Weblab in Chemical Engineering between France and Brazil : validation of the methodology

A Weblab is an experiment operated remotely via internet. Besides the strictly technical aspects of such an experiment, which may contribute for the learning of Chemical Engineering fundamentals, there is another important feedback when teams of students of two different countries are working together: the Weblab turns into an intercultural experience, enhancing the communication skills of the students. A Weblab between Universidade Federal de São Carlos (DEQ/UFSCar) and the Ecole Nationale Supérieurs d’Ingénieurs en Arts Chimiques et Technologiques (ENSIACET) is presented in this work. A mass transfer experiment in a bench scale reactor (agitated and aerated) had to be studied by heterogeneous teams, thus emulating challenges that will be common in future work environments. In order to perform the experiment, students in Brazil and in France were gathered into groups. The students had to make decisions about the procedure to drive the experiments. All the students were able to control the equipment, no matter where they physically were. Students communicated using video conference software. The students and teachers opinions on this experience were very positive. This methodology is an important contribution to the formation of engineers in a world integrated by modern communication technologies

Type of treating physician is associated with long-term disease outcome in the prospective Belgian pediatric Crohn's disease registry (BELCRO)

info:eu-repo/semantics/publishe

Tailored step-up approach results in beneficial long-term disease outcome in the prospective Belgian Paediatric Crohn's disease registry (BELCRO)

L. WAUTERS (1), F. SMETS (2), E. DE GREEF (3), I. HOFFMAN (4), P. BONTEMS (5), S. VAN BIERVLIET (6), E. VAN DE VIJVER (7), I. PAQUOT (8), P. ALLIET (9), W. ARTS (10), B. HAUSER (11), H. PEETERS (12), M. DE VOS (13), P. BOSSUYT (14), J. RAHIER (15), O. DEWIT (16), O. DEWIT (16), T. MOREELS (16), F. FONTAINE (17), E. LOUIS (17), D. FRANCHIMONT (18), V. MULS (18), J. COCHE (19), F. BAERT (20), S. VERMEIRE (1), G. VEEREMAN (11) / [1] University Hospitals Leuven, Leuven, Belgium, Gastroenterology and Hepatology, [2] Clin universitaires St-Luc, UCL, Brussels, Belgium, Paediatric Gastroenterology, [3] UZ Brussel, Jette, Belgium, Paediatric Gastroenterology, [4] University Hospitals Leuven, Leuven, Belgium, Paediatric Gastroenterology, [5] HUDERF, City of Brussels, Belgium, Paediatric Gastroenterology, [6] UZ Gent, Gent, Belgium, Paediatric Gastroenterology, [7] UZ Antwerpen, Antwerp, Belgium, , Belgium, Pediatric Gastroenterology, [8] CHC Clinique de l'Esperance, Liège, Belgium, Paediatric Gastroenterology, [9] Jessa Hospital, Hasselt, Belgium, Paediatric Gastroenterology, [10] ZOL, Genk, Belgium, Paediatric Gastroenterology, [11] UZ Brussel, Jette, Belgium, Pediatric Gastroenterology, [12] AZ St Lucas, Ghent, Belgium, Gastroenterology, [13] UZ Gent, Gent, Belgium, Gastroenterology, [14] Imelda Hospital, Bonheiden, Belgium, Gastroenterology, [15] UCL, Mont-Godinne, Belgium, Gastroenterology, [16] Clin universitaires St-Luc, UCL, Brussels, Belgium, Gastroenterology, [17] CHU Liege, Liège, Belgium, Gastroenterology, [18] ULB Hôpital Erasme, Brussels, Belgium, Gastroenterology, [19] Clinique St. Pierre, Ottignies, Belgium, Gastroenterology, [20] Heilig Hart Ziekenhuis, Roeselare, Belgium, Gastroenterology Introduction The prolonged use of biologic agents with or without immunomodulators (IM) remains controversial in the management of paediatric Crohn’s disease (CD). Aim The prolonged use of biologic agents with or without immunomodulators (IM) remains controversial in the management of paediatric Crohn’s disease (CD). Methods Five-year follow-up (FU) data from the BELCRO, an observational prospective cohort of children (< 18 years) diagnosed with CD in Belgium, were analysed. Disease severity was scored as inactive, mild or moderate-to-severe on a 3-point PCDAI scale and monitored yearly. Treatment and outcomes were recorded from diagnosis until 5 yrs FU. Remission was defined as inactive disease and sustained remission when achieved for ≥ 2 yrs FU. Univariate analyses were performed between patients with or without anti-TNF and Spearman’s correlation between treatment and outcomes. Results A total of 91 patients (median (IQR) age 12.7 (10.9 – 14.8) yrs, 53% male) were included. Disease location was 12% ileal, 23% colonic (L2), 64% ileocolonic, 76% upper GI and 30% perianal. Disease severity was 25% mild and 75% moderate-to-severe. Anti-TNF was started in 73% after median (IQR) 1.1 (0.6 – 2.2) yrs with duration of 3.9 (2.5 – 4.7) yrs of which 89% combination therapy with duration of 1.3 (0.6 – 2.0) yrs. Older age (13.1 (11.5 – 15.2) vs. 11.8 (8.7 – 13.8) yrs; p< .05) and location L2 (29% vs. 8%; p= .04) were associated with need to start anti-TNF. Despite shorter delay to corticosteroids (CS) (0 (0 – 0.02) vs. 0.02 (0 – 0.06); p= .04), total duration of CS was similar and total duration of IM (2.5 (1.4 – 4.7) vs. 4.7 (3.6 – 5.2); p= .001) was shorter in the anti-TNF group. Time to first (1.1 (0.5 – 1.8) vs. 0.6 (0.3 – 1.1); p= .01) and sustained (2.9 (2.3 – 3.9) vs. 2.3 (2.1 – 2.9); p= .03) remission was longer with anti-TNF use. Mean disease severity (1.7 (1.4- 1.9) vs. 1.4 (1.3- 1.6); p< .01) during 5 yrs FU was higher with anti-TNF but rates of inactive disease (65% vs. 76%; p= .32) after 5 yrs FU were similar with less ongoing CS (41% vs. 72%; p= .008) in the anti-TNF group. Delay to IM treatment was correlated with mean disease severity (r= .26; p= .02) and duration of CS with duration of sustained remission (r= -.24, p= .03), though not significantly after correction for multiple testing. Rates of perianal flares, hospitalizations or surgery were similar and no serious opportunistic infections, cancer or deaths were reported with use of anti-TNF. Conclusions Prospective data from the BELCRO demonstrate beneficial long-term outcomes using a step-up approach with anti-TNF in over 2/3 of patients, limiting IM treatment. The gain of top-down and early combination therapy remains to be determined in paediatric CD

Accuracy in Diagnosis of Celiac Disease Without Biopsies in Clinical Practice

Background &amp; Aims The guidelines of the European Society of Pediatric Gastroenterology, Hepatology, and Nutrition allow for diagnosis of celiac disease without biopsies in children with symptoms and levels of immunoglobulin A against tissue-transglutaminase (TGA-IgA) 10-fold or more the upper limit of normal (ULN), confirmed by detection of endomysium antibodies (EMA) and positivity for HLA-DQ2/DQ8. We performed a large, international prospective study to validate this approach. Methods We collected data from consecutive pediatric patients (18 years or younger) on a gluten-containing diet who tested positive for TGA-IgA from November 2011 through May 2014, seen at 33 pediatric gastroenterology units in 21 countries. Local centers recorded symptoms; measurements of total IgA, TGA, and EMA; and histopathology findings from duodenal biopsies. Children were considered to have malabsorption if they had chronic diarrhea, weight loss (or insufficient gain), growth failure, or anemia. We directly compared central findings from 16 antibody tests (8 for TGA-IgA, 1 for TGA-IgG, 6 for IgG against deamidated gliadin peptides, and 1 for EMA, from 5 different manufacturers), 2 HLA-DQ2/DQ8 tests from 2 manufacturers, and histopathology findings from the reference pathologist. Final diagnoses were based on local and central results. If all local and central results were concordant for celiac disease, cases were classified as proven celiac disease. Patients with only a low level of TGA-IgA (threefold or less the ULN) but no other results indicating celiac disease were classified as no celiac disease. Central histo-morphometry analyses were performed on all other biopsies and cases were carefully reviewed in a blinded manner. Inconclusive cases were regarded as not having celiac disease for calculation of diagnostic accuracy. The primary aim was to determine whether the nonbiopsy approach identifies children with celiac disease with a positive predictive value (PPV) above 99% in clinical practice. Secondary aims included comparing performance of different serological tests and to determine whether the suggested criteria can be simplified. Results Of 803 children recruited for the study, 96 were excluded due to incomplete data, low level of IgA, or poor-quality biopsies. In the remaining 707 children (65.1% girls; median age, 6.2 years), 645 were diagnosed with celiac disease, 46 were found not to have celiac disease, and 16 had inconclusive results. Findings from local laboratories of TGA-IgA 10-fold or more the ULN, a positive result from the test for EMA, and any symptom identified children with celiac disease (n = 399) with a PPV of 99.75 (95% confidence interval [CI], 98.61–99.99); the PPV was 100.00 (95% CI, 98.68–100.00) when only malabsorption symptoms were used instead of any symptom (n = 278). Inclusion of HLA analyses did not increase accuracy. Findings from central laboratories differed greatly for patients with lower levels of antibodies, but when levels of TGA-IgA were 10-fold or more the ULN, PPVs ranged from 99.63 (95% CI, 98.67–99.96) to 100.00 (95% CI, 99.23–100.00). Conclusions Children can be accurately diagnosed with celiac disease without biopsy analysis. Diagnosis based on level of TGA-IgA 10-fold or more the ULN, a positive result from the EMA tests in a second blood sample, and the presence of at least 1 symptom could avoid risks and costs of endoscopy for more than half the children with celiac disease worldwide. HLA analysis is not required for accurate diagnosis. Clinical Trial Registration no: DRKS00003555. © 2017 AGA Institut