bluuebunny/crossref_metadata_2025 huggingface dataset:
Feature Specific Hybrid Framework on composition of Deep learning architecture for speech emotion recognition
Authors: Hussain Mansoor , Abishek S , Ashwanth K P , Bharanidharan C , Girish S
Published: May 2021

Speech cues may be used to identify human emotions using deep learning model of speech emotion recognition using supervised learning or unsupervised learning as machine learning concepts, and then it build the speech emotion databases for test data prediction. Despite of many advantageous, still it suffers from accuracy and other aspects. In order to mitigate those issues, we propose a new feature specific hybrid framework on composition of deep learning architecture such as recurrent neural network and convolution neural network for speech emotion recognition. It analyses different characteristics to make a better description of speech emotion. Initially it uses feature extraction technique using bag-of-Audio-word model to Mel-frequency cepstral factor characteristics and a pack of acoustic words composed of emotion features to feed the hybrid deep learning architecture to result in high classification and prediction accuracy. In addition, the proposed hybrid networks’ output is concatenated and loaded into this layer of softmax, which produces a for speech recognition, a categorical classification statistic is used. The proposed model is based on the Ryerson Audio-Visual Database of Emotional Speech and Song audio (RAVDESS) dataset, which comprises eight emotional groups. Experimental results on dataset prove that proposed framework performs better in terms of 89.5% recognition rate and 98% accuracy against state of art approaches.
Solar Powered Real Time Transformer Health Monitoring System Using Internet of Things (IoT)
Authors: Jeevanandham A , Nitin B , Maheshkumar M , kumar B Jeevith , Monish B
Published: May 2021

Distribution transformer are primary and most important segment in a distribution system. As there is no efficient protocols to monitor the vital parameters of the transformer, the transformers health declines rapidly, thereby resulting in complete failure or partial malfunction in the distribution transformer. So we give a system to detect the health of the transformer. Using the help of the sensors we can sense that variations in current, voltage, temperature in the transformer. Before this changes cause any damage in transformer we will cut off the supply. Also it will store in cloud for the future analysis. The system will also detect the abnormalities in the measured parameters and then sends an alert message to the authorized personnel about the situation. Then the personnel can assess the situation by viewing the real time data that is made available in the IoT platform and can download for any report.
Administered Machine Learning Models for Covid-19 Future Forecasting
Authors: Atchaya K , Darshinii M , Harini R , Suganya T
Published: May 2021

The spread of COVID-19 in the entire world has put the human kind in danger. The assets of probably the biggest economies are worried because of the enormous infectivity and contagiousness of this illness. The ability of ML models to conjecture the quantity of forthcoming patients influenced by COVID-19 which is by and by considered as a likely danger to humanity. Specifically, four standard estimating models linear regression (LR), least total shrinkage and determination administrator (LASSO) Support vector Machine (SVM) have been utilized in this examination to figure the undermining components of COVID-19. Three sorts of expectations are made by every one of the models, for example, the quantity of recently tainted cases, the quantity of passing, and the quantity of recuperations But in the can’t foresee the precise outcome for the patients. To defeat the issue, proposed strategy utilizing the exponential smoothing (ES) anticipate the quantity of COVID-19 cases in next 30 days ahead and impact of preventive estimates like social seclusion and lockdown on the spread of COVID-19.
IOT Based Tool Garbage Management System
Authors: Sathyabama S , Bharath Raaj A , Cibi Saamraat S S , Girimurugan T
Published: May 2021

These days, safe and hygiene disposal of waste via dustbins in smart cities needs a centralized and monitored system. This system monitors various bins used for rubbish and garbage collectionextent is also informed inside these garbage bins via centralized online Application. For this the system the bins are fitted specially placed ultrasonic sensors to determine the level and depth of rubbish. It incorporates an AVR based microcontroller, GSM Module, Wi-Fi modem, a buzzer for alert and LCD screen for viewing data. The voltage support is given by a 12V transformer. To determine the display status and the extent to which the rubbish bin is loaded an LCD screen is used. These LCD screens are used inside the rubbish bins. To point out the condition however the web application is designed which is used to monitor the garbage or rubbish bins. The geographical view of rubbish bins can be obtained by the web page and also these web pages indicate the colored rubbish that they can highlight
Fine Grained Sentimental Analysis of Social Network Chat Using R
Authors: Kiruthika J K , Janani A P , Sudha M , Yawanikha T
Published: May 2021

In current years, sentiment examination has expanded much consideration in, analyzing and monitoring data of social media, public relations, data mining, market research, medical data, political analysis, cyberbullying etc., in all areas extended the utilization of sentiment analysis. Sentiment exploration are classified into three categories in which Rule-based frameworks accomplish sentiment analysis based on a set of physically created procedures. Programmed frameworks rest on machine learning procedures to learn from information though Hybrid frameworks combine both procedure based and programmed approaches. In this paper we apply rule based characteristic language processing and content analysis procedures to recognize and extricate subjective data from content of social media and centering on extremity such as positive, negative, unbiased conjointly on sentiments and feelings as irate, upbeat, pitiful.. By periodically sorting the assumption behind surveys, social media conversations and more ready to make quicker and more precise decisions.
Detection of Leukemia Using Machine Learning Algorithms
Authors: Jayavikash K P , Gopinath P , Nandheeswaran U , Sivabalan R , Divya Bharathi T
Published: May 2021

Detection of disorders of Blood usually include visual inspection through a microscope. This may help to classify various conditions related to human blood. The paper details about evolving a system that could help in diagnosis and detection of Leukemia at an early stage. Only then controlling and prevention can be done. The proposed system focuses on White Blood Cells as they are the affected ones in case of Leukemia. The affected cells differ in shape and color features, which are used as classifier inputs.
Using FDA-approved drugs as off-label fluorescent dyes for optical biopsies: from in silico design to ex vivo proof-of-concept
Authors: Larson Michael C , Gmitro Arthur F , Utzinger Urs , Rouse Andrew R , Woodhead Gregory J , Carlson Quinlan , Hennemeyer Charles T , Barton Jennifer K
Published: May 2021

Optical biopsies bring the microscope to the patient rather than the tissue to the microscope, and may complement or replace the tissue-harvesting component of the traditional biopsy process with its associated risks. In general, optical biopsies are limited by the lack of endogenous tissue contrast and the small number of clinically approved in vivo dyes. This study tests multiple FDA-approved drugs that have structural similarity to research dyes as off-label in situ fluorescent alternatives to standard ex vivo hematoxylin & eosin tissue stain. Numerous drug-dye combinations shown here may facilitate relatively safe and fast in situ or possibly in vivo staining of tissue, enabling real-time optical biopsies and other advanced microscopy technologies, which have implications for the speed and performance of tissue- and cellular-level diagnostics.
Microstructure, erosion and tribological behaviour of thick DLC coatings by the filtered cathodic vacuum arc combined with a high-voltage pulse power
Authors: Shen Yongqing , Luo Jun , Liao Bin , Zhang Xu , Zhao Yuanyuan , Chen Lin , Pang Pan , Zeng Xinmiao
Published: May 2021

Hydrogen-free diamond-like carbon (DLC) films with thickness of 36 μm and 50 μm have been prepared on Si and AISI 304L stainless steel substrates, respectively, by filtered cathodic vacuum arc (FCVA) together with a high-voltage pulse power. The structure, chemical bonding state, mechanical properties and wear, corrosion resistance and anti-erosion performance were evaluated. The thick DLC films with compressive stress of 0.71 GPa and hardness of 3160 HV were obtained. The preparation of the low stress but high hardness coating mainly due to the appropriate high negative bias and short pulse duration, which could result in an alternate ion bombardment and deposition. The 50 μm-thick coating showed corrosion resistance with high polarization resistance of 4.69 × 108 Ω·cm2 and low corrosion current density of 5.47 × 10−8 A·cm−2. Thick coating exhibited outstanding sand particle erosion resistance with low average mass loss rate of 0.035 mg g−1. Under high-speed sand erosion conditions, the coating remains unbroken, without peeling or cracking were observed on the erosion center. In addition, DLC coatings showed good tribological performance under dry, water- and oil-lubricated condition.
Can a risk of harm itself be a harm?
Authors: Rowe Thomas
Published: May 2021

Many activities impose risks of harm on other people. One such class of risks are those that individuals culpably impose on others, such as the risk arising from reckless driving. Do such risks in themselves constitute a harm, over and above any harm that actually eventuates? This paper considers three recent views that each answer in the affirmative. I argue that each fails to overcome what I call the ‘interference objection’. The risk of harm itself, whether taken as a subjective or an objective risk, is unable to interfere with the interests of victims in order to constitute a harm. This does not mean that a risk of harm cannot itself be wrongful, but the conclusion does weaken the moral objectionableness of impositions of risks of harm.
Structural classification of proteins based on the computationally efficient recurrence quantification analysis and horizontal visibility graphs
Authors: Zervou Michaela Areti , Doutsi Effrosyni , Pavlidis Pavlos , Tsakalides Panagiotis
Published: May 2021

Motivation

Protein structural class prediction is one of the most significant problems in bioinformatics, as it has a prominent role in understanding the function and evolution of proteins. Designing a computationally efficient but at the same time accurate prediction method remains a pressing issue, especially for sequences that we cannot obtain a sufficient amount of homologous information from existing protein sequence databases. Several studies demonstrate the potential of utilizing chaos game representation along with time series analysis tools such as recurrence quantification analysis, complex networks, horizontal visibility graphs (HVG) and others. However, the majority of existing works involve a large amount of features and they require an exhaustive, time consuming search of the optimal parameters. To address the aforementioned problems, this work adopts the generalized multidimensional recurrence quantification analysis (GmdRQA) as an efficient tool that enables to process concurrently a multidimensional time series and reduce the number of features. In addition, two data-driven algorithms, namely average mutual information and false nearest neighbors, are utilized to define in a fast yet precise manner the optimal GmdRQA parameters.

Results

The classification accuracy is improved by the combination of GmdRQA with the HVG. Experimental evaluation on a real benchmark dataset demonstrates that our methods achieve similar performance with the state-of-the-art but with a smaller computational cost.

Availability and implementation

The code to reproduce all the results is available at https://github.com/aretiz/protein_structure_classification/tree/main.

Supplementary information

Supplementary data are available at Bioinformatics online.
A Refinement of Key Mismatch Attack on NewHope
Authors: Zhang Xue , Zheng Zhongxiang , Wang Anyu
Published: May 2021

NewHope cryptosystem is one of the second-round submissions of the National Institute of Standards and Technology post-quantum cryptography standardization process, which is a suite of two key encapsulation mechanisms based on the ring-learning with errors (LWE) problem. It has received much attention from the research community due to its small key size and high efficiency. Recently, three key mismatch attacks are proposed against NewHope under the condition of key reuse. They do not solve the ring-LWE instance directly but exploit the leakage of secret information. As far as we know, the best result is given by Okada et al. ((2020) Improving Key Mismatch Attack on NewHope with Fewer Queries. In Proc. of the 25th Australasian Conf. on Information Security and Privacy, Perth, WA, Australia, November 30–December 2, pp. 505–524. Springer Cham, Switzerland), which recovers the whole secret with a success probability of $97\%$ and $233,803$ average queries. In this paper, we further improve the key mismatch attack of NewHope by reducing the average queries to $106,577$ and raising the success probability to $100\%$. Moreover, we analyze the key mismatch attack without key reuse for the first time and we propose a combinatorial attack against NewHope1024. The total complexity of the combinatorial attack is $2^{253}$, which is lower than the complexity of primal attack and the claimed security strength of NewHope1024.
N07 A qualitative study of the impact of inflammatory bowel disease on partners
Authors: Thapwong P , Norton C , Terry H , Czuber-Dochan W
Published: May 2021

Background

Inflammatory Bowel Disease (IBD) not only impacts the quality of life of the patient, but also affects their family members. Studies to date have provided an understanding of impact of IBD and IBD implications for people with IBD. However, little is known about the impact of IBD on their family members. Therefore, the current study aimed to explore the lived experience of people with IBD and their family members regarding the impacts of IBD on family members and their coping methods.

Methods

Twelve participants, including six people with IBD with their six partners, were purposively selected, no other family members (parents / children, sibling) came forward to participate in the study. The in-depth, semi-structured online interviews were conducted via Skype, Zoom, or Microsoft Teams between February-June 2020. Interviews were audio-recorded, transcribed verbatim, and analysed using inductive thematic analysis by Braun and Clarke.

Results

Four main themes emerged during the analysis under the central theme “our relationship with IBD, for better or worse”. IBD affected the partners in terms of their own relationship, relationship with others, everyday life, and emotional and mental well-being. The theme “our relationship” showed the impact of IBD on the relationship between a couple, including the intimate relationship, family planning, role change as partner and carer, and the importance of honest communication. IBD also affected wider relationships with family, children, and social life, but teamwork could mediate negative impact in relationships. Emotional well-being was impacted by living in constant fear and guilt. Humour and knowledge of IBD reduced negative impacts. IBD impacts on everyday life (diet, finances, and travel) for both patients and partners. Planning for uncertain situations was helpful to reduce restrictions.

Conclusion

The study provides an understanding of IBD impact on partners and the coping strategies from patients and partners’ perspectives. There are wide-ranging implications for health and social care professionals caring for people with IBD and their families. Social support has been recognised as a vital buffering mechanism in facilitating an individual’s adjustment to IBD. Healthcare professionals and researchers may integrate a bio-psycho-social approach into their work with IBD family members. There is a need to develop interventions to help family members of IBD patients to better cope with the illness and to have a more fulfilling life.
OP22 Factors independently associated with fatigue in IBD: Results from the baseline dataset of the PREdiCCt study
Authors: Derikx L , Siakavellas S , Derr L , Williams L , Nikolas P , Jenkinson P , Lucaciu L , Constantine-Cooke N , Covil K , Murdoch L , Jones G R , Lees C
Published: May 2021

Background

Fatigue is one of the most common symptoms in IBD resulting in decreased quality of life, impaired work productivity, and higher societal costs. However, little is known about its etiology and pathophysiology. We aimed to estimate the prevalence of fatigue and to identify predictive factors for fatigue.

Methods

The PREdiCCt study (https://www.predicct.co.uk) is the largest prospective study of the causes of IBD flare. 2629 patients in clinical remission were recruited from 48 UK sites. 1946 (74%) patients completed the baseline questionnaires. We assessed the prevalence of fatigue at baseline using a single item from the IBD Control questionnaire. To identify predictors for fatigue, we performed univariable and multivariable analyses including demographic, biochemical, environmental and psychosocial factors such as anxiety and depression [HADS], sleep quality [PSQI] and physical exercise [GPAQ]).

Results

759/1919 IBD patients in clinical remission (39.6%) reported fatigue in the past 2 weeks, while 1034 patients (53.9%) did not report fatigue. Patients who reported fatigue were more frequently female, had more frequently CD, and were more frequently smokers (Table 1). Univariable comparisons showed higher inflammatory markers in the fatigued group, with fewer patients in clinical remission. Multivariable analyses identified female sex (OR 2.4), CRP>5 (OR 2.1), bad sleep quality (OR 2.5), anxiety (OR 1.8) and depression (OR 6.2) as independent factors associated with fatigue (Table 2).

Conclusion

We show the significant burden of fatigue in IBD patients and describe putative causes which demonstrate both the impact of residual gut inflammation and the relationship between fatigue and psychological well-being. The impact of environmental and dietary factors on fatigue is being further investigated with ongoing longitudinal data collection in the PREdiCCt study.
P092 Development and evaluation of i-Tracker Ustekinumab and i-Tracker Anti-ustekinumab kits: fast and innovative chemiluminescent assays for the monitoring of patients treated with ustekinumab
Authors: Noguier G , Montaillier C , Daviere S , Yang Y , Colombeau L , Parussini E
Published: May 2021

Background

Ustekinumab, a monoclonal antibody directed against IL12/23, is a drug widely used for the treatment of Chronic Inflammatory Diseases (Psoriasis, Crohn’s disease, etc.). Therapeutic Drug Monitoring is currently proposed to provide useful information to clinicians to improve the efficacy of the treatment. Theradiag has just developed the innovative i-Tracker ustekinumab and i-Tracker Anti-ustekinumab kits: fast quantification of ustekinumab and Anti-ustekinumab antibodies fully automated on the random access i-Track10 chemiluminescent analyzer.

Methods

Analytical performances were assessed using 2 types of serum samples: human serum spiked with ustekinumab or Anti-ustekinumab antibodies, and samples from Inflammatory Bowel Diseases patients treated with ustekinumab (n=32). For drug measurement, ustekinumab from serum sample was captured by anti-idiotypic antibody coupled magnetic microparticles and anti-ustekinumab polyclonal antibodies conjugated to acridinium ester were used for the detection of ustekinumab. For anti-drug antibodies measurement, Anti-ustekinumab antibodies were captured according to Ustekinumab coupled magnetic microparticles and detected with the use of ustekinumab conjugated to acridinium ester. Light emission was linked to the quantity of ustekinumab, or anti-ustekinumab antibodies presents in the sample.

Results

Ustekinumab measurement showed high accuracy (recovery was comprised between 98% and 120%). High precision weas reached for both assays (intra-precision CV were below 9.1% and 5.3% for ustekinumab and Anti-ustekinumab assays; inter-precision CV were below 4.6% and 10.6% for ustekinumab and Anti-ustekinumab assays) and no interference was seen with biologic agents (bilirubin, hemoglobin, lipids, biotin and rheumatoid factors). The dynamic ranges of the assays were 100ng/ml to 10 000ng/ml for ustekinumab quantification and 1 AU/ml to 250 AU/ml for anti-ustekinumab antibodies quantification. i-Tracker ustekinumab and i-Tracker anti-ustekinumab assays were compared to respective ELISA based LISA-TRACKER assays and showed excellent correlation (R² = 0.96, Slope = 0.93 for ustekinumab assay; Spearman’s coefficient correlation was 0.95 for Anti-ustekinumab assay).

Conclusion

i-Tracker kits are innovative assays which exhibit fast (time to results < 40min), accurate and reproducible results for the quantification of ustekinumab and Anti-ustekinumab antibodies. Excellent agreements were observed with respective LISA-TRACKER assays. i-Tracker kits are valuable tools for the monitoring of patients treated with ustekinumab.
P112 Impact of the SARS-COV2 pandemic on patients with inflammatory bowel disease - Preliminary results of a prospective, single-center study
Authors: Martins Figueiredo L , Correia F , Rafael M A , Lourenço L , Oliveira A M , Branco J C , Santos L , Martins A
Published: May 2021

Background

The real impact of COVID-19 infection on patients with Inflammatory Bowel Disease (IBD) is unknown. It was speculated that this population could be a risk group. The aim of this study is to evaluate the incidence of SARS-CoV2 infection, the impact of initiation/change of IBD therapy and its morbidity and mortality, during the COVID-19 pandemic in Portugal.

Methods

Prospective cross-sectional study. Patients with IBD followed at a Gastroenterology Department in an area with a high incidence rate of SARS-CoV2 were included, from 01/03/2020 to 31/08/2020. Data was obtained through telephonic appointments, hospital inpatients admissions, Emergency Department Service and Day Hospital episodes.

Results

335 patients were included, 194 female, with a mean age of 47.4 years (18–88). 200 had Crohn’s disease (CD), 132 Ulcerative Colitis, 3 unclassified colitis. 320 were on therapy (95.5%): salicylates n=230 (71.9%), systemic corticosteroids n=34 (10.6%) (18 started during the pandemic), thiopurines/methotrexate n=117 (36.6%) (8 started in this period), biological n=148 (46.3%) (14 started in this period). 7 patients (2.2%) triple immunosuppressed. 75 patients had disease in remission, 232 mild/moderate, 28 severe disease (requiring hospitalization). SARS-CoV2 infection was observed in 3 patients (incidence rate: 0.89%), treated as an outpatient basis. 2 male, mean age 58 years, 2 with CD. Comorbidities: 0: n = 1; 2: n = 1; 4: n = 1. 2 patients were on salicylates and one on adalimumab (monotherapy, before the pandemic). There were no deaths.

Conclusion

All patients started or maintained their IBD therapy according to current international guidelines. A significantly higher incidence of COVID-19 infection than that of the local and Portuguese population in general has not been documented. According to our preliminary results, the population with IBD does not appear to be a risk group for acquiring infection or having a severe course of the disease.
P120 Developing “My quality of life” programme based on ICHOM Standard Set for IBD: 1-year results
Authors: Roa I , Merino O , Gómez Irwin L , Arosa M , García González J M , Ituarte R , Méndez T Á , Cortón L , Castelo S , Suárez M J
Published: May 2021

Background

Inflammatory bowel diseases (IBD) are chronic relapsing diseases of unknown etiology, usually beginning at a young age. Although life expectancy of IBD patients is near to the mean of healthy population, IBD has a significantly negative impact on patients’ quality of life. Recent research has evidenced that a poorer quality of life can contribute to relapse or worsening of IBD symptoms, reduce treatment adherence and lead to poorer outcomes.

The Ezkerraldea-Enkarterri-Cruces Healthcare Organization in Spain has made a firm commitment to adopt the Value-Based Health Care (VBHC) model, which advocates for the incorporation of patient-perceived quality of life variables to the items we normally assess. The IBD Unit, in pursuit of adhering to the VBHC corporate programme, has launched on a process to analyze our health care delivery system and improve the effectiveness of our Performance Improvement Plan based on patients’ experience.

Objectives:

- To identify and systemize the incorporation of perceived quality of life variables

- To reorient medical care towards what really matters to patients

Methods

We have built a multi-disciplinary team comprised of healthcare professionals involved in IBD management (Figure 1). Patients form the core of the team’s meetings, helping in the development of User Experience (Figure 2) and Empathy Maps (Figure 3) by using Design Thinking strategies. After the detection of the obstacles faced by patients, we outlined a Process Map (Figure 4), where we critically analyzed the route followed by patients in our health-care system before reaching the IBD Unit. Subsequently, a specific route was outlined considering the set proposed for the disease by the ICHOM consortium as a reference framework. Questionnaires and surveys were designed using patient information across different areas of care, in order to guarantee the correct functioning of the route.

Results

We obtained a list of 14 improvement proposals which are currently at different levels of evaluation. In our first year, we have been able to implement important modifications which include:

- A specific remote consultation for IBD patients

- Fast track pathways

- Nutritional guidelines to assure compliance

- Shortening waiting lists

- Reduction in patient bureaucracy and paperwork

- Virtual monitorization of patients with asymptomatic disease

Conclusion

- VHBC implementation implies a transformation of the organization

- User Experience tools add a different perspective to the route design, focusing on what really matters to patients and improving their quality of life

- This change of perspective is important, especially in chronic diseases, so that patients feel less lonely with their disease and better outcomes can be obtained
P136 Management of patients with Inflammatory Bowel Disease and their outcome during the first wave of Covid-19 pandemics
Authors: Viola A , Giambò F , Chiappetta M F , Costantino G , Pallio S , Navarra G , Alibrandi A , Fries W
Published: May 2021

Background

The restrictions adopted in Italy during the phase I COVID-19 pandemics with a nationwide lockdown period, represented a challenge in the management of Patients with Inflammatory Bowel Disease (IBD) patients. The aim of the present study was to assess if, and how, a limited course of telemedicine did influence the clinical outcome in patients with Crohn’s disease (CD) and Ulcerative Colitis (UC).

Methods

IBD patients followed before March 8th, 2020 were included and divided into 3 groups (Fig.1): group 1, patients on endovenous biologics (EV); group 2, patients on biologics administered subcutaneously (SC); and group 3, patients on conventional treatments (CT) at the start of lockdown. The primary outcome was to assess the occurrence of disease flare in the three groups since only the EV group received face-to-face visits during lockdown. As secondary outcome we assessed the number of control endoscopies performed and the start of new biologic therapies, compared with a reference period in 2019.

Results

A total of 689 patients (CD: 369, UC 320) were included in the study (247 IV, 217 SC and 225 CT, respectively). Telemedicine was more frequently adopted in SC and CS, (p<0.001) both. Treatment delays or transitory stops were more frequent in EV (p<0.001), whereas there was a significantly greater need to change therapy (p= 0.038) and need for steroids (p = 0.008) in the SC group compared with EV (Tab.1). Concerning endoscopies, compared with the reference period in 2019 only 25% of scheduled endoscopies were performed. The only risk factor for disease flare during or shortly after lockdown was belonging to the patient groups subjected to telemedicine (SC and CT groups) (p < 0.001).

Conclusion

Patients followed with a face-to-face approach instead of telemedicine, had a lower risk of disease flare during lockdown period. The impact of the important reduction of endoscopic assessments still needs to be assessed.
P165 Non-invasive biomarkers of type III collagen cross-linking reflects fibrolysis in patient with luminal CROHN’S DISEASE
Authors: Pehrsson M , Godskesen L E , Bay-Jensen A C , Asser Karsdal M , Krag A , Kjeldsen J , Høg Mortensen J
Published: May 2021

Background

Type III collagen of the interstitial matrix is highly expressed in fibrotic tissue of Crohn’s disease (CD) and suggested to undergo remodelling during the characteristic deep tissue inflammation. Periods of inflammatory flares and remission could thus be reflected by varying degrees of type III collagen degradation and formation in relation to fibrogenesis and resolution of fibrosis. The aim was to investigate the association between type III collagen remodelling and CD disease phenotypes based on the Montreal classification

Methods

40 CD patients were endoscopically assessed according to the Montreal B classification (luminal or stricturing phenotype) and Harvey Bradshaw Index for clinical disease activity (<4 = inactive; >4 = active). Patients were stratified based on both the Montreal B classification and HBI scores. Biomarkers were assessed by ELISA: 1) CTX-III (cross-linked protease degraded fragments of type III collagen), PC3X (cross-linked type III collagen formation), 3) PRO-C3 (type III collagen formation), and 4) C3M (MMP-9 degradation fragments)

Results

Biomarker levels of CTX-III was significantly elevated in CD patients with luminal- and clinically inactive- disease compared to patients with stricturing- and clinically inactive- disease and luminal- and clinically active- disease (p<0.01 and p<0.05, fig 1A). The levels of net fibrolysis of cross-linked type III collagen (CTX-III/PC3X) was significantly higher in patients with luminal- and clinically inactive- disease compared to patients with stricturing- and clinically inactive- disease (p<0.001), luminal- and clinically active- disease (p<0.001), and patients with stricturing- and clinically active- disease (p<0.05, fig 1C). Significantly elevated levels of net type III collagen degradation (C3M/PRO-C3) were observed in patients with a luminal- and clinically active- disease compared to luminal- and clinically inactive- as well as stricturing- and clinically inactive- disease (p<0.05). Furthermore, net type III collagen degradation was elevated compared to patients with stricturing- and clinically active- disease (p<0.05, fig 1F). Biomarker levels of PC3X, C3M, and PRO-C3 were unable to differentiate between patient groupings (fig 1B, D, and E)

Conclusion

Proteolytic degradation of cross-linked type III collagen (CTX-III) reflecting resolution of fibrosis in CD patients with luminal disease, may be associated with a protective effect against fibrogenesis and progression to fibrostenosis. These data indicate differences in cross-linked and non-cross-linked type III collagen remodelling in CD patients, and their potential use for differentiating patient phenotypes and disease activity
P171 Immune-mediated diseases (IMID) and COVID-19: results from an observational retrospective multicenter study
Authors: Calviño Suárez C , Dos-Santos R , Baston-Rey I , Montero F J , Ferreiro-Iglesias R , Marin-Jimenez I , Gonzalez C M , Perez-Pampin E , Barreiro-de Acosta M
Published: May 2021

Background

The novel coronavirus emerged in 2019 in Wuhan has caused a global pandemic of coronavirus disease (COVID-19). Immune-mediated diseases (IMID), as inflammatory arthritis or inflammatory bowel disease (IBD), have some special implications due to their pathogenesis and treatments. Some treatments employed in IMID are now being used in the treatment of severe COVID-19. There still exists controversy about IMID behavior and its complications. Our aim was to assess COVID-19 severity in IMID patients and its prognosis predictors.

Methods

An observational retrospective multicenter study was performed in two Spanish Hospitals (University Clinical Hospital in Santiago de Compostela and Gregorio Marañón Hospital). Patients were selected if they were diagnosed of an IMID (rheumatoid arthritis, psoriatic arthritis, espondyloarthritis, ulcerative colitis and Crohn’s disease) and had COVID-19 infection between February and April 2020. Demographic, clinical, analytical and treatment data were collected. Stata 15.1 was used to perform statistical analysis.

Results

91 patients were included. 55 suffered from a rheumatic disease and 36 suffered IBD. Univariable analysis reached age, comorbidity, female gender, flu vaccine, arthropathy, basal csDMARD, pneumonia and basal CRP as potential predictors of non-severe (absence of death, respiratory insufficiency, intensive care unit admission or sepsis) COVID-19 disease (p < 0.2). After multivariable analysis, only female gender (OR 4.60 [CI95% 1.00, 21.2] p=0.050), lower age (OR 0.94 [CI95% 0.88, 1.00] p=0.042) and lower basal levels of CRP (OR 0.87 [CI95% 0.77, 0.97] p=0.010) were predictors for non-severe disease (p < 0.005). Mean time of healing (symptoms solved in outpatient and hospital discharge in admitted) from COVID-19 was 13.8 days (SD 16.3). Univariable analysis showed arthropathy, COVID-19 symptomatic and basal GC dose as potential predictors of higher time-to-healing from COVID-19 disease (p < 0.2). After multivariable analysis, only lower GC basal dose predicts higher time-to-healing (OR -1.83 [CI95% -2.81, -0.84] p=0.001).11 patients deceased because of SARS-CoV-2 infection. Univariable analysis reached age, basal csDMARD, pneumonia and basal CRP as potential predictors of COVID-19 mortality (p < 0.2). After multivariable analysis, only higher age was a predictor for mortality (OR 1.14 [CI95% 1.04,1.25] p=0.006).

Conclusion

IMID patients showed similar predictors of mortality than general population involving COVID-19. Immune-modulating agents did not seem to overshadow the prognosis of COVID-19 infection. Female gender, lower age and lower basal CRP is associated with mild COVID-19 disease as well higher age points out the worst prognosis. Even that, each case should be individualized.
P208 Differentiating intestinal tuberculosis from Crohn’s Disease: External validation of a new nomogram
Authors: Dahmani W , Sahar N , Ay H , Nour E , Wafa B A , Aida B S , Ahlem B , Mehdi K , Hanene J , Ali J
Published: May 2021

Background

Intestinal tuberculosis (IT) poses a real problem of differential diagnosis with Crohn’Disease (CD). Indeed, the distinction between these two pathologies represents a real challenge for clinicians because of their multiple similarities. Based on simple biological, endoscopic and radiological criteria, A new nomogram was developed by Yao He et al. who would differentiate between the two diseases.

Objective

To validate externally this new nomogram in a series of patients with IT and CD.

Methods

We have collected retrospectively patients diagnosed with CD and IT in our center for a period 11 years old. Patients whose medical file included the data used in the nomogram have been included. The discrimination performance of the nomogram was evaluated by calculating the area under the ROC curve.

Results

Of the 76 included patients, 16 had one IT and 60 had one CD. The average age of patients with IT was 44.76 ± 19 years old. The most frequent revealing symptoms were subocclusive syndromes (n = 10) followed by abdominal pain (n = 8). Endoscopic lesions were located in the majority of cases in the ileocecal region (n = 12) and were dominated by the retracted aspect of the cecum (n = 5), transverse colonic ulcerations (n = 4) and valvular stenosis (n = 2). A tumor appearance was noted in two patients.The radiological images of the lungs suggestive of pulmonary tuberculosis were found only in two patients. Intradermal reaction (IDR) to tuberculin was positive in all cases where it was practiced. (n = 14). In ten cases, the diagnosis of ITwas made following bowel resection whose indications were diagnostic uncertainty (n = 4), acute bowel obstruction (n = 4) and suspected CD ileocecal refractory to medical treatment (n = 2). The discrimination of the nomogram analyzed by the ROC curve was 0.956 (95% CI [0.875; 1]). A threshold of 0.5 was associated with a sensitivity of 98.3%; a specificity of 92.8% and a positive and negative predictive value for the diagnosis CD of 98.3 and 92.8 respectively.

Conclusion

Although Tunisia is a country of strong endemicity for tuberculosis, intestinal localization seems infrequent and misdiagnosed. The nomogram applied seems to have excellent performance diagnose what could prevent resections intestinal for diagnostic purposes. However, studies multicenter prospective studies remain necessary for a large-scale validation.
P212 Assessment of Crohn’s disease activity using global MaRIA score in patients with ileal and ileocolonic disease
Authors: Hrabric Sonje K , Domislović V , Brinar M , Cukovic-Cavka S , Turk N , Grgic D , Sjekavica I , Krznaric Z
Published: May 2021

Background

Magnetic resonance index of activity (MaRIA) is composed of features independently associated with endoscopic disease activity and is surrogate marker of disease activity. The aim of this study was to evaluate correlation of global MaRIA (gMaRIA) with clinical and biochemical disease activity indices and diagnostic accuracy for active disease in patients with terminal ileum disease and ileocolonic disease.

Methods

This is a cross-sectional study which included 251 patients with diagnosed CD. Global MaRIA (gMaRIA) index was calculated on 6 bowel segments (the distal ileum, ascending, transverse, descending, sigmoid colon and rectum) using following parameters: bowel wall thickness, ulcers, edema and relative contrast enhancement. Disease activity was defined as combination of clinical and biochemical disease activity (CRP>5 or HBI≥5). Disease extension was classified using Montreal classification (L1 ileum, L2 colon, L3 ileum and colon).

Results

This study included 251 CD patients [age 35 (25–47), 55.3% males, BMI 21.8 (18–25) kg/m2, median disease duration 7 (2–15) years]. Ileal disease (L1) was present in 84 (33.5%) and ileocolonic disease (L3) in 151 (60.1%) patients. Correlation of gMARIA with biochemical indices of disease activity (CRP) was r=0.48, p<0.001 and with HBI r=0.33, p<0.001. Diagnostic accuracy of gMARIA in defining active disease in patients with L1 disease was considerably high [AUC 0.83 (95%CI 0.72–0.91)]. On the other hand, diagnostic accuracy in defining active disease in patients with L3 disease was good [AUC 0.71 (95%CI 0.62–0.79)], which is lower compared to L1 disease. In surgically naïve patients diagnostic accuracy of L1 disease was [AUC 0.88 (95%CI 0.72–0.96)], and for L3 disease [AUC 0.78 (95%CI 0.64–0.89)].

Conclusion

Global MaRIA index showed higher diagnostic accuracy in detecting clinically and biochemically active disease in terminal ileum compared to ileocolic disease. These results emphasize the important role of magnetic resonance enterography in monitoring disease activity in patients with isolated ileal disease. Global MaRIA score correlates better with biochemical disease activity compared to clinical disease activity, which points out to the significance of biochemical remission.
P215 Blood-based prognostic biomarkers in Crohn’s patients treated with biologics: a new promising tool to predict endoscopic outcomes
Authors: Grova M , Crispino F , Maida M , Renna S , Mocciaro F , Casà A , Rizzuto G , Scimeca D , Di Mitri R , Macaluso F S , Orlando A
Published: May 2021

Background

There is a growing need for biomarkers of inflammation to monitor and predict therapeutic outcome in Crohn’s disease (CD) patients. We aimed to evaluate whether the level of circulating blood cells, expressed as ratios (NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; ELR, eosinophil-to-lymphocyte ratio and ENLR, eosinophil*neutrophil-to-lymphocyte ratio), could be used as early prognostic biomarker of endoscopic response (ER) in patients starting biological therapy with infliximab, adalimumab, vedolizumab and ustekinumab. Association with steroid-free clinical remission at week 54 and endoscopic disease activity at baseline, as well as other variables related with ER were also evaluated as secondary outcomes.

Methods

Consecutive patients with CD who started biological therapy between June 2016 and July 2019 in two Italian tertiary centers were enrolled. We used multivariate analysis to evaluate whether NLR, PLR, ELR and ENLR at baseline and after 12 weeks of treatment could predict ER (SES-CD ≤ 2 or SES-CD ≤ 2 and Rutgeerts score i0-i1) after 54 weeks of treatment. Receiver operating characteristic (ROC) curves were generated to identify the area under the curve (AUC) and find the best cut-off values of NLR, PLR, ELR and ENLR for the prediction of ER. To enhance the diagnostic performance, these ratios were combined with baseline Harvey Bradshaw Index (HBI) in a prognostic model.

Results

107 patients were included. Patients who achieved ER had significantly lower baseline NLR (p = 0.025), ELR (p = 0.013) and ENLR (p = 0.021) compared with those without ER; similar results were confirmed after 12 weeks of treatment for ELR (p = 0.006) and ENLR (p = 0.026). AUC was 0.64 (p = 0.003), 0.67 (p = 0.006) and 0.65 (p = 0.014) for NLR, ELR and ENLR, respectively. The best cut-offs values were included in the HBI-based prognostic model: 81.8% of patients with HBI ≥ 5 and higher ratios did not achieve ER, while all patients with HBI < 5 and lower ratios reached ER. Interestingly, ENLR was found to be linearly associated with SES-CD at baseline (p = 0.035).

Conclusion

To the best of our knowledge, this is the first study assessing NLR, ELR and ENLR as predictive markers of therapeutic response in CD patients. Low levels of these ratios can predict endoscopic response and could be used in clinical practice for a better management of CD patients needing biological therapy. Further prospective studies are needed to confirm these results in larger cohorts.
P217 Clostridium Difficile Infection as a cause of severe outcomes in patients with Inflammatory Bowel Disease
Authors: Fadeeva N , Knyazev O , Parfenov A , Kagramanova A , Lishinskaya A , Babayan A , Danilov M , Dolgopyatov I
Published: May 2021

Background

The prevalence of Clostridium difficile infection (CDI) in patients with inflammatory bowel disease (IBD) is higher than in general population. CDI may produce a negative effect on the clinical course of IBD. The aim of the study was to define the frequency of CDI in patients with IBD and to study risk factors that predict severe outcomes associated with CDI in IBD patients.

Methods

1278 medical records were analyzed in a retrospective study of patients with IBD, of which 808 patients met the inclusion criteria. Patients were divided into 2 groups based on the presence of a preliminary diagnosis of CDI. Our primary outcome was time to total colectomy or death with follow-up censored at 180 days after CDI. Statistical analysis was carried out using Pearson Chi-square and two-sample t-test.

Results

The frequency of CDI in patients with IBD was 17.6%. The mean age of occurrence of CDI in patients with IBD was 37.8±12.9. The first group included 143 patients CDI+IBD, and the second group - 665 patients IBD without CDI. In the first group C-reactive protein, erythrocyte sedimentation rate and fecal calprotectin levels were significantly higher and albumin level was lower than in the second group (р<0.05). The average albumin level in the first group was 20.8±1.83 mg/l, in the second group – 38.7±2.36 mg/l (р<0.05). Only 25.3% of all patients with CDI had a history of antibiotic use, and 30.4% had previously used steroids. Long-term immunosuppressive therapy in patients with IBD has an impact on the development of CDI: among patients with CDI 48.7% long-term received azathioprine/6-mercaptopurine, in patients without IBD – 18.3% (p<0.001). Only 19% of patients with CDI had control of the disease with salicylate therapy, while 62% of patients without CDI achieved remission by taking salicylates (p<0.05). Of these, 7 patients (4.9%) met our primary outcome (1 death, 6 colectomy) at a median of 21 days. On multivariate analysis, serum albumin<22 mg/L (HR 7.93, 95% CI 1.006–62.57), was independent predictors of our primary outcome.

Conclusion

The frequency of CDI in patients with IBD was 17.6%. The study shows that patients with IBD are more sensitive to the development of CDI at a young age, while not having such traditional risk factors as recent hospitalization or antibiotic use. Patients with IBD with CDI in history often noted the ineffectiveness of therapy with salicylates; often require the assignment of biological therapy. IBD patients with CDI have a lower average albumin, and a higher activity of the inflammatory process (p<0.05). Serum albumin<22 mg/L was independent predictors of severe outcomes in hospitalized IBD patients with CDI.