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The adenoma detection rate (ADR) is the primary quality indicator for colonoscopies. The polyp detection rate (PDR) is available from administrative data and does not depend on histology verification. The correlation between PDR and ADR and the ADR/PDR conversion factor in preventive colonoscopies were evaluated. In the prospective study, asymptomatic individuals aged 45-75 years with preventive colonoscopy in 2012-2016 were included. Spearman's correlation coefficient was used to assess PDR/ADR for each endoscopist. Conversion factor predicting ADR from PDR was obtained by linear regression and subsequently compared with adenoma to polyp detection rate quotient. One thousand six hundred fourteen preventive colonoscopies performed by 16 endoscopists in 8 screening colonoscopy centres in the Czech Republic were analysed. Correlation between PDR and ADR in all preventive colonoscopies was high and statistically significant (Rs 0.82; P0.001). There was a strong correlation between PDR and ADR in men (Rs 0.74; P = 0.002) and in screening colonoscopies (Rs 0.85; P0.001). The conversion factor to convert ADR from PDR was 0.72 in all preventive colonoscopies, 0.76 in FOBT+ colonoscopies and 0.67 in screening colonoscopies. ADR may be replaced by PDR in the assessment of colonoscopy quality. The value of the conversion factor varies according to colonoscopy indication and gender of examined individuals; in this Czech study, it was 0.72 in all preventive colonoscopies. The minimum requested ADR of 25 % corresponds to a PDR of 35 %, when converted with the appropriate conversion factor.

Background The phylum Euglenozoa is a group of flagellated protists comprising the diplonemids, euglenids, symbiontids, and kinetoplastids. The diplonemids are highly abundant and speciose, and recent tools have rendered the best studied representative, Diplonema papillatum, genetically tractable. However, despite the high diversity of diplonemids, their lifestyles, ecological functions, and even primary energy source are mostly unknown. Results We designed a metabolic map of D. papillatum cellular bioenergetic pathways based on the alterations of transcriptomic, proteomic, and metabolomic profiles obtained from cells grown under different conditions. Comparative analysis in the nutrient-rich and nutrient-poor media, as well as the absence and presence of oxygen, revealed its capacity for extensive metabolic reprogramming that occurs predominantly on the proteomic rather than the transcriptomic level. D. papillatum is equipped with fundamental metabolic routes such as glycolysis, gluconeogenesis, TCA cycle, pentose phosphate pathway, respiratory complexes, β-oxidation, and synthesis of fatty acids. Gluconeogenesis is uniquely dominant over glycolysis under all surveyed conditions, while the TCA cycle represents an eclectic combination of standard and unusual enzymes. Conclusions The identification of conventional anaerobic enzymes reflects the ability of this protist to survive in low-oxygen environments. Furthermore, its metabolism quickly reacts to restricted carbon availability, suggesting a high metabolic flexibility of diplonemids, which is further reflected in cell morphology and motility, correlating well with their extreme ecological valence.

Background Changes of white matter integrity in people with multiple sclerosis (MS) were documented following mainly motor/skill acquisitions physical therapy, while following neuroproprioceptive "facilitation, inhibition" (neurofacilitation) only by two pilot studies. Neurofacilitation has potential to induce white matter changes due to possibility to interfere with the neuronal tactility threshold, but stronger evidence is missing. Aim This study investigates whether neurofacilitation (three physical therapy types) induce white matter changes and if they relate to clinical improvement. Design The Three-Arm Parallel-Group Exploratory Trial (NCT04355663). Setting Each group underwent different kind of two months ambulatory therapy (Motor Program Activating Therapy, Vojta's reflex locomotion, and Functional Electric Stimulation in Posturally Corrected Position). Population MS people with moderate disability. Methods At baseline and after the program, participants underwent magnetic resonance diffusion tensor imaging (DTI) and clinical assessment. Fractional anisotropy maps obtained from DTI were further analyzed using tract-based spatial statistic exploring the mean values in the whole statistic skeleton. Moreover, additional exploratory analysis in 48 regions of white matter was done. Results 92 people were recruited. DTI data from 61 were analysed. The neurofacilitation (irrespective type of therapy) resulted in significant improvement on the Berg Balance Scale (p=0.0089), mainly driven by the Motor Program Activating Therapy. No statistically significant change in the whole statistic skeleton was observed (only a trend for decrement of fractional anisotropy after Vojta's reflex locomotion). Additional exploratory analysis confirmed significant decrement of fractional anisotropy in the right anterior corona radiata. Conclusions Neurofacilitation improved balance without much evidence of white matter integrity changes in people with MS. Clinical rehabilitation impact The study results point to the importance of neuroproprioceptive "facilitation and inhibition" physical therapy in management of balance in people with multiple sclerosis and the potential to induce white matter changes due to possibility to interfere with the neuronal tactility threshold.

Background Fecal immunochemical tests (FIT) have been used as an initial test in CRC screening programs. However, majority of patients don`t have advanced neoplasia on colonoscopy. Colon capsule endoscopy (CCE) has the potential to reduce the need for optical colonoscopy (OC). Material and methods: In this multicentre (three gastroenterology units) feasibility study, second generation of colon capsule endoscopy (CCE2) has been prospectively compared with OC in persons with positive semi-quantitative FIT. CCE2 videos were viewed independently by a nurse and a physician, both blinded to the results of OC. Main aim of the study was negative predictive value (NPV) of the CCE2 for large polyps (≥ 10 mm). The secondary aims were: accuracy of detection of all polyps and cancers and number of complications. Results: From April 2016, 111 individuals have been enrolled; data from 54 persons has been analyzed. During optical colonoscopy, polyps were diagnosed in 37 persons (69%), polyps ≥ 6 mm and ≥ 10 mm in 22 (41%) and 12 (22%) persons, respectively. The sensitivity of CCE2 for polyps ≥ 6 mm and ≥ 10 mm was 82% (95% confidence interval [CI]: 60-95%) and 75% (95% CI: 43-95%), respectively. The specificity for polyps ≥ 6 mm and ≥ 10 mm reached 88% (95% CI: 71-96%) and 93% (95% CI: 81-99%), respectively. Two cancers were diagnosed at both CCE2 and OC. The negative predictive value of CCE2 for polyps ≥ 10 mm was 93% (95% CI: 81-99%). Nurses identified 17 polyps ≥ 6 mm of 22 (77%) and 10 polyps ≥ 10 mm of 12 (83%) found on OC. No patient had serious adverse event that was related to both methods. Conclusion: Second generation of colon capsule has appeared to have a high negative predictive value for the detection of clinically relevant colorectal neoplasia in screening population.

Backround. Capsule colonoscopy might present an alternative to colonoscopy for colorectal neoplasia screening. Aim. To assess the accuracy of second-generation capsule colonoscopy (CCE2) for colorectal neoplasia detection compared with conventional colonoscopy (CC). Methods. From 2011–2015, we performed a multicenter, prospective, cross-over study evaluating the use of CCE2 as a possible colorectal cancer (CRC) screening test based on the assessment of the method’s characteristics (accuracy) and safety and patient acceptance of the routine. Enrolled participants fulfilled the CRC screening population criteria if they were asymptomatic, were older than 50, and had no personal or familial history of colorectal neoplasia. The primary outcome was accuracy for the detection of polyps≥6 mm. Secondary outcomes were accuracy for all polyps, polyps≥10 mm, adenomas≥10 mm, and cancers, the quality of bowel cleansing, safety, and CCE2 acceptability by the screening population. Results. A total of 236 individuals were examined; 11 patients (5%) were excluded. Therefore, 225 subjects (95%) were considered in the intention-to-screen (ITS) group. A total of 201 patients (89%) completed both examinations successfully (per protocol group). In the ITS group, polyps were diagnosed during CC in 114 subjects (51%); polyps≥6 mm, polyps≥10 mm, and adenomas≥10 mm were diagnosed in 34 (15%), 16 (7%), and 11 (5%) patients, respectively. The sensitivity of CCE2 for polyps≥6 mm, polyps≥10 mm, and adenomas≥10 mm was 79% (95% confidence interval (CI): 62–91%), 88% (95% CI: 62–98%), and 100% (95% CI: 72–100%), respectively. Conclusion. Second-generation capsule colonoscopy is a safe, noninvasive, and sensitive method for colorectal neoplasia detection although CC remains the preferred method for considerable proportion of subjects. CCE2 may therefore be accepted as the primary screening test for colorectal cancer screening.

Adenoma detection rate (ADR) is the primary quality indicator for colonoscopy; however, it is difficult to obtain in terms of time and personnel. Polyp detection rate (PDR) is an alternative indicator easily evaluated from administrative data. The main aim of the study was to assess whether PDR and ADR are correlated and to determine the conversion factor to predict ADR from PDR in preventive (screening and FOBT+) colonoscopies.