The cost of inflammatory bowel disease management matches with clinical course: A single outpatient centre analysis

Inflammatory bowel diseases (IBD) have a large economic burden on health systems. Our single-centre observational retrospective study aimed to assess an economic evaluation in two IBD outpatient cohorts (biological and conventional therapy) in relation to disease activity within a three-year follow-up. Four hundred and seventeen consecutive IBD patients referred to our tertiary gastroenterology unit (Bari-Puglia-Southern Italy) on January 2014–December 2016 were included. For each group (conventional/biological), we assessed direct/indirect costs and clinical/endoscopic activity within the first year and along the three-year follow-up. Statistical analyses: Wilcoxon signed-rank test (continuous variables), chi-square and Fisher’s test (categorical variables), Spearman ranks (single outcome) and ANOVA (detection time, clinical/endoscopic scores) were used. Continuous variables were expressed as mean ± standard deviation and range and/or median, interquartile range and range; categorical variables were expressed as proportions with 95% confidence interval. Direct and indirect cost items of 2014 and 2014–2016 were higher in patients treated with biological than conventional therapy. Subjects on biological therapy were younger and showed clinical and endoscopic moderate-to-severe disease activity. After three years, they reached a significant improvement from baseline. Conversely, disease activity was mild when conventional treatment had a beneficial effect. In conclusion, overall IBD management cost matches with clinical course and needs long-term evaluation in critical patients

Assessment of the hyperspectral data analysis as a tool to diagnose xylella fastidiosa in the asymptomatic leaves of olive plants

Xylella fastidiosa is a bacterial pathogen affecting many plant species worldwide. Recently, the subspecies pauca (Xfp) has been reported as the causal agent of a devastating disease on olive trees in the Salento area (Apulia region, southeastern Italy), where centenarian and millenarian plants constitute a great agronomic, economic, and landscape trait, as well as an important cultural heritage. It is, therefore, important to develop diagnostic tools able to detect the disease early, even when infected plants are still asymptomatic, to reduce the infection risk for the surrounding plants. The reference analysis is the quantitative real time-Polymerase-Chain-Reaction (qPCR) of the bacterial DNA. The aim of this work was to assess whether the analysis of hyperspectral data, using different statistical methods, was able to select with sufficient accuracy, which plants to analyze with PCR, to save time and economic resources. The study area was selected in the Municipality of Oria (Brindisi). Partial Least Square Regression (PLSR) and Canonical Discriminant Analysis (CDA) indicated that the most important bands were those related to the chlorophyll function, water, lignin content, as can also be seen from the wilting symptoms in Xfp-infected plants. The confusion matrix of CDA showed an overall accuracy of 0.67, but with a better capability to discriminate the infected plants. Finally, an unsupervised classification, using only spectral data, was able to discriminate the infected plants at a very early stage of infection. Then, in phase of testing qPCR should be performed only on the plants predicted as infected from hyperspectral data, thus, saving time and financial resources

Computer-Aided Imaging Analysis of Probe-Based Confocal Laser Endomicroscopy With Molecular Labeling and Gene Expression Identifies Markers of Response to Biological Therapy in IBD Patients: The Endo-Omics Study

Abstract Background We aimed to predict response to biologics in inflammatory bowel disease (IBD) using computerized image analysis of probe confocal laser endomicroscopy (pCLE) in vivo and assess the binding of fluorescent-labeled biologics ex vivo. Additionally, we investigated genes predictive of anti-tumor necrosis factor (TNF) response. Methods Twenty-nine patients (15 with Crohn’s disease [CD], 14 with ulcerative colitis [UC]) underwent colonoscopy with pCLE before and 12 to 14 weeks after starting anti-TNF or anti-integrin α4β7 therapy. Biopsies were taken for fluorescein isothiocyanate–labeled infliximab and vedolizumab staining and gene expression analysis. Computer-aided quantitative image analysis of pCLE was performed. Differentially expressed genes predictive of response were determined and validated in a public cohort. Results In vivo, vessel tortuosity, crypt morphology, and fluorescein leakage predicted response in UC (area under the receiver-operating characteristic curve [AUROC], 0.93; accuracy 85%, positive predictive value [PPV] 89%; negative predictive value [NPV] 75%) and CD (AUROC, 0.79; accuracy 80%; PPV 75%; NPV 83%) patients. Ex vivo, increased binding of labeled biologic at baseline predicted response in UC (UC) (AUROC, 83%; accuracy 77%; PPV 89%; NPV 50%) but not in Crohn’s disease (AUROC 58%). A total of 325 differentially expressed genes distinguished responders from nonresponders, 86 of which fell within the most enriched pathways. A panel including ACTN1, CXCL6, LAMA4, EMILIN1, CRIP2, CXCL13, and MAPKAPK2 showed good prediction of anti-TNF response (AUROC >0.7). Conclusions Higher mucosal binding of the drug target is associated with response to therapy in UC. In vivo, mucosal and microvascular changes detected by pCLE are associated with response to biologics in inflammatory bowel disease. Anti-TNF–responsive UC patients have a less inflamed and fibrotic state pretreatment. Chemotactic pathways involving CXCL6 or CXCL13 may be novel targets for therapy in nonresponders

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Young people in Southern Italy and the phenomenon of immigration: what is their perception?

In Italy, the issues of immigration, integration and perception of the phenomenon are extremely topical and have prompted a rather heated debate. Lacking official data on the citizens’ “sentiment”, a survey was carried out through a questionnaire addressed to about 1,200 students attending the Apulian high schools. The aims are mainly two: to ascertain possible misperceptions or information gaps and to better understand young people’s opinions about the positive or negative effects of the immigrants’ presence in our communities, and their behaviour to facilitate the integration process. Some relevant misperceptions are highlighted, and the respondents’ perceptions are detected by means of exploratory analyses, heterogeneity indexes and multiple correspondence analysis

Evaluating people's awareness about climate changes and environmental issues: A case study

In the last decade, environmental issues have become a major topic of public opinion. People have begun to develop increasing environmental awareness and positive attitudes toward ecological matters. In particular, young people have begun to actively participate in environmental challenges by organizing green movements and engaging with policymakers. In this perspective, this study explores two main aspects: 1) awareness of the potential impacts of climate change and of environmental issues in each individual's daily life, and 2) the relationship between attitudes and pro-environmental actions. To this end, we analyse qualitative data obtained from a tailored online survey involving either students from a selected group of Italian High schools or volunteer respondents from the students' acquaintances. A total of 1834 responses are analysed using statistical tools to assess the multiple objectives of the survey. We distinguish between young and adult respondents and examine the relationships between awareness, personal experience, and risk perception in the two groups. We then propose a Multiple Correspondence Analysis that focuses on youth attitudes to examine the factors that influence their propensity to environmental issues and to determine the impact of global green movements on the onset or acceleration of their environmental awareness. Although the results show a more pessimistic view of the threats posed by environmental crises, our results highlight that younger generations have a deeper awareness of environmental conditions and are committed to environmental recovery by adopting “good ecological practices” and “active ecological behaviors.

Response to Biologics in Ibd Patients Assessed by Computerized Image Analysis of Probe Based Confocal Laser Endomicroscopy With Molecular Labeling

Background The increase in therapeutic choices in inflammatory bowel diseases (IBD) imposed the identification of personalized therapeutic strategy. Confocal laser endomicroscopy (CLE) is a new endoscopic tool developed to obtain virtual in vivo histology. This study aimed to identify CLE in vivo and ex vivo features predictive of response for patients starting biologics. Methods We performed a prospective observational study: 29 patients (14 ulcerative colitis-UC and 15 Crohn’s Disease-CD) underwent CLE before and after biological treatment. CLE parameters analyzed were: crypt distribution, crypt area (CA), eccentricity, diameter, inter-cryptic distance (ICD), vessel tortuosity (VT), wall thickness (WT), fluorescein leakage (FLCM) and ex-vivo binding activity of fluorescein-labelled biologics on biopsies. Mosaicism of CLE images were analyzed using a dedicated software algorithm (CellvizioViewer, Mauna-Kea-Technologies, Paris-France). A Graphical User Interface was designed for a semiautomated analysis. Results After treatment, VT changed in overall population; FLCM decreased in UC patients, whilst CA, eccentricity and ICD in CD patients (p< 0.05). FLCM was the best parameter for predicting responsiveness (AUROC 83%, accuracy 83%, PPV 94% and NPV 57%). FLCM and ICD were the best discriminants in responders Vs non-responders in UC (AUROC85%, accuracy 85%, PPV 100% and NPV 71%); whilst VT, CA and ICD in CD (AUROC 95%-86%-83%; accuracy 90%-90%-88%; PPV 100%-100%-86%; and NPV 75%-75%-100%, respectively). UC patients, but not CD patients, had higher basal fluorescent intensity signals with a significant reduction after treatment (p< 0.05). An increased mucosal binding to the fluorescent labelled biological agent was associated to a higher likelihood of therapy response (AUROC 81%-64%, accuracy 77%-79%, PPV 100%-80%, NPV 63%-50% in UC and CD patients respectively). Conclusion FLCM and ICD were the best discriminants of response in UC, while VT, CA and ICD in CD. A higher mucosal binding to a biological agent before treatment was observed in responders UC patients but not in CD patients

A Virtual Chromoendoscopy Artificial Intelligence system to detect endoscopic and histologic activity/remission and predict clinical outcomes in Ulcerative Colitis

Background and study aims Endoscopic and histologic remission (ER, HR) are therapeutic targets in ulcerative colitis (UC) and virtual chromoendoscopy (VCE) improves the endoscopic assessment and the prediction of histology. However, interobserver variability is a limitation for widespread standardised endoscopic assessment using all scoring systems. We aimed to develop an artificial intelligence tool to distinguish ER/activity, and predict histology and risk of flare from white-light-endoscopy (WLE) and VCE videos. Patients and methods 1090 endoscopic videos (638287 frames), from 283 patients, were used to develop a convolutional neural network (CNN). UC endoscopic activity was graded by experts with Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and PICaSSO. The CNN was trained to distinguish ER/activity on endoscopy videos, and retrained to predict HR/activity, defined according to multiple indices, and predict outcome; CNN and humans agreement was measured. Results The AI system detected ER (UCEIS ≤1) in WLE videos with 72% sensitivity (Se), 87% specificity (Sp), and area under the ROC curve (AUROC) of 0.85; For detection of ER in VCE videos (PICaSSO ≤3) Se was 79%, Sp 95%, and the AUROC 0.94. Prediction of HR was similar between WLE and VCE videos (accuracies ranging 80%-85%). The model’s stratification of risk of flare was similar to that of physician-assessed endoscopy scores. Conclusions Our system accurately distinguished ER/activity and predicted HR and clinical outcomes from colonoscopy videos. This is the first computer model developed to detect inflammation/healing using VCE through the PICaSSO score and the first computer tool providing endoscopic, histologic, and clinical assessmen

Female reproductive health and inflammatory bowel disease: A practice-based review

Inflammatory bowel diseases, namely ulcerative colitis and Crohn's disease, occur worldwide and affect people of all ages, with a high impact on their quality of life. Sex differences in incidence and prevalence have been reported, and there are also gender-specific issues that physicians should recognize. For women, there are multiple, important concerns regarding issues of body image and sexuality, menstruation, contraception, fertility, pregnancy, breastfeeding and menopause. This practice-based review focuses on the main themes that run through the life of women with inflammatory bowel diseases from puberty to menopause. Gastroenterologists who specialize in inflammatory bowel diseases and other physicians who see female patients with inflammatory bowel diseases should provide support for these problems and offer adequate therapy to ensure that their patients achieve the same overall well-being and health as do women without inflammatory bowel diseases