How to improve the adenoma detection rate in colorectal cancer screening? Clinical factors and technological advancements

Introduction: Colonoscopy has been widely regarded as the gold standard in colorectal cancer (CRC) screening. Within recent years different endoscopic imaging techniques have been introduced to improve the quality of colonoscopy. The adenoma detection rate (ADR) is the single most important quality indicator for colonoscopy. The aim of this study was to evaluate the quality of CRC screening expressed by ADR in two different eras of endoscopic technology advancement. Material and methods: We conducted a dual-center study that enrolled 24 055 patients, who underwent colonoscopy as part of a national screening program. Patients were sorted into two groups according to the advancement of endoscopic equipment used for colonoscopic examination: group I - 10 405 patients examined between 2004 and 2008 (standard electronic endoscopes); group II - 13 650 patients examined between 2009 and 2014 (modern endoscopes). The ADR in two different eras and the impact of endoscopic novelties were determined. Results: The ADR in group I was 29.14%, in group II 31.73% (p < 0.001). The overall ADR was 30.88% - 38.80% and 25.95% (p < 0.001) for the male and female patients, respectively. The mean adenoma number per colonoscopy was 0.366 (95% CI: 0.357-0.375; p < 0.001), 0.337 (0.321-0.352) and 0.380 (0.369-0.392) for patients in group I and group II, respectively. Conclusions: Our study shows that technological innovation, novel endoscopy devices and diagnostic techniques improve the quality in CRC screening by increasing the ADR. However, we need to determine which of the technologies are supreme to achieve excellence in colorectal cancer screening

Colonoscopy for colorectal cancer screening : is it effective in the hands of a general surgery resident?

INTRODUCTION: Colonoscopy is considered to be a gold standard for colorectal cancer (CRC) screening. Endoscopy training is an essential component of general surgery training program. Patients should receive care at the highest level possible, nevertheless residents need to gain experience. The aim of our study was to evaluate the effectiveness of colonoscopy performed by general surgery residents by comparing quality indicators between surgical trainees and consultants. MATERIALS AND METHODS: The analysis included 6384 patients aged 40–65 who underwent screening colonoscopy between October 2014 and February 2018. The patients were divided into two groups: group I – patients examined by residents, group II - patients examined by board-certified general surgeons. Quality indicators such as cecal intubation rate, adenoma detection rate and patient tolerance scale were compared between the two groups. RESULTS: Group I comprised 2268 (35.53%) and group II 4116 (64.47%) patients. The overall cecal intubation rate (CIR) was 95.99%, equal for both groups (p = 0.994). There was no statistically significant difference in adenoma detection rate: 29.30% among residents and 27.66% among consultants (p = 0.203). Patient tolerance of the examination was very good (4-point scale) in consultants group in 78.98% of cases and in 75.18% cases among residents (p < 0.001). CONCLUSION: In a proper learning environment general surgery residents are able to perform high-quality and effective screening colonoscopy. However, residents need to continue the progress in their technique to improve patient tolerance in order to reach the proficiency of a consultant

Wspieranie działań na rzecz równości w zdrowiu w Unii Europejskiej – historia projektu DETERMINE

Mobilising action for health equity across the European Union – the story of DETERMINE projectThe DETERMINE project (2007–2010) was coordinated by EuroHealth-Net and there were 24 countries involved. It was an EU consortium for action on the socio-economic determinants of health (SDH). The overall objective was to mobilize action for health equity in the European Union, especially through achieving greater awareness and capacity amongst decision makers in all policy sectors to take health and health equity into consideration when developing policy and to strengthen collaboration between health and other sectors. Several phases of activities were carried out e.g.: identification of actions and policies addressing the socio-economic determinants of health inequalities (SDHI) in UE member states, recognition of innovative approaches in the context of SDH and selection of three small pilot projects with promising approach, consultations with politicians and policy makers outside the health sector on their attitude towards SDHI and their role in achieving health equity, identification of economic analyses addressing SDHI. There were also capacity building and awareness raising activities carried out by DETERMINE partners, such us: skills development, partnership development, leadership, awareness raising and advocacy

Differences in treatment outcomes in selected cancers in Poland compared to other European countries in 2005–2009, based on CONCORD 2 study

Wstęp. Wskaźniki 5-letnich przeżyć populacyjnych obrazują poziom wyleczalności nowotworów złośliwych w populacji, a zatem są jednym z najważniejszych narzędzi do oceny efektywności walki z rakiem. Dzięki ujednoliconej metodologii ogólnoświatowego badania CONCORD 2 wskaźniki obliczone dla Polski można było porównać z innymi krajami Europy. Celem opracowania była ocena wyleczalności chorych na wybrane nowotwory w Polsce oraz w niektórych województwach na tle krajów europejskich. Materiał i metody. W analizach własnych wykorzystano wyniki badania CONCORD 2 obliczone na podstawie danych zgromadzonych przez populacyjne rejestry nowotworów chorych, u których rozpoznano nowotwór złośliwy w latach 2005–2009 i obserwowanych do końca 2009 roku. Z wyników wyodrębniono dane dotyczące Polski udostępnione dla celów CONCORD 2 przez Krajowy Rejestr Nowotworów oraz Wojewódzkie Biura Rejestracji Nowotworów w województwach: dolnośląskim, podkarpackim, świętokrzyskim i wielkopolskim. Wskaźniki 5-letnich przeżyć obliczono metodą estymacji Pohar Perme net survival. Wyniki. W Polsce u chorych na raka gruczołu krokowego (74%), piersi (74%), szyjki macicy (53%), okrężnicy (50%), odbytnicy (47%), jajnika (34%) i żołądka (19%) wskaźniki 5-letnich przeżyć należały do najniższych w Europie. Natomiast u chorych na białaczki (49%) i raka płuca (13%) przeżycia były na poziomie przeciętnych w Europie. Analiza według województw wykazała zróżnicowanie regionalne. Największe różnice dotyczyły białaczek w województwach dolnośląskim i świętokrzyskim (14%), raka gruczołu krokowego w wielkopolskim i świętokrzyskim (10%) oraz raka piersi w wielkopolskim i podkarpackim (6%), co wskazuje na zróżnicowanie w standardach profilaktyki i leczenia. Wnioski. Badanie wykazało zróżnicowanie wskaźnika 5-letnich przeżyć w Europie na niekorzyść Polski. W nowotworach dobrze rokujących takich jak: rak gruczołu krokowego, piersi, okrężnicy i odbytnicy wskaźniki należały do najniższych w Europie, natomiast u chorych na raka płuca oraz białaczki były na poziomie przeciętnych w Europie.  Background. The 5-year net survival rates show the outcomes of cancer treatment in population, therefore, they are one of the most important measures used to evaluate the effectiveness of cancer treatment. The standardized methodology in CONCORD 2 study of global cancer survival allows to compare the net survival in Poland with other European countries. The aim of this article was to assess the treatment in selected cancers in Poland and selected Polish voivodships in comparison to other European countries. Methods. In our analyses the CONCORD 2 results, based on the data from population-based Cancer Registries for patients diagnosed: 2005–2009 and followed up to 2009, were used. The results regarding Poland included the data previously provided by the National Cancer Registry and four Regional Cancer Registries: Greater Poland, Świętokrzyskie, Lower Silesia and Podkarpackie. The Pohar Perme’s method called net survival was used to calculate the 5-year survival. Results. The 5-year net survival in Poland was the lowest in Europe for patients diagnosed with prostate (74%), breast (74%), colon (50%), rectum (47%), stomach (19%), ovary (34%), cervical (53%) cancers. However, the survival for patients diagnosed with leukemias (49%) and lung cancer (13%) was on the average European level. The analysis of voivodships’ data proved the differences in the regions. The highest differences were for patients with leukemias in Lower Silesia and Świętokrzyskie (14%), prostate cancer in Greater Poland and Świętokrzyskie (10%), breast cancer in Greater Poland and Podkarpackie (6%), which showed differences in prevention and treatment standards. Conclusions. The study showed the differences in 5-year net survival rates in Europe, which were unfavourable for Poland. Cancers that have good prognosis such as: prostate, breast, colon and rectum had the lowest survival rates in Europe, however, patients with lung cancer and leukemias were on the average European level.

Heat treatment of NiTi alloys fabricated using laser powder bed fusion (LPBF) from elementally blended powders

The use of elemental metallic powders and in situ alloying in additive manufacturing (AM) is of industrial relevance as it offers the required flexibility to tailor the batch powder composition. This solution has been applied to the AM manufacturing of nickel-titanium (NiTi) shape memory alloy components. In this work, we show that laser powder bed fusion (LPBF) can be used to create a Ni55.7Ti44.3 alloyed component, but that the chemical composition of the build has a large heterogeneity. To solve this problem three different annealing heat treatments were designed, and the resulting porosity, microstructural homogeneity, and phase formation was investigated. The heat treatments were found to improve the alloy’s chemical and phase homogeneity, but the brittle NiTi2 phase was found to be stabilized by the 0.54 wt.% of oxygen present in all fabricated samples. As a consequence, a Ni2Ti4O phase was formed and was confirmed by transmission electron microscopy (TEM) observation. This study showed that pore formation in in situ alloyed NiTi can be controlled via heat treatment. Moreover, we have shown that the two-step heat treatment is a promising method to homogenise the chemical and phase composition of in situ alloyed NiTi powder fabricated by LPBF.peer-reviewe

Brouwer Fixed Point Theorem in the General Case

In this article we prove the Brouwer fixed point theorem for an arbitrary convex compact subset of εn with a non empty interior. This article is based on [15].Institute of Informatics, University of Białystok, PolandGrzegorz Bancerek. Cardinal numbers. Formalized Mathematics, 1(2):377-382, 1990.Grzegorz Bancerek. The fundamental properties of natural numbers. Formalized Mathematics, 1(1):41-46, 1990.Grzegorz Bancerek. The ordinal numbers. Formalized Mathematics, 1(1):91-96, 1990.Agata Darmochwał. Compact spaces. Formalized Mathematics, 1(2):383-386, 1990.Agata Darmochwał. Families of subsets, subspaces and mappings in topological spaces. Formalized Mathematics, 1(2):257-261, 1990.Agata Darmochwał. The Euclidean space. Formalized Mathematics, 2(4):599-603, 1991.Noboru Endou, Takashi Mitsuishi, and Yasunari Shidama. Convex sets and convex combinations. Formalized Mathematics, 11(1):53-58, 2003.Noboru Endou, Takashi Mitsuishi, and Yasunari Shidama. Dimension of real unitary space. Formalized Mathematics, 11(1):23-28, 2003.Krzysztof Hryniewiecki. Basic properties of real numbers. Formalized Mathematics, 1(1):35-40, 1990.Stanisława Kanas, Adam Lecko, and Mariusz Startek. Metric spaces. Formalized Mathematics, 1(3):607-610, 1990.Artur Korniłowicz and Yasunari Shidama. Intersections of intervals and balls in En/T. Formalized Mathematics, 12(3):301-306, 2004.Artur Korniłowicz and Yasunari Shidama. Brouwer fixed point theorem for disks on the plane. Formalized Mathematics, 13(2):333-336, 2005.Yatsuka Nakamura, Andrzej Trybulec, and Czesław Byliński. Bounded domains and unbounded domains. Formalized Mathematics, 8(1):1-13, 1999.Beata Padlewska and Agata Darmochwał. Topological spaces and continuous functions. Formalized Mathematics, 1(1):223-230, 1990.Karol Sieklucki. Geometria i topologia. PWN, 1979.Andrzej Trybulec. Domains and their Cartesian products. Formalized Mathematics, 1(1):115-122, 1990.Andrzej Trybulec. A Borsuk theorem on homotopy types. Formalized Mathematics, 2(4):535-545, 1991.Wojciech A. Trybulec. Vectors in real linear space. Formalized Mathematics, 1(2):291-296, 1990.Zinaida Trybulec. Properties of subsets. Formalized Mathematics, 1(1):67-71, 1990.Edmund Woronowicz. Relations defined on sets. Formalized Mathematics, 1(1):181-186, 1990.Mirosław Wysocki and Agata Darmochwał. Subsets of topological spaces. Formalized Mathematics, 1(1):231-237, 1990

Small Inductive Dimension of Topological Spaces. Part II

In this paper we present basic properties of n-dimensional topological spaces according to the book [10]. In the article the formalization of Section 1.5 is completed.Institute of Computer Science, University of Białystok, PolandGrzegorz Bancerek. Cardinal numbers. Formalized Mathematics, 1(2):377-382, 1990.Grzegorz Bancerek. The fundamental properties of natural numbers. Formalized Mathematics, 1(1):41-46, 1990.Grzegorz Bancerek. König's theorem. Formalized Mathematics, 1(3):589-593, 1990.Grzegorz Bancerek. The ordinal numbers. Formalized Mathematics, 1(1):91-96, 1990.Grzegorz Bancerek and Krzysztof Hryniewiecki. Segments of natural numbers and finite sequences. Formalized Mathematics, 1(1):107-114, 1990.Leszek Borys. Paracompact and metrizable spaces. Formalized Mathematics, 2(4):481-485, 1991.Agata Darmochwał. Families of subsets, subspaces and mappings in topological spaces. Formalized Mathematics, 1(2):257-261, 1990.Agata Darmochwał. Finite sets. Formalized Mathematics, 1(1):165-167, 1990.Agata Darmochwał. The Euclidean space. Formalized Mathematics, 2(4):599-603, 1991.Ryszard Engelking. Teoria wymiaru. PWN, 1981.Robert Milewski. Bases of continuous lattices. Formalized Mathematics, 7(2):285-294, 1998.Beata Padlewska. Families of sets. Formalized Mathematics, 1(1):147-152, 1990.Beata Padlewska and Agata Darmochwał. Topological spaces and continuous functions. Formalized Mathematics, 1(1):223-230, 1990.Karol Pąk. Small inductive dimension of topological spaces. Formalized Mathematics, 17(3):207-212, 2009, doi: 10.2478/v10037-009-0025-7.Andrzej Trybulec. A Borsuk theorem on homotopy types. Formalized Mathematics, 2(4):535-545, 1991.Michał J. Trybulec. Integers. Formalized Mathematics, 1(3):501-505, 1990.Zinaida Trybulec. Properties of subsets. Formalized Mathematics, 1(1):67-71, 1990.Mirosław Wysocki and Agata Darmochwał. Subsets of topological spaces. Formalized Mathematics, 1(1):231-237, 1990

The surgical treatment of rectal cancer in Poland. The findings of a multi-center observational study by the Polish Society of Surgical Oncology (PSSO-01)

Introduction. PSSO-01, a Polish prospective multi-center project on rectal cancer, started in 2016 with participation on a voluntary basis. This study evaluates the early outcome of the surgical treatment of rectal cancer in Poland according to hospital volume. Material and methods. The dataset derives from 17 clinical centers registered in the PSSO-01 study. From 2016 to 2020, the data of 1,607 patients were collected. Taking into account the number of patients enrolled in the study, the centers were divided into three categories: high volume, medium volume, and low volume. Nominal variables were compared between different categories of centers using the chi-square test. The STROBE guidelines were used to guarantee the reporting of this observational study. Results. More patients with metastatic disease were operated on in the low volume centers (p = 0.020). Neoadjuvant treatment was used in 35%, 52%, and 66% of patients operated on in low, medium, and high volume centers respectively (p &lt; 0.001). Laparoscopic resection in medium volume centers was performed more often than in other centers (p &lt; 0.001). The total rate of postoperative complications related to high, medium, and low centers was 22%, 26%, 18% (p = 0.044). One year following surgery, a stoma was present in 63% of patients. A defunctioning stoma following anterior resection was reversed in only 55% of patients. Anastomotic leakage was the main reason for a non-reversal diverting stoma. Conclusions. The representation of low volume centers in the PSSO-01 study was understated. However, the outcomes may show the actual situation of surgical treatment of rectal cancer in high and medium volume centers in Poland