bluuebunny/crossref_metadata_2025_split huggingface dataset:
Monitoring tafamidis treatment with quantitative SPECT/CT in transthyretin amyloid cardiomyopathy
Authors: Rettl René , Wollenweber Tim , Duca Franz , Binder Christina , Cherouny Bernhard , Dachs Theresa-Marie , Camuz Ligios Luciana , Schrutka Lore , Dalos Daniel , Beitzke Dietrich , Loewe Christian , Badr Eslam Roza , Kastner Johannes , Hacker Marcus , Bonderman Diana 
Published: March 2023

Abstract

Aims
Tafamidis treatment positively affects left ventricular (LV) structure and function and improves outcomes in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). We aimed to investigate the relationship between treatment response and cardiac amyloid burden identified by serial quantitative 99mTc-DPD SPECT/CT. We furthermore aimed to identify nuclear imaging biomarkers that could be used to quantify and monitor response to tafamidis therapy.

Methods and results
Forty wild-type ATTR-CM patients who underwent 99mTc-DPD scintigraphy and SPECT/CT imaging at baseline and after treatment with tafamidis 61 mg once daily [median, 9.0 months (interquartile range 7.0–10.0)] were divided into two cohorts based on the median (−32.3%) of the longitudinal percent change in standardized uptake value (SUV) retention index. ATTR-CM patients with a reduction greater than or equal to the median (n = 20) had a significant decrease in SUV retention index (P &lt; 0.001) at follow-up, which translated into significant benefits in serum N-terminal prohormone of brain natriuretic peptide levels (P = 0.006), left atrial volume index (P = 0.038), as well as LV [LV global longitudinal strain: P = 0.028, LV ejection fraction (EF): P = 0.027, LV cardiac index (CI): P = 0.034] and right ventricular (RV) [RVEF: P = 0.025, RVCI: P = 0.048] functions compared with patients with a decrease less than the median (n = 20).

Conclusion
Treatment with tafamidis in ATTR-CM patients results in a significant reduction in SUV retention index, associated with significant benefits for LV and RV function and cardiac biomarkers. Serial quantitative 99mTc-DPD SPECT/CT imaging with SUV may be a valid tool to quantify and monitor response to tafamidis treatment in affected patients.

Translational perspective
99mTc-DPD SPECT/CT imaging with determination of SUV retention index as part of a routine annual examination can provide evidence of treatment response in ATTR-CM patients receiving disease-modifying therapy. Further long-term studies with 99mTc-DPD SPECT/CT imaging may help to evaluate the relationship between tafamidis-induced reduction in SUV retention index and outcome in patients with ATTR-CM and will demonstrate whether highly disease-specific 99mTc-DPD SPECT/CT imaging is more sensitive than routine diagnostic monitoring.
Health economic consequences of optimal vs. observed guideline adherence of coronary angiography in patients with suspected obstructive stable coronary artery in Germany: a microsimulation model
Authors: Seleznova Yana , Bruder Oliver , Loeser Simon , Artmann Jörg , Shukri Arim , Naumann Marie , Stock Stephanie , Wein Bastian , Müller Dirk 
Published: March 2023

Abstract

Aims
While the number of patients with stable coronary artery disease (SCAD) is similar across European countries, Germany has the highest per capita volume of coronary angiographies (CA). This study evaluated the health economic consequences of guideline-non-adherent use of CA in patients with SCAD.

Methods and results
As part of the ENLIGHT-KHK trial, a prospective observational study, this microsimulation model compared the number of major adverse cardiac events (MACE) and the costs of real-world use of CA with those of (assumed) complete guideline-adherent use (according to the German National Disease Management Guideline 2019). The model considered non-invasive testing, CA, revascularization, MACE (30 days after CA), and medical costs. Model inputs were obtained from the ENLIGHT-KHK trial (i.e. patients’ records, a patient questionnaire, and claims data). Incremental cost-effectiveness ratios were calculated by comparing the differences in costs and MACE avoided from the perspective of the Statutory Health Insurance (SHI). Independent on pre-test probability (PTP) of SCAD, complete guideline adherence for usage of CA would result in a slightly lower rate of MACE (–0.0017) and less cost (€–807) per person compared with real-world guideline adherence. While cost savings were shown for moderate and low PTP (€901 and €502, respectively), for a high PTP, a guideline-adherent process results in slightly higher costs (€78) compared with real-world guideline adherence. Sensitivity analyses confirmed the results.

Conclusion
Our analysis indicates that improving guideline adherence in clinical practice by reducing the amount of CAs in patients with SCAD would lead to cost savings for the German SHI.
Using an Immersive Video Environment to Assess Pedestrians’ Compliance With COVID Distance Keeping Interventions
Authors: Stenkamp Jan , Karic Benjamin , Scharf Paula , Verstegen Judith A , Kray Christian 
Published: March 2023

Abstract
Physical distancing is a key measure to slow the spread of many highly infectious diseases, e.g. COVID-19. Streetscape interventions such as pedestrian signage can contribute to ensuring distances are kept, but it is unclear to what extent people comply with these in practice. This paper tackles this question using an immersive video environment to realistically simulate real-life streetscapes in the lab. In a controlled user study, we augmented panoramic video footage with pedestrian one-way street signage and recorded route decisions to assess compliance with distance keeping measures. Our results indicate that such signage affects routing decisions and can thus help pedestrians to avoid crowded situations where distance keeping is difficult. We also identified further factors affecting decisions and a correlation between intention to comply and actual compliance. The experimental method we used enabled us to effectively and safely carry out a study of a phenomenon that in the real world depends on interaction with the physical environment. This method may have applications in other areas in which simulations of physical environments are important.
A4 PREDNISOLONE, A GLUCOCORTICOID WIDELY USED FOR TREATMENT OF IBD, ENHANCES A HUMAN INTERLEUKIN-4-ACTIVATED MACROPHAGE PHENOTYPE
Authors: Deshpande R S , Callejas Pina B E , Peng R , Sousa J A , Wang A , Panaccione R , McKay D M 
Published: March 2023

Abstract

Background
With cellular immunotherapy, the individuals’ medication could ablate (or enhance) any therapeutic benefit of the transferred cells. Murine and human macrophages activated with IL-4 (i.e., M(IL4)) improve wound healing and reduce the severity of disease in murine models of colitis. Advancing the position that autologous M(IL4) could be a novel approach to IBD, a critical question arises: will concurrent medication impact the M(IL4)s anti-colitic effect? To address this, we tested if prednisolone, a synthetic, anti-inflammatory glucocorticoid used to induce remission in IBD flares,impacts human M(IL4) phenotype and function.

Purpose
To determine if prednisolone suppresses or enhances a human M(IL4) phenotype as defined by canonical marker molecules and wound healing and anti-colitic activities.

Method
Macrophages were differentiated from the blood monocytes of healthy volunteers using M-CSF (7 days) and treated with GMP-grade IL-4 (10 ng/mL, 48h) ± a 24h treatment with prednisolone (1μg/mL). Subsequently, conditioned medium was collected for TGFb measurement by ELISA and for use in a T84 epithelial cell in vitro wound healing assay. Retrieved M(IL4) and M(IL4,pred.) were characterized by mRNA expression of CD206 (mannose receptor), RAMP1 (CGRP receptor), and CD14 (LPS co-receptor). One million murine bone marrow-derived M(IL4) or M(IL4,pred.) were injected into BALB/c mice 48h prior to intra-rectal DNBS (3mg), and colitis was assessed 72h-post DNBS.

Result(s)
Human M(IL4)s displayed increased mRNA expression of CD206 and RAMP1, and reduced CD14 compared to M(0), with the CD206 and RAMP1 being further increased by prednisolone treatment. M(IL4,pred.) produced more TGF-β than M(IL4) upon LPS stimulation [363 ± 30 vs. 241 ± 24 pg/ml, n= 4, p&lt;0.05], which would predict an enhanced wound healing capacity. Stimulated M(IL4,pred.) produced more IL-10 than M(IL4). Furthermore, murine M(IL4,pred.) retained an anti-colitic capacity comparable to M(IL4) as determined by disease activity score in the DNBS model.

Conclusion(s)
Human M(IL4)s subsequently exposed to the potent immunomodulatory glucocorticoid, prednisolone show increased expression of phenotypic markers and increased output of TGFb and IL-10. Crucially M(IL4,pred.) retained an anti-colic effect in the murine DNBS model of colitis. Interpreting these data, we suggest that the anti-colitic effect of M(IL4) immunotherapy would not be adversely offset by the individuals concomitant use of steroids. Our preliminary findings support pursuing M(IL4) transfers as a novel approach to the management of IBD.

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Helmsley Charitable Trust

Disclosure of Interest
None Declared
A66 PROTON PUMP INHIBITORS AND THE RISK OF INFLAMMATORY BOWEL DISEASE: A REAL WORLD POPULATION-BASED COHORT STUDY
Authors: Yanofsky R P , Abrahami D , Pradhan R , Yin H , McDonald E G , Bitton A , Azoulay L 
Published: March 2023

Abstract

Background
Proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) are acid suppressant drugs indicated in highly prevalent conditions such as gastroesophageal reflux disease and peptic ulcer disease. A recent observational study reported an increased risk of inflammatory bowel disease (IBD) with the use of PPIs. However, this association may have been driven by certain methodological shortcomings, such as failure to properly account for protopathic bias, a conclusion-altering bias.

Purpose
To determine whether the use of PPIs compared with the use of H2RAs is associated with an increased risk of IBD.

Method
Using the longitudinal primary care records from the United Kingdom Clinical Practice Research Datalink database, we identified 1,498,416 initiators of PPIs and 322,474 initiators of H2RAs from January 1, 1990, through December 31, 2018, with follow-up until December 31, 2019. Standardized morbidity ratio weighted Cox proportional hazards models were used to estimate marginal hazard ratios (HRs) and 95% confidence intervals (CIs). Patients were analyzed according to the timing of the IBD events after treatment initiation (early versus late). In the early-event analysis, IBD events were assessed within the first two years of treatment initiation, an analysis subject to potential protopathic bias. In the late-event analysis, all exposures were lagged by two years to account for latency and minimize protopathic bias.

Result(s)
In the early-event analysis, the use of PPIs was associated with an increased risk of IBD within the first two years of treatment initiation, compared with H2RAs (HR: 1.39, 95% CI: 1.14-1.69). In contrast, the use of PPIs was not associated with an increased risk of IBD in the late-event analysis (HR: 1.05, 95% CI: 0.90 to 1.22). The results remained consistent in several sensitivity analyses.

Image

Conclusion(s)
Compared with H2RAs, PPIs were not associated with an increased risk of IBD, after accounting for protopathic bias.

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CIHR

Disclosure of Interest
R. Yanofsky: None Declared, D. Abrahami Employee of: pfizer, R. Pradhan: None Declared, H. Yin: None Declared, E. McDonald: None Declared, A. Bitton Consultant of: Member of Advisory Boards for Abbie, Pfizer, Takeda, Jansen, and Merck, Speakers bureau of: Has received speaker fees for Abbie, Jansen, Takeda, and Pfizer, L. Azoulay Consultant of: Has received consults fees from Jansen, Pfizer, and Roche, Speakers bureau of: Has received speaker fees from Jansen, Pfizer, and Roche
A71 SIGNIFICANT RACIAL/ETHNIC DIFFERENCES EXIST IN THE RECEIPT OF IBD-RELATED SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Chhibba T , Tandon P , Natt N , Brar G , Malhi G , Nguyen G 
Published: March 2023

Abstract

Background
Patients with inflammatory bowel disease (IBD) may require surgical intervention for management of their disease. There is a rising incidence of IBD in racial and ethnic minorities but studies regarding healthcare utilization patterns in these populations have yielded variable results.

Purpose
We aimed to examine the differences in surgical rates of ethnic and racial groups compared to White patients with IBD.

Method
Electronic databases were searched through December 20, 2021. Studies that compared ulcerative colitis (UC) or Crohn’s disease (CD) surgery rates between different racial/ethnic groups were included. Both pediatric and adult studies were included. Pooled event rates were generated and p-value &lt; 0.05 was considered statistically significant in generating odds ratios (OR) with 95% confidence interval (CI). We also compared differences in disease location, phenotype, and IBD-medication exposure amongst different groups included.

Result(s)
Forty-one studies stratified rates of IBD-related surgeries by race or ethnicity (n=1,094,693 patients). Black patients were less likely to undergo IBD-related surgeries compared to White patients (pooled OR 0.70, 95% CI, 0.55-0.89, I2=87.0%). Black patients were also less likely compared to White patients to undergo an emergent colectomy with an incidence rate ratio of 0.43 (95% CI, 0.32-0.58). Furthermore, Hispanic patients were less likely to undergo a CD-related surgery (pooled OR 0.57, 95% CI, 0.48-0.68, I2=0%) compared to White patients. Finally, Asian patients had no significant difference in likelihood of CD-related and UC-related surgeries compared to White patients. Black patients were more likely to have perianal disease (pooled OR 1.40, 95% CI, 1.06-1.86), I2=58.2%) but otherwise disease characteristics and phenotypes were similar across all populations compared to Caucasians.

Conclusion(s)
Black and Hispanic patients with IBD are less likely to have surgery, including emergent surgery, for IBD compared to White patients with IBD, despite similar disease phenotype characteristics. Disparities in access to care may be contributory toward these findings and efforts should be made to provide equitable care to all persons living with IBD, regardless of race and ethnicity.

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Other

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Nil

Disclosure of Interest
None Declared
A96 IMPROVING AUTOMATED TELEHEALTH SERVICES TO MEET THE NEEDS OF PATIENTS AND HEALTHCARE PROFESSIONALS
Authors: Calman T'ien L , Galorport C , Enns R A 
Published: March 2023

Abstract

Background
There is a growing demand for automated telehealth programs in medicine to improve health-related behaviours such as adherence to treatment schedules. In addition, these services are a promising alternative to increase access to medical care for rural and marginalized patients.
Although promising, telehealth programs need to be evaluated based on patient responsiveness in order to tailor automated services to their target population and identify factors that minimize response rates.

Purpose
To evaluate the effect of socioeconomic, health and structural factors on the response rate of an automated follow-up program implemented at St. Paul’s Hospital in Vancouver, BC.

Method
A retrospective chart review was conducted of patients who did not respond when contacted by a PAtient-Guided Complication Tracking System (PACTS). PACTS sent Short Message Service (SMS) to outpatients having a flexible sigmoidoscopy, gastroscopy and/or colonoscopy one week post-procedure.
Patients who received PACTS SMS between 03/21-08/21 were included in this study. Individuals were considered non-responsive if they failed to reply after receiving an initial SMS and a second reminder text message (sent 24 hours after the first SMS).
Socioeconomic factors including: age, sex and personal annual income were assessed. Income was analyzed using postal code census data. To study health factors, patient comorbidity was evaluated using the Charlson Comorbidity Index (CCI) where CCI &gt; 2 was considered high. Finally, access to a general practitioner (GP) was investigated to study structural factors influencing responsiveness to PACTS.

Result(s)
Of the 200 people studied, 109 of these individuals were male (54%) and 91 were female (46%). The mean age of non-respondents was 60.2 ± 16.4. Postal codes were reported for 144 patients (72%) and the mean annual income of these individuals was $48 928 ± $9710. The mean Charlson Comorbidity Index was 2.1 ± 1.7. 109 non-respondents (54%) had a family doctor listed in their chart and 91 non-respondents (46%) did not.

Conclusion(s)
Based on the age, sex, personal annual income and comorbidity results, socioeconomic and health factors do not impact response rate. The large number of non-respondents without GPs indicate that structural factors influence responsiveness. The high proportion of non-respondents lacking GPs may represent a subgroup of individuals that under-use healthcare services.
Further evaluation of non-respondents and comparative analysis with a large group of respondents are pending and will likely support these conclusions.

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None

Disclosure of Interest
None Declared
A101 VIRTUAL MINDFULNESS-BASED STRESS REDUCTION FOR ADULTS WITH INFLAMMATORY BOWEL DISEASE: FEASIBILITY TRIAL PRELIMINARY RESULTS
Authors: Chappell K , Goodman K J , Le Melledo J -M , Meakins D , Marsh-Joyal M , Kroeker K I 
Published: March 2023

Abstract

Background
Patients with Inflammatory Bowel Disease (IBD) often suffer from high levels of anxiety and depression. Despite high rates of mental health comorbidity, a low proportion of patients receive psychiatric referrals and treatment. In Canada, provincial health care plans cover psychiatric services, making them affordable for patients and making referral efficient for gastroenterologists. Psychiatrist-led virtually-delivered Mindfulness-Based Stress Reduction (MBSR) has been associated with reducing feelings of stress, anxiety, and depression in several high-quality randomized control trials. It also reduces cost and travel requirements for patients, both which have been identified as barriers to accessing mental health treatment.

Purpose
To assess the feasibility of online-delivered MBSR for IBD patients, with feasibility outcomes defined as recruitment success, and attendance, adherence, and attrition of participating patients.

Method
Eligible participants were adult IBD patients aged 18-65 attending gastroenterology clinics in Edmonton, Alberta who self-identified as being anxious or depressed and/or were referred by their gastroenterologist. A research coordinator contacted eligible patients who expressed interest in participating after completing an assessment of symptoms and a semi-structured interview with a psychiatrist. The MBSR protocol was an 8-week group-based intervention aimed at giving participants tools to cope with stress effectively. Participants attended 8 weekly sessions lasting 2.5 hours/week and a one-time weekend session lasting 5 hours. They were also asked to practice every night for 45-60 minutes. Completion of the program required attendance of at least 6 of 8 weekly sessions and the weekend session. Two groups, led by the same team of qualified psychiatrists, started MBSR, with sessions occurring in the evening via Zoom.

Result(s)
Of the 64 patients referred to the study, 16 (25%) agreed to participate. Reasons for declining to participate are shown in Table 1, with 80% indicating they were too busy. Of the 16 patients enrolled, the median age was 36 (range: 18-55), 10 identified as female (62.5%) and 8 had Crohn’s Disease (50%). Attendance, adherence, and attrition data from the first group of 7 participants were recorded. Only 3 (42.8%) successfully completed the program. The participants that completed the program had an attendance rate of 100% and practiced 6 nights a week for an average of 25 minutes a night. A second group with 9 participants is currently ongoing.

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Conclusion(s)
Although interest in a cost-free, virtual stress management resource was relatively high, willingness to enroll in MBSR specifically, was low, largely due to the time commitment. Follow-up interviews with those who enrolled and did not enroll in the intervention are underway to highlight the benefits and barriers to MBSR.

Disclosure of Interest
None Declared
A110 INCIDENCE AND PREDICTORS OF ASYMPTOMATIC ABNORMALITIES IN BIOCHEMICAL AND RADIOLOGIC PANCREATIC MARKERS FOLLOWING UNCOMPLICATED ERCP
Authors: Samnani S , Chau M , Ruan Y , Forbes N 
Published: March 2023

Abstract

Background
Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is common. Its diagnosis relies on characteristic abdominal pain in addition to biochemical and/or radiographic evidence of pancreatic inflammation.

Purpose
Little is known regarding the frequency with which asymptomatic alterations in biochemical and/or imaging parameters occur following uncomplicated ERCP. We sought to assess the incidence and predictors of such alterations following uncomplicated ERCP.

Method
This study was an analysis of a prospectively maintained ERCP registry. All inpatients ³ 18 years old who underwent ERCP between 2018/09/01 and 2022/02/28 were identified. Patients with acute pancreatitis or abdominal pain following ERCP were excluded, as were patients with lipase levels ≥3x the upper limit of normal (ULN) within 7 days preceding ERCP. Primary outcomes were (1) asymptomatic lipase elevation within 48 hours of uncomplicated ERCP or (2) asymptomatic cross-sectional imaging findings of pancreatic inflammation within 14 days of ERCP.Descriptive statistics were presented as means with accompanying standard deviations (SD) and percentages by lipase categories and PEP, or by imaging categories. Multiple logistic regression was used to examine the associations of exposure variables with PEP or imaging findings.

Result(s)
A total of 646 patients were analyzed in the biochemical cohort, and 187 patients were analyzed in the radiologic cohort. In the biochemical cohort, 478 patients (74.0%) had no elevations in pancreatic enzymes, while 81 (12.5%) had elevations up to 2x ULN, 26 (4.0%) had elevations between 2-3x ULN, and 61 (9.4%) had elevations &gt;3x ULN. In the radiologic cohort, 148 (79.1%) had no abnormalities on cross-sectional imaging within 14 days of ERCP, while 39 (20.9%) had one or more imaging finding typically associated with acute pancreatitis. Among these, 22 (11.8%) had peri-pancreatic fluid collections and 2.1-9.6% of patients had pancreatic findings that included edema, enlargement, inflammation, or fat-stranding. On multivariable analysis, predictors of lipasemia &gt;3x ULN included balloon sphincteroplasty (odds ratio, OR, 2.29, 95% confidence intervals, CI, 1.08 to 4.85) and the placement of a common bile duct stent (OR 4.19, 95% CI 1.37 to 12.77), whereas cannulation of the pancreatic duct or performance of a pancreatogram were not significantly associated (OR 0.75, 95% CI 0.24 to 2.35 and OR 1.07, 95% CI 0.18 to 6.26, respectively).

Conclusion(s)
Over 25% of patients will have asymptomatic elevations in pancreatic enzymes following ERCP, while over 20% will have asymptomatic cross-sectional imaging findings suggestive of pancreatic inflammation. Clinical symptoms should guide post-ERCP care rather than biochemical or imaging parameters.

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None

Disclosure of Interest
None Declared