How to Evaluate Fibrosis in IBD?

In this review, we will describe the importance of fibrosis in inflammatory bowel disease (IBD) by discussing its distinct impact on Crohn's disease (CD) and ulcerative colitis (UC) through their translation to histopathology. We will address the existing knowledge on the correlation between inflammation and fibrosis and the still not fully explained inflammation-independent fibrogenesis. Finally, we will compile and discuss the recent advances in the noninvasive assessment of intestinal fibrosis, including imaging and biomarkers. Based on the available data, none of the available cross-sectional imaging (CSI) techniques has proved to be capable of measuring CD fibrosis accurately, with MRE showing the most promising performance along with elastography. Very recent research with radiomics showed encouraging results, but further validation with reliable radiomic biomarkers is warranted. Despite the interesting results with micro-RNAs, further advances on the topic of fibrosis biomarkers depend on the development of robust clinical trials based on solid and validated endpoints. We conclude that it seems very likely that radiomics and AI will participate in the future non-invasive fibrosis assessment by CSI techniques in IBD. However, as of today, surgical pathology remains the gold standard for the diagnosis and quantification of intestinal fibrosis in IBD.info:eu-repo/semantics/publishedVersio

Sistema de normalização contabilístico: justo valor versus credibilidade contabilística

A adopção das normas internacionais de contabilidade na União Europeia e o seu previsível impacto no ordenamento contabilístico português renovaram a actualidade do debate em torno do conceito de justo valor e da sua eventual utilização alargada. Assim, com base na literatura nacional e internacional, analisa-se a aplicação do «justo valor» na preparação das demonstrações financeiras e discute-se a credibilidade contabilística do correspondente sistema de informação em Portugal

DA DOR SOLITÁRIA E DAS LÁGRIMAS QUE NÃO SE MOSTRA: A CRIMINALIZAÇÃO DO ABORTO COMO PUNIÇÃO DA SEXUALIDADE DA MULHER

Considerando que, não obstante a legislação criminalizante do aborto, as mulheres ainda o praticam, objetiva-se tecer considerações sobre a possibilidade e cabimento da legalização do ato, com finalidade protetiva da saúde reprodutiva das mulheres. Para tanto, através do método hipotético-dedutivo, selecionou-se dois eixos argumentativos, o primeiro quanto ao uso político de direitos das mulheres e do controle de seus corpos e de sua sexualidade postas numa estrutura misógina, e o segundo quanto aos efeitos diretos e indiretos que a legislação penal promove. Ainda, analisou-se a possibilidade constitucional da legalização do aborto através das manifestações proferidas no HC 124.306/RJ por Luis Roberto Barroso, Ministro do Supremo Tribunal Federal, apresentando algumas considerações pertinentes ao tema. Concluiu-se que a legislação em vigência tem propósito não declarado de segregação das mulheres, cuja situação se agrava por questões de classe e raça, como forma de controle e de punição de sua sexualidade, e que legalizar o aborto seria medida de cidadania para considerar a mulher em sua esfera de liberdade e escolha

Soluble human Suppression of Tumorigenicity 2 is associated with endoscopic activity in patients with moderate-to-severe ulcerative colitis treated with golimumab

Suppressor of Tumorigenicity 2 (ST2) is an IL33 receptor detected in the mucosa and serum of ulcerative colitis (UC) patients. We evaluated soluble ST2 (sST2) as a surrogate biomarker of disease outcome and therapeutic response, in moderate-to-severe UC patients treated with golimumab.Agência financiadora Merck Sharp and Dohme, Lda, Portugal MK8259-22info:eu-repo/semantics/publishedVersio

Portuguese consensus on the best practice for the management of inflammatory bowel disease: IBD ahead 2010 meeting results

AbstractIntroductionThe treatment of inflammatory bowel disease (IBD) has focussed on the management of symptoms but is becoming more resolute on changing the course of the disease and its complications in the long-term. In order to minimize the development of complications and to improve outcomes for these patients it is important to develop other strategies to manage IBD and to optimize current clinical practice.ObjectiveThis article reports the main consensus statements reached during the Portuguese National Meeting on improvement of disease control in IBD, on optimization of corticosteroid and immunosuppressive use in Crohn's disease and on best practice in topics of current interest in Crohn's disease.MethodsAn International Steering Committee selected the top 10 most important unanswered practical questions on the use of conventional therapy in Crohn's disease, to be debated and analysed in several National Meetings of different countries. In each country a National Steering Committee (NSC) was created to moderate a National Meeting during which several expert groups answered the selected questions in light of their clinical practice. Answers were classified according to the Oxford levels of evidence.ConsensusA general consensus was obtained, some of the conclusions were as follows. It is important to introduce conventional corticosteroids in moderate to severely active Crohn's disease of any localization with initial duration of treatment varying according to patient's response; the best option to prevent steroid-induced side effects is to avoid its prolonged or repetitive use and switching appropriate patients to immunosuppressive therapy. Initiation of immunomodulators early in the disease course should be considered for patients with a poor prognosis and optimal safety monitoring was discussed, with the need to reassess patients at appropriate timepoints, make corticosteroid-free remission a goal and treat beyond symptoms

Endoscopic balloon dilation of Crohn’s disease strictures-safety, efficacy and clinical impact

To evaluate the incidence of anastomotic strictures after intestinal resection in Crohn’s disease (CD), demonstrate long-term efficacy and safety of endoscopic balloon dilation (EBD) in CD strictures and its impact on the diagnosis of subclinical postoperative endoscopic recurrence

Ileal Crohn's Disease Exhibits Similar Transmural Fibrosis Irrespective of Phenotype

Transmural inflammation and submucosal fibrosis are important hallmarks of Crohn’s disease (CD) (1). Intestinal fibrosis concerns extracellular matrix accumulation and mesenchymal cell expansion (2,3). In this process, inflammation is the main activator of mesenchymal cells and an essential factor to initiate fibrogenesis. Still, once fibrosis is established, it may be selfpropagating (3,4). In the setting of CD, patients with inflammatory lesions are considered medical therapy-responsive, while those with more fibrotic lesions will eventually need surgery (4). Hence, despite all the available therapies targeting inflammation, intestinal fibrosis remains difficult to treat and pre vent (3,4). Strictures are subdivided in fibrotic, inflammatory, and mixed forms (5). Pure fibrotic or inflammatory strictures are rare, with both components presenting overlapped histopathology (3,6–10). In CD, transmural intestinal inflammation can be assessed by cross-sectional imaging (2,11–16). On the other hand, fibrosis cannot be measured by this technique nor through biomarkers (16,17). Endoscopy or biopsy-based histology (2,11) is not feasible as tissue remodeling occurs mostly in deeper layers (18). Thus, the extent and severity of fibrosis must be evaluated by histopathological analysis of intestinal resection specimens, resorting to several histopathological scoring systems (19,20). The main objective of our work was to characterize and quantify inflammation and fibrosis, in ileal CD resection specimens, according to a CD transmural histopathological scoring system. We also aimed to correlate inflammation and fibrosis profiles with progressive disease.info:eu-repo/semantics/publishedVersio

Therapeutic drug monitoring of CT-P13: a comparison of four different immunoassays

Background: The commercialization of CT-P13, an infliximab (IFX) biosimilar, has the potential to decrease health-related costs and enhance access to biological therapies. This study aimed to address the accuracy and inter-assay agreement of the CT-P13 quantification using four different assays initially developed to assess IFX. Methods: The four different methods, one in-house method and three commercially available kits, were used to quantify exogenously-spiked samples and the sera from 185 inflammatory bowel disease (IBD) patients on CT-P13 therapy. Results: The quantification of the spiked samples unveiled a consistent and accurate behaviour of three of the tested methods, with average percentage recoveries of 90%, 102% and 109%. Results from the clinical samples demonstrated that these three assays were also highly correlated, both concerning Spearman's rank coefficients (range 0.890-0.947) and intraclass correlation coefficients (range 0.907-0.935). There were a few systematic deviations among them, but their impact in the clinical stratification of the patients using different cut-offs was minimal, particularly when these cut-offs were in the 3-4 mu g/ml range, for which the strength of agreement (as assessed by the Kappa statistics that ranged from 0.732 to 0.902) was substantial to almost perfect. Conclusions: Our results indicate that three of the tested IFX quantification methods can be used to accurately quantify CT-P13 without any adjustments.Portuguese IBD Group (GEDII, Grupo de Estudo da Doenca Inflamatoria Intestinal)Portuguese IBD Group (GEDII, Grupo de Estudo da Doença Inflamatória Intestinal