Long-term efficacy and safety of single fecal microbiota transplantation for recurrent active ulcerative colitis

AimsTo assess the long-term safety and efficacy of single fecal microbiota transplantation (FMT) for recurrent ulcerative colitis (UC).Methods20 UC patients were randomly divided into single FMT (n=10) and standard of care (SOC) (n=10) group. Patients in FMT group were just treated with single fresh FMT. Patients in SOC group with mild to moderate UC were treated with mesalazine, those with severe UC were given corticosteroids-induced remission, mesalazine maintenance treatment. The primary endpoint was clinical and mucosal remission at week 8. The second endpoint was the maintenance of clinical and mucosal remission, and possible adverse events during the long term follow up (12 to 24 months).Results90% (9/10) patients in FMT group and50% (5 /10)in SOC group could achieve primary endpoint at week-8.After 12 months of follow-up, 66.7% (6/9) FMT initial responder and 80.0% (4/5) SOC initial responder could maintain remission.5 FMT initial responder recipients and5SOC initial responder completed 24-months follow up and mainly could maintain remission [FMT vs SOC580% (4/5) vs 60% (3/5)].No adverse events occurred post FMT during long-term follow-up. At Phylum level, Bacteroidetes, Firmicutes and Proteobacteria were the dominant bacteria of gut microbiota in active UC patients. Compared with donor, the relative abundance of Bacteroidetes decreased and Proteobacteria increased significantly in active UC patients, Firmicutes showed no significant changes. Single fresh FMT could effectively reconstruct the composition of gut microbiota in active UC and maintain stability level with increased Bacteroidetes and decreased Proteobacteria abundance. FMT significantly reduced the relative abundance of Escherichia and increased the relative abundance of Prevotella at genera level. Pyruvate metabolism, glyoxylate and dicarboxylate metabolism, pantothenate and CoA biosynthesis showed significantly differences.ConclusionsSingle fresh FMT is an effective and safe strategy to induce long-term remission in patients with active UC and could be expected to be an alternative induction therapy for recurrent UC, even primary UC.What does this paper add to the literature?FMT is an effective and safe therapy for UC. However, long-term efficacy and safety of a single FMT was very limited. The present study found that a single fresh FMT could induce long-term remission in UC with no drugs need and could be expected to be an alternative induction therapy for recurrent UC, even primary UC

Abstract TP256: Ems Run Times by Weekday vs. Weekend For Stroke Patients in San Diego County

Background: Emergency Medical Services (EMS) is important as the initial responder, very little data examines EMS response and transport to hospital diagnosis. Understanding differences between weekday and weekend is informative for resource and staff planning. Using a countywide registry, we evaluated differences in EMS response times on weekdays and weekends and in-hospital treatment. Methods: We included EMS San Diego County Stroke Registry cases with a computer automated dispatch (CAD) and base hospital record (BHR) from July 2017 through December 2018; linked on EMS incident number. We analyzed EMS response, scene and transport time by weekday and weekend for all cases and cases with last known normal (LKN) to EMS enroute time < 6 hours. Hospital arrival to tPA and to embolectomy therapy (EVT) time was analyzed for this subgroup. Weekend was defined as Friday 1800 through Monday 0600. Results: Of 2,376 cases, 726 (30.6%) arrived during weekends. Weekend mean (±SD) response time was 6.7 (±3.4) minutes (min); 7.1 min (±3.9) on weekdays. Mean weekend scene time was 12.8 (±5.1) min, 13.2 (±5.3) min on weekdays (p=.18). Transport time was 13.2 (±7.6) min on weekends, 14.1 (±7.8) min on weekdays (p=.01). There were 1,190 cases with LKN to EMS enroute time < 6 hours, 379 arrived on weekends (31.8%). Mean (±SD) response time was 6.6 (±3.4) min on weekends, 7.2 (±3.9) min on weekdays; weekend scene time 12.1 (±4.5) min, weekday scene time 12.2 (±4.9); weekend transport time 12.2 (±6.6) min, weekday transport time 12.7 (±7.4) min. Of this group, 378 received tPA, 126 (33.3%) on the weekend. Mean (±SD) weekend arrival to tPA was 53.6 (±22.2) min; 56.0 (±32.1) min on weekdays (p=.39). 100 cases received EVT, 39 on a weekend. Mean (±SD) weekend arrival to EVT was 2.1 (±0.6) hours; weekdays 1.9 (±0.8) hours (p=.13). Conclusion: One in three patients arrived at the hospital on weekends. EMS response time and scene time did not differ, while transport time on the weekend was shorter, although this may not be clinically significant. This may be attributed to traffic volume and patterns during these times. However, among patients with shorter LKN time and patients receiving tPA no difference in EMS times was seen. Overall acute stroke transfer times did not differ across weekends and weekdays.