bluuebunny/crossref_metadata_2025_split huggingface dataset:
A202 IMPACT OF THE COVID-19 PANDEMIC ON THE EPIDEMIOLOGY OF ALCOHOL-RELATED HEPATITIS
Authors: Frolkis A , Borman M , Sadler M D , Congly S E , Nguyen H H , Lee S , Stinton L , Swain M , Coffin C S , Aspinall A , Burak K W , Shaheen A M 
Published: February 2022

Abstract

Background
Alcohol-related hepatitis (AH) is the most severe form of alcohol-related liver disease, with rising incidence. Stay-at-home orders for the COVID-19 pandemic were associated with increased alcohol consumption. Online sales reported a 262% increase from March 2019 to 2020.

Aims
The purpose of this study was to track the epidemiology of hospitalizations for AH by sex before and after the COVID-19 pandemic. We hypothesized that AH would be more severe in females and younger individuals during the pandemic.

Methods
Using the Discharge Abstract Database, we identified all hospitalizations in Alberta with international classification of disease-10 codes for AH between March 2018 and September 2020. We merged this dataset with provincial laboratory data to identify all inpatient lab values. We calculated Model for End-Stage Liver Disease (MELD) and Maddrey scores and validated a laboratory-based algorithm for AH. Severe AH was defined as Maddrey score &gt; 32. Onset of the pandemic was defined as March 2020. Stratified by pandemic onset, descriptive statistics were done with Chi-squared and Kruskal Wallis tests. Inpatient mortality was assessed as a primary outcome. Binomial regression was used to assess changes in frequency of admission for AH with the denominator as all cirrhosis-related admissions over the same time-period.

Results
We identified 991 hospitalizations for AH prior to the pandemic (n=381, 38.5% female) and 417 during the pandemic (n=144, 34.5% female). Hospitalizations for AH significantly increased during the pandemic (p = 0.04) (Figure 1). Median Maddrey score for females (30.5) before the pandemic was significantly higher than for males (22.9), p &lt; 0.01. During the pandemic, median Maddrey for females (28.7) was higher than males 21.4, p = 0.07. Median age at admission was significantly lower for both males and females during the pandemic (age 44 and 41, respectively) as compared to prior (age 47 and 45, respectively) p &lt; 0.05. There was no significant difference in MELD between sexes before (13.5 for females, 14.0 for males, p = 0.15) and during the pandemic (13.3 for females, 13.0 for males, p = 0.75). Additionally, there was no significant difference in mortality between sexes before (10.4% in females, 11.5% in males, p = 0.22) and after the pandemic (9.2% in females, 9.9% in males, p = 0.67).

Conclusions
Hospitalizations for AH rose during the pandemic and occurred at younger ages. There was no significant difference in disease severity or mortality before and during the pandemic. Overall, females have more severe AH than males. Public health efforts should continue to be made to educate about the harms of alcohol excess and offer community support. Future studies will expand the trend through multiple pandemic waves.

Funding Agencies
None
A209 EXPERT CONSENSUS CRITERIA AND PRACTICAL RECOMMENDATIONS FOR PBC CARE IN THE COVID-19 ERA AND BEYOND
Authors: Hirschfield G , Berenguer M , Kremer A E , Jones D , Leroy V , Adekunle F , Carbone M 
Published: February 2022

Abstract

Background
Primary biliary cholangitis (PBC) is a chronic autoimmune cholestatic liver disease that can progress to liver fibrosis and cirrhosis, and requires timely diagnosis, optimal treatment, and risk stratification. Several guidelines for the management of PBC have been published, including the American Association for the Study of Liver Disease (AASLD) and European Association for the Study of the Liver (EASL) Clinical Practice Guidelines, which include goals for standards of PBC care. However, recent audits have identified deficiencies in real-world PBC care. In addition, the global coronavirus (COVID-19) pandemic has generally reduced access to care, diminished healthcare resources and accelerated the use of remote patient management. There is therefore a need for simple, actionable guidance that physicians can implement in order to maintain standards of care in PBC in the new environment.

Aims
A working group of ten PBC specialists from Europe and Canada were convened by Intercept Pharmaceuticals in January 2020 with the aim of defining key criteria for the care of patients with PBC.

Methods
Following the outbreak of the COVID-19 pandemic, based on these criteria, a smaller working group of six PBC specialists developed practical recommendations to assist physicians in maintaining standards of care and to guide remote management of patients.

Results
The working group defined five key criteria for care in PBC, encompassing PBC diagnosis, initiation of first line therapy with ursodeoxycholic acid (UDCA), risk stratification on UDCA, symptom management, and initiation of 2L therapy. The group developed 21 practical recommendations for the management of patients with PBC in the COVID-19 environment including modality, frequency and timing of investigations and monitoring. (Figure 1).

Conclusions
The delivery of PBC care during the COVID-19 pandemic carries significant challenges. These consensus criteria and practical recommendations provide guidance for the management of PBC during the pandemic era and beyond.

Funding Agencies
NoneIntercept Pharmaceutical
A211 INCIDENCE OF PRIMARY SCLEROSING CHOLANGITIS: A META-ANALYSIS OF POPULATION-BASED STUDIES
Authors: Cooper J , Markovinovic A , Coward S , Shaheen A M , Swain M , Panaccione R , Ma C , Novak K L , Kaplan G G 
Published: February 2022

Abstract

Background
Primary sclerosing cholangitis (PSC) is a chronic liver disease associated with significant morbidity, mortality and healthcare utilization. Understanding the incidence of PSC is important in defining the burden of disease and planning for allocation of healthcare resources.

Aims
To conduct a systematic review and meta-analysis of population-based studies of the incidence of PSC and to assess temporal trends of incidence overtime.

Methods
Medline and Embase (from inception to May 10, 2021) were systematically searched to identify studies via the following inclusion criteria: 1) original articles, 2) population-based study of defined geographic area, 3) reported the incidence of PSC or provided data to calculate the incidence of PSC. Studies that assessed specific populations (e.g., pediatric-only, IBD-only) or reported less than 1 year of data were excluded. Abstracts and full texts were reviewed for inclusion and data was extracted independently in duplicate by two individuals (JC, AM). Meta-analyses were performed to calculate overall and country-specific incidence rates (per 100,000 persons) with 95% confidence intervals (CI). Meta-regression calculated the Average Annual Percentage Change (AAPC) of PSC incidence rates overtime.

Results
The initial search returned 3,958 abstracts. After duplicates were removed, abstracts (3,443) were screened, and full texts were reviewed (317), 17 studies met the criteria for inclusion and underwent data extraction. Meta-analysis included 6 studies with annual data contributing to the calculation of AAPC. Studies originated from 10 countries from North America, Europe, and Oceania; however, no population-based studies were published in Asia, Africa, or Latin America (Figure 1). Overall, the incidence rates of PSC was 0.82 per 100,000 (95% CI: 0.62, 1.02) (Figure 1). Incidence rates of PSC were significantly increasing overtime (AAPC: 4.56%; 95% CI: 0.45, 8.68).

Conclusions
The incidence of PSC is low at 0.82 per 100,000 but has been significantly increasing over time. Future studies on the incidence of PSC should be directed at Asia, Africa of Latin America to assess the global epidemiology of PSC.

Figure 1: Pooled incidence rate estimates of PSC per 100,000 person-years at risk.

Funding Agencies
None
A216 WHEN CANCER CASTS THE FIRST STONE: A CASE REPORT OF GALLBLADDER CANCER PRESENTING AS GALLSTONE ILEUS
Authors: Shelton J , McCall M , Strickland M 
Published: February 2022

Abstract

Background
Gallstone ileus is a rare cause of mechanical bowel obstruction. It occurs when a biliary stone passes through a cholecystoenteric fistula and becomes impacted in the bowel lumen, most commonly at the terminal ileum or ileocecal valve.
Gallbladder cancer is rare and often has a poor prognosis. Many patients present with advanced-stage disease and only 10% of patients are candidates for surgical resection. Early research has shown there is an increased incidence of gallbladder cancer among patients with gallstone ileus. To date, this relationship remains poorly understood.

Aims
To present a case of an elderly female whose gallbladder cancer presented after causing a cholecystoenteric fistula and gallstone ileus.

Methods
A retrospective review of a single patient case.

Results
Our patient was a 78-year-old female with a background history of hypertension, iron-deficiency anemia, osteoporosis, and treated bilateral breast cancer. She initially presented with acute cholecystitis, complicated by a concurrent pulmonary embolism. Given her need for systemic anticoagulation, she was treated non-operatively with antibiotics and an outpatient cholecystectomy was planned.
She returned to hospital eight months later reporting two days of nausea and vomiting. A repeat CT scan showed a cholecystoduodenal fistula with a 3.5cm x 2.6cm gallstone impacted 20cm from the ileocecal valve. A laparoscopic-assisted enterolithotomy was performed and her postoperative course was uneventful.
One month later, a CT scan was organized by her family physician to follow-up on incidental liver lesions. While the liver lesions were deemed benign, there was new lobulated soft tissue within the gallbladder, measuring 4.8cm x 4.7cm x 6.2cm, suspicious for a primary gallbladder malignancy. A follow-up MRI confirmed an intraluminal mass with direct invasion into hepatic segment III as well as marked segment III intrahepatic biliary dilatation. Endoscopy to the duodenum and cholecystoduodenal fistula was performed with a biopsy confirming gallbladder adenocarcinoma.
She underwent an open radical cholecystectomy, left hepatic lobectomy, antrectomy, resection of 1st portion of duodenum, and reconstruction with a Roux-en-Y gastrojejunostomy. Final pathology and staging confirmed a pT3pN0M0 adenocarcinoma of the gallbladder with a fistula tract within the cancer extending to the duodenum. She was then referred to a cancer center to complete a six-month course of adjuvant chemotherapy with capecitabine.

Conclusions
Gallstone ileus is a cause of mechanical bowel obstruction and rarely, it can be the first presentation of gallbladder cancer. Gallbladder cancer has a poor prognosis with many patients presenting with late-stage disease. As a result, we recommend the consideration of post-enterolithotomy imaging in select patients to evaluate for evidence of malignancy.

Funding Agencies
None
A241 KIWIFRUIT AND KIWIFRUIT EXTRACTS FOR TREATMENT OF CONSTIPATION: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Eltorki M , Leong R , Ratcliffe E 
Published: February 2022

Abstract

Aims
This systematic review and meta-analysis aimed to determine the effectiveness of kiwifruit or kiwifruit extracts in thetreatment of constipation.

Methods
Electronic databases were searched from inception until January 2021. Eligible studies enrolled participants with functional constipation (FC) or irritable bowel syndrome with constipation (IBS-C) with randomization to receive kiwifruit or kiwifruit extracts vs. any non-kiwifruit control. Standardized meandifference (SMD) or mean difference (MD) with confidence intervals (CI) were determined for the following outcomes: weekly frequency of spontaneous bowel movements (SBM) and Bristol Stool Scale (BSS). GRADE approach was used to rate the certainty of evidence. PROSPERO registration number CRD42020207365.

Results
Seven randomized controlled trials including 399 participants (82% female; mean age 42 years [Standard Deviation 14.6]) were included. Compared with placebo, kiwifruit extract might increase weekly frequency of SBM (MD 1.36; 95% CI -0.44 to 3.16) with low certainty evidence. Kiwifruit had an uncertain effecton BSS (SMD 1.54; 95% CI -1.33 to 4.41) with very low certainty evidence. Compared with psyllium, kiwifruitmay increase weekly SBM (MD 1.1; 95% CI -0.02 to 2.04) and may increase BSS (softer stools) (MD 0.63;95% CI 0.01 to 1.25) both with low certainty evidence. Compared to placebo, kiwifruit encapsulated extracts may result in an increase in minor adverse events (Relative Risk 4.58; 95% CI 0.79 to 26.4).

Conclusions
Among individuals with constipation, overall low certainty of evidence indicate that kiwifruit may increase SBM when compared to placebo or psyllium. Although overall results are promising, establishing therole of kiwifruit in FC or IBS-C requires large, methodologically rigorous trials.

Funding Agencies
None
A245 DETERMINING THE PREVALENCE OF DELAYED GASTRIC EMPTYING IN PEDIATRIC PATIENTS WITH CONSTIPATION USING NUCLEAR SCINTIGRAPHY
Authors: Rogalsky A , Gould M , Vali R , Marcon P 
Published: February 2022

Abstract

Background
Gastrointestinal motility is coordinated by complex neurohormonal circuits existing between different segments of the gastrointestinal tract. It has been hypothesized that one of these pathways, the “cologastric brake,” acts as a negative feedback system to inhibit gastric motility when there is loading of stool within the colon in conditions such as constipation.

Aims
To assess gastric emptying in pediatric patients presenting with constipation using whole-gut nuclear scintigraphy. We hypothesize that children with constipation are likely to exhibit delayed gastric emptying due to neurohormonal pathways such as the cologastric brake.

Methods
A retrospective review of all patients under 18 years of age who underwent a whole-gut nuclear scintigraphy study for the work-up of constipation at The Hospital for Sick Children between January 2014 and May 2021 was completed. Demographic and clinical data at the time of presentation was summarized. The proportion of patients with delayed gastric emptying and delayed small and large bowel transit were calculated. Exploratory univariable analyses were performed to identify clinical predictors of delayed gastric emptying.

Results
This study identified 140 patients meeting inclusion criteria of whom 72 were male (51.4%), (meanage = 10.04 ± 4.79). The prevalence of patients with delayed gastric emptying was 61.9% (n = 86). Despite this, only 5.0% (n = 7) and 21.8% (n = 29) had delayed small and large bowel transit respectively. Children with delayed gastric emptying were significantly younger (meanage = 9.15 ± 4.60) than those with normal gastric emptying (meanage = 11.53 ± 4.79), p = .01. A chi-square test of independence showed that there was no significant relationship between use of a promotility agent and delayed gastric emptying ( p = .48). There was also no significant association between the presence of upper gastrointestinal symptoms and delayed gastric emptying ( p = .79).

Conclusions
We found that children with constipation have a high prevalence of delayed gastric emptying. However, only a small proportion of these patients have delayed bowel transit. This supports the idea that delayed gastric emptying in children with constipation is likely not due to intrinsic neuromuscular defects of the gut but rather, secondary to a neurohormonal “cologastric brake.” This is important information for clinicians as it suggests that a key step in managing delayed gastric emptying in this scenario is to treat patients’ constipation as opposed to initiating therapies, such as prokinetic agents, which attempt to directly improve gastric emptying.

Funding Agencies
None
A255 INCREASED ENERGY EXPENDITURE AND REDUCED EXERCISE CAPACITY IN CELIAC DISEASE PATIENTS ON A GLUTEN-FREE DIET
Authors: Faisal M , Russell L , Collins A W , Armstrong D , Pinto-Sanchez M I 
Published: February 2022

Abstract

Background
Celiac disease (CeD) patients often exhibit impaired nutritional status due to nutrient malabsorption and altered metabolism. Accurate clinical assessment of malnutrition, muscle function and energy requirements are thus essential to prevent and treat malnutrition. Indirect calorimetry (IC) is the most accurate method to measure energy needs, but it is underutilized in outpatient settings.

Aims
To assess the use of IC testing in estimating the resting energy expenditure and exercise-related energy utilization in treated CeD patients compared to patients with other gastrointestinal (GI) conditions.

Methods
Adult patients attending the Celiac and Nutrition Clinic at McMaster University that underwent rest and exercise testing as a part of their nutritional assessment were enrolled. CeD diagnosis was based on positive CeD serology and confirmed by biopsy, and all of them were on a GFD for at least 6 months. Patients with inflammatory bowel disease (IBD), functional gastrointestinal disorders (FGID) and undernutrition due to other causes (UN) were included as controls. Resting energy expenditure was assessed using 3

methods
1) predictive formula (25kcal/kg), 2) Harris Benedict and 3) estimation of VO2 by IC. Exercise capacity and energy expenditure (EE) during exercise was estimated at baseline, moderate and maximum exercise. Statistical analysis was performed using SPSS. ANOVA with Bonferroni corrections and Chi2 test were used to assess differences between continuous and categorical variables, respectively.

Results
A total of 66 patients (CeD n=24; IBD n=15; FGID n=17; UN n=10) were included in the analysis. The REE of GI patients measured using the HB equation and the predictive formula were significantly underestimated compared to IC [Mean Difference (MD)=229 kcal/day p=0.03 and MD=365 kcal/day p&lt;0.001, respectively]. The EE during exercise increased with intensity of exercise. CeD patients had the highest EE during moderate and strenuous exercise (Mean EE = 286 kcal/h and 494 kcal/h respectively) compared to patients with other GI conditions (Moderate and Strenuous for IBD= 218kcal/h and 373kcal/h; for FGIDs 296kcal/hand 467kcal/h, for UN, Mean EE = 181kcal/h and 294kcal/h). Exercise capacity was reduced in CeD compared to predicted exercise capacity (Mean = 86% predicted work capacity, range 72.5–107%), but was significantly higher than IBD (86% vs 73%; p=0.65) and UN patients (86% vs 46%; p=0.004).

Conclusions
Increased energy consumption and reduced exercise capacity is suggestive of chronic impaired nutritional status in treated CeD patients. Future studies with larger sample sizes are needed to understand whether incorporating accurate estimations of energy expenditure in nutritional practices can improve CeD outcomes.

Funding Agencies
CAG
Convergent Validity for the Individual Music-Centered Assessment Profile for Neurodevelopmental Disorders
Authors: Carpente John A , Gattino Gustavo Schulz , Berrones Cortez Gisela X , Kelliher Michael , Mulholland Jill 
Published: February 2022

Abstract
A significant percentage of music therapists actively provides services to children with autism spectrum disorder (ASD). There is an absence, however, of a widely accepted clinical instrument, specific to music therapy work with this population, that demonstrates psychometric validation. Establishing commonality in assessing and documenting this particular work within the field would be pivotal to furthering the efforts which have established music therapy as evidenced-based practice. A study was conducted to explore the convergent validity between the Musical Emotion Assessment Rating Scale (MEARS), which is Scale I of the Individual Music-Centered Assessment Profile of the Neurodevelopmental Disorders (IMCAP-ND) assessment tool, with the Social Affect Scale domains and item variables of the Autism Diagnostic Observation Schedule (ADOS). The data revealed statistical significance, thus supporting convergent validity with several specific MEARS scores when compared with the ADOS Social Affect domain score. The current investigation supports the IMCAP-ND’s soundness as an assessment tool possessing valid and reliable psychometric properties. The convergent validity between MEARS and ADOS showed positive results in the area of social affect. Implications of this study are related to clinical practice and may impact how music therapists assess children with autism. Furthermore, this study contributes to the growing body of music therapy assessments that have yielded valid and reliable scores used to evaluate core features of ASD (e.g., social affect).
Oxidation of ferumoxytol by ionizing radiation releases iron. An electron paramagnetic resonance study
Authors: Petronek Michael S , Spitz Douglas R , Buettner Garry R , Allen Bryan G 
Published: February 2022

Abstract
Ferumoxytol (FMX) is an iron oxide nanoparticle that is FDA approved for the treatment of iron deficiency anemia. FMX contains an Fe3O4 core. Currently, the redox chemistry of Fe3O4 nanoparticles remains relatively unexplored. FMX has recently gained interest as an anti-cancer agent. Ionizing radiation (IR) is a treatment modality employed to treat several types of cancer. Utilizing electron paramagnetic resonance (EPR) spectroscopy, we found that the products produced from the radiolysis of water can oxidize the Fe3O4 core of FMX. Because of the limited diffusion of the HO2• and HO• produced, these highly oxidizing species have little direct effect on FMX oxidation. We have determined that H2O2 is the primary oxidant of FMX. In the presence of labile Fe2+, we found that reducing species generated from the radiolysis of H2O are able to reduce the Fe3+ sites of the Fe3O4 core. Importantly, we also have shown that IR stimulates the release of ferric iron from FMX. Because of its release of iron, FMX may serve as an adjuvant to enhance radiotherapy.
Partial nephrectomy of a huge solid-cystic renal mass with final pathology of renal cell carcinoma
Authors: Mohammadi Abdolreza , Aghamir Seyed Mohammad Kazem 
Published: February 2022

Abstract
Partial nephrectomy has been established as a standard treatment of renal mass &lt;4 cm(cT1a), but mostly it is performed in larger tumors of size up to 7 cm (cT2b). The maximum size of a tumor that could undergo partial nephrectomy is controversial. In this case report, we present a case of a large renal mass (17 cm) that underwent open partial nephrectomy successfully. To our knowledge, this case is the giant tumor that underwent partial nephrectomy in the literature. Partial nephrectomy could be performed if technically feasible irrespective of the tumor size.