A proposal for a study on treatment selection and lifestyle recommendations in chronic inflammatory diseases:A danish multidisciplinary collaboration on prognostic factors and personalised medicine

Chronic inflammatory diseases (CIDs), including Crohn’s disease and ulcerative colitis (inflammatory bowel diseases, IBD), rheumatoid arthritis, psoriasis, psoriatic arthritis, spondyloarthritides, hidradenitis suppurativa, and immune-mediated uveitis, are treated with biologics targeting the pro-inflammatory molecule tumour necrosis factor-α (TNF) (i.e., TNF inhibitors). Approximately one-third of the patients do not respond to the treatment. Genetics and lifestyle may affect the treatment results. The aims of this multidisciplinary collaboration are to identify (1) molecular signatures of prognostic value to help tailor treatment decisions to an individual likely to initiate TNF inhibitor therapy, followed by (2) lifestyle factors that support achievement of optimised treatment outcome. This report describes the establishment of a cohort that aims to obtain this information. Clinical data including lifestyle and treatment response and biological specimens (blood, faeces, urine, and, in IBD patients, intestinal biopsies) are sampled prior to and while on TNF inhibitor therapy. Both hypothesis-driven and data-driven analyses will be performed according to pre-specified protocols including pathway analyses resulting from candidate gene expression analyses and global approaches (e.g., metabolomics, metagenomics, proteomics). The final purpose is to improve the lives of patients suffering from CIDs, by providing tools facilitating treatment selection and dietary recommendations likely to improve the clinical outcome

‘Validation of ultrasound examinations performed by general practitioners’

Objective: The aim of this study was to evaluate the diagnostic agreement when a general practitioner and subsequently a specialist (radiologist/gynecologist) performed point-of-care ultrasound examinations for certain abdominal and gynecological conditions of low to moderate complexity. Design: A prospective study of inter-rater reliability and agreement. Setting: Patients were recruited and initially scanned in general practice. The validation examinations were conducted in a hospital setting. Subjects: A convenient sample of 114 patients presenting with abdominal pain or discomfort, possible pregnancy or known risk factors toward abdominal aortic aneurism were included. Main outcome measures: Inter-rater agreement (Kappa statistic and percentage agreement) between ultrasound examinations by general practitioner and specialist for the following conditions: gallstones, ascites, abdominal aorta >5 cm, intrauterine pregnancy and gestational age. Results: An overall Kappa value of 0.93 (95% confidence interval (CI): 0.87–0.98) was obtained. Ascites, abdominal aortic diameter >5cm, and intrauterine pregnancy showed Kappa values of 1. Conclusion: Our study showed that general practitioners performing point-of-care ultrasound examinations with low-to-moderate complexity had a very high rate of inter-rater agreement compared with specialists

Simultaneous endoscopic and video-assisted retroperitoneal debridement in walled-off pancreatic necrosis using a laparoscopic access platform:Two case reports

BACKGROUND: Infected walled-off necrosis is a potentially life-threatening complication of necrotizing pancreatitis. While some patients can be treated by drainage alone, many patients also need evacuation of the infected debris. Central necroses in relation to the pancreatic bed are easily reached via an endoscopic transluminal approach, whereas necroses that involve the paracolic gutters and the pelvis are most efficiently treated via a percutaneous approach. Large and complex necroses may need a combination of the two methods. CASE SUMMARY: Transluminal and percutaneous drainage followed by simultaneous endoscopic and modified video-assisted retroperitoneal debridement was carried out in two patients with very large (32-38 cm), infected walled-off necroses using a laparoscopic access platform. After 34 d and 86 d and a total of 9 and 14 procedures, respectively, complete regression of the walled-off necroses was achieved. The laparoscopic access platform improved both access to the cavities as well as the overview. Simultaneous transluminal and percutaneous necrosectomy are feasible with the laparoscopic access platform serving as a useful adjunctive. CONCLUSION: This approach may be necessary to control infection and achieve regression in some patients with complex collections