Lesions In Ulcerative Colitis Research Articles

ROS/Thermo dual-sensitive hydrogel loaded with a nanoemulsion of patchouli essential oil for ulcerative colitis

Patchouli essential oil (PEO) is acknowledged as a potent contender for the management of ulcerative colitis (UC). However, the limited ability of PEO to be absorbed by the body and its low stability substantially limit its potential uses. Furthermore, UC lesions are mainly concentrated in the rectal and colonic mucosa, with excessive production of reactive oxygen species (ROS). Herein, a nanoemulsion of PEO (PEONE) was developed to enhance the stability and bioavailability of a drug. Subsequently, we developed a novel platform for the rectal administration of a ROS/thermo dual-sensitive Bletilla striata polysaccharide-based hydrogel (RTH) co-loaded with PEONE to efficiently treat UC. As expected, the sol–gel transition of PEONE@RTH, after its intrarectal administration, resulted in its extended presence in the colon and facilitated its attachment to the inflammation site. Moreover, PEONE@RTH alleviated dextran sulfate sodium-induced UC symptoms by suppressing inflammation and oxidative stress, repairing the damage to the intestinal epithelial barrier (claudin-1 and occludin), increasing short-chain fatty acid content and inhibiting the MAPK signalling pathway. Additionally, PEONE@RTH exhibits exceptional safety and biocompatibility. Thus, PEONE@RTH has the potential to provide a novel approach for treating UC and other intestinal disorders characterised by similar clinical conditions.

Ki-67 distribution, α-methylacyl-CoA racemase (AMACR) expression and mucin phenotypes are associated with non-polypoid growth in ulcerative colitis-associated neoplasia.

Ulcerative colitis-associated neoplasia (UCAN) is characterised by multifocal tumourigenesis. A wide range of metachronous lesions have been reported to occur after endoscopic treatment of UCAN, which suggests the development of sporadic tumours in lesions treated as UCAN. Therefore, we aimed to evaluate differences of immunohistochemistry (IHC) in features and clinicopathological characteristics of intramucosal lesions in patients with ulcerative colitis (UC). We examined 35 intramucosal lesions resected for carcinoma or dysplasia by total colectomy from patients with UC and 71 sporadic adenomas (SAs) endoscopically resected from patients without UC. UC lesions were divided into the conventional UCAN group, defined as p53 mutant pattern andnormal expression of β-catenin, and the non-conventional UCAN group, defined as the rest. Ki-67 distribution, α-methylacyl-CoA racemase (AMACR) expression and mucin phenotypes were compared using IHC, and clinicopathological characteristics were investigated. Conventional and non-conventional UCAN lesions were located in the left colon and rectum. Relative to the SA lesions, UCAN lesions occurred in much younger patients and exhibited more frequent basal distribution of Ki-67 in tumour crypts. Conventional UCAN lesions tended to be non-polyploid and exhibited a higher frequency of normal AMACR expression than SA lesions. UC lesions were heterogeneous-only two of the eight patients with multiple lesions had lesions (both non-conventional UCAN lesions) exhibiting concordant IHC staining features. The basal pattern of Ki-67 distribution, normal expression of AMACR and a non-intestinal mucin phenotype were determined as characteristic features suggestive of UCAN. Non-polypoid growth was another a key feature of UCAN.

Survey on Patient Satisfaction with the Usability and Formulation of Budesonide Rectal Foam Following a Change in Head and Applicator Shape and Properties

Budesonide Rectal Foam (BF) was introduced in 2017 and changed in November 2022 upon request, addressing the challenges encountered with liquid rectal formulations indicated for ulcerative colitis (UC). This formulation is an important agent in the treatment of rectal to sigmoid colon lesions in moderate UC. As the characteristics of the formulation of the rectal formulation are thought to influence patient satisfaction, a survey was conducted on the formulation and patient satisfaction among patients who used BF before and after the change. The survey spanned from January 2023 to May 2023. As the primary endpoint, the same patients were evaluated on the Visual Analogue Scale (VAS) for patient satisfaction. Significant variations in formulation usability and patient satisfaction were observed in 20 eligible patients before and after the change (p<0.05). Patient satisfaction with the formulation was strongly correlated with formulation usability, ease of pushing the head, and ease of insertion (r>0.7). The change in packaging was thought to improve the usability of the formulation and patient satisfaction. The formulation's usability and ease of insertion had a clear influence on satisfaction with the rectal formulation.

Accuracy of optical diagnosis with narrow band imaging in the surveillance of ulcerative colitis: a prospective study comparing Kudo, Kudo-IBD and NICE classifications

PurposeThe diagnostic accuracy of Narrow Band Imaging (NBI) in the endoscopic surveillance of ulcerative colitis (UC) has been disappointing in most trials which used the Kudo classification. We aim to compare the performance of NBI in the lesion characterization of UC, when applied according to three different classifications (NICE, Kudo, Kudo-IBD).MethodsIn a prospective, real-life study, all visible lesions found during consecutive surveillance colonoscopies with NBI (Exera-II CV-180) for UC were classified as suspected or non-suspected for neoplasia according to the NICE, Kudo and Kudo-IBD criteria. The sensitivity (SE), specificity (SP), positive (+LR) and negative (-LR) likelihood ratios of the three classifications were calculated, using histology as the reference standard.Results394 lesions (mean size 6 mm, range 2–40 mm) from 84 patients were analysed. Twenty-one neoplastic (5%), 49 hyperplastic (12%), and 324 inflammatory (82%) lesions were found. The diagnostic accuracy of the NICE, Kudo and Kudo-IBD classifications were, respectively: SE 76%-71%-86%; SP 55-69%-79% (p < 0.05 Kudo-IBD vs. both Kudo and NICE); +LR 1.69-2.34-4.15 (p < 0.05 Kudo-IBD vs. both Kudo and NICE); -LR 0.43-0.41-0.18.ConclusionThe diagnostic accuracy of NBI in the differentiation of neoplastic and non-neoplastic lesions in UC is low if used with conventional classifications of the general population, but it is significantly better with the modified Kudo classification specific for UC.

Histologic Disease Persists beyond Mucosal Healing and Could Predict Reactivation in Ulcerative Colitis.

Mucosal healing (MH) is the main target in ulcerative colitis (UC) treatment. Even if MH lowers the risk of disease reactivation, some patients still relapse. Histologic activity (HA) beyond MH could explain these cases. This study aims to assess how many patients with MH have HA and which lesions are associated with relapse. We retrospectively enrolled UC patients showing MH, expressed as a Mayo Endoscopic Subscore (MES) of 0 and 1 upon colonoscopy. We reviewed the histological reports of biopsies evaluating the presence of typical lesions of UC and assessed the number of clinical relapses after 12 months. Among 100 enrolled patients, 2 showed no histological lesions. According to univariate analysis, patients with a higher number of histological lesions at the baseline had a higher risk of relapse (OR 1.25, p = 0.012), as well as patients with basal plasmacytosis (OR 4.33, p = 0.005), lamina propria eosinophils (OR 2.99, p = 0.047), and surface irregularity (OR 4.70, p = 0.010). However, in the multivariate analysis, only basal plasmacytosis (OR 2.98, p = 0.050) and surface irregularity (OR 4.50, p = 0.024) were confirmed as risk factors for disease reactivation. HA persists in a significant percentage of patients with MH. Despite the presence of MH, patients with basal plasmacytosis and surface irregularity have a higher risk of relapse.

Tissue-specific reprogramming leads to angiogenic neutrophil specialization and tumor vascularization in colorectal cancer.

Neutrophil (PMN) tissue accumulation is an established feature of ulcerative colitis (UC) lesions and colorectal cancer (CRC). To assess the PMN phenotypic and functional diversification during the transition from inflammatory ulceration to CRC we analyzed the transcriptomic landscape of blood and tissue PMNs. Transcriptional programs effectively separated PMNs based on their proximity to peripheral blood, inflamed colon, and tumors. In silico pathway overrepresentation analysis, protein-network mapping, gene signature identification, and gene-ontology scoring revealed unique enrichment of angiogenic and vasculature development pathways in tumor-associated neutrophils (TANs). Functional studies utilizing ex vivo cultures, colitis-induced murine CRC, and patient-derived xenograft models demonstrated a critical role for TANs in promoting tumor vascularization. Spp1 (OPN) and Mmp14 (MT1-MMP) were identified by unbiased -omics and mechanistic studies to be highly induced in TANs, acting to critically regulate endothelial cell chemotaxis and branching. TCGA data set and clinical specimens confirmed enrichment of SPP1 and MMP14 in high-grade CRC but not in patients with UC. Pharmacological inhibition of TAN trafficking or MMP14 activity effectively reduced tumor vascular density, leading to CRC regression. Our findings demonstrate a niche-directed PMN functional specialization and identify TAN contributions to tumor vascularization, delineating what we believe to be a new therapeutic framework for CRC treatment focused on TAN angiogenic properties.

Detection of Ulcerative Colitis Lesions from Weakly Annotated Colonoscopy Videos Using Bounding Boxes

Ulcerative colitis is a chronic disease characterized by bleeding and ulcers in the colon. Disease severity assessment via colonoscopy videos is time-consuming and only focuses on the most severe lesions. Automated detection methods enable fine-grained assessment but depend on the training set quality. To suit the local clinical setup, an internal training dataset containing only rough bounding box annotations around lesions was utilized. Following previous works, we propose to use linear models in suitable color spaces to detect lesions. We introduce an efficient sampling scheme for exploring the set of linear classifiers and removing trivial models i.e., those showing zero false negative or positive ratios. Bounding boxes lead to exaggerated false detection ratios due to mislabeled pixels, especially in the corners, resulting in decreased model accuracy. Therefore, we propose to evaluate the model sensitivity on the annotation level instead of the pixel level. Our sampling strategy can eliminate up to 25% of trivial models. Despite the limited quality of annotations, the detectors achieved better performance in comparison with the state-of-the-art methods. When tested on a small subset of endoscopic images, the best models exhibit low variability. However, the inter-patient model performance was variable suggesting that appearance normalization is critical in this context.

Usefulness of a combination of an adaptive traction device and an insulated-type knife for a neoplastic lesion in ulcerative colitis.

Usefulness of a combination of an adaptive traction device and an insulated-type knife for a neoplastic lesion in ulcerative colitis.

Endoscopic on-site characterization of a large excavated lesion in longstanding ulcerative colitis using a novel bioinformatic tool.

Endoscopic on-site characterization of a large excavated lesion in longstanding ulcerative colitis using a novel bioinformatic tool.

S3244 Interesting Presentation of Ulcerative Gastroduodenal Lesion in Ulcerative Colitis

S3244 Interesting Presentation of Ulcerative Gastroduodenal Lesion in Ulcerative Colitis

Multipolar traction with an eight-point adaptive traction device allowed comfortable resection of a challenging giant rectal lesion in ulcerative colitis.

Multipolar traction with an eight-point adaptive traction device allowed comfortable resection of a challenging giant rectal lesion in ulcerative colitis.

HLA Class I Expression Is Associated with DNA Damage and Immune Cell Infiltration into Dysplastic and Neoplastic Lesions in Ulcerative Colitis.

Human leukocyte antigen class I (HLA-I) is considered a genetic pathogen for ulcerative colitis (UC). This study aimed to investigate the significance of DNA damage and HLA-I expression in infiltrating immune cells and immune checkpoint protein PD-L1 expression in dysplasia/colitic cancer (CC) and sporadic colorectal cancer (SCRC). We performed immunohistochemical staining for HLA-I, PD-L1, γH2AX (DNA damage marker), and immune cell markers such as CD8, FOXP3, CD68, and CD163 (in surgically resected specimens from 17 SCRC patients with 12 adjacent normal mucosa (NM) and 9 UC patients with 18 dysplasia/CC tumors. The ratio of membrane HLA-I-positive epithelial cells in UC and dysplasia/CC tissues was significantly higher than that in NM and SCRC. High HLA-I expression in dysplasia/CC was associated with high positivity of γH2AX and PD-L1 expression compared to SCRC. The infiltration of CD8-positive T cells and CD68-positive macrophages in HLA-I-high dysplasia/CC was significantly higher than in UC and SCRC. Dysplasia/CC specimens with DNA damage exhibited high levels of HLA-I-positive epithelial cells with high CD8- and CD68-positive immune cell infiltration compared to UC and SCRC specimens. Targeting DNA damage in UC may regulate immune cell infiltration, immune checkpoint proteins, and carcinogenesis by modulating DNA damage-induced HLA-I antigen presentation.

Achillea wilhelmsii-Incorporated Chitosan@Eudragit Nanoparticles Intended for Enhanced Ulcerative Colitis Treatment.

Achillea wilhelmsii (A. wilhelmsii) contains several therapeutic phytochemicals, proposing a protective effect on inflammatory responses in autoimmune diseases such as ulcerative colitis (UC). However, its activities against UC encounter multiple obstacles. The current study aimed to formulate a colon-specific delivery of A. wilhelmsii for treating UC using chitosan nanoparticles (NPs) and Eudragit S100 as a mucoadhesive and pH-sensitive polymer, respectively. Core chitosan NP was loaded with A. wilhelmsii extract, followed by coating with Eudragit S100. Then, physicochemical characterizations of prepared NPs were conducted, and the anti-UC activity in the rat model was evaluated. The relevant physicochemical characterizations indicated the spherical NPs with an average particle size of 305 ± 34nm and high encapsulation efficiency (88.6 ± ‏7.3%). The FTIR (Fourier transform infrared) analysis revealed the Eudragit coating and the extract loading, as well as the high radical scavenging ability ofA. wilhelmsiiwas confirmed. The loaded NPs prevented the extract release in an acidic pH-mimicking medium and presented a complete release thereafter at a colonic pH. The loaded NPs markedly mitigated the induced UC lesions in rats, reflected by reducing inflammation, ulcer severity, and UC-related symptoms. Further, histopathological analysis exhibited reducing the extent of the inflammation and damage to colon tissue, and the determination of the involved pro-inflammatory cytokines in serum showed a significant reduction relative to free extract. The present results show that chitosan NPs containingA. wilhelmsiiextract coated with Eudragit having proper physicochemical properties and substantial anti-inflammatory activity can significantly improve colonic lesions caused by UC.

Accuracy of Transperineal Ultrasonography for Assessing Rectal Lesions in Paediatric Ulcerative Colitis: A Prospective Study.

Transabdominal ultrasonography [TAUS] appears comparable to colonoscopy for evaluating ulcerative colitis [UC] activity, but it has low accuracy in rectal evaluation. In this study, the accuracy of transperineal ultrasonography [TPUS] for evaluating rectal activity was compared to that of colonoscopy in paediatric UC cases. Faecal calprotectin [FCP] values and TPUS and colonoscopic findings were compared prospectively in paediatric UC cases. Rectal wall thickening [RWT] and rectal wall flow [RWF] on power Doppler evaluated by TPUS were compared with the colonoscopy findings and were also measured on TAUS and assessed for the concordance rate of each finding. Thirty Mayo endoscopic sub-score [MES] 0-1 UC cases and 57 MES 2-3 UC cases were enrolled. FCP, RWT and RWF showed significant differences between the two groups [p < 0.05]. RWT and RWF were independent predictors of UC endoscopic activity, showing sensitivity of 95.8% and specificity of 100% with RWT ≥ 4.5 mm and positive RWF. The concordance rates between TPUS and TAUS findings in MES 2-3 were moderate to fair, whereas those in MES 0-1 were fair to poor. The concordance rates between ultrasonic examiners were good for both TAUS and TPUS. TPUS may evaluate rectal activity of UC with accuracy comparable to endoscopy. If accurate ultrasonic screening for the total colon can be performed by TPUS and TAUS, repeated evaluation of short-term treatment response may be possible.

P866 Skin lesions among consecutive Inflammatory bowel disease patients in outpatient setting

Abstract Background It is well known that skin lesions may be frequent extraintestinal manifestations of inflammatory bowel diseases (IBD). During literature analysis we found out that there is an obvious lack of epidemiological data regarding this issue. Therefore, the aim of our study was to establish the prevalence of skin lesions among consecutive IBD patients in outpatient department. Methods Prospective study included out-patients with IBD who were managed in the hospital of Lithuanian University of Health Sciences from January to October of 2022. Patients completed the questionnaires including the demographic and the IBD data and history or present state of cutaneous lesions. We considered skin lesions related to IBD or its treatment if they were diagnosed following the diagnosis of IBD. Skin lesions which were reported before the diagnosis of IBD were considered as not related to IBD. Results 152 patients were included, mean age (MA) – 42.0±13.9 years. There were 88 (57.9%) males and 64 (42.1%) females. Ulcerative colitis (UC) was diagnosed in 110 (72.4%) patients, Crohn’s disease (CD) – in 42 (27.6%) patients. MA of UC patients was 42.3±13.6, CD – 41.1±14.9, p&amp;gt;0.05. In total, skin lesions were indicated by 65 (42.8%) subjects. According to our criteria, in 46 (30.3%; 95% CI: 23-38%) cases, skin lesions were considered as obviously related to IBD or its treatment. We further analyzed latter cases. Among UC patients, 32 (29.1%; 95% CI: 20-38%) had skin lesions related to IBD, among CD patients – 14 (33.3%; 95% CI: 18-48%), p&amp;gt;0.05. Erythema nodosum was diagnosed in 6 (3.9%) patients, pyoderma gangrenosum – 5 (3.3%), acne – 1 (0.7%), psoriasis – 9 (5.9%), vitiligo – 2 (1.3%), epidermolysis bullosa acquisita – 1 (0.7%), hemorrhagic vasculitis – 1 (0.7%), eczema – 9 (5.9%), allergic rash – 4 (2.6%). The comparison of different skin lesions among UC and CD patients is presented in table 1. Among the patients with UC proctitis, skin lesions were reported in 2 of 15 (13.3%) patients; among left-sided colitis – in 8 of 27 (29.6%); among pancolitis – in 22 of 67 (32.8%), p=0.03 between the groups of proctitis and pancolitis. Comparing the different forms of CD, skin lesions were reported in 3 of 15 (20.0%) patients with ileitis, 4 of 10 (40.0%) patients with colitis and 7 of 17 (41.2%) patients with ileocolitis; p&amp;gt;0.05 between different groups. Conclusion In our series the prevalence of skin lesions obviously related to IBD or its treatment is 30.3%. There were no differences in the prevalence of skin lesions between the UC and CD patients. The most common skin lesions in UC were psoriasis and skin eczema, in CD – erythema nodosum and skin eczema. Cutaneous lesions were significantly more prevalent in extensive UC compared to distal disease.

P125 LCI/BLI chromoendoscopy plus CAD-EYE artificial intelligence for the detection and characterization of endoscopic visible lesions in ulcerative colitis

Abstract Background LCI/BLI chromoendoscopy and CAD-EYE artificial intelligence have been developed for the detection and characterization of colorectal neoplasia in the general population. In this study, we analyzed their diagnostic accuracy in the detection and characterization of endoscopic visible lesions (EVL) during endoscopic surveillance of ulcerative colitis (UC). Methods A prospective tandem study on consecutive UC patients was performed, using Eluxeo white light endoscopy (WLE), LCI and LCI+CAD-EYE during a back-to-back withdrawal phase. Lesion characterization of all EVL was performed according to three classifications (Kudo, NICE and Kudo-IBD) and, finally, by BLI+CAD-EYE. The lesion/neoplasia miss rates were analyzed during the detection phase. Sensitivity (SE), specificity (SP), positive- and negative-predictive values (PPV/NPV) and accuracy (ACC) for lesion characterization by Kudo, NICE and Kudo-IBD were calculated when applied to BLI and compared with CAD-EYE, using histology as reference test. Results 62 patients (mean age 54 years, mean disease duration 18 years) were included; 133 lesions (mean size 6 mm, 18 neoplastic) were found in 35 patients. The lesion miss rate was significantly higher (p&amp;lt;0.05) with WLE (9.8%) and LCI (5.3%) than CAD-EYE (0%), with no differences in neoplasia miss rates. For lesion characterization, the SE, SP, PPV, NPV and ACC of BLI+CAD-EYE (83%, 65%, 27%, 96%, 68%, respectively) were not inferior to the conventional Kudo (67%, 71%, 27%, 93%, 71%) and NICE (72%, 68%, 26%, 94%, 68%) classifications, while Kudo-IBD had higher SE (89%) and significantly (p&amp;lt;0.05) higher SP (83%) and ACC (84%) than Kudo, NICE and CAD-EYE. Conclusion LCI+CAD-EYE and the Kudo-IBD criteria applied to BLI can improve, respectively, the detection and characterization of EVL in UC.

Highly Sensitive Bilirubin Biosensor Based on Photonic Crystal Fiber in Terahertz Region

An unstable bilirubin level in the human blood causes many dangerous health problems, such as jaundice, coronary artery disease, ulcerative colitis, and brain lesions. Therefore, the accurate and early detection of bilirubin concentrations in the blood is mandatory. In this work, a highly sensitive biosensor based on photonic crystal fiber (PCF) for monitoring bilirubin levels is proposed and analyzed. The sensor parameters, including relative sensitivity, effective mode area, confinement loss, and effective material loss, are calculated. The geometrical parameters are studied, and a modal analysis of the suggested sensor is carried out using the full-vectorial finite element method (FEM). The fabrication tolerance of the geometrical parameters is also studied to ensure the fabrication feasibility of the reported design. High sensitivities of 95% and 98% are obtained for the x-polarized and y-polarized modes, respectively. Furthermore, a small material loss of 0.00193 cm−1, a small confinement loss of 2.03 × 10−14 dB/cm, and a large effective mode area of 0.046 mm2 are achieved for the y-polarized mode. It is believed that the presented sensor will be helpful in health care and in the early detection of bilirubin levels in the blood.

Diagnostic value of different serological markers and correlation analysis with disease phenotype in inflammatory bowel disease

Objective: To explore the diagnostic value of different serological markers and the correlation with disease phenotype in inflammatory bowel disease (IBD). Methods: The clinical data of 445 IBD patients in Peking Union Medical College Hospital from June 2010 to December 2020 were retrospectively collected, including 223 cases of ulcerative colitis (UC) [111 males, 112 females, with a median age of 46(20,79) years] and 222 cases of Crohn's disease (CD) [147 males, 75 females, with a median age of 39 (19, 72) years]. The positive rates of serum anti-neutrophil cytoplasmic antibodies (ANCA), anti-Saccharomyces cerevisiae antibodies (ASCA), goblet cell autoantibodies (GAB) and pancreatic autoantibodies (PAB) in the two groups were analyzed. The sensitivity, specificity, positive predictive value and negative predictive value of UC and CD were calculated. Logistic regression was performed to analyze the relationship between different combinations of antibodies and disease phenotype. Results: The positive rates of ASCA and PAB in CD patients were 34.7% (77/222) and 38.3% (85/222), respectively, which were higher than those in UC patients [10.3% (23/223) and 4.5% (10/223), P<0.001]. The positive rate of ANCA in UC patients was 50.2% (112/223), which was higher than that in CD patients [5.4% (12/222), P<0.001]. The positive rates of serum GAB in CD and UC patients were 21.6% (48/222) and 28.3% (63/223), respectively, with no significant difference (P=0.760). In patients with CD, the sensitivity of mono-marker ASCA (+), dual-marker ASCA (+) ANCA (-), quadruple-marker ASCA (+) ANCA (-) PAB (+) GAB (-) in diagnosing CD was 34.7%, 32.9%, 20.7%, the specificity was 89.7%, 95.5%, 100.0%, the positive predictive value was 77.0%, 90.1%, 100.0%, and the negative predictive value was 58.0%, 58.7%, 55.9%, respectively. In patients with UC, the sensitivity of mono-marker ANCA (+), dual-marker ANCA (+) ASCA (-), quadruple-marker ANCA (+) ASCA (-) PAB (-) GAB (+) in diagnosing UC was 50.2%, 40.4%, 24.2%, the specificity was 94.6%, 95.5%, 100.0%, the positive predictive value was 90.3%, 90.0%, 100.0%, and the negative predictive value was 65.4%, 61.4%, 56.8%, respectively. Mono-marker ASCA (+) (OR=3.39, 95%CI: 1.59-7.21), dual-marker ASCA (+) ANCA (-) (OR=2.87, 95%CI: 1.34-6.14), triple-marker ASCA (+) ANCA (-) GAB (-) (OR=3.09, 95%CI: 1.31-7.31) and quadruple-marker ASCA (+) ANCA (-) PAB (+) GAB (-) (OR=3.15, 95%CI: 1.56-8.03) were associated with stenosis and/or penetrating type CD. The mono-marker ANCA (+) (OR=2.69, 95%CI: 1.42-5.12) and dual-marker ANCA (+) ASCA (-) (OR=2.11, 95%CI: 1.03-4.16) were associated with extensive colonic lesions in UC. Conclusion: Based on ASCA or ANCA, the combination with PAB or GAB, is conducive to IBD diagnosis, and is associated with stenosis and/or penetrating type of CD and extensive type of UC.

PHF3 Technique: A Pyramid Hybrid Feature Fusion Framework for Severity Classification of Ulcerative Colitis Using Endoscopic Images.

Evaluating the severity of ulcerative colitis (UC) through the Mayo endoscopic subscore (MES) is crucial for understanding patient conditions and providing effective treatment. However, UC lesions present different characteristics in endoscopic images, exacerbating interclass similarities and intraclass differences in MES classification. In addition, inexperience and review fatigue in endoscopists introduces nontrivial challenges to the reliability and repeatability of MES evaluations. In this paper, we propose a pyramid hybrid feature fusion framework (PHF3) as an auxiliary diagnostic tool for clinical UC severity classification. Specifically, the PHF3 model has a dual-branch hybrid architecture with ResNet50 and a pyramid vision Transformer (PvT), where the local features extracted by ResNet50 represent the relationship between the intestinal wall at the near-shot point and its depth, and the global representations modeled by the PvT capture similar information in the cross-section of the intestinal cavity. Furthermore, a feature fusion module (FFM) is designed to combine local features with global representations, while second-order pooling (SOP) is applied to enhance discriminative information in the classification process. The experimental results show that, compared with existing methods, the proposed PHF3 model has competitive performance. The area under the receiver operating characteristic curve (AUC) of MES 0, MES 1, MES 2, and MES 3 reached 0.996, 0.972, 0.967, and 0.990, respectively, and the overall accuracy reached 88.91%. Thus, our proposed method is valuable for developing an auxiliary assessment system for UC severity.

Immuno-mediated comorbidity: clinical and pathogenetic aspects of the infl ammatory bowel diseases and spondyloarthritis association

Background. The problem of comorbidity is becoming increasingly important in modern medicine and healthcare. A combination of infl ammatory bowel diseases (IBD) and spondyloarthritis (SpA), the genesis of which is closely related to immune infl ammation, can be attributed to the number of comorbid mutually aggravating pathology. In real clinical practice, there is often a late diagnosis of these comorbid processes, which aff ects the quality and eff ectiveness of treatment and worsens the outcomes of diseases.Aim. In order to attract the attention of specialists of various profi les to immuno-i nfl ammatory comorbidity, the article presents current data on the association between IBD and SpA with an analysis of the frequency of joint and spine lesions in ulcerative colitis (UC) and Crohn’s disease (CD), as well as the frequency of detection of intestinal lesions in various SpA phenotypes.Basic provisions. It has been shown that joint lesions in IBD and intestinal lesions in SpA, as a rule, occur in severe and moderate forms of these diseases, occurring with high or moderate activity. The HLA B27 genotype is more typical for individuals with manifest SpA, including developed against the background of IBD. The combination of IBD and SpA is caused by similar disorders of immunoregulation, the functional state of cells of native and adaptive immunity, and an imbalance of cytokines. These mechanisms have become the basis for the use of biological and targeted therapy in IBD and SpA, as well as in their combination. It has been shown that approximately half of patients resistant to standard drugs can achieve clinical remission on biological therapy.Conclusions. Thus, in order to objectify the severity of the immuno- infl ammatory process and improve outcomes, it is advisable to diagnose the most likely comorbid pathology in a timely manner and take this factor into account to optimize treatment.