Central Europe Research Articles

Central European Elements in the Central Adriatic and its Hinterland in the Early Bronze Age – a Recapitulation

Research has shown a complementary image of three main elements as indications of contacts between the region of the central Adriatic and its hinterland with the cultures of the Early Bronze Age in Central Europe. They encompass the settlement material culture (Litzen pottery), military equipment or weapons (solid-hilted daggers), and attire (pins with an eyelet). On the basis of their typological analysis and distribution, which showed that they overlap each other spatially and temporally in certain segments, it can be concluded that within the framework of the Posuška/Posušje or Dinaric group, they are indicators of one and the same cultural and possibly migratory event occurring during the Early Bronze Age.

Sedimentology, lithostratigraphy, paleogeography and water level changes in a lacustrine basin: the depositional model of Lake Pannon

Advances in sedimentology and basin analysis provide the foundation for a comprehensive basin-fill model and lithostratigraphic framework of Lake Pannon, Central Europe, highlighting the dynamical changes of the depositional environments. The lake's ca. 8 Myr long evolution began with transgression and deepening, followed by normal regression, forming up to 7 km thick sediment fill. Initial coarse-grained coastal deposits are overlain by offshore to deep-water marls, with varying carbonate- and organic-matter content and include both anoxic laminites and sediment gravity-flow deposits. Later confined and unconfined turbidite systems developed due to interactions between basin-floor relief and shelf-slope progradation. Stacked deltaic cycles followed by clayey alluvial plain deposits with anastomosing and meandering sandy channel fills comprise the upper part of the succession. Repeated aggradational to progradational clinothem architectures, thickness and distribution of muddy to sandy delta lobes on the shelf, and distribution of turbidite lobes in the deep basins reflect lake-level fluctuations. While climate primarily controlled lake level, coastal sedimentation is identified as a new factor driving long-term lake-level rise. Therefore, Lake Pannon's stratigraphy demonstrates that, in contrast to marine systems, in supply-dominated endorheic lakes accommodation space is created by sedimentation.

Robotic Liver Resection for Hepatocellular Carcinoma: A Multicenter Case Series

Background: Liver resection is the standard treatment for resectable hepatocellular carcinoma (HCC). The advent of robotic surgery has extended its application in liver surgery, reducing post-operative complications without compromising oncological safety. This study is a retrospective series with the aim of analyzing the preoperative patient’s and tumor’s characteristics and evaluating intraoperative and post-operative data in terms of hospital stay, complications, and oncological radicality. Methods: Data were collected from a multicenter retrospective database that includes 1070 consecutive robotic liver resections (RLRs) performed in nine European hospital centers from 2011 to 2023. Of the entire series, 343 liver resections were performed for HCC. Results: A total of 247 patients (72.3%) had mono-focal lesions. Major hepatectomies and anatomical resections have been perfomed in 87% and 55% of patients, respectively. All 17 conversions (4.95%) were to the open approach. The operative mean time was 239.56 min and the estimated blood loss was 229.45 mL. The overall post-operative complication rate was 22.74%, but severe complications occurred in 4.08% of patients and one of them (0.29%) was reoperated on. The mean hospital stay was 5.82 days with a mean ICU stay of 0.9 days. Twenty-six resections (7.6%) were R1 parenchymal. Forty-six patients (4.08%) were readmitted to the hospital within 90 days after discharge and seventy-eight patients (22.74%) had disease recurrence. Total deaths included 36 (10.5%) patients with a 90-day mortality of 0.9%. Conclusions: Robotic liver resection for HCC is feasible and safe when performed in experienced centers by surgeons who have completed the learning curve.

Corrigendum to Three poorly known Acarosporaceae of Central Europe: new reports from Czech Republic, Germany, and Italy. Herzogia 37 (1), 2024: 5 –15

Corrigendum to Three poorly known Acarosporaceae of Central Europe: new reports from Czech Republic, Germany, and Italy. Herzogia 37 (1), 2024: 5 –15

Analysing the Impact of Entrepreneurship Education on Early-Stage Entrepreneurship—Focusing on the Transitional Countries of Central and Eastern Europe

Entrepreneurship is deeply rooted in tradition and culture in many countries; however, transitional market economies in Central and Eastern Europe (CEE) underwent 40–45 years of socialism, which disrupted these traditions by collectivising private property. Education is recognised as a key tool for regional development and restoring entrepreneurial knowledge and skills, potentially enhancing entrepreneurial intentions within society. This paper investigates the impact of entrepreneurial education on entrepreneurial activity in transitional CEE countries. Pearson’s correlation analysis was conducted using a combined national-level dataset from the Annual Population Survey (APS) and the National Expert Survey of the Global Entrepreneurship Monitor (GEM) spanning 2021–2023. Results reveal inconsistent findings across the years. In 2021 and 2022, there was a significant moderate correlation between total early-stage entrepreneurial activity (TEA) and an indicator of entrepreneurial education at primary and secondary levels in CEE countries. In contrast, no such relationship was observed in other regions. In 2023, however, no significant correlations were identified for any country group. These results highlight the temporal variability of education’s influence on entrepreneurship in transitional economies.

Successful Translocation of a Long‐Distance Migrating Passerine—New Impetus for the Conservation of the Globally Threatened Aquatic Warbler

ABSTRACTTranslocations are a conservation measure that is increasingly applied to assist the recovery of animal populations threatened with extinction. Long‐distance migrating passerines, however, have been rarely addressed in translocation projects so far. One such species is the globally threatened Aquatic Warbler Acrocephalus paludicola, a habitat specialist breeding in fen mires in Central Europe and wintering in sub‐Saharan Africa. The global breeding population has severely declined during the last decades due to habitat loss. Although the implementation of conservation measures has stopped the decline in the core breeding area, peripheral populations continue to decline. The aim of this pilot study was to reveal whether translocated Aquatic Warblers will return to a distant release site after wintering in Africa. Our translocation method is based on natal habitat imprinting of juvenile passerines before their first migration. In 2018 and 2019, 50 chicks (10–12 entire broods) each year were translocated 526 km from Belarus to Lithuania at an age of about 7 days and hand‐reared with predominantly wild insects captured in the surroundings of the release site. The survival rate of chicks until soft release from outdoor aviaries was 98% (49 fledglings released) in 2018 and 100% (50 fledglings released) in 2019. In 2019, 11 Aquatic Warblers (9 males, 2 females) were resighted at the release site after returning from wintering grounds. In 2020, nine birds (6 males, 3 females) were observed, including three males from the 2018 release cohort. An average apparent first‐year survival of 0.30 was estimated. The very successful outcome gives new impetus for the restoration prospects of declined populations of the Aquatic Warbler to halt extinction at the margins of the breeding range.

Hrádok nad Váhom

In the Bronze Age, the initial production of sheet metal vessels was limited to specialised workshops in eastern Mediterranean centres such as Troy or Mycenae, spreading slowly to the European hinterland. In this sense, the recently discovered hoard at Hrádok in Western Slovakia, dated to ca. 1225–1175 BC, represents the earliest and most complete set of bronzeworking tools in Central Europe, providing a deeper understanding of the making and decorating of bronze vessels in an Early Urnfield environment. Through a comprehensive evaluation of tin content analysis results of copper alloy vessels from western Eurasia, the spread of this most advanced contemporary technology could be reconstructed, highlighting the importance of such research in understanding the processes leading to the emergence of the Urnfield power structures and centralised political control over secondary metallurgy (the production of artefacts from already processed raw materials) in Europe in the Bronze Age.

Globalization and European Integration: A Central European Perspective

Two decades after the biggest ever enlargement of the European Union, post-transition countries face a series of challenges, posed primarily by de-globalization and growing illiberalism. Declining European competitiveness, as highlighted by the Draghi Report (2024), calls for major restructuring both regionally and community-wide. This invited survey article attempts to solve a puzzle: if Europeanization has not been very successful, how could it promote globalization? Furthermore, Central Europe counts as a success story, both in terms of convergence and in terms of stabilizing west Europe’s previously restive neighborhood. Sustaining this success is not automatic. We posit the two main conditions. These are: more focus on Ordnungspolitik (single market, competition policy, and capital markets union) and de-emphasis of re-distrubution (CAP and Cohesion). We also show why and how Central Europe will decide the future of the EU and the ways it can cope with globalization.

Některé aktuální problémy návrhu kodifikace trestního zákoníku v roce 2007

The Czech Republic, analogous to the other post-communist countries of the Central and Eastern Europe, face the challenge to create a new modem Criminal Code, which includes a need of discussion and legislative processing of questions and institutes, that despite a Jong-term criminal substantive law code preparation, continue to draw attention of the specialized legal society. This entry shows in a few general and other most important issues of the Criminal Code concept, such as problems of material and formal conception of a criminal offence, criminal responsibility of legal entities, exercise of the criminal prosecution of the offences in relation to business area, but also the general issue of euthanasia and related killing on request offence (mercy-killing offence), or a question of extremely dangerous recidivism etc. These issues are not only named in this entry, but there are also solutions as a base of a potential discussion. The code is based on the forma! conception of a criminal offence and it is refered in this connection to the possibility of using the subsidiary role of criminal prosecution principle and a principle “ultima ratio” arising therefrom, which means that a criminal prosecution is the ultimate instrument in the relation to another legal delict regulations (administrative, civil, business etc.). This is a basic principle also for solving problems of exercising criminal prosecution in the area of offences related to business. That is why the attitudes to some newly proposed offences in relation to business were revised. In terms of the legal entities criminal responsibility, which probably won't be authorized in context of the new Criminal Code concept, a solution in the area of administrative sentencing presents itself. The killing on request problem should be solved globally on the basis of broad public discussion in relation to detailed regulation in the Health Care Law, where should be primarily regulated the patients possibility to express an option not to be treated in case of falling into a status without a chance to express his will (problem of so-called living will). Responsible approach is also necessary in reference to the extremely dangerous recidivism inherently related to recidivism of criminal activity, which continues to be considered as a very serious and dangerous fenomenon.

Global, regional, and national burden of low back pain for adults aged 55 and older 1990–2021: an analysis for the global burden of disease study 2021

BackgroundLow back pain (LBP) is a widespread condition that increasingly affects the older adults, highlighting the need for a detailed examination of its global impact. Our research aimed to evaluate the LBP’s burden and trends in individuals over 55 years of age across 204 countries and territories from 1990 to 2021.MethodsWe analyzed the data from the Global Burden of Disease 2021, focusing on LBP prevalence, incidence, and years lived with disability (YLDs), along with associated risk factors.ResultsIn 2021, a total of 271,680,057 individuals aged 55 and older globally suffered from LBP. The age-standardized prevalence rate was 18,282.8 per 100,000 population, marking a 10.4% decrease since 1990. The age-standardized incidence and YLD rates had decreased by 9.4% and 11.0%, respectively. Central and Eastern Europe and Australasia had the highest burden, while Andean Latin America, Caribbean, and East Asia had the lowest. Notably, there were significant gender differences, with males experiencing lower rates than females. Occupational ergonomic factors, smoking, and high body mass index were identified as major contributors to the LBP burden.ConclusionThis study analyzed the global burden of LBP in adults aged 55 and older, noting a decrease in age-standardized rates but an increase in total cases and regional disparities. It stressed the need to tackle modifiable risk factors like occupational ergonomics, smoking, and obesity to lessen LBP’s impact. The study also called for region-specific, gender-sensitive healthcare policies to ensure fair health outcomes for all adults aged 55 and older.

Probable Use of Labrets Among the Mid Upper Paleolithic Pavlovian Peoples of Central Europe

Probable Use of Labrets Among the Mid Upper Paleolithic Pavlovian Peoples of Central Europe

Long-term exposure to air pollution and greenness in association with respiratory emergency room visits and hospitalizations: The Life-GAP project.

Air pollution has been linked to respiratory diseases, while the effects of greenness remain inconclusive. We investigated the associations between exposure to particulate matter (PM2.5 and PM10), black carbon (BC), nitrogen dioxide (NO2), ozone (O3), and greenness (normalized difference vegetation index, NDVI) with respiratory emergency room visits and hospitalizations across seven Northern European centers in the European Community Respiratory Health Survey (ECRHS) study. We used modified mixed-effects Poisson regression to analyze associations of exposure in 1990, 2000 and mean exposure 1990-2000 with respiratory outcomes recorded duing ECRHS phases II and III. We assessed interactions of air pollution and greenness, and of atopic status (defined by nasal allergies and hay fever status) and greenness, on these outcomes. The analysis included 1,675 participants, resulting in 119 emergency visits and 48 hospitalizations. Increased PM2.5 by 5 μg/m³ was associated with higher relative risk (RR) of emergency visits (1990: RR 1.16, 95% CI: 1.00-1.35; 2000: RR 1.24, 95% CI: 0.98-1.57; 1990-2000: RR 1.17, 95% CI: 0.97-1.41) and hospitalizations (1990: RR 1.42, 95% CI: 1.00-2.01; 2000: RR 2.20, 95% CI: 1.43-3.38; 1990-2000: RR 1.44, 95% CI: 1.04-2.00). Similar trends were observed for PM10, BC, and NO2, with only PM10 showing significant associations with hospitalizations across all periods. No associations were found for O3. Greenness exposure was linked to more emergency visits in 2000 but to fewer hospitalizations in 1990. Significant interactions were observed between greenness and atopic status for emergency visits, and between NDVI with O3 and BC for some time windows. Long-term exposure to particulate matter was associated with increased emergency room visits and hospitalizations. Significant associations were observed for BC and NO2 with hospitalizations. No link was found with O3. Greenness indicated a lower risk of hospitalizations, but increased risks for emergency visits for those with atopic status.

P0510 Evaluation of organizational and healthcare provider level readiness in European Inflammatory Bowel Disease centres for outcome-based quality improvement

Abstract Background Inflammatory bowel disease (IBD) affects quality of life and increases healthcare costs. Measuring patient outcomes for continuous quality improvement (QI) can optimize care, but resource limitations, infrastructure challenges, and strategic misalignments hinder progress. We assessed the readiness for outcome-based QI in European IBD centres at both the organizational and professional levels. Methods We employed a mixed-methods design, starting with a survey with follow-up interviews of IBD-specialized gastroenterologists. Dutch centres were approached through the Initiative of Crohn’s and Colitis (ICC) organization and other European centres were recruited through the European Crohn’s and Colitis Organization (ECCO). Eligible centres had a multidisciplinary care model with at least one dedicated gastroenterologist, nurse, and surgeon. Participants completed a web-based survey covering team characteristics, outcome-based monitoring for QI, resources, and attitudes toward outcome-based QI. Quantitative data were analysed using descriptive statistics, and follow-up interviews are ongoing. Results Of the 42 IBD centres surveyed, 69% were in the Netherlands (Figure 1). After exclusions, 36 centres were analysed (Table 1), mostly non-academic hospitals (58%) with 500-800 beds. Monitoring practices varied, with 25% monitoring outcomes annually, 25% monitoring outcomes biannually, or 28% more frequently, while 22% did not monitor outcomes. Manual or hybrid EHR data extraction was common, with few using fully automated methods. Doctors (100%) and specialized nurses (96%) consistently engaged in data discussions. Non-academic centres involved more data managers (53%) and patients (65%) than academic hospitals. Doctors led discussions in most cases (82%), particularly in academic centres (91%), with significant nurse involvement (64%). Non-academic centres had diverse leadership, including data managers (47%) and occasional patient involvement (12%). Frequently monitored outcomes included medication use (71%), clinician-reported measures (61%), healthcare utilization data (57%) and patient-reported outcomes (50%). Most centres (68%) had implemented 2-3 QI initiatives in the past year, with 48% regularly assessing their effectiveness, and most respondents recognized the value of outcome monitoring for providers and patients. Conclusion Outcomes monitoring is seen as an approach for QI in IBD care, yet practices varied across centres. Academic centres monitor outcomes more frequently and rely on care professionals to lead discussions, whereas non-academic centres often rely on data managers. These differences highlight the need for standardization in monitoring practices and team roles to support consistent, outcome-based QI across Europe.

Formation of adult learning systems in Central Europe

Formation of adult learning systems in Central Europe

Elucidating diverse population exposure to compound drought and heatwave events from two meteorological drought indices (SPI and SPEI)

Abstract Anthropogenic climate change has significantly exacerbated the frequency and severity of Compound Drought and Heatwave (CDHW) events, increasing risks such as water shortages, wildfires, and heat-related mortality. Previous studies often use singular drought indices, such as the Standardized Precipitation Index (SPI) or the Standardized Precipitation Evapotranspiration Index (SPEI). This study quantifies population exposure to CDHW events using both SPI and SPEI, based on data from six General Circulation Models (GCMs) under four future Shared Socioeconomic Pathways (SSP1-2.6, SSP2-4.5, SSP3-7.0, SSP5-8.5). Exposure is defined as the product of CDHW Magnitude (℃) and the population in each region (million people), providing a quantitative measure of how CDHW events affect populations. The role of potential evapotranspiration (PET) in CDHW population exposure projections is examined by comparing SPI, which considers only precipitation, with SPEI, which accounts for both precipitation and PET in drought measurements. Results show that after 2050, CDHW Magnitude population exposure diverges significantly across scenarios, with SSP3-7.0 exhibiting the largest increase, reaching 0.72 (SPI) and 1.78 (SPEI) million person-℃ by the end of the century. Regions such as Western Africa (WAF), Southeastern Africa (SEAF), and South Asia (SAS) experience the largest increases in population exposure under SSP3-7.0 with SPEI, reaching 6.93, 6.77, and 5.56 million person-℃, respectively. Additionally, regions like Western & Central Europe (WCE), the Mediterranean (MED), WAF, Western Central Africa (WCA), Eastern Asia (EAS), and SAS display heightened sensitivity to PET, with discrepancies between SPEI and SPI projections exceeding 1 million person-℃. Attribution analysis reveals that climate change, particularly when drought is calculated using PET by SPEI, is the primary factor, followed by interaction change and population change. These findings emphasize the critical role of PET in CDHW projections and the need for region-specific adaptation strategies to manage escalating risks in highly vulnerable areas.

P0423 Anastomotic leakage after ileoanal pouch surgery: risk factors and salvage

Abstract Background Chronic anastomotic leakage (AL) is the most common cause of pouch failure after restorative proctocolectomy with ileal pouch-anal anastomosis for Ulcerative Colitis. This study aims to investigate the factors associated with AL and successful salvage of leaking anastomoses after ileoanal pouch surgery. Methods This multicentre retrospective cohort study included patients ≥18 years old with Ulcerative Colitis or unclassified Inflammatory Bowel Disease who underwent ileoanal pouch surgery between 2016 and 2021 in six European centres, with >12 months follow-up. The primary outcome was AL rate. Secondary outcomes included factors associated with the occurrence of AL, diagnosis, management and salvage of AL and stoma-free survival. Results 411 patients were included, of which 13.6% (n=56) had a diagnosed AL with a significantly higher rate in low-volume centres. Of the 56 AL, 44 were diagnosed early and 12 late. Three-stage approach was associated with late diagnosis and treatment. AL were managed using various techniques. The overall AL salvage rate was 85.4%, 92% when diagnosed and treated early and 60% when diagnosed and treated late (p=0.010). Successful AL salvage was associated with long-term stoma-free status (p=0.002). The long-term stoma-free rate was 95.5% in patients with early diagnosed and treated leaks, but only 41.7% when diagnosed and treated late (p<0.001). Conclusion Early diagnosis and treatment of AL diminishes the negative effect of AL after ileoanal pouch surgery. Pro-active anastomotic assessment is mandatory to enable early diagnosis and management especially in patients at increased risk of silent leaks such as three-staged patients.

P1156 Fidaxomicin for Clostridiodes difficile infection in inflammatory bowel disease: a multicenter retrospective cohort study

Abstract Background Inflammatory bowel disease (IBD) patients with Clostridiodes difficile Infection (CDI) are at increased risk of disease exacerbations, therapy escalation, colectomy, and mortality. Data on fidaxomicin use in IBD patients with CDI are very limited. We aimed to assess the effectiveness and safety of fidaxomicin for CDI and its impact on IBD outcomes in a large retrospective multicenter cohort study. Methods Adult ulcerative colitis (UC) or Crohn’s disease (CD) patients with a CDI episode (positive toxin enzyme immunoassay or polymerase chain reaction for toxigenic C. difficile) treated with fidaxomicin for at least 7 consecutive days were included. The primary outcome was CDI recurrence rate, defined as C. difficile toxin detection and treatment with any antibiotic targeting CDI or faecal microbial transplantation within 8 weeks. Secondary outcomes included sustained response rate (no CDI treatment for 12 weeks), IBD therapy escalation, colectomy, and all-cause mortality at 30, 90, and 180 days. Pre-specified and any other adverse events were collected. Results A total of 96 patients (57 CD and 39 UC) were included from 20 European IBD centers. Patient demographics, IBD, and CDI characteristics are summarized in Tables 1 and 2. Most patients (73%) were on advanced IBD therapy, and 34% on steroids. Half of the patients were hospitalized, and 15% had a severe CDI episode. Half of the patients had a prior episode of CDI (30% with one, 21% with two or more), predominantly treated with vancomycin. Most patients (86%) received a fidaxomicin standard dose regimen, while 9 received extended-pulsed dosing. CDI recurrence occurred in 10 (10%) patients, while 79 (82%) patients achieved a sustained response. Compared to CDI-experienced patients, CDI naïve patients tended to have a lower recurrence (4.3 vs 16%; p=0.06) and higher sustained response (91 vs 75%; p=0.04) rate. Induction treatment with an IBD advanced therapy was required in 22 (24%), 18 (20%), and 11 (13%) patients at 30, 90, and 180 days, respectively. No difference in terms of CDI recurrence and sustained response was identified between CD and UC patients. Patients achieving, compared to not-achieving, CDI sustained response, showed a numerically lower need for IBD therapy escalation, with 2 (12%) vs 20 (26%), at day 30. Five UC patients underwent colectomy. A 79-year-old UC patient died unrelated to IBD or CDI. Mild episodes of rash, nausea, conjunctivitis, asthenia, hypokalemia, and hypocalcemia were reported. Conclusion In this large cohort of IBD patients with CDI, fidaxomicin was effective and safe for CDI resolution, with greater effectiveness for CDI first episodes. CDI resolution might influence short-term IBD-related outcomes, although further studies are required.

First farmers of Central Europe do not show family-related inequality.

First farmers of Central Europe do not show family-related inequality.

P1036 The PODIUM Study: A three-arm comparison of target therapies after anti-TNFα in ulcerative colitis – an interim analysis

Abstract Background Anti-tumor necrosis factor(TNF)α are the first target therapies approved to treat ulcerative colitis(UC). Drugs with different mechanisms of action(MoA) have then entered the market, but data on the optimal management of UC after failure of 1-line anti-TNFα are lacking. Methods The PODIUM study is a retrospective, observational study comparing the real-life effectiveness and safety of 2-line vedolizumab(VDZ), ustekinumab (UST) and JAK inhibitors(JAKi). Consecutive UC patients(pts) failure to 1+ anti-TNFα and never exposed to other MoA were enrolled from 13 European centres. Sociodemographic data, data on clinical activity and adverse events of interest(AEIs) were collected, from the initiation of 2-line therapy until 1 year of observation/drug discontinuation/last follow-up. The primary outcome was steroid-free clinical remission(SFCR); inverse probability of treatment weighting(IPTW) was applied to all outcomes. This interim analysis includes data collected up to August 2024; data collection is still ongoing. Results Data on 352 patients (187VDZ, 76UST, 89JAKi) were included. Baseline characteristics are presented in Table1. After IPTW, the cumulative probability of achieving SFCR during the first year was 52%, 68% and 71% for VDZ, UST and JAKi, respectively; both UST and JAKi were superior to VDZ at Log-rank test(p<0.05), with no differences between the two (Figure1). Stool frequency scores were significantly lower at 12 months in the UST- and JAKi-groups, compared to the VDZ-group(0.5 and 0.5 vs 1.2, p<0.05 for both); rectal bleeding scores were nearly significantly lower at 12 months in the UST- and JAKi-groups, compared to the VDZ-group(0.2 and 0.2 vs 0.6, p<0.05 for both). Recorded AEIs were 10(5.3% of VDZ pts, 4 infections) in the VDZ group, 7(9.2% of UST pts, 1 infection) in the UST group, 17(19.1% of JAKi pts, 10 infections including 1 Zoster reactivation) in the JAKi group. Conclusion This preliminary analysis suggests that both UST and JAKi might have superior effectiveness, compared to VDZ, as second-line agents in patients with UC, after anti-TNF-α. A significantly higher rate of AEIs was observed in the TOF group. Confirmatory analysis with a larger sample size will be performed.

P0527 Bowel Ultrasound Scan (BUS) in Pediatric Acute Severe Colitis (ASC): a multicenter prospective study on behalf of the IBD Porto group

Abstract Background Acute severe colitis (ASC) is a potentially life-threatening event. Optimal timing for second-line treatment in children is mainly based on the clinical score Pediatric Ulcerative Colitis Activity Index (PUCAI) score. The aim of our study was to evaluate the potential role of bowel ultrasound scan (BUS) in predicting short-term treatment outcomes in pediatric ASC. Methods This was a prospective longitudinal study, conducted across ten European centers between March 2020 and March 2024. Biologic-naïve children with Ulcerative Colitis hospitalized for ASC, either at diagnosis or at disease relapse, were included. Each patient underwent two BUS, the first one within the first 48 hours of from IVCS intravenous corticosteroids administration and the second one within 5-7 days from treatment initiation. Key metrics assessed included colonic wall thickness (CWT), colonic wall stratification (CWS) and colonic wall blood flow via power Doppler. All the above-mentioned ultrasound parameters were recorded in 4 different segments of the bowel: ascending, transverse, descending, and sigmoid colon. Furthermore, Milan ultrasound criteria (MUC) score was also calculated for each colonic quadrant. Clinical, laboratory, and treatment data were gathered during hospitalization and at 2-, 4-, and 8-weeks follow-up. Results 59 patients (61% males, median age at ASC: 14.2 years) were included. Almost 60% of patients had pancolitis, 22 (37.3%) experienced ASC at disease onset. Table 1. summarizes patients’ characteristics at ASC. 38 (64.4%) patients failed to respond intravenous corticosteroids (IVCS) and required second-line therapy with infliximab (IFX). Patients who required step-up treatment with IFX had higher colonic wall thickness (CWT) and more frequently an increased vascularization (Limberg score > 2) (p=0.041 and p=0.005, respectively). Furthermore, patients who failed to respond to IVCS and required escalation to IFX had a higher MUC score at firs BUS (p=0.042). Ten patients (16.9%) failed to respond to medical treatment and required short-term colectomy (within 8 weeks of follow-up). Patients who required colectomy had a higher CWT both at first and at second BUS (p=0.033 and p=0.004, respectively). Moreover, patients who responded to medical therapy had higher DeltaCWT (difference between worse CWT at first and at second BUS) compared to those who required surgery (p=0.0018). Conclusion BUS may serve as an effective noninvasive tool to predict first-line therapy failure and the need for colectomy in patients with ASC. Its implementation in clinical practice may enable physician to support clinical evaluation and tailor treatment escalation upon patient’s individual characteristics.