bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tiempos de Guerra. El soldado que salvó Spielberg
Authors: Camaño Puig Ramón E. , Almudéver Campo Laura 
Published: December 2019

Durante la Segunda Guerra Mundial, concretamente tras el Desembarco de Normandía, unos soldados norteamericanos capitaneados por Jonh Miller deben arriesgar sus vidas para salvar al soldado James Ryan, cuyos tres hermanos han muerto en la guerra. Lo único que se sabe del soldado Ryan es que se lanzó con su escuadrón de paracaidistas detrás de las líneas enemigas. El jefe del estado mayor ha ordenado devolverlo a su hogar, en Iowa, donde lo espera su desconsolada madre.Se trata de un filme bélico donde la muerte está siempre presente y en la cual, el soldado Ryan rememorará todas las vicisitudes por las que tuvieron que pasar los soldados para salvarlo.
P015 Persistent Disparities in Colectomy Rate in Ulcerative Colitis
Authors: Bhurwal Abhishek , Seril Darren 
Published: December 2019

BACKGROUND:
Colectomy is a curative treatment modality for ulcerative colitis (UC). Racial disparities have been described for colectomy in UC patients prior to the advent of anti-tumor necrosis factor (TNF) alpha agents. The goal of this study was to characterize racial and geographic trends in colectomy rates among hospitalized UC patients during the era of anti-TNF alpha agents.

METHODS:
A retrospective study was conducted utilizing the 2008–2014 National Inpatient Sample (NIS) database. Included were hospital discharges between the years 2010 and 2014, within the age range of 5–80 years, and with a primary diagnosis of UC identified by ICD-9-CM code of 556.x or primary diagnosis of complication of UC with a secondary or tertiary diagnosis of UC. Hospital administrative data were utilized to derive data for race and ethnicity and categorized into non-Hispanic white, African American, Hispanic, Asian or Pacific Islander, Native American, or other. ICD-9-CM procedure code 45.8 was applied to identify colectomy. Colectomy rates, in-hospital mortality, and length-of-stay were calculated for non-Hispanic whites, African Americans, and Hispanics. Data were analyzed with the Stata.

RESULTS:
The national estimate of the unadjusted colectomy rate among hospitalized UC patients between 2010 and 2014 was 3.90 per 1000 hospitalization days (95% confidence interval [CI] 3.72–4.08). The crude colectomy rates in African Americans (2.33) and Hispanics (3.99) were significantly lower than that of non-Hispanic whites (4.35, P < 0.001 and P < 0.009, respectively). After multivariate adjustment for confounders, the incidence rate ratio for African American versus whites was 0.43 (95% CI 0.32–0.58; P < 0.001). Medicare insurance was associated with a lower colectomy rate compared to possession of private insurance (3.83 vs 5.17; P < 0.0001). Assessment of colectomy rate by geographic region showed higher rates in the West (4.76) and Midwest (5.12) compared to the Northeast (3.20, P < 0.001 and P < 0.001, respectively).

CONCLUSION(S):
The nationwide rate of colectomy among hospitalized UC patients continues to vary significantly by race and geographic region in the era of anti-TNF alpha agents. Our analysis suggests that colectomy rates among hospitalized African Americans and Hispanics were lower than those of non-Hispanic whites during the 5-year period studied. There are multiple possible factors contributing to the observed racial differences in colectomy rates for UC, including differences in access to and utilization of healthcare resources, type of health insurance, and ethnic variation in healthcare literacy and attitudes toward the healthcare field. Further studies are needed to further elucidate the social and biologic underpinnings of these variations.
P025 Simplify in Capsule Endoscopy – TOP100 is a Swift and Reliable Evaluation Tool for the Inflammatory Activity in Crohn’s Disease
Authors: Freitas Marta , Arieira Cátia , Boal Carvalho Pedro , Bruno Rosa , Moreira Maria João , Cotter José 
Published: December 2019

BACKGROUND:
Capsule endoscopy is a widely recognized method to study the small bowel, including in patients with suspected or established Crohn’s Disease (CD). The Lewis Score (LS) is a valuable tool in this setting, able to assess inflammatory activity. TOP 100, a new software tool of the RAPID Reader, emerged with the purpose of assisting in the time-consuming capsule reading process, by automatically selecting 100 images that will most likely contain abnormalities.

AIM:
Evaluate the agreement between TOP 100 and classic reading (CR) in determining LS in the setting of suspected or established CD.

METHODS:
Retrospective study including consecutive patients undergoing small bowel capsule endoscopy (SBCE) for suspected or established CD. One experienced reader performed CR, reported findings and calculated the LS. Another experienced reader, blinded to the CR results, reviewed all SBCE videos using TOP 100 and calculated the LS.

RESULTS:
One hundred fifteen patients were included, 86 females (74.8%), mean age of 36.2 ± 12.1 years. Eighty-one patients (70.4%) performed SBCE for suspected CD and 34 (29.6%) for established CD. SBCE detected significant inflammatory activity (LS ≥ 135) in 64 patients (55.2%). We verified a strong agreement between the two methods of capsule reading (Kappa = 0.83, P < 0.001), with an agreement on 89.6% of the cases. They agreed in 83.6% of SBCE with insignificant inflammatory activity (LS < 135) (Kappa = 0.83, P < 0.001), 76.4% in mild inflammatory activity (135 ≤ LS < 790) (Kappa = 0.78, P < 0.001) and 86.7% in moderate to severe disease (LS ≥ 790) (Kappa = 0.92, P < 0.001). All cases of moderate to severe inflammatory activity detected by CR were identified by TOP 100 as significant (LS ≥ 135) inflammatory activity. A good agreement was verified in all tertiles (P < 0.001).

CONCLUSION(S):
Although the classical review of the entire video remains the gold standard, the TOP 100 has been shown to be a useful tool in assisting the reader in a prompt calculation of LS, in particular for identifying patients with moderate to severe inflammatory disease.
P027 Could Fecal Calprotectin Guide the Therapeutic Regimen of Infliximab in Inflammatory Bowel Disease?
Authors: Freitas Marta , Magalhaes Rui , Dias de Castro Francisca , Moreira Maria João , Cotter José 
Published: December 2019

BACKGROUND:
Infliximab is a monoclonal antibody against tumor necrosis factor α approved for induction and maintenance of remission in inflammatory bowel disease (IBD). Therapeutic monitoring, with determination of infliximab levels, allows to guide therapeutic decisions and helps to prevent loss of response.

AIM:
To identify predictive factors of non-therapeutic infliximab levels (<0.50 µg/mL) in IBD patients.

METHODS:
Retrospective single-center study including patients treated with infliximab with at least one determination of infliximab levels and with a minimum follow-up of six months. Clinical and demographic data obtained included disease phenotype, surgical background, duration of infliximab therapy, presence of anti-infliximab antibodies at the time of analysis, concomitant immunomodulator therapy, compliance, occurrence of an infusion reaction and biochemical assessment at the time of first induction infusion.

RESULTS:
104 patients were included, 56 females (53.8%) with a mean age of 38.2 ± 13.1 years. The overall prevalence of non-therapeutic infliximab levels was 29.8%. In the majority (90.4%) of the patients, the first determination was performed during maintenance therapy. 29.0% of the patients with non-therapeutic levels had simultaneously positive antibodies, and of the remainder, 27.3% acquired antibodies in a subsequent analysis. It was found that patients with non-therapeutic levels had significantly higher fecal calprotectin values at the initiation of treatment with infliximab (1184 ± 679 vs 708 ± 621, P = 0.02). No statistically significant association was found with other analytical parameters, like haemoglobin (12.7 ± 1.7 vs 12.9 ± 1.6, P = 0.55), C-reactive protein (11.2 ± 12.2 vs 15.9 ± 20.0, P = 0.22), sedimentation rate (22.4 ± 20.7 vs 23.7 ± 19.3, P = 0.76), ferritin (138.3 ± 128.2 vs 165.5 ± 166.6, P = 0.42) or albumin (3.50 ± 0.45 vs 3.56 ± 0.47, P = 0.54).

CONCLUSION(S):
Patients with non-therapeutic levels of infliximab have higher values of calprotectin prior to treatment, which may be related to increased inflammatory activity. In these cases infliximab regimens with higher and/or more frequent doses may be considered.
P028 The Use of Combination Biologic or Small Molecule Therapy in Inflammatory Bowel Disease: A Retrospective Cohort Study
Authors: Glassner Kerri , Oglat Ayah , Duran Antonio , Koduru Pramoda , Perry Caroline , Wilhite Amanda , Abraham Bincy 
Published: December 2019

BACKGROUND:
There is limited data on the use of more than one biologic or small molecule in the treatment of patients with inflammatory bowel disease (IBD). The aim of our study was to determine the effectiveness and safety of combining two or more biologics or a biologic and small molecule in patients with IBD.

METHODS:
We collected data on 50 patients with Crohn’s disease (CD) or ulcerative colitis (UC) who received treatment with a combination of two biologics or a biologic and small molecule from 2015 to 2019 for persistent disease activity or concomitant rheumatologic or dermatologic disease. Combinations included vedolizumab (VDZ) with either ustekinumab (UST) (n = 25), adalimumab (ADA) (n = 3), certolizumab (CZP) (n = 2), golimumab (GOL) (n = 2), or tofacitinib (TOF) (n = 8); or TOF with either infliximab (IFX) (n = 4), GOL (n = 4), CZP (n = 1), or UST (n = 3); or ADA and apremilast (n = 1). There were 3 patients who received more than one combination during follow up for a total of 53 combinations in 50 patients. Clinical scoring and inflammatory markers (ESR, CRP, hemoglobin, and albumin) were collected within one month prior to starting combination therapy (baseline) and at follow up (after at least two months on combination therapy). Endoscopic data was collected within 6 months prior to initiation of combination therapy and at follow up (after at least two months on combination therapy). Adverse events were documented.

RESULTS:
The mean age was 36.7 years, 68% were female, 76% Caucasian, with a disease duration of 14.8 years (2–48). Patients had failed therapy with an average of 2 previous biologic medications. There were significantly more patients in clinical and endoscopic remission at follow up, 50% vs 14%, P = 0.002, delta 33%; 95% CI 0.13–0.53, and 34% vs 6%, P = 0.004, delta 28%; 95% CI 0.09–0.47 respectively. The median ESR and CRP decreased, 17 vs 13, P = 0.002, and 5 vs 2.35, P = 0.002, respectively. The mean hemoglobin and albumin improved, 12.12 vs 12.6, P = 0.022, and 3.58 vs 3.79, P = 0.017. There were 8 serious adverse events (SAE), and no deaths. Of those with a SAE, 57% were on an immunomodulator compared to 17.4% of those without a SAE, P = 0.019.

CONCLUSION(S):
Combination biologic therapy is an effective option for IBD patients with refractory disease or concomitant autoimmune disease inadequately controlled by biologic monotherapy. There appears to be an increased risk of serious infection compared to biologic monotherapy, however this risk may be minimized by discontinuing immunomodulators prior to initiation of combination therapy. Larger prospective studies are needed to confirm these findings.
P044 Comparative Frequency of Adverse Events in Patients With Ulcerative Colitis, Receiving the Original Infliximab and Its Biosimilar
Authors: Knyazev Oleg , Shkurko Tatyana , Kagramanova Anna , Lishchinskaya Albina , Korneeva Irina , Zvyaglova Mariya , Kulakov Dmitriy , Parfenov Asfold 
Published: December 2019

BACKGROUND:
Biosimilars are analogues of biopharmaceutical drugs, with a close but not identical original molecule. They are modern drugs based on proteins obtained by biological synthesis in yeast and bacteria cells. Biosimilars offer greater access to affordable treatment for inflammatory bowel diseases, and they are comparable in efficacy and safety to the original drugs.

OBJECTIVE:
To identify the frequency of adverse events during the year of observation in patients with ulcerative colitis, receiving the original drug infliximab and its biosimilar.

METHODS:
In the Department of inflammatory bowel diseases from December 2017 to December 2018, 56 patients with UC were observed who received the original infliximab (IFX) for a long time (more than 5 years); 16 (26.6%) patients switched to the introduction of biosimilar; 13 bionic patients with UC were prescribed the original drug IFX, 29 patients biosimilar IFX. In 14 cases there was an alternation of the introduction of the original IFX and its biosimilar. Thus, the analytical group included 98 patients with UC receiving the original infliximab and its biosimilar. The comparative analysis was carried out by the method of four-field tables using nonparametric statistical criteria.

RESULTS:
During the year, adverse events (AE) of different clinical significance (urticaria, bronchospasm, nausea, headaches, anaphylactic shock) developed in 12 patients with UC. Among patients with UC, receiving the original IFX for a long time, AE for a year of observation was not observed. Of the 16 patients who switched to biosimilar administration, AE developed in 2/16 (12.5%) (OR-1.62; 95% CI 0.65–15.98; x2 -0.18, P = 0.673). Bioneurix among patients with UC who received the original IFX, AE occurred in 1/13 (7.7 %). Among bionaive patients with UC treated with biosimilar, AE also developed in 1/29 (3.5%) patient (OR-2.2; 95% CI 0.151–32.98; x2 -0.36, P = 0.852). Most AE (8 (66.7%)) developed in the case of alternating administration of the original IFX and its biosimilar (OR-7.4; 95% CI 1.1–51.5; x2 -9.9, P = 0.007).

CONCLUSION(S):
The frequency of adverse events in patients with UC regularly receiving the original IFX and its biosimilar does not differ. The frequency of adverse events in patients with UC when translated from the original IFX to its biosimilar IFX is not higher than in patients with UC, regularly receiving the original IFX. The frequency of adverse events is much higher in patients with UC, alternating the introduction of the original IFX and its biosimilar.
P049 Correlation of Surgical Pathology With Preoperative Colonoscopy in Patients With IBD
Authors: Seok Lee Hyun , Kim Kyeong Ok , Chiorean Michael , Boden Elisa , James Lord , Simianu Val 
Published: December 2019

BACKGROUND:
Previous studies have shown a very high rate of advanced neoplasia including cancer among patients referred for colectomy for dysplasia detected during surveillance colonoscopy. Our goal was to re-evaluate this correlation using a more recent cohort of patients from a single IBD center.

METHODS:
This is a single center, retrospective study of IBD patients who underwent colectomy for any indication from 1998 to 2017. Patients who underwent colonoscopy before colectomy were included. Demographic and clinical variables as well as the colonoscopy to surgery interval were collected from medical records. Pathological findings including location, lesion type and grade were compared between surgery and colonoscopy using the Spearman correlation index. Variables associated with discordant findings were also determined using regression analysis.

RESULTS:
A total of 192 patients with IBD (31.8% CD, 68.2% UC) underwent colectomy and all but 2 preceding colonoscopies were performed with white light (median interval t months, range s-z). All but 2 colonoscopies were performed with white light only. 52 patients had neoplasia in the resected specimen: 10 adenocarcinoma (Ca), 7 HGD, 30 LGD, 3 indefinite and 2 were sessile serrated lesion (SSL). Colonoscopy identified 4 patients with Ca, 4 with HGD, 1 LGD, and 1 SSL. The correlation between surgical and endoscopic pathological findings was modest (r = X, P = z). The following variables were associated with a missed diagnosis of advanced neoplasia during colonoscopy in univariate and multivariate analysis (a, b, c, d, e.g. male sex, moderate-severely active disease, standard vs. HD imaging and length of time between colonoscopy and surgery).

CONCLUSION(S):
These findings confirm a poor correlation between pre- and postoperative findings when using white light colonoscopy in patients with IBD. Image enhanced colonoscopy may reduce the rate of discordant results but this needs to be addressed in a prospective fashion.
P050 Endoscopic Balloon Dilation of Crohn's Disease Strictures With or Without Fluoroscopic Guidance
Authors: Hyun Seok Lee , Chiorean Michael 
Published: December 2019

BACKGROUND:
Strictures are common complications in Crohn’s disease (CD). CD-associated strictures are usually managed with medical, endoscopic, and surgical approaches, or combinations. Endoscopic therapy is easier to perform in experienced hand and helpful to avoid the need for surgery. In clinical practice, endoscopic balloon dilatation (EBD) under a fluoroscopic guidance is preferred. The use of fluoroscopy allows for the delineation of the stricture and the orientation of the entire balloon catheter. The use of fluoroscopy exposes the patient, the endoscopist, and the endoscopy nurses to excessive radiation. EBD is performed without fluoroscopic guidance in some cases. However, the benefit of fluoroscopic guidance for dilating CD strictures has not been readily demonstrated. The hypothesis of the study is that there are no significant differences in efficacy and safety between EBD with and without fluoroscopic guidance for CD strictures. The aim of this study is to compare efficacy and safety between EBD with and without fluoroscopic guidance for CD strictures.

METHODS:
We performed a retrospective review of EBD for CD strictures between 2016 and 2017. We investigated the technical success and clinical success as the efficacy in EBD with and without fluoroscopic guidance for CD strictures. Technical success was defined as the ability to pass the scope through the stricture after balloon dilation. Clinical success was defined as improved obstructive symptoms.

RESULTS:
A total of 43 patients with CD strictures were identified (11 at EBD with fluoroscopic guidance group and 32 at EBD without fluoroscopic guidance group). Technical success was achieved in 10 patients (90.9%) at EBD with fluoroscopic guidance and 32 patients (100%) at EBD without fluoroscopic guidance (P = 0.084). Clinical success was achieved in 4 patients (36.4%) at EBD with fluoroscopic guidance and 18 patients (56.2%) at EBD without fluoroscopic guidance (P = 0.255). Additional surgery was performed in 4 patients (36.4%) at EBD with fluoroscopic guidance and 8 patients (25.0%) at EBD without fluoroscopic guidance (P = 0.469). Secondary EBD was performed in 2 patients (18.2%) at EBD with fluoroscopic guidance and 6 patients (18.8%) at EBD without fluoroscopic guidance (P = 0.967).There were no serious complications in both groups.

CONCLUSION(S):
There were no significant differences in efficacy and safety between EBD with and without fluoroscopic guidance for CD strictures. EBD guidance for CD strictures could be safe and effective in the setting without fluoroscopic guidance.
P087 Prevalence and Risk Factors for Developing Anastomotic Ring Inflammation After Ileal Resection and Ileo-Colonic Anastomosis in Patients With Crohn’s Disease
Authors: Schwartz Michael , Stein Daniel , Beniwal-Patel Poonam , Patel Amir , Otterson Mary , Yarur Andres 
Published: December 2019

BACKGROUND:
The development of early inflammation proximal to the anastomosis in patients with Crohn’s disease that undergo ileal resection has a significant prognostic significance. However, many patients also develop inflammatory changes at the level of the anastomotic ring. The prevalence and significance of this findings is unknown. The aim of this study is to assess the prevalence and risk factors for developing anastomotic ring inflammation (ARI) in patients with Crohn’s disease after an ileal resection and ileo-colonic anastomosis.

METHODS:
In this retrospective cohort study we analyzed 91 patients with Crohn’s disease (CD) who underwent ileal resection and ileocolonic anastomosis and surveillance colonoscopy within 24 months. The patients were followed from time of surgery through up to four subsequent colonoscopes if applicable. A board certified gastroenterologist reviewed all the endoscopic images for the procedures done. The primary outcome was ARI (partial or full).

RESULTS:
The cohort population of 91 patients was 51.6% female. Twenty patients had ARI on the first surveillance colonoscopy (4 of the complete anastomotic ring and 16 partial), with an additional 13 developing inflammation at subsequent colonoscopies. The type of surgical anastomosis performed (end to end, end to side or side to side) was not associated with the development of ARI (P > 0.05 for all). There was no difference in time between bowel resection and endoscopic assessment between those patients with and without ARI (12 [IQR: 7-26] and 11 [IQR: 8-18] months respectively [P = 0.62]). There were no differences in median Rutgeerts score or simple endoscopic score (SES-CD) in patients that did present with ARI versus those who did not (median Rutgeerts score of 1 [IQR: 0-2] and 0 [IQR: 0-2] [P = 0.37], and median SES-CD of 2 (IQR: 0-3] and 0 [IQR: 0-4] respectively [P = 0.52]). There was also no association between the presence of ARI and active histologic inflammation in the ileum proximal to the anastomosis (P = 0.23). There was also no statistically significant difference in age at the time of surgery between those patients with and without ARI (median of 35 [IQR:28-42] and 36 [IQR: 27-52] years respectively [P = 0.7]). Starting post-operative prophylaxis for CD recurrence was not associated with a lower prevalence of ARI (OR: 0.26 [95% CI: 0.03-2.1]. P = 0.18).

CONCLUSION(S):
No demographic or phenotypic variables were associated with development of inflammatory changes at the level of the anastomotic ring. Furthermore, the presence of inflammation did not correlate with endoscopic CD disease activity. Studies looking into the long term clinical significance of ARI are warranted.