Diagnostic and prognostic value of fecal, serum and endoscopic markers in inflammatory bowel disease and colorectal cancer

Background. The most important goals of the recent therapies of inflammatory bowel disease (IBD) are to induce and maintain clinical remission and mucosal healing (MH), which can be achieved with anti-TNF-α biological therapy. CT-P13 is the first biosimilar to infliximab (IFX) that has been approved for the same indications as its originator IFX, but no data was available on the effect of IFX biosimilar on mucosal healing. Serum IFX and antibody-to-infliximab (ATI) levels are objective parameters, that may have a great role in the therapeutic decisions during maintenance biological therapy in the use of original and biosimilar agents. The aims of this thesis were, to evaluate (I) the correlation between clinical and endoscopic disease activities of UC defined by activity scores. (II) the efficacy of CT-P13 induction therapy, (III) to assess the correlation between serum IFX and ATI levels, the response to IFX therapy, and to determine the accuracy of serum drug concentration measurement in the prediction of the long-term clinical response. The last part of this thesis evaluates (IV) the diagnostic accuracy of different fecal markers in the detection of colorectal adenomas and cancer. Biomarkers are important in not only studying IBD, but may be important in colorectal cancer (CRC) as well. As CRC is the second deadliest malignancy worldwide, the simple and early detection methods are critical for theeffective management of this disease. Methods Clinical and endoscopic activities were evaluated in 100 consecutive UC patients. Clinical activities were defined by two activity indices: the Rachmilewitz Activity Index (CAI) and the partial Mayo score. They graded the findings both according to the endoscopic part of the Rachmilewitz Endoscopic Activity Index (EI) and the Mayo endoscopic subscore. MH was defined as Mayo endoscopic subscore and EI of 0. Histological activity was scored by the Riley score. Sixty-three UC patients who underwent CT-P13 induction therapy were enrolled in the second study. Sigmoidoscopy was performed after the end of the induction therapy at week 14. Mucosal healing was defined as Mayo endoscopic subscore 0 or 1. Complete mucosal healing was defined as Mayo endoscopic subscore 0. Trough level (TL) of CT-P13 was measured at week 14. Fourty-eight IBD patients receiving maintenance IFX therapy were prospectively enrolled and divided into adequate and inadequate groups. Blood samples were collected just before (trough level) and two (W2aTL) and six weeks (W6aTL) after the administration of IFX. Stool samples of patients referred to colonoscopy were collected, from 95 non-IBD patients, for the analysis of tumor M2 pyruvate kinase (M2PK), human hemoglobin (Hb), hemoglobin/haptoglobin (Hb/Hp) complex, fecal calprotectin (FC), and matrix metalloproteinase-9 (MMP-9). Results Clinical and endoscopic activities showed strong correlations using both scoring systems (p = 0.0029 and p = 0.0001). Endoscopic disease activity also correlated with the histological activity (p 1 cm were 60% and 67.5% and for CRC were 94.7% and 67.5%. Sensitivity and specificity of iFOBT for adenomas sized ≥ 1 cm were 80% and 72.5% and for CRC were 94.7% and 72.5%. Sensitivity and specificity of Hb/Hp complex for adenomas sized≥ 1 cm were 80% and 52.9% and for CRC were 100% and 52.9%. Sensitivity of FC andMMP-9 for CRC was 77.8% and 72.2%. Combined use ofM2PK, iFOBT, and FC resulted in a sensitivity and specificity of 95% and 47.5% for the detection of adenomas sized ≥ 1 cm. Conclusion Assessment of MH is very important for guiding therapy and for the evaluation of remission in patients with UC..

Perfection as a pedagogical category : evidence from the works of Polish Neo-Thomists

Fundamentem artykułu jest kategoria doskonałości. Autorka rozpoczyna od symbolicznego ukazania pochodzenia tego pojęcia w myśli filozoficznej: źródeł pojęcia, ewolucji definiowania oraz rozumienia doskonałości. Następnie wskazuje na związki doskonałości z pojęciami związanymi z wychowaniem (kalokagatia, paideia). Głównym celem niniejszej pracy jest zlokalizowanie kategorii doskonałości w myśli tomistycznej. Ma to miejsce w obszarach takich jak: wychowanie, moralność, cele wychowania oraz cele życia. Wśród pism polskich neotomistów autorka poszukuje odwołań do doskonałości, form jej postrzegania oraz zakresu realizacji tej kategorii. Kluczem do powyższych rozważań jest wykazanie zależności pomiędzy pojęciami doskonałości, cnoty i sprawności.The article is based on the category of perfection. The author begins by symbolically showing the origin of this concept in philosophical thought: the sources of the concept as well as the evolution of various defi nitions and conceptualisations of perfection. Then, she points to the relationship between excellence and concepts related to education (kalokagathia, paideia). The main purpose of this article is to situate the category of perfection in Neo-Thomistic thought. This takes place in such areas as: upbringing, morality, purposes of education and purposes of life. Among the works of Polish Neo-Thomists, the author seeks appeals to perfection, forms of its perception and the scope of this category. The analysis chiefly aims to show the relationship between the concepts of perfection, virtue and efficiency

A neoadjuváns kezelés mint a rectalis ultrahangvizsgálat korlátozó tényezője

Absztrakt Bevezetés: A rectalis ultrahang a rectumtumorok stagingjének egyik alapmódszere. Előrehaladott tumorok esetén a műtét előtti neoadjuváns kezelés hatására létrejövő szöveti változások hatással vannak a módszer pontosságára. Célkitűzés: A rectalis ultrahang pontosságának felmérése preoperatív kemo-radioterápiát követően, összehasonlítva az iniciális staging során tapasztalt pontossággal. Módszer: Retrospektív módon vetették össze a Szegedi Tudományegyetem I. Belgyógyászati Klinikán 2006 és 2014 között végzett rectalis ultrahangvizsgálatok során meghatározott T-, illetve N-stádiumot a műtéti reszekátum feldolgozásakor megadott patológiai T- és N-stádiummal neoadjuváns kezelést követően és az iniciális staging során (kontrollcsoport). Eredmények: A T-stádium esetén az iniciális staging 70%-ban, a re-staging 61%-ban volt pontos, utóbbinál 31%-ban túlértékelés történt. Az ypT0 stádiumot egy esetben sem sikerült azonosítani. Az N-stádium meghatározásának pontossága 64% volt a kontrollcsoportban és 61% volt re-staging alkalmával. Következtetések: Neoadjuváns kezelést követően a rectalis ultrahang pontossága romlik. Az onkológiai kezelés hatásosságának megítélésében és a műtéti tervezésben a rectalis ultrahanggal történő re-staging szerepe megkérdőjelezhető. Orv. Hetil., 2016, 157(30), 1193–1197

Predictors of seizure outcomes in children with tuberous sclerosis complex and intractable epilepsy undergoing resective epilepsy surgery: an individual participant data meta-analysis.

ObjectiveTo perform a systematic review and individual participant data meta-analysis to identify preoperative factors associated with a good seizure outcome in children with Tuberous Sclerosis Complex undergoing resective epilepsy surgery.Data sourcesElectronic databases (MEDLINE, EMBASE, CINAHL and Web of Science), archives of major epilepsy and neurosurgery meetings, and bibliographies of relevant articles, with no language or date restrictions.Study selectionWe included case-control or cohort studies of consecutive participants undergoing resective epilepsy surgery that reported seizure outcomes. We performed title and abstract and full text screening independently and in duplicate. We resolved disagreements through discussion.Data extractionOne author performed data extraction which was verified by a second author using predefined data fields including study quality assessment using a risk of bias instrument we developed. We recorded all preoperative factors that may plausibly predict seizure outcomes.Data synthesisTo identify predictors of a good seizure outcome (i.e. Engel Class I or II) we used logistic regression adjusting for length of follow-up for each preoperative variable.ResultsOf 9863 citations, 20 articles reporting on 181 participants were eligible. Good seizure outcomes were observed in 126 (69%) participants (Engel Class I: 102(56%); Engel class II: 24(13%)). In univariable analyses, absence of generalized seizure semiology (OR = 3.1, 95%CI = 1.2-8.2, p = 0.022), no or mild developmental delay (OR = 7.3, 95%CI = 2.1-24.7, p = 0.001), unifocal ictal scalp electroencephalographic (EEG) abnormality (OR = 3.2, 95%CI = 1.4-7.6, p = 0.008) and EEG/Magnetic resonance imaging concordance (OR = 4.9, 95%CI = 1.8-13.5, p = 0.002) were associated with a good postoperative seizure outcome.ConclusionsSmall retrospective cohort studies are inherently prone to bias, some of which are overcome using individual participant data. The best available evidence suggests four preoperative factors predictive of good seizure outcomes following resective epilepsy surgery. Large long-term prospective multicenter observational studies are required to further evaluate the risk factors identified in this review

Clinical role, optimal timing and frequency of serum infliximab and anti-infliximab antibody level measurements in patients with inflammatory bowel disease

BACKGROUND: Serum infliximab (IFX) and antibody-to-infliximab (ATI) levels are objective parameters, that may have a great role in the therapeutic decisions during maintenance biological therapy. RESEARCH DESIGN AND METHODS: 48 inflammatory bowel disease patients receiving maintenance IFX therapy were prospectively enrolled and divided into adequate (complete remission N = 20) and inadequate responder (partial response, loss of response, dose escalation; N = 28) groups. Blood samples were collected just before (trough level, TL) and two (W2aTL) and six weeks (W6aTL) after the administration of IFX. RESULTS: Single measurement of ATI titer was insufficient for predicting therapeutic response due to transient expression of ATI, however, using the three points' measurements, significant difference has been detected between the adequate and inadequate responder group (5.0% vs 35.7%; p = 0.016). The mean value of TL was significantly higher in the adequate responder group (3.11+/-1.64 vs.1.19+/-1.11; p<0.001) without further difference on the second and sixth week. Sensitivity and specificity for predicting the therapeutic response were 85.0% and 71.4% based on the cut-off value of TL 2.0 mug/ml. CONCLUSION: Simultaneous measurement of serum IFX level prior to administration of regular IFX infusion and ATI titers significantly increase the diagnostic accuracy for the therapeutic decision in patients uncertainly responding to the therapy. The measurement of W2aTL and W6aTL levels did not result in further improvement in the prediction of therapeutic response

The Ultrasound-Based Diagnosis of Sudden Scrotal Enlargement in an Infant: A Case Report

Scrotal enlargement in infants has a variety of causes, ranging from benign conditions like hydrocele to more serious issues such as scrotal hernias or testicular tumors. We present the case of a 3-month-old infant with progressive right-sided scrotal swelling, diagnosed with a scrotal hernia through an urgent ultrasound examination. The ultrasound revealed intestinal loops within the scrotum, confirming the diagnosis and ruling out complications such as incarceration. This case underscores the pivotal role of ultrasonography as a first-line, non-invasive diagnostic tool for scrotal conditions in infants, facilitating timely surgical intervention and preventing long-term complications

Characteristics of an enterprise indicating its capability of "learning"

In modern market economy enterprises must meet new requirements. This assumption refers particularly to enterprises functioning in countries which are moving from centrally planned economy toward market economy. The centrally planned economy was the economy of permanent shortage of goods and services which made enterprises turn away from the existing market. In extreme cases it manifested in total disregard for the client. Central planning imposed on the enterprise the obligation to produce unchanged goods as long as possible. In this way the company could avoid the risk of failing to meet the planned objectives. Any innovation is connected with additional problems concerning deliveries, suppliers, technical changes, conflicts about terms of labour, etc

Evaluation Criteria of Managerial Staff in Judiciary Administration in the Context of Their Organizational Roles

The main objective of the paper is to state whether the evaluation criteria of managerial roles in judiciary administration suit the specificity of these roles. The first part of the paper presents the concept of systematic approach to organizational behavior and underlines the need of watching the criteria of assessment of managers’ performance with the tasks they perform. The second part of the article focuses on the results of the Authors’ researches, conducted among three groups of managers: directors, managers of divisions and managers of secretariats. In all three groups efficiency criteria were given priority – meeting the deadlines set and acting in compliance with formal procedures. Less frequently applied criteria were: evenness of delegating tasks to subordinates considering the competences of employees who are to compete the delegated tasks. The list of the evaluation criteria includes also the least frequently used ones, i.e. knowledge sharing and motivating employees with the tools tailored to their tasks and organizational environment