bluuebunny/crossref_metadata_2025_split huggingface dataset:
30-day readmissions for venous thromboembolism and pulmonary embolism in patients with pancreatic cancer: A national population-based study.
Authors: Akhiwu Ted , Kanemo Philip Onyekaoso , Olafimihan Ayobami Gbenga , Ibrahim Muhammad Bilal , Ijeli Anthonia , Edigin Ehizogie 
Published: June 2023

e16318 Background: Pancreatic cancer patients have a strong risk of Deep Venous thrombosis (DVT). Pulmonary Embolism (PE) can be a fatal complication of DVT. Both DVT/PE increases the risk of hospitalization and subsequent readmission. National population-based studies are scarce on DVT/PE readmissions among pancreatic cancer patients in the United States (U.S). In this study, we aim to describe the rate, reasons for readmissions, and outcome of readmissions for pancreatic cancer patients hospitalized for DVT/PE in the U.S. Methods: We analyzed the 2018 Nationwide Readmissions Database (NRD). It includes nested and weighted discharge data for 60% of the total U.S population from 28 states. These data are stratified in clusters to produce national estimates. The NRD captures admissions on a calendar-year basis without links to the following or preceding year. We included index hospitalizations for all pancreatic cancer patients (aged ≥18 years) admitted principally for DVT/PE using the International Classification of Diseases (ICD)-10 codes. We excluded elective and traumatic readmissions. 30-day readmission was calculated as the percentage of patients readmitted within 30 days over index hospitalizations that were discharged alive. Using a "rank" command in STATA, the most common reasons for readmission were outlined. Logistic regression was used to compare inpatient mortality between readmissions and index hospitalizations. STATA, 16 was used for analysis. Since NRD contains de-identified patient data, Institutional Review Board (IRB) review was not sought. Results: A total of 2339 index hospitalizations for DVT/PE among pancreatic cancer patients were discharged alive. Among these, 510 (21.8%) were readmitted within 30 days. The top 5 reasons for 30-day readmissions were sepsis, pancreatic cancer, PE without cor pulmonale, metastatic cancer of the liver and intra-hepatic duct, and pneumonia. 30-day readmissions were responsible for an aggregate of 5.9 million U.S dollars in hospital costs and 2443 hospital days in 2018. Compared to index hospitalizations, 30-day readmissions had higher inpatient mortality (13.4% vs 5.9%, p < 0.0001). Conclusions: 30-day readmissions for DVT/PE in patients with pancreatic cancer have a significant healthcare economic burden. PE, Pancreatic cancer, and infections were common reasons for readmissions. Readmissions have significantly greater inpatient mortality compared to index admissions. Adequate management of DVT/PE and underlying malignancy during index admissions and ensuring timely outpatient follow-up are important in reducing 30-day readmissions of these patients.
Does non-alcoholic fatty liver disease (NAFLD) influence outcomes of pancreatic cancer (PANC)? A nationwide analysis.
Authors: Chowdary Sriram Basappa , Yadukumar Lekha , Asija Udit , Sharma Amit Munshi , Sharma Namita 
Published: June 2023

e16319 Background: Incidence of pancreatic cancer is 13.3 per 100,000 in the US, with a five-year survival rate of 11%. Studies worldwide have shown inconsistent positive associations between NAFLD and PANC in the general population. We aimed to assess the impact of NAFLD on trends of hospitalizations and outcomes of patients presenting with PANC in the US. Methods: We conducted a retrospective study from 2016 to 2020 using the National Inpatient Sample to identify PANC-related hospitalizations using ICD 10 codes. Population was divided based on the presence and absence of NAFLD. Pearson chi-square test and t-test were utilized. Primary outcome was in-hospital mortality. Secondary outcomes of hospitalization characteristics and comorbidities were compared. Multivariate analysis was used to adjust for confounders. Results: Out of the 4,34,160 hospitalizations with primary diagnosis of PANC, 1.43% of patients were found to have NAFLD. PANC with NAFLD cohort were younger with mean age 64.34 +/- 10.78 (vs. 68 +/-11.39). Females were common in the NAFLD group (56% vs. 48%). Caucasians were predominantly affected in both study groups. Patients with NAFLD had higher comorbidities such as diabetes (45.6% vs. 40%) and dyslipidemia (41.5% vs. 37%). Charlson's comorbidity index was > 3 in the entire population with NAFLD compared to 85% in the group without NAFLD. Mortality was lower in patients with NAFLD (5.22 vs. 7.51). NAFLD did not lead to poor survival outcomes in pancreatic cancer patients with an Odds ratio of 0.31 (95% CI 0.24 - 0.41, p-value <0.01). NAFLD patients had higher mean length of stay of 6.42 days (6.09-6.75) and were likely to incur higher hospitalization charges of $21,924 ($20,594 - $23,253). Conclusions: Patients with NAFLD presenting with PANC were younger, predominantly females, and had a marginally longer length of stay and healthcare utilization. NAFLD did not impact the mortality in patients hospitalized for PANC. [Table: see text]
An estimate of the burden of pancreatic cancer globally and its comparison with different WHO regions using Global Burden of Disease Database: A retrospective population-based analysis.
Authors: Punjwani Shoheera , Jaroenlapnopparat Aunchalee , Jani Chinmay , Singh Harpreet , Marshall Dominic C , Salciccioli Justin D , Shalhoub Joseph 
Published: June 2023

e16321 Background: Pancreatic cancer is a highly aggressive malignancy and is the fourth leading cause of cancer-related deaths in the United States and seventh globally. Most pancreatic cancers are adenocarcinomas that have poor prognoses. The highest incidence is reported between 65-69 in men and 75-79 in women. Worldwide, both incidence and mortality are increasing. We must evaluate the global and regional patterns to understand the impact of risk factors and develop early detection methods and treatments. Methods: We extracted pancreatic cancer mortality data from the Global Burden of Disease database based on the International Classification of Diseases versions 10 and 9. Age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), the age-specific death rate(ASDR), mortality-incidence ratio (MIR) and disability-adjusted life years (DALYs) were extracted for global as well as six WHO regions (Africa, Region of the Americas, South-East Asia, Europe, Eastern Mediterranean, Western Pacific) for both for the years 1990 and 2019. Joinpoint regression analysis was used to describe trends. Results: Between 1990 and 2019, pancreatic cancer ASIRs, ASMRs, and DALYs increased among the six regions in both males and females. Globally, ASIR, ASMR and DALY increased in males (+25.02%, +23.40%, +19.97%) and females (+26.35%, +24.30%, +22.08%). However, MIR decreased globally (males: -1.29%, females: -1.62%). The Eastern Mediterranean region showed the highest percentage change in ASIR, ASMR, and DALY in both males (+110.45%, +106.53%, +103.24%, respectively) and females (+140.20, +135.48%, +127.20% respectively), followed by the South-East Asia region (males: +71.38%, +70.03%, +63.80% respectively; females: +114.20%, +111.78%, +106.91% respectively). MIRs showed decreased trends among all six regions in both sexes. Europe region showed the highest decrease in males (-1.91%) and females (-3.09%). Conclusions: Overall, we reported the increasing disease burden of pancreatic cancer globally between 1990 and 2019. ASIRs, ASMRs and DALYs all increased throughout the six regions in both sexes, with the Eastern Mediterranean region being the highest. MIRs showed a global decreasing trend in both sexes, which may indicate an overall improvement in pancreatic cancer clinical care.
Genomic biomarker for the top risk factor of gallbladder cancer, cholelithiasis, in a Latinx population.
Authors: Yang Ping 
Published: June 2023

e16326 Background: Cholelithiasis or Gallstone disease (GSD), is one of the most common and costly digestive disorders in adults worldwide, presenting 10-20% of the general population but in greater than 30% of Latina and Hispanic American women aged 40 years or older. Moreover, GSD individuals contribute significantly to the incidence and mortality of gallbladder and other digestive system cancers; specifically, the excessive risk of gallbladder cancer is 3-10-fold. Parallel to gallbladder cancer, an appalling female preponderance of GSD has been documented for decades; thus, precisely defining high-risk populations and properly managing patients with GSD would lead to reduced disease burden from GSD and multiple cancers. Several genome-wide association studies (GWAS) in the past have identified genes associated with GSD but few were focused on Latinx population. Methods: To identify genetic risk factors for GSD in Latinx population, we used the Sangre Por Salud cohort (SPS) where participants are Latinx adult individuals aged 18-85 years who were current patients in the Mountain Park Health Center in Arizona. This sample represents historically underrepresented population with low socioeconomic status that are primarily Spanish-speaking, majority being born outside of the US, with low rates of health insurance coverage. A total of 172 GSD cases were identified, each matched with 6 controls (n = 1032) who were people from the same community but without history of GSD diagnosis; matching variables are age at enrollment to SPS, sex, height and weight, dyslipidemia, and HbA1C level indicative of type 2 diabetes. We characterized genome-wide interrogation for biomarkers predicting GSD and contributing to the observed gender disparity by performing a GWAS using a matched case-control design. Results: We identified several novel loci associated with GSD and validated few loci that were reported in previous GWAS. The top 3 loci (MATN2, GPRIN3, GPC6) were strongly associated with GSD in our overall analysis; follow-up pathway enrichment analysis suggests enrichment of GO terms that are associated with immunological pathways, enzymatic processes in gallbladder, liver and gastrointestinal tract and GSD pathology. In a sex-specific analysis, CDHR3 and RPL31P35-SEC61G were identified for females, which have been associated respectively with rhinovirus C infection and HbA1c level in previous studies. Conclusions: Our findings suggest directions towards better and deeper understanding of sex differences in GSD pathology, biological mechanisms, and disease progression among Latinx people. Knowing approximately 80% of gallbladder cancer patients harbored gallstones, our optimal goal is to provide evidence for an innovative strategy to early detect and effectively intervene the modifiable risk factors to reduce gallbladder cancer burden in high risk populations.
Predictors of re-admission after COVID-19 hospitalizations in patients with underlying gastrointestinal malignancy.
Authors: Shah Mihir , Gajjar Rohan , Deenadayalan Vaishali , Ishaya Michelle , Litvin Rafaella , Ibrahim Muhammad Bilal , Olafimihan Ayobami Gbenga , Batra Kunnal 
Published: June 2023

e16327 Background: COVID-19 infections have been known to cause worse outcomes in patients with underlying co-morbid conditions. Currently, there is limited data regarding re-admissions in such patients after COVID-19 infection. So, we pursued to assess the rates, predictors, and causes of re-admission after COVID-19 infection in patients who had underlying gastrointestinal malignancy. Methods: The National Readmission Database for 2020 was analyzed to identify patients with COVID-19 hospitalizations who also had a co-diagnosis of GI malignancy. Data for re-admission was gathered, at 30 and 90 days after initial hospitalization. Multivariate logistic and linear regression analysis was used accordingly to adjust for possible confounders. Results: For 30 days: A total of 2,726 COVID-19 hospitalizations had a co-diagnosis of GI malignancy. The mean LOS (length of stay) for index admission was 8.7 days. The mean TOTCHG (total hospital charge) for index admission was $85,747. Within 30 days from discharge, 462 (21%) were re-admitted. The in-hospital mortality in re-admissions (18.4%) was quite similar to that for index hospitalization (18.5%). Positive predictors of re-admission include shorter length of stay during initial hospitalization (<3 days), anemia, renal insufficiency/chronic kidney disease, and atherosclerosis of the aorta. Females had a lower chance of re-admission compared to males. Among the top causes of re-admission were ongoing COVID-19 infection (27%), sepsis (16.3%), acute kidney injury (2.4%), and metabolic encephalopathy (1.2%). For 90 days: A total of 1,782 COVID-19 hospitalizations had a co-diagnosis of GI malignancy. The mean LOS (length of stay) for index admission was 9.2 days. The mean TOTCHG (total hospital charge) for index admission was $90,908. Within 90 days from discharge, 411 (29%) were re-admitted. The in-hospital mortality in readmissions (14%) was lower than that for index hospitalization (20.3%). Predictors of re-admissions include secured insurance, anemia, renal insufficiency/chronic kidney disease, and cerebrovascular accidents. Top causes of re-admission were ongoing COVID-19 infection (18.5%), aspiration pneumonitis (2.9%), pneumonia (2.3%), and acute kidney injury (1.4%). Conclusions: Infections were the leading cause of re-admission, which is an important factor to consider when managing patients with GI malignancies due to sub-optimal immunity. Among these patients, those with concomitant anemia and chronic kidney disease were more prone to being re-admitted. Patients with GI malignancies also tended to have a higher length of stay, leading to higher charges, more exposure to nosocomial infections, and delays in cancer treatment leading to worse cancer outcomes. Pre-mature discharges, without medical optimization, can also potentially predispose to higher rates of re-admissions.
A phase II basket trial of dual anti–CTLA-4 and anti–PD-1 blockade in rare tumors (DART SWOG 1609) in patients with refractory gallbladder cancer (cohort 48).
Authors: Patel Sandip Pravin , Guadarrama Elizabeth , Chae Young Kwang , Liao Chih-Yi , Kasi Anup , Tarabay Grace R. , George Thomas J. , Chung Liam , Lopez Gabby , McLeod Christine , Othus Megan , Chen Helen X. , Sharon Elad , Streicher Howard , Ryan Christopher W. , Blanke Charles David , Kurzrock Razelle 
Published: June 2023

e16330 Background: Immune checkpoint blockade has improved outcomes in multiple tumor types, however little is known about the efficacy of these agents in rare tumors. We report the results of the gallbladder cohort of SWOG S1609 Dual Anti–CTLA-4 and anti–PD-1 blockade in Rare Tumors (DART). Methods: We performed a prospective, open label, multicenter phase II clinical trial of ipilimumab plus nivolumab across multiple rare tumor cohorts, with the gallbladder cohort reported here. Eligible patients had progressed following at least one line of standard systemic therapy, and did not have an approved or standard therapy available that had been shown to prolong survival. All participants received nivolumab 240 mg i.v. every 2 weeks and ipilimumab 1 mg/kg i.v. every 6 weeks on a continuous schedule. The primary endpoint was overall response rate [ORR; RECIST v1.1; complete response (CR) and partial response (PR)]; secondary endpoints included progression-free survival (PFS), overall survival (OS), stable disease >6 months, and toxicity Results: Nineteen patients (79% female) with a median age of 60 years were enrolled and received treatment. The median prior lines of therapy was 2 (range 1-6). The confirmed overall response rate was 16% [complete response, n=1 (5%); partial response, n=2 (11%)] (duration = 35+, 16, 13 mo). The unconfirmed overall response rate and clinical benefit rate were both 32% [complete response, n=1 (5%); partial response, n=5 (26%); stable disease > 6 months, n=0 (0%)]. The 6-month progression-free survival was 26% (95% CI 12-55%); median overall survival was 7.0 months (95% CI, 3.9-19.1 months). The most common toxicities were fatigue (32%), anemia (26%), and anorexia (26%). Aspartate aminotransferase elevation was the most common grade 3/4 toxicity (11%). There was one death from hepatic failure possibly related to treatment in the setting of progressive liver metastasis and biliary infection. Conclusions: Ipilimumab plus nivolumab demonstrated a 16% ORR in patients with gallbladder cancer including a complete response lasting 35+ months; The unconfirmed overall response rate was 32%. Clinical trial information: NCT02834013 . [Table: see text]
Utility of circulating tumor DNA for identifying genetic mutations in cholangiocarcinoma of East Asian patients.
Authors: Liu Cheng , Fu Yiming , Xiao Zebin , Chen Yaru , Dai Defeng , Cheng Shaochen , Li Xiang 
Published: June 2023

e16332 Background: Cholangiocarcinoma, also referred to as bile duct cancer, is a major global health concern. The diagnosis of this cancer is often difficult due to its lack of distinctive symptoms and its tendency to present at advanced stages. However, the recent emergence of blood liquid biopsy as a diagnostic tool has shown great potential for detecting and managing cholangiocarcinoma. The use of blood liquid biopsy in East Asian populations, where the incidence of cholangiocarcinoma is particularly high, has the potential to improve the accuracy of diagnosis, prognosis, and targeted treatment planning. Methods: The study cohort contains 53 Chinese cholangiocarcinoma patients, the examination of DNA from tumor tissue (tDNA), blood (cfDNA), and blood leukocytes (gDNA) was performed using 680 gene targeted capture sequencing and analyzing for CNV, fusion, SNV, indel, MSI, and TMB. The sequencing depth was 2200X for tDNA, 20000X for bDNA, and 10000X for gDNA. In the tissue samples evidence of PD-L1 expression was examined. The TMB was classified as high (TMB-H) with a cutoff > 10 mutations/megabase and low (TMB-L) < 10. Microsatellite instability-high (MSI-H) was identified in cases where instability was observed > 20% of 117 loci, and the microsatellite stable (MSS) rate was determined to be < 20%. Results: In a cohort of 53 patients, a thorough analysis of tissue and blood samples was conducted to detect somatic mutations. 146 (38.1%) shared mutations were found in both tDNA and cfDNA, while 211 (55.09%) and 25 (6.53%) unique mutations were found in tDNA and cfDNA respectively. Of the 64 mutations found in CNV, 5 (7.81%) were shared in tDNA and cfDNA, 52 (81.25%) were unique in tissues, and 7 (10.93%) were unique in blood. High frequency mutated genes were also revealed as TP53, KRAS, SMAD4, LRP1B, and ARID1A, which were consistent with the results from the IntoGen database (4 cohorts, 393 samples). Notably, LRP1B (11.32%, 6/53) was not detected in the validation cohort. 96.23% of the samples showed consistent tTMB vs. bTMB outcomes, with only 1 sample exhibiting high PD-L1 expression and TMB-L, MSS, and 1 sample (out of 52 with MSS) having TMB-H and PD-L1 expression less than 1%. Conclusions: The results of the mutation analysis suggest that relying solely on cfDNA for molecular typing of cholangiocarcinoma is not sufficient. This highlights the importance of testing tissue samples in order to accurately detect tumor mutations in cholangiocarcinoma. Further research is needed to determine the significance of LRP1B, a gene that was frequently mutated in the study cohort but not found in the validation cohort, in the diagnosis and treatment of cholangiocarcinoma.
A retrospective study on the efficacy and safety of avatrombopag in the treatment of chemotherapy-induced thrombocytopenia in gastrointestinal cancer.
Authors: Chen Junliang , Liao Wangjun , Zhu Lingjun , He Yifu , Jin Gang , Pan Ying , Wang Fenghua 
Published: June 2023

e16334 Background: Chemotherapy-induced thrombocytopenia (CIT) is defined as post-chemotherapy platelets count < 100×109/L. Avatrombopag is an oral thrombopoietin receptor to treat thrombocytopenia. Although many factors lead to an increased risk of CIT in gastrointestinal cancer, there is currently no targeted research. This study aimed to investigate the efficacy and safety of avatrombopag for CIT in gastrointestinal cancer. Methods: This multicenter, retrospective study included adult gastrointestinal cancer patients with CIT who received avatrombopag treatment (40mg/60mg, 5 days) between September 2020 and February 2022. The patient meets one of the following conditions were included in this study: a) Platelet count <100×109/L before receiving avatrombopag treatment in the current chemotherapy cycle, and platelet count <50×109/L in the last cycle; b) Platelet count <75×109/L before receiving avatrombopag treatment in the current chemotherapy cycle. The main endpoint was the proportion of patients with platelet count >100×109/L or platelet count increased by >50×109/L or platelet count increased by > 100% in the cycle after the start of avatrombopag therapy. Results: 58 patients were included in this study. 53.40%, 82.80%, and 96.6% of the patients reached the effective endpoint after 5±2, 11±3, and 18±3 days of avatrombopag treatment, respectively. No drug toxicity related to avatrombopag was found in this study. No significant influencing factors of effective rate were found. And there was no significant difference was found among the effective rate and platelet transfusion rate of avatrombopag (AVA), AVA+Recombinant Human Interleukin-11 (rhIL-11), and AVA+Recombinant Human Thrombopoietin (rhTPO). However, compared with AVA+IL-11, the AVA+rhTPO group had lower baseline platelet counts. And the mean of increasing platelet counts on the 5±2 (41.32×109/L vs. 37.00×109/L) and 11±3 day (110.94×109/L vs. 84.00×109/L) were better in the AVA+rhTPO group, though not significantly. Conclusions: Avatrombopag has high efficacy and safety in the treatment of CIT in gastrointestinal cancer. rhTPO rather than rhIL-11 combined with avatrombopag may be more suitable for patients with low baseline platelet counts. [Table: see text]