bluuebunny/crossref_metadata_2025_split huggingface dataset:
Eating and Psychiatric Disorders Are Independent Risk Factors for Rumination Syndrome
Authors: Cai Jennifer X. , Wong Danny , Lee Darren J.H. , Chan Walter W. 
Published: March 2021

Goal:
The goal of this study was to evaluate whether a history of eating disorders (EDs) or psychiatric disorders (PDs) are risk factors for rumination syndrome (RS).

Background:
RS is a disorder of gut-brain interaction characterized by an effortless postprandial retrograde flow of ingested contents. Disorder of gut-brain interactions have been associated with psychiatric and behavioral comorbidities. No prior comparative study has assessed the relationship between RS and ED or PD.

Methods:
This was a case-control study of adults with RS at a tertiary center in January 2013 to January 2018. Two age-matched/gender-matched controls per RS case were identified. The Fisher exact test (categorical)/Student t test (continuous) and forward stepwise logistic regression were performed for univariate and multivariable analyses, respectively.

Results:
Seventy-two patients (24 cases/48 controls) were included. Baseline demographics and characteristics were similar between cases and controls. Among RS patients, 9 (37.5%) had a history of ED, including 3 (12.5%) anorexia nervosa and 4 (16.7%) bulimia nervosa; and 20 (83.3%) had a PD, including 9 (37.5%) anxiety and 7 (29.2%) depression. Prevalence of ED (37.5% vs. 4.2%, P=0.0002) and PD (83.3% vs. 50.0%, P=0.0062) were higher among RS patients than controls. Specifically, the risks of anorexia nervosa (16.7% vs. 0%, P=0.005) and bulimia nervosa (21.1% vs. 0%, P=0.001) were both increased in RS patients. On multivariable analysis, ED (adjusted odds ratio=16.4, P=0.0033) and PD (adjusted odds ratio=4.47, P=0.029) remained independent predictors for RS.

Conclusions:
A history of ED and PD were independent risk factors for RS. Abnormal eating behaviors and psychiatric comorbidities may contribute to the pathogenesis of RS. Evaluation of RS should include a detailed history for ED and PD.
Impact of COVID-19 on Individuals With Irritable Bowel Syndrome and Comorbid Anxiety and/or Depression
Authors: Kamp Kendra J. , Levy Rona L. , Munson Sean A. , Heitkemper Margaret M. 
Published: March 2021

Goals:
The goal of this study was to describe the influence of the COVID-19 pandemic on ability to engage in activities and the influence on psychological distress and gastrointestinal symptoms among individuals with irritable bowel syndrome (IBS) and comorbid anxiety and/or depression.

Background:
Individuals with IBS and comorbid anxiety and/or depression report increased symptoms and decreased quality of life compared with individuals with IBS alone. The current COVID-19 pandemic has the potential to further influence symptoms among individuals with IBS and comorbid anxiety and/or depression.

Study:
Individuals who met the Rome-IV IBS criteria and reported mild to severe anxiety and/or depression were included. Participants completed an online survey with questions about anxiety, depression, impact of COVID on activities and symptoms, and demographics.

Results:
Fifty-five individuals participated in the study. The COVID-19 pandemic most commonly influenced their ability to spend time with friends and family, shop for certain types of food, and access health care. Participants also reported increased stress (92%), anxiety (81%), and depressive symptoms (67%). Finally, around half the sample reported increases in abdominal pain (48%), diarrhea (45%), or constipation (44%).

Conclusions:
The COVID-19 pandemic is related to self-reported increases in psychological distress and gastrointestinal symptoms among individuals with IBS and comorbid anxiety and/or depression. Additional research is needed to intervene on these symptoms.
Trends and Socioeconomic Health Outcomes of Cannabis Use Among Patients With Gastroparesis
Authors: McCarty Thomas R. , Chouairi Fouad , Hathorn Kelly E. , Chan Walter W. , Thompson Christopher C. 
Published: March 2021

Background:Although cannabis may worsen nausea and vomiting for patients with gastroparesis, it may also be an effective treatment for gastroparesis-related abdominal pain. Given conflicting data and a lack of current epidemiological evidence, we aimed to investigate the association of cannabis use on relevant clinical outcomes among hospitalized patients with gastroparesis.Materials and Methods:Patients with a diagnosis of gastroparesis were reviewed from the National Inpatient Sample (NIS) database between 2008 and 2014. Gastroparesis was identified by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes with patients classified based on a diagnosis of cannabis use disorder. Demographics, comorbidities, socioeconomic status, and outcomes were compared between cohorts using χ2and analysis of variance. Logistic regression was then performed and annual trends also evaluated.Results:A total of 1,473,363 patients with gastroparesis were analyzed [n=33,085 (2.25%) of patients with concomitant cannabis use disorder]. Patients with gastroparesis and cannabis use disorder were more likely to be younger and male gender compared with nonusers (36.7±18.8 vs. 51.9±16.8;P<0.001 and 52.9% vs. 33.5%;P<0.001, respectively). Race/ethnicity was different between groups (P<0.001). Cannabis users had a lower median household income and were more likely to have Medicaid payor status (allP<0.001). Controlling for confounders, length of stay, and mortality were significantly decreased for patients with gastroparesis and cannabis use (allP<0.001).Conclusion:While patients with gastroparesis and cannabis use disorder were younger, with a lower socioeconomic status, and disproportionately affected by psychiatric diagnoses, these patients had better hospitalization outcomes, including decreased length of stay and improved in-hospital mortality.
Spontaneous regression of liver hemangiomas: a single-institution analysis of 46 patients
Authors: Aydin Oğuzhan , Acunaş Bülent , Poyanli Arzu , Serin Kürşat Rahmi , İbiş Cem , Özden İlgin 
Published: March 2021

Objective
The aim of this study was to determine the nature of spontaneous regression of liver hemangiomas.

Patients and methods
The records of the liver hemangioma patients who attended the out-patient clinic between 1988 and 2018 were evaluated. The data of the 716 adult patients who were followed for at least 3 years with cross-sectional imaging were analyzed.

Results
Spontaneous regression was documented in 46 patients (6.4%). Twenty-eight patients had a single hemangioma (61%), eight (17%) had two hemangiomas; the other 10 patients had 3–6 hemangiomas. Of the 87 lesions in 46 patients, 69 actually regressed during the study. Twelve patients with more than one lesion exhibited discordant courses – one of the hemangiomas of a patient with multiple lesions regressed, whereas the other enlarged or remained stable. Eleven of the regressed hemangiomas exhibited enlargement first, followed by spontaneous regression. Fourteen (20%) of the regressed hemangiomas acquired atypical characteristics that would have suggested a malignancy had the original films been unavailable.

Conclusion
Spontaneous regression of liver hemangiomas is an underrecognized phenomenon. Enlargement should not be a straightforward indication for intervention because it may be followed by regression. A regressed hemangioma should be considered in the differential diagnosis of liver lesions suspicious for malignancy.
Serum anandamide level as a potential indicator for nonalcoholic fatty liver disease severity
Authors: Ramadan Ahmed , Khalaf Asmaa R. , El Ray Ahmed , Saad Yasmin 
Published: March 2021

Introduction and aim
Nonalcoholic fatty liver disease (NAFLD) is a very common disease, ranging from simple steatosis to nonalcoholic steatohepatitis (NASH) and is considered the hepatic expression of metabolic syndrome. Liver biopsy is currently considered the gold standard in diagnosis of NAFLD; however, it is an invasive technique and carries many risks. The serum anandamide level is recently discovered to play an important role as the potential indicator for NAFLD severity. The purpose of the study is to determine the association of endocannabinoid metabolite anandamide and NAFLD severity and to investigate its association with anthropometric and metabolic features in NAFLD patients.

Methodology
A case–control study on 36 NAFLD biopsy-proven NAFLD patients and 15 healthy volunteers. They were subjected to full clinical history and examination, laboratory tests, abdominal ultrasound and serological testing of anadamide.

Results
The anadamide level was significantly higher among NAFLD subgroups (simple steatosis and NASH) vs. the normal group (1.1, 0.29 vs. 0.2 P value = 0.00085), with cutoff 0.58 in the NASH group (accuracy 89%; sensitivity 66% and specificity 100%) (P value < 0.01).

Conclusion
Anandamide could be a specific serum marker for NASH and can be used to detect NAFLD severity.
Complications and management of elective endoscopic cyanoacrylate injection with lauromacrogol for gastric varices
Authors: Zhou Ji , Liu Chengfeng , Ma Lili , Chen Jie , Luo Tiancheng , Li Feng , Wang Jian , Zeng Xiaoqing , Chen Shiyao 
Published: March 2021

Objective
To report the complications and evaluate the risk factors of elective endoscopic cyanoacrylate injection with lauromacrogol for gastric varices in cirrhotic patients.

Methods
A total of 583 elective endoscopic tissue adhesives procedures were performed in 439 patients in our hospital from January 2015 to December 2016. The clinical characteristics and complications were retrospectively collected and evaluated.

Results
The median age was 56 ± 11 years, and 290 (66.1%) patients were male. The main etiology of liver cirrhosis was hepatitis virus (63.3%). Two hundred fifty-nine (59.0%) patients were classified as Child-Pugh Class A. Bleeding occurred in 44 patients (7.5%) during procedures. Two patients developed distant embolism (0.5%; one pulmonary, one cerebra). In perioperative period, fever was a common complication; however, only 16 cases had high fever and one case had sepsis. Bleeding was observed in 7 (1.2%) patients. Overall incidence of the major perioperative complication was 3.8%. The major postoperative complication rate was 10.4% (60/582, 26 rebleeds, 27 ascites increase, 12 new-onset portal vein thrombosis). The complication-related death was 1.6% (one death from embolism, five deaths from rebleeding, one death from refractory ascites). Injection point was the only factor related to the major perioperative complications [odds ratio (OR) = 1.581, 95% CI, 1.086–2.301; P < 0.05]. Etiology of cirrhosis and injection point were independent risk factors of major postoperative complications (OR = 1.830, 95% CI, 1.005–3.331, P = 0.048; OR = 1.373, 95% CI, 1.089–1.731, P = 0.007).

Conclusion
The incidence of complications after elective endoscopic cyanoacrylate injection with lauromacrogol for gastric varices was low. The injection point was the risk factor for both perioperative and postoperative complications.
Early thiopurine maintenance is associated with reduced proximal disease progression and colectomy rate in ulcerative colitis
Authors: Kariyawasam Viraj C. , Mourad Fadi H. , Mitrev Nikola , Paramsothy Sudarshan , Selinger Christian P. , Katelaris Peter H. , Jones Brian , McDonald Charles , Barr Gavin , Chapman Grace , Cowlishaw James , Andrews Jane , Leong Rupert W. 
Published: March 2021

Background
Thiopurines effectively maintain remission in ulcerative colitis patients. Whether early initiation of thiopurines after ulcerative colitis diagnosis decreases proximal disease progression and colectomy rates is not known.

Methods
We conducted a cohort study of ulcerative colitis subjects recruited from 1970 to 2009. Early thiopurine maintenance was defined as commencement of azathioprine or mercaptopurine within 5 years of diagnosis and maintenance for at least 6 months. Propensity score matching was conducted to correct for confounders influencing early thiopurine introduction. Outcomes of interest were colectomy rate and endoscopic proximal disease extension.

Results
982 consecutive ulcerative colitis subjects (12 879 patient-years) were recruited with 116 requiring colectomy. Thiopurines initiation and maintenance increased over time with median time to thiopurine commencement decreasing from 23 years in the first decade to 2 years in the last decade (P < 0.0001). Multivariate analysis showed that early thiopurine maintenance significantly decreased the need for colectomy [hazard ratio, 0.13; 95% confidence interval (CI):0.03–0.55; P = 0.006]. The number of subjects needed to be treated to reduce one colectomy at 5 and 10 years was 18 (95% CI, 16– 36) and 12 (95% CI, 11–25). After propensity score matching, early thiopurine maintenance was significantly associated with decreased colectomy (hazard ratio, 0.10; 95% CI, 0.03–0.43; P = 0.002) and proximal progression of disease extent (hazard ratio, 0.26; 95% CI, 0.10–0.78; P = 0.015).

Conclusion
Early thiopurine maintenance for >6 months is significantly associated with reduced colectomy and proximal progression of disease extent in ulcerative colitis.
Association between nonalcoholic fatty liver disease and cardiovascular disease revealed after comprehensive control of metabolic risk factors: a nationwide population-based study in Korea
Authors: Seo Bong-suk , Roh Jae-Hyung , Lee Jae-Hwan , Lee Hanbyul , Min Kim Young , Yoon Yong-Hoon , Kim Minsu , Kim Yong-Giun , Park Gyung-Min , Park Jae-Hyeong , Seong In-Whan 
Published: March 2021

Objectives
Previous epidemiological studies have limitations in revealing whether cardiovascular disease (CVD) incidence is mediated by interim occurrence of other metabolic diseases in otherwise healthy nonalcoholic fatty liver disease (NAFLD) patients.

Methods
The study population consisted of 334 280 healthy subjects who had had the National Health check-ups in South Korea from 2009 to 2014. The fatty liver index (FLI) was used to identify subjects with NAFLD. CVD was defined as occurrence of a composite of cardiovascular death, myocardial infarction, ischemic stroke, or coronary revascularization. The association between FLI and CVD incidence was analyzed using time-dependent Cox regression analyses.

Results
The study population was categorized into quartile groups according to FLI (range: Q1, 0–4.9; Q2, 5.0–12.5; Q3, 12.6–31.0; Q4, >31.0). The median follow-up duration was 5.4 years, during which subjects with higher FLIs experienced CVD more frequently than did those with lower FLIs [Q1, 215 (0.3%); Q2, 498 (0.6%); Q3, 753 (0.9%); Q4, 981 (1.2%); P < 0.001]. Adjustment of baseline characteristics revealed that a higher FLI was independently associated with an increased risk for CVD [hazard ratio between Q4 and Q1, 1.86; 95% confidence interval (CI), 1.59–2.17; P < 0.001]. The association between them remained statistically significant (hazard ratio between Q4 and Q1, 1.92; 95% CI, 1.63–2.25; P < 0.001) after further adjustment for the interim events (diabetes, hypertension, heart failure, and atrial fibrillation).

Conclusions
Otherwise healthy NAFLD patients progressed to develop CVD independently of the interim occurrence of other metabolic diseases, which emphasizes the importance of NAFLD as a potential therapeutic target for prevention of CVD.
Endoscopic ultrasound-guided sampling of gastrointestinal subepithelial lesions: just wet it
Authors: Pita Inês , Pimentel-Nunes Pedro , Dinis-Ribeiro Mário , Bastos Pedro 
Published: March 2021

Introduction
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the main method for acquisition of tissue from gastrointestinal subepithelial lesions (SELs). Despite the development of new needles, diagnostic yield remains low. A new method of aspiration has been described, where the needle is filled with saline [wet-suction technique (WST)], with promising results in pancreatic lesions. This method has not been tested in SELs.

Aims and methods
Prospective single center study to assess the diagnostic yield of EUS-FNA+WST in the diagnosis of SELs, without the use of rapid on-site evaluation. In mesenchymal tumors, the diagnosis was considered positive only when immunohistochemistry could differentiate between gastrointestinal stromal tumor and leiomyoma.

Results
Eighty-seven patients with SELs were included (55% male, mean age 66 years). Mean SEL size was 25 mm (min 10 mm, max 120 mm), mean number of passes was 3 (±0.8). A 22G needle was used in 72 patients (83%), 19G in 10 (12%) and 25G in 5 (6%). We obtained a conclusive cytopathological diagnosis in 74 cases (diagnostic yield of 85%) and immunohistochemistry was performed in 70 cases (81%). The most frequent diagnoses were gastrointestinal stromal tumor (n = 34, 37%), leiomyoma (n = 13, 15%) and metastases (n = 10, 11%).

Conclusion
Wet suction technique allowed an excellent diagnostic yield in the EUS-guided evaluation of SELs. We suggest that, after proper replication of these results, WST may become the first-line method in the management of these lesions.
Ustekinumab induction concentrations are associated with clinical and biochemical outcomes at week 12 of treatment in Crohn’s disease
Authors: Walshe Margaret , Borowski Krzysztof , Boland Karen , Rho Stella , Stempak Joanne M. , Silverberg Mark S. 
Published: March 2021

Background
We investigated relationships between induction ustekinumab levels and clinical and biochemical outcomes in Crohn’s disease.

Methods
Following standard IV induction, ustekinumab levels were measured at week 2 (wk2) and week 6 (wk6). Ustekinumab levels were compared in patients receiving 260, 390 and 520 mg at induction. Crohn’s disease activity index (CDAI), serum albumin, C-reactive protein (CRP) and fecal calprotectin (FCP) were measured at baseline and week 12 (wk12). Associations between ustekinumab levels and these parameters were assessed. Ustekinumab levels were compared between patients requiring dose intensification within one year of induction and those remaining on standard dosing.

Results
Of 23 wk2 ustekinumab levels, 22(95.7%) were above the upper limit of quantification of the assay (25 µg/mL). Median wk6 ustekinumab level (n = 25) was 14.2 μg/mL [interquartile range (IQR), 9.6–20.1]. Median wk6 ustekinumab levels in patients receiving 260, 390 and 520 mg were 8.6, 16.3 and 25.0 µg/mL, respectively, P = 0.01. There were significant correlations between baseline albumin and wk6 ustekinumab levels; r = 0.644 [95% confidence interval (CI), 0.304–0.839], P < 0.001, and between baseline FCP and wk6 ustekinumab levels; r = −0.678 (95% CI, −0.873 to −0.296), P < 00.01. Median wk12 CDAI (n = 18), CRP (n = 22) and FCP (n = 13) were 78 (IQR, 52.5–152), 1.75 mg/L (IQR, 0.93–7.03) and 746 μg/g (IQR, 259–2100), respectively. There were significant correlations between wk6 ustekinumab levels and wk12 CDAI; r = −0.513 (95% CI, −0.796 to −0.046), P = 0.03; and between wk6 ustekinumab levels and wk12 CRP; r = −0.578 (95% CI, −0.808 to −0.194), P < 0.01. Wk6 ustekinumab levels were lower in patients undergoing subsequent dose intensification; 12.5 vs. 19.6 µg/mL, P = 0.04.

Conclusion
Wk6 ustekinumab levels are significantly associated with baseline Crohn’s disease biomarkers and subsequent clinical and biochemical outcomes.
Genetic variants of tissue inhibitors of matrix metalloproteinase 1 (rs4898) and 2 (rs8179090) in diverticulosis
Authors: Nehring Piotr , Gromadzka Grażyna , Giermaziak Anna , Jastrzębski Miłosz , Przybyłkowski Adam 
Published: March 2021

Introduction
Diverticulosis affects approximately 60% of population after 60th year of age. Diverticular disease is symptomatic diverticulosis characterized by abdominal pain, flatulence and bloating, and bowel habits change. Age and lifestyle are risk factors for diverticulosis, additionally genetic predisposition is postulated. The aim of the study was to assess whether tissue inhibitors of matrix metalloproteinase (TIMP) 1 rs4898 and TIMP2 rs8179090 genetic variants are related to colonic diverticulosis.

Methods
The study included 220 patients, 100 with colon diverticulosis diagnosed on colonoscopy and 120 controls. TIMP1 rs4898 and TIMP2 rs8179090 variants were examined using PCR–restriction fragments length polymorphism from a blood sample.

Results
Allele T of TIMP1 rs4898 was more frequent in male patients with diverticulosis than in controls (P < 0.01), whereas in women there were no differences in its distribution, both in heterozygotes and homozygotes or in homozygotes separately, proving a recessive effect. TIMP2 s8179090 allele G frequency was 0.95 in cases and controls, there were no CC homozygotes identified, and no associations with diverticulosis showed.

Conclusion

TIMP1 rs4898 allele T may be a genetic determinant of the risk of diverticulosis in men.
Impact of Adding Pharmacists and Comprehensive Medication Management to a Medical Group’s Transition of Care Services
Authors: Xuan Si , Colayco Danielle , Hashimoto Jonathan , Barca Jason , Dekivadia Dharagauri , Padula William V. , McCombs Jeffrey 
Published: March 2021

Objectives:
Evaluate the impact of pharmacist-provided transition of care (TOC) services on hospital readmissions.

Methods:
Starting March 2014, TOC services were provided to all hospitalized patients from an at-risk medical group. Data covering all inpatient and outpatient services and prescription drugs were retrieved for all adult patients discharged between January 2010 and December 2018. The overall impact of TOC was estimated using a generalized estimating equation with logistic regression. Longitudinal TOC effects were estimated using generalized estimating equation in an interrupted time series model. Parallel analyses were conducted using data from an affiliated medical group in a neighboring county without access to the TOC intervention.

Results:
The study included 13,256 hospital discharges for adult patients for the 30-day readmission analysis and 10,740 discharges for the 180 days analysis. The TOC program reduced 30-day readmission risk by 34.9% [odds ratio (OR)=0.651 (range, 0.590–0.719)] and 180-day readmissions by 33.4% [OR=0.666 (range, 0.604–0.735)]. The interrupted time series results found the 30-day readmission rate to be stable over the pre-TOC period (OR=0.00; not significant) then to decreased by 1.5% per month in the post-TOC period [OR=0.985 (range, 0.980–0.991)]. For 180-day readmissions, risk decreased by 1% per month after TOC implementation [OR=0.990 (range, 0.984–0.996)]. Referral to the medical group’s pre-existing Priority Care clinic also reduced readmission risk. Results from the comparison medical group found 180-day readmission declined by 1% per month after March 2014 [OR=0.990 (0.891–1.00)].

Conclusions:
Adding a pharmacist-led TOC program to the medical group’s existing outpatient services reduced 30- and 180-day readmissions by “bending the curve” for readmission risk over time.