomic features to develop a promising noninvasive grading model for mucosal activity of CD. In combination with clinical data, the fusion-image score may yield an accurate prognostic model for time to surgery. [ABSTRACT FROM AUTHOR]

Background: Enteral nutrition [EN] was reported to be as effective as steroids in achieving shortterm remission in patients with Crohn's disease [CD], and exclusive EN [EEN] is widely used as primary therapy in children with CD. The aim of this study was to investigate the effect of a specific multi-fibre mix [MF], designed to match the fibre content of a healthy diet, on intestinal epithelial barrier function in IL-10 knockout [IL-10-/-] mice with spontaneous chronic colitis. Methods: IL-10-/- mice aged 16 weeks, with established colitis, were used for the experiments with multi-fibre mix diet [MF] for 4 weeks. Severity of colitis, levels of short cahin fatty acids [SCFA] in caecum contents, expression of STAT 3 and STAT 4 proteins, CD4+ CD45+ lymphocytes, CD4+Foxp3+ regulatory T cells [Tregs] and cytokines in the lamina propria [LP], epithelial expression of tight junction proteins, TNF-α/TNFR2 mRNA expression, and epithelial apoptosis in the proximal colon were measured at the end of the experiment. Results: MF feeding effectively attenuated disease activity index and colitis associated with decreased lamina propria CD4+ CD45+ lymphocytes, IFN-?/IL-17A mRNA expression, and p-STAT 3 and p-STAT 4 expression in colonic mucosa of IL-10-/- mice [p < 0.05]. Furthermore, CD4+Foxp3+ Tregs in the LP and concentrations of total SCFA, acetate, propionate, and butyrate in the caecum were markedly increased after MF feeding in IL-10-/- mice. After MF feeding, increased epithelial expression and correct localisation of tight junction proteins [occludin and zona occludens protein 1], as well as reducedTNF-α/TNFR2 mRNA expression and epithelial apoptosis, were also observed in IL-10-/- mice. Conclusions: These results indicated that EEN supplemented with the tested fibre mix, known to modulate the intestinal microbiota composition and SCFA production, could possibly improve efficacy in inducing remission in patients with active CD. [ABSTRACT FROM AUTHOR]

Background and Aims: Bacterial DNA (bactDNA) translocation occurs frequently in patients with Crohn's disease and can be present in patients with a negative blood microbiological culture. We aimed to determine the effects of bactDNA translocation on postoperative outcomes in Crohn's disease patients undergoing abdominal surgery. Methods: Patients with Crohn's disease who underwent abdominal surgery between January 2012 and March 2014 were identified. General and postoperative outcome-related information was retrieved from a database, and the data were compared between patients with and without bactDNA translocation. Multivariate analysis was used to determine the independent effect of bactDNA translocation on postoperative morbidity. Results: One hundred and seven patients who underwent abdominal surgery were included in our study. The presence of bactDNA in blood samples was identified in 29 patients (27.1%). There was a total of 55 complications in 28 patients (26.2%). Patients with bactDNA in their blood had a mean postoperative hospital stay of 12.7 ± 4.2 days and patients without DNA translocation had a mean postoperative hospital stay of 10.1 ± 4.8 days (p = 0.009). The readmission rate was increased in patients with bactDNA translocation (p = 0.032). A low preoperative level of serum albumin (p = 0.024), preoperative immunosuppressive agent use (p = 0.046), and the presence of bactDNA in blood (p = 0.005) were independently associated with increased postoperative adverse outcomes. Conclusions: Preoperative bactDNA translocation into the blood increases the incidence of postoperative adverse outcomes in patients with Crohn's disease who undergo abdominal surgery. [ABSTRACT FROM AUTHOR]

The article provides information on a study which investigated the role of polymorphisms in the chemokine CXCL13 or its receptor CXCR5 in HIV-associated non-Hodgkin B-cell lymphoma (AIDS-NHL) risk. Tests conducted and the results yielded are reported. It concludes that genetic variation on CXCL13 may contribute to susceptibility to AIDS-NHL.

Background: Our objective was to compare the effect of a restricted intravenous fluid regimen adjusted by serum lactate level with a standard restricted regimen on complications after major elective surgery for gastrointestinal malignancy. Methods: This is a randomized, observer-blinded, single-center trial conducted across a time span of 13 months. A total of 299 patients were allocated to either a restricted intravenous fluid regimen with supplementary intravenous fluids given based on serum lactate level (group A) or a standard restricted regimen (group R). In group A, the serum lactate level was monitored closely postoperatively to maintain a normal pre-operative serum lactate level. Group R involved patients treated with a restricted fluid regimen in whom additional fluid and electrolytes were administered when deemed necessary based on the usual clinical criteria. The primary outcome measure was complications; the secondary measures were death and adverse effects. Results: Additional fluid supplementation was needed in some patients in both groups (group A [28%] vs group R [26%]). In group A, the time for additional fluid infusion occurred earlier in the postoperative period than group R. Patients in group A received their first supplementary fluid treatment within the first 12 h more commonly than those in group R (74% vs 37%, respectively; P < .004). The regimen adjusted by serum lactate decreased systemic postoperative complications in group A versus group R (10% vs 22%, respectively; P = .023) but not overall total complications (23% vs 33%, respectively; P = .090). In contrast, in patients who required additional fluid infusion, the difference in complications between the 2 groups was greater (overall complication, 45% vs 85%, respectively; P = .023; major complication, 16% vs 44%, respectively; P = .018; systemic complications, 19% vs 63%, respectively; P = .001). One patient died in group A and 4 died in group R (1% vs 4%, respectively; P = .206). Conclusion: A fluid-restricted regimen after elective gastrointestinal operations for malignancy may lead to fluid insufficiency and low tissue perfusion in up to 28% of patients. Close monitoring of serum lactate levels with adjustment of intravenous fluid administration intraoperatively and in the early postoperative period may improve the early detection and correction of inadequate tissue perfusion, thereby decreasing the rate of complications. [Copyright &y& Elsevier]