A255 EMPHYSEMATOUS CYSTITIS: A MARKER OF SEVERE CROHN’S DISEASE?

Background

Emphysematous cystitis (EC) is characterized by the presence of air within the bladder walls, a complication of infection by gas producing organisms within the urinary system. However, rare cases of EC in the setting of infectious gastroenteritis have been reported suggesting an alternate etiology. We report a case of EC in the setting of severe Crohn’s colitis with no clinical evidence of urinary tract infection.

Aims

This report outlines the rare case of a patient with active Crohn’s disease who presented with bloody diarrhea, anemia, hypoalbuminemia and initial radiological evidence of EC. We expand on the subsequent clinical investigations, diagnosis, treatment plan and hospital course of the patient.

Methods

Case report, review of literature.

Results

A 43-year old female presented with a 2-month history of bloody diarrhea consisting of 8–12 bowel movements a day, 10 kg of weight loss and peripheral edema. She also had multiple ulcerated lesions on her abdominal wall and in the perianal region. Initial CT scan was significant for pancolitis, anasarca and EC. The follow-up CT cystogram, flexible cystoscopy and pelvic MRI confirmed the diagnosis of EC and ruled out any fistulous tracts in the pelvis including enterovesical/colovesical fistula. The patient did not report any urinary symptoms and the urinalysis was within normal limits. Infectious workup including urine and blood cultures, stool ova and parasite, stool C. difficile PCR, TB IGRA, Hep A, Hep B, Hep C and HIV serologies were all negative. Despite the paucity of infectious findings, the EC was empirically treated with an intravenous third-generation cephalosporin. Colonoscopy was significant for multiple ulcerated and hyperemic areas with pseudopolyps all throughout the right, transverse and left colon. Biopsies confirmed Crohn’s colitis with no evidence of granulomata or dysplasia, and were also negative for CMV immunohistochemistry. The perianal and abdominal wall lesions were suspected to be pyoderma gangrenosum although biopsies were equivocal. The colitis was initially treated with intravenous steroids followed by biologic therapy with Infliximab. While there was some interval improvement of symptoms, the in-hospital course was further complicated by a rectal bleed requiring surgical obliteration of the rectal artery, then a colonic perforation requiring total colectomy.

Conclusions

This is a rare case of EC in a patient with severe Crohn’s colitis. There was no clinical evidence of urinary tract infection or fistulising disease. According to our review, this is the first reported incident of EC in a patient with inflammatory bowel disease without any prior intra-abdominal surgeries. While active Crohn’s disease alone is a critical illness, we conclude that concomitant EC is a poor prognostic factor.

Funding Agencies

None

Final results for the neutron -asymmetry parameter A0 from the UCNA experiment

The UCNA experiment was designed to measure the neutron β-asymmetry parameter A0 using polarized ultracold neutrons (UCN). UCN produced via downscattering in solid deuterium were polarized via transport through a 7 T magnetic field, and then directed to a 1 T solenoidal electron spectrometer, where the decay electrons were detected in electron detector packages located on the two ends of the spectrometer. A value for A0 was then extracted from the asymmetry in the numbers of counts in the two detector packages. We summarize all of the results from the UCNA experiment, obtained during run periods in 2007, 2008–2009, 2010, and 2011–2013, which ultimately culminated in a 0.67% precision result for A0.

Characterization and Adsorption Behavior of Strontium from Aqueous Solutions onto Chitosan-Fuller's Earth Beads

Fuller's earth spherical beads using chitosan as a binder were prepared for the removal of strontium ions from aqueous solution. The adsorbents were characterized by scanning electron microscopy (SEM) and transmission electron microscopy (TEM), which revealed the porous nature of the beads. The Brunauer⁻Emmett⁻Teller (BET) surface area of the beads was found to be 48.5 m²/g. The adsorption capacities of the beads were evaluated under both batch and dynamic conditions. The adsorption capacity was found to be ~29 mg/g of adsorbent at 298 K when the equilibrium concentration of strontium in the solution was 925 mg/L at pH 6.5. The X-ray photoelectron spectroscopy (XPS) data suggest that strontium uptake by the beads occurs mainly through an ion-exchange process. Kinetic data indicate that the sorption of strontium onto the beads follows anomalous diffusion. Thermodynamic data suggest that the ion-exchange of Sr²⁺ on the bead surface was feasible, spontaneous and endothermic in nature.

Elevated fibrinogen, von Willebrand factor, and Factor VIII confer resistance to dilutional coagulopathy and activated protein C in normal pregnant women

BACKGROUND

Gestational changes in coagulation factor concentrations include elevations in fibrinogen, Factor VIII, and von Willebrand factor (vWF). We hypothesised that blood samples from term pregnant (TP) subjects are less prone to coagulation disturbances from haemodilution compared with those from non-pregnant (NP) females.

METHODS

Blood samples were collected from 15 NP and 15 TP subjects. In vitro haemodilution with normal saline was assessed by modified Clauss fibrinogen assay, factor activity, flow-chamber assay, and thromboelastometry. The impact of human fibrinogen concentrate (hFC), cryoprecipitate, and vWF/Factor VIII (FVIII) concentrate replacement in diluted TP and NP blood was compared. Thrombin generation and activated protein C sensitivity were assessed.

RESULTS

TP blood contained twice the concentrations of fibrinogen, FVIII, and vWF relative to NP blood (P<0.0001). Platelet thrombus formation (PTF) under flow was reduced by 99.2% and 69.2% in diluted NP and TP blood, respectively. Platelet thrombus formation was partially restored by adding vWF/FVIII, but not hFC or cryoprecipitate. Fibrin clot firmness approached the threshold of 10 mm in diluted NP blood, and clot firmness was effectively restored by hFC, but not by vWF/FVIII. In the presence of thrombomodulin, peak thrombin generation was decreased by 86.7% in NP plasma, but by 31.8% in TP plasma (P<0.0001 vs NP plasma), indicating reduced activated protein C sensitivity in TP plasma. Both elevated FVIII and haemodilution contributed to activated protein C insensitivity.

CONCLUSIONS

Our in vitro model showed relative resistance of TP blood to dilutional coagulation changes with respect to platelet adhesion, fibrin polymerisation, and thrombin generation. Careful therapeutic monitoring for different pro-haemostatic agents in pregnant women is warranted.

TP1-7 Extended glasgow outcome scale – when would you rather die?

Objectives

Extended Glasgow Outcome Scale is the primary outcome measure in trials involving neurotrauma patients. Conventional dichotomization characterises unfavourable outcomes as upper severe disability or worse, however RESCUE-ICP changed this to consider upper severe disability as a favourable outcome. As the recent consensus meeting in Cambridge proved, opinion of what constitutes acceptable recovery can vary widely between individuals.

Design

To survey patients with brain injury and compare them to the opinions of staff routinely involved in the care of such patients.

Subjects

Patients with brain injuries, neurosurgery staff and ITU staff.

Method

GOS-E sheets were given to neurotrauma patients and asked to circle the outcome they considered unfavourable and therefore would rather not survive. This was compared to the same question posed to neurosurgery staff members, and ITU staff members.

Results

67 responses collected (20 patients, 27 neurosurgery staff, 20 ITU staff). Mean GOS-E score deemed unfavourable and therefore not worth survival was 3.6, mode 3 (Patient mean 3.15, mode 3. Neurosurgery mean 3.63, mode 4. ITU mean 4.0, mode 5. p>0.05).

Conclusion

What constitutes unfavourable outcome varies between each group of people questioned. Patients who have experienced brain injuries were more likely to feel that upper severe disability was an acceptable outcome when compared to the staff that care for them. It is imperative we take this in to consideration when recommending treatment strategies in an acute setting.

Abstract P6-02-05: Downstream workup after post-treatment mammography in breast conservation therapy: Is there a significant difference between tomosynthesis and 2-dimensional mammograms?

Introduction:

Emerging data suggest that tomosynthesis mammograms (TS) are considerably superior to two-dimensional (2D) screening mammograms (2DMG) at reducing false positive biopsies for breast cancer screening. However, very little is reported about the comparative efficacy of the two modalities in the post-treatment setting. We compared the rate of downstream workup up after undergoing post-radiation screening 2DMG and TS following breast conservation therapy at our institution.

Methods:

Between the years 2011-2017, 712 breast cancer patients (range 31-91 years) were treated with lumpectomy and adjuvant radiotherapy. As per institutional standard, follow up included either screening 2DMG (n=569) or TS(n=143) and reviewed in this IRB-approved study. The primary endpoint for comparison was the rate of further imaging/workup post-treatment . Comparative analysis was conducted via multivariable binomial regression with propensity matching between the 2DMG and TS groups. Patients with clinical suspicion of recurrence otherwise were excluded.

Results:

The patient cohort in both groups included the following clinical characteristics,: 129 patients with ductal carcinoma in-situ (the remainder were invasive carcinoma; ductal or lobular). A total of 418 patients had T1 lesions, 143 T2, and 22 T3/T4. Eighty-five patients were node positive. Of those, 501 ER+/Her2-, 101 triple negative, and 96 triple positive. Adjuvant radiation included conventional fraction (457) or hypofractionation (153) with boost to the surgical cavity in523Accelerated Partial Breast Irradiation (APBI) was delivered in 106 patients. Post treatment scans occurred within 3 months (166), at 3-6 months (256), or 6+ months (281). The aforementioned characteristics were similarly distributed between 2DMG and TS groups, except for slightly more DCIS in the 2D group.

There was a significantly higher proportion of patients that were recommended for immediate downstream workup in the 2D group (40.7%) compared to in the tomo group (16.8%) (HR = 3.40, P &lt;0.001), leading to 12 biopsies in the 2D group (3 positive) and 4 biopsies in the TS group (0 positive). Upon multivariate analysis, the use of tomo was the lone correlate of reduced downstream workup (p &lt; 0.05), although there was a trend toward significance in patients who were first imaged at a post-treatment interval of 6+ months and in patients not undergoing a radiation boost (P &lt; 0.10).

Conclusion:

Post-breast conservation follow-up with tomo synthesis mammography resulted in significantly less downstream workup as compared to conventional 2D screening mammography. Further investigation is warranted to unveil the absolute and relative cost-effectiveness between the two modalities.

Citation Format: Colosimo BL, Weinberger K, Hasan S, Gresswell S, Anderson S, Wegner RE, Trombetta M. Downstream workup after post-treatment mammography in breast conservation therapy: Is there a significant difference between tomosynthesis and 2-dimensional mammograms? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-02-05.

Search for neutron dark decay: n → χ + e+e−

In January, 2018, Fornal and Grinstein proposed that a previously unobserved neutron decay branch to a dark matter particle (χ) could account for the discrepancy in the neutron lifetime observed in two different types of experiments. One of the possible final states discussed includes a single χ along with an e+e− pair. We use data from the UCNA (Ultracold Neutron Asymmetry) experiment to set limits on this decay channel. Coincident electron-like events are detected with ∼ 4π acceptance using a pair of detectors that observe a volume of stored Ultracold Neutrons (UCNs). We use the timing information of coincidence events to select candidate dark sector particle decays by applying a timing calibration and selecting events within a physically-forbidden timing region for conventional n → p + e- + ν̅e decays. The summed kinetic energy (Ee+e−) from such events is reconstructed and used to set limits, as a function of the χ mass, on the branching fraction for this decay channel.

Late gestation diet supplementation of resin acid-enriched composition increases sow colostrum immunoglobulin G content, piglet colostrum intake and improve sow gut microbiota

Resin acid-enriched composition (RAC) mainly containing tall oil fatty acid with an active component of resin acid (RA) can improve the microbial population in the digestive system, change the microbial fermentation, and improve the feed conversion ratio. We investigated the effects of dietary supplementation of RAC on sow colostrum yield (CY), colostrum composition and gut microbiota. Tall oil fatty acid and RA are commonly termed RAC and CLA, pinolenic, abietic, dehydrobiotic acids are characteristic components of RAC. The experiment was conducted in three trials in three respective herds. Sows were fed with a control diet and the same diet supplemented with 5 g RAC/day per sow during the last week of gestation. The 16S ribosomal RNA gene sequencing technique was used to assess sows' faecal microbiota populations at farrowing. Colostrum nutritional composition, acute phase proteins (APPs) and immunoglobulin (Ig) content were also assessed. Individual piglets were weighed at birth and 24 h after the birth of first piglets in order to calculate CY and later at 3 to 4 weeks to calculate average daily gain. The RAC-fed sows had significantly higher IgG levels (P0.05), but those fed RAC had higher levels of colostrum serum amyloid A. Colostrum yield was significantly higher in RAC-fed sows in herds 2 and 3 with heavier piglets between 3 and 4 weeks of age (P0.05). Resin acid-enriched composition supplementation significantly increased some beneficial and fermentative bacteria (Romboutsia and Clostridium sensu stricto) than the control diet (P<0.01) while some opportunistic pathogens (Barnesiella, Sporobacter, Intestinimonas and Campylobacter), including Proteobacteria, were suppressed. Therefore, RAC added to the sow diet at late pregnancy increases colostrum IgG, colostrum availability for neonate piglets, and seems to promote better maternal intestinal microbial sources.