bluuebunny/crossref_metadata_2025_split huggingface dataset:
P644 Hospitalization and abdominal surgery rates in CD according to drug-dispensing: a temporal trend analysis from the Brazilian public healthcare national system
Authors: Magro D O , Kotze P G , Quaresma A B , Damiao A O M C , Valverde D A , Panaccione R , Coward S , Ng S C , Kaplan G G , Coy C S R 
Published: May 2021

Abstract

Background
The impact of current medical options in Crohn’s disease (CD) on hospitalization and surgical rates may be conflicting, and there is lack of data in newly industrialized countries. This study aims to describe temporal trends of proportional hospitalization and CD-related abdominal surgery rates according to drug-dispensing in Brazil, using public healthcare datasets.

Methods
All CD patients from the unique public healthcare national system (DATASUS) were included from January 2012 to December 2020 and identified according to ICD codes, medication or CD-related procedures. Data extraction was performed with the platform “TT Disease Explorer” (Techtrials Healthcare Data Science), which collects publicly available data via electronic algorithms with automatic updates. Annual rates of all-cause hospitalization and CD-related abdominal surgical procedures were captured and stratified by type of drug dispended. Average Annual Percent Change (AAPC) and 95% confidence intervals (CI) were calculated using poisson (or negative binomial) regression.

Results
The absolute number of registries of overall drug-dispensing for CD was 178,209, being 32.03% for Azathioprine (AZA), 10.91% for infliximab (IFX) and 10.52% for Adalimumab (ADA). AZA dispensing increased from 28.60% to 30.83% (AAPC 1.15; CI 0.23–2.09; p=0.015), ADA increased from 5.98% to 12.03% (AAPC 8.79; CI 6.33–11.30; p&lt;0.001) and IFX increased from 7.09% to 12.03% (AAPC 7.52; CI 6.94–8.10; p&lt;0.001) (figure 1). A total of 39,161 hospitalizations (all-cause) were captured in the same period. Hospitalization rates with AZA varied from 37.09% to 36.35% (AAPC -0.42, CI -1.08-0.24; p=0.209); for ADA remained stable (13.16% to 13.12%, AAPC -0.03; CI -1.10-1.05; p=0.962) and for IFX increased from 17.93% to 22.49% (AAPC 3.21; CI 1.66–4.79, p&lt;0.001) (figure 2). Regarding CD-related abdominal surgical procedures (n=1181), rates were stable for AZA (AAPC 1.34; CI -8.41–12.12; p=0.797). Considering the use of anti-TNF agents, rates were stable with ADA, varying from 26,7% to 20,0% (AAPC -1.64; CI -13.84-12.29; p=0.807) and decreased from 33,3% to 4,5% for IFX (AAPC -17.05; CI -28.19- -4.17; p=0.011) (figure 3).

Conclusion
In this large national study, there was an increase in the number of dispensings of AZA, IFX and ADA for CD from 2012–2020 in the public healthcare system in Brazil, due in part to the increasing prevalence of CD. All-cause hospitalization rates remained stable for AZA and ADA, and increased in IFX patients. A reduction in CD-related abdominal surgical procedures was observed in patients who used IFX and were stable with AZA and ADA. These data can be used for future strategic planning in the national public healthcare system (SUS) in CD management in Brazil.
P645 Mental health, work presenteeism and exercise in IBD patients
Authors: Sciberras M , Nascimento C , Tabone T , Karmiris K , Nikolaou P , Theodoropoulou A , Mula A , Goren I , Yanai H , Amir H , Mantzaris G , Georgiadi T , Foteinogiannopoulou K , Koutroubakis I , Allocca M , Fiorino G , Furfaro F , Katsanos K H , Fousekis F , Michalopoulos G , Torres J , Ellul P 
Published: May 2021

Abstract

Background
IBD has been shown to increase the rates of anxiety and depression amongst diagnosed individuals, with a prevalence rate of approximately 15- 20%. Chronic diseases such as IBD can have a significant impact on productivity at work (presenteeism). This can lead to emotional distress, poor quality of life and cost effects on employers. The primary aim of the study was to assess the prevalence of psychological problems, exercise levels and presenteeism at work among IBD patients.

Methods
This was a multicentre international study whereby IBD patients (&gt;18 years) in clinical remission over the last year, were asked to answer an anonymous questionnaire. Demographic data, type of IBD, current and previous medication, admissions to hospital, history of psychiatric referrals, Stanford Presenteeism Scale (SPS-6), Godin Score (exercise related score) were collected.
Exclusion criteria included patients with IBD flares requiring corticosteroids in the previous 12 months.

Results
573 patients (CD: n=318) from 8 European Centres and Israel participated in the study. The mean patient age was 39.9 years (SD+/- 13.0). 21.6% were smokers and 48.5% were non-smokers. The rest were ex-smokers.

10.9% of patients had a diagnosis of depression/anxiety prior to the diagnosis of IBD, whereas this increased to 20.6% post-IBD diagnosis, this being significantly commoner in the CD cohort (23.0%, p&lt;0.05) and in females (55.8%, p&lt;0.05). 37.7% of patients had been to a psychiatrist or a psychologist (41% of CD, p&lt;0.05) with 11.7% of patients being on psychiatric medication (14.5% of CD, p&lt;0.05).
Low presenteeism at work was evident in 34.7%, with no statistically significant difference between UC and CD patients (p=0.5). 39.9% had a Godin Exercise Score being in the active range, 38.8% had a sedentary/insufficient exercise score. The rest were moderately active. Patients diagnosed with depression/anxiety had a more sedentary lifestyle.

Conclusion
In our study 37.7% of patients were referred for psychological help. This can have several effects including poor presenteeism at work (34.7%) and reduced efficiency. These issues are commoner in patients with CD than in UC. Active involvement of a psychologist/ psychiatrist as part of the IBD team should be routine as to improve the patient’s quality of life.
P648 Physical and mental health during COVID-19 quarantine in adolescents with chronic immunocompromised conditions and inflammatory bowel disease
Authors: Lindoso L , Oba J , Miranda L C A , Deboni M , Jiro Ozaki M , Lima D C C , Queiroz L B , Astley C , Gualano B , Polanczyk G V , Toma R K , da Silva C A A 
Published: May 2021

Abstract

Background
Social connection is a fundamental part of the psychosocial development in adolescence; therefore quarantine has a potentially negative impact in the physical and mental health.
Therefore, the objective of this study was to evaluate physical and mental health indicators in adolescents with preexisting chronic immunocompromised conditions, including inflammatory bowel disease(IBD) compare to healthy adolescents during COVID-19 quarantine.

Methods
A cross-sectional study included 355 adolescents with chronic conditions(IBD, n=44) and 111 healthy adolescents. An online self-rated survey was used to investigate socio-demographic features, healthcare routine and the quarantine impact on physical and mental health. Validated self-reported version of Strengths and Difficulties Questionnaire(SDQ) evaluated psychosocial functioning.

Results
No differences were observed between adolescents with preexisting chronic immunocompromised conditions versus healthy adolescents during quarantine of COVID-19 pandemic for age, sex and ethnicity, as well as for household conditions and schooling(p&gt;0.05). The frequencies of psychosocial functioning abnormalities according to total difficulties SDQ score were high and similar in patients and controls(30% vs. 31%, p=0.775). Logistic regression analysis showed that being female(OR=1.965, 95%CI=1.091–3.541,p=0.024), fear of underlying disease activity/complication(OR=1.009, 95%CI=1.001–1.018, p=0.030) were associated with severe psychosocial dysfunction in adolescents with chronic conditions, whereas school homework(OR=0.449, 95%CI=0.206–0.981,p=0.045), physical activity (OR=0.990, 95%CI=0.981–0.999,p=0.030) and sleep quality(OR=0.986, 95%CI=0.975–0.998,p=0.017) were protective factors. Further analysis showed similar median age, fear (disease activity/complication, immunosuppressive use, and COVID-19), physical activity, sleep difficulties, and total difficulties SDQ score in IBD adolescents versus with chronic conditions (p&gt;0.05). The frequencies of psychosocial functioning abnormalities according to total difficulties score of SDQ were high and similar in IBD adolescents vs. chronic condition(37% vs. 29%, p=0.329), as well sleep difficulties(34% vs. 32%, p=0.797).

Conclusion
Being female, fear of underlying disease activity/complication and household members working outside of home were relevant issues for adolescents with preexisting chronic conditions. We also demonstrated that adolescents with IBD during COVID-19 quarantine had high risk of adverse health indicators, particularly psychosocial functioning and sleep difficulties. This study reinforces the need to establish mental health strategies for teens with chronic conditions, particularly during pandemic periods.
P654 Prevalence of Inflammatory Bowel Disease in young Greek Army male recruits from 2006 to 2018: a thirteen-year retrospective study from a tertiary center
Authors: Kyriakos N , Papaefthymiou A , Giakoumis M , Galanopoulos M , Galanis P , Mylonas I , Karatzas P , Mantzaris G , Liatsos C 
Published: May 2021

Abstract

Background
Prevalence and incidence of Inflammatory Bowel Diseases (IBD), vary among different countries. Data regarding prevalence of IBD in Greece are limited or outdated.

Methods
We studied retrospectively, using the official Hospital electronic-form database, medical records of IBD patients from a population of 551,808 Greek Army candidates for recruitment in a thirteen-year period from 2006 to 2018. Study population consisted of males aged 18 to 37 from Northwest, Central Greece (including Athens) and South Aegean Islands. Age, disease distribution, surgery and pharmaceutical treatment at the time of patients’ admission were recorded.

Results
Prevalence of IBD among male recruits during the studied period was 0.15% (n=839 patients), (95% confidence interval = 0.14% to 0.16%). Out of them, 448 (53.4%) had Crohn’s Disease (CD) and 391 (46.6%) Ulcerative Colitis (UC). Figures 1 & 2 illustrate the percentages of pharmaceutical treatment for CD and UC respectively, while figures 3 & 4 their distribution and fluctuation during the studied period for CD and UC respectively . Concerning CD cases, monotherapy with biologics was the most commonly used pharmaceutical choice (32.1%) with Infliximab being the predominant one (60% of them), though azathioprine had been used more often than any other isolated drug agent (27%). Interestingly, 21% of CD patients received 5-ASA as monotherapy, mainly in cases of mild CD colitis or terminal ileitis. Among UC patients, mesalamine was the most often prescribed treatment (64.2%), while biological drugs and combination therapy were not so widely administered as in CD (ratio 1:2). During the recorded period for CD patients we noticed that: i) there was a reducing trend in azathioprine prescription, ii) adalimumab presented to be an increasing predilection iii) infliximab’s use was maintained at the same level all these years. Among UC cases, mesalamine was constantly the first choice, while adalimumab was not so widely administered as in CD. A distinct reduction in steroid use was noted from 2006 to 2018, coming alongside with biologics establishment. Additionally, 8% of CD and 2.8% of UC patients had undergone a surgery due to disease complications. This low proportion could be explained by the relatively young age of the study population.

Conclusion
Prevalence of IBD in Greek recruits was 0.15% with a slight CD predominance. This is the first Greek epidemiological study that recorded also the provided treatment at the time of patient’s admission giving useful information upon IBD epidemiological profile in a wide region of our country and contributing to quantification of public health burden of those diseases in Greece.
P673 Microbial diversity in newly diagnosed treatment naïve Inflammatory Bowel Disease patients
Authors: Ellul S , Rausch P , Pisani A , Bang C , Ellul P , Franke A 
Published: May 2021

Abstract

Background
The role of microbiome with the alteration between commensal and pathogenic bacteria, has been linked to IBD. Meanwhile Escherichia coli Nissle 1917, Lactobacillus rhamnosus GG (LGG) and faecal transplantation are used in IBD. The aim of this study was to prospectively determine faecal microbiota composition of newly diagnosed treatment naïve IBD patients.

Methods
Patients diagnosed with IBD between January 2018-September 2019 were recruited. Clinical data was collected and patients asked to submit stool samples for microbiome analysis. Stool samples from a control population were recruited and analysed via the bacterial 16s rRNA gene sequencing on illumine MiSeq.

Results
100 IBD patients (CD: n=46, UC: n=53 & IBDU: n=1) and 97 controls with specific inclusion and exclusion criteria collected.
IBD patients were noted to display reduced average species richness and community evenness compared to healthy controls (Alpha- Diversity) (Figure 1).
Beta-diversity between microbial communities of healthy individuals and IBD patients was significantly different, but no observed separation between the two types of IBD was noted (Figure 2).
11 ASVs were abundant in CD patients including: ASV-70 – Lactobacillus gasseri, Klebsiella uncl., Candidatus-saccharibacteria, ASV-157 - Acteroides clarus and ASV 249- Parasutterella uncl. In UC cohort, 10 ASVs were abundant including: ASV 6-Escherichia/Shigella uncl., ASB-41-Sutterella wadsworthensis, ASV 44- Bacteroides faecis and Actinobacteria. An association between UC and ASV 313 (Faecalibacteria) was present. In the microbiome of healthy controls, 20 ASVs were abundant, including: ASV-14 G-Alistipes uncl., ASV 20-(Akkermansia muciniphila),(bacterium belonging to the phylum Verrucomicrobia), ASV 321 (Clostridia uncl.), ASV 96 (Rumminococcaceae uncl.), Alistepes uncl. (ASV 61), Subdoligranulum uncl. (ASV 453) and the unclassifiable bacteria. A higher amount of Verrucomicrobia was present in the healthy group as opposed to the IBD.

Conclusion
ASV 249- Parasutterella unlc., was indicative of CD associated microbiome through the indicator species analysis. Typical microbiome changes in IBD patients include increased abundance of the pro-inflammatory species with a reduction in anti-inflammatory bacterial species, with a noticeable reduction in alpha and beta diversity. In the local cohort, a particular change in the local α- and β diversity was noted to be present between healthy controls and IBD cohort. This could be a potential way in which targeted therapeutic approaches using specific dosage and durations of probiotic or faecal transplant can be used to alter faecal microbiome using specific bacteria present in healthy controls and with elimination of potentially harmful bacteria in IBD patients.

Figure 1: Alpha diversity between different Groups using Chao1 species richness and Simpson 1-D

Figure 2: Beta diversity between different groups using Bray-Curtis dissimilarity, Jaccard distance.
The impact of left lower paratracheal (4L) lymph node dissection on survival in patients with surgically treated left-sided NSCLC
Authors: Gryszko Grzegorz M , Cackowski Marcin M , Zbytniewski Marcin , Woźnica Katarzyna , Orłowski Tadeusz M , Dziedzic Dariusz A ,   the Polish Lung Cancer Study Group (PLCSG), Gabryel Piotr , Rudzinski Piotr , Wlodarczyk Robert , Laudanski Wojciech , Marjanski Tomasz , Buczynski Krzysztof , Pawelczyk Konrad , Lewandowski Roman , Wawrzycki Marcin , Bala Andrzej , Brulinski Krzysztof , Gebski Arkadiusz , Talar Piotr , Lochowski Mariusz , Golota Janusz , Zel Anna , Preis Dariusz , Wojtun Kazimierz , Rybka Janusz , Lis Adam , Kobak Grzegorz , Bielewicz Michal , Pryszczek Pawel , Wilkojc Michal , Bella Mariusz , Chabowski Mariusz , Nogaj Joanna 
Published: May 2021

Abstract

OBJECTIVES
We aimed to investigate the clinical significance of left lower paratracheal nodes (#4L) and their impact on survival in patients with left-sided lung cancer.

METHODS
This was a retrospective analysis of prospective data. The study included 5369 patients who underwent surgery between 2005 and 2015. Six hundred fifty-nine patients underwent #4L dissection (4LND+), and 4710 did not (4LND−). Propensity score matching was used to minimize analytic error (659 vs 659).

RESULTS
The percentage of #4L metastasis increased with tumour size. Between pT2a and pT2b, it nearly doubled from 8% to 14%. The mean percentage of #4L metastasis in the pN2 group was 46, which was higher in left upper lobectomy compared to left lower lobectomy (63% vs 43%, respectively, P &lt; 0.001). In univariable analysis, no differences in 5-year survival were observed between 4LND+ and 4LND− (48% vs 50%, respectively, P = 0.65). However, we detected a significant difference among non-metastatic 4LND+, 4LND− and metastatic 4LND+ (P &lt; 0.0001). After propensity score matching, there were no significant differences in survival among the pN2 subgroups (pN2a1, pN2a2, pN2b1, pN2b2). Multivariable analysis after propensity score matching for each pN2 subgroup did not confirm the effect of #4L metastasis as an independent prognostic factor.

CONCLUSIONS
Despite #4L nodes not being an independent prognostic factor in lung cancer, the percentage of nodal metastases notably increases above pT2a grade and is comparable to the percentage of #5 and #7 metastasis. Therefore, lymphadenectomy in advanced stages of cancer could benefit from resections of the #4L nodes.
Evidence to support magnetic resonance conditional labelling of all pacemaker and defibrillator leads in patients with cardiac implantable electronic devices
Authors: Bhuva Anish N , Moralee Russell , Brunker Tamara , Lascelles Karen , Cash Lizette , Patel Kush P , Lowe Martin , Sekhri Neha , Alpendurada Francisco , Pennell Dudley J , Schilling Richard , Lambiase Pier D , Chow Anthony , Moon James C , Litt Harold , Baksi A John , Manisty Charlotte H 
Published: May 2021

Abstract

Aims
Many cardiac pacemakers and defibrillators are not approved by regulators for magnetic resonance imaging (MRI). Even following generator exchange to an approved magnetic resonance (MR)-conditional model, many systems remain classified ‘non-MR conditional’ due to the leads. This classification makes patient access to MRI challenging, but there is no evidence of increased clinical risk. We compared the effect of MRI on non-MR conditional and MR-conditional pacemaker and defibrillator leads.

Methods and results
Patients undergoing clinical 1.5T MRI with pacemakers and defibrillators in three centres over 5 years were included. Magnetic resonance imaging protocols were similar for MR-conditional and non-MR conditional systems. Devices were interrogated pre- and immediately post-scan, and at follow-up, and adverse clinical events recorded. Lead parameter changes peri-scan were stratified by MR-conditional labelling. A total of 1148 MRI examinations were performed in 970 patients (54% non-MR conditional systems, 39% defibrillators, 15% pacing-dependent) with 2268 leads. There were no lead-related adverse clinical events, and no clinically significant immediate or late lead parameter changes following MRI in either MR-conditional or non-MR conditional leads. Small reductions in atrial and right ventricular sensed amplitudes and impedances were similar between groups, with no difference in the proportion of leads with parameter changes greater than pre-defined thresholds (7.1%, 95% confidence interval: 6.1–8.3).

Conclusions
There was no increased risk of MRI in patients with non-MR conditional pacemaker or defibrillator leads when following recommended protocols. Standardizing MR conditions for all leads would significantly improve access to MRI by enabling patients to be scanned in non-specialist centres, with no discernible incremental risk.
Mild Parkinsonian Signs, Energy Decline, and Striatal Volume in Community-Dwelling Older Adults
Authors: Tian Qu , Ehrenkranz Rebecca , Rosso Andrea L , Glynn Nancy W , Chahine Lana M , Hengenius James , Zhu Xiaonan , Rosano Caterina 
Published: May 2021

Abstract

Background
Mild parkinsonian signs (MPS), highly prevalent in older adults, predict disability. It is unknown whether energy decline, a predictor of mobility disability, is also associated with MPS. We hypothesized that those with MPS had greater decline in self-reported energy level (SEL) than those without MPS, and that SEL decline and MPS share neural substrates.

Method
Using data from the Health, Aging and Body Composition Study, we analyzed 293 Parkinson’s disease-free participants (83 ± 3 years old, 39% Black, 58% women) with neuroimaging data, MPS evaluation by Unified Parkinson Disease Rating Scale in 2006–2008, and ≥3 measures of SEL since 1999–2000. Individual SEL slopes were computed via linear mixed models. Associations of SEL slopes with MPS were tested using logistic regression models. Associations of SEL slope with volume of striatum, sensorimotor, and cognitive regions were examined using linear regression models adjusted for normalized total gray matter volume. Models were adjusted for baseline SEL, mobility, demographics, and comorbidities.

Results
Compared to those without MPS (n = 165), those with MPS (n = 128) had 37% greater SEL decline in the prior 8 years (p = .001). Greater SEL decline was associated with smaller right striatal volume (adjusted standardized β = 0.126, p = .029). SEL decline was not associated with volumes in other regions. The association of SEL decline with MPS remained similar after adjustment for right striatal volume (adjusted odds ratio = 2.03, 95% CI: 1.16–3.54).

Conclusion
SEL decline may be faster in those with MPS. Striatal atrophy may be important for declining energy but does not explain the association with MPS.
Sex Difference in the Case Fatality of Older Myocardial Infarction Patients
Authors: Kytö Ville , Nuotio Maria , Rautava Päivi 
Published: May 2021

Abstract

Background
The female sex is associated with poorer outcomes after myocardial infarction (MI), although current evidence in older patients is limited and mixed. We sought to evaluate sex-based differences in outcome after MI in older patients.

Method
Consecutive older (≥70 years) all-comer patients with out-of-hospital MI admitted to 20 hospitals in Finland between 2005 and 2014 were studied using national registries (n = 40 654, mean age 80 years, 50% women). The outcome of interest was death within 1 year after MI. Differences between sexes (age, baseline features, medication, comorbidities, revascularization, and treating hospital) were balanced by inverse probability weighting.

Results
Adjusted all-cause case fatality was lower in women than in men at 30 days (16.0% vs 19.0%, respectively) and at 1 year (27.7% vs 32.4%, respectively) after MI (hazard ratio: 0.83; confidence interval [CI]: 0.80–0.86; p &lt; .0001). Excess 1-year case fatality after MI compared to the corresponding general population was 22.1% (CI: 21.4%–22.8%) in women and 24.1% (CI: 23.4%–24.9%) in men. Women had a lower adjusted hazard of death after MI in subgroups of patients aged 70–79 years and ≥80 years, patients with and without ST elevation MI, revascularized and non-revascularized patients, patients with and without atrial fibrillation, and patients with and without diabetes. The sex difference in case fatality remained similar during the study period.

Conclusions
Older women were found to have a lower hazard of death after an out-of-hospital MI when compared to older men with similar features and treatments. This finding was consistent in several subgroups.