bluuebunny/crossref_metadata_2025_split huggingface dataset:
1101 Study of Outcomes of Nephrectomy in Cirrhotic Patients: A National Analysis From a Large Database
Authors: Vedachalam Srikanth , Porter Kyle , Li Na , Kelly Sean , Conteh Lanla , Hanje James , Michaels Anthony , Black Sylvester , Mumtaz Khalid 
Published: October 2019

INTRODUCTION:
Nephrectomy is the definitive treatment of the 9th most common cancer- renal cell carcinomas (RCC). Outcomes of various elective surgeries in patients with cirrhosis depends on its stage-compensated cirrhosis (CC) or decompensated (DC). Small-scale studies have reported nephrectomy to be safe in patients with CC. We studied the 30 day readmission rates and its predictors in cirrhotic patients undergoing nephrectomy. We also studied the index and calendar year mortality and their predictors in the cirrhotic patients.

METHODS:
The National Readmission Database (NRD) was queried using ICD-9 codes to identify 158,443 non-cirrhotic (NC), 942 CC and 212 DC who underwent total or partial nephrectomies, open or laparoscopically from 2010-2014. DC was identified by Baveno IV criteria. Patient demographics, Elixhauser comorbidity index, hospital characteristics, and extent and approach of nephrectomy were collected from the NRD.

RESULTS:
Thirty-day readmission rates were significantly higher in DC (18.3%) compared to NC patients (7.5%), P < 0.001; it was elevated in CC (11.2%) compared to NC (P = 0.28). Predictors of 30-day readmission were DC (OR: 7.12 versus NC; CI: 4.09-12.38) followed by Elixhauser Comorbidity ≥3 (OR 2.94, Cl: 2.77-3.12), Medicare insurance (OR 1.76 versus private insurance, Cl 1.59, 1.95), and open surgery (OR 1.64, Cl 1.49-1.80). Index and calendar year morality were higher in cirrhotics as compared to NC; CC (OR: 3.80; CI:1.86-7.74) and DC (OR: 7.91; CI: 3.30 -18.92) were the main predictors of morality at index admissions. However, only DC (OR: 3.62; 1.26-10.40) had significant increased risk of calendar year mortality compared to NC. CC (80.9%) and DC (85.8%) were more likely to be treated at metropolitan teaching hospitals as compared to NC (64%).

CONCLUSION:
Patients with DC undergoing nephrectomy had seven times the odds of 30-day readmission as compared to NC suggesting increased healthcare utilization. DC increased the odds of early readmission and presence of cirrhosis (CC or DC) increased index admission mortality, despite being predominantly managed at metropolitan teaching units where expertise with cirrhotics is greater. Increased attention to medical optimization and surgeon awareness of inherent risks in patients with cirrhosis undergoing nephrectomy is required to improve outcomes.
1104 Low Rates of Hepatitis A Virus, Hepatitis B Virus, and Hepatitis C Virus Screening Among Adults With Nonalcoholic Fatty Liver Disease at an Ethnically Diverse Safety Net Health System
Authors: Mendoza Brian , Ohikere Kabiru , Liu Benny , Bhuket Taft , Wong Robert 
Published: October 2019

INTRODUCTION:
Screening for viral hepatitis among adults with nonalcoholic fatty liver disease (NAFLD) is important to evaluate for possibility of concurrent infection and to assess for opportunities to appropriately vaccinate for hepatitis A virus (HAV) and hepatitis B virus (HBV). We aim to assess viral hepatitis screening rates and rates of susceptibility to viral hepatitis due to lack of immunity among NAFLD patients at an ethnically diverse safety-net health system.

METHODS:
We retrospectively evaluated adults with confirmed diagnosis of NAFLD from August 1, 2017 to April 1, 2019 at a single-center safety-net hospital to determine rates of screening for HAV, HBV, and hepatitis C virus (HCV). HAV and HBV immunity was determined by reactive HAV IgG and reactive HBV surface antibody (HBsAb), respectively. HCV exposure was determined with reactive HCV antibody (HCV Ab). Viral hepatitis screening rates and rates of susceptibility (lack of demonstrated immunity) among those tested were compared using chi-squared testing.

RESULTS:
Among 325 NAFLD patients (67.0% women, mean age 53.3 ± 12.6, 58.3% Hispanic), 25.3% had advanced fibrosis at time of diagnosis. Overall, only 26.9% had prior HAV screening, among which 91.9% demonstrated immunity and 8.1% remained susceptible. 33.1% had prior HBV screening, among which 27.1% demonstrated immunity and 70.8% remained susceptible. 31.5% received prior HCV screening, among which 7.8% had concurrent chronic HCV infection. Compared to women with NAFLD, men were significantly more likely to have received HAV screening (35.2% vs. 28.7%, P < 0.01), HBV screening (40.7% vs. 35.1%, P < 0.01), and HCV screening (41.8% vs. 31.9%, P < 0.01). Compared to NAFLD patients without advanced fibrosis, there was a trend towards higher rates of having received screening for HAV (50.0% vs. 36.2%, P = 0.09) and HCV (56.0% vs. 40.5%, P = 0.06) in NAFLD patients with advanced fibrosis. No race/ethnicity-specific differences in viral hepatitis screening were observed.

CONCLUSION:
Among an ethnically diverse safety-net health cohort of NAFLD patients, less than one-third of adult NAFLD patients had evidence of receiving prior viral hepatitis screening. Among those previously screened, more than 70% remained susceptible to HBV infection and were in need of vaccination. These data highlight the need for greater education and awareness of appropriate viral hepatitis screening and vaccination for those not immune among patients with NAFLD.
1111 Clinical Significance of Isolated Gastric Varices in Liver Cirrhosis Patients: Re-Visited the Unsolved Problem
Authors: Lesmana Cosmas Rinaldi A. , Kalista Kemal F. , Sandra Sharon , Lirendra Mutiara , Aprilicia Gita , Hasan Irsan , Sulaiman Andri S. , Kurniawan Juferdy , Jasirwan Chyntia O. , Nababan Saut H. , Gani Rino 
Published: October 2019

INTRODUCTION:
Gastric varices (GV) presents in 10-30% of liver cirrhosis patients with mortality rate up to 45%. Isolated gastric varices rupture is less frequent than esophageal varices (EV) rupture, but the hemorrhage is often more severe, more difficult to control, and have higher risk of recurrent bleeding and mortality. However, there are still debatable and no clear consensus yet about optimal management especially for incidentally discovered IGV.

METHODS:
This was a cohort retrospective endoscopy database study at Dr. Cipto Mangunkusumo National General Hospital from 2016 until 2017. All liver cirrhosis (LC) patients’ database who underwent upper GI endoscopy were included. Patients without the presence of varices, patients with malignancy or uncomplete database were excluded. Patients’ characteristic including MELD score, and Child Pugh score were collected for data analysis. Data analysis was performed using IBM SPSS version 23 for Windows.

RESULTS:
Of 328 patients, there were 153 patients that can be included in this study with the mean age 51 years old. The most prevalent etiology of liver disease is hepatitis B virus. Child Pugh (CP) A was found in 74 (48.36%) patients, CP B was found in 53 (34.64%) patients, and CP C was found in 26 (16.99%) patients. Isolated GV (IGV) was found in 13 (8.49%) patients, meanwhile esophageal varices (EV) found in 112 (73.20%) patients, and both (Gastroesophageal Varices/GOV) in 28 (18.30%) patients. CP C, GV and EV were found to be independent risk factors for variceal bleeding. CP C is still the strongest independent risk factor for variceal bleeding occurrence in bivariate (HR: 10.21, 95% CI:4.15-25.12 P .001) as well as in multivariate analysis (HR: 12.49, 95% CI: 4.95-31.54 0 0.001), whereas the presence of GOV is an independent risk factor associated with bleeding incidence in bivariate analysis (HR: 2.51, 95% CI: 1.26-4.99 P .009) as well as in multivariate analysis (HR: 2.95, 95% CI: 1.40-6.19 P .004) but not IGV. However, CP C score is still the only significant risk factor associated with survival liver cirrhosis patients based on multivariate analysis (HR: 26.77 95% CI: 6.01-119.34 P .001).

CONCLUSION:
The concern of high potential of bleeding occurrence in the presence of IGV sometimes give a clinical dilemma regarding the potential risk and side effect of endoscopic therapy for IGV. Our study results showed that the presence of IGV is not the strongest risk factor for bleeding occurrence as well as patient's survival.
1116 The Role of Perioperative Transjugular Intrahepatic Portosystemic Shunt in Cirrhotic Patients Undergoing Extrahepatic Surgery
Authors: Castillo Michael , Kapila Nikhil , Wakim-Fleming Jamile 
Published: October 2019

INTRODUCTION:
The use of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the perioperative period in cirrhotic patients with portal hypertension has been limited to small case series. The aim of this study is to describe a multi-center experience with the use of TIPS prior to abdominal surgery in patients with cirrhosis and portal hypertension.

METHODS:
In a retrospective multi-center case-matched study, we compared outcomes between patients with cirrhosis who received TIPS prior to abdominal surgery and patients who did not. Patients with liver transplantation were excluded. All patients had ascites and were matched 1/1 for same surgical procedure and for similar Model for End Stage Liver Disease (MELD) score. Outcomes evaluated included MELD scores at 30- and 180-day post-surgery, bleeding varices, development of hepatic encephalopathy, medical and surgical complications, 30- and 180-day mortality, length of hospital stay, and 30-day readmission rate. Statistical significance was determined using a paired t test and Fischer’s exact test.

RESULTS:
There were 14 patients in each group. In each group, 5 patients (35.7%) underwent colorectal surgery and the remainder underwent umbilical hernia repair. The majority of patients in both cohorts had advanced cirrhosis as characterized by their pre-operative Child Pugh score B and C. TIPS was performed an average of 18.4 days prior to surgery. In the post-operative period, 4 patients with TIPS had ascites compared to 12 patients without TIPS (P = 0.006). Post-operative hepatic encephalopathy and esophageal variceal bleeding were more common in the non-TIPS cohort. Length of stay was 11.4 days in TIPS patients and 6.6 days in non-TIPS patients (P = 0.19). Five TIPS patients (35.7%) were re-admitted within 30-days compared to 7 non-TIPS patients (50%) (P = 0.7).

CONCLUSION:
Our study indicates that preoperative TIPS significantly improved ascites post TIPS in cirrhotic patients with portal hypertension in comparison with patients who did not receive TIPS. Our study also shows improvement although not statistically significant in 30- and 180-day MELD scores, incidence of esophageal variceal bleeding, incidence of hepatic encephalopathy, post-operative medical and surgical complications, and 180-day mortality. TIPS did not improve length of stay or readmission rates. TIPS appears to have a role in patients with cirrhosis however further studies are required to better characterize the potential benefit of TIPS in the perioperative period.
1124 Identifying Predictors of Weight Loss for Patients Enrolled in an Intensive Medical Weight Management Program
Authors: Bodiwala Vimal , Gardiner Catherine , Pothraj Sonia , Marshall Timothy , Clifford Shannon , Schwartz Mark , Hunt Rameck 
Published: October 2019

INTRODUCTION:
Identifying predictors of weight loss are of paramount importance for patients and clinicians involved in obesity management. The aim of this study was to identify predictors of weight loss for patients enrolled in an intensive medical weight management program (IMWMP).

METHODS:
Our IMWMP involved visits every two to four weeks with medical providers, a recommended low carbohydrate diet with the goal carbohydrates individualized and often fewer than 100 g per day, encouraging physical activity, pharmacotherapy for some patients and surveillance every three months with bioimpedance plethysmography analysis (BIA). A binomial logistic regression was performed to ascertain the effects of gender, number of visits, number of daily steps, waist circumference, starting weight, starting fat mass measured by BIA, body mass index, HgbA1C, carbohydrate intake and pharmacologic medications to identify predictors of 10% weight loss from the time of enrollment to most recent office visit over a three year period.

RESULTS:
160 consecutive patients enrolled in our IMWMP who had at least three or more follow-up visits were analyzed. The mean weight at the time of joining IMWMP and most recent office visit were 238.8 lbs and 214.6 lbs, respectively, for a mean weight loss of 24.2 lbs (-10.1%; P = 0.01). Ten or more visits to our IMWMP was identified a predictor of 10% weight loss (P = .012; eB: 9.6 [CI (1.63-55.5)]; see Table 1). Female gender (P = .139; eB: 3.1 [CI (.69-14.0)]) and starting fat mass less than the mean of 106 kg on BIA (P = .054; eB: 6.37 [CI (0.97-41.7)]) showed trends towards significance. Interestingly, a starting weight under the mean of 242 pounds was associated with a reduction in the likelihood of losing 10% body weight (P = .113; eB: 0.213[CI (0.031-1.45)]. Other predictors of 10% weight loss that had a positive estimate of odds ratio (eB) but did not achieve or show trends towards significance included starting waist circumference below mean of 45 inches, daily carbohydrate intake less than 65 grams, daily steps greater than 5000 and use of pharmacologic therapy intended for weight loss.

CONCLUSION:
10 or more visits to our IMWMP are identified as a predictor of 10% weight loss. These results provide insights into predictors of weight loss in obesity management. Further studies are needed to establish the current trends and to identify additional modifiable factors.
1151 Linaclotide Safety and Efficacy in Children Aged 6 to 17 Years With Functional Constipation
Authors: Di Lorenzo Carlo , Nurko Samuel , Hyams Jeffrey S. , Weissman Taryn , Borgstein Niels , Mallick Madhuja , Muslin Anna , Saps Miguel , Simon Michael 
Published: October 2019

INTRODUCTION:
Functional constipation (FC), also known as chronic idiopathic constipation, is a common problem in children that may severely impact quality of life and persist into adulthood. Currently there are no approved therapies for children and more effective treatments are needed to provide symptomatic relief. This study evaluated the safety and efficacy of a range of linaclotide (LIN) doses for treatment of FC in children aged 6–17 years.

METHODS:
This multicenter, randomized, double-blind, placebo (PBO)-controlled, parallel-group safety and efficacy study of a range of LIN doses compared to PBO randomized participants aged 6–11 years to once-daily PBO or LIN doses A, B, or C based on weight and those aged 12–17 years to once-daily PBO or LIN doses A, B, C, or 145 μg (Table 1) for 4 weeks. Primary efficacy endpoint was change from baseline (CFB) in 4-week overall spontaneous bowel movement (SBM) frequency rate. Secondary efficacy endpoints included CFB in 4-week daytime abdominal pain and bloating, stool consistency, straining severity, overall complete SBMs frequency rate, and daytime fecal incontinence. Safety assessments included adverse events (AEs), specifically AEs of special interest, treatment-emergent AEs (TEAEs), causality, severity, and serious AEs (SAEs).

RESULTS:
173 participants were randomized; 90 (52%) aged 6–11 years and 83 (48%) aged 12–17 years. For the primary endpoint, or the secondary efficacy endpoints, none of the LIN doses (A, B, C) led to a clear improvement over PBO (P ≥ 0.1502) in the ITT population. A trend toward improved efficacy at the high LIN dose vs. PBO was observed for the primary endpoint, stool consistency, and straining severity (Table 2). Similar results were observed in each age group. TEAEs were reported in 16.7% (LIN A), 29.3% (LIN B), 38.5% (LIN C), 22.0% (PBO), and 25% in the LIN 145 μg group (Table 3). The most commonly reported TEAE was diarrhea; the majority of cases were mild, and none were severe. No SAEs or AEs leading to discontinuation were reported in participants aged 6–11 years. Two SAEs were reported in participants aged 12–17 years (suicidal ideation and vomiting; 1 each); neither were considered related to study treatment.

CONCLUSION:
In children with FC, no clear improvement over PBO was observed for LIN; however, a trend for improved efficacy was observed at higher doses. LIN was well tolerated with a safety profile consistent with studies in adults with chronic idiopathic constipation.
1158 Increasing Gastroenterology Related Scholarly Output in Internal Medicine Residents Using a Novel Individualized Curriculum
Authors: Bilal Mohammad , Hernandez-Barco Yasmin G. , Parupudi Sreeram , Sonstein Lindsay , Powell Don , Buck Era , Szauter Karen 
Published: October 2019

INTRODUCTION:
Scholarly work in residency can be challenging due to a busy clinical schedule, lack of prior research and biostatistical experience, and absence of a formal curriculum. Scholarly work is a mandatory requirement from the Accreditation Council for Graduate Medical Education (ACGME) for residents. Therefore, we designed and implemented a formal individualized research curriculum to enhance gastroenterology-related scholarly output in internal medicine residents.

METHODS:
We developed and instituted a research curriculum to enhance and increase scholarly activity and culture amongst internal medicine residents. The components of the curriculum were: i) Learner assessment, ii) identify needs of learner, iii) selection of the correct type of scholarly work, iv) Learner education [Referencing software (writing skills), IRB training, Institute for Healthcare Improvement modules (quality improvement projects), writing templates, statistical help / learning], finding mentorship, and dissemination of work. Our objectives were: i) foster and develop an interest in research and academic career paths, ii) meet ACGME requirements for research in residency, and iii) to increase knowledge regarding various types of scholarly work.

RESULTS:
This curriculum was applied to a total of 16 internal medicine residents and 7 medical students over a period of 30 months. A total of 30 peer-reviewed publications in PubMed indexed journals, and 50 presentations/abstracts at national meetings were presented as a result of this curriculum. In addition, a total of 7 national research awards including Presidential Poster Abstract Awards at the American College of Gastroenterology annual meeting, national American College of Physicians meeting presentation awards, and best Poster Presenter Awards were attained by these learners in recognition of their scholarly work. Also, 9 research awards were won at local/regional research meetings by the learners participating in the curriculum.

CONCLUSION:
In conclusion, a formal, systematic and individualized curriculum improved gastroenterology related scholarly output in internal medicine residents at our institution. The success of the program was largely due to the presence of identified mentors in the division who were interested in guiding enthusiastic learners. Further outcomes from the implementation of this curriculum by other departments and institutions are needed to validate the transferability and overall success of the curriculum.
1164 Breaking the Academic Ceiling: Gender Disparities and Bias in Authorship in Leading Gastroenterological Journals
Authors: Ou Amy , Lin Elissa , Pavri Tanya , Williams Renee L. , Thompson Christopher , Popov Violeta 
Published: October 2019

INTRODUCTION:
The number of women entering gastroenterology in the US has steadily increased over the last quarter century. Women made up 28% of gastroenterology trainees on average during this period and are 33.6% now. When it comes to academics, however, women lag behind in all major leadership roles; for example, only 7% of gastroenterology division chiefs were women in 2015. Gender inequality has become a prominent area of concern, with many institutions taking steps to increase equality; one aspect affecting academic appointments is publication of articles as senior or first author. The objective of this study is to evaluate if these efforts have decreased gender disparities in female authorship.

METHODS:
We evaluated all original research papers and invited reviews published in 2017 and 2018 in leading gastroenterology journals: Hepatology, Gastroenterology, American Journal of Gastroenterology (AJG), Gastrointestinal Endoscopy (GIE), and Clinical Gastroenterology and Hepatology (CGH). Our primary outcome was the rate of female senior authors. Our secondary outcome was the rate of female first authors. We also assessed whether single versus double-blinded peer review has an impact on women’s authorship. We included the journal Endoscopy as a comparator to GIE, as well as New England Journal of Medicine (NEJM) as a non-gastroenterology journal.

RESULTS:
The gender was determined for 97% of authors of 3100 included articles. Female authorship is presented in Table 1 and Figure 1 along with historical data. Hepatology had the highest female senior authorship rate of 24% while GIE had the lowest: 12%. When comparing single-blinded vs. double-blinded review process in two journals with similar impact factors and scope (GIE and Endoscopy), the journal with a double-blinded review had a higher rate of senior female authors (P = 0.3), but had lower first female authorship (P = 0.001).

CONCLUSION:
Female authorship continues to lag behind the rate of women entering the field. There were fewer senior female authors than first authors across all journals. First authorship by women appears to have plateaued in several journals. Although senior authorship appears to be growing, the rate of growth in the last 10 years lags behind the growth in first authorship and number of female gastroenterologists. Overall, female authorship has gradually increased over the years but the rate of increase appears to be slowing or stalling altogether. Gender equality in authorship remains a goal to strive for.