bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anticoagulation in patients with end-stage kidney disease and atrial fibrillation: a national population-based study
Authors: Kim Deok-Gie , Kim Sung Hwa , Park Sung Yong , Han Byoung Geun , Kim Jae Seok , Yang Jae Won , Park Young Jun , Lee Jun Young 
Published: February 2024

ABSTRACT

Background
The prevalence of atrial fibrillation (AF) in patients with end-stage kidney disease (ESKD) is high and increasing. However, evidence regarding oral anticoagulant (OAC) use in these patients is insufficient and conflicting.

Methods
This retrospective cohort study included patients in the Korea National Health Insurance System diagnosed with AF after ESKD onset from January 2007 to December 2017. The primary outcome was all-cause death. Secondary outcomes were ischaemic stroke, hospitalization for major bleeding and major adverse cardiovascular events (MACE). Outcomes were compared between OAC users and non-users using 6-month landmark analysis and 1:3 propensity score matching (PSM).

Results
Among patients with ESKD and AF, the number of prescribed OACs increased 2.3-fold from 2012 (n = 3579) to 2018 (n = 8341) and the proportion of direct OACs prescribed increased steadily from 0% in 2012 to 51.4% in 2018. After PSM, OAC users had a lower risk of all-cause death {hazard ratio [HR] 0.67 [95% confidence interval (CI) 0.55–0.81]}, ischaemic stroke [HR 0.61 (95% CI 0.41–0.89)] and MACE [HR 0.70 (95% CI 0.55–0.90)] and no increased risk of hospitalization for major bleeding [HR 0.99 (95% CI 0.72–1.35)] compared with non-users. Unlike warfarin, direct OACs were associated with a reduced risk of all-cause death and hospitalization for major bleeding.

Conclusions
In patients with ESKD and AF, OACs were associated with reduced all-cause death, ischaemic stroke and MACE.
Ambient temperature and risk of cardiovascular and respiratory adverse health outcomes: a nationwide cross-sectional study from Spain
Authors: Achebak Hicham , Rey Grégoire , Lloyd Simon J , Quijal-Zamorano Marcos , Méndez-Turrubiates Raúl Fernando , Ballester Joan 
Published: February 2024

Abstract

Aims
We assessed the association of temperature and temperature variability with cause-specific emergency hospitalizations and mortality from cardiovascular and respiratory diseases in Spain, as well as the effect modification of this association by individual and contextual factors.

Methods and results
We collected data on health (hospital admissions and mortality), weather (temperature and relative humidity), and relevant contextual indicators for 48 Spanish provinces during 2004–2019. The statistical analysis was separately performed for the summer (June–September) and winter (December–March) seasons. We first applied a generalized linear regression model with quasi-Poisson distribution to estimate daily province-specific temperature-health associations, and then we fitted multilevel multivariate meta-regression models to the evaluate effect modification of the contextual characteristics on heat- and cold-related risks. High temperature increased the risk of mortality across all cardiovascular and respiratory diseases, with the strongest effect for hypertension (relative risk (RR) at 99th temperature percentile vs. optimum temperature: 1.510 [95% empirical confidence interval {eCI} 1.251 to 1.821]), heart failure (1.528 [1.353 to 1.725]), and pneumonia (2.224 [1.685 to 2.936]). Heat also had an impact on all respiratory hospitalization causes (except asthma), with similar risks between pneumonia (1.288 [1.240 to 1.339]), acute bronchitis and bronchiolitis (1.307 [1.219 to 1.402]), and chronic obstructive pulmonary disease (1.260 [1.158 to 1.372]). We generally found significant risks related to low temperature for all cardiovascular and respiratory causes, with heart failure (RR at 1st temperature percentile vs. optimum temperature: 1.537 [1.329 to 1.779]) and chronic obstructive pulmonary disease (1.885 [1.646 to 2.159]) exhibiting the greatest risk for hospitalization, and acute myocardial infarction (1.860 [1.546 to 2.238]) and pneumonia (1.734 [1.219 to 2.468]) for mortality. Women and the elderly were more vulnerable to heat, while people with secondary education were less susceptible to cold compared to those not achieving this educational stage. Results from meta-regression showed that increasing heating access to the highest current provincial value (i.e. 95.6%) could reduce deaths due to cold by 59.5% (57.2 to 63.5).

Conclusion
Exposure to low and high temperatures was associated with a greater risk of morbidity and mortality from multiple cardiovascular and respiratory conditions, and heating was the most effective societal adaptive measure to reduce cold-related mortality.
Digest: Habitat and competition drive diversification in Gondwanan fish
Authors: Dhanda Aavika , Hubbard Lillian , Goyal Naman 
Published: February 2024

Abstract
Why do some clades diversify more than others? And what are the roles of abiotic and biotic factors in driving such unequal diversification? To explore this, Burns et al. (2024) investigate variation in body morphology in a group of freshwater fish, Characiformes, across South America and Africa. They find that habitat features such as slope, elevation, and flow rates have played a major role in the diversification of morphological variation in the Characiformes. The Neotropical lineages residing in significantly more diverse slope and elevation habitats were found to display more body shape diversity than African lineages. The authors also report that competition might have limited the morphological variation in African Characiformes compared to the Neotropical lineages. This study highlights the importance of exploring both abiotic and biotic factors when examining diversification.
Increased Care Provision and Caregiver Wellbeing: Moderation by Changes in Social Network Care Provision
Authors: Kirkegaard Allison , Friedman Esther M , Edgington Sarah , Kennedy David 
Published: February 2024

Abstract

Objectives
Previous research links increased care provision to worse wellbeing among family and friend caregivers, both before and during the coronavirus disease 2019 (COVID-19) pandemic. We expand on this by incorporating data on caregivers’ social networks and exploring the relationships between own and network changes in care during the pandemic and caregiver wellbeing.

Methods
We use nationally representative data from 1,876 family and friend caregivers in the first wave of our Care Network Connections over Time study (fielded 12/17/2020–1/4/2021) who had provided care continuously since before the COVID-19 pandemic began. Caregivers were asked about the amount of care that they and each member of their social networks were providing at the time of the survey relative to before the pandemic. We use multivariate regression models to examine the associations between five caregiver wellbeing outcomes and changes in care, and explore the moderating role of networks’ changes in care.

Results
Among caregivers who had provided care since prior to the pandemic, most increased (42.0%) or maintained the same (40.8%) care. Their networks also typically increased (33.4%) or maintained (46.5%) care. Increasing one’s own care provision was associated with higher levels of anxiety, depression, loneliness, and emotional difficulty than maintaining stable care. Among those who increased care, these levels were highest when the network also increased or decreased care.

Discussion
Increased care provision was most strongly associated with poor caregiver wellbeing in contexts where caregivers’ social networks also changed care provisions. Supports for caregivers undertaking additional care tasks should take into account caregivers’ networks.
Sleep and Caregiver Burden Among Caregivers of Persons Living With Dementia: A Scoping Review
Authors: Mattos Meghan K , Bernacchi Veronica , Shaffer Kelly M , Gallagher Virginia , Seo Shinae , Jepson Laura , Manning Carol 
Published: February 2024

Abstract

Background and Objectives
Caregivers of persons with dementia report worse sleep when compared to the general population. The objective of this review was to synthesize evidence regarding the link between caregiver burden and dementia caregivers’ sleep.

Research Design and Methods
We conducted a scoping review using a systematic search for pertinent literature in PubMed, CINAHL, and Web of Science through March 2022. Keywords included content areas of dementia, caregiver burden, and sleep. Inclusion criteria were informal caregivers of persons living with dementia, a measured relationship between informal dementia caregiver sleep and subjective caregiver burden variables, and original research. Non-English studies were excluded. Extracted data were organized in tables, compared, and synthesized.

Results
The search yielded 540 nonduplicate articles screened by title and abstract; 118 full-text articles were reviewed; 24 were included. Most studies were cross-sectional, with variable sample sizes. Dementia caregivers had significantly poorer overall perceived sleep than noncaregivers across 4 studies that examined self-reported sleep measures. Eighteen studies investigated the association between caregiver burden and self-reported sleep quality, with 14 reporting a significant positive association between caregiver burden and self-reported sleep quality, and 4 finding null results. Only 2 of the 4 studies reporting the association between caregiver burden and objective sleep parameters (ie, actigraphy and polysomnography) reported a significant positive association for at least one sleep subdomain.

Discussion and Implications
Although subjective sleep quality is commonly affected by dementia caregiving burden, there is a lack of corresponding evidence on the relationship between burden and objective sleep metrics. Healthcare providers should consider the dementia caregiver burden’s impact on sleep and regularly assess caregivers’ sleep difficulties. Future studies should focus on consistently measuring caregiver burden and sleep to promote dementia caregiver health and well-being.
A95 INCIDENCE OF LUMINAL GASTROINTESTINAL CANCERS IN PATIENTS WITH CIRRHOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Jogendran M , Zhu K , Jogendran R , Sabrie N , Chahal D 
Published: February 2024

Abstract

Background
The global incidence of cirrhosis is increasing, as is the incidence of luminal gastrointestinal cancers. It is unknown, however, if cirrhosis itself is a predisposing factor for luminal gastrointestinal cancer. Such an association would have significant clinical implications, particularly for cancer screening prior to liver transplantation.

Aims
To investigate the incidence of luminal gastrointestinal cancers in patients with underlying cirrhosis.

Methods
An electronic search was conducted to study the incidence of luminal gastrointestinal cancers in patients with cirrhosis. Study-specific standardized incidence ratios (SIR) along with their corresponding 95% confidence intervals for both overall cancer incidence and luminal cancer incidence were analyzed using a random-effects model. Statistical heterogeneity was assessed using the Cochran’s Q test and I2 statistic. Subgroup analysis was performed based on cirrhosis etiology and location of luminal malignancy.

Results
We identified 5054 articles; 4 studies were selected for data extraction. The overall incidence of all cancers was significantly higher in patients with cirrhosis, with a SIR of 2.79 (95% CI 2.18–3.57). When stratified by cirrhosis etiology, the incidence of all cancers remained significantly elevated for alcohol (SIR 3.13, 95% CI 2.24–4.39), PBC (SIR 1.40, 95% CI 1.10–1.79), and unspecified cirrhosis (SIR 3.52, 95% CI 1.87–6.65). Unspecified cirrhosis had the greatest overall cancer risk followed by alcohol, and PBC cirrhosis (p ampersand:003C 0.01). Alcohol related cirrhosis was significantly associated with an increased incidence of luminal cancers (SIR 4.39, 95% CI 2.84–6.78). Specifically, the highest incidence was observed for oral cavity and pharyngeal cancer (SIR 10.44, 95% CI 8.90–12.24), followed by esophageal cancer (SIR 7.85, 95% CI 4.98–12.36), and colorectal cancer (SIR 2.43, 95% CI 1.62–3.66) (p ampersand:003C 0.01). PBC cirrhosis was significantly associated with an increased incidence of luminal cancers (SIR 2.11, 95% CI 1.10–4.04). However, subgroup analysis did not reveal a significant association with the incidence of any subgroups. Unspecified cirrhosis was significantly associated with an increased incidence of luminal cancers (SIR 2.60, 95% CI 1.65–4.09). Risk of oral cavity and pharynx cancers (SIR 4.75, 95% CI 2.18–10.33) were greatest, followed by esophageal (SIR 4.52, 95% CI 1.57–12.99), stomach (SIR 2.12, 95% CI 1.31–3.42), and colorectal cancer (SIR 1.57, 95% CI 1.14–2.16) (p = 0.03).

Conclusions
The incidence of luminal gastrointestinal cancer is increased amongst patients with cirrhosis. Oral cavity, pharyngeal and esophageal cancer had increased incidence across all cirrhosis etiologies compared to gastric and colorectal cancer. Therefore, increased screening of luminal cancers should be considered in this population.

Funding Agencies
None
A169 A RARE MANIFESTATION OF ENTERITIS DUE TO IMMUNE CHECKPOINT INHIBITOR: CASE REPORT OF PYLORIC STRICTURE
Authors: Cintosun A , Bollegala N 
Published: February 2024

Abstract

Background
Immune checkpoint inhibitors (ICI) are immunomodulatory antibodies used to enhance the immune response against tumor cells that have revolutionized the treatment of various malignancies. ICIs pose a risk of immune-related adverse events in various organs including the gastrointestinal tract, with diarrhea and colitis being most common. ICIs can rarely cause involvement of the upper gastrointestinal tract, with case reports of gastritis, duodenitis, and esophagitis. There are very rare reports of strictures caused by ICIs, more frequently in the lower gastrointestinal tract, and only a few reports in the esophagus or duodenum.

Aims
We report a rare case of an upper gastrointestinal stricture due to ICI at the pylorus.

Methods
Case report.

Results
A 38-year-old woman with breast cancer on ICI pembrolizumab presented with several weeks of nausea and early satiety. She had started pembrolizumab 8 months prior, underwent neoadjuvant chemotherapy and mastectomy months ago, and completed radiation 6 weeks earlier. She also described nocturnal reflux and heartburn, but no vomiting, weight loss, or other gastrointestinal symptoms. Her examination was normal and recent bloodwork only showed a mild normocytic anemia.
EGD (esophagogastroduodenoscopy) showed friable circumferential ulceration of the distal antrum with surrounding erythema and luminal narrowing from the pyloric channel to duodenum. 1-centimetre gastroscope was not passable but 4.9-millimetre pediatric gastroscope passed into the duodenum where there were no abnormalities past the duodenal bulb. Pathology showed granulation tissue, fibrinopurulent exudate, and antral mucosa with chronic active inflammation negative for Helicobacter pylori and malignancy. Oncology felt that radiation was too far from the pylorus to be responsible for the findings.
High-dose proton pump inhibitor (PPI) and soft diet were recommended with minimal symptomatic improvement. 2 months later, she developed weight loss and repeat EGD showed minimal endoscopic improvement (Figure 1).
ICI-related enteritis was suspected and she was started on prednisone 50 mg daily. Her appetite and nausea significantly improved. Steroid taper was planned for 8 weeks.
At 3 months, symptoms recurred with prednisone taper. EGD showed only mild improvement of the duodenal stricture. Prednisone dose was increased. On repeat EGD at 7 months, the pylorus was patent with only granular inflammation predominantly in the apex of the duodenal bulb. She tolerated a slower prednisone taper thereafter.

Conclusions
ICI-related inflammation is common in the lower gastrointestinal tract and can less commonly affect the upper gastrointestinal tract. This is a rare report of upper gastrointestinal stricture and the first report known to us of pyloric stricture caused by ICI. Treatment may be challenging, but was achieved with PPI and high-dose steroids with slow taper.

Funding Agencies
None
A265 BARRIERS TO DIETARY MODIFICATION IN INFLAMMATORY BOWEL DISEASE (IBD): A MIXED-METHODS ASSESSMENT OF PATIENT PERCEPTIONS
Authors: Szeto J , Noejovich C V , Verma R , Miranda P , Pinto-Sanchez M , Verdu E , Armstrong D 
Published: February 2024

Abstract

Background
Many patients living with IBD identify diet as a key factor in managing their disease, symptoms and general health, and many report implementing dietary restrictions in response to disease activity and symptoms. Despite increasing data on the role of diet, IBD patients face a variety of challenges that can compromise adherence to dietary recommendations in clinical practice.

Aims
To identify IBD patients’ perceptions regarding barriers to dietary modification and to understand their experiences and expectations of dietary advice from gastroenterologists (GI) or dietitians (RD).

Methods
A mixed-method qualitative data collection strategy with semi-structured focus group and individual one-on-one interviews moderated by a clinical psychologist over a web-based, video communication platform (Zoom). Adult IBD patients (between 18 to 75 years old) attending the McMaster University Medical Centre IBD Clinic were invited to join a focus group consisting of 2-6 individuals or a one-on-one interview. All participants were asked to complete a demographics survey (REDCap) before the session. Recorded audio files for all sessions were transcribed, de-identified and reviewed for accuracy by 2 reviewers with an independent adjudicator to resolve discrepancies followed by thematic analysis (NVIVO).

Results
Between May to December 2022 and May 2023, 38 of 90 invitees took part in 11 focus groups and 9 chose individual interviews. Most participants (mean age 42 years; 60% female) were Caucasian (87%); 42% had a self-reported history of mental health disorders. Mean IBD duration was 16 years (min-max: 0.5–44 years); 73% were in remission and 68% had Crohn’s disease. Thematic analysis identified 5 primary and 11 secondary barriers to dietary adoption (Table).
Participants reported positive and negative experiences with dietary advice from GIs and RDs; expectations included GI referral to a specialist RD and integration of an RD into the health care team.

Conclusions
IBD patients report multiple, varied barriers to dietary adoption and identify a need for improved access to dietary advice and other resources, including integration of RDs into primary and IBD Clinic care teams. The identification of multiple, varied patient-reported barriers offers an opportunity to develop personalized dietary advice for IBD patients to enhance health, well-being and quality of life.
Thematic map of barriers experienced by patients when adopting dietary modifications

Funding Agencies
Farncombe Family Digestive Health Research Institute; Douglas Family
A306 A CASE OF SCLEROSING CHOLANGITIS AS A COMPLICATION OF CAR-T THERAPY
Authors: Zhao B , Kim H , Huang A , Jain A , Chahal D , Yoshida E 
Published: February 2024

Abstract

Background
Chimeric antigen receptor T-cell (CAR-T) therapy is a novel immunotherapy for treating hematological malignancies. CAR-T therapy starts with the collection of T-cells from patients. Then, receptors on the T-cell membrane are re-engineered to become chimeric antigen receptors that specifically target antigens on the surface of malignant cells. These engineered cells are grown ex vivo and infused back into the patient, leading to a targeted immune response against cancer. While CAR-T therapy has shown promising results in treating malignancies refractory to conventional treatment, there have also been reports of complications from unwanted off-target effects with CAR-T therapy.

Aims
We report a case of sclerosing cholangitis secondary to CAR-T therapy for the treatment of mantle cell lymphoma.

Methods
Case report.

Results
A 67-year-old male with refractory stage IVB mantle cell lymphoma underwent CAR-T therapy. His lymphoma was first diagnosed in 2011 and previous treatment included R-CHOP followed by autologous stem cell transplant. He had disease progression despite rituximab maintenance therapy and was switched to ibrutinib therapy with good response until 2023.
In 2023, he was noted to have progression of his lymphoma. He subsequently underwent CAR-T therapy. His treatment was complicated by grade 2 cytokine release syndrome requiring two doses of tocilizumab. Other complications included immune effector cell-associated neurotoxicity syndrome leading to status epilepticus. He was intubated and required monitoring in the ICU however he was not in shock, nor did he require vasopressors.
Post-CAR-T therapy he developed an increase of his liver enzymes in a cholestatic pattern. Magnetic resonance cholangiopancreatography (MRCP) showed irregular biliary dilation with beading suggestive of sclerosing cholangiopathy. He subsequently underwent multiple endoscopic retrograde cholangiopancreatography (ERCP) with stent insertions but there were no improvements in his liver enzymes and jaundice. A liver biopsy was performed which showed large bile duct obstruction with extensive cholestasis and some evidence of non-caseating granulomatous inflammation. Given the timing of new sclerosing cholangiopathy post-CAR-T therapy along with multiple other complications related to CAR-T therapy, it was thought this patient developed sclerosing cholangitis secondary to CAR-T therapy. Due to worsening clinical status along with progression of mantle cell lymphoma, he was transitioned to comfort care.

Conclusions
CAR-T therapy is a novel immunotherapy for the treatment of refractory hematological malignancies. However, complications from the off-target effects of CAR-T therapy can occur. This case highlighted a rare side effect associated with CAR-T therapy. In the future, more research will be needed to further characterize the risks associated with CAR-T therapy.

Cholangiogram showing no visible filling defects or obstructive lesion.

Funding Agencies
None
Spontaneous pneumoperitoneum presenting as an acute abdomen
Authors: Bedard Megan , McInnis Madison , Banton Kaysie 
Published: February 2024

Abstract
Most cases of pneumoperitoneum with associated peritonitis are due to perforation of a hollow viscus. In cases where hollow viscus perforation is not the cause, the pneumoperitoneum is classified as spontaneous and typically can be further subcategorized into thoracic, abdominal, gynecologic, and idiopathic categories. Spontaneous pneumoperitoneum is classically seen in asymptomatic patients, however in a small number of cases patients can present with a concomitant peritonitis. This case report presents a patient that had signs of sepsis and peritonitis with moderate pneumoperitoneum on computed tomography (CT) imaging but was found to have no perforated hollow viscus after an extensive operative and non-operative work up.
An unusual hernia postkidney transplantation led to intermittent ureteric obstruction
Authors: Shaheen Mohammed F , Almalki Faisal J , Altheaby Abdulrahman , Alsaikhan Bader 
Published: February 2024

Abstract
A 53-year-old man underwent a living donor kidney transplantation in the right iliac fossa 25 years prior to presentation. He had been noting an inguinal bugle that became more prominent as the day progressed, and it regressed at night. Upon further investigations, an ultrasound of the allograft revealed moderate-to-severe hydronephrosis. A computed tomography scan revealed herniation of the bladder and part of the transplanted ureter within the supravesical/direct inguinal space. Lichtenstein-like fashion of repair was performed, and the patient continues to enjoy satisfactory graft function with no recurrence. The case illustrates a rare hernia as a late complication of the kidney transplant incision leading to ureteric obstruction and a successful attempt at operative repair.