bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology and Natural History of Elderly-onset Inflammatory Bowel Disease: Results From a Territory-wide Hong Kong IBD Registry
Authors: Mak Joyce Wing Yan , Lok Tung Ho Carmen , Wong Kylie , Cheng Tsz Yan , Yip Terry Cheuk Fung , Leung Wai Keung , Li Michael , Lo Fu Hang , Ng Ka Man , Sze Shun Fung , Leung Chi Man , Tsang Steven Woon Choy , Shan Edwin Hok Shing , Chan Kam Hon , Lam Belsy C Y , Hui Aric Josun , Chow Wai Hung , Ng Siew Chien 
Published: September 2020

Abstract

Background
Elderly-onset inflammatory bowel disease [IBD], defined as age ≥60 at diagnosis, is increasing worldwide. We aimed to compare clinical characteristics and natural history of elderly-onset IBD patients with those of adult-onset IBD patients.

Methods
Patients with a confirmed diagnosis of IBD from 1981 to 2016 were identified from a territory-wide Hong Kong IBD registry involving 13 hospitals. Demographics, comorbidities, clinical features, and outcomes of elderly-onset IBD patients were compared with those of adult-onset IBD patients.

Results
A total of 2413 patients were identified, of whom 270 [11.2%] had elderly-onset IBD. Median follow-up duration was 111 months (interquartile range [IQR]: 68–165 months). Ratio of ulcerative colitis [UC]: Crohn’s disease [CD] was higher in elderly-onset IBD than in adult-onset IBD patients [3.82:1 vs 1.39:1; p &lt;0.001]. Elderly-onset CD had less perianal involvement [5.4% vs 25.4%; p &lt;0.001] than adult-onset CD. Elderly-onset IBD patients had significantly lower cumulative use of immunomodulators [p = 0.001] and biologics [p = 0.04]. Elderly-onset IBD was associated with higher risks of: cytomegalovirus colitis (odds ratio [OR]: 3.07; 95% confidence interval [CI] 1.92–4.89; p &lt;0.001); herpes zoster [OR: 2.42; 95% CI 1.22–4.80; p = 0.12]; and all cancer development [hazard ratio: 2.97; 95% CI 1.84–4.79; p &lt;0.001]. They also had increased number of overall hospitalisations [OR: 1.14; 95% CI 1.09–1.20; p &lt;0.001], infections-related hospitalisation [OR: 1.87; 95% CI 1.47–2.38; p &lt;0.001], and IBD-related hospitalisation [OR: 1.09; 95% CI 1.04- 1.15; p = 0.001] compared with adult-onset IBD patients.

Conclusions
Elderly-onset IBD was associated with increased risk of infections and cancer development, and increased infection- and IBD-related hospitalisations. Specific therapeutic strategies to target this special population are needed.
Risk of Relapse in Patients With Ulcerative Colitis With Persistent Endoscopic Healing: A Durable Treatment Endpoint
Authors: Jangi Sushrut , Holmer Ariela K , Dulai Parambir S , Boland Brigid S , Collins Angelina E , Pham Lysianne , Sandborn William J , Singh Siddharth 
Published: September 2020

Abstract

Background
Deep remission in patients with UC has relied on initial achievement of biochemical, endoscopic, and/or histological remission. We evaluated persistent symptomatic remission and endoscopic healing (EH: Mayo endoscopy score [MES] 0 or 1) on consecutive endoscopic examinations as a durable treatment endpoint.

Methods
In a retrospective cohort study, we estimated and compared cumulative risk of clinical relapse in patients with persistent EH, with and without persistent histological remission and depth of EH, among adults with active UC treated-to-target of symptomatic remission and EH who achieved and maintained symptomatic remission and EH over two serial endoscopic assessments. We also explored risk of relapse in patients with persistent EH whose therapy was de-escalated.

Results
Of 270 patients who initially achieved EH with treatment-to-target, 89 maintained symptomatic remission and EH on follow-up endoscopy [interval between EH1 and EH2, 16 months]. On follow-up after EH2 [median, 19 months], 1-year cumulative risk of relapse in patients with persistent EH was 11.5%, and with persistent histological remission was 9.5%. Seventeen patients with persistent EH, who underwent de-escalation of therapy, did not have an increased risk of relapse as compared with patients who continued index therapy [5.3% vs 14%, p = 0.16].

Conclusions
Patients with active UC treated-to-target of clinical remission, who achieve and maintain symptomatic remission and EH over consecutive endoscopies, have a low risk of relapse, particularly in a subset of patients who simultaneously achieve histological remission. Persistent EH should be examined as a treatment endpoint suggestive of deep remission.
Intestinal Receptor of SARS-CoV-2 in Inflamed IBD Tissue Seems Downregulated by HNF4A in Ileum and Upregulated by Interferon Regulating Factors in Colon
Authors: Verstockt Bram , Verstockt Sare , Abdu Rahiman Saeed , Ke Bo-jun , Arnauts Kaline , Cleynen Isabelle , Sabino João , Ferrante Marc , Matteoli Gianluca , Vermeire Séverine 
Published: September 2020

Abstract

Background
Patients with inflammatory bowel disease [IBD] are considered immunosuppressed, but do not seem more vulnerable for COVID-19. Nevertheless, intestinal inflammation has shown to be an important risk factor for SARS-CoV-2 infection and prognosis. Therefore, we investigated the role of intestinal inflammation on the viral intestinal entry mechanisms, including ACE2, in IBD.

Methods
We collected inflamed and uninflamed mucosal biopsies from Crohn’s disease [CD] [n = 193] and ulcerative colitis [UC] [n = 158] patients, and from 51 matched non-IBD controls for RNA sequencing, differential gene expression, and co-expression analysis. Organoids from UC patients were subjected to an inflammatory mix and processed for RNA sequencing. Transmural ileal biopsies were processed for single-cell [sc] sequencing. Publicly available colonic sc-RNA sequencing data, and microarrays from tissue pre/post anti-tumour necrosis factor [TNF] therapy, were analysed.

Results
In inflamed CD ileum, ACE2 was significantly decreased compared with control ileum [p = 4.6E-07], whereas colonic ACE2 was higher in inflamed colon of CD/UC compared with control [p = 8.3E-03; p = 1.9E-03]. Sc-RNA sequencing confirmed this ACE2 dysregulation and exclusive epithelial ACE2 expression. Network analyses highlighted HNF4A as key regulator of ileal ACE2, and pro-inflammatory cytokines and interferon regulating factors regulated colonic ACE2. Inflammatory stimuli upregulated ACE2 in UC organoids [p = 1.7E-02], but not in non-IBD controls [p = 9.1E-01]. Anti-TNF therapy restored colonic ACE2 regulation in responders.

Conclusions
Intestinal inflammation alters SARS-CoV-2 coreceptors in the intestine, with opposing dysregulations in ileum and colon. HNF4A, an IBD susceptibility gene, seems an important upstream regulator of ACE2 in ileum, whereas interferon signalling might dominate in colon.
Independent and incremental prognostic value of semiquantitative measures of tricuspid regurgitation severity in heart failure with preserved ejection fraction
Authors: Harada Tomonari , Obokata Masaru , Omote Kazunori , Iwano Hiroyuki , Ikoma Takahiro , Okada Kenya , Yoshida Kuniko , Kato Toshimitsu , Kurosawa Koji , Nagai Toshiyuki , Negishi Kazuaki , Anzai Toshihisa , Kurabayashi Masahiko 
Published: September 2020

AbstractAimsThis study sought to determine the independent and incremental prognostic value of semiquantitative measures of tricuspid regurgitation (TR) severity over right heart remodelling and pulmonary hypertension (PH) in heart failure with preserved ejection fraction (HFpEF).Methods and resultsEchocardiography was performed on 311 HFpEF patients. TR severity was defined by the semiquantitative measures [i.e. vena contracta width (VCW) and jet area] and by the guideline-based integrated qualitative approach (absent, mild, moderate, or severe). All-cause mortality or heart failure hospitalization occurred in 101 patients over a 2.1-year median follow-up. There was a continuous association between TR severity and the composite outcome with a hazard ratio (HR) of 1.17 per 1 mm increase of VCW [95% confidence interval (CI) 1.08–1.26, P &lt; 0.0001]. Compared with patients with the lowest VCW category (≤1 mm), RV-adjusted HRs for the outcome were 1.99 (95% CI 1.05–3.77), 2.63 (95% CI 1.16–5.95), and 5.00 (95% CI 1.60–15.7) for 1–3, 3–7, and ≥7 mm VCW categories, respectively. TR severity as defined by the guideline-based approach showed a similarly graded association, but it was no longer significant in models including PH. In contrast, VCW remained independently and incrementally associated with the outcome after adjusting for established prognostic factors, as well as RV diameter and PH (fully adjusted HR 1.14 per 1 mm, 95% CI 1.02–1.27, P = 0.02; χ2 58.8 vs. 51.5, P = 0.03).ConclusionThe current data highlight the potential value of the semiquantitative measures of TR severity for the risk stratification in patients with HFpEF.
Myocardial ischaemia caused by bilateral coronary ostial stenosis from pseudointimal membranes in a full root freestyle valve: a case report
Authors: Bekke Kirstine , Dagnegård Hanna , Sigvardsen Per E , Smerup Morten 
Published: September 2020

Abstract

Background
Coronary artery ostial stenosis is a rare but well-known complication to aortic root replacement. The occurrence of this complication in patients with the Medtronic Freestyle bioprosthesis is poorly described. We report a case of late bilateral coronary ostial stenosis due to pseudointimal membranes within a Medtronic Freestyle bioprosthesis, resulting in acute coronary syndrome.

Case summary
In 2013, a 43-year-old male patient received a Medtronic Freestyle bioprosthesis as a full aortic root implantation due to endocarditis with root abscess. Preoperative coronary angiography was normal. The patient, who had no previous symptoms of coronary ischaemia, presented with severe chest pain and acute coronary syndrome in 2017. Coronary angiography and electrocardiogram-gated contrast-enhanced cardiac computed tomography showed bilateral coronary ostial stenosis. The patient was successfully treated with coronary artery bypass grafting. Intraoperative inspection revealed pseudointimal membranes covering the coronary ostia. Histology showed fibro-intimal thickening with areas of inflamed granulation tissue.

Discussion
Bilateral coronary ostial stenosis is a severe, potentially life-threatening condition, and a possible complication to implantation of the Medtronic Freestyle bioprosthesis as a full root. The phenomenon may occur late and should be distinguished from arteriosclerotic coronary artery disease.
The role of intracoronary thrombolysis in selected patients presenting with ST-elevation myocardial infarction: a case series
Authors: Barua Sumita , Geenty Paul , Deshmukh Tejas , Ada Cuneyt , Tanous David , Cooper Mark , Fahmy Peter , Denniss Alan Robert 
Published: September 2020

Abstract

Background
Primary percutaneous coronary intervention (PCI) is the cornerstone of management for ST-elevation myocardial infarction (STEMI). However, large intracoronary thrombus burden complicates up to 70% of STEMI cases. Adjunct therapies described to address intracoronary thrombus include manual and mechanical thrombectomy, use of distal protection device and intracoronary anti-thrombotic therapies.

Case summary
This series demonstrates the use of intracoronary thrombolysis in the setting of large coronary thrombus, bifurcation lesions with vessel size mismatch, diffuse thrombosis without underlying plaque rupture, and improving coronary flow to allow vessel wiring and proceeding to definitive revascularization.

Discussion
Larger intracoronary thrombus burden correlates with greater infarct size, distal embolization, and the associated no-reflow phenomena, and propagates stent thrombosis, with subsequent increase in mortality and major adverse cardiac events. Intracoronary thrombolysis may provide useful adjunct therapy in highly selected STEMI cases to reduce intracoronary thrombus and facilitate revascularization.
The role of four-dimensional computed tomography in transcatheter aortic valve replacement prosthesis endocarditis with concurrent leaflet thrombosis: a case report
Authors: Khav Nancy , Rashid Hashrul N , Brown Adam J 
Published: September 2020

Abstract

Background
Transcatheter aortic valve replacement (TAVR) is becoming increasingly utilized for the treatment of severe aortic valvular heart disease. Infective endocarditis of TAVR is rare but associated with higher mortality and morbidity. The potential for leaflet thrombosis following TAVR is also becoming increasingly recognized. Diagnosis of these conditions on echocardiography can be challenging due to prosthesis artefact.

Case summary
An 84-year-old man with a previous transcatheter aortic valve replacement presented with a febrile illness and bacteraemia. Transthoracic and transoesophageal echocardiography demonstrated high transvalvular gradients with features of prosthesis endocarditis, though leaflet morphology could not be fully assessed due to prosthesis artefact. Four-dimensional computed tomography revealed hypo-attenuated leaflet thickening with reduced leaflet motion, consistent with prosthesis leaflet thrombosis. The patient was successfully treated with antibiotics and anticoagulation, with resolution of the infection and normalization of the transvalvular gradient after 6 weeks.

Discussion
Echocardiography should be the first-line investigation for assessing leaflet morphology in suspected prosthetic valve endocarditis or leaflet thrombosis but its accuracy may be limited by artefact. Our case highlights that four-dimensional computed tomography provides further evaluation of prosthesis leaflet morphology/motion, providing valuable diagnostic information.
Right atrial thrombus in a patient with COVID-19 pneumonia: a case report
Authors: Shamsah Mohammed A , Bitar Zouheir Ibrahim , Alfoudri Huda 
Published: September 2020

Abstract

Background
Significant coagulopathy and hyperinflammation are found in patients with coronavirus disease 2019 (COVID-19). Expert consensus has recommended prophylactic anticoagulation in COVID-19 patients due to the risk of thrombo-embolism. However, the use of therapeutic anticoagulation in these patients is still a matter of debate.

Case summary
We describe a patient with COVID-19 pneumonia and a clinical hyperinflammatory state. He developed early respiratory depression and required ventilation, and he subsequently developed haemodynamic instability. Point-of-care echocardiography demonstrated a right atrial thrombus and right ventricular dysfunction suggestive of acute massive pulmonary embolism. He was managed with veno-arterial extracorporeal membrane oxygenation and local thrombolysis.

Discussion
Critical cases of COVID-19 pneumonia are associated with hypercoagulation, and these patients should be monitored closely for complications. Therapeutic anticoagulation may play a role in the management and prevention of thrombo-embolism.
Potentially inappropriate prescriptions in heart failure with reduced ejection fraction: ESC position statement on heart failure with reduced ejection fraction-specific inappropriate prescribing
Authors: El Hadidi Seif , Rosano Giuseppe , Tamargo Juan , Agewall Stefan , Drexel Heinz , Kaski Juan Carlos , Niessner Alexander , Lewis Basil S , Coats Andrew J S , Savarese Gianluigi 
Published: September 2020

AbstractHeart failure (HF) is a chronic debilitating and potentially life-threatening condition. HF patients are usually at high risk of polypharmacy and consequently, potentially inappropriate prescribing leading to poor clinical outcomes. Based on the published literature, a comprehensive HF-specific prescribing review tool is compiled to avoid medications that may cause HF or harm HF patients and to optimize the prescribing practice of HF guideline-directed medical therapies. Recommendations are made in line with the last versions of European Society of Cardiology (ESC) guidelines, ESC position papers, scientific evidence, and experts’ opinions.
Short dual antiplatelet therapy followed by P2Y12 inhibitor monotherapy vs. prolonged dual antiplatelet therapy after percutaneous coronary intervention with second-generation drug-eluting stents: a systematic review and meta-analysis of randomized clinical trials
Authors: Giacoppo Daniele , Matsuda Yuji , Fovino Luca Nai , D’Amico Gianpiero , Gargiulo Giuseppe , Byrne Robert A , Capodanno Davide , Valgimigli Marco , Mehran Roxana , Tarantini Giuseppe 
Published: September 2020

Abstract

Aims
After percutaneous coronary intervention (PCI) with second-generation drug-eluting stent (DES), whether short dual antiplatelet therapy (DAPT) followed by single antiplatelet therapy (SAPT) with a P2Y12 receptor inhibitor confers benefits compared with prolonged DAPT is unclear.

Methods and results
Multiple electronic databases, including PubMed, Scopus, Web of Sciences, Ovid, and ScienceDirect, were searched to identify randomized clinical trials comparing ≤3 months of DAPT followed by P2Y12 inhibitor SAPT vs. 12 months of DAPT after PCI with second-generation DES implantation. The primary and co-primary outcomes of interest were major bleeding and stent thrombosis 1 year after randomization. Summary hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by fixed-effect and random-effects models. Multiple sensitivity analyses including random-effects models 95% CI adjustment were applied. A sensitivity analysis comparing trials using P2Y12 inhibitor SAPT with those using aspirin SAPT was performed. A total of five randomized clinical trials (32 145 patients) were available. Major bleeding was significantly lower in the patients assigned to short DAPT followed by P2Y12 inhibitor SAPT compared with those assigned to 12-month DAPT (random-effects model: HR 0.63, 95% 0.45–0.86). No significant differences between groups were observed in terms of stent thrombosis (random-effects model: HR 1.19, 95% CI 0.86–1.65) and the secondary endpoints of all-cause death (random-effects model: HR 0.85, 95% CI 0.70–1.03), myocardial infarction (random-effects model: HR 1.05, 95% CI 0.89–1.23), and stroke (random-effects model: HR 1.08, 95% CI 0.68–1.74). Sensitivity analyses showed overall consistent results. By comparing trials testing ≤3 months of DAPT followed by P2Y12 inhibitor SAPT vs. 12 months of DAPT with trials testing ≤3 months of DAPT followed by aspirin SAPT vs. 12-month of DAPT, there was no treatment-by-subgroup interaction for each endpoint. By combining all these trials, regardless of the type of SAPT, short DAPT was associated with lower major bleeding (random-effects model: HR 0.63, 95% CI 0.48–0.83) and no differences in stent thrombosis, all-cause death, myocardial infarction, and stroke were observed between regimens.

Conclusion
After second-generation DES implantation, 1–3 months of DAPT followed by P2Y12 inhibitor SAPT is associated with lower major bleeding and similar stent thrombosis, all-cause death, myocardial infarction, and stroke compared with prolonged DAPT. Whether P2Y12 inhibitor SAPT is preferable to aspirin SAPT needs further investigation.
The effect of spironolactone on cardiovascular function and markers of fibrosis in people at increased risk of developing heart failure: the heart ‘OMics’ in AGEing (HOMAGE) randomized clinical trial
Authors: Cleland John G F , Ferreira João Pedro , Mariottoni Beatrice , Pellicori Pierpaolo , Cuthbert Joe , Verdonschot Job A J , Petutschnigg Johannes , Ahmed Fozia Z , Cosmi Franco , Brunner La Rocca Hans-Peter , Mamas Mamas A , Clark Andrew L , Edelmann Frank , Pieske Burkert , Khan Javed , McDonald Ken , Rouet Philippe , Staessen Jan A , Mujaj Blerim , González Arantxa , Diez Javier , Hazebroek Mark , Heymans Stephane , Latini Roberto , Grojean Stéphanie , Pizard Anne , Girerd Nicolas , Rossignol Patrick , Collier Tim J , Zannad Faiez ,   the HOMAGE Trial Committees and Investigators, Atar Dan , Kober Lars , Dickstein Kenneth , Lange Theis 
Published: September 2020

AbstractAims To investigate the effects of spironolactone on fibrosis and cardiac function in people at increased risk of developing heart failure.Methods and results Randomized, open-label, blinded-endpoint trial comparing spironolactone (50 mg/day) or control for up to 9 months in people with, or at high risk of, coronary disease and raised plasma B-type natriuretic peptides. The primary endpoint was the interaction between baseline serum galectin-3 and changes in serum procollagen type-III N-terminal pro-peptide (PIIINP) in participants assigned to spironolactone or control. Procollagen type-I C-terminal pro-peptide (PICP) and collagen type-1 C-terminal telopeptide (CITP), reflecting synthesis and degradation of type-I collagen, were also measured. In 527 participants (median age 73 years, 26% women), changes in PIIINP were similar for spironolactone and control [mean difference (mdiff): −0.15; 95% confidence interval (CI) −0.44 to 0.15 μg/L; P = 0.32] but those receiving spironolactone had greater reductions in PICP (mdiff: −8.1; 95% CI −11.9 to −4.3 μg/L; P &lt; 0.0001) and PICP/CITP ratio (mdiff: −2.9; 95% CI −4.3 to −1.5; &lt;0.0001). No interactions with serum galectin were observed. Systolic blood pressure (mdiff: −10; 95% CI −13 to −7 mmHg; P &lt; 0.0001), left atrial volume (mdiff: −1; 95% CI −2 to 0 mL/m2; P = 0.010), and NT-proBNP (mdiff: −57; 95% CI −81 to −33 ng/L; P &lt; 0.0001) were reduced in those assigned spironolactone.Conclusions Galectin-3 did not identify greater reductions in serum concentrations of collagen biomarkers in response to spironolactone. However, spironolactone may influence type-I collagen metabolism. Whether spironolactone can delay or prevent progression to symptomatic heart failure should be investigated.
Associations between BMI and visual impairment of 33 407 preschool children in Germany: a pooled cross-sectional study
Authors: Liu Weina , Schwertz Rainer , Welker Andreas , Welker Judith , Chen Simiao , Dambach Peter , Marx Michael 
Published: September 2020

Abstract

Background
Prevalence of overweight and obesity in Germany is increasing. High body weight can affect children’s growth and development. This paper aimed to determine the association between body mass index (BMI) and visual impairment among preschool children and explore the potential role of obesity in predicting visual developmental disorder.

Methods
Six consecutive years of data from the School Entry Examination were collected for all preschool children aged from 4 to 6 years residing in Rhine-Neckar County and the City of Heidelberg, Germany from 2013 to 2018. Univariate and multivariate regression were used to analyze the complete data, multiple imputation was used to deal with missing data.

Results
Among the group with an immigrant background, children with obesity [OR = 1.20, 99% (1.02–1.42)] were more likely to have visual impairment compared to those with normal body weight (P &lt; 0.01) after adjusting for survey year, age, and gender of children, education and occupation of parents, screen time-frequency, whether a television was in their bedroom, and quality of preschool outdoor environment.

Conclusion
There were significant associations between obesity and visual impairment among German preschool children with immigrant backgrounds. Strategies to support vulnerable groups were needed across all regional schools.