Fatigue in Patients with Newly Diagnosed Inflammatory Bowel Disease: Results from a Prospective Inception Cohort, the IBSEN III Study

BACKGROUND AND AIMS

Although fatigue is common in inflammatory bowel disease [IBD], its pathogenesis remains unclear. This study aimed to determine the prevalence of fatigue and its associated factors in a cohort of patients newly diagnosed with IBD.

METHODS

Patients ≥18 years old were recruited from the Inflammatory Bowel Disease South-Eastern Norway [IBSEN III] study, a population-based, observational inception cohort. Fatigue was assessed using the Fatigue Questionnaire and compared with data from a Norwegian general population. Univariate and multivariate linear and logistic regression analyses were performed to evaluate the associations of total fatigue [TF; continuous score] and substantial fatigue [SF; dichotomized score ≥4] with sociodemographic, clinical, endoscopic, laboratory, and other relevant patient data.

RESULTS

In total, 983/1509 [65.1%] patients with complete fatigue data were included (ulcerative colitis [UC], 68.2%; Crohn's disease [CD], 31.8%). The prevalence of SF was higher in CD [69.6%] compared with UC [60.2%] [p < 0.01], and in both diagnoses when compared to the general population [p < 0.001]. In multivariate analyses, depressive symptoms, pain intensity, and sleep disturbances were associated with increased TF for both diagnoses. In addition, increased clinical disease activity and Mayo endoscopic score were significantly associated with TF in UC, whereas all disease-related variables were insignificant in CD. Similar findings were observed for SF, except regarding the Mayo endoscopic score.

CONCLUSIONS

SF affects approximately two-thirds of patients newly diagnosed with IBD. Fatigue was associated with depressive symptoms, sleep disturbances, and increased pain intensity in both diagnoses, while clinical and endoscopic activity were associated factors only in UC.

Inflammatory bowel disease in South-Eastern Norway III (IBSEN III): a new population-based inception cohort study from South-Eastern Norway

BACKGROUND AND AIM

Modern treatment strategies for inflammatory bowel disease (IBD) are postulated to change the natural disease course. Inception cohort studies are the gold standard for investigating such changes. We have initiated a new population-based inception cohort study; Inflammatory bowel disease in South Eastern Norway III (IBSEN III). In this article, we describe the study protocol and baseline characteristics of the cohort.

METHODS

IBSEN III is an ongoing, population-based observational inception cohort study with prospective follow-up. Adult and pediatric patients with suspected IBD in the South-Eastern Health Region of Norway (catchment area of 2.95 million inhabitants in 2017), during the 3-year period from 2017 to 2019, were eligible for inclusion. Comprehensive clinical, biochemical, endoscopic, demographic, and patient-reported data were collected at the time of diagnosis and throughout standardized follow-up. For a portion of the patients, extensive biological material was biobanked.

RESULTS

The study included 2168 patients, of whom 1779 were diagnosed with IBD (Crohn's disease: 626, ulcerative colitis: 1082, IBD unclassified: 71). In 124 patients, there were subtle findings indicative of, but not diagnostic for, IBD. The remaining 265 patients were classified as symptomatic non-IBD controls.

CONCLUSION

We have included patients in a comprehensive population-based IBD cohort from a catchment population of 2.95 million, and a unique biobank with materials from newly diagnosed and treatment-naïve IBD patients and symptomatic non-IBD controls. We believe this cohort will add important knowledge about IBD in the years to come.

Calibration process for rechargeable cell and battery test systems

Coulombic efficiency is a powerful metric for evaluating the performance of materials in rechargeable cells and batteries. The ideal Coulombic efficiency, the ratio of charge removed to charge inserted, is unity. Some specialized systems can accurately measure cell capacity and Coulombic efficiency within 0.001%, which requires precise control and measurement of current, voltage, time, and temperature. Most battery electrode and electrolyte research is not performed with such precise but complex systems. The purpose of this paper is to demonstrate a simple, robust procedure to measure and possibly improve the accuracy of capacity and Coulombic efficiency measurements on standard systems in their as-used state. This approach is built on a commercially available thin film rechargeable cell for micro or milliampere currents and can be extended to, e.g., 18 650, cells for higher currents. An improved method to display Coulombic efficiency data is also presented. Regular, consistent calibration of testing systems and reporting of system resolution at specified test conditions is encouraged.

Rate of Anastomotic Leakage After Rectal Anastomosis Depends on the Definition: Pelvic Abscesses are Significant

BACKGROUND AND AIMS

The International Study Group of Rectal Cancer has proposed that a pelvic abscess in the proximity of the anastomosis is considered an anastomotic leak, whether or not its point of origin is detectable. This study describes how the inclusion of pelvic abscesses alters the leakage rate.

MATERIAL AND METHODS

Risk factors and postoperative complications in patients with visible anastomotic leakage ("direct leakage"), pelvic abscesses alone in the vicinity of a visibly intact anastomosis ("abscess leakage"), and no leakage were retrospectively evaluated.

RESULTS

In total, 341 patients operated with anterior resections and who received an anastomosis within 15 cm as measured from the anal verge were included. A total of 37 patients (10.9%) had direct leakage, 13 (3.8%) had abscess leakage, and 291 (85.3%) had no leakage. The overall anastomotic leakage rate was 14.7% (50 patients). In accordance with the grading system outlined by International Study Group of Rectal Cancer, 7 patients (2.1%) experienced Grade A leakage, 19 (5.6%) Grade B, and 24 (7.0%) Grade C. Direct leak patients had more often a reoperation due to anastomotic complications (odds ratio = 19.7, p = 0.001), a permanent stoma (odds ratio = 28.5, p = 0.001), and a longer hospital stay than abscess leak patients (29.0 vs 15.5 days, p = 0.030).

CONCLUSION

Abscess leakage accounted for over one-fourth of the overall leakage rate, raising the leakage rate. Direct leak patients were at a higher risk of requiring a reoperation, permanent stoma, and longer hospital stay than abscess leak patients. Abscess leak patients were at a greater risk for a urinary tract infection, wound infection, and postoperative intestinal obstruction than non-leak patients.

Validity of Norwegian Rectal Cancer Registry data at a major university hospital 1997-2005

BACKGROUND

The Norwegian Rectal Cancer Registry (NRCR) has been used extensively to monitor patient treatment and outcomes since its establishment in 1993. Control of data validity is crucial to ensure reliable information, but an audit of the NRCR data validity has not been performed so far. This study aims to validate NRCR data on patients diagnosed in the period 1997-2005, Department of Surgery, Haukeland University Hospital.

MATERIAL AND METHODS

The material comprises NRCR data on all 482 patients diagnosed with rectal cancer in the period 1997-2005 at a major Norwegian university hospital. We checked 50 variables for discrepancies by comparing NRCR data with the medical records. All erroneous registrations were recorded.

RESULTS

One hundred patients (21%) had one or more data discrepancies in the registry, and 131 errors (0.5%) were noted in total. Sixteen variables (32%) had no erroneous registrations. Pre-operative CT and type of surgical procedure had the highest proportion of erroneous registrations (2.1%). Recorded errors were grouped into five variable categories: Pre-operative evaluation and adjuvant treatment (40 errors), surgical treatment (44 errors), pathological evaluation (20 errors), complications (7 errors) and oncological outcomes (20 errors). The majority of erroneous registrations (45%) were considered minor in severity, 27% were moderate and 28% were major.

CONCLUSION

Assessment of the NRCR data from a nine-year period showed a good data validity in this hospital cohort.

All-metal AFM probes fabricated from microstructurally tailored Cu-Hf thin films

A growing number of atomic force microscope (AFM) applications make use of metal-coated probes. Probe metallization can cause adverse side-effects and disadvantages such as stress-induced cantilever bending, thermal expansion mismatch, increased tip radius and limited device lifetime due to coating wear. In this study we demonstrate how to overcome these limitations using microstructural design to create a metallic glass thin film alloy, from which monostructural all-metal AFM cantilevers are fabricated. A detailed compositional study of co-sputtered Cu-Hf films is performed using x-ray diffraction (XRD), nanoindentation, four-point probe and in situ multi-beam optical stress sensing (MOSS). Metallic glass Cu(90)Hf(10) films are found to possess an optimal combination of electrical resistivity (96 microOmega cm), nanoindentation hardness (5.2 GPa), ductility and incremental stress. A continuum model is developed which uses measured MOSS data to predict cantilever warping caused by stress gradients generated during film growth. Subsequently, a microfabrication process is developed to create Cu(90)Hf(10) AFM probes. Uncurled, 1 microm thick cantilevers having lengths of 100-400 microm are fabricated, with tip radii ranging from 10 to 40 nm. As a proof of principle, these all-metal Cu-Hf AFM probes are mounted in a commercial AFM and used to successfully image a known test structure.