Exacerbated gastrointestinal symptoms and long COVID in IBD patients with SARS-CoV-2 infection: A multi-center study from taiwan.

BACKGROUND/PURPOSE: Limited studies have addressed the exacerbation of symptoms and long COVID in inflammatory bowel disease (IBD) patients following non-severe COVID-19 infection, particularly with post-COVID-19 vaccination. We aim to investigate factors associated with exacerbated gastrointestinal symptoms (EGS) and long COVID in IBD patients with non-severe COVID-19, which is most common situation in daily practice. METHODS: This is an observational study by multiple centers in Taiwan from May 2020 to March 2023. We collected clinical manifestation, data, and medication information from IBD patients with non-severe COVID-19. EGS was defined as increased frequency of diarrhea, bloody stool, and abdomen pain within 14 days after SARS-COV-2 infection. Long COVID was defined following the guidelines of the World Health Organization. RESULTS: Out of 90 patients, most of them (88.9%) received at least standard two doses of COVID-19 vaccination and the majority (87.8%) were mild diseases of COVID-19.30% of patients experienced EGS during COVID-19 with higher ESR levels serving as a predictive factor (Odds ratio: 3.6, 95% confidence interval: 1.2-10.5, P = 0.02). 38.1% of those patients developed long COVID. The patients who experienced EGS during COVID-19 and with a history of longer IBD duration showed a significant association with long COVID (p = 0.03 and p = 0.02). CONCLUSIONS: Our study revealed that EGS and long COVID occurred in one third of IBD patients with non-severe COVID-19, even though most of them had received the standard plus booster vaccination. We identified associated factors for EGS and long COVID, emphasizing the importance of post-COVID-19 follow-up in IBD patients.

A simplified fecal leukocyte esterase strip test results as a low cost, widely available, alternative bowel inflammation biomarker.

BACKGROUND: /Purpose: Leukocyte esterase strips have been widely used to detect the presence of leukocyte in human body fluids. We investigated the correlation between fecal leukocyte esterase (FLE) and fecal calprotectin (FC) levels and compared manual with machine automated interpretation of FLE level. METHODS: This prospective study enrolled inflammatory bowel disease and colitis patients in National Taiwan University Hospital from Dec 2021 to Feb 2022. FLE and FC measured using the same sample were compared with various FC cutoff values. The correlation between values indicated by the two tests was analyzed. Sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUROC) were calculated using SAS. RESULTS: A total of 103 samples were analyzed. The correlation between FLE and FC level was moderate and positive (r = 0.3505, P = 0.0003). With an FLE reading more than 1+ indicating mucosa inflammation, when the FC cutoff was 50, 250, and 500 mg/kg, the sensitivities of FLE readings were 60.3 %, 74.3 %, and 84.6 %, respectively, and the specificities were 62.9 %, 58.8 %, and 58.4 %, respectively. With an FLE reading greater than 1+ indicating mucosa inflammation, FLE reflected FC with AUROC values at the optimal cutoff (500 mg/kg) of 0.72. No difference was noted between manual and machine readings for FLE. CONCLUSION: Positive FLE can predict FC levels of more than 500 mg/kg. The test is widely available, produces results on the same day, and is low cost; therefore, FLE should be further investigated for use in bowel inflammation monitoring.

Green synthesis and characterization of silicate nanostructures coated with Pluronic F127/gelatin for triggered drug delivery in tumor microenvironments.

Thermo-/pH-sensitive nanocomposites based on mesoporous silicate MCM-41 (MSNCs) derived from rice husk ash were synthesized and characterized. MSNCs were coated with thermo-/pH-sensitive Pluronic® F127 and gelatin to form MSNCs@gp nanocomposites, serving as carriers for controlled release of the anticancer drug doxorubicin (Dox). The in vitro and in vivo antitumor efficacy of MSNCs@gp-Dox against liver cancer was evaluated. Fourier-transform infrared (FTIR) spectra confirmed the silica nature of MSNCs@gp by detecting the Si-O-Si group. Under acidic microenvironments (pH 5.4) and 42 °C, MSNCs@gp-Dox exhibited significantly higher Dox release (47.33 %) compared to physiological conditions. Thermo-/pH-sensitive drug release (47.33 %) was observed in simulated tumor environments. The Makoid-Banakar model provided the best fit at pH 7.4 and 37 °C with a mean squared error of 0.4352, an Akaike Information Criterion of 15.00, and a regression coefficient of 0.9972. Cytotoxicity tests have demonstrated no significant toxicity in HepG2 cells treated with various concentrations of MSNCs@gp, while MSNCs@gp-Dox induced considerable cell apoptosis. In vivo studies in nude mice revealed effective suppression of liver cancer growth by MSNCs@gp-Dox, indicating high pharmaceutical efficacy. The investigated MSNCs@gp-based drug delivery system shows promise for liver cancer therapy, offering enhanced treatment efficiency with minimal side effects.

Epidemiology, Disease Course, and Clinical Outcomes of Perianal Fistulas and Fissures Crohn's Disease: A Nationwide Population-Based Study in Taiwan.

Background: Population-based data on the course of perianal disease in East Asian populations with Crohn's disease (CD) are limited. This study examined the prevalence, clinical course, and compared the outcomes of CD patients with perianal CD (pCD) versus without pCD in Taiwan. Methods: A nationwide population-based study was implemented from 2000 to 2017 by using the Taiwan National Health Insurance Research Database. Results: Of 2424 patients with CD, 358 (14.8%) patients with pCD were identified. Most patients with CD and pCD were men (79.3%). The mean age at CD diagnosis was lower in patients with pCD (33.7 years) than in those without pCD (44.9 years). Approximately half the patients with pCD received the pCD diagnosis at least 6 months before receiving a CD diagnosis. Approximately one-third (121/358) of patients with pCD had recurrent fistula; the median recurrence interval was 239 days. Compared with patients without pCD, patients with pCD had higher mean incidences of hospitalization (7.0 vs 3.8, P < .01), outpatient visits (13 vs 2.9, P < .01), and emergency room visits (10.3 vs 4.4, P < .01) over a 15-year period. Although patients with pCD had higher rates of healthcare utilization, their 15-year mortality rate was lower than that of those without pCD (6.1% vs 17.3%, P < .01). Conclusions: The period prevalence of pCD in Taiwanese patients with CD was 14.8%. Although patients with pCD required more intensive care and had greater healthcare utilization, they did not have inferior survival outcomes compared with those without pCD.

Comparison of the magnetic resonance scoring systems for Crohn's disease activity: MaRIA, simplified MaRIA, and Nancy scores.

PURPOSE: The most widely used score for assessing the activity of Crohn's disease (CD) is the Magnetic Resonance Index of Activity (MaRIA) score, but it is time-consuming. The aim of this study was to compare the diagnostic accuracy of MaRIA score to the other two easily calculated scores. METHODS: Between January 2011 and May 2021, 67 patients with CD who underwent MRE and ileocolonoscopy within 2 weeks were enrolled. The MRE-based scores including the MaRIA score, simplified MaRIA (sMaRIA) score, and Nancy score for each colonic segment and terminal ileum were calculated and correlated with the ileocolonoscopic findings. The simplified endoscopic score for Crohn's disease (SES-CD) was considered the gold standard. RESULTS: A total of 343 intestinal segments were included in the analysis, of which 109 (31.8%) showed active inflammation on ileocolonoscopy. The areas under the receiver operating characteristic curve (AUC) of the MaRIA, sMaRIA, and Nancy scores for detecting active disease were 0.752, 0.764, and 0.765, respectively. In the sub-analysis for different indications, the MaRIA and sMaRIA scores showed a higher AUC (0.721 and 0.741) than the Nancy score (0.652) for disease monitoring. CONCLUSION: The sMARIA and Nancy scores showed comparable diagnostic accuracy to the MaRIA score, and thus could be used as alternatives to the MaRIA score. Furthermore, considering the range of application, especially for disease monitoring, the sMaRIA score may be more suitable for use in clinical practice.

Neoantigen vaccination augments antitumor effects of anti-PD-1 on mouse hepatocellular carcinoma.

Immune checkpoint inhibitors are groundbreaking resources for cancer therapy. However, only a few patients with hepatocellular carcinoma (HCC) have shown positive responses to anti-PD-1 therapy. Neoantigens are sequence-altered proteins resulting from somatic mutations in cancer. This study identified the neoantigens of Hep-55.1C and Dt81 Hepa1-6 HCCs by comparing their whole exome sequences with those of a normal C57BL/6 mouse liver. Immunogenic long peptides were pooled as peptide vaccines. The vaccination elicited tumor-reactive immune responses in C57BL/6 mice, as demonstrated by IFN-γ ELISPOT and an in vitro killing assay of splenocytes. In the treatment of three mouse HCC models, combined neoantigen vaccination and anti-PD-1 resulted in more significant tumor regression than monotherapies. Flow cytometry of the tumor-infiltrating lymphocytes showed decreased Treg cells and monocytic myeloid-derived suppressor cells, increased CD8+ T cells, enhanced granzyme B expression, and reduced exhaustion-related markers PD-1 and Lag-3 on CD8+ T cells in the combination group. These findings provide a strong rationale for conducting clinical studies of using neoantigen vaccination in combination with anti-PD-1 to treat patients with HCC.

Rheumatic manifestations of hepatitis C virus infection are associated with autoantibodies but not viremia.

BACKGROUND: To investigate the associations between extrahepatic manifestations, autoantibodies, and viremia in patients with hepatitis C virus (HCV) infection. METHODS: This cross-sectional study recruited patients with HCV infection from the outpatient department of a tertiary medical center in Northern Taiwan between January 2017 and August 2019. Autoantibody profiles and the clinical parameters of HCV infection were evaluated using laboratory tests, and a questionnaire was used to record extrahepatic manifestations. HCV infection status, including inactive HCV infection, active hepatitis, and cirrhosis, was defined according to abdominal ultrasonography findings and alanine transaminase levels. RESULTS: A total of 77 patients with HCV were recruited, with 19.5% and 16.9% of patients, respectively, presenting with arthritis and dry eyes. Autoantibody screening revealed rheumatoid factor (RF), antinuclear antibody (ANA), anti-Ro antibody, and anti-La antibody positivity in 20.8%, 23.4%, 13.0%, and 2.6% of the patients, respectively. The presence of RF was associated with arthritis, whereas the presence of ANA was associated with dry eyes but not dry mouth. Active hepatitis and HCV-related cirrhosis were associated with viremia, but not autoantibody profiles. CONCLUSION: In this single-center study, the prevalence of extrahepatic manifestations and autoantibodies did not differ in patients stratified by the HCV infection status. Rheumatic manifestations were associated with the presence of autoantibodies but not with viremia.

Synthesis and Characterization of Supermagnetic Nanocomposites Coated with Pluronic F127 as a Contrast Agent for Biomedical Applications.

Nanomedicine has garnered significant interest owing to advances in drug delivery, effectively demonstrated in the treatment of certain diseases. Here, smart supermagnetic nanocomposites based on iron oxide nanoparticles (MNPs) coated with Pluronic F127 (F127) were developed for the delivery of doxorubicin (DOX) to tumor tissues. The XRD patterns for all samples revealed peaks consistent with Fe3O4, as shown by their indices (220), (311), (400), (422), (511), and (440), demonstrating that the structure of Fe3O4 did not change after the coating process. After loading with DOX, the as-prepared smart nanocomposites demonstrated drug-loading efficiency and drug-loading capacity percentages of 45 ± 0.10 and 17 ± 0.58% for MNP-F127-2-DOX and 65 ± 0.12 and 13 ± 0.79% for MNP-F127-3-DOX, respectively. Moreover, a better DOX release rate was observed under acidic conditions, which may be credited to the pH sensitivity of the polymer. In vitro analysis demonstrated the survival rate of approximately 90% in HepG2 cells treated with PBS and MNP-F127-3 nanocomposites. Furthermore, after treatment with MNP-F127-3-DOX, the survival rate decreased, confirming cellular inhibition. Hence, the synthesized smart nanocomposites showed great promise for drug delivery in liver cancer treatment, overcoming the limitations of traditional therapies.

In situ vaccination followed by intramuscular poly-ICLC injections for the treatment of hepatocellular carcinoma in mouse models.

The efficacy of treatment for advanced hepatocellular carcinoma (HCC) has remained limited. Polyinosinic-polycytidylic acid-poly-L-lysine carboxymethylcellulose (poly-ICLC) is a synthetic double-stranded RNA that serves as a viral mimic and induces an immune response. Intratumoral (IT) poly-ICLC injections can induce an autovaccination effect and prime the immune system, whereas intramuscular (IM) injection of poly-ICLC can attract and maintain tumor-specific cytotoxic T lymphocytes in tumors. We found that IT injection of poly-ICLC upregulated the expression of CD83 and CD86 on conventional type 1 dendritic cells in tumors. Combination therapy with IT followed by IM injections of poly-ICLC significantly inhibited tumor growth and increased the tumor-infiltrating CD8+ T cells in two syngeneic mouse models of HCC. Depletion of CD8+ T cells attenuated the antitumor effect. An IFN-γ enzyme-linked immunospot of purified tumoral CD8+ T cells revealed a significant proportion of tumor-specific T cells. Finally, the sequential poly-ICLC therapy induced abscopal effects in two dual-tumor models. This study provides evidence that the sequential poly-ICLC therapy significantly increased infiltration of tumor-specific CD8+ T cells in the tumors and induced CD8+ T cell-dependent inhibition of tumor growth, as well as abscopal effects.

Magnetic boron nitride nanosheets-based on pH-responsive smart nanocarriers for the delivery of doxorubicin for liver cancer treatment.

A new drug delivery system (DDS) type complexing magnetic nanoparticles (MNP) along with boron nanosheets (BNN) coated with a pH-responsive polymer-polyethylene glycol (PEG) for the manageable loading/release of the anti-cancerous drug, doxorubicin (DOX), was created (MNP-BNN-PEG-DOX). The X-ray diffraction patterns of the nanocomposites displayed wide diffraction peaks for BNN at 25.1° and 42.3°, belonging to the (002) and (100) planes, correspondingly. Additionally, the characteristic peaks of Fe3O4 appeared at 30.5°, 35.9°, 43.6°, 54.1°, 57.5°, and 63.2°, belonging to the (220), (311), (400), (422), (511), and (440) crystal planes, correspondingly. Moreover, the magnetic properties of the nanocomposites revealed that the MNP-BNN remained magnetic after coating with PEG. The saturation magnetization (Ms) of the uncoated-MNP-BNN and MNP-BNN-PEG-1 were 49.4 and 42.3 emu g-1, respectively. Both in vitro and in vivo analyses shown that DDS might inhibit tumor growth, provoke cancer cell apoptosis, and reduce the cytotoxic effects of DOX. In vivo analysis demonstrated that after treatment with phosphate-buffered saline (PBS), MNP-BNN-PEG-1, free DOX, and MNP-BNN-PEG-1-DOX, the average tumor growth and weight were 1906, 1997, 1188, and 1043 nm and 0.17, 0.20, 0.13, and 0.07 g, respectively. The MNP-BNN-PEG-DOX nanoparticles could be an effective treatment and potential alternative for liver cancer therapy.

Anemia in inflammatory bowel disease course is associated with patients' worse outcome.

BACKGROUND: Purpose: Anemia affects the life quality of inflammatory bowel disease (IBD) patients, but no report from Asian about anemia screening and its impact previously. We aimed to explore the prevalence and impact of anemia among the IBD patients in Taiwan. METHODS: A retrospective study was conducted from January 2006 to February 2018 at National Taiwan University Hospital. Clinical characteristics and outcomes were analyzed. RESULTS: A total of 1604 IBD patients were enrolled [494 Crohn's disease (CD) and 1110 ulcerative colitis (UC)]. Overall, 95.3% (471/494) of CD and 87.9% (976/1110) of UC patients underwent anemia screening. Anemia screening rate in IBD patients significantly increased from 62.6% (162/259) in 2006 to 77.2% (838/1086) in 2017. The mean time from IBD diagnosis to anemia screening was 122.4 days in CD patients and even longer in UC patients at 216.2 days. Persistent anemia was found in 47.3% (548/1158) of the screened patients. Risk factors of persistent anemia included low body mass index [odds ratio (OR) = 1.96, p < 0.01], steroid [OR = 2.96, p < 0.01], thiopurine [OR = 2.62, p < 0.01], colectomy [OR = 6.3, p < 0.01], and small bowel resection [OR = 3.21, p < 0.05)] after IBD diagnosis. Compared with those without anemia, anemic IBD patients had higher admission (p < 0.01) and mortality rates (p < 0.01). CONCLUSION: The anemia screening rate was acceptable and increased over time in Taiwan. Since anemia is associated with worse outcomes, earlier survey and treatment of anemia in IBD patients is recommended.

Synthesis and characterization of silica nanoparticles from rice ashes coated with chitosan/cancer cell membrane for hepatocellular cancer treatment.

Dual pH-sensitive smart nanocarriers based on silica nanoparticles (SNPs) extracted from rice husk ashes (RHAs) to effectively inhibit liver cancer cell proliferation were investigated. The SNPs were coated with chitosan (CH) and loaded with doxorubicin (DOX), then functionalized with cell membrane (CM) for homologous targeting ability. The FTIR spectra showed an absorption wave number at 1083 cm-1 which confirmed the existence of the SiOSi group, ratifying that the nanocarriers belong to silica species. The Korsmeyer-Peppas kinetic model reported R2 values of 0.996 and 0.931 for pH = 5.4 and pH = 7.4, respectively, demonstrating pH-responsive behavior of the nanocarriers. The cytotoxicity test confirmed that the HepG2 cell line treated with different SNP-CH-CM concentrations had no detectable significant cell toxicity, however, SNP-CH-DOX-CM induced greater cell death. In vivo tests revealed that SNP-CH-DOX-CM suppressed liver cancer growth in nude mice, demonstrating high pharmaceutical capability. Histological examination of vital organs showed that the targeted drug delivery system (DDS) had minor in vivo toxicity. In the light of its high treatment efficacy and minimal side effects, the investigated DDS is promising for the therapy of liver cancer.

Therapeutic Effects of Anti-PD1 Immunotherapy on Hepatocellular Carcinoma Under Administration of Tacrolimus.

BACKGROUND: Liver transplantation (LT) is the treatment of choice for patients with hepatocellular carcinoma (HCC). Recurrence of HCC after LT occurs in 10% to 20% of cases. Preclinical studies to evaluate immune checkpoint inhibitors in conjunction with immunosuppressant treatment in transplant recipients have been lacking. Here, we evaluated the efficacy, safety, and mechanism of programmed cell death-1 (PD1) blockade under tacrolimus treatment in transplant recipients. METHODS: We used a murine allogeneic skin transplantation model and murine syngeneic subcutaneous and orthotopic HCC models and measured the tumor volume and the change in tumor-infiltrating lymphocytes under PD1 blockade and tacrolimus treatment. RESULTS: Tacrolimus treatment prolonged allograft survival in the allogeneic transplantation model and enhanced tumor growth in both subcutaneous and orthotopic HCC models. PD1 blockade suppressed tumor growth and lung metastasis in correlation with the number of infiltrating CD8 + T cells. Under tacrolimus treatment, PD1 blockade still resulted in an antitumor effect accompanied by a significant increase in tumor-infiltrating CD8 + T cells, natural killer cells, dendritic cells, and natural killer T cells. Tacrolimus treatment rescued the acceleration of transplant rejection induced by PD1 blockade in the allogeneic transplantation model. CONCLUSIONS: Our data suggest that treatment with high-dose tacrolimus in conjunction with PD1 blockade has an antitumor effect and reduces transplant rejection in mouse models of allograft skin transplantation and HCC. Thus, these results suggest that a clinical trial of PD1 inhibitors for HCC in LT merits consideration.

Preparation and in-vitro/in-vivo evaluation of doxorubicin-loaded magnetic SBA-15 nanocomposites from rice husk for enhancing therapeutic efficacy.

In recent years, nanoscience has attracted considerable attention in the field of biomedicine. This involves the use of engineered nanomaterials as vital platforms for targeted drug delivery, diagnosis, imaging, and observation of therapeutic efficiency. This study explored the preparation, characterization, and applications of doxorubicin-loaded magnetic rice husk ash-derived SBA-15 (MIO@RHAS15-DOX nanocomposites) for drug delivery and in vitro/in vivo efficiency in the treatment of liver cancer. The small-angle XRD patterns of the MIO@RHAS15 nanocomposites demonstrated a core diffraction peak at 0.94°, with two noticeable peaks at 1.6° and 1.8°, representing (100), (110), and (200) crystalline planes, respectively, thereby indicating the existence of a well-defined mesostructure. A sharp melting endothermic peak (Tm) at 79 °C was observed for MIO@RHAS15 nanocomposites. The DOX release from MIO@RHAS15 followed the Higuchi model with the best correlation coefficient R2 value of 0.9799. The in vitro studies indicated a concentration dependent anticancer efficiency, with high cancer cells inhibition for MIO@RHAS15-DOX than free DOX. At the highest concentration of DOX (120 µg/mL), there was less than 25% and 15% cell viability after 24 h and 48 h, respectively. The in vivo studies demonstrated that the tumor sizes after treatment with PBS, MIO@RHAS15, free DOX, and MIO@RHS15-DOX were 1081, 904, 143, and 167 mm3, respectively. The in vivo animal test results depicted that the MIO@RHAS15-DOX nanocomposites were able to inhibit liver tumors in all tested mice. Therefore, the prepared nanocomposites possess a great potential for drug delivery application towards cancer treatment, thereby overcoming the limitations of traditional chemotherapy.

Dietary beliefs and information resources of ulcerative colitis patients in clinical remission: A cross-sectional survey in Taiwan.

BACKGROUND & AIMS: Despite the lack of evidence for the benefits of dietary restrictions for ulcerative colitis (UC), the majority of patients with UC restrict their diets to avoid relapses. Few studies have examined information resources that affect patients' dietary beliefs or practices, but none have investigated UC patients in clinical remission from Asia. This survey investigated the dietary beliefs, practices, and information resources of Taiwanese UC patients in clinical remission. METHODS: A self-reported questionnaire was administered. Fifty UC patients in clinical remission (defined based on having a 2-item patient-reported outcome score of ≤1 with no rectal bleeding for ≥90 days) were recruited from National Taiwan University Hospital between September 2017 and March 2018. RESULTS: In total, 22 patients (45.8%) believed diet to be the initiating factor for UC, and 48.0% of patients believed diet has ever triggered relapses. Forty-two patients (85.7%) avoided specific foods to prevent a relapse. Spicy foods were the most avoided foods (75.5%), following by alcohol (69.4%), carbonated beverages (63.3%), milk or milk products (59.2%), and fatty foods (59.2%). The patients' information resources for dietary beliefs and practices consisted mainly of their own experience. Approximately one-third of the patients have avoided the same menu with their family or avoided outdoor dining to prevent UC relapses. CONCLUSIONS: This is the first dietary belief survey focusing on clinical remission UC patients from Asia. Most clinical remission UC patients spontaneously avoided specific foods based on their own experiences. Dietary restrictions may negatively affect patients' social lives. Further dietary counseling is necessary to minimize the possible negative impacts on UC patients in clinical remission.

De novo synthesis of a MIL-125(Ti) carrier for thermal- and pH-responsive drug release.

Microporous round cake-like (diameter: 900 ± 100 nm) MIL-125(Ti) carrier with a central metal (Ti) exhibiting bio-affinity and possessing a great potential to be used as drug release platform, has been synthesized in the present study. The thermal and pH responsiveness of drug delivery systems (DDS) are the most important parameters for drug release and can be provided through polymer coating techniques. The Pluronic F127 (F127) and chitosan (CH) monomers were inserted into the crystal lattice of MIL-125(Ti) carrier during the de novo synthesis process, which were subsequently loaded with doxorubicin (DOX). The results reveal particle size changes (ranged between 30 and 50 %) from the original size of the MIL-125(Ti) carrier in response to temperature and pH when the carrier reaches acid environment. The drug release profiles have been completed through self-design device, which provides for the real-time release in the DOX amounts via UV-Vis spectra. The kinetics analysis was used to evaluate the R2 values of first order, Higuchi, Korsmeyer-peppas, and Weibull fitting equations, where the Weibull fitting indicated the best R2. An increase by 59.3 % of DOX released under the acid status (pH = 5.4) was observed, indicating that the CH-MIL-125(Ti) carrier is temperature and pH responsive. Moreover, the lattice explosion resulting from the temperature increase in the range of 25-42 °C caused an increase in F127-MIL-125(Ti) by 30.8-38.3 %. The simulated SAXS/WAXS studies for the microstructures of MIL-125(Ti) based DDS at different temperatures after polymer coating (F127-MIL-125(Ti)) provide the possible mechanism of lattice explosion. As such, the responsive Ti-MOF has a highly potential for use in the applications of cancer treatment.

Effect of smoking on the development and outcomes of inflammatory bowel disease in Taiwan: a hospital-based cohort study.

Smoking influences the risks of inflammatory bowel disease (IBD). A hospital-based cohort was conducted to evaluate the effect of smoking on the development and outcomes of IBD, with age, sex and comorbidities matched non-IBD controls from the National Health Interview Survey database of Taiwan. 700 IBD patients (360 ulcerative colitis (UC), 340 Crohn's disease (CD)) were analyzed for outcomes; and 575 patients (297 UC, 278 CD) were analyzed for prevalence. Smoking prevalence was significantly lower in UC patients than controls (20.9% vs. 30.4%, p < 0.01), but no difference between CD patients and controls (19.8% vs. 22.1%, p = 0.60). UC smokers had fewer admissions (1.6 vs. 2.5, p < 0.05) but higher rates of new cancer development (16% vs. 6.7%, p < 0.05) and mortality (16% vs. 4.9%, p < 0.01) than nonsmokers. CD smokers tended to have higher rates of stricturing and penetrating diseases (p < 0.05), and higher surgery risk (60.3% vs. 38.3%, p < 0.01) than nonsmokers. Smoking prevents UC occurrence and is associated with fewer hospitalization but increases risks of cancer and mortality. By contrast, smoking does not affect CD occurrence but is related to more aggressive behavior which results in a higher surgical rate.

Characteristics of primary signet ring cell carcinoma of colon and rectum: a case control study.

BACKGROUND: Primary signet ring cell carcinoma of the colon and rectum (PSRCCR) is rare, usually diagnosed at advanced stage with poor outcomes. We aimed to find possible diagnostic clues in order to help diagnosis. METHODS: A retrospective study of PSRCCR patients from 1993 to 2018 was reviewed at a single tertiary center. Colorectal adenocarcinoma patients as control group with 1:4 ratio was also enrolled. RESULTS: 18 patients with PSRCCR were identified. The prevalence rate was 0.16% (18 of 11,515). The mean age was 50.2 years-old in PSRCCR group and 63 years-old in non-SRCC colorectal cancer patients (p < 0.001). Diagnosis tool depends on colonoscopy were much less in PSRCCR group than control group (44.4% vs 93%, p < 0.001). SRCC patients had higher level of CEA (68.3 vs 17.7 ng/mL, p = 0.004) and lower level of Albumin (3.4 vs 4.3 g/dL, p < 0.001). The majority of PSRCCR tumor configuration was ulcerative and infiltrative. More PSRCCR pathology presented as high-grade carcinoma (66.7 vs 1.4%, p < 0.001) and lymphovascular invasion (77.8 vs 44.4%, p = 0.011) than control group. More PSRCCR patients were diagnosed at advanced stage (88.8 vs 40.3%, p = 0.001). Higher mortality was also noticed in PSRCCR group than control group (72.2 vs 20.8%, p < 0.001). CONCLUSION: For young patients with long segment colonic stenosis and ulcerative/ infiltrative mucosa but endoscopic biopsy failed to identify malignant cells, earlier operation or non-colon site biopsy is suggested for diagnosing the PSRCCR.

Association of young age and male sex with primary sclerosing cholangitis in Taiwanese patients with inflammatory bowel disease.

BACKGROUND/AIMS: Primary sclerosing cholangitis (PSC) is associated with inflammatory bowel disease (IBD). We aimed to evaluate the prevalence, clinical manifestation, and outcomes of PSC in Taiwanese patients with IBD. METHODS: This retrospective study enrolled patients with IBD admitted from January 1, 1996, to December 31, 2018, to National Taiwan University Hospital. A case-matched analysis was performed comparing patients with IBD with and without PSC according to age, sex, and time of admission, with ratios of 1:4 and 1:2 in the adult and pediatric groups, respectively. RESULTS: In total, 763 patients with IBD were enrolled, 12 of whom were also diagnosed with PSC (1.57%). All these patients had ulcerative colitis (UC). A greater incidence of IBD with PSC was observed in younger patients than in older patients. Male sex was a risk factor for PSC in pediatric patients with IBD (P=0.015); 75% of these patients were diagnosed with PSC along with or after the diagnosis of UC. There was no significant difference in colitis extent and severity between the groups; however, a higher proportion of rectal sparing was observed in patients with PSC (P=0.001). There was no significant difference in cancer development between the groups (P=0.679). CONCLUSIONS: A 1.57% prevalence of PSC was observed in Taiwanese patients with IBD. The majority of patients with IBD and PSC were men and were diagnosed at a younger age. Hence, routine evaluation of biliary enzymes and liver imaging is recommended in young male patients with IBD.