bluuebunny/crossref_metadata_2025_split huggingface dataset:
A210 DECLINE IN HEPATITIS B QUANTITATIVE SURFACE ANTIGEN LEVELS IN CHRONIC HEPATITIS B PATIENTS ON TREATMENT WITH NUCLEOS(T)IDE ANALOGUES
Authors: Stach J , Zhao I , Frolkis A , Haylock-Jacobs S , Israelson H , Pinto J , Williams S , Swain M , Stinton L , Aspinall A , Borman M , Sadler M D , Burak K W , Congly S E , Lee S , Coffin C S 
Published: March 2021

Abstract

Background
The Hepatitis B virus (HBV) affects over 250 million people worldwide and can lead to cirrhosis and hepatocellular carcinoma. HBV surface antigen (HBsAg) quantification is increasingly used to predict disease activity and treatment response. As there is no virologic cure, clinicians are seeking a “functional cure”, or HBsAg loss, as a guide to safely stopping nucleos(t)ide analogue therapy. Tenofovir Disoproxil Fumarate (TDF) and Entecavir (ETV) are first line therapy but require prolonged treatment to achieve HBsAg clearance.

Aims
To assess the association between nucleos(t)ide therapy and decline in quantitative HBsAg (qHBsAg) in patients with HBV from Calgary, Alberta.

Methods
A retrospective review of adult patients with chronic HBV, followed at the University of Calgary Liver Clinic, was conducted between January 2012 and October 2020. Patients were excluded if treatment was discontinued or changed, only had a single qHBsAg measurement, or were co-infected with hepatitis C virus, hepatitis delta virus, or HIV. Patients were stratified according to therapy with TDF, ETV, or no treatment. To identify associations between mean changes in qHBsAg by medication exposure, one-way ANOVAs and t-tests were performed. Results were reported as means and 95% confidence intervals (CI). The median time from initial qHBsAg to most-recent was calculated.

Results
187 patients were included in the final analysis (Table 1). 77 were excluded for being on more than one medication over the study period, 10 were excluded due to discontinuation of treatment, and 195 were excluded for single qHBsAg measurements. The mean qHBsAg decline was -750.04 IU/mL (95% CI -1311.58, -188.50) in the TDF group (n=45) and -309.20 IU/mL (95% CI -600.90, -17.50) in the ETV group (n=35) (p=0.20). In the no treatment group (n=107), the mean qHBsAg increased by 711.29 IU/mL (95% CI -600.78, 2023.80)(Figure 1). The median time from initial qHBsAg to most-recent was 980 days.

Conclusions
Quantitative HBsAg levels declined in patients on TDF and ETV, but increased in untreated patients. Although HBsAg levels showed a trend for greater decline in TDF-treated patients, results failed to reach statistical significance, and may be affected by overall treatment duration. Future studies will explore medication use as a time-varying covariate to identify how change in treatment influences changes in HBsAg over time.

Funding Agencies
None
A224 LIVER CIRRHOSIS AND VENOUS THROMBOEMBOLISM: A NATIONAL INPATIENT SAMPLE STUDY
Authors: Balubaid I , Alghamdi W , Khanna R , Teriaky A 
Published: March 2021

Abstract

Background
The sequelae of decompensated cirrhosis include a reduction in both hepatic coagulation factors and platelets. While historically it was felt that patients with cirrhosis were naturally anticoagulated, recent studies have refuted this. As a result, cirrhotic patients may be a risk for development of venous thromboembolism (VTE). Conflicting data regarding VTE risks limits guidance for clinicians.

Aims
National Inpatient Sample (NIS) data were analyzed to compare the prevalence of VTE among hospitalized patients with and without cirrhosis.

Methods
NIS is a database of US inpatient admissions. The 2014 NIS database was interrogated using ICD-9-CM codes to identify adult patients with cirrhosis and VTE. Baseline characteristics for patients with and without cirrhosis were compared. Multivariate regression models identified risks of VTE adjusting for survey procedures. Data were presented with odds ratio (OR) with 95% confidence intervals (95% CI). A p-value &lt;0.05 was statistically significant.

Results
605,825 patients with cirrhosis were included. VTE occurred in 8,940 patients with cirrhosis and 627,490 controls (1.5% and 2.2% respectively). The corresponding values for PE were 0.5% and 1.1%; and for DVT were 1.1% and 1.4%. The OR for VTE in patients with cirrhosis was 0.547 [95% CI (0.520–0.576), p &lt;0.001] when adjusting for risk factors for VTE (table 1).

Conclusions
Prevalence of VTE was lower among inpatients with cirrhosis compared to controls. Use of anticoagulation was not controlled as these data were not available, which could limit some associations. Further prospective studies are needed to overcome the limitations of retrospective analysis.

Funding Agencies
None
A239 AN APPROACH TO GASTRIC BALLOON RETRIEVAL ADMIDST COVID-19 RELATED TRAVEL RESTRICTIONS
Authors: Dahiya M , Tomaszewski M , Bond A , Donnellan F , Mohamed R 
Published: March 2021

Abstract

Background
Given the COVID-19 pandemic, international travel restrictions have been in effect since March 2020 in Canada. As a result, some patients requiring international travel for medical care have experienced delays. Therefore, innovative techniques were required to provide care that would not routinely be performed in Canada, as in the case of Orbera® gastric balloon retrieval.

Aims
To describe an approach to gastric balloon retrieval amidst COVID-19 related travel restrictions

Methods
Case review of three cases of gastric balloon retrieval was performed

Results
1: A 41-year-old (yo) woman had an Orbera® gastric balloon placement in Washington state in September 2019. She lost 42lbs. Retrieval was scheduled for March 2020, but was delayed due to COVID-19 restrictions. In May 2020, she developed symptoms of balloon dysfunction. The patient was referred to a Canadian tertiary care centre. Gastroscopy was performed under conscious sedation. The Orbera® balloon was in the distal gastric body. The balloon was punctured with a 19G EUS FNA needle; 600cc of blue tinted liquid was aspirated. The emptied balloon was retrieved successfully using rat tooth forceps.
2: A 35-yo woman had an Orbera® gastric balloon placed in October 2019 in Toronto at a private health facility. She lost 20lbs. Retrieval of the balloon was scheduled for March 2020, but due to COVID-19 restrictions, it was not possible at the original facility. She did not have symptoms related to the balloon. Gastroscopy was performed under general anesthesia (GA) on October 8, 2020. The balloon was intact in the distal gastric body. The balloon was punctured with a 19G Cook Echotip Needle and vacuum suction applied; 400cc of blue tinted fluid was removed. Alligator forceps were used to create holes in the underside of the balloon, allowing excess fluid to be expelled as the balloon was pulled up against the GEJ. Once the balloon was deflated, it was removed successfully through the mouth.
3: A 38-yo man had an Orbera® gastric balloon placed in his native Columbia in March 2020. He did not achieve weight loss. Due to COVID-19 restrictions, he was unable to return for planned removal. He did not have symptoms related to the balloon. Gastroscopy was performed under GA on October 8, 2020. The balloon was intact in the distal gastric body. The balloon was punctured with a 19G Cook Echotip Needle and vacuum suction applied; 600cc of blue tinted fluid was removed. Alligator forceps were used in retroflexion to tear the underside of the flattened balloon to ensure all liquid and air had escaped from the balloon. Once the balloon was deflated, it was removed successfully through the mouth.

Conclusions
Although Orbera® gastric balloon retrieval is not routinely performed in Canada, we demonstrate that gastroscopy with balloon puncture and forceps-retrieval is a safe option.

Funding Agencies
None
A244 SUCCESS RATE AND SAFETY OF SINGLE-OPERATOR PANCREATOSCOPY (SOP) IN THE EVALUATION OF SUSPECTED PANCREATIC DUCT NEOPLASIA: A RETROSPECTIVE COHORT STUDY
Authors: Abdel Moaein T , Moffatt D C , Coneys G 
Published: March 2021

Abstract

Background
Pancreatic intraductal papillary mucinous neoplasms (IPMNs) carry malignant risk and they account for up to 7% of pancreatic neoplasms, hence it is crucial to identify high-risk lesions to determine timely therapy
Distinction between main duct-IPMN (MD-IPMN) and other pancreatic disorders often relies on endoscopic ultrasound, MRI, and CT findings. These findings are very accurate in advanced cases, yet they are less sensitive for the diagnosis of early lesions
Direct endoscopic visualization of the biliary and pancreatic ducts has gained an increased interest due to the development of single-operator scopes with a better image resolution. Several case series and a retrospective single-center cohort study report the beneficial role of single operator pancreatoscopy (SOP) in the evaluation and sampling of indeterminate PD lesions

Aims
Evaluate our experience with SOP and determine its
1.Efficacy and safety in diagnosing MD-IPMN and PD neoplasia
2.Sensitivity (Sn) and specificity (Sp) in diagnosing high risk PD lesions

Methods
All patients (age ≥18 year old) who had attempted SOP using the SpyGlass (Boston Scientific Corp, Natick, MA) between June 2013 and November 2019 for the evaluation of indeterminate main PD strictures, dilatation, or with suspected or known MD-IPMN were included
The primary outcome was the efficacy and safety of SOP in diagnosing high-risk PD lesions
A minimum of 12 months follow-up (F/U) from index SOP was required to define a true negative for patients (pts) with benign SOP findings

Results
A total of 43 pts underwent SOP; 18 (42%) males and 25 (58%) females, with a mean age of 66.1 years. Technical success was (n=35/43; 81.4%)
In the diagnosed MD-IPMN group (n=14/35; 40%), all underwent surgery except three; one is awaiting surgery, the second had an aborted Whipple’s and the last was lost to F/U. The remaining eleven pts (78.6%) had confirmed diagnosis of MD-IPMN with moderate or high-grade dysplasia, or pancreatic cancer
Of those who had benign SOP findings (n=21), nineteen (90.5%) did not develop pancreatic neoplasm during a mean F/U period of 59.3 months (range 13 to 84 months). One Pt developed mild pancreatitis

Conclusions
This study suggests that SOP is a safe, effective and feasible procedure that should be considered in the diagnostic algorithm of indeterminate main PD strictures, dilatation, or those with suspected or known MD-IPMN with or without side branch involvement. We demonstrate a high technical success rate, Sn, and Sp of 81.4%, 100%, and 100%, respectively
If all pts with incomplete outcomes data are considered to have be diagnostically inaccurate, the Sn and Sp remain high at 81.4% and 86.4% respectively. The adverse events seem similar to ERCP with only one Pt. (2.7%) developed mild pancreatitis, although this sample has insufficient numbers to evaluate rare events

Funding Agencies
None
Reliability of the classification of cartilage and labral injuries during hip arthroscopy
Authors: Mayer Stephanie W , Fauser Tobias R , Marx Robert G , Ranawat Anil S , Kelly Bryan T , Lyman Stephen , Nawabi Danyal H 
Published: March 2021

AbstractTo determine interobserver and intraobserver reliabilities of the combination of classification systems, including the Beck and acetabular labral articular disruption (ALAD) systems for transition zone cartilage, the Outerbridge system for acetabular and femoral head cartilage, and the Beck system for labral tears. Additionally, we sought to determine interobserver and intraobserver agreements in the location of injury to labrum and cartilage. Three fellowship trained surgeons reviewed 30 standardized videos of the central compartment with one surgeon re-evaluating the videos. Labral pathology, transition zone cartilage and acetabular cartilage were classified using the Beck, Beck and ALAD systems, and Outerbridge system, respectively. The location of labral tears and transition zone cartilage injury was assessed using a clock face system, and acetabular cartilage injury using a five-zone system. Intra- and interobserver reliabilities are reported as Gwet’s agreement coefficients. Interobserver and intraobserver agreement on the location of acetabular cartilage lesions was highest in superior and anterior zones (0.814–0.914). Outerbridge interobserver and intraobserver agreement was &gt;0.90 in most zones of the acetabular cartilage. Interobserver and intraobserver agreement on location of transition zone lesions was 0.844–0.944. The Beck and ALAD classifications showed similar interobserver and intraobserver agreement for transition zone cartilage injury. The Beck classification of labral tears was 0.745 and 0.562 for interobserver and intraobserver agreements, respectively. The Outerbridge classification had almost perfect interobserver and intraobserver agreement in classifying chondral injury of the true acetabular cartilage and femoral head. The Beck and ALAD classifications both showed moderate to substantial interobserver and intraobserver reliabilities for transition zone cartilage injury. The Beck system for classification of labral tears showed substantial agreement among observers and moderate intraobserver agreement. Interobserver agreement on location of labral tears was highest in the region where most tears occur and became lower at the anterior and posterior extents of this region. The available classification systems can be used for documentation regarding intra-articular pathology. However, continued development of a concise and highly reproducible classification system would improve communication.
The Behavioral Response to Heat in the Common Bed Bug,Cimex lectularius (Hemiptera: Cimicidae)
Authors: Berry Raymond 
Published: March 2021

AbstractThe bed bug, Cimex lectularius L., is a common ectoparasite found to live among its vertebrate hosts. Antennal segments in bugs are critical for sensing multiple cues in the environment for survival. To determine whether the thermo receptors of bed bugs are located on their antennae; innovative bioassays were created to observe the choice between heated and unheated stimuli and to characterize the response of bugs to a heat source. Additionally, the effect of complete antenectomized segments on heat detection were evaluated. Heat, carbon dioxide, and moisture are cues that are found to activate bed bug behavior; a temperature at 38°C was used to assess the direction/degree at which the insect reacts to the change in distance from said stimulus. Using a lightweight spherical ball suspended by air through a vacuum tube, bed bugs and other insects are able to move in 360° while on a stationary point. Noldus EthoVision XT was used to capture video images and to track the bed bugs during 5-min bioassays. A bioassay was created using four Petri dish arenas to observe bed bug attraction to heat based on antennae segments at 40°C. The purpose of this study was to evaluate the effects of heat on complete antenectomized segments of the antennae. The results in this experiment suggest that bed bugs detect and are attracted to heat modulated by nutritional status. Learning the involvement of antennae segments in heat detection will help identify the location and role of thermoreceptors for bed bug host interaction.
‘This spasm upon canvas’: George Eliot, Gustave Courbet and Realist Aesthetics
Authors: Jones Charlotte 
Published: March 2021

Abstract
This article offers sustained consideration for the first time of George Eliot’s entanglement with mid-nineteenth-century French art. Taking realism’s transnational nature as its point of origin, this essay probes Eliot’s claim in Adam Bede (1859) for seventeenth-century genre painting as the most conspicuous visual precedent to define, embody and vindicate her aesthetic choices – at just the moment when Gustave Courbet makes realism scandalous in the Salons of the Second Empire. Questioning Eliot’s deliberate disavowal of influence, I trace the modes of transmission through which Courbet’s art was exported to and circulated within Britain during the 1850s; while London’s official art world was unreceptive to French art in the nineteenth century, a different picture emerges if we consider the visibility afforded by independent galleries and the periodical press, and if we take account of these diverse reading, viewing and citational practices. I then offer close readings of works by Eliot and Courbet to suggest that both evidence a discomfort with representation as the primary methodology of realism, and consider the consequences for the ideological, epistemological and affective energies of realist aesthetics. Reading Eliot alongside Courbet reveals her radicalism, but this only becomes clear when we place her realism within the orbit of a broader European tradition and understand her aesthetics as a form of praxis.
Second-Reprise Opening Schemas in Bach’s Binary Movements
Authors: Brody Christopher 
Published: March 2021

AbstractA harmonic pattern, termed the V–I schema, is shown to structure most of the second-reprise openings in Bach’s binary movements. This pattern combines cross-repertoire harmonic consistency with context-dependent prolongational variability, a juxtaposition that causes intractable contradictions to emerge within Schenkerian theory. The schematic aspect to early eighteenth-century tonality suggested by this feature is expanded to include two additional second-reprise openings, the V–vi schema and the in-III opening. A staple of most Baroque composers’ harmonic vocabulary, the V–I schema declined in the later eighteenth century, incompatible with the new prevalence of rounded binary form.
People confabulate with high confidence when their decisions are supported by weak internal variables
Authors: Rebouillat Benjamin , Leonetti Jean Maurice , Kouider Sid 
Published: March 2021

Abstract
People can introspect on their internal state and report the reasons driving their decisions but choice blindness (CB) experiments suggest that this ability can sometimes be a retrospective illusion. Indeed, when presented with deceptive cues, people justify choices they did not make in the first place, suggesting that external cues largely contribute to introspective processes. Yet, it remains unclear what are the respective contributions of external cues and internal decision variables in forming introspective report. Here, using a brain–computer interface, we show that internal variables continue to be monitored but are less impactful than deceptive external cues during CB episodes. Moreover, we show that deceptive cues overturn the classical relationship between confidence and accuracy: introspective failures are associated with higher confidence than genuine introspective reports. We tracked back the origin of these overconfident confabulations by revealing their prominence when internal decision evidence is weak and variable. Thus, introspection is neither a direct reading of internal variables nor a mere retrospective illusion, but rather reflects the integration of internal decision evidence and external cues, with CB being a special instance where internal evidence is inconsistent.
Chemotherapy for adult patients with spinal cord gliomas
Authors: Gramatzki Dorothee , Felsberg Jörg , Hentschel Bettina , Bähr Oliver , Westphal Manfred , Schackert Gabriele , Tonn Jörg Christian , Herrlinger Ulrich , Loeffler Markus , Pietsch Torsten , Steinbach Joachim Peter , Reifenberger Guido , Roth Patrick , Weller Michael 
Published: March 2021

Abstract

Background
The incidence of spinal cord gliomas, particularly in adults is low, and the role of chemotherapy has remained unclear.

Methods
We performed a multicenter, retrospective study of 21 patients diagnosed with spinal cord glioma who received chemotherapy at any time during the disease course. Benefit from chemotherapy was estimated by magnetic resonance imaging. Data on radiotherapy were taken into consideration.

Results
Thirteen patients were diagnosed with astrocytic gliomas World Health Organization (WHO) grades 1-4, the remaining eight patients with ependymomas WHO grades 1 or 3. Most patients had more than one neurosurgical intervention. Median age at time of first chemotherapy was 33 years (range 21-67 years). Seven patients had chemotherapy combined with radiotherapy as first-line treatment. Two patients had chemoradiotherapy at recurrence, without prior tumor-specific treatment beyond surgery. One patient received chemotherapy alone as first-line treatment and 2 patients had chemotherapy alone at recurrence, without prior treatment. Nine patients had received radiation therapy at an earlier time and chemotherapy was given at time of further recurrences. Best responses in astrocytomas were as follows: chemotherapy alone—2 stable disease (SD) and 3 progressive disease (PD); chemoradiotherapy—1 complete response, 3 SD, and 4 PD. Best responses in ependymomas were as follows: chemotherapy alone—1 partial response, 5 SD, and 1 PD; chemoradiotherapy—1 SD.

Conclusions
Spinal cord gliomas represent a heterogeneous group of tumors. Survival outcomes in response to chemotherapy in adult spinal cord glioma patients vary substantially, but individual patients appear to derive benefit from chemotherapy.
The intestinal luminal sources of α-synuclein: a gastroenterologist perspective
Authors: Lerner Aaron 
Published: March 2021

AbstractParkinson’s disease is characterized by nonmotor/motor dysfunction, midbrain dopaminergic neuronal death, and α-synuclein (aSN) deposits. The current hypothesis is that aSN accumulates in the enteric nervous system to reach the brain. However, invertebrate, vertebrate, and nutritional sources of aSN reach the luminal compartment. Submitted to local amyloidogenic forces, the oligomerized proteins’ cargo can be sensed and sampled by a specialized mucosal cell to be transmitted to the adjacent enteric nervous system, starting their upward journey to the brain. The present narrative review extends the current mucosal origin of Parkinson’s disease, presenting the possibility that the disease starts in the intestinal lumen. If substantiated, eliminating the nutritional sources of aSN (eg, applying a vegetarian diet) might revolutionize the currently used dopaminergic pharmacologic therapy.