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Background: The usability of subcutaneous vedolizumab (s.c. VDZ) treatment in inflammatory bowel diseases (IBD; ulcerative colitis (UC), Crohn’s disease (CD)) has been proven via clinical trials while real-world data collection is ongoing. Objectives: Our study evaluates the effectiveness, safety, patients’ preferences, and psychological factors associated with s.c. VDZ treatment, after switching from intravenous (i.v.) formulation. Design: Prospective, multicenter cohort study including IBD patients switching from i.v. VDZ to s.c. treatment and were evaluated over 52 weeks. Methods: Serum VDZ levels and C-reactive protein (CRP) were measured at the baseline and w52. At w12, a questionnaire on the patient’s satisfaction and psychological characteristics was administered. The primary outcome was the drug persistence rate (cessation was due to loss of response (LOR), adverse events, patient request, and other causes) at w52, while the secondary outcomes were the changes in the clinical corticosteroid-free remission (CSFR) and biochemical remission (BR; CRP ⩽ 5 mg/L) rates, safety issues, serum drug levels, patients’ preferences, and psychological features. Results: In total, 70 IBD patients were evaluated (32 CD patients, 38 UC patients; male/female ratio: 41.4%; median age: 43.2 years). In the CD group, 81.3% were in CSFR and 65.6% were in BR, while in the UC group, 71.7% were in CSFR and 69.4% were in BR. Overall, 17.1% of the patients ceased s.c. VDZ treatment after a median of 26.2 (interquartile range 20–47) weeks. LOR was registered in 3/12 ceased patients. In addition, CSFR and BR rates were stable, while serum VDZ levels increased by w52 ( p

Background: The standardized diagnostic categories defined by the World Health Organization (WHO) reporting system support the interdisciplinary interpretation of cytological findings in the management of pancreatic cancer. Objective: To compare this classification to the Papanicolaou Society of Cytopathology (PSC) system in terms of predictive value and risk of malignancy (ROM) in solid pancreatic lesions. Design: Retrospective cohort study. Methods: All consecutive patients with solid pancreatic lesions who underwent endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) sampling at the University of Szeged from 2014 to 2021 were retrospectively enrolled. The predictive value and ROM of cytological findings were determined with comparison to histologic outcome and/or clinical follow-up. Results: A total of 521 EUS-FNAs were performed with a malignancy rate of 81.76%. In both classification systems, the absolute ROM of “non-diagnostic,” “negative for malignancy,” “atypical,” “suspicious for malignancy,” and “malignant” categories were 48.2%, 2.3%, 78.1%, 100.0%, and 99.4%, respectively. Despite the heterogeneous nature of the “neoplastic: other” category of the PSC system, the absolute ROM for solid lesions was 100%. Pancreatic neoplasm: high-risk/grade category including only two endosonographically solid cases of high-grade intraductal papillary mucinous neoplasms showed 100% ROM. There were no differences between PSC and WHO systems in sensitivity, specificity, and negative and positive predictive values: excluding the “atypical” category, these were 99.7%, 95.6%, 97.7%, and 99.5%, respectively. The “atypical” category considered benign resulted in a higher decrease in validity and negative predictive value, compared to “atypical” considered true malignant (93.6% vs 97.7% and 65.8% vs 97.7%). Conclusion: For solid pancreatic lesions, the WHO system was identical to the PSC system in terms of ROM and predictive values.

Alterations to intestinal microbiota are assumed to occur in the pathogenesis of inflammatory bowel disease (IBD). This study aims to analyze the association of fecal microbiota composition, body composition, and lipid characteristics in patients with Crohn’s disease (CD). In our cross-sectional study, patients with CD were enrolled and blood and fecal samples were collected. Clinical and endoscopic disease activity and body composition were assessed and laboratory tests were made. Fecal bacterial composition was analyzed using the shotgun method. Microbiota alterations based on obesity, lipid parameters, and disease characteristics were analyzed. In this study, 27 patients with CD were analyzed, of which 37.0% were obese based on visceral fat area (VFA). Beta diversities were higher in non-obese patients (p < 0.001), but relative abundances did not differ. C. innocuum had a higher abundance at a high cholesterol level than Bacillota (p = 0.001, p = 0.0034). Adlercreutzia, B. longum, and Blautia alterations were correlated with triglyceride levels. Higher Clostridia (p = 0.009) and B. schinkii (p = 0.032) and lower Lactobacillus (p = 0.035) were connected to high VFA. Disease activity was coupled with dysbiotic elements. Microbiota alterations in obesity highlight the importance of gut microbiota in diseases with a similar inflammatory background and project therapeutic options.

Background: Different endoscopic scoring systems for assessing ulcerative colitis (UC) severity are available. However, most of them are not correlated with disease extent. Objectives: Our study aimed to compare the predictive value of the PanMay score versus the endoscopic Mayo (MES), Ulcerative Colitis Endoscopic Index of Severity (UCEIS), and Dublin score in predicting long-term outcomes of UC. Design: This retrospective study enrolled consecutive UC patients who underwent colonoscopy before at least a 3-year follow-up. Methods: The PanMayo, MES, UCEIS, and Dublin scores and the baseline clinical and demographic characteristics of the participants were assessed. Endpoints were disease flare that required novel biological therapy, colectomy, and hospitalization. Patients were stratified using baseline clinical activity. Results: Approximately 62.8% of the 250 enrolled patients were in clinical remission. In these patients, the PanMayo, MES, and Dublin scores were positively associated with the risk of clinical flare. The MES score increased with clinical flare. The PanMayo score (>12 points), but not the MES score, was associated with the need for novel biological initiation and biological escalation. Furthermore, the Dublin and UCEIS scores of patients in remission who need novel biological treatment had a similar trend. Colectomy risk was associated with PanMayo and Dublin scores. Conclusion: The combined endoscopic assessment of disease extent and severity can be more accurate in predicting outcomes among patients with UC. PanMayo score can be utilized in addition to the existing scoring systems, thereby leading to a more accurate examination. Summary: UC endoscopic scores do not assess extension. Our study aimed to analyze the predictive value of the PanMayo score. Based on 250 patients, results showed that the long-term disease outcomes of UC could be predicted with the PanMayo score more accurately.

Abstract Background According to the European Society of Gastrointestinal Endoscopy guidelines, self-expandable metal stents (SEMSs) are preferable to plastic stents (PSs) in the management of pancreatic cancer, regardless of cancer stage. The aim of this study was to compare the therapeutic efficacy and treatment costs of SEMS and PS in the management of malignant biliary obstruction. Methods One hundred and thirty-five patients who underwent endoscopic stent placement were retrospectively enrolled and divided into PS (41 patients), primary SEMS (39 patients) and secondary SEMS (55 patients) groups. We determined the technical and functional success rate, stent patency, and cumulative treatment cost. Results A total of 111 SEMSs and 153 PSs were placed with similar technical (100% vs. 98.69%) and functional success rate (90.10% vs. 86.27%) but with different stent patency (10.28 vs. 22.16 weeks; p

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has complicated the management of inflammatory bowel diseases (IBD). Objectives: This study aimed to assess the efficacy of different anti-SARS-CoV-2 vaccines under different treatments in IBD patients and identify predictive factors associated with lower serological response, including anti-tumor necrosis factor (anti-TNF) drug levels. Design: A prospective, double-center study of IBD patients was conducted following messenger ribonucleotide acid (mRNA) and non-mRNA anti-SARS-CoV-2 vaccination. Methods: Healthy control (HC) patients were enrolled to reduce bias. Baseline and control samples were obtained 14 days after the second dose to assess the impact of conventional and biological treatments. Clinical and biochemical activity, serological response level, and anti-TNF drug levels were measured. Results: This study included 199 IBD (mean age, 40.9 ± 12.72 years) and 77 HC participants (mean age, 50.3 ± 12.36 years). Most patients (76.9%) and all HCs received mRNA vaccines. Half of the IBD patients were on biological treatment (anti-TNF 68.7%). Biological and thiopurine combined immunomodulation and biological treatment were associated with lower serological response ( p

Background: In patients with inflammatory bowel disease (IBD), Crohn’s disease (CD), and ulcerative colitis (UC), numerous cases of exacerbations could be observed after colonoscopy, raising the possible pathogenetic effect of colonic microbiota alterations in IBD flare. Objectives: We aimed to investigate the changes in the fecal microbiota composition in IBD patients influenced by the bowel preparation with sodium picosulfate. Design: We enrolled patients with IBD undergoing bowel preparation for colonoscopy in the prospective cohort study. The control group (Con) comprised non-IBD patients who underwent colonoscopy. Clinical data, blood, and stool samples were collected before colonoscopy (timepoint A), 3 days later (timepoint B), and 4 weeks later (timepoint C). Methods: Disease activity and gut microbiota changes were assessed at each timepoint. Fecal microbiota structure – at family level – was determined by sequencing the V4 region of the 16S rRNA gene. Statistical analysis included differential abundance analysis and Mann–Whitney tests. Results: Forty-one patients (9 CD, 13 UC, and 19 Con) were included. After bowel preparation, alpha diversity was lower in the CD group than in the UC ( p = 0.01) and Con ( p = 0.02) groups at timepoint B. Alpha diversity was significantly higher in the UC group than in the CD and Con ( p = 0.03) groups at timepoint C. Beta diversity difference differed between the IBD and Con ( p = 0.001) groups. Based on the differential abundance analysis, the Clostridiales family was increased, whereas the Bifidobacteriaceae family was decreased in CD patients compared to the Con at timepoint B. Conclusions: Bowel preparation may change the fecal microbial composition in IBD patients, which may have a potential role in disease exacerbation after bowel cleansing.

Introduction: Inflammatory bowel disease potentially elevates the risk of infections, independently from age, while the disease activity and medical treatment(s) can also increase the risks. Nevertheless, it is necessary to clarify these preconceptions as well during the COVID-19 pandemic. Methods: An observational, questionnaire based study was conducted in Hungary between February and August 2021. 2 questionnaires were completed. The first questionnaire surveyed the impact of the pandemic on patients with biologic treatments and assessed the severity and outcome of the infection, whereas the second one assessed vaccination rate and adverse events. Results: 472 patients participated in the study. 16.9 % of them acquired the infection and 6.3 % needed hospitalization. None of them required ICU care. Male sex elevated the risk of infection (p = 0.008), while glove (p = 0.02) and mask wearing (p = 0.005) was the most effective prevention strategy. Nevertheless, abstaining from community visits or workplace did not have an impact on the infection rate. Smoking, age, and disease type did not elevate the risk. UC patients had poorer condition during the infection (p = 0.003); furthermore, the disease activity could potentially worsen the course of infection (p = 0.072). The different biological treatments were equally safe; no difference was observed in the infection rate, course of COVID-19. Azathioprine and corticosteroids did not elevate the infection rate. 28 patients (35.0 %) suspended the ongoing biologic treatment, but it had no impact on the disease course. However, it resulted in changing the current treatment (p = 0.004). 9.8 % of the respondents were sceptic about being vaccinated, and 90 % got vaccinated. In one case, a serious flare-up occurred. Discussion: Most patients acquired the infection at workplace. Biologic therapies had no effect on the COVID-19 infection, whereas male sex, an active disease, and UC could be larger threat than treatments. Vaccination was proved to be safe, and patient education is important to achieve mass vaccination of the population.

Background: The inconclusive cytological findings of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) remain a major clinical challenge and often lead to treatment delays. Methods: Patients who had undergone EUS-FNA sampling for solid pancreas lesions between 2014 and 2021 were retrospectively enrolled. The “atypical” and “non-diagnostic” categories of the Papanicolaou Society of Cytopathology System were considered inconclusive and the “negative for malignancy” category of malignancy was suspected clinically. We determined the frequency and predictors of inconclusive cytological finding. Results: A total of 473 first EUS-FNA samples were included, of which 108 cases (22.83%) were inconclusive. Significant increases in the odds of inconclusive cytological findings were observed for lesions with a benign final diagnosis (OR 11.20; 95% CI 6.56–19.54, p < 0.001) as well as with the use of 25 G FNA needles (OR 2.12; 95% CI 1.09–4.01, p = 0.023) compared to 22 G needles. Furthermore, the use of a single EUS-FNA technique compared to the combined use of slow-pull and standard suction techniques (OR 1.70; 95% CI 1.06–2.70, p = 0.027) and less than three punctures per procedure led to an elevation in the risk of inconclusive cytology (OR 2.49; 95% CI 1.49–4.14, p < 0.001). Risk reduction in inconclusive cytology findings was observed in lesions between 2–4 cm (OR 0.40; 95% CI 0.23–0.68, p = 0.001) and >4 cm (OR 0.16; 95% CI 0.08–0.31, p < 0.001) compared to lesions ≤2 cm. Conclusions: The more than two punctures per EUS-FNA sampling with larger-diameter needle (19 G or 22 G) using the slow-pull and standard suction techniques in combination may decrease the probability of inconclusive cytological findings.

Background: Treatment with antitumor necrosis factor alpha (anti-TNF-α) is safe and effective as first-line therapy; however, its efficacy is limited due to primary nonresponse (PNR) and secondary loss of response (LOR), resulting in treatment discontinuation in approximately 40%–50% of cases. Vedolizumab (VDZ) and ustekinumab (UST) therapies could be good alternatives in patient with anti-TNF failure; however, no head-to-head randomized comparison of these drugs as second- or third-line treatments has been made. Objectives: This study aimed to assess the treatment persistence and comparative effectiveness of UST and VDZ in patients with refractory Crohn’s disease (CD). Design: In this nationwide retrospective study, patients with CD on UST or VDZ maintenance therapy were enrolled. Clinical data at baseline, after induction, and at week 52 were obtained. Methods: Clinical and biochemical activities as well as corticosteroid-free remission (SFR) rates were assessed, while concomitant medications, comorbidities, hospitalizations, and surgeries were recorded during the follow-up to detect any predictors. Results: A total of 161 UST- and 65 VDZ-treated patients completed the follow-up. No significant difference in clinical or biochemical remission rates was observed after induction between the two treatment groups; however, clinical remission rate at week 52 was higher in UST group. UST showed superior drug persistence than VDZ (86.5%, 57.9%, p

Abstract Background Health care professionals in endoscopic labs have an elevated risk for COVID-19 infection, therefore, we aimed to determine the effect of current pandemic on the workflow and infection prevention and control strategies of endoscopy units in real-life setting. Methods All members of Hungarian Society of Gastroenterology were invited between 7 and 17 April 2020 to participate in this cross-section survey study and to complete an online, anonymous questionnaire. Results Total of 120 endoscopists from 83 institutes were enrolled of which 35.83% worked in regions with high cumulative incidence of COVID-19. Only 33.33% of them had undergone training about infection prevention in their workplace. 95.83% of endoscopists regularly used risk stratification of patients for infection prior endoscopy. While indications of examinations in low risk patients varied widely, in high-risk or positive patients endoscopy was limited to gastrointestinal bleeding (95.00%), removal of foreign body from esophagus (87.50%), management of obstructive jaundice (72.50%) and biliary pancreatitis (67.50%). Appropriate amount of personal protective equipment was available in 60.85% of endoscopy units. In high-risk or positive patients, surgical mask, filtering facepiece mask, protective eyewear and two pairs of gloves were applied in 30.83%, 76.67%, 90.00% and 87.50% of cases, respectively. Personal protective equipment fully complied with European guideline only in 67.50% of cases. Conclusions Survey found large variability in indications of endoscopy and relative weak compliance to national and international practical recommendations in terms of protective equipment. This could be improved by adequate training about infection prevention.

Abstract Background The usage of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for the diagnosis of solid pancreatic cancer is increasing, however mainly retrospective studies are available about the detailed methods of sampling. Methods To compare prospectively the diagnostic yield of EUS-FNA samples obtained with slow-pull (SP) and with standard suction technique (SS). Results EUS-FNA sampling was diagnostic in 72 of 92 cases (78.3%). Diagnostic yield was 67.4% in the SS and 65.2% in the SP group. The number of smear pairs (1.84 vs. 3.56; p

The coronavirus disease 2019 (COVID-19) outbreak emerged in December 2019 in China and rapidly spread worldwide. Inflammatory bowel disease (IBD) patients are likely to be more susceptible to viral infections, and this is significantly influenced by the type of therapy they receive. Thus, issues specifically concerning the medical treatment of IBD patients were shortly addressed at the beginning of the pandemic. However, recently available data on the occurrence and outcome of SARS-CoV-2 infection in IBD patients does not address the concerns raised at the beginning of the pandemic. Growing evidence and the rapid changes happening over the past few weeks have helped elucidate the current situation, contribute to our understanding of the disease, and many previously raised questions could now be answered. We hereby summarise available evidence regarding viral infections and IBD, focusing on SARS-CoV infections, and we provide practical recommendations related to patient management during the COVID-19 pandemic era.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic poses a challenge to healthcare. Staff and patients are at increased risk during an examination or intervention, so certain restrictions ought to be introduced. Hence, we aimed to measure the effect of the pandemic on endoscopy units in real-life settings. Methods: This was an observational, cross-sectional, questionnaire-based study, carried out between 7 April and 15 June 2020. Responds came from many countries, and the participation was voluntary. The survey contained 40 questions, which evaluated the effect of the COVID-19 pandemic on the endoscopy units and assessed the infection control. Results: A total of 312 questionnaires were filled, 120 from Hungary, and 192 internationally, and 54 questionnaires (17.3%) were sent from high-risk countries; 84.9% of the gastroenterologists declared that they read the European Society of Gastrointestinal Endoscopy (ESGE) statement, while only 32.1% participated in any advanced training at their workplace. Overall, 92.1% of gastroenterologists realized risk stratification, and 72.1% claimed to have enough protective equipment. In 52.6% of the endoscopy units, at least one endoscopist had to discontinue the work due to any risk factor, while 40.6% reported that the reduced staff did not affect the workflow. Gastroenterologists considered that the five most important examinations both in low and high-risk patients are the following: lower/upper gastrointestinal (GI) bleeding with hemodynamic instability, endoscopic retrograde cholangiopancreatography (ERCP) in obstructive jaundice, foreign body in the esophagus, ERCP in acute biliary pancreatitis, and iron deficiency anemia with hemodynamic instability, which correlates well with the ESGE recommendation. Significant correlation was found in the usage of the necessary protective equipment in high-risk patients depending on the countries ( p

Abstract Background Colonoscopy plays crucial role in the establishment of the diagnosis, management and follow-up of ulcerative colitis (UC). None of the currently widely used endoscopic scores consider disease extent, and therefore do not correlate with the real severity of UC. Our aim was to assess the accuracy of a new score, the Pancolonic Modified Mayo Score that can reflect not only the severity, but the extent of active UC. Methods One hundred and four UC patients were enrolled in this prospective study. The Endoscopic Mayo Scores of the involved area of the five colorectal segments were added; furthermore, the sum was multiplied by 3 in case of eMayo ≥2 (range 0 [normal] to 45 [most severe]) to obtain the Pancolonic Modified Mayo Score (panMayo) in order to clearly distinguish the active and inactive disease. We analysed the correlation of panMayo Score with eMayo and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and complicated disease outcome. We compared the endoscopic indices with serum and faecal inflammatory parameters and Riley Score. Results The panMayo Score correlated with eMayo and UCEIS. Every endoscopic score showed correlation with Riley Score, CRP, haemoglobin, haematocrit, serum iron, faecal MMP-9 and calprotectin and also predicted a complicated disease outcome. Only panMayo score correlated exclusively with the extent of UC. Conclusions We suggest that this new score gives additional information about disease extent besides disease activity with a strong correlation with laboratory parameters of inflammation and with the other widely used endoscopic indices.

Background: Biological therapy has revolutionized the treatment of inflammatory bowel disease (IBD). After the expiration of patents for biological innovator products, development of biosimilars increased. CT-P13 was the first biosimilar approved for the same indications as the reference product; however, the approval was based on extrapolated data from rheumatoid arthritis and ankylosing spondylitis. Our aim was to review clinical studies about switching from originator infliximab (IFX-O) to biosimilar infliximab (IXF-B) in IBD, focusing on recently published data and the future of biosimilars. Methods: The PubMed database was searched for original articles published up to 1 December 2018 reporting data on IFX-B in IBD. Results: A total of 29 studies assessing switching from IFX-O to IFX-B, 14 assessing induction therapy with IFX-B were found. Efficacy, safety and immunogenicity were discussed. Studies confirm that CT-P13 is safe and equally efficient as the reference product for both induction and maintenance therapy; and that switching from the reference product to biosimilar is non-inferior to continuous biosimilar use. However, efficacy and safety data on Flixabi (SB2) in IBD patients is lacking. Conclusion: Switching from the originator to a biosimilar in patients with IBD is acceptable, although scientific and clinical evidence is lacking regarding reverse switching, multiple switching and cross-switching among biosimilars in IBD patients.

Gut microbial composition alters in some special situations, such as in ulcerative colits (UC) after total proctocolectomy and ileal pouch-anal anastomosis (IPAA) surgery. The aim of our study was to determine the composition of the intestinal microbiome in UC patients after IPAA surgery, compared with UC patients, familial adenomatous polyposis (FAP) patients after IPAA surgery and healthy controls. Clinical data of patients, blood and faecal samples were collected. Faecal microbiota structure was determined by sequencing the V4 hypervariable region of the 16S rRNA gene. Overall, 56 patients were enrolled. Compared to the Healthy group, both the Pouch active and UC active groups had higher Enterobacteriaceae, Enterococcaceae and Pasteurellaceae abundance. The Pouch and UC groups showed distinct separation based on their alpha and beta bacterial diversities. The UC group had higher Prevotellaceae, Rikenellaceae, Ruminococcaceae abundance compared to the Pouch active group. Pouch and FAP participants showed similar bacterial community composition. There was no significant difference in the bacterial abundance between the active and inactive subgroups of the Pouch or UC groups. Gut microbiome and anatomical status together construct a functional unit that has influence on diversity, in addition to intestinal inflammation that is a part of the pathomechanism in UC.

Background and Aims. Complementary and alternative medicine (CAM) is commonly used among patients with inflammatory bowel diseases (IBD), but evidence about its real-life use is limited. We aimed to assess and compare CAM use in outpatients with IBD and other gastrointestinal diseases. Materials and Methods. The use of herbs and botanicals, lifestyle modifications and mind/body therapies, patient satisfaction, and continuous use of conventional medicine were assessed with an anonymous questionnaire at a tertiary IBD unit in Hungary. 396 IBD patients (207 with Crohn’s disease, 185 with ulcerative colitis, and 4 with indeterminate colitis) and 164 patients with gastric acid-related diseases, premalignant and malignant colorectal diseases, lactose intolerance, celiac disease, dysbacteriosis, and so on were included. Results. IBD patients reported significantly lower usage of herbs than did controls (25% versus 42%, p

Inflammatory bowel diseases (IBD) [Crohn's disease (CD) and ulcerative colitis (UC)], are chronic relapsing disorders of unknown etiology. The aim of this study was to determine demographic features, disease phenotypes, medical and surgical therapies in our IBD patients and to identify which parameters are in association with the need of surgery and/or biologic therapy. Data on demographic and clinical characteristics of the patients were analyzed from the IBD registry of the 1st Department of Medicine, University of Szeged. The study period was between January 2007 and March 2015. Data of 911 IBD patients (428 CD, 483 UC) were analyzed. The median lag time between onset of symptoms and diagnosis proved to be significantly longer in UC than in CD (4.6 years vs. 2.1 years, p = 0.01). 40% of the patients received biological therapy, 301 patients underwent surgery required more frequently for CD than UC. Surgery was more common in CD patients with ileal location and penetrating behaviour. In UC, more severe disease onset predicted to unfavourable disease course. Higher proportion of surgery was shown in patient aged above 40 years in both CD and UC. Diagnostic delay of more than 1 year and appendectomy predicted to unfavourable disease outcome of both CD and UC. This analysis revealed that more than 1 year of diagnostic delay, disease activity at diagnosis in UC, CD, ileal location and penetrating behaviour are factors that may influence disease outcome. Use of thiopurines seemed to be protective in UC.

Background: Self-expandable metal stent (SEMS) implantation may rapidly improve the symptoms of malignant esophageal stenosis and tracheoesophageal fistulas (TEF). However, dysphagia often returns subsequently and repeated endoscopic intervention may be necessary. The aims of the study were to identify the risk factors of complications, and the frequency and efficacy of repeated endoscopic interventions; and to provide technical recommendations on appropriate stent selection. Methods: We analyzed retrospectively the clinical data of 212 patients with locally advanced esophageal cancer who underwent SEMS implantation. Results: A total of 238 SEMS implantations were performed with 99.06% technical success and 1.26% procedure-related deaths in the enrolled 212 cases. Complications occurred in 84 patients (39.62%) and in 55 cases (25.94%) repeated endoscopic procedures were required. Early reintervention 24–48 h after the stent implantations was necessary due to stent migration (12 cases), arrhythmia (2 cases), intolerable retrosternal pain (1 case) and dyspnea (1 case). An average of 1.98 repeated gastroscopies (range 1–6; median 2), 13.58 weeks (range 1.5–48; median 11) after the stent implantation were performed during the follow-up period: 37 stent repositions, 23 restent implantations, 15 endoscopic esophageal dilations and 7 stent removals. In 48 cases (87.3%) oral feeding of patients was made possible by endoscopic interventions. Conclusions: In a quarter of SEMS implantations, complications occur that can be successfully managed by endoscopic interventions. Our experiences have shown that individualized stent choice may substantially reduce the complications rate and make repeated endoscopic interventions easier.

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

Introduction: Crohn’s disease (CD) is a chronic inflammatory disease which is frequently complicated by obstructive symptoms secondary to development of intestinal strictures. The aim of this “real life” study was to assess the effectiveness, safety and outcome of endoscopic balloon dilatation (EBD) in de novo vs. anastomotic stenoses. Patients and methods: Data of 93 EBDs in 46 CD patients were retrospectively analyzed. Technical success rate was defined as the ability of endoscope to traverse the stenosis after dilatation. Long-term clinical success rate was claimed if a patient remained asymptomatic and did not require surgery or further endoscopic dilatation following the technical success. Results: About 62.4% of strictures were de novo and 37.6% anastomotic. The elapsed time between diagnosis and the first balloon dilatation was 9.5 (0–35) years. About 73.1% of dilatations were successful over a short-term period without serious complications. About 47.8% of patients showed that EBD is effective over a long-term period. EBD of anastomotic strictures showed better outcome than that of de novo strictures, however biological therapy before or after dilatation, immunomodulatory therapy and the time between the diagnosis and the first dilatation had no influence on long-term effectiveness. Nine subjects required surgery due to strictures after balloon dilatation. Conclusion: The results of this study highlight that EBD is an effective therapy of short strictures in CD with low complication rate. Using this endoscopic method we can avoid surgical interventions in most of the cases. EBD of anastomotic stenosis may be more preferable than that of the de novo strictures.

Background. Rectal tumour management depends highly on locoregional extension. Rectal endoscopic ultrasound (ERUS) is a good alternative to computed tomography and magnetic resonance imaging. However, in Hungary only a small amount of rectal tumours is examined with ERUS. Methods. Our retrospective study (2006–2012) evaluates the diagnostic accuracy of ERUS and compares the results, the first data from Central Europe, with those from Western Europe. The effect of neoadjuvant therapy, rectal probe type, and investigator’s experience were also assessed. Results. 311 of the 647 ERUS assessed locoregional extension. Histological comparison was available in 177 cases: 67 patients underwent surgery alone; 110 received neoadjuvant chemoradiotherapy (CRT); ERUS preceded CRT in 77 and followed it in 33 patients. T-staging was accurate in 72% of primarily operated patients. N-staging was less accurate (62%). CRT impaired staging accuracy (64% and 59% for T- and N-staging). Rigid probes were more accurate (79%). At least 30 examinations are needed to master the technique. Conclusions. The sensitivity of ERUS complies with the literature. ERUS is easy to learn and more accurate in early stages but unnecessary for restaging after CRT. Staging accuracy is similar in Western and Central Europe, although the number of examinations should be increased.

Background. Colorectal cancer (CRC) is the second deadliest malignancy worldwide. This study aimed to compare the diagnostic accuracy of different fecal markers in the detection of colorectal adenomas and cancer. Methods. Stool samples of patients referred to colonoscopy were collected 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. Sensitivity and specificity of M2PK for adenomas sized > 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 and MMP-9 for CRC was 77.8% and 72.2%. Combined use of M2PK, iFOBT, and FC resulted in a sensitivity and specificity of 95% and 47.5% for the detection of adenomas sized ≥ 1 cm. Discussion. In CRC, sensitivity of M2PK, iFOBT, and Hb/Hp complex proved to be high. Combined use of M2PK, iFOBT, and FC may be valuable in the detection of large adenomas.

Abstract Lentiviral vectors (LV) are efficient vehicles for in vivo gene delivery to the liver. LV integration into the chromatin of target cells ensures their transmission upon proliferation, thus allowing potentially life-long gene therapy following a single administration, even to young individuals. The glycoprotein of the vesicular stomatitis virus (VSV.G) is widely used to pseudotype LV, as it confers broad tropism and high stability. The baculovirus-derived GP64 envelope protein has been proposed as an alternative for in vivo liver-directed gene therapy. Here, we perform a detailed comparison of VSV.G- and GP64-pseudotyped LV in vitro and in vivo. We report that VSV.G-LV transduced hepatocytes better than GP64-LV, however the latter showed improved transduction of liver sinusoidal endothelial cells (LSEC). Combining GP64-pseudotyping with the high surface content of the phagocytosis inhibitor CD47 further enhanced LSEC transduction. Coagulation factor VIII (FVIII), the gene mutated in hemophilia A, is naturally expressed by LSEC, thus we exploited GP64-LV to deliver a FVIII transgene under the control of the endogenous FVIII promoter and achieved therapeutic amounts of FVIII and correction of hemophilia A mice.

Concomitant medications may alter the effect of biological therapy in inflammatory bowel disease. The aim was to investigate the effect of proton pump inhibitors on remission rates in patients with inflammatory bowel disease treated with the gut-selective vedolizumab. Patients from the Hungarian nationwide, multicenter vedolizumab cohort were selected for post hoc analysis. Primary outcomes were the assessment of clinical response and endoscopic and clinical remission at weeks 14 and 54. Secondary outcomes were the evaluation of the combined effect of concomitant steroid therapy and other factors, such as smoking, on remission. A total of 108 patients were identified with proton pump inhibitor data from 240 patients in the original cohort. Patients on steroids without proton pump inhibitors were more likely to have a clinical response at week 14 than patients on concomitant PPI (95% vs. 67%, p = 0.005). Non-smokers with IBD treated with VDZ were more likely to develop a clinical response at week 14 than smokers, particularly those not receiving PPI compared with patients on co-administered PPI therapy (81% vs. 53%, p = 0.041, and 92% vs. 74%, p = 0.029, respectively). We found that the use of PPIs in patients treated with VDZ may impair the achievement of response in certain subgroups. Unnecessary PPI prescriptions should be avoided.

A platform for systemic therapeutic transgene expression independent of patient mutations needs a safe and highly transcribed locus. Here the authors ex vivo edit HPSCs using CRISPR-Cas9 to integrate transgenes under the α-globin promoter to achieve erythroid specific expression.

Correct posture is a harmonized system of individual parts of the body in relation to each other and in relation to the mechanical axis of the body, maintained at minimum tension of the muscular and nervous systems [1,2,3]. Any postural defect is commonly referred to as a bad posture. According to Wilczyński, these are changes in an upright, free position of the body, which differ significantly from the typical posture of a given gender, age, constitutional structure and race, which are the result of pathological changes and may occur at all body levels [4,5,6]. The most common postural defects associated with the spine include concave, round, round-concave, flat and scoliosis back. Problems that occur in relation to each disease are not only a part of bad posture and do not concern only the spine itself. This is a complex problem and it is necessary to approach the subject holistically and in many directions.

Aim of the study: The aim of the study was to analyze the influence of tokophobia on delivery solution by Caesarean section. The number of deliveries solved by Caesarean section has increased significantly in recent years. In Poland, it has almost doubled since 2000 (from 18.1% to 37%) Research methods: A survey was used in the study. 25 first-born girls and 25 multi-rivers took part, the selection criterion was delivered by caesarean section. Results: The fear of giving birth was the cause of caesarean section in 12 of the 25 primigravidas and 12 of the 25 multigravidas. Conclusion: Fear of childbirth may be a very important issue related to planning the delivery method.

The daily energy requirement of infants depends on age, sex and body weight. Breastfeeding is the most appropriate way to feed babies in the first 6 months of their lives. According to WHO recommendations, one should aim for exclusive breast-feeding for the first 6 months of your child's life. After 6 months, the baby's diet should be extended, continuing breastfeeding. It is recommended to continue feeding with the mother's milk, according to the WHO, until the second year of life, and according to AAP up to 12 months, with the simultaneous introduction of supplementary foods. When, for various reasons, it is not possible to feed the infant with mother's milk, the products substituting for female milk are used. Infant formula is intended for children under 6 months of age and fully satisfies the nutritional needs of an infant. Complementary Feeding should be started between 17 and 26 weeks of age.

Myopia is an increasing problem worldwide. Its prevalence is predicted to over 4 billion of people in 2050, what would be almost 50% of the population. Therefore, authors have analyzed available literature in terms of treatment that may be able to prevent or slow the progression of myopia. There are risk factors such as genetic factors which nowadays could not be modified. However, there are other risk factor such as near work or protective factor such as time spent outdoor which could be modified. Moreover, therapeutic interventions seem to play more significant role. Among available methods it is mentioned: pharmacology including drops of atropine and pirenzepine, undercorrection, contact lenses, orthokeratology, bifocal or multifocal spectacles and soft multifocal contact lenses. Methods are described with their mechanism of action and efficacy.

Microscopic assessment of peripheral blood smears belongs to the basic techniques of quantitative and qualitative analysis of leukocytes, erythrocytes and platelets. Modern hematology analyzers allow accurate and precise assessment of blood cells, flagging parameters that are beyond the limit of the norm. Despite advanced technologies, the automatic peripheral blood smear is devoid of detailed data on abnormalities in the shape of erythrocytes, the presence of inclusions and erythroblasts, which can only be obtained by manual evaluation of peripheral blood smears. The following work aims to highlight the role of manual evaluation of peripheral blood smears, with particular emphasis on the assessment of abnormalities in the morphology of erythrocytes, which despite the passage of time should still be routinely performed as a supplement to modern diagnostic tools.

Hiperuricemia is associated mostly with gout and urolithiasis. However, it is now known that it affects a number of other health problems. It plays an important role in the development of hypertension, metabolic syndrome and other cardiovascular diseases. In addition, the relationship between hyperuricemia and obesity, hyperlipidemia, stroke and vascular dementia, renal disease, obstructive sleep apnea and insulin resistance has been proven. Increased serum uric acid is a risk factor for cardiovascular disease and contributes to increased mortality in patients with ischemic heart disease. The preferred drugs for the treatment of hypertension with increased uric acid concentration are calcium channel blockers (urinary properties) and losartan. From diuretics aldosterone antagonists are prefered. Other blockers of the angiotensin receptor should be avoided because they reduce the excretion of uric acid by the kidneys. B-blockers, thiazide and loop diuretics, ACE inhibitors are also inadvisable.

Teachers belong to professions particularly vulnerable to burnout. Due to level of teacher’s legal and social responsibility, and impact they have on students, this occupational group is under constant research interest about burnout and coping with stress. Many analyzes indicate connection between individual differences (coping style, emotional intelligence), working conditions, and level of burnout. This article provides review of this research.

Diseases of the throat and tonsils are one of the most frequent causes of patient visits to pediatricians and family doctors. It should be emphasized that to protect the vast majority of them, symptomatic management is sufficient. When applying for pharmacological interventions, the physician should be guided by experience, while supporting himself with objective scientific data confirming the effectiveness of the recommended treatment. It is worth emphasizing the necessity to implement the vaccination calendar as a proven effective method of protecting patients from serious complications of infectious diseases.

Introduction: Physical effort has a positive effect on the human body, through its protective effect on the development of many diseases, along with cardiovascular system diseases. Irisin is an adipomiokine that is a fragment of the doemeny of extracellular FNDC5 protein. It is released from FNDC5 due to physical activity and peroxisome proliferator receptor-γ coactivator 1α (PGC-1α) stimulation. It forms a link between the muscles and other tissues of the body. Moreover, it affects the conversion of white adipose tissue into brownish-like fat tissue. Aim: For over 15 years ischemic heart disease has been one of the most common causes of death in the world. Therefore, attempts have been made to clarify the role it has in ischemic heart disease. Conclusions: It has been proven, that the concentration of irisin decreases in patients with myocardial infarction it also correlates with the severity of stable coronary disease and a higher SYNTAX score. Hence, the hypothesis was that the level of this protein probably depends on the inflow of blood to the myocardium. It can therefore be used for the panel of myocardial damage. The New Approach of therapeutic options uses irisin with stem cells during the repairing of myocardium. Despite much interest in irisin, there are still many questions that need to be answered, in particular those related to the irisin cell receptor and what is related to the clarification of its mechanisms in physiology.

A significant increase in the incidence of depression, change of lifestyle and nutrition, forces researchers to seek understanding of the various mechanisms of the formation of such a disorder. Numerous studies draw attention to dysbiosis - a disorder of the composition and function of the intestinal microflora. In current studies, strong correlations can be observed between microbiota disorders and the occurrence of autoimmune and inflammatory diseases.

This paper aims to is to review the literature on the relationship between microbiota and the immune system in terms of the quality of life of patients after arterial repair operations. Angiology is a branch of medicine dealing with vascular diseases of the blood and lymphatic system. As a sub-discipline of surgery, together with techniques of surgical radiology, it has gained high recognition in the medical environment. Despite increasing progress in the process of arterial repair, postoperative complications in the form of swelling of the lower extremities of the operated side are still a problem. This problem concerns about 6% of patients. Another problem is the risk of vascular transplant infection. The high mortality rate estimated at 9% is worrying. Equally alarming is the percentage of limb amputations at the level of the shin or thigh. It should also be emphasized that the above complications may significantly indicate weakened immunity of patients, thus translating into the slower tissue regeneration process. Even the increasing degree of emotional disturbances as a result of weakened microflora.

Tattoo is one of the most frequently used techniques of permanent body decoration, it is a graphic sign obtained on the skin as a result of the introduction of dye into the skin tissue. It happens that the tattoo begins to disturb, life circumstances change, the tattoo reminds you of something you would like to forget. The development of tattoo removal methods is the expression of a search for a method to completely remove it without damaging the tissue. The methods used so far include: lasers, surgery, peels, dermabrasion (chemical and mechanical), cryosurgery, electrosurgery, light coagulation in the infrared range, salabrasia (use of sodium chloride), camouflage, etc., however, no method guarantees complete removal of the tattoo.

Rehabilitation of patients after reconstruction of the anterior cruciate ligament is the subject of many physiotherapeutic discussions. Of all sports injuries, about 70% are damage to the knee joint. Among these, in turn, the injuries of the anterior cruciate ligament occupy the leading position. Reconstruction is the best way to recreate a damaged ACL. The return of the patient to full physical fitness and daily activities are conditioned by surgery and improvement procedures. Early rehabilitation, the selection of appropriate rehabilitation methods, as well as individual characteristics of the patient affect the acceleration of the rehabilitation procedure and the results achieved at particular stages of physiotherapy

SIDS - Sudden Infant Death Syndrome is a sudden, unexpected death of an infant during sleep, which can not be justified by a medical history or post-mortem examination. This is undoubtedly one of the worst situations that young parents can encounter. Fear for child is enormous and often man tries to do everything to protect his offspring from danger, pain and illness. Unfortunately, SIDS concern healthy-growing infants, who are not suspected of any disease. The vast majority of cases occur in a baby cot, less often in the bed of parents, a pram or a car seat. It mainly concerns children up to 6 months old, but it also happens at a later age. The aim of this work is to discuss the risk factors and prevention of Sudden Infant Death Syndrome

The human motoriness is the whole of behaviors, possibilities and needs movement differently manifested at every stage of life. The pre-school period is the so-called golden period of motoriness. At this stage of life, all movement skills that affect further development of the child are improved, both in the physical, mental, intelectual and social spheres. External interventions to improve and improve skills in small and large motor skills seem to be extremely important. We should hold on the occurrence of motor development disorders and the introduction of rehabilitation as soon as possible.

Dysmorphophobia (BDD), also called the obsession of perfection, is a disorder involving the extreme negative assessment of one's own appearance resulting from a slight defect that is exaggerated. Dysmorfophobia belongs to hypochondriac disorders. This disease affects 0.7-2.4% of the total population, but knowledge about it is still not common. Perceptual disorders most often affect the skin, hair, nose, body weight, stomach, breasts, eyes, thighs and teeth. Legs, body build, face and face size are less often. In addition to typical psychotherapy, well-chosen relaxation techniques and cognitive-behavioral therapy as well as pharmacotherapy are also applied.

Microbiome is a key element in maintaining health, forming all saprophytic, commensal and parasitic microorganisms that invade the human body. The development of microbiota begins already in the prenatal period, providing the way for further studies on the influence of the course and duration of pregnancy, delivery mode, feeding, exposure to environmental factors and gestational age. Colonization of the gastrointestinal tract of infants is an important aspect of later health. Probiotics and prebiotics can regulate the composition of bacterial flora of the gastrointestinal tract and thus influence the homeostasis of human body.

Pregnancy, childbirth and postpartum care is special time in woman’s life. Often those moment cause many different emotions, both positive and negative. Mothers-to-be are often scared of childbirth, with following strong fear for life and health of their baby. The very moment of delivery can be special experience, unfortunately not always pleasant. This is why there is special note given to the role of social support as factor enhancing the proces of adaptation to the new role. Adequate support can reduce fear of childbirth, reduce probability of postpartum depression and enhance proper mother – child interaction.

Cerebral palsy is a broad term, including various, changing with age movement and postural disorders of cerebral origin [1]. Gait of children suffering from cerebral palsy is characterized by changeability. Observed gait abnormalities are caused by incorrect steering of movements of a child and they are the effects of brain damage and compensation mechanisms. The orthoses should be applied in children suffering from cerebral palsy to protect against deformations of lower limbs. An orthosis prevents the occurrence of articular contractures, probably as a result of inhibition of biomechanical changes in periarticular collagen caused by immobilization [9,10]. Selecting an appropriate orthosis is a key element of the process of treatment of diseases of musculoskeletal system. Orthosis should always be selected individually, depending on the needs and capabilities of a patient. The following orthoses can be distinguished: ankle joint orthoses, dynamic foot orthosis and complex orthoses stabilizing ankle joint, knee joint and hip joint. Selecting an appropriate orthopedic equipment is a very important aspect in complex rehabilitation of children suffering from cerebral palsy.

The basic direction of monitoring and analyzing the process of procreation, getting pregnant, its course, possible complications and delivery is a medical, biological perspective. Psychology has entered medical areas practically with all its basic research directions. Many publications from the fringe of psychology and obstetrics draw attention to the magnitude of possible factors affecting the quality of the relationship of the mother and her newborn child. Preliminary conclusions were based on a pilot study - it included 43 pregnant women. The study was conducted among patients in hospitals, specialist counseling centers and gynecological surgeries, and clients of birthing class. The respondents filled out the following questionnaires: Author's sociometric-medical survey, Maternal Fetal Attachment Scale (Cranley); General Self-Efficacy Scale (Schwarzerer and Jerusalem). Statistical analysis (Pearson correlation coefficient) of selected variables showed statistically insignificant (p> 0.05) correlations from very weak to high. A high correlation occurs between the week of pregnancy and a sense of bond with the child (r = 0.792) and a week of pregnancy and a sense of self-generalized effectiveness (r = 0.847).

The current patterns of perioperative management are subject to dynamic changes, questioning and modifying the previously used ones. In modern surgical practice, it is recommended to apply a comprehensive peri-operative care protocol to improve the results of ERAS (Enhanced Recover After Surgery) treatment. ERAS is a multidirectional path of perioperative care over a patient, used all over the world, developed by the international scientific society ERAS Society, initiated by the Danish surgeon Henrik Kehlet. This protocol aims to achieve the fastest possible recovery of the patient by minimizing metabolic stress caused by surgery, improving the healing process, reducing tissue swelling, reducing the number of postoperative complications, shortening the duration of hospitalization and reducing the cost of health care.

The most important course in thyroid diseases is pharmacological treatment - thyroid hormone supplementation or inhibition of gland function in case of its hyperactivity. There is more and more evidence for the beneficial effect of a proper diet on the course of the disease and the effectiveness of the therapy. There are also a lot of scientifically unjustified myths functioning in society, mistakenly imposing too restrictive approaches to people's diet. Nutrition in thyroid diseases should be individualized and adapted to the needs and preferences of a particular patient. Great attention should be paid to the caloric content of meals and the content of micronutrients, especially iodine. A properly developed diet can significantly improve the course of the disease and the quality of life of patients. There is no justification for introducing a gluten-free or lactose-free diet in all cases of Hashimoto's disease.

Introduction: PCOS is a hyperandrogenic and low-pathogenic disease and patients suffering from PCOS have significantly lower intestinal microbiota variation in comparison with healthy individuals. Aim of the study:The aim of the work is to overview the literary production regarding reliance between intestinal microbiota and polycystic ovary syndrome. Conclusions: Results of the research show change in microbiome data amongst women suffering from polycystic ovary syndrome.