bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Hybrid Intelligent Text Watermarking and Natural Language Processing Approach for Transferring and Receiving an Authentic English Text Via Internet
Authors: Hilal Anwer Mustafa , Al-Wesabi Fahd N , Abdelmaboud Abdelzahir , Hamza Manar Ahmed , Mahzari Mohammad , Hassan Abdulkhaleq Q A 
Published: May 2021

Abstract
Due to the rapid increase in the exchange of text information via internet networks, the security and the reliability of digital content have become a major research issue. The main challenges faced by researchers are authentication, integrity verification, and tampering detection of the digital contents. In this paper, a Robust English Text Watermarking and Natural Language Processing Approach (RETWNLPA) is proposed based on word mechanism and first level order of Markov model to improve the accuracy of tampering detection of sensitive English text. The RETWNLPA approach embeds and detects the watermark logically without altering the original text document. Based on the hidden Markov model (HMM), the first-level order of word mechanism is used to analyze the interrelationship between English text. The extracted features are used as watermark information and integrated with text zero-watermarking techniques. To detect eventual tampering, RETWNLPA has been implemented and validated with attacked English text. Experiments were performed on four datasets of varying sizes under random locations of common tampering attacks. The simulation results prove the tampering detection accuracy of our method against all kinds of tampering attacks. Comparison results show that RETWNLPA outperforms baseline approaches HNLPZWA (an intelligent hybrid of natural language processing and zero-watermarking approach) and ZWAFWMMM (Zero-Watermarking Approach based on Fourth level order of Word Mechanism of Markov Model) in terms of tampering detection accuracy.
The Reliability of Patient Self-reported Utilization in an Inflammatory Bowel Diseases Learning Health System
Authors: van Deen Welmoed K , Freundlich Noah , Kwon Michelle H , Patel Devin B , Crate Damara J , Oberai Ridhima , Shah Samir A , Hwang Caroline , Weaver S Alandra , Siegel Corey A , Melmed Gil Y 
Published: May 2021

Abstract

Background
Inflammatory bowel disease (IBD) care is beset with substantial practice variation. Learning health systems (LHSs) aim to learn from this variation and improve quality of care by sharing feedback and improvement strategies within the LHS. Obtaining accurate information on outcomes and quality of care is a priority for LHS, which often includes patients’ self-reported data. While prior work has shown that patients can accurately report their diagnosis and surgical history, little is known about their ability to self-report recent healthcare utilization, medication use, and vaccination status.

Methods
We compared patient self-reported data within the IBD Qorus LHS regarding recent IBD-related emergency department (ED) visits, hospitalizations, computerized tomography (CT) scans, corticosteroid use, opioid use, influenza vaccinations, and pneumococcal vaccinations with electronic health record (EHR) data.

Results
We compared 328 patient self-reports to data extracted from the EHR. Sensitivity was moderate-to-high for ED visits, hospitalizations, and CT scans (76%, 87%, and 87%, respectively), sensitivity was lower for medication use with 71% sensitivity for corticosteroid use and only 50% sensitivity for self-reported use of opioids. Vaccinations were reported with high sensitivity, but overall agreement was low as many patients reported vaccinations that were not registered in the EHR.

Conclusions
Self-reported IBD-related ED visits, hospitalizations, and CT scans are reported with high sensitivity and accuracy. Medication use, and in particular opioid use, is less reliably reported. Vaccination self-report is likely more accurate than EHR data as many vaccinations are not accurately registered.
Serum Ustekinumab Concentrations Are Associated With Remission in Crohn’s Disease Defined by a Serum-Based Endoscopic Healing Index
Authors: Walshe Margaret , Borowski Krzysztof , Battat Robert , Hudesman David , Wolf Douglas C , Okada Lauren , Jain Anjali , Silverberg Mark S 
Published: May 2021

Abstract

Background
Optimal ustekinumab levels (UST) in Crohn disease (CD) treatment have not been defined. We set out to define the optimal UST to differentiate between remission and active CD, as defined using the serum-based endoscopic healing index (EHI).

Methods
Paired serum UST and EHI tests were analyzed. Remission was defined as EHI &lt;20. Active disease was defined as EHI ≥50. The proportion of patients in remission was compared across UST quartiles. UST in subjects with EHI &lt;20 and EHI ≥50 were compared. An area under receiver operating characteristic curve was generated to identify an optimal UST to differentiate between active disease and remission.

Results
A total of 337 unique patients were identified; median UST and EHI were 5.0 µg/mL [interquartile range (IQR) 2.7–9.1] and 37 (IQR 26–53), respectively. EHI &lt;20 (remission) was found in 57 (16.9%) patients. EHI ≥50 (active disease) was found in 97 (28.8%) patients. Higher proportions of subjects were in remission for increasing UST quartiles, P = 0.01. Median UST in patients with EHI &lt;20 and EHI ≥50 were 7.5 µg/mL (IQR 4.6–10.9) and 3.1 µg/mL (IQR 1.8–6.6), respectively, P &lt; 0.001. An UST threshold of 3.75 µg/mL optimally differentiated between active disease and remission (area under the curve 0.725). UST levels &gt;3.75 µg/mL were associated with a lower proportion of subjects with active disease (EHI ≥50; 18.9%) compared with UST levels ≤3.75 µg/mL (45.6%, P &lt; 0.001).

Conclusions
Using the EHI, we identified a threshold UST level of 3.75 µg/mL to optimally differentiate between active and quiescent CD. These data suggest that UST serum concentrations of &gt;3.75 µg/mL are optimally associated with endoscopic remission in CD.
DOP06 Histologic activity in Ulcerative Colitis patients achieving endoscopic healing is associated with higher rate of relapse and a distinct mucosal microbial and transcriptional profile
Authors: Hernandez-Rocha C , Turpin W , Nayeri S , Borowski K , Stempak J , Conner J , Silverberg M S 
Published: May 2021

Abstract

Background
Histologic remission (HR) in ulcerative colitis (UC) has been associated with better clinical outcomes. However, this therapeutic target is hard to achieve with the available medications. We aim to assess the relapse-free survival (RFS) of patients with persistent histologic activity (HA) upon achieving endoscopic healing (EH) and the microbial and molecular signatures associated with this condition.

Methods
Left-sided and extensive UC patients and healthy controls (HC) were recruited at colonoscopy and sigmoid colon (SC) biopsy samples were obtained for HA evaluation, 16S rRNA sequencing and host RNA-seq. EH was defined as Mayo endoscopic subscore (MES) 0–1, and HA and histologic remission (HR) as the presence and absence of neutrophil infiltration, respectively. UC relapse was retrospectively evaluated and defined as symptomatic and endoscopic worsening. Cumulative RFS was assessed by log-rank test. Principal component analysis (PCA) was used for capturing cluster structure. For differential expressed genes (DEG) and enrichment pathway analyses, glmQLFTest in EdgeR and enrichKEGG in clusterProfiler were applied, respectively. Genes with log fold change &gt; 2 and a log count per million &gt; 1 were considered DEG. Dada2 algorithm in QIIME2 for amplicon sequence variant generation and ANCOM-BC package for differential abundance (DA) taxa analysis were applied. P-values of omics data were corrected by false discovery rate (FDR) method.

Results
Sixty-five UC patients had EH (37 MES 0 and 28 MES 1). Nine (20.9%) MES 0 and 17 (40.5%) MES 1 showed HA. Over a median follow-up of 4.2 years (IQR 2.6–6.1), UC patients with HA showed a significant lower RFS compared to HR (p &lt; 0.05; Figure 1). This difference was not observed between MES 0 and MES 1 (p = 0.2). Transcriptomics data was available for 27 samples with HR and 9 samples with HA, as well as 43 HC and 13 MES 2–3 samples. PCA showed that HR and HA samples cluster with HC and MES 2–3 samples, respectively (Figure 2). Compared to HR, 163 DEG (118 up and 45 downregulated) were found in HA. Enrichment analysis showed significant upregulation of cytokine-cytokine interaction, Th17 and chemokine signaling pathways (Figure 3). Microbiome data was available for 43 and 19 samples with HR and HA, respectively. Three genera had significant DA in HA compared to HR (Figure 4).

Conclusion
HA in UC is better than MES at distinguishing a higher risk of relapse and has a transcriptomics profile closer to active endoscopic disease despite EH with significant upregulation of chemokine, cytokine and Th17 pathways. A different microbial signature is also observed in HA. These particular signatures could help to define strategies to reduce the risk of UC relapse in patients achieving EH.
P183 Risk of eating disorders in italian children and adolescents with Inflammatory Bowel Disease: results of a multicenter nationwide study
Authors: Gatti S , Vallorani M , Zoppi E , Palego G , Aloi M , Bramuzzo M , Felici E , Zuin G , Borali E , Catassi G , Grazian F , Quagliarella A , Catassi C 
Published: May 2021

Abstract

Background
The prevalence and risk of Eating Disorders (ED) in IBD, despite the potential overlap of these two conditions, have been rarely reported. ED diagnosis should be considered in patients with IBD and multidisciplinary approach would be recommended in these complex cases to provide an adequate therapeutic intervention. Screening tools to evaluate eating attitudes and behaviours in patients with IBD could be used in daily practice, as for example the Eating Attitude Test – 26

Methods
Children and adolescents (8–18 years) with IBD and age and gender matched healthy controls were prospectively enrolled in 5 italian pediatric IBD units between June 2019 and August 2020. Subjects with an existing diagnosis of ED were excluded. The risk of ED was assessed using a 26 points Likert scale screening tool (CH-EAT-26 and EAT-26 for children &lt; and &gt; 14 years respectively), with a total score of 20 or above indicating a risk for ED. Correlations between clinical and disease’s parameters and the CH-EAT-26/EAT-26 score were calculated

Results
110 patients with IBD and 110 age and matched healthy controls were screened with the CH-EAT26/EAT-26 questionnaire. The total EAT26 scores and the prevalence of an at-risk score (score&gt;20) did not differ in IBD subjects compared to controls. IBD patients were more frequently on an exclusion diet with lactose free-diet being the most common regimen. Furthermore, 8.1% of IBD children was on a partial enteral nutrition (PEN). In IBD subjects elevated scores on the Ch-EAT26/EAT-26 were associated with being younger (r=-0,2226, p=0.002), following an exclusion diet (r=0.25, p=0.009) and a partial enteral nutrition (PEN: r=0,2507, p=0.009). Type, duration and activity of disease, gender, weight, height and BMI z-scores were not significantly correlated to the CHEAT26/EAT-26 score. Being on a PEN and following an exclusion diet were the only independents factors influencing the EAT26 score at the multiple regression analysis (p= 0,004; p= 0,034; R2 = 0,25)

Conclusion
Our results indicate that 5.45% of IBD children have a behavior at risk for developing an ED, a percentage that is not statistically different compared to healthy controls. A particular follow-up should be reserved to patients on restricted diets and on partial enteral nutrition, that can develop maladaptive attitudes toward eating. The development of a disease specific tool or a validation of pre-existing questionnaires would help to identify a robust screening instrument and ultimately to correctly classify the risk of patients. Once the risk is correctly assessed it is mandatory to address the patient to a specific multidisciplinary follow-up.
P203 Sexual Dysfunction in Chronic Inflammatory Bowel Disease: Myth or Reality?
Authors: Hassine A , Hammami A , Ben Ameur W , Dahmani W , Elleuch N , Jaziri H , Ben Slama A , Braham A , Ksiaa M , Bannour R , Jmaa A 
Published: May 2021

Abstract

Background
Sexual dysfunction is often associated with impaired body image and quality of life in patients. However, little data exists on sexual dysfunction (SD) in patients with Chronic Inflammatory Bowel Disease (IBD). The aim of this study was to assess the prevalence and risk factors for sexual dysfunction in patients with IBD.

Methods
This is a cross-sectional study of all patients followed for IBD. Sexual function was assessed by the Female Sexual Index Function (FSIF) for women and the International Index of Erectile Function (IIEF) for men. Sexual dysfunction was confirmed when the total FSIF score was less than 26, or the IIEF score less than 26. Crohn’s disease (CD) activity was assessed by the Harvey-Bradshaw index (HBI), and that of ulcerative colitis (UC), by the clinical Mayo scores.

Results
We collected 100 patients, with a mean age of 42.18 ± 15.71 and a sex ratio (M / F) = 1.5. Sixty eight patients had CD and 32 patients had UC. Ano-perineal manifestations were present in 38.2% of cases. Severe disease activity was noted in 14 patients (20.6%) with CD and 10 patients (31.3%) with UC. Twelve patients had proctitis. 38% of patients had surgical treatment: 18.75% for patients with UC and 47.05% for those with CD. Total colectomy was performed in 12% of cases. At the time of the study, 20% of patients were on systemic corticosteroid therapy, 22% on Azathioprine, 4% on Salazopyrine, 8% on 5-ASA and 46% on Anti-TNFα. Sexual dysfunction was reported by 42.9% of women: 57.14% (UC) vs 38.46% (CD) (p = 0.042). On the other hand, sexual dysfunction was reported by 27.6% of men: 22.2% of men with UC and 28.57% with CD, with no statistically significant difference (p = 0.78). A significant association was found between sexual dysfunction and the degree of disease activity (p &lt;0.001 for CD, p = 0.003 for UC), as well as pancolitic involvement in women with UC (p = 0.002). However, the presence of anoperineal manifestations, rectal involvement and history of surgery were not significantly associated with the frequency of sexual disturbances.

Conclusion
Our study showed a high prevalence of sexual dysfunction in patients with IBD. Training gastroenterologists in the management of sexual dysfunction would make it possible to satisfy patient expectations.
P319 Impact of biological agents on postoperative complications in inflammatory bowel disease: a multicentre study of GETECCU
Authors: García García M J , Rivero M , Miranda-Bautista J , Bastón-Rey I , Mesonero F , Leo-Carnerero E , Casas-Deza D , Cagigas Fernández C , Martin-Cardona A , El Hajra I , Hernández-Aretxabaleta N , Pérez-Martínez I , Fuentes-Valenzuela E , Jiménez N , Rubín de Célix C , Gutiérrez A , Suárez Ferrer C , Huguet J M , Fernández-Clotet A , González-Vivó M , Del Val B , Castro-Poceiro J , Melcarne L , Dueñas C , Izquierdo M , Monfort D , Bouhmidi A , Ramírez De la Piscina P , Romero E , Molina G , Zorrilla J , Calvino-Suárez C , Sánchez E , Nuñez A , Sierra O , Castro B , Zabana Y , González-Partida I , Chaparro M , Gisbert J P 
Published: May 2021

Abstract

Background
It has been suggested that biologic therapy may increase the risk of postoperative complications in inflammatory bowel disease (IBD), but the evidence is scarce. Our aim was to evaluate whether the treatment with anti-TNF agents, ustekinumab or vedolizumab increase the risk of complications after surgery.

Methods
IBD patients undergoing intra-abdominal surgery between 1st January 2009 and 31st December of 2019 were retrospectively selected. Data collection included clinical characteristic of IBD, biochemical parameters and surgical aspects. Postoperative complications (PC) were defined as those occurring within 30 days after surgery. Exposed cohort (EC): Patients who received the last dose of the biologic within 3 months before surgery. Non-exposed cohort (NEC): Patients who did not receive biologic treatment within 3 moths prior to surgery. Predictive factors for PC and for infections were identified by logistic regression analyses. A genetic matching score was performed to balance the clinical characteristics of both groups.

Results
A total of 1,535 surgeries performed in 37 centres were included: 81% in Crohn’s disease, 18% in ulcerative colitis and 1% in unclassified-IBD patients. A total of 711 surgeries (46.3%) had been exposed to biologics (583 under anti-TNF therapy, 58 under vedolizumab and 69 under ustekinumab) and 824 surgeries (53.7%) the NEC. PC were reported in 38% (n=267) of patients in the exposed cohort and in 34% (n=280) of patients in the non-exposed one (p=0.15), including dehiscence, infection, obstruction, ileus, bleeding, thrombosis, fistula and evisceration. The most frequent complications were infections (48% of all the cases). A 30-day hospital readmission was needed in 7% (n=110) of the patients, and 2% (n=29) required a new surgery with no differences (p&gt;0.05). Multivariate analysis for PC and infections is presented in table 1. The frequencies of PC for each biologic in the univariate analysis are represented in figure 1. No specific treatment was associated to PC or infections in multivariate analysis.

Conclusion
Preoperative administration of biological therapy does not seem to be a risk factor for overall PC, although it may be for postoperative infections.
P364 Patient reported outcomes, partial MAYO score and SCCAI are equally accurate in predicting mucosal healing in UC: final results form a prospective study
Authors: Golovics P , Gonczi L , Reinglass J , Verdon C , Pundir S , Afif W , Wild G , Bitton A , Bessissow T , Lakatos PhD P L 
Published: May 2021

Abstract

Background
Optimal management of patients with ulcerative colitis (UC) requires the accurate assessment of disease activity. Endoscopic evaluation is considered the gold standard approach, but it is invasive. We aimed to determine how strong patient reported outcomes, clinical scores and symptoms correlate with endoscopy for assessment of disease activity in UC patients.

Methods
171 patients were included prospectively and consecutively (age: 49 (IQR: 38-61) years, duration 12 (4-19)years, 79 females (46.2%), 57.3% extensive disease, 42.7% on biologicals) at the time of the colonoscopy. The 2 item patient reported outcome (PRO), partial MAYO, Simple Clinical Colitis Activity Index (SCCAI), Mayo endoscopic subscore (MES), Baron and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) scores were calculated. C reactive Protein (CRP) and fecal calprotectin (FCAL) was available in 83 and 45.6% of patients. 17.0% had clinical flare, treatment was escalated in 14.6% of patients. Sensitivity, specificity, PPV and NPV values were calculated, ROC analysis and K-statistics were performed.

Results
Rectal bleeding (RBS), stool frequency (SF) subscore of 0, or total PRO2 remission (RBS 0 and SF ≤1), partial MAYO (≤2) and SCCAI (≤2.5) remission were similarly associated to mucosal healing defined by MES (0 or ≤1) or Baron (0 or ≤1) scores (Table 1).
PRO2 (AUCMES0/Baron0: 0.770/0.740, AUCMES0-1/Baron0-1: 0.868/0.858), SF (AUCMES0/Baron0:0.751/0.724, AUCMES0-1/Baron0-1:0842/0.820), RBS (AUCMES0/Baron0: 0.718/0.698, AUCMES0-1/Baron0-1: 0.814/0.845) partial Mayo (AUCMES0/Baron0: 0.823/0.788, AUCMES0-1/Baron0-1: 0.927/0.902) and SCCAI (AUCMES0/Baron0: 0.767/0.752, AUCMES0-1/Baron0-1:0.888/0.867) were similarly associated with mucosal healing in a ROC analysis.
There was a strict association between MES 0 and Baron 0 (k=0.917) and UCEIS &lt;4 and MES 0-1 (k=0.813), while moderate to fair agreement between UCEIS &lt;4 and MES 0 (K=0.471) or Baron 0 (K=0.414)/Baron 0-1 (K=0.353), and between MES 0-1 and Baron 0-1 (K= 0.350) scores.
Agreement between CRP and clinical remission or endoscopic healing (MES/Baron) was poor (K~0.2), while agreement between FCAL (&gt;100 or &gt;250) and RBS-PRO2 remission (K&gt;100 or &gt;250: 0.44-0.60) or pMAYO (K&gt;100 or &gt;250: 0.41-0.59) or MES/Baron 0 was moderate to good (K&gt;100:0.53-0.52 and K&gt;250:0.57-0.53).

Conclusion
We found no difference across accuracy of RBS, SF, PRO2, partial Mayo and SCCAI in predicting endoscopic healing. A strong association was found with high PPV for MES/Baron ≤1 and high NPV for MES/Baron 0. FCAL, but not CRP was associated to clinical and endoscopic remission.
P369 High prevalence of abdominal pain in Crohn’s Disease patients of the TRUST study cohort- Is there a connection to inflammatory activity?
Authors: Kugel T , Maaser C , Kucharzik T , Fischer I , Kolterer S , Hammer L , Rath S , Sturm A 
Published: May 2021

Abstract

Background
Pain is a debilitating symptom in many patients with Crohn’s disease (CD) both in flare and in remission [1]. However, pain is insufficiently understood and therefore often underrepresented in disease management [2]. Thus, it is of paramount importance to raise awareness for this common but insufficiently managed IBD symptom. With this analysis, we aimed to investigate (1) the prevalence of abdominal pain (AP) and (2) the correlation of AP with further parameters including inflammatory activity assessed by intestinal ultrasound (IUS), lab parameters and patient-well-being in CD patients of the TRUST study cohort.

Methods
We evaluated the prevalence of pain in 230 of 234 CD patients of the prospective, non-interventional, multi-centre TRUST study. At baseline, all patients were in clinical flare (Harvey-Bradshaw index (HBI) of≥7) and received treatment intensification. IUS parameters such as bowel wall thickness (BWT) and clinical data were assessed at baseline and after 3, 6, and 12 months. AP was analysed using the HBI subscore 2. To investigate the connection between AP and inflammation, AP was correlated with BWT and C-reactive protein (CRP).

Results
Based on the TRUST study, we found that 95.2% of patients in clinical flare experienced AP. AP was significantly reduced within 12 weeks after treatment intensification (p &lt; 0.001) but 30% (n=69) to 48.3% (n=111) of patients still experienced AP at the subsequent visits (p(T1-T2) = 0.668; p(T2-T3) = 1.000) (figure 1). Of note, 35.6%-42.5% of patients with clinical response had a lasting pain experience (figure 2). AP positively correlated with poor well-being which is in line with previously published results [3]. We found a weak positive correlation between AP and inflammatory activity, represented by BWT (not shown), and between AP and CRP (table 1).

Figure 1: Percentage of patients with mild, moderate or severe abdominal pain during the study. *Friedman test with post-hoc Wilcoxon tests.

Figure 2: Percentage of patients with abdominal pain and clinical response (reduction of total HBI≥3 points) at the indicated visit
Table 1: Spearmann rank correlations for abdominal pain vs. poor general well-being (as measured by the HBI subscore 1) and vs. CRP at baseline

Conclusion
Our results clearly demonstrate that more than 1/3 of CD patients suffers from AP despite treatment intensification and clinical improvement. We found a weak correlation between AP and markers of inflammatory activity suggesting the existence of a subgroup of patients with persistent pain experience even with IBD treatment. Our data emphasize the importance of adjuvant pain management in IBD.

References